California medical board could be facing real changes

Physicians in California are bracing for a possible increase in medical license fees -- the first hike in 11 years -- to help fund improvements to the Medical Board of California. But another possibility is that the state may abolish the board under Gov. Arnold Schwarzenegger's plan to eliminate many state boards.

A state-mandated review of the medical board determined it takes too long to resolve complaints against physicians, and its program to monitor doctors with alcohol and abuse problems is flawed and understaffed. The report recommends the board raise the license fee that physicians pay every two years from $600 to $800, which would allow the board to restore about 45 positions it lost to budget cuts from 2001 to 2003.

"Medical boards have to be sufficiently funded because enforcement is very expensive. What we found was a combination of problems, some within the board's control, some outside of the board's control," said Julianne D'Angelo Fellmeth, an independent monitor who issued the report.

Fellmeth presented her findings to a state legislative committee on Jan. 25. She said the board takes an average of about 2½ years to investigate and resolve a serious complaint against a physician. It inadequately oversees a diversion program for physicians who are alcohol and drug abusers. The investigation process suffers from lack of coordination and teamwork between investigators and state prosecutors.

Recommendations from Fellmeth's report, released in November 2004, include raising the license fee, having prosecutors and investigators team up when an investigation begins, and reevaluating whether the physician diversion program is protective of the public.

"[Reducing staff] is one of the reasons for a lot of the problems in the [enforcement] program. There are not a lot of bodies," said Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego School of Law.

Fee increase expected

California Medical Assn. President Robert Hertzka, MD, also spoke at the Jan. 25 legislative hearing about the report. He told legislators the CMA supports a strong and effective medical board and has supported past license fee increases when there was a demonstrated need for additional funds.

Dr. Hertzka expects the state to impose a license fee increase to improve the medical board. But he doesn't want the state to give the board a blank check. He said doctors want to see how the money would be spent before they back an increase.

"We certainly want to see what's going to happen with [the money]," said Dr. Hertzka, a San Diego anesthesiologist. "We're just looking for a little accountability."

Hanging over proposed changes to the board is Schwarzenegger's plan to eliminate the medical board and scores of other state boards.

The medical board's duties could be shifted to the State and Consumer Services Agency under the governor's reorganization. But an oversight panel that makes recommendations to legislators said the plan would reduce public oversight.

Medical board Executive Director Dave Thornton doubts the board will be abolished.

Thornton said the board views Fellmeth's report as an opportunity to improve how it operates. The board, which regulates 91,000 California physicians, supports the fee increase to $800 and said the hike would allow it to restore enforcement positions lost through budget cuts.

"We can't fulfill our public protection mission without additional resources," Thornton said.

California Sen. Liz Figueroa said the board must fix its poor record of protecting the public. She supports the report's recommendation of an investigative model that brings in the attorney general's office at the start of an investigation. She also favors a fee increase.

"This board really does need more money. They're getting to the point where they're going to use up their reserves," said Figueroa, chair of the state's Joint Committee of Boards, Commissions and Consumer Protection.

She said she will propose legislation this month to remedy the board's problems.

"It's going to take a lot of work. It's going to take the [cooperation] of the [CMA] and medical board," she said.