California law aims at medical board makeover

The new year brought with it a license fee increase for California physicians -- the first hike since 1994. Effective Jan. 1, the license fee that doctors pay every two years went from $600 to $790.

Medical Board of California Executive Director Dave Thornton said the license fee increase will generate an extra $10 million a year for the board, allowing it to restore some of the 45 positions lost to budget cuts from 2001 to 2003.

Anmol S. Mahal, MD, president-elect of the California Medical Assn., said the group's physicians were not opposed to a fee increase as long as the medical board could justify it.

"We want an effective and well-funded medical board that fulfills its mandate of public safety and that also is fair to California physicians," said Dr. Mahal, a gastroenterologist in Fremont, Calif.

The increase is one of several changes taking effect this year under a new law designed to improve how the medical board licenses and regulates the state's nearly 93,000 physicians. In addition to the fee increase, the board will change how it investigates complaints, improve its diversion program for troubled physicians and strengthen its public disclosure policy.

Dr. Mahal said, "All in all, we think the medical board has worked well." But he added that the new measures would strengthen the board's efforts to crack down on bad doctors.

"What we don't want out there are physicians who are sub-par physicians," he said. "It's to the detriment of the medical community and certainly to society as a whole."

One change that will help the board is the switch to a "vertical prosecution." Previously, an investigator looked into a complaint, then handed off the findings to a prosecutor in the state attorney general's office. Now the investigator and prosecutor will work as a team from the beginning.

"What it will mean is hopefully these complaints will be resolved sooner," Thornton said.

Also, the board is no longer allowed to charge physicians for the cost of investigating and prosecuting their cases, a change the CMA had sought for years.

In addition, the new law requires the diversion program to make improvements and be subject to a performance audit in 2006. If the program has not improved, it can be terminated in 2008.

The board's makeover stems from a state-mandated review that found that it had problems, including taking too long to resolve complaints against physicians.

Independent monitor Julianne D'Angelo Fellmeth conducted the review that state legislators ordered. Her report, released in November 2004, said the board took an average of about 2½ years to investigate and resolve a serious complaint. It also concluded that the board did a poor job of overseeing a diversion program for physicians who are alcohol and drug abusers, and that investigations suffered because investigators and state prosecutors did not coordinate efforts.

Following up on the report's recommendations, California Sen. Liz Figueroa introduced a measure to improve the board. A revised version of that bill, incorporating some recommendations, became law in October 2005 and took effect Jan. 1.