THIRD READING  

Bill No: AB 845

Author: Maienschein (D)

Amended: 4/1/19 in Assembly

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/3/19

AYES: Glazer, Chang, Archuleta, Dodd, Galgiani, Hill, Leyva, Pan, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 76-0, 4/25/19 (Consent) - See last page for vote

SUBJECT: Continuing education: physicians and surgeons: maternal mental health

SOURCE: 2020 Mom

Maternal Mental Health NOW

DIGEST:

This bill requires the Medical Board of California (MBC), in determining its continuing education requirements for licensed physicians and surgeons, to consider including a course in maternal mental health.

ANALYSIS:

Existing law:

1. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. (BPC § 2190)
2. Specifies that CME standards may include, but are not limited to, educational activities that meet specified criteria. (BPC § 2190.1)
3. Requires the MBC, in determining its continuing education (CE) requirements, to consider including a course in: (BPC § 2191)
4. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
5. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
6. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
7. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
8. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
9. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
10. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
11. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
12. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.
13. Pain management and the risks of addiction associated with the use of Schedule II drugs.
14. Geriatric care for emergency room physicians and surgeons.
15. Integrating HIV/AIDS pre-exposure prophylaxis and post-exposure prophylaxis medication maintenance and counseling in primary care settings.
16. Integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

This bill:

1. Requires MBC, in determining its CE requirements, to consider including a course in maternal mental health that addresses:
   1. Best practices in screening for maternal mental health disorders, including cultural competency and unintended bias as a means to build trust with mothers.
   2. The range of maternal mental health disorders.
   3. The range of evidence-based treatment options, including the importance of allowing a mother to be involved in developing the treatment plan.
   4. When an obstetrician or a primary care doctor should consult with a psychiatrist versus making a referral.
2. Requires MBC to periodically update any curriculum developed to account for new research.

Background

Physicians are required to complete no less than 50 hours of approved CME during each two-year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

Through its committees, MBC has discussed CME, specifically the issue of Maintenance of Licensure (MOL) options being weighed by the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards in the U.S. which would require more in-depth and specific continuing education than the current CME required by the Act and MBC. The framework for MOL, adopted by the FSMB’s House of Delegates in 2010, recommends that state medical boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine:

• Reflective Self-Assessment (What improvements can I make?): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities.
• Assessment of Knowledge and Skills (What do I need to know and be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice.
• Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 6/24/19)

2020 Mom (co-source)

Maternal Mental Health NOW (co-source)

County Behavioral Health Directors Association of California

Depression and Bipolar Support Alliance

OPPOSITION: (Verified 6/24/19)

None received

ARGUMENTS IN SUPPORT: According to Maternal Mental Health NOW “1 in 5 women will be affected by a maternal mental health disorder like postpartum depression making these disorders the most common complication of child birth. For women living in poverty the rate soars to 50%. To exacerbate the issue, women are rarely screened for such disorders, and of those screened fewer than 15% receive appropriate treatment. In 2018, AB 2193 was signed into law requiring obstetricians screen for these disorders.

The importance of screening and treatment has been recognized nationally. In 2015, the American College of Obstetricians and Gynecologists publicly recommended that clinicians screen perinatal patients (pregnant women and those in the postpartum period) at least once for depression and anxiety symptoms. The American Medical Association followed suit in 2018, recommending doctors screen.

Though there is a recognition for the importance of screening, training for physicians and surgeons, including obstetricians, on the prevalence, range of maternal mental health disorders and evidence-based treatment options, isn’t yet available.”

According to the County Behavioral Health Directors Association of California, “should the [MBC] develop this [CE] course, it would educate physicians and surgeons about existing laws pertaining to maternal mental health screenings and referrals, and provide guidance about when a physician or surgeon should consult with a psychiatrist or make a referral for services.”

The Depression and Bipolar Support Alliance states that “perinatal depression is prevalent almost to the point of ubiquity…we applaud efforts to provide this training to all physicians, first responders and other providers of care.”

ASSEMBLY FLOOR: 76-0, 4/25/19

AYES: Aguiar-Curry, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Arambula, Chen, Eduardo Garcia, Gray

Prepared by: Sarah Mason / B., P. & E.D. /

6/26/19 15:38:43

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Steven Glazer, Chair

2019 - 2020 Regular

Bill No: AB 845 Hearing Date: June 3, 2019

Subject: Continuing education: physicians and surgeons: maternal mental health

SUMMARY: Requires the Medical Board of California (MBC), in determining its continuing education requirements for licensed physicians and surgeons, to consider including a course in

maternal mental health.

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the MBC. (Business and Professions Code (BPC) § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
3. Specifies that CME standards may include, but are not limited to, educational activities that meet any of the following criteria: (BPC § 2190.1)
4. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
5. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
6. Concern bioethics or professional ethics.
7. Are designed to improve the physician-patient relationship.
8. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
9. Requires all physicians and surgeons to complete a mandatory CME course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of
   12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form. (BPC § 2190.5)
10. Requires the MBC, in determining its continuing education (CE) requirements, to consider including a course in: (BPC § 2191)
11. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
12. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
13. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
14. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
15. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
16. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
17. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
18. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
19. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.
20. Pain management and the risks of addiction associated with the use of Schedule II drugs.
21. Geriatric care for emergency room physicians and surgeons.
22. Integrating HIV/AIDS pre-exposure prophylaxis and post-exposure prophylaxis medication maintenance and counseling in primary care settings.
23. Integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues in children and young adults and their appropriate care and treatment.

This bill:

1. Requires MBC, in determining its CE requirements, to consider including a course in maternal mental health that addresses:
2. Best practices in screening for maternal mental health disorders, including cultural competency and unintended bias as a means to build trust with mothers.
3. The range of maternal mental health disorders.
4. The range of evidence-based treatment options, including the importance of allowing a mother to be involved in developing the treatment plan.
5. When an obstetrician or a primary care doctor should consult with a psychiatrist versus making a referral.
6. Requires MBC to periodically update any curriculum developed to account for new research.

FISCAL EFFECT: This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated April 10, 2019, this bill has negligible state fiscal effect.

COMMENTS:

1. Purpose. Maternal Mental Health NOW and 2020 Mom are the Sponsors of this bill. According to the Author, “1 in 5 women will be affected by a maternal mental health (MMH) disorder like postpartum depression making these disorders the most common complication of child birth. For women living in poverty the rate soars to 50%. To exacerbate the issue, women are rarely screened for such disorders, and of those screened fewer than 15% receive appropriate treatment. In 2018, AB 2193 was signed into law requiring obstetricians screen for these disorders.

The importance of screening and treatment has been recognized nationally. In 2015, the American College of Obstetricians and Gynecologists publicly recommended that clinicians screen perinatal patients (pregnant women and those in the postpartum period) at least once for depression and anxiety symptoms. The American Medical Association followed suit in 2018, recommending doctors screen.

Though there is a recognition for the importance of screening, training for physicians and surgeons, including obstetricians, on the prevalence, range of maternal mental health disorders and evidence-based treatment options, isn’t yet available.”

1. Continuing Medical Education (CME) Requirements in California. Physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver. MBC is authorized to audit a random sample of physicians who have reported compliance with the CME requirements for verification purposes. MBC reports that it currently audits approximately one percent of the total number of renewing physicians per year.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

Through its committees, MBC has discussed CME, specifically the issue of Maintenance of Licensure (MOL) options being weighed by the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards in the U.S. which would require more in-depth and specific continuing education than the current CME required by the Act and MBC. The framework for MOL, adopted by the FSMB’s House of Delegates in 2010, recommends that state medical boards require physicians to periodically demonstrate participation in three components of effective lifelong learning in medicine:

• Reflective Self-Assessment (What improvements can I make?): Physicians must participate in an ongoing process of reflective self-evaluation, self-assessment and practice assessment, with subsequent successful completion of appropriate educational or improvement activities.
• Assessment of Knowledge and Skills (What do I need to know and be able to do?): Physicians must demonstrate the knowledge, skills and abilities necessary to provide safe, effective patient care within the framework of the six general competencies as they apply to their individual practice.
• Performance in Practice (How am I doing?): Physicians must demonstrate accountability for performance in their practice using a variety of methods that incorporate reference data to assess their performance in practice and guide improvement.

1. Arguments in Support. Maternal Mental Health NOW cites the rationale noted in the Author’s purpose above.

According to the County Behavioral Health Directors Association of California, “should the [MBC] develop this [CE] course, it would educate physicians and surgeons about existing laws pertaining to maternal mental health screenings and referrals, and provide guidance about when a physician or surgeon should consult with a psychiatrist or make a referral for services.”

The Depression and Bipolar Support Alliance states that “perinatal depression is prevalent almost to the point of ubiquity…we applaud efforts to provide this training to all physicians, first responders and other providers of care.”

SUPPORT AND OPPOSITION:

Support:

Maternal Mental Health NOW (Sponsor)

County Behavioral Health Directors Association

Depression and Bipolar Support Alliance

Opposition:

None on file as of May 29, 2019.

-- END --

Date of Hearing: April 10, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 845

Author:(Maienschein) – As Amended Ver:April 1, 2019

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the Medical Board of California (MBC) to consider including a course in maternal mental health when determining its continuing education requirements for doctors.

FISCAL EFFECT:

Negligible.

COMMENTS:

1. Purpose. According to the author, maternal mental health disorders are the most common complication of giving birth, and in light of prevalence, these disorders health care providers need training to identify and treat them appropriately. Recent legislation requires providers to screen pregnant and postpartum women for maternal mental health conditions as of July 1, 2019. The author states it is imperative that providers who treat moms during the perinatal period are empowered to deliver quality care.
2. Background. Maternal mental health conditions, including post-partum depression, anxiety and psychosis, affect about one in five mothers in California. Research shows these conditions are often undiagnosed and untreated and, if left untreated, can be harmful for the mother and for infant development.
3. Related Legislation. AB 577 (Eggman), pending in this committee, extends from the current 60 days postpartum to one year postpartum full-scope Medi-Cal coverage for postpartum mothers diagnosed with a maternal mental health condition.
4. Prior Legislation. AB 2193 (Maienschein), Chapter 755, Statutes of 2018, requires a licensed health care practitioner who provides prenatal or postpartum care to offer to screen a mother for maternal mental health conditions.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: March 26, 2019

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 845

Author:(Maienschein) – As Amended Ver:March 14, 2019

SUBJECT: Continuing education: physicians and surgeons: maternal mental health.

SUMMARY: Requires the Medical Board of California (MBC) to include a course in maternal mental health when determining its continuing education requirements for physicians and surgeons.

EXISTING LAW:

1. Establishes the Medical Practice Act, which provides for the state’s licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) § 2000 et seq.)
2. Establishes the MBC, a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members. (BPC § 2001)
3. Includes among the MBC’s responsibilities the administration of a continuing medical education program. (BPC § 2004)
4. Requires the MBC to adopt and administer standards for the continuing education of its licensees; authorizes the MBC to set content standards for any education regarding the prevention and treatment of a chronic disease; and mandates that the board shall require each licensed physician and surgeon to demonstrate satisfaction of continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
5. Authorizes the MBC’s Division of Licensing to establish continuing medical education standards for courses that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. (BPC § 2190.1)
6. Requires the MBC to consider including a course in human sexuality and nutrition in its continuing education requirements. (BPC § 2191)
7. Requires the MBC’s Division of Licensing to encourage every physician and surgeon to take a course in pharmacology as part of their continuing education. (BPC § 2191.1)
8. Requires the MBC’s Division of Licensing to encourage every physician and surgeon to take a course in geriatric medicine as part of their continuing education. (BPC § 2191.2)
9. Requires the MBC to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling. (BPC § 2191.4)
10. Requires the MBC to consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment. (BPC § 2191.5)
11. Requires all physicians and surgeons to complete a continuing education course in pain management and the treatment of terminally ill and dying patients, which must include the subject of the risks associated with the use of Schedule II drugs. (BPC § 2190.5)
12. Authorizes a physician and surgeon to complete a one-time continuing education course in the subjects of treatment and management of opiate-dependent patients as an alternative to the required course in pain management. (BPC § 2190.6)

THIS BILL:

1. Requires the MBC to, in determining its continuing education requirements for physicians and surgeons, include a course in maternal mental health.
2. Specifies that the required course in maternal mental health must address the following:
   1. Best practices in screening for maternal mental health disorders, including cultural competency and unintended bias as a means to build trust with mothers.
   2. The range of maternal mental health disorders.
   3. The range of evidence-based treatment options, including the importance of allowing a mother to be involved in developing the treatment plan.
   4. When an obstetrician or a primary care doctor should consult with a psychiatrist versus making a referral.
   5. Applicable existing requirements relative to prenatal, postpartum, and perinatal care.
3. Requires the MBC to periodically update the in maternal mental health course curriculum to account for new research.

FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by Maternal Mental Health NOW. According to the author:

Maternal mental health disorders are the most common complication of giving birth, and in light of its prevalence, health care providers need training to identify and treat them appropriately. As the new screening mandate under AB 2193 takes effect on July 1, 2019, it is imperative that providers who treat moms during the perinatal period are fully supported and empowered to deliver quality care.

Background.

Continuing Medical Education. All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved continuing medical education during each two-year license renewal cycle. This requirement can be met by taking a variety of approved continuing education courses. The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. Otherwise, physician and surgeons have the discretion to select what courses to take to meet their education requirements.

When determining what continuing education courses to approve, the MBC’s Division of Licensing currently considers programs accredited by the American Medical Association, the Institute for Medical Quality/California Medical Association, and the Accreditation Council for Continuing Medical Education (ACCME), as well as programs that qualify for prescribed credit from the American Academy of Family Physicians. The MBC also has broad authority to consider other programs offered by organizations and institutions acceptable to the MBC.

Maternal Mental Health. According to the World Health Organization, an estimated 10% of pregnant women and 13% of women who have recently given birth experience some form of mental health condition. The most common and well-known of these conditions is postpartum depression, which the National Institute of Mental Health describes as causing new mothers to “experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others.” Data supplied by the author indicates that as many as one in five women suffer from a maternal mental health disorder, which rises to a rate of 50% for women living in poverty.

Prior legislation introduced by the author of this measure was chaptered in 2018 to require a licensed health care practitioner who provides prenatal or postpartum care to offer to screen a mother for maternal mental health conditions. Health care practitioners included in the requirements of that legislation include physicians and surgeons, naturopathic doctors, nurse practitioners, physician assistants, nurse midwives, and licensed midwives. This measure seeks to build upon the maternal mental health condition screening requirement, which goes into effect on July 1, 2019, as it applies to physicians and surgeons, by requiring the MBC to include maternal mental health in its continuing medical education requirements.

Current Related Legislation. AB 241 (Kamlager-Dove) would require all continuing medical education courses to contain curriculum that includes a minimum of eight hours of instruction regarding understanding implicit bias and the promotion of bias-reducing strategies. This bill is pending in the Assembly Business and Professions Committee.

AB 577 (Eggman) would extend Medi-Cal postpartum care for up to one year beginning on the last day of the pregnancy for an eligible individual diagnosed with a maternal mental health condition. This bill is pending in the Assembly Appropriations Committee.

Prior Related Legislation. AB 2487 (McCarty, Chapter 301, Statutes of 2018) would have required physicians and surgeons to take mandatory continuing education courses in medication-assisted treatment for opiate-addicted patients; this bill was subsequently amended to instead authorize a physician and surgeon to complete a one-time continuing education course on opiate-dependent patient treatment and management as an alternative to the existing mandatory education course on pain management and the treatment of terminally ill and dying patients.

AB 1790 (Salas, Chapter 338, Statutes of 2018) would have required physicians and surgeons to take mandatory continuing education relating to preventing, diagnosing, and treating infections commonly known as Valley Fever; these provisions were subsequently struck from the bill.

AB 1791 (Waldron, Chapter 122, Statutes of 2018) requires the MBC to consider including a continuing medical education course relating to the integration of HIV/AIDS PrEP and PEP medication maintenance and counseling in primary care setting.

AB 1340 (Maienschein, Chapter 759, Statutes of 2017) requires the MBC to, when determining its continuing education requirements, consider including a course in integrating mental and physical health care in primary care settings.

AB 2193 (Maienschein, Chapter 755, Statutes of 2018) requires a health plan or insurer to develop a maternal mental health program by July 1, 2019, and required a licensed health care practitioner who provides prenatal or postpartum care for a patient to ensure the mother is offered screening or is appropriately screened for maternal mental health conditions.

ARGUMENTS IN SUPPORT:

This bill is sponsored by Maternal Mental Health NOW, a Los Angeles-based nonprofit organization that advocates for “removing barriers to the prevention, screening and treatment of prenatal and postpartum depression”; the organization also offers an online certification training on perinatal mood and anxiety disorders that is currently approved as a continuing medical education course for physicians and surgeons. The organization states that “AB 845 will build upon recent legislation to ensure that California’s screening providers have access to training that will prepare them to screen and treat for these disorders.” According to Maternal Mental Health NOW, “though there is a recognition for the importance of screening, training for obstetricians, including prevalence, range of maternal mental health disorders, screening techniques and evidence-based treatment options, isn’t yet widely and regularly available.”

ARGUMENTS IN OPPOSITION:

None on file.

POLICY ISSUE(S) FOR CONSIDERATION:

Currently under the Medical Practice Act, physicians and surgeons are provided with broad discretion in which courses they take to satisfy their 50-hour continuing medical education requirement every two years. Statute contains very few prescriptive requirements for this continuing education, and physicians and surgeons are generally allowed to take any course they choose as long as it has been approved by the MBC’s Division of Licensing. This flexibility exists to ensure that physicians and surgeons remain educated on subjects pertinent to their specialties and tailored to the context of their practice.

While AB 2193 of 2018 will require licensed health care practitioners to offer screenings to mothers for maternal mental health conditions, the bill only applies to practitioners who provide prenatal or postpartum care for a patient. The bill also specifically exempts from its requirements practitioners who are providing emergency services or care. While those practitioners who will provide screening services pursuant to the bill would arguably benefit from additional training relating to maternal mental health conditions, there is nothing currently impeding those practitioners from fulfilling part of their 50-hour requirement through courses on that subject. Meanwhile, requiring practitioners who are unlikely to ever engage in the practice of screening new mother patients to divert a portion of their hours away from training that is more pertinent to their individual practices may arguably hinder those practitioners’ ability to competently practice within their field or specialty.

AMENDMENTS:

1. To clarify that the continuing medical education described in this bill would not be made mandatory for all practitioners, but instead must be considered by the MBC when discussing what requirements should be included in the continuing education of its licensees:

Amend 1 of the bill as follows:

(a) In determining its continuing education requirements for physicians and surgeons, the board shall include consider including a course in maternal mental health, which shall address the following:

…

(b) Subject to Section 2001.1, the board shall periodically update the any curriculum developed pursuant to this section to account for new research.

REGISTERED SUPPORT:

Maternal Mental Health NOW (Sponsor)

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301