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[Karl Note: In another move which should reveal the true intentions of Democrats, the Democrats' last shot at the citizens of California increased the danger to nutritionists and health food stores to offer help to people seeking an alternative to medical malpractice!
The language of this Bill does not mention nutritionists or health food stores, but it can be used to prosecute them!
As usual the bill is cloaked in terms of protecting the consumer, but in fact it is just another pay off by the drug industry to the corrupt politicians in Sacramento.
Bowen Bill Assuring Medical Advice By Licensed Staff Signed Into Law
10/14/2003
SACRAMENTO – People handing
out medical advice and assessing a patient’s condition over the phone will have
to be licensed medical professionals after January 1, following the Governor’s
decision to sign SB 969 by Senator Debra Bowen (D-Redondo Beach) into law late
Sunday night.
“Assessing a person’s medical condition is serious business and call center
operators who diagnose people over the phone and hand out medical advice need to
be qualified to give it,” said Bowen. “I’m sure plenty of people who call an
advice nurse would be surprised, or more accurately, shocked, to find out the
people they’re speaking with on the other end of the phone may not have any more
medical expertise than they do.”
Many health care service plans use call centers to handle calls made to “medical
advice” or “advice nurse” lines. Current law allows people who aren’t medically
licensed professionals to handle calls, answer basic questions and schedule
appointments, but it precludes them from providing medical advice. The problem
is current law doesn’t provide a clear definition of what constitutes medical
advice. As a result, often times non-medically licensed call center operators
are charged with assessing a patient’s medical condition and making
determinations about if and when callers need to talk with or see a nurse or
doctor.
“When you call an advice nurse, you shouldn’t have to play a game of ‘Twenty
Questions’ to figure out whether the person on the other end of the line knows
what they’re talking about and is licensed to assess your condition,” continued
Bowen.
SB 969 clarifies that assessing a patient’s condition qualifies as “medical
advice” and it only permits people who are licensed, certified, or registered
medical professionals to provide medical advice to a patient. Health plans could
still use call center operators to ask questions about a patient’s condition and
gather basic information about how a patient is feeling. However, that
information must be given to a medically-licensed professional who can then
provide medical advice, assess the caller’s condition and determine if and when
a caller needs to see a doctor. The bill also precludes call center operators
from using titles that may mislead patients into believing they are talking to a
licensed, certified, or registered medical professional.
Kaiser Permanente, which opposed the bill along with Molina Healthcare, defended
its practice of using unlicensed medical professionals to answer medical
questions by saying computer scripts used by the unlicensed operators, not the
operators themselves, are actually assessing a patient’s medical needs.
“People call an advice nurse line because they want, expect, and frankly deserve
help from a licensed professional, not from someone reading from a computer
script,” concluded Bowen. “Call centers shouldn’t be deliberately misleading
people into thinking they’re talking to a medically-licensed professional, then
turning around and relying on computerized scripts to decide whether a person
needs to talk to an advice nurse, call 911, or make an appointment to see a
doctor.”
SB 969 was supposed by the American Nurses Association, the California Nurses
Association, the Congress of California Seniors, CareCounsel, and the California
Alliance for Consumer Protection. The measure will take effect on January 1,
2004.
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Evan Goldberg (916) 445-5953 or (916) 855-9176 |
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BILL NUMBER: SB 969 CHAPTERED
BILL TEXT
CHAPTER 885
FILED WITH SECRETARY OF STATE OCTOBER 12, 2003
APPROVED BY GOVERNOR OCTOBER 12, 2003
PASSED THE SENATE SEPTEMBER 9, 2003
PASSED THE ASSEMBLY SEPTEMBER 4, 2003
AMENDED IN ASSEMBLY AUGUST 26, 2003
AMENDED IN ASSEMBLY JULY 24, 2003
AMENDED IN ASSEMBLY JULY 15, 2003
AMENDED IN SENATE MAY 8, 2003
AMENDED IN SENATE APRIL 21, 2003
INTRODUCED BY Senator Bowen
(Principal coauthor: Assembly Member Corbett)
FEBRUARY 21, 2003
An act to amend Sections 4999.2 and 4999.7 of the Business and
Professions Code, and to amend Section 1348.8 of the Health and
Safety Code, relating to health care service plans.
LEGISLATIVE COUNSEL'S DIGEST
SB 969, Bowen. Telephone medical advice services.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a violation
of the act's provisions a crime. Under the act, a health care
service plan that provides, operates, or contracts for telephone
medical advice services for its enrollees and subscribers is required
to ensure those services comply with certain standards, including
that staff providing telephone medical advice are licensed,
certified, or registered professionals. Existing law also provides
for the regulation and certification of telephone medical advice
services, and requires the staff of those advice services to be
appropriately licensed, certified, or registered in various healing
arts professions.
This bill would include licensed clinical
social workers as health
care service professionals, for purposes of these provisions. The
bill would require a health care service plan to ensure that staff
handling enrollee or subscriber calls, but who are not licensed,
certified, or registered in various healing arts professions, do not
provide telephone medical advice. The bill would also require a
health care service plan and a telephone medical advice service to
ensure that no staff member uses a title or designation that would
cause a reasonable person to believe the staff member is licensed,
certified, or registered as a specified type of health care
professional unless the staff member meets those requirements. The
bill would enact other related provisions.
Because the bill would add requirements
concerning the operation
of a health care service plan, the violation of which would be a
crime, it would impose a state-mandated local program.
The California Constitution requires the state to
reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement
is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4999.2 of the Business and Professions Code is
amended to read:
4999.2. (a) In order to obtain and maintain a registration,
in-state or out-of-state telephone medical advice services shall
comply with the requirements established by the department. Those
requirements shall include, but shall not be limited to, all of the
following:
(1) (A) Ensuring that all staff who provide medical advice
services are appropriately licensed, certified, or registered as a
physician and surgeon pursuant to Chapter 5 (commencing with Section
2000) or the Osteopathic Initiative Act, as a dentist pursuant to
Chapter 4 (commencing with Section 1600), as a dental hygienist
pursuant to Sections 1760 to 1775, inclusive, as a psychologist
pursuant to Chapter 6.6 (commencing with Section 2900), as a marriage
and family therapist pursuant to Chapter 13 (commencing with Section
4980), as a licensed clinical social worker pursuant to Chapter 14
(commencing with Section 4990), as an optometrist pursuant to Chapter
7 (commencing with Section 3000), or as a chiropractor pursuant to
the Chiropractic Initiative Act, and operating consistent with the
laws governing their respective scopes of practice in the state
within which they provide telephone medical advice services, except
as provided in paragraph (2).
(B) Ensuring that all staff who provide telephone medical advice
services from an out-of-state location are health care professionals,
as identified in subparagraph (A), who are licensed, registered, or
certified in the state within which they are providing the telephone
medical advice services and are operating consistent with the laws
governing their respective scopes of practice.
(2) Ensuring that all registered nurses providing telephone
medical advice services to both in-state and out-of-state business
entities registered pursuant to this chapter are licensed pursuant to
Chapter 6 (commencing with Section 2700).
(3) Ensuring that the telephone medical advice provided is
consistent with good professional practice.
(4) Maintaining records of telephone medical advice services,
including records of complaints, provided to patients in California
for a period of at least five years.
(5) Ensuring that no staff member uses a title or designation when
speaking to an enrollee or subscriber that may cause a reasonable
person to believe that the staff member is a licensed, certified, or
registered professional described in subparagraph (A) of paragraph
(1), unless the staff member is a licensed, certified, or registered
professional.
(6) Complying with all directions and requests for information
made by the department.
(b) To the extent permitted by Article VII of the California
Constitution, the department may contract with a private nonprofit
accrediting agency to evaluate the qualifications of applicants for
registration pursuant to this chapter and to make recommendations to
the department.
SEC. 2. Section 4999.7 of the Business and Professions Code is
amended to read:
4999.7. (a) Nothing in this section shall limit, preclude, or
otherwise interfere with the practices of other persons licensed or
otherwise authorized to practice, under any other provision of this
division, telephone medical advice services consistent with the laws
governing their respective scopes of practice, or licensed under the
Osteopathic Initiative Act or the Chiropractic Initiative Act and
operating consistent with the laws governing their respective scopes
of practice.
(b) For the purposes of this chapter, "telephone medical advice"
means a telephonic communication between a patient and a health care
professional in which the health care professional's primary function
is to provide to the patient a telephonic response to the patient's
questions regarding his or her or a family member's medical care or
treatment. "Telephone medical advice" includes assessment,
evaluation, or advice provided to patients or their family members.
(c) For the purposes of this chapter, "health care professional"
is a staff person described in Section 4999.2 who provides medical
advice services and is appropriately licensed, certified, or
registered as a registered nurse pursuant to Chapter 6 (commencing
with Section 2700), as a physician and surgeon pursuant to Chapter 5
(commencing with Section 2000) or the Osteopathic Initiative Act, as
a dentist pursuant to Chapter 4 (commencing with Section 1600), as a
dental hygienist pursuant to Sections 1760 to 1775, inclusive, as a
psychologist pursuant to Chapter 6.6 (commencing with Section 2900),
as a marriage and family therapist pursuant to Chapter 13 (commencing
with Section 4980), as a licensed clinical social worker pursuant to
Chapter 14 (commencing with Section 4990), as an optometrist
pursuant to Chapter 7 (commencing with Section 3000), or as a
chiropractor pursuant to the Chiropractic Initiative Act, and who is
operating consistent with the laws governing his or her respective
scopes of practice in the state in which he or she provides telephone
medical advice services.
SEC. 3. Section 1348.8 of the Health and Safety Code is amended to
read:
1348.8. (a) Every health care service plan that provides,
operates, or contracts for, telephone medical advice services to its
enrollees and subscribers shall do all of the following:
(1) Ensure that the in-state or out-of-state telephone medical
advice service is registered pursuant to Chapter 15 (commencing with
Section 4999) of Division 2 of the Business and Professions Code.
(2) Ensure that the staff providing telephone medical advice
services for the in-state or out-of-state telephone medical advice
service are licensed as follows:
(A) For full service health care service plans, the staff hold a
valid California license as a registered nurse or a valid license in
the state within which they provide telephone medical advice services
as a physician and surgeon or physician assistant, and are operating
in compliance with the laws governing their respective scopes of
practice.
(B) (i) For specialized health care service plans providing,
operating, or contracting with a telephone medical advice service in
California, the staff shall be appropriately licensed, registered, or
certified as a physician and surgeon pursuant to Chapter 5
(commencing with Section 2000) of Division 2 of the Business and
Professions Code or the Osteopathic Initiative Act, as a registered
nurse pursuant to Chapter 6 (commencing with Section 2700) of
Division 2 of the Business and Professions Code, as a dentist
pursuant to Chapter 4 (commencing with Section 1600) of Division 2 of
the Business and Professions Code, as a dental hygienist pursuant to
Article 7 (commencing with Section 1740) of Chapter 4 of Division 2
of the Business and Professions Code, as a psychologist pursuant to
Chapter 6.6 (commencing with Section 2900) of Division 2 of the
Business and Professions Code, as a marriage and family therapist
pursuant to Chapter 13 (commencing with Section 4980) of Division 2
of the Business and Professions Code, as a licensed clinical social
worker pursuant to Chapter 14 (commencing with Section 4990) of
Division 2 of the Business and Professions Code, as an optometrist
pursuant to Chapter 7 (commencing with Section 3000) of Division 2 of
the Business and Professions Code, or as a chiropractor pursuant to
the Chiropractic Initiative Act, and operating in compliance with the
laws governing their respective scopes of practice.
(ii) For specialized health care service plans providing,
operating, or contracting with an out-of-state telephone medical
advice service, the staff shall be health care professionals, as
identified in clause (i), who are licensed, registered, or certified
in the state within which they are providing the telephone medical
advice services and are operating in compliance with the laws
governing their respective scopes of practice. All registered nurses
providing telephone medical advice services to both in-state and
out-of-state business entities registered pursuant to this chapter
shall be licensed pursuant to Chapter 6 (commencing with Section
2700) of Division 2 of the Business and Professions Code.
(3) Ensure that every full service health care service plan
provides for a physician and surgeon who is available on an on-call
basis at all times the service is advertised to be available to
enrollees and subscribers.
(4) Ensure that staff members handling enrollee or subscriber
calls, who are not licensed, certified, or registered as required by
paragraph (2), do not provide telephone medical advice. Those staff
members may ask questions on behalf of a staff member who is
licensed, certified, or registered as required by paragraph (2), in
order to help ascertain the condition of an enrollee or subscriber so
that the enrollee or subscriber can be referred to licensed staff.
However, under no circumstances shall those staff members use the
answers to those questions in an attempt to assess, evaluate, advise,
or make any decision regarding the condition of an enrollee or
subscriber or determine when an enrollee or subscriber needs to be
seen by a licensed medical professional.
(5) Ensure that no staff member uses a title or designation when
speaking to an enrollee or subscriber that may cause a reasonable
person to believe that the staff member is a licensed, certified, or
registered professional described in Section 4999.2 unless the staff
member is a licensed, certified, or registered professional.
(6) Ensure that the in-state or out-of-state telephone medical
advice service designates an agent for service of process in
California and files this designation with the director.
(7) Requires that the in-state or out-of-state telephone medical
advice service makes and maintains records for a period of five years
after the telephone medical advice services are provided, including,
but not limited to, oral or written transcripts of all medical
advice conversations with the health care service plan's enrollees or
subscribers in California and copies of all complaints. If the
records of telephone medical advice services are kept out of state,
the health care service plan shall, upon the request of the director,
provide the records to the director within 10 days of the request.
(8) Ensure that the telephone medical advice services are provided
consistent with good professional practice.
(b) The director shall forward to the Department of Consumer
Affairs, within 30 days of the end of each calendar quarter, data
regarding complaints filed with the department concerning telephone
medical advice services.
(c) For the purposes of this section, "telephone medical advice"
means a telephonic communication between a patient and a health care
professional in which the health care professional's primary function
is to provide to the patient a telephonic response to the patient's
questions regarding his or her or a family member's medical care or
treatment. "Telephone medical advice" includes assessment,
evaluation, or advice provided to patients or their family members.
SEC. 4. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
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