Existing law establishes a peer review process for certain healing arts licensees and requires peer review bodies to review licensee conduct under specified circumstances. If a licentiates membership, staff privileges, or employment is terminated or revoked for a medical disciplinary cause or reason, existing law requires the chief executive officer or administrator of a licensed health care facility, among others, to file an 805 report with the relevant state licensing agency having regulatory jurisdiction over the licentiate.

This bill would require a health care facility or peer review body, on or before March 1 of each year, to submit a report to the Civil Rights Department and the Medical Board of California that includes, among other data, the number of physicians and surgeons and medical residents at the health care facility who were terminated, the number of physicians and surgeons who applied completed an application for staff privileges, were granted staff privileges, or for whom staff privileges were suspended or revoked, and the number of physicians and surgeons or medical residents in those categories, stratified by race and gender. The bill would require the Civil Rights Department, on or before September 1 of each year, to publish the data information on the departments internet website without disclosing website, would require the information to be aggregated and deidentified, and would prohibit disclosure of the names of the health care facilities or any personally identifiable information.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

Existing law, the Medical Practice Act, establishes the Medical Board of California to license and regulate physicians and surgeons, and imposes education, examination, and other qualifications to obtain a license to practice medicine.

This bill would express the intent of the Legislature to enact legislation to report on data collection as it relates to residency programs and privileges for physicians and surgeons.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

SB 679 (Weber Pierson) - Health care facilities: physicians and surgeons: terminations and revocation of staff privileges: data reporting by race and gender

Bill Summary:

SB 679 requires a health care facility or peer review body to submit a report to the Civil Rights Department (CRD) that includes certain information about medical resident and staff employment and privileges, as specified, and requires the CRD to publish this information on its website.

Fiscal Impact:

The CRD anticipates ongoing costs of approximately $510,000 (General Fund) beginning in Fiscal Year 2026-27 for additional staff and IT resources to intake and analyze data submitted by health care facilities and peer review bodies. Actual costs to CRD are unknown, but will depend on, among things, the number of health care facilities and peer review bodes required to submit data specified by the bill. For context, there are over 400 hospitals in the state and each hospital has at least one peer review body. This does not include other setting which constitute a health facility as defined in Health and Safety Code §1250 (which includes intermediate care facilities, correctional treatment centers, and nursing facilities, among others).

CRD notes that it may have an increase in inquiries to its Contact Center from health care facilities and peer review bodies and their respective employees regarding the information required to be published by this bill. To the extent this results in a significant increase in complaints filed with the department, CRD would likely require additional resources to handle increased complaint intake and investigatory workload.

Background:

Physician peer review is one of the regimes used to ensure that quality of care is delivered while minimizing medical errors and managing patient risks. During a peer review, physicians evaluate their colleagues’ work to determine compliance with the standard of care. Reviews are intended to detect incompetent or unprofessional physicians early and terminate, suspend, or limit their practice if necessary. Peer review is triggered by a wide variety of events including patient injury, disruptive conduct, substance abuse, or other medical staff complaints. A peer review committee investigates the allegation, comes to a decision regarding the physician’s conduct, and takes appropriate remedial actions.

In prior informational hearings by Legislative policy committees and through the review of legislation related to peer review, it has been noted that historically there has been reluctance among physicians to serve on peer review committees due to the risk of involvement in related future litigation, including medical malpractice lawsuits against a physician under review. There have also been concerns “sham peer review”, using the peer review system to discredit, harass, discipline, or otherwise negatively affect a physician’s ability to practice medicine or exercise professional judgment for a non-medical or patient safety related reason. Other criticisms of peer review have included over legalization of the process, lack of transparency in the system, and burdensome human and financial toll peer review brings not only to the hospital but also to a physician under review.

The California Department of Public Health’s Licensing and Certification Program (DPH) licenses, regulates, and inspects hospitals and other health care facilities throughout California. DPH regulations require all hospitals to have an organized medical staff and to also have formal peer review procedures in place as part of their licensing requirements. DPH has also issued more stringent peer review requirements for hospitals engaging in medical specializations such as heart surgery. All DPH licensed healthcare facilities are required to have an organized medical staff which establishes controls to ensure that physicians practicing at the faculty meet all required ethical and professional standards.

Proposed Law:

• By March 1 of each year, requires a health care facility or peer review body to submit a report to the CRD that includes, for the prior calendar year, the following:
  • The number of physicians and surgeons and medical residents at the health care facility who were terminated.
  • The number of physicians and surgeons who completed an application for staff privileges at the health care facility.
  • The number of physicians and surgeons who were granted staff privileges at the health care facility.
  • The number of physicians and surgeons whose staff privileges were revoked at the health care facility.
  • The number of physicians and surgeons and medical residents at the health care facility whose staff privileges were suspended.
  • The percentage of physicians and surgeons in specified categories who identified their race or gender.
  • The percentage of medical residents at the health care facilities who were terminated and who identified their race or gender.
  • The number of physicians and surgeons in specified categories who identified their race or gender, stratified by race and gender.
  • The number of medical residents at the health care facilities who were terminated and who identified their race or gender, stratified by race and gender.
• By September 1 of each year, requires the CRD to publish the information required by this bill in an aggregated and deidentified form on its website.

-- END --

SENATE JUDICIARY COMMITTEE

Senator Thomas Umberg, Chair

2025-2026 Regular Session

Bill No: SB 679 (Author:Weber Pierson)

Version: April 22, 2025

Hearing Date: April 29, 2025

Fiscal: Yes

Urgency: No

Consultant: AM

SUBJECT

Health care facilities: physicians and surgeons: terminations and revocation of staff privileges: data reporting by race and gender

DIGEST

The bill requires a health care facility or peer review body to submit a report to the Civil Rights Department (CRD) that contains certain information related to staff privileges, including the number of physicians and surgeons and medical residents who were terminated and their race or gender if that information was provided. The bill requires CRD to publish the aggregated and deidentified data on its website, as provided.

EXECUTIVE SUMMARY

The author and sponsor argue this bill will provide the public with crucial data on the demographics of physicians, surgeons, and medical residents in order to identify existing gaps in representation and access to care, which would enable the state to take steps to address any disparities. They point to a 2017 study by the California Research Bureau (Bureau) that concluded that the data the Bureau reviewed showed a correlation between physician race and the pattern of complaints, investigations and discipline.

This bill is sponsored by the Golden State Medical Association and supported by the California-Hawaii State Conference of the NAACP and Sinkler Miller Medical Association. This bill is sponsored by the Golden State Medical Association and supported by various organizations representing medical professionals and the California-Hawaii State Conference of the NAACP. The Committee received no timely opposition. This bill passed the Senate Business, Professions and Economic Development Committee on a vote of 8 to 0.

PROPOSED CHANGES TO THE LAW

Existing law:

1. Regulates the practice of medicine under the Medical Practice Act and establishes the Medical Board of California (Medical Board) and Osteopathic Medical Board of California for the licensure, regulation, and discipline of physicians and surgeons. (Bus. & Prof. Code §§ 2000 et seq.)
2. Defines “peer review body” as specified multi-member bodies that review the basic qualifications, staff privileges, employment, medical outcomes, or professional conduct of licensees to make recommendations for quality improvement and education, as specified. (Bus. & Prof. C § 805(a).)
3. Establishes the Civil Rights Department (CRD) and outlines various prohibited practices, including but not limited to practices by employers related to discrimination. (Gov. Code §§ 12900 et seq.)
   1. Requires employers with 100 or more employees to submit a pay data report to the CRD that includes specified information, including but not limited to the number of employees by race, ethnicity, and sex in specified job categories and authorizes CRD to annually publish and publicize aggregate reports based on this data. (Gov. Code §§ 12999.)
4. Provides, pursuant to the California Constitution, that the people have the right of access to information concerning the conduct of the people’s business, and, therefore, the meetings of public bodies and the writings of public officials and agencies are required to be open to public scrutiny. (Cal. const. art. I, § 3(b)(1).)
   1. Requires a statute to be broadly construed if it furthers the people’s right of access, and narrowly construed if it limits the right of access. (Cal. const. art. I, § 3(b)(1).)
   2. Requires a statute that limits the public’s right of access to be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. (Cal. const. art. I, § 3(b)(1).)
5. Governs the disclosure of information collected and maintained by public agencies pursuant to the CPRA. (Gov. Code §§ 7920.000 et seq.)
   1. States that the Legislature, mindful of the individual right to privacy, finds and declares that access to information concerning the conduct of the people’s business is a fundamental and necessary right of every person in this state. (Gov. Code § 7921.000.)
   2. Defines “public records” as any writing containing information relating to the conduct of the public’s business prepared, owned, used, or retained by any state or local agency regardless of physical form or characteristics. (Gov. Code § 7920.530.)
   3. Provides that all public records are accessible to the public upon request, unless the record requested is exempt from public disclosure. (Gov. Code § 7922.530.)

This bill:

1. Requires a health care facility or peer review body to submit a report to CRD that includes the following in a) through i), below, for the prior year:
   1. The number of physicians and surgeons and medical residents at the health care facility who were terminated.
   2. The number of physicians and surgeons who completed an application for staff privileges at the health care facility.
   3. The number of physicians and surgeons who were granted staff privileges at the health care facility.
   4. The number of physicians and surgeons whose staff privileges were revoked at the health care facility.
   5. The number of physicians and surgeons and medical residents at the health care facility whose staff privileges were suspended.
   6. The percentage of physicians and surgeons in each of the categories specified in paragraphs (a) to (e), above, who identified their race or gender.
   7. The percentage of medical residents at the health care facilities who were terminated and who identified their race or gender.
   8. The number of physicians and surgeons in each of the categories specified in paragraphs (a) to (e), above, and who identified their race or gender, stratified by race and gender.
   9. The number of medical residents at the health care facilities who were terminated and who identified their race or gender, stratified by race and gender.
2. Requires CRD to publish on its website and make available to the public the information submitted under 1).
   1. The published information must be aggregated and deidentified. It cannot disclose the names of the health care facilities, or personally identifying information.
   2. Provides that, except as provided in (a), above, the information submitted under 1, above, is confidential and is not to be disclosed under the CPRA.

COMMENTS

1. Stated need for the bill

The author writes:

California’s healthcare system relies on the strength and diversity of its physician workforce to ensure that all communities have access to quality care. However, the ongoing physician shortage, particularly in underserved and minority communities, has led to increasing concerns about the retention and equitable treatment of physicians, especially those from underrepresented racial and ethnic backgrounds. This bill would gather non-definable demographic data on physicians, surgeons, and medical residents whose hospital privileges have been granted, reduced, limited, or revoked, with the goal of mitigating the loss or removal of competent, qualified physicians from the workforce.

In 2013, the Golden State Medical Association raised concerns regarding racial biases in the dismissal of medical professionals. In response, the Medical Board commissioned a 2015 study by the California Research Bureau, analyzing over 125,000 physician records. The study, which confirmed racial disparities, found that Latino and Black physicians were more likely to face complaints, investigations, and disciplinary actions, with Latino physicians especially targeted. A 2021 report revealed that Black medical residents had disproportionately high dismissal rates of up to 19%, despite making up only 5% of the population, leading to the launch of the #BlackDocsBelong campaign in 2022 to address these inequities and the physician shortage.

The lack of minority physicians contributes to healthcare disparities, affecting access, treatment, and outcomes in underserved communities. A diverse workforce leads to more culturally competent care, improving patient outcomes and fostering trust. Ensuring healthcare providers reflect the communities they serve is vital to reducing disparities and ensuring equitable access for all. The bill would gather crucial data on the demographics of physicians, surgeons, and medical residents in order to identify existing gaps in representation and access to care, and enable the state to take steps to effectively address these disparities.

1. Background
2. Physician peer review

The Senate Business Professions and Economic Development Committee provides useful background on the physician peer review process:

Physician peer review is one of the regimes used to ensure that quality of care is delivered while minimizing medical errors and managing patient risks. During a peer review, physicians evaluate their colleagues’ work to determine compliance with the standard of care. Reviews are intended to detect incompetent or unprofessional physicians early and terminate, suspend, or limit their practice if necessary. Peer review is triggered by a wide variety of events including patient injury, disruptive conduct, substance abuse, or other medical staff complaints. A peer review committee investigates the allegation, comes to a decision regarding the physician’s conduct, and takes appropriate remedial actions.[…]

Recognizing that peer review is necessary to maintain and improve quality medical care, Congress in 1986 enacted the Health Care Quality Improvement Act (HCQIA). HCQIA established standards for hospital peer review committees, provided immunity for those who participate in peer review, and created the National Practitioner Data Bank (NPDB). The NPDB is a confidential repository of information related to the professional competence and conduct of physicians, dentists, and other health care practitioners. Credentialing bodies are required to check the NPDB database before granting privileges to physicians or re-appointing them.[…]

The California Department of Public Health’s Licensing and Certification Program (DPH) licenses, regulates, and inspects hospitals and other health care facilities throughout California. DPH regulations require all hospitals to have an organized medical staff and to also have formal peer review procedures in place as part of their licensing requirements. DPH has also issued more stringent peer review requirements for hospitals engaging in medical specializations such as heart surgery. All DPH licensed healthcare facilities are required to have an organized medical staff which establishes controls to ensure that physicians practicing at the faculty meet all required ethical and professional standards.^[1]

1. Corporate practice of medicine

California bans the corporate practice of medicine and; therefore, physicians are rarely employed by health facilities, with certain exceptions. The rationale behind the ban is that the professional standards, obligations, and ethics of physicians is incompatible with the profit motive of a corporation. As such, many physicians are not employees of the heath facilities in which they practice.

1. Concerns about disparity in disciplinary actions by the Medical Board

In 2013, the Golden State Medical Association, the sponsor of the bill, raised concerns regarding racial biases in the dismissal of medical professionals. The Medical Board commissioned a 2015 study by the California Research Bureau in response to these concerns. In 2017, the California Research Bureau published a report titled Demographics of Disciplinary Actions by the Medical Board of California (2003-2013) that used archival data of complaints, investigations, and discipline from July 2003 through June 2013. The report concluded that “although limitation with the study prevent the Research Bureau from providing a definitive answer, the data does show a correlation between physician race and the pattern of complaints, investigations and discipline.^[2] After controlling for a number of other variables, Latino/a and Black physicians were both more likely to receive complaints and more likely to see those complaints escalate to investigations. Latoio/a physicians were also more likely to see those investigations result in disciplinary outcomes.”

1. Privacy and limitation on access to public records

Access to information concerning the conduct of the people’s business is a fundamental and necessary right of every person in this state. (Gov. Cod § 7921.000.) In 2004, the right of public access was enshrined in the California Constitution with the passage of Proposition 59 (Nov. 3, 2004, statewide general election),^[3] which amended the California Constitution to specifically protect the right of the public to access and obtain government records: “The people have the right of access to information concerning the conduct of the people’s business, and therefore . . . the writings of public officials and agencies shall be open to public scrutiny.” (Cal. Const., art. I, sec. 3 (b)(1).) In 2014, voters approved Proposition 42 (Jun. 3, 2014, statewide direct primary election)^[4] to further increase public access to government records by requiring local agencies to comply with the CPRA and the Ralph M. Brown Act^[5], and with any subsequent statutory enactment amending either act, as provided. (Cal. Const., art. I, sec. 3 (b)(7).)

Under the CPRA, public records are open to inspection by the public at all times during the office hours of the agency, unless they are exempt from disclosure. (Gov. Code § 7922.525.) A public record is defined as any writing containing information relating to the conduct of the public’s business that is prepared, owned, used, or retained by any public agency regardless of physical form or characteristics. (Gov. Code § 7920.530.) There are several general categories of documents or information that are permissively exempt from disclosure under the CPRA essentially due to the character of the information. The exempt information can be withheld by the public agency with custody of the information, but it also may be disclosed if it is shown that the public’s interest in disclosure outweighs the public’s interest in non-disclosure of the information. (CBS, Inc. v. Block (1986) 42 Cal.3d 646, at 652.). Additionally, some records are prohibited from disclosure or are specifically stated to not be public records. (see Gov. Code § 7924.110(a).)

California generally recognizes that public access to information concerning the conduct of the people’s business is a fundamental and necessary right.^[6] At the same time, the state recognizes that this right must be balanced against the right to privacy.^[7] The general right of access to public records may, therefore, be limited when records include personal information. The bill states that it strikes a balance between disclosing relevant information to the public while protecting the privacy of individuals and health care facilities.

1. Statements in support

The Golden State Medical Association, sponsor of the bill, writes in support:

California’s healthcare system relies on the strength and diversity of its physician workforce to ensure that all communities have access to quality care. However, the ongoing physician shortage, particularly in underserved and minority communities, has led to increasing concerns about the retention and equitable treatment of physicians, especially those from underrepresented racial and ethnic backgrounds.

CRDMS (Golden State Medical Association’s (GSMA) Los Angeles Society, began raising concerns to the Medical Board California (MBC) about racial biases in regards to the dismissals of medical professionals in 2013, then GSMA took on the mantle, carrying it through until 2015 when the MBC finally commissioned the California Research Bureau (CRB) to do a study investigating these claims. While previous studies have explored factors like specialization or education, the role of race and gender in disciplinary outcomes has been less frequently addressed.

In January 2017, CRB released to the public their results of analyzing data from July 2003 to June 2013, which included 125,792 physician records and 32,978 complaint records. The study sought to determine whether racial disparities existed in the disciplinary process. While observational, the study identified a correlation between a physician’s race and the likelihood of receiving complaints, undergoing investigations, and facing disciplinary actions. Specifically, Latino and Black physicians were 60% and 40%, respectively, more likely to be subject to complaints and investigations, with Latino physicians particularly prone to disciplinary action. In contrast, Asian and White physicians were less likely to face complaints or investigations.

A report from the Accreditation Council for Graduate Medical Education in 2021 revealed that Black residents experienced disproportionately high dismissal rates, representing as much as 19% of those dismissed, despite making up only 5% of the total resident population. This stark disparity highlights the broader issue of inequities that disproportionately affect minority physicians. This disparity prompted the Black Doc Village to launch the #BlackDocsBelong campaign in 2022 to raise awareness about the disproportionate dismissal rates among Black medical residents, alongside the ongoing physician shortage.

The underrepresentation of minority physicians contributes to significant disparities in healthcare access and outcomes. Addressing these disparities and supporting the retention of physicians from underrepresented groups is essential to building a healthcare system that is both competent and representative of the populations it serves. By needs of all communities.[…]

SUPPORT

Golden State Medical Association (sponsor)

Black Doc Village

California-Hawaii State Conference of the NAACP

Medical Bridge of the Motherland

National Medical Association Western Region VI

Nigerian Physician Advocacy Group

Sinkler Miller Medical Association

OPPOSITION

None received

RELATED LEGISLATION

Pending Legislation: None known.

Prior Legislation: None known.

PRIOR VOTES:

Senate Business, Professions and Economic Development Committee (8 Ayes, 0 Noes)

**************

1. Sen. Bus. Prof. and Econ. Dev. Comm. analysis of SB 679 (2025-26 reg. sess.) p. 5-7. ↑

2. Demographics of Disciplinary Actions by the Medical Board of California (2003-2013), Cal. Res. Bur. (Jan. 2017) at pp. 2-3, available at https://www.library.ca.gov/wp-content/uploads/2021/08/MedicalBoardDemographicsJan17.pdf. ↑

3. Prop. 59 was placed on the ballot by a unanimous vote of both houses of the Legislature. (SCA 1 (Burton, Ch. 1, Stats. 2004)) ↑

4. Prop. 42 was placed on the ballot by a unanimous vote of both houses of the Legislature. (SCA 3 (Leno, Ch. 123, Stats. 2013)) ↑

5. The Ralph M. Brown Act is the open meetings laws that applies to local agencies. (Gov. Code §§ 59450 et. seq.) ↑

6. Cal. Const., art. I, § 3; Gov. Code, § 7921.000. ↑

7. Cal. Const., art. I, § 1. ↑

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Angelique Ashby, Chair

2025 - 2026 Regular

Bill No: Hearing Date: April 21, 2025

Subject:

SUMMARY:

Establishes a new mandatory reporting requirement for health care facilities and peer review bodies to report to the Civil Rights Department (CRD) and Medical Board of California (MBC) that includes specified information about physician and medical resident employment and staff privileges.

NOTE: This bill is double-referred to the Senate Committee on Judiciary, second.

Existing law:

1. Establishes various reporting and record keeping requirements related to the practice of licensed healthcare providers for purposes of consumer protection. (BPC §§ 800-809.9)
2. Requires healing arts boards to create and maintain a central file of the names of all persons who hold a license or similar authority from a board confidentially containing an individual historical record for each licensee including, among other things, disciplinary information. (BPC § 800)
3. Specifies that the contents of a central file that are not public records must remain confidential, except that the licensee involved, or their counsel or representative, have the right to inspect and have copies made of the licensee’s complete file, other than provisions that could potentially disclose the identity of an information source. A board is authorized to protect an information source by redacting the source’s identifying information or providing a comprehensive summary of the material. (BPC § 800(c)
4. Defines “805 report” as a written report required to be submitted following certain actions of a peer review body, as specified. (BPC § 805(a)(7))
5. Defines “peer review body” as specified multi-member bodies that review the basic qualifications, staff privileges, employment, medical outcomes, or professional conduct of licentiates to make recommendations for quality improvement and education, as specified. (BPC § 805(a))
6. Requires a peer review body and a licensed health care facility or clinic to file an “805 report” with the relevant agency within 15 days after the effective date on which specified disciplinary actions occur as a result of an action of a peer review body. (BPC § 805(b))
7. Makes a willful failure to file an “805 report” punishable by a fine of $100,000 per violation, and any other failure is punishable by a fine of $50,000. (BPC § 805(k) & (l))
8. Requires a licensed health care facility to file a separate report with the relevant state agency within 15 days after a peer review body makes a final decision or recommendation to take disciplinary action against a licensee that must be reported as an “805 report,” if the peer review body determines, following a formal investigation, that specified acts occurred, including, sexual misconduct with one or more patients during a course of treatment or an examination. (BPC § 805.01(b))
9. Makes a willful failure to make the separate report punishable by a fine of $100,000 per violation, and any other failure is punishable by a fine of $50,000. (BPC § 805.01(g) & (h))
10. Regulates the practice of medicine under the Medical Practice Act and establishes the MBC and Osteopathic Medical Board of California (OMBC) for the licensure, regulation, and discipline of physicians and surgeons. (BPC §§ 2000-2525.5)
11. Specifies that provisions of the Evidence Code, the Government Code, including the Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code), the Civil Code, the BPC, and other applicable law pertaining to the confidentiality of peer review activities of peer review bodies shall apply to the peer review activities of the hospital authority. States that peer review proceedings shall constitute an official proceeding authorized by law and those privileges set forth in that section with respect to official proceedings shall apply to peer review proceedings of the hospital authority. If the hospital authority is required by law or contractual obligation to submit to the state or federal government peer review information or information relevant to the credentialing of a participating provider, that submission shall not constitute a waiver of confidentiality. The laws pertaining to the confidentiality of peer review activities shall be together construed as extending, to the extent permitted by law, the maximum degree of protection of confidentiality. (Health and Safety Code §101848.9)
12. States that neither the proceedings nor the records of organized committees of medical, medical-dental, podiatric, registered dietitian, psychological, marriage and family therapist, licensed clinical social worker, professional clinical counselor, pharmacist, prehospital emergency medical care person or personnel, or veterinary staffs, or of a peer review body, as defined in BPC Section 805, having the responsibility of evaluation and improvement of the quality of care rendered in the hospital, or for that peer review body, or medical or dental review or dental hygienist review or chiropractic review or podiatric review or registered dietitian review or pharmacist review or veterinary review or acupuncturist review or licensed midwife review or prehospital emergency medical care person or personnel review committees of local medical, dental, dental hygienist, podiatric, dietetic, pharmacist, veterinary, acupuncture, chiropractic, or prehospital emergency medical care person or personnel societies, marriage and family therapist, licensed clinical social worker, professional clinical counselor, or psychological review committees of state or local marriage and family therapist, state or local licensed clinical social worker, state or local licensed professional clinical counselor, or state or local psychological associations or societies or licensed midwife associations or societies having the responsibility of evaluation and improvement of the quality of care, shall be subject to discovery. (Evidence Code § 1157)
13. Establishes the Civil Rights Department (CRD) and outlines various prohibited practices, including but not limited to practices by employers related to discrimination. Requires employers with 100 or more employees to submit a pay data report to the CRD that includes specified information, including but not limited to the number of employees by race, ethnicity, and sex in specified job categories and authorizes CRD to annually publish and publicize aggregate reports based on this data. (Government Code § 12900-12907)

This bill:

1. Establishes a new mandatory reporting requirement for health care facilities and peer review bodies to report to the CRD and MBC that includes the following for the prior year:
2. The number of physicians and surgeons and medical residents at the health care facility who were terminated.
3. The number of physicians and surgeons who applied for staff privileges at the health care facility.
4. The number of physicians and surgeons who were granted staff privileges at the health care facility.
5. The number of physicians and surgeons whose staff privileges were revoked at the health care facility.
6. The percentage of physicians and surgeons in each of the categories specified in paragraphs (1) to (4), inclusive, who identified their race or gender.
7. The percentage of medical residents at the health care facilities who were terminated and who identified their race or gender.
8. The number of physicians and surgeons in each of the categories specified in paragraphs (1) to (4), inclusive, and who identified their race or gender, stratified by race and gender.
9. The number of medical residents at the health care facilities who were terminated and who identified their race or gender, stratified by race and gender.
10. Requires the CRD, on or before September 1 of each year, to publish on its internet website and make available to the public the information outlined in 1) above. Prohibits the CRD from disclosing the names of the health care facilities and requires any personally identifying information to be removed.
11. States findings and declaration that this bill imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, states that the Legislature finds that the proposed law strikes a balance between disclosing relevant information to the public while protecting the privacy of individuals and health care facilities, as a demonstration of the interest protected by the limitation on the public’s right of access of information and the need for protecting that interest:

FISCAL EFFECT:

Unknown. This bill is keyed fiscal by Legislative Counsel.

COMMENTS:

1. Purpose. This bill is sponsored by the Golden State Medical Society. According to the Author, “As a physician, I have seen firsthand the critical role that a diverse and skilled healthcare workforce plays in ensuring effective and equitable access to care. California’s healthcare system depends on this diversity to meet the needs of our communities, yet we face a growing physician shortage, particularly in underserved and minority populations. This shortage raises urgent concerns about the fair treatment and retention of physicians from underrepresented racial and ethnic backgrounds.

In 2013, the Golden State Medical Association highlighted concerns about racial biases in medical dismissals, an issue I have witnessed in my own career. A 2015 study by the California Research Bureau revealed troubling racial disparities in disciplinary actions, with Latino and Black physicians more likely to face complaints and penalties. A 2021 report further exposed that Black medical residents experienced disproportionately high dismissal rates, despite representing only 5% of the population.

The lack of minority physicians contributes to healthcare disparities, affecting access, treatment, and outcomes in underserved communities. These inequities cannot continue. A diverse healthcare workforce improves culturally competent care, boosting patient outcomes and trust. The bill aims to collect data on the demographics of physicians, surgeons, and medical residents to identify gaps in representation and access, allowing the state to take targeted actions to effectively address these disparities and promote equitable care for all Californians.”

The Author states that “The current law requires the collection and reporting of licentiate’s dismissals to the relevant state licensing agency, however the demographics of involved licentiates are not required or reported, and nor are suspensions. As a result of this omission, there is no generally accessible, validated compilation of data to assist in determining if there are any disparate dismissals for non-medical cause or reason, particularly among Under-Represented in Medicine (URiM) physicians. Presently, there is increasing anecdotal findings suggesting URiM physicians and medical students are heavily over-represented in such unwarranted dismissals. Since URiM physicians are the most likely to work in medically underserved areas (where the need is greatest with doctor/patient ratios often reaching 1:6,000 as compared to the State average of 1:1,480), and studies show that they improve patient health outcomes in these sectors, this would represent a grave disservice to the State’s Public Health, as well as a waste of the significant tax dollars that we have already invested in them. Graduating adequate physicians to maintain healthy Populations throughout California is imperative if we are to keep our economy stable and maintain our reputation as a safe and welcoming State. As we experience outbreaks of tuberculosis and influenza, the highest rates of Chlamydia, gonorrhea and syphilis in 30 years, and children dying from measles infections in America, we are reminded that healthcare for all Californians’ is important and impacts all of us. We cannot afford to lose qualified physicians as our population ages and our physician workforce shrinks, as it decreases the quality and quantity of life here.

This legislation is needed because there are multitudes of issues that prevent affected physicians from reporting unjustified dismissals themselves. For those in training, they fear reprisal, or not being able to get into another Residency Program to complete their training if they speak up. Physicians in practice want to keep their name out of public view if it gives an appearance of them not being qualified or competent in any way, may prevent them from getting privileges at another hospital,. Physicians are among the most trusted professionals, and losing any privileges at a hospital suggests either, both or fraudulence in the minds of the public, who are generally unaware of these demographic concerns, so can cause them to lose patients. Additionally, those physicians who litigate and prevail against an institution that has wrongfully dismissed them or withdrawn privileges are routinely made to sign Non-Disclosure Agreements as part of the settlement, and are thereby prevented from making public in any form what was done to them at the violating facility. And for almost all physicians who find themselves in these situations, the psychological trauma of the experience and shame is often overwhelming, rendering them unable to speak out about it, thus the need to place the onus of reporting on the institution doing the dismissing, rather than on the impacted person.”

1. Peer Review. Physician peer review is one of the regimes used to ensure that quality of care is delivered while minimizing medical errors and managing patient risks. During a peer review, physicians evaluate their colleagues’ work to determine compliance with the standard of care. Reviews are intended to detect incompetent or unprofessional physicians early and terminate, suspend, or limit their practice if necessary. Peer review is triggered by a wide variety of events including patient injury, disruptive conduct, substance abuse, or other medical staff complaints. A peer review committee investigates the allegation, comes to a decision regarding the physician’s conduct, and takes appropriate remedial actions. In prior informational hearings and through the review of legislation related to peer review, it has been noted that historically there has been reluctance among physicians to serve on peer review committees due to the risk of involvement in related future litigation, including medical malpractice lawsuits against a physician under review. There have also been concerns “sham peer review”, using the peer review system to discredit, harass, discipline, or otherwise negatively affect a physician’s ability to practice medicine or exercise professional judgment for a non-medical or patient safety related reason. Other criticisms of peer review have included over legalization of the process, lack of transparency in the system, and burdensome human and financial toll peer review brings not only to the hospital but also to a physician under review.

Recognizing that peer review is necessary to maintain and improve quality medical care, Congress in 1986 enacted the Health Care Quality Improvement Act (HCQIA). HCQIA established standards for hospital peer review committees, provided immunity for those who participate in peer review, and created the National Practitioner Data Bank (NPDB). The NPDB is a confidential repository of information related to the professional competence and conduct of physicians, dentists, and other health care practitioners. Credentialing bodies are required to check the NPDB database before granting privileges to physicians or re-appointing them. Entities such as hospitals, professional societies, state boards, and plaintiffs’ attorneys are given access to the NPDB. In enacting the NPDB, the United States Congress intended to improve the quality of health care by encouraging state licensing boards, hospitals, and other health care entities, and professional societies to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history.

Private standard setting is also common in peer review. Organizations like the Joint Commission, which accredits hospitals, health care providers and other health care settings across the country, have established peer review standards. In order to receive Joint Commission accreditation, hospitals must have peer review and other quality assurance measures. Eligibility for federal funds such as Medicare and Medicaid often depends on accreditation. In 2004, the Joint Commission renamed peer review into “Focused Review of Practitioner Performance” which was later renamed to Focused Professional Practice Evaluation (FPPE). In 2007, the Joint Commission defined two types of reviews aimed at assuring physician competence: the FPPE and “ongoing professional practice evaluation” (OPPE.) The FPPE applies to new applicants for medical staff membership and to existing practitioners requesting new privileges for which the hospital has no documented evidence of their competence. FPPE may also apply to a practitioner whose current abilities are questioned because of negative performance issues or because an adequate volume of cases are not available to assess current competence. In the case of initial medical staff appointments, the hospital must check with primary sources to determine whether the practitioner requesting medical staff membership and privileges has the requisite current training, knowledge, skills and abilities. These same parameters must be evaluated for practitioners during the re-credentialing process, with the additional requirement that granting of privileges is based in part on the results of peer review and OPPE. Proctoring is a form of focused evaluation involving one-on-one evaluation of a practitioner’s performance by another peer practitioner (a proctor). Direct observation is used to gauge the ability of the proctoree to perform a procedure or use a new technology. Focused proctoree evaluation may occur retrospectively through peer review if on-site, real-time evaluations are not feasible. In the case where same specialty peer reviewers are not available internally, external peer review can be used as a viable substitute for on-site proctoring.

In 2007, the Joint Commission established OPPE because of the recognition that there is need to evaluate practitioners on an ongoing basis rather than at the usual two year reappointment process and allow practitioners to take steps to improve performance on a more timely basis. OPPE applies to practitioners who have already been granted patient care privileges, to revise existing privileges, or to revoke an existing privilege prior to or at the time of renewal. The revised OPPE process requires a clearly defined process for the evaluation of each practitioner's professional practice which would include the following: who will be responsible for reviewing performance data, how often the data will be received, the process to be implemented to make a decision on whether to continue, limit or revoke privileges, and how the data will be incorporated into the credentials’ files. OPPE standards require an evaluation for all practitioners and not just those with performance issues.

The California Department of Public Health’s Licensing and Certification Program (DPH) licenses, regulates, and inspects hospitals and other health care facilities throughout California. DPH regulations require all hospitals to have an organized medical staff and to also have formal peer review procedures in place as part of their licensing requirements. DPH has also issued more stringent peer review requirements for hospitals engaging in medical specializations such as heart surgery. All DPH licensed healthcare facilities are required to have an organized medical staff which establishes controls to ensure that physicians practicing at the faculty meet all required ethical and professional standards.

Title 22 § 70703 of the California Code of Regulations requires a medical staff committee in all hospitals licensed by DPH. Section 70703 requires that each hospital have an organized medical staff made up of qualified physicians empowered to establish written by-laws detailing the formal procedures for, “the evaluation of staff applications and credentials, appointments, reappointments, assignment of clinical privileges, appeals mechanisms and such other subjects or conditions which the medical staff and governing body deem appropriate.” The medical staff is required to meet regularly and to keep written minutes of its meetings. Further, the medical staff shall provide rules and regulations for the practices and procedures to be used at the hospital. The medical staff is also to engage in continuing education and maintain evidence of participation. The hospital governing body and medical staff are given significant leeway in implementing peer review procedures.

Members of the medical staff must continuously demonstrate competence in their specialty. Title 22 § 70701(7) requires the medical staff “establish controls” that are designed to ensure the achievement and maintenance of high standards of professional practice including provision “that all members of the medical staff . . . demonstrate their ability to perform surgical and/or other procedures competently and to the satisfaction of an appropriate committee or committees of the staff . . . at the original application . . . and at least every two years thereafter.”

Peer review proceedings and outcomes are privileged and confidential in California.

1. Mandatory Reporting. There are a significant number of reporting requirements outlined in BPC designed to inform licensing boards about possible matters for investigation. Mandatory reports about physicians include:

BPC 801.01 requires MBC and OMBC to receive reports of settlements over $30,000 or arbitration awards or civil judgments of any amount. The report must be filed within 30 days by either the insurer providing professional liability insurance to the licensee, the state or governmental agency that self-insures the licensee, the employer of the licensee if the award is against or paid for by the licensee or the licensee if not covered by professional liability insurance.

BPC 802.1 requires physicians to report indictments charging a felony and/or any convictions of any felony or misdemeanor, including a guilty verdict or plea of no contest.

BPC Section 802.5 requires a coroner who receives information, based on findings reached by a pathologist that indicates that a death may be the result of a physician’s gross negligence, to submit a report to MBC or OMBC. The coroner must provide relevant information, including the name of the decedent and attending physician as well as the final report and autopsy.

BPC Sections 803, 803.5 and 803.6 require the clerk of a court that renders a judgment that a licensee has committed a crime, or is liable for any death or personal injury resulting in a judgment of any amount caused by the licensee’s negligence, error or omission in practice, or his or her rendering of unauthorized professional services, to report that judgment to MBC or OMBC within 10 days after the judgment is entered. In addition, the court clerk is responsible for reporting criminal convictions to MBC or OMBC and transmitting any felony preliminary hearing transcripts concerning a licensee to MBC or OMBC.

BPC Section 805 is one of the most important reporting requirements that allows MBC and OMBC to learn key information about a physician or surgeon. Section 805 requires the chief of staff and chief executive officer, medical director, or administrator of a licensed health care facility to file a report when a physician’s application for staff privileges or membership is denied, or the physician’s staff privileges or employment is terminated or revoked for a medical disciplinary cause. The reporting entities are also required to file a report when restrictions are imposed or voluntarily accepted on the physician’s staff privileges for a cumulative total of 30 days or more for any 12-month period. The report must be filed within 15 days after the effective date of the action taken by a health facility peer review body.

BPC Section 805.01 is a similarly extremely important requirement. The law requires the chief of staff and chief executive officer, medical director, or administrator of a licensed health care facility to file a report within 15 days after the peer review body makes a final decision or recommendation to take disciplinary action which must be reported pursuant to section 805.

This reporting requirement became effective January 2011 and is only required if the recommended action is taken for the following reasons:

• Incompetence, or gross or repeated deviation from the standard of care involving death or serious bodily injury to one or more patients in such a manner as to be dangerous or injurious to any person or the public.
• The use of, or prescribing for or administering to him/herself, any controlled substance; or the use of any dangerous drug, as defined in BPC Section 4022, or of alcoholic beverages, to the extend or in such a manner as to be dangerous or injurious to the licentiate, or any other persons, or the public, or to the extent that such use impairs the ability of the licentiate to practice safely.
• Repeated acts of clearly excessive prescribing, furnishing or administering of controlled substances or repeated acts of prescribing, dispensing, or furnishing of controlled substances without a good faith effort prior examination of the patient and medical reason therefor.
• Sexual misconduct with one or more patients during a course of treatment or an examination.

The purpose of 805.01 reports is to provide MBC or OMBC with early information about these serious charges so that MBC or OMBC may investigate and take appropriate action to further consumer protection at the earliest possible moment. Accordingly, for any allegations listed above, the Legislature determined that an 805.01 report must be filed once a formal investigation has been completed, and a final decision or recommendation regarding the disciplinary action to be taken against a physician has been determined by the peer review body, even when the physician has not yet been afforded a hearing to contest the findings.

BPC Section 805.8 requires a health care facility or other entity that makes any arrangement under which a healing arts licensee is allowed to practice or provide care for patients must file a report of any allegation of sexual abuse or sexual misconduct made against a healing arts licensee by a patient, if the patient or the patient’s representative makes the allegation in writing, to the agency within 15 days of receiving the written allegation of sexual abuse or sexual misconduct.

BPC Section 2216.3 requires accredited outpatient surgery settings to report an adverse event to MBC no later than five days after the adverse event has been detected, or, if that event is an ongoing urgent or emergent threat to the welfare, health or safety of patients, personnel, or visitors, not later than 24 hours after the adverse event has been detected.

BPC Section 2240(a) requires a physician and surgeon who performs a medical procedure outside of a general acute care hospital that results in the death of any patient on whom that medical treatment was performed by the physician and surgeon, or by a person acting under the physician and surgeon’s orders or supervision, to report, in writing, on a form prescribed by the MBC, that occurrence to MBC within 15 days after the occurrence.

1. Physician Employment. The Equal Employment Opportunity Commission (EEOC) is a federal commission, created by the Civil Rights Act of 1964. Since its inception, the EEOC has fought discrimination throughout America’s workplaces, including discrimination based on race, color, religion, national origin, age, disability, and sex. The EEOC was an early pioneer in the fight for gender equality – as early as 1968, the EEOC argued in court that state laws that prevented women from certain occupations were illegal and preempted under federal law.

Starting in 1966, the EEOC required employers with 100 or more employees to submit EEO-1 forms, which showed the representation of men and women of different ethnic groups in nine different occupational classifications. According to the EEOC, the EEO-1 data was invaluable in enforcing anti-discrimination laws and conducting public hearings throughout the country to bring attention to the issue of discrimination in the workplace. The EEO-1 continues to be required by the EEOC, and continues to be used to enforce antidiscrimination laws throughout the country.

However, physicians are rarely employed by health facilities in light of California’s ban on the corporate practice of medicine (CPM).

CPM is usually referred to in the context of a prohibition, banning hospitals from employing physicians. The ban on CPM evolved in the early 20th century when mining companies had to hire physicians directly to provide care for their employees in remote areas. Problems arose when physicians’ loyalty to the mining companies conflicted with patients' needs. Eventually, physicians, courts, and legislatures prohibited CPM in an effort to preserve physicians’ autonomy and improve patient care.

According to a 2007 CRB report, “…Although some non-profit clinics may employ physicians, California applies the CPM doctrine to most other entities.... Teaching hospitals may employ physicians, but other hospitals, including most public and non-profit hospitals, may not employ physicians. Professional medical corporations are expressly permitted to engage in the practice of medicine, and may employ physicians.”

1. MBC Enforcement Study. MBC can only collect certain demographic information from licensees on a voluntary basis.

In response to concerns raised by members of the African American physician community and a formal request from the Golden State Medical Association, MBC contracted with the California Research Bureau (CRB) in 2016 to conduct a study aimed at determining if disparity exists in MBC’s enforcement efforts. Anthony Jackson, M.D., an anesthesiologist from Southern California and GSMA raised the issue to MBC over the course of a number of meetings that African-American physicians were targeted and received discipline from MBC in higher numbers than other comparable ethnic groups.

CRB’s study was released in January 2017. Using archival data provided by MBC of complaints, investigations and discipline that occurred from July 2003 through June 2013, CRB determined that there was a correlation between physician race and the pattern of complaints, investigations and discipline. Latino and black physicians were both more likely to receive complaints and more likely to see those complaints escalate to investigations. According to the study, Latino physicians were also more likely to see those investigations result in disciplinary outcomes.

CRB noted that the findings “should be taken with the caveat that this is an observational study, and many variables affecting the perception of physician performance (for instance, “bedside manner”) could not be taken into account.” CRB further determined that while there is evidence of disparate outcomes, there is no evidence that any actor has specifically applied racial bias to achieve these outcomes.

MBC had used and continues to rely on the Department of Consumer Affairs (DCA) Non-Discrimination Policy and Complaint Procedures, which must be reviewed and signed by all employees. This policy states that the DCA enforces a zero tolerance policy against discrimination, harassment, and retaliation. Every year, all employees must review this policy and indicate that they will comply with the policy.

MBC formed a Disciplinary Demographic Study Task Force to further explore this issue and provide additional direction to MBC. MBC also noted at the time of the report that it would promptly begin training for members and all staff to ensure equity in its work. In September 2017, the Board held in-person implicit bias trainings for almost 300 employees of the Board, its investigators, Deputies Attorney General, and Board Members. MBC produced a webinar version of the training in 2019 and required the training be competed every two years. Board staff are encouraged to participate in other training on this topic, as well.

MBC implemented a policy to remove information from documents submitted to expert reviewers, and in the stipulation memos submitted to Board Members for review in licensing and disciplinary cases that is not essential to the evaluation of the matter, but that could trigger unconscious or implicit bias relating to race, ethnicity, or other factors, including where the person went to school, where they completed postgraduate training, and whether they are board certified by a specialty board. MBC previously noted that addressing implicit bias requires steadfast commitment at every level, and advises that it will continue to look for and implement new approaches to training, as well as reviewing, investigating, and determining case outcomes in a manner that reduces the influence of unconscious bias.

1. Arguments in Support. Supporters note similar sentiments to the Author above and state that “A report from the Accreditation Council for Graduate Medical Education in 2021 revealed that Black residents experienced disproportionately high dismissal rates, representing as much as 19% of those dismissed, despite making up only 5% of the total resident population. This stark disparity highlights the broader issue of inequities that disproportionately affect minority physicians. This disparity prompted the Black Doc Village to launch the #BlackDocsBelong campaign in 2022 to raise awareness about the disproportionate dismissal rates among Black medical residents, alongside the ongoing physician shortage.” Supporters state that this bill aims to gather non-definable demographic data on physicians, surgeons, and medical residents whose hospital privileges have been granted, reduced, limited, or revoked, with the goal of mitigating the loss or removal of competent, qualified physicians from the workforce, a majority of whom have had over $500,000 of taxpayers’ money invested in their education.”
2. Proposed Author’s Amendments. The Author is proposing amendments to make various conforming changes and to eliminate the requirement that health facilities report information to MBC. The amendments also:

• Require a health facility to report the number of physicians and surgeons and medical residents at the health care facility whose staff privileges were suspended.
• Specifies that when posting on the CRD website, information must be aggregated and deidentified.
• Specifies that the information reported to CRD is confidential and shall not be disclosed pursuant to the California Public Records Act.

SUPPORT AND OPPOSITION:

Support:

Golden State Medical Association (sponsor)

California-Hawaii State Conference of the NAACP

Medical Bridge of the Motherland

Sinkler Miller Medical Association

Opposition:

None received

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