Assembly Standing Committee on Business and Professions

Good morning, everyone. For the record, the Assembly Members are here and ready to have a hearing. So if we get a Senator to show up and present a Bill, that would be fantastic. So if you're watching the hearing and you're a staffer to a Senator, go find your Boss, drag them to what hearing room are we in? 1100. Drag them to 1100 and we can have our hearing.

I just wasted 20 minutes of in my life that I won't get back in a Senate Committee hearing waiting for Senators to show up. So I don't know where all the Senators are, but they're not where they're supposed to be. So if we could go find some Senators, that would be awesome. Thank you. Good morning, everybody. I have two binders. Which one is yours and which one is mine? Good morning.

Welcome to this morning's Business and Professions Committee hearing, which is our final regularly scheduled hearing for the year. We have nine bills on today's agenda, including the following two bills on consent SB 813 by Senator Roth, and SB 887 by the Senate Committee on Business and Professions and Economic Development. As always, for each measure being presented today, we will be allowing primary witnesses here in the room today to speak for up to two minutes each, with up to two primary witnesses per side.

Any additional witnesses will be limited to name position on the Bill and the organization they represent, if any. For those wishing to provide further comments, we are accepting written testimony through the position letter portal on the Committee's website. With that, we will begin today's hearing. And I see General Roth is with us. General, please come on up and present whichever bills you want to present first.

And I would say to Senator Bradford and Senator Wiener's staff, hang out for a little bit, because General Roth has five bills. Ready when you are, sir.

I'll present the first file. Order one, SB 812. Great. California Tax Education Council. This is the sunset Bill for the California Tax Education Council. The Bill ensures continued oversight of tax preparers in California by extending the operations of the Council for 4 years. I think we all agree that consumers are better off with standardized education and professional accountability for professionals who provide fee based tax preparation services at the appropriate time, I would respectfully request an aye vote.

Thank you. General, do you have any primary witnesses in support?

Not to my knowledge,

And I would hope there are no primary witnesses in opposition. Seeing none. Let's open it up to anybody who wants to add on in support or opposition to the Bill. Does anybody in the hearing room want to add on in support or opposition to the Bill, seeing none? Going to bring it back to colleagues for questions or comments? We don't have a quorum yet, so we can't take motions and seconds. I don't see any. This is a very straightforward Bill would you like to close?

At the appropriate time, Mr. Chair. Respectfully ask for an aye vote.

Thank you. Chair Roth, I understand conversations are ongoing with the DOJ to determine how best to ensure CTEC receives federal criminal history information from the FBI. And I'm sure we'll come to resolution on that. And I'm happy to support the Bill today to continue oversight of paid tax preparers in this state. And I have no doubt we'll have a motion in a second when the time comes.

Thank you, Mr. Chair. The next item on the file is Senate Bill 814. It's the Sunset Bill for the Bureau of Household Goods and Services. The changes in this Bill stem from our work during the joint Sunset Review hearing. It makes a number of changes to the Bureau of Household Goods and Services in order to create some efficiencies and updates some provisions.

The Bill merges three separate funds that the Bureau oversees into one Household Goods and Services Fund and updates definitions in the Electronic and Appliance Repair Act to keep pace with evolving technology, cell phones and the like. The Bill also authorizes the Bureau to issue licenses to limited liability companies, a common practice at multiple other licensing entities within the DCA.

And it deletes an arbitrary and unnecessary requirement for the Bureau to assess the financial resources of household movers who are applying for a permit with the Bureau, and notably confirms that the Bureau will come under legislative review via the sunset review process once again four years from now at the appropriate time. I would also respectfully request an aye vote on this one.

Thank you, Chair Roth. Do we have primary witnesses in support, primary witnesses in opposition? Tweeners, add ons? There it is.

I wouldn't say I'm a primary witness. Matt Robinson with Shaw Yoder Antwih Schmelzer & Lange. On behalf of the California Moving and Storage Association, we appreciate the author and the Bill. We have actually found quite a home at BHGS, the Bureau of Household Goods and Services, since we were moved from the Public Utilities Commission to BHGS several years ago.

Appreciate the cleanup amendments that this Bill is doing, and we continue to work with staff, with the author's office and your Committee staff, Mr. Chair, on some final tweaks to the law. We don't get a lot of shots at this. As you see in the analysis. We've been doing cleanup bills for a couple of years now after SB 19 went into effect. And so really appreciate the author and your efforts to move this forward. Thank you.

Thank you very much. Any other witnesses who want to add on in support or opposition to the Bill? Seeing none. Going to bring it back to colleagues for questions or comments? Seeing none. Chair Roth, would you like to close.

Just at the appropriate time. Respectfully request an aye vote, sir.

Thank you very much. Thank you for your presentation. SB 814, BHGS Sunset Bill provides necessary technical cleanup and clarifies the Bureau authority over its licensed population. These necessary revisions ensure BHGS is equipped to protect consumers and its licensed workforce. Happy to support the Bill today, and I'm sure we'll have a motion second at the appropriate time.

Thank you, sir. If I could skip 815 for the moment.

Gladly.

And take Senate Bill 816. This is a sunset cleanup Bill, contains several changes to a number of practice acts administered by the Department of Consumer Affairs, includes necessary fee increases for boards that are in dire fiscal situation, and makes changes to the operations of a number of programs, and the California Council for Interior Design Certification, following our recent sunset review work for these entities.

I appreciate the opportunity to amend the Bill leaving the Committee today in order to extend the current requirements for a junk dealer or recycler to submit additional information to the Department of Food and Agriculture when applying for a weighmaster's license.

Along with the payment of additional fees for each fixed location, this Bill updates provisions of the Interior Design chapter to include, or to clarify rather, that the California Council for Interior Design certification is the certifying entity, including codifying the Commercial Design stamp designation, among other technical and clarifying changes.

The Bill increases various license fees in order to ensure solvency for the Board of Psychology, the Board of Pharmacy, the Board of Accountancy, and the Landscape Architects Technical Committee, as requested by those entities and the Department of Consumer Affairs. The Bill deletes a current provision or prohibition in the Veterinary Medical Practice Act that prevents the Veterinary Medical Board from being able to issue a probationary certificate, if appropriate, to an applicant for a Veterinary Assistant controlled substance permit.

The Bill also makes technical changes related to the authority for the Board of Vocational, Nursing and Psychiatric Technicians to decrease community college fees for that board's school approval process when those institutions face declines in enrollment and commensurate declines in state funding. The appropriate point in time, respectfully requests an aye vote.

Thank you, Mr. Chair. Any primary witnesses in support? Seeing one. Come on up. Take your time. You have two minutes.

Just want to say thank you to the Committee staff and Senator Roth for his leadership on this Bill, and it will help the Board of Psychology continue its fiscal solvency in future years.

Thank you, and we all want that. Thank you very much. Any additional witnesses in support?

Hi, my name is Ellen Madill. I'm here on behalf of the International Interior Design Association, both Northern and Southern California chapters in support and want to thank staff and the author for the recent clarifying amendments to the Interior Design section. Thank you.

Thank you very much. Any additional witnesses in support? Any witnesses in opposition? Seeing none. Any add ons, me too's? Bring it back to colleagues for questions or comments. No. Seems pretty straightforward, Chair. Would you like to close.

Just at the appropriate point in time, ask for an aye vote.

Thank you very much. Thank you for working on these important issues. I'm happy to support the Bill today and appreciate you and your staff's effort on that Bill. And we'll have a motion and second when we have a quorum.

Mr. Chair, the next would be SB 817. This is the barbering and cosmetology Bill. It simply ensures that the Board of Barbering and Cosmetology does not charge more than $50 to an individual who seeks to become a hairstylist. As currently written, the law leaves open the potential for the Board of Barbering and Cosmetology to charge over this amount and more than it charges other professionals like Cosmetologists and Barbers. The appropriate point in time, respectfully ask for an aye vote.

Thank you, Mr. Chair. Do we have any primary witnesses in support of the Bill? Any primary witnesses in opposition to the Bill? Anybody wants to add on in support of opposition? Bring it back to colleagues for questions or comments. This is agenda item number eight, SB 817. Seeing none. Senator, would you like to close.

At the appropriate point in time, respectfully ask for an aye vote.

Thank you, Senator. Thank you for your work on this Bill. I'm happy to support the Bill when the time comes.

Thank you, Mr. Chair. And now, the Bill everyone's been waiting for, Senate Bill 815, the Medical Board of California. This is the sunset Bill for the Medical Board of California, and I accept the Committee's proposed amendments. As you know, without this legislation, the Medical Board will no longer exist after January 1, 2024, as proposed to be amended.

The Bill responds to a number of the issues discussed publicly at Medical Board meetings and discussed publicly in this Committee and collaboratively with the Senate Business, Professions and Economic Development Committee for a number of years. I do want to thank you, Mr. Chair, and acknowledge the excellent work of your staff in the analysis. It was very comprehensive, and I do appreciate that.

The changes to the Medical Practice Act that will be contained in this Bill, or are contained in this Bill directly correspond to this Linkly sunset review oversight hearing we held earlier this year and are aimed at ensuring that the Medical Board has the tools to do the job that we've tested with. There are a number of enhancements to the enforcement process built into the Bill to allow for swift disciplinary action when necessary and to promote consumer and patient interests.

As you all know from what the work you do in this Committee, the Medical Board is currently insolvent and has attempted to receive increased revenue for a number of years. This Bill increases physician and surgeon licensing fees to allow the Medical Board simply to function.

The Board has been paying its bills thanks to loans from other special funds and other boards and bureaus for years, and it is far past time for us to Fund this important program at the appropriate rate and to allow it to effectively do its licensure and enforcement work.

The Bill retains a high burden of proof, clear and convincing evidence for enforcement cases that would result in license revocation, but notably provides the Board with authority that 41 other states currently have to utilize a preponderance of evidence standard for cases that are less severe. The Bill also speeds up the Medical Board's ability to take enforcement action against a current licensee who is convicted of a felony where the conviction involves moral turpitude, dishonesty or corruption, fraud or sexual assault.

Whether in the course of the licensee's actions as a physician and surgeon or otherwise at the appropriate point in time, I respectfully ask for non vote.

Thank you, Chair. I have a feeling we might have primary witnesses in support and opposition for this Bill. Come on up. You have two minutes. You can come to the dais if you want. You can speak from the mic, whichever you prefer.

Thank you. Microphone's fine. Thank you. Mr. Chairman, Aaron Bone with the Medical Board of California first wish to thank the author and his staff for their diligent efforts to support the Board's mission and address many of the concerns and requests the Board raised in its Sunset Report also appreciate you, your leadership, Mr. Chair, and your staff.

While we are disappointed with the public Member majority changes proposed in the analysis, we otherwise appreciate most of the proposed amendments and will continue to work with the author to further refine the language. We recognize that the fee increase proposed in the Bill is controversial, but as touched on by Senator Roth, it reflects the unfortunate reality that the Board currently faces. With the indulgence of the Chair, I'd like to read a brief statement from two of our physician Members.

Our Vice President, Dr. Randy Hawkins, who practices in Inglewood and is an assistant Professor at Charles Drew University of Medicine. And the other Member is Dr. Richard Thorpe, who practices in paradise outside of Chico. And Dr. Thorpe is a former President of the California Medical Association. Quote we are physician Members of the Medical Board of California who each have more than 35 years of experience in medical practice.

We are committed to the Board's consumer protection mission, and that is why we enthusiastically support increasing physician licensing fees as proposed in SB. 815. 2 years ago, the Legislature approved an $80 increase, which was the first physician fee change since 2009. But that was far less than what the Board requested based on an independent third party report. Therefore, we are back today, unfortunately seeking a larger fee increase.

The simple reality is that the Board is not able to pay its bills, which is why we've had to take on $18 million in loans just to maintain our typical operations. As a result, a large fee increase is necessary so the Board can perform its vital work, pay off our debt, and rebuild our reserves like other licensing boards. We receive no support from the General Fund.

We are physicians in private practice, and this fee increase will impact us personally, albeit at an increased cost of less than $20 per month. We do not see this as a burden, but rather as an investment into the organization that helps ensure that physicians have the confidence of the patients that we are privileged to treat. Inflation impacts all areas of life, including the expenses of the Board. About $0.75 out of every dollar of revenue is spent on our enforcement program.

This includes investigating and prosecuting, licensees and monitoring those on probation. That is why it is critical that the board has the financial resources it needs to perform the work expected by the Legislature and public. Therefore, we respectfully ask each Committee Member today to vote aye on SB 815. That concludes their statement. But I would just like to add, Mr. Chair,

Very quickly, please.

That today, again is the final hearing. And if the sunset date for the board is not extended, the board Members will be dismissed and the Executive Director will be dismissed. And the board will be without its key leadership until a new board is constituted.

And nobody wants that.

Thank you. Ask for a nice vote.

Thank you very much.

Hello, Chair. Senator Roth. My name is Carmen Balber, Executive Director of consumer watchdog. And you have all been here on the many, many occasions over the recent years when patients who have been injured, their family Members, and consumer advocates have come before you, begging for change, begging for reforms at the Medical Board that the LA Times said had a pattern of leniency and discipline.

I want to thank all of you, including the Medical Board, for the reforms in SB 815 that finally address some of the systemic problems that patient advocates have been bringing to you for years. As the Medical Board said, we regret the removal of the public member majority in the Bill, but otherwise, it contains key reforms that we urge your support of. That includes the patient interview, so patients no longer submit a complaint to the board and then get it dismissed without being spoken to.

That will give the board information it needs and give the public the responsiveness it needs. The Bill gives patients a voice by creating a complaint liaison unit, and also by allowing patients to give a victim Impact statement to the board before final enforcement is decided upon. It creates significant structural changes to prevent delays and increase costs in the board's processes. And that's critical to reform. And it changes the standard of proof in Medical Board cases.

So California is on par with other states, can move more quickly to get enforcement actions completed. That's better for doctors and better for patients. Finally, they need that full fee increase in order to do that job, or patient safety will continue to suffer in California. That's why we urge your aye vote. Thank you.

Thank you very much. We're going to take a quick break to establish a quorum while we have one before everyone runs away. Madam Secretary, can you please call the roll?

Berman here. Flora, Aguirkuri, Alanis, Baines, Bonta, Chen, Dixon, Gibson, Grayson, Erwin, Jackson, Lee, Lowenthal, Mccarty, Mckinnor, Wynn, Patterson, Ting.

It great we have a quorum. Do we have any? First, we're going to go to primary witnesses in opposition do we have any primary witnesses in opposition to the Bill? Do.

You have two minutes, maybe.

There we go.

Perfect.

Good morning, Chair and Members. My name is George Sores with the California Medical Association. We greatly appreciate the chair and the Committee staff's work on this Bill. CMA is still opposed unless amended to this measure. With the proposed amendments in the analysis, we have three main concerns left with the Bill going forward. First, being the fee increase. Second, lowering the evidentiary standard, and third, the uncertainty as to what exact felonies would constitute moral turpitude, dishonesty and fraud in the automatic revocation provision in this Bill.

The proposed fee increase in this Bill will go from $863 to $1289. CMA cannot agree to a fee increase of about 50%. That will go towards building a multimillion dollar Reserve Fund for the Medical Board, with a significant amount of the fee increase going toward new programs with little demonstration of why these programs are needed.

Additionally, the Medical Board has some of the longest application wait times as compared to other states, and nothing in this fee increase will alleviate the time physicians must wait for Licensure applications to be processed. CMA is willing to agree to a fee increase to fully Fund the board, but the $1,289 fee figure is unjustified. Currently, the $863 fee is the top 5 highest in the nation, and the proposed fee would make it the most expensive one in the country and about double the nationwide average.

We're committed to continue to work with all stakeholders, including the Governor's office, to find a reasonable fee number and ensure the Medical Board has the resources it needs to function. We are opposed to changing the current evidentiary standard and would respectfully ask that that is removed from the Bill before moving forward.

The clear and convincing standard has been law for all Healing Arts boards since 1982, and it is not clear why we would single out the medical Board alone and not have a change across the board. Finally, we are opposed to the way the current section on felony convictions is drafted. It is not clear what crimes would be defined under the definitions of dishonesty, fraud or moral turpitude. We request this section is removed from the Bill or explicitly clarified in the statute before moving forward.

And finally, just wanted to make a note that the current PTL proposal, we appreciate it, but it's being further analyzed and we're working with the Stakeholder Group and we do think we'll find something on that, but the current form of it, we still have some concerns about with this Bill as is. We respectfully ask that you vote no on this measure. I appreciate the time and I'm happy to answer any questions at the appropriate time. Thank you.

Thank you very much. Any additional primary witnesses in opposition to the Bill? Folks want to come up, get 2 minutes? We've got one more primary witness in opposition. Go ahead.

Jay Doucet, trauma surgeon Professor in chief of Trauma Surgery at UC San Diego. I'm also Governor in the American College of Surgeons and representing the chapters of the American College of Surgeons in California. So we're strongly opposed, particularly the public majority section, which is unprecedented in various states. The profession of medicine as a profession is self regulated and self educating.

To take that away from us, I think, is a pretty major slight on how much commitment and time and effort it takes to become a surgeon or physician. And as a result, we're in strong opposition on that basis alone.

Thank you. And it's hard just to confirm that your comment had to do with the public Member majority and an amendment is being taken that will change, that will keep the status quo.

Thank you. That would be a good move for us. Otherwise, we are in full agreement with the CMA position.

Thank you very much. Any witnesses want to add on in opposition or support to the Bill? Let's just do everyone at once. Come on up. Give me your name, please. Provide your name, organization you're with, if any, and position on the Bill.

Rebecca Marcus, representing the Consumer Protection Policy Center. Excuse me, at the University of San Diego Law School. Thank you.

Thank you. And I'm sorry, was that support?

Yes, and strong support of the Bill.

Thank you very much.

Nora Smith with Stone Advocacy on behalf of the California Orthopedic Association. Respectfully opposed.

Thank you very much.

Antonette Sorrick with the Board of Psychology in support of the Bill. We appreciate the amendment on the delayed implementation for research psychoanalysts. And there's just one technical amendment on the fees. For some reason, they went up, or down sorry, we want them to stay the same. So that's it.

Thank you.

Thank you very much.

Mr. Chairman, Members, Tim Madden, representing a number of organizations, including the California chapter of the American College of Emergency Physicians, the California Society of Plastic Surgeons, the California chapter of the American College of Cardiology, the California Rheumatology Alliance, and consensure all with an opposed unless amended position. Thank you.

Thank you very much.

Mr. Chair Members Andrew K. Antwih with Shaw Yoder Antwih Schmelzer & Lange here today on behalf of the California Association of Psychiatry, State Association of Psychiatry opposing unless amended.

Thank you very much. Any additional witnesses who want to add on in support or opposition to the Bill? Seeing none. Going to bring it back to colleagues for questions or comments. Dr. Baines.

Thank you very much.

Good morning. Matt was on behalf of SEIU, California. Just in a support, if amended, position if we can address the PTL issue, the timeliness of the licensing, processing and also the mental health issue, and appreciate the work of both committees on this Bill.

Thank you. First of all, there's two parts to this Bill. The first part holding bad actors accountable, bad physicians accountable. Absolutely. Long time overdue. Absolutely. Hold people, bad physician. There's good physicians, there's bad physicians, as in any industry. And in order to hold bad people accountable, you got to strengthen the laws around that. But the part that I do have an issue with is let's go back to three years ago. 3 years ago, COVID hit. Physicians were asked to sacrifice around the clock, including myself.

My life got flipped upside down 3 years ago. I worked around the clock selflessly, staying away from my family, staying away from my loved ones, working more hours these past three years in my entire life, including my residency. While other states were getting hazard pay for working in situations life risking situations like COVID, our state is working on increasing our licensure fees. It's not just a slap in the face for physicians that have selfishly worked around the clock for these past 3 years.

We don't want a pizza. We don't want a snickers bar. We just want to be supported, to do our job, and to do it rightfully. Let's think about that. We're just 1 year out of COVID We have asked our physicians, not just physicians, everyone in healthcare to work around the clock. And you don't want to do things like hazard pay in the fourth largest economy, but you want to do things like increase our licensure fees. That's the issue I have with this Bill.

Thank you, Dr. Baines. Senator Grayson. And then Assembly Member Lowenthal. And then Assembly Erwin.

Thank you, Mr. Chair. And just for clarification and this can come from either the author or the opposition and for the public that's listening, the difference between the current standard, which is clear and convincing, versus the preponderance of evidence, again, this is clarity for the public. But what exactly is the difference? And then what would the burden be upon the board? Because it seems like the board should have to prove its case up. But what does this do?

The preponderance of the evidence standard is the lowest standard. 51% of the evidence, for example, 50 plus one supports whatever it is. The Proposition clear and convincing is the highest standard in the legal field, aside from criminal cases, which are beyond a reasonable doubt. So what we've done in this particular Bill is to take those lesser forms of discipline and say, okay, preponderance of the evidence standard will work here.

Not revoking losing a license, not suspending the physician's ability to practice, but reprimands and the other disciplinary actions that the board has available to it when the evidence dictates. But for those cases where revocation is the penalty sought or suspension, lengthy suspension, where the physician will either be put out of business for a while or permanently put out of business, losing the ability to practice the trade, the profession for which the physician went to school, we say the highest evidentiary standard should apply.

Now, the board proposed preponderance of the evidence for everything. And obviously, there are 41 states who do that or that do that. But that didn't seem quite right to me, because if you're going to lose your license, then the person or the group or the entity or the board that's proposing that should have to meet the highest burden. So that's the difference here.

Senator, thank you for that answer.

Assemblymember Lowenthal.

Thank you very much. First of all, I'd like to state that I share the concerns brought forward by the representative of CMA about bifurcating the expenses associated with the fees that are called for in the Bill. That is to say, the fees directly affecting operations of the Med board itself, as opposed to new programs wishing to implement. So I want to share some concern about that.

And I'd like to ask a question directly because I also want to be mindful of the very important comments by my colleague from Kern County, which is, are we pushing our physicians in the wrong direction? What I'm particularly worried about and I ask you to think about, or if you have thought about it, why you've arrived at this place right now is, are these fees equal for all doctors?

That is to say, is the fee going to be the same for somebody who's doing plastic surgery in Beverly Hills or somebody who's working at a clinic along the border for a population that can't afford to pay very much? You know, Dr. Bain spoke very much, very passionately about the challenges in COVID. But to be honest, with or without know, it is a trying profession. for people who have an inordinate amount of debt?

And are we pushing our physicians to only pursue areas of the fields where they're going to be remunerated and serving a population that can afford to pay? And do the heightened fees push them in a direction where we're not going to be serving populations that can't afford to pay? And I like to ask, did you consider a different fee structure based on the type of medicine or the populations being served?

Well, let me step back, and let's just make sure we all understand where we are with the fees per year, because this is a biannual fee Bill, so it's every two years that the fees are assessed. So back about 15 years ago or so, the fees were $391 a year for a physician and surgeon for the privilege of practicing medicine in the State of California.

Then about, what, 2 years ago or so, 2021, there was a fee study done by the board that suggested a fee of $1150 every 2 years. So that's a little less than $600 500 and something dollars a year. We engaged with CMA on this issue who pushed back on that.

And at the time, I was told that the only thing that physicians would accept was a $40 a year fee increase, we the Legislature said, okay, we'll put that in with a commitment that you'll sit down with us and work on what it is exactly inside the medical board that is causing these fees to go up. We know what it is. It's the Department of Justice legal fees.

It's the expert witness fees that the board has to pay in order to discipline physicians and the fact that it's a state entity with state employees. So every time the Governor and the Administration negotiate a new MoU and there are, I don't know, 10 or 12 or 15 of them over there, I think then there's an increase in the operating costs of the Medical Board that neither the physicians nor this Legislature really have any control over.

Despite the commitment, there was no engagement whatsoever on the issue of expenses on the expense side of the equation. So, by the way, that $40 put the annual fee for physicians and surgeons at about $432 a year. The problem is the board has been running at a structural deficit. The Fund balance in 2023 was $10 million. But that was because there was a $10 million loan from another special fund in 2021 and a $12 million loan to the board from another special fund in 2022.

The loans are coming from the Bureau of Automotive repair. So the auto mechanics are financing the Medical Board of California? No, there's been no engagement on bifurcating fees or dividing fees or charging plastic surgeons or orthopedic surgeons or neurosurgeons a higher fee than those family practice physicians that are working in the clinics of the Central Valley or Eastern Riverside County.

Why is that?

You will have to ask CMA about that Assembly.

No, the question is, why is the Med Board not considered bifurcating the fees based on the type of medicine?

Well, you can't negotiate against yourself. I took a personal interest in this and actually had a commitment admittedly prior to CMA staff to sit down to work on the expense side of the equation at the Medical Board. But if they don't come.

That's a holistic cost. It's not considering my question, which is, is there going to be an impact for people who are earning on the lower end of the spectrum in medicine based on these higher fees? And will that have an unintended consequence?

It's a $212 increase per year.

That's correct.

I don't know what to tell you.

It's worth looking into, chair's prerogative. It's worth looking into, worth having the conversation. One thing to keep in mind is that anything that costs more has to be covered by fees. Creating an income eligibility standard and doing that now. So it might be worth looking into, but we have to keep in mind all the different consequences, intended or unintended, that might come up.

Mr. Chair, if I may. This is the first year I asked for and received, and it wasn't easy to get a detailed financial statement. Fund balance and projection going out from 2020 to 2028 29 for the Medical Board of California. It's a balance sheet financial statement. I provided that to CMA as soon as I got it. We had an opportunity to sit down.

We reviewed this both in the Senate side and I provided it to the Assembly here to go through the expense side of the medical board and decide what expenses are unacceptable. But of course, the problem is when you're trying to do it in the last month or so, when you have to do these sorts of bills, it's difficult and it should have been done last year and frankly, the year before that. Of course we should sit down and figure these things out.

I suspect that if we start charging plastic surgeons and orthopedic surgeons more than we charge family practice physicians, CMA is going to have a client and others are going to have a client management problem in dealing with that. But it's not to say we shouldn't try.

Is we really have quite a quandary today because obviously we have to try to move this through Committee. But a 50% increase is quite substantial. And Assembly Member Lowenthal was talking about folks that are working with lower income communities, but residents have to pay these fees too. And as having a son that has a lot of debt is a resident currently, there is a burden there. I know the first speaker had said this is not really a burden, but it's a huge increase.

And it seems somewhere along the line there has been an unwillingness to look at reality and have these fees keep up with the cost. So I just want to go back to and this is, I guess, a CMA question when are we looking at ways to reduce or the medical board question when are we looking at ways to reduce these fees? You mentioned DOJ and the legal fees are very high. Why not bring an attorney in house? Is that something that has been considered?

How can we look comprehensively at how to lower these fees?

We've looked at that. I suggested enforcement, bringing enforcement in house, changes to the enforcement process, looked at the legal costs of some of the enforcement actions. The problem is the fees, the lawyer fees and the paralegal fees charged by the Department of Justice are relatively insignificant in comparison to what private practice attorneys charge for the same type of work.

As I recall, the DOJ attorney fee is 200 and something dollars an hour when private practice attorneys today in this particular field are charging 600, 700, 800 dollars an hour. So I'm not sure that we would necessarily save any money, but it's certainly something that we need to look at. I do note the irony in CMA's position as they complain about the fee increase.

They also complain about some of the provisions in this particular Bill that seek to streamline the provisions of the medical board enforcement process, lowering the evidentiary standard where the livelihood of the physician is not necessarily impacted with revocation or suspension felony convictions, moral turpitude, et cetera, well defined in the case law. And by the way, the provision in this Bill was lifted, taken from the Business Professions Code provisions that are directly applicable to lawyers. And if it works for lawyers, it should work for physicians.

And there shouldn't be any question about how it works, but it streamlines the process. Why? Because the board does not have to retain hire expert witnesses at huge cost where the case has already proceeded to trial in a criminal court. There is a conviction. A full appeal process is granted to the lawyer. When the appeal process is over, then the lawyer, the physician, the physician has an opportunity to go to hearing on the issue of revocation or suspension. So full due process there.

But again, it's an attempt to achieve some cost saving and some efficiency in the medical board operation. But of course, there's an objection to that proceeding too. So it will remain to be seen whether we can actually have a meaningful negotiation to delve into the expense side of the medical board operation and see how we can achieve some further efficiencies. I hope that answered the question.

Certainly. So just for a moment, going back to the idea of a sliding scale, the bar exam does that for I mean, the bar does it for lawyers that are making under a certain amount. Would that be something that would is that the board that would decide that or the Legislature, who would look at the potential for charging the plastic surgeon in Beverly Hills more and the resident or people working in underserved communities less?

The board could propose it. The Legislature could propose it through the Sunset Review process and have a discussion about it. I've only been doing this job for 3 years, and no one has suggested it during the sunset Review hearings, and we've had a variety of hearings on this medical board. It's been something attached to my shoe for the entire time that I've been chair of the Senate side of this Committee. So absolutely.

But the other component is, will the physician groups, of which there are many coming from different directions, support that, or will we be right back here talking about the same thing?

All right, well, appreciate the conversation, and I hope the discussions continue, especially around the fee issue.

Thank you, assemblymember, any additional questions or comments? Senator Patterson.

Thank you very much and apologize being late for some of the discussion here. So I appreciate obviously we have to keep the medical board going, and it's a big challenge that you're taking with this. So I'm going to talk for a second just on some philosophical things that I have with how agencies and the regulatory agencies are working that I've seen firsthand in California and in a prior life, I was involved in a particular agency that was moving forward, did fees and things like that.

It got so bad that actually, a state audit was requested on this particular agency. They did a state audit. The audit came back and said the fees were too high, processes were duplicative, and it was also inefficient. So the organization goes through redoes all their fees and sure enough does their fee study. And the amount of money that they need to collect is the same amount of money they just shifted around who is paying what fees.

And so I've seen how also the background check process works when you go get your licenses and the analysts that are working on both the background check from a legal standpoint, but also just all the qualifications meet and things like that. And I think when we talk about the expense side, look, we can go through and we can say, hey, look, we got to look at this expense and this expense.

But I'm just not so sure that the processes are efficient, that there aren't duplicative processes in there and that we can't justify that. I'm not so sure we need to cut this expense or this expense. I think to ask for a 50% fee increase when I think there are some concerns about whether the efficiencies of the process in the first place is tough. A bite of the apple to take.

Obviously, if you want to respond to this, I'm not really supportive of the idea of increasing the fee that much. I understand that the medical board is borrowing money from other places, but I think we might have more of a systemic issue that needs to be looked at, especially if we're going to be asking for a 50% fee increase before I feel comfortable supporting that magnitude of a fee increase. And I know it's hard. I'm not in there every day looking at this.

So none of us really have expertise on this. You know more about it way more than probably anybody in this building. And that's what makes it kind of hard, because I want to respect that. But I've seen this from another side, and I don't feel confident that giving a 50% fee increase does anything other than just balance their budget out. And obviously, I'd love you to respond to that.

Well, I should note we have an enforcement monitor that the Legislature a year or so ago voted to put in an outside enforcement monitor to put inside the medical board to take a look at the enforcement processes, procedures, take a look at efficiencies and effectiveness. That process is, I believe, still ongoing, about to wind itself up. There was a preliminary report issued. I'm not in there, and I can't attest to how efficient the medical board is with respect to its internal operations.

Chair Berman and I have conducted several of these hearings, and we've tried to get a handle on how that works. I do know this. The Medical Practice Act was drafted years ago, and it was drafted with the input from the stakeholders and the stakeholders are the physicians and the physician support groups. And it's a very cumbersome medical practice act. We're trying to clean some of it up, but everything takes a lot of time. Everything costs a lot of money. Most everything requires expert witnesses.

There are lawyers involved at every stage of the process. And when you have a system that's designed around and I'm a lawyer, or used to be, I'm clearly in favor of protecting rights and due process, particularly when it costs people their livelihood. But it's very complicated and it's very expensive.

So it doesn't surprise me that the medical board runs at a deficit where, as I said, particularly where there are state employees with MoUs and their fixed costs having to do with wages and benefits at pensions that, I don't know, maybe 3, 4% per year. And we haven't had a 3 or 4% fee increase for physicians in a long time. I'm happy to take a look at that. I think we should take a look at that.

If someone thinks that an audit is appropriate, I'm okay with that too. We clearly have to try to achieve efficiency. Because while we need enough money in this and other DCA agencies, by the way, because there were some other bills with some fee increases to make them solvent, we don't ever want to charge people fees that are not absolutely necessary because we require them to be licensed in the State of California.

And then unfortunately, the way we collectively have designed the system here, we say we're going to license you for consumer protection purposes, but you're going to pay for the entire cost of your licensing, the licensing, the applications, the renewals and the enforcement, because none of it is funded out of the General Fund. And I don't necessarily agree with that because I think there's a public safety consumer piece of this that ought to be funded out of the General Fund, but unfortunately it's not.

We turn to the licensees and say, guess what? You're paying.

Yeah. This is a hard I don't want to take it out on the medical board, per se, when I think there's probably other DCA regulatory bodies that that need to be really looked at. On the licensing in General for various agencies and various but at the same time I look at it, this is actually our only chance to put some accountability on these agencies.

And I feel like if we pass out the extensions without having that qualitative analysis that affects the quantitative part of it, then I don't think we're necessarily doing what we're to do. I'm not suggesting you are, but we're clearly not here just to extend it because it needs to be extended. I think we want to take a closer look at this. Again, it's tough because you spent more time on this than the five minutes I have right here.

But it gives me a lot of heartburn to give that big of a fee increase when I'm not so sure that they've had the opportunity to justify it with an audit.

I appreciate your comments, Senator.

Member Senator Dixon.

Thank you, Chair. I guess to follow up on that, I think we're all swatting at clouds here. The 50% seems high, but given the history of the or just the reality of the cost, we don't have visibility on a budget for the California Medical Board, do we? I didn't see it. I'm kind of new here. Is there a financial statement that supports. Okay, that's part.

For the first time? Assembly Member I ask that the Administration and DCA produce for me the financial statement that reflects the various loans that were extended the payout periods in working with CMA to try to lower the fee.

We've put in place a swap out of loans that were restricted and had to be paid out over a very limited 2 or 3 year period to extend the loan payouts for the board over 6 years back to the Bureau of Automotive Repair because they have to be paid back to attempt to lower the fee. Unfortunately, it didn't lower it very much or certainly enough to ease the objection.

But, yes, I would expect that when I come and go, that those viewers still here would request the financial statement and the Fund balance condition on the Medical Board in years to come. So you know exactly what's going on.

Is that just related to the loan and their loan repayment? Does it talk about payroll costs, the entire cost structure of the California Medical Board, where you were suggesting and stating correctly that your payroll costs, your costs of operations have increased and the elements of that are headcount or labor costs, et cetera, that you have no control over anyway? Is that in that document? I apologize. I do not have all that information in front of me.

The expenditures are somewhat summarized, but they can spread these out for you.

Well, and I think I get back to my opening comment. That's part of the problem. You both are making compelling cases, but we're not dealing with all the information that helps us understand what's the costs that are driving the California Medical Board. And you've got these external as well as internal costs that you have no control over. And you've got a medical community that doesn't want to see 50% increase in their rates or in their license fees renewals.

And then you've got other provisions of this Bill related to evidentiary matters and felonies and all kinds of operational issues that are in this basket full of improvements or changes without really understanding what's driving all of this. I just wonder if the license fee increase can be a separate entity with the financials behind it to explain so we know what we're dealing mean. I think it's very difficult to make a financial decision here with incomplete information.

Well, I will say this Assembly. Member on the Senate side. We've attempted over several years to deal with these fee increases in the budget because it's really a budget issue, it's not a policy Committee issue.

But frankly, the Assembly and, I assume stakeholders outside the building have decided that it should not be in the budget and we should be debating these fees in a policy Committee, which we're not really equipped to do because we don't deal with numbers and we also don't see the larger picture in the budget and whether General Fund money should be used to accomplish which is what I think some of these objectives that the medical board has to achieve.

So I agree with you, which is this is the first time I've seen this and this is 3 years for me.

It's like in any business where the cost of doing business increases inflation, whatever market conditions exist. So you may hold off raising a business, may hold off raising prices, they don't want to disrupt their customer base, but at some point in time, you can't continue to operate unless you really sacrifice the quality of your product or your employee labor force or what have you. So there are just so many factors that are going into this and we're only dealing with just a very sliver of it.

And I agree with your point. I mean, it just makes it very difficult to accurately and fairly equitably deal with a cost increase and a 50% fee increase. License fee increase sounds high. Granted, it's over a two year biannual, it's over a two year period. I'm not in a position to say it's too high or too low or it should stay the same, but I am concerned with the calls for complaints against medical professionals that are not being investigated. Do we have any data on that?

The caseload that comes in that needs to be reviewed and that's driving some of your cost as well. It says it's been increased by a lot. I mean, how much is a lot in terms of investigations that are underway? Have they increased 10%, 20%, 50% over the last 2 years? How do we evaluate the pressures on the organization when we really don't understand the true cost?

Drivers well, we have a lot of data. I did not bring that data with me today because I was prepared to deal with the financial issues. We have protections built into this Bill for the first time where complainants have a voice both at the beginning and various points in the process. So those callers that have called in, I think some of their issues will be resolved by the amendments in this Bill if the Bill happens to pass.

And again, I don't disagree with you that it is very difficult to get a handle on some of these issues. We've tried to do that this year, working with Chair Berman and his staff. We've tried to build in, tried to work with CMA, on medical board loan repayments to try to lower the fee as much as we can.

But as I've told my friends from outside the building, the reality is, unless and until the Administration decides to apply General funds to this, it's a zero sum game. The expenses are what they are. We can reduce them as much as we can by changing the evidentiary standard, making it easier on the lower end cases, and not have to deal with expert witnesses on criminal convictions and try to monitor DOJ attorneys fees and all of that.

But at the end of the day, the expenses are what they are. And since this is a board that is funded exclusively by the licensees it regulates, at some point fees have to go up.

Ask one further question. Do you know I don't know the answer to this. For example, the State Bar, are there the bar fees? Do you know if they're 100% funding the State board?

I'm not sure about that, but I do know that the bar fees are as much an item of contention every single year as the physician and surgeon fees at the medical board. And I'm not even sure that I have lost track of it. When there was a bar fee Bill, and there is one, there were no fees inserted in it. So I guess that if it hasn't been resolved, it's still under negotiation.

This is kind of a systemic issue. Maybe this isn't the place to deal with it, but perhaps there's a different way that we approach this in the future in terms of looking at the auditing of the costs and operational costs and expenses. Anyway, thank you very much.

I will say the State Bar is a government agency as well, so it's staffed by state employees who have purrs and wages and benefits, and there's the same cost pressures there. I know.

All right, thank you very much.

Okay. Any additional questions or comments from colleagues? I am looking for a motion in a second. Have a motion, have a second. Chair Roth, would you like to close?

Well, I just want chair, I want to thank you and your colleagues for your patience. I know this is a very difficult Bill. I know the pressures are fairly intense. I feel them the same way in a slightly different context. I'd ask for your aye vote.

Thank you, Chair. And I know that when you ran for the Senate, negotiating the licensing fees for doctors was not at the top of your list of things that you planned on doing in office. I appreciate the work that you've put in to this challenging issue. Frankly, made way more challenging by the fact that the Legislature hadn't increased fees since 2009 and then did a very modest fee increase in 2021 that didn't really address the problem.

And I know that this isn't something you want to be doing, but you look at numbers on a spreadsheet and see a conclusion that one needs to get to. There can be debate about the numbers on that spreadsheet, and I know there are, and I'm going way off my comments here, but I know that CMA, we didn't quite get what we wanted over the last two years, but over the last couple of months, there's been better engagement, which I appreciate.

We're still waiting for the governor's office to engage more than they have. And that's been a challenge to getting all the parties together to come to an agreement on both the numbers on the page, what amount we need to get to, and then the right process for getting to that amount. So I know that these are all things that are being actively discussed right now. It would have been better if those conversations had started in earnest two years ago like we had.

You know, that being said, I'm also sympathetic to the CMA and their Members because it is all of a sudden a big spike to licensing fees, and that's not something to be minimized. And I think that's something that you and I, as lawyers, can appreciate. Given paying our bar dues, it's become clear that a significant fee increase can't be avoided to keep the board solvent. But I will continue to work with Chair Roth and stakeholders to explore options for softening the immediate impact on licensees.

And I urge an aye vote on the Bill as amended today, and look forward to continuing to work collaboratively with Chair Roth as the Bill moves forward in the process. With that, Madam Secretary, please call the vote.

SB 815. Roth the motion is due pass as amended to the Committee on Appropriations. Berman aye. Berman aye. Flora? Flora? No. Aguirre Curry. Aguirre Curry? Aye. Alanis Baines. Baines not voting. Bonta. Not voting. Bonta. Not voting. Chen Chen? No. Dixon? Dixon no. Gibson Grayson. Erwin Jackson? Lee Lee aye Lowenthal.

Aye. Lowenthal. I Mccarty Mckinnor Wynn. When not voting. Patterson Patterson? No. Ting.

We'll leave that open for absent Members. Thank you, Chair Roth.

Thank you, Mr. Chair.

We had two Senators, but we lost them. Why don't we move to the consent calendar? Can I get a motion and second on the consent calendar? Got a motion and a second. Madam Secretary, please call a vote on the consent calendar.

Berman aye. Berman. Aye Flora. Flora. Aye Aguia curry. Aguirre Curry. Aye Alanis Baines Baines. Aye Bonta Bonta. Aye Chen. Chen. Aye Dixon. Dixon. Aye Gibson. Gibson. Aye Grayson. Erwin Jackson Lee. Lee. Aye Lowenthal. Lonthal. Aye Mccarty Mckinnor, Wynn, Min. Aye Patterson. Patterson.

Iting consent calendars out. Now. We just need those. Senators back. Take a quick pause.

SB 812, Roth. The motion is due passed to the Committee on Appropriations. Berman? Aye. Berman, aye. Flora? Flora, aye. Aguiar-Curry? Aguiar-Curry, aye. Alanis? Bains? Bains, aye. Bonta? Bonta, aye. Chen? Chen, aye. Dixon? Dixon, aye. Gipson? Gipson, aye. Grayson? Irwin? Jackson? Lee? Lee, aye. Lowenthal? Lowenthal, aye. McCarty? Mckinnor? Nguyen? Nguyen, aye. Patterson? Patterson, aye. Ting?

Is that bill out? That bill's out. Please move on to the next one. Go. Which bill? Sorry, you call it out. Go ahead and ask for a motion and a second for... or can I get a motion a second on AB 814? Got a motion from Flora. Got a second from a Assembly Member Nguyen.

On SB 814, Roth, the motion is due passed to the Committee on Appropriations. Berman? Aye. Berman, aye. Flora? Flora, aye. Aguiar-Curry? Aguiar-Curry, aye. Alanis? Bains? Bains, aye. Bonta? Bonta, aye. Chen? Chen, aye. Dixon? Dixon, aye. Gipson? Gipson, aye. Grayson? Irwin? Jackson? Lee? Lee, aye. Lowenthal? Lowenthal, aye. McCarty? Mckinnor? Nguyen? Nguyen, aye. Patterson? Patterson, aye. Ting?

That bill is out. Next up is SB 816, I believe. Is that right? I got a motion and a second on SB 816? Thank you very much.

SB 816, Roth, the motion is due pass as amended to the Committee on Appropriations. Berman? Aye. Berman, aye. Flora? Flora, no. Aguiar-Curry? Aguiar-Curry, aye. Alanis? Bains? Bains, not voting. Bonta? Bonta, aye. Chen? Chen, not voting. Dixon? Dixon, not voting. Gipson? Gipson, aye. Grayson? Irwin? Jackson? Lee? Lee, aye. Lowenthal? Aye, Lowenthal, aye. McCarty? Mckinnor? Nguyen? Nguyen, aye Patterson? Patterson, no. Ting?

We'll leave that roll open. I see Senator Bradford is here. Senator Bradford, we would love to have you present, if you are ready, sir. It is agenda item number one, SB 51. Have a bipartisan motion and second.

Thank you. I respectfully ask for an aye vote. I'll just start by saying I accepted Committee amendments. I thank the Chair and the Committee for the work that we're doing here. And this measure simply provides opportunity to extend a provisional license for so many of our equity operators who are trying to exist in this cannabis world. And I was happy to author 1294 six years ago to help create this environment for social equity applicants. And this bill simply gives them a longer runway to hopefully stand up a business and become successful. So I respectfully ask for your aye vote.

Thank you, Senator Bradford. Any primary witnesses in support of the bill? Come on up. You have two minutes each. Thank you for your patience.

Good morning, esteemed... Good morning, esteemed Committee Members. It's my honor to be here. My name is Eliana Green. I'm the Director of Community Engagement and Reentry Staff Attorney at the Hood Incubator, where we empower drug war survivors to end the drug war by 2040 through economic development, power building, and policy advocacy. As a practicing attorney, I also work to ensure that cannabis related laws and policies are equitable and drug war survivor friendly, while addressing and preventing future disparities.

The Hood Incubator Is a proud co sponsor of Senate Bill 51, a bill that would provide a much needed lifeline to equity entrepreneurs and help to ensure we have a fair shot in the commercial cannabis marketplace. As we discuss Senate Bill 51, which sits before you today, I want you to be repetitively thinking about two pieces of existing authority, as we must keep in mind one, the spirit of Proposition 64, and two, the legislative intent of the Cannabis Equity Act of 2018.

Prop 64 was passed to reduce barriers to entry into the legal regulated cannabis market, and the Cannabis Equity Act intended to offer financial assistance to those most harmed by cannabis criminalization. As we discuss Senate Bill 51, which would provide retail social equity operators with a provisional license for five years, these two pieces of authority should serve as a guide for our actions today. Did you know in the last five years, 18 cannabis social equity programs have rolled out throughout the state?

But in just the last two grant periods, an additional 13 local jurisdictions have applied for funding to start developing their equity programs, but aren't quite ready to launch. This means only about half of the jurisdictions interested in developing a social equity program have actually launched their program. The urgent need for provisional license will continue to increase as more social equity programs roll out.

Provisional licenses allow business owners temporary approval to operate and earn revenue while working toward fulfilling the complex and expensive requirements of an annual license, giving an operator more time to be compliant while still making money. This is a benefit that was afforded to general operators for a period of five year window. It's crucial that social equity applicants be afforded the same opportunities for success that have been extended to General operators for the last half decade.

Without Senate Bill 51, forthcoming social equity program participants will not have the opportunity to benefit from the privileges of a provisional license, which are immense. Without SB 51, California cannabis social equity programs will fail. Thank you.

Thank you very much. Next witness.

Good day, esteemed Members. My name is Kika Keith. I am the proud owner of Gorilla RX Wellness Co. LA's first black woman owned social equity retail dispensary, and co founder of the Social Equity Owners and Workers Association, co sponsors of SB 51. Today, I stand here before you as a drug war survivor, a single mother of three beautiful daughters from South Central LA, and the voice for the voiceless.

My pathway to licensure in Los Angeles took over 1730 days and costs over $350,000 before I opened my doors. My story is not an exception. It is the reality of black and brown small cannabis business owners across the state. We believed in entering the cannabis industry was a true opportunity to create generational wealth. Six years later, less than 10% of the more 850 retail license are actually owned by social equity retail owners. This bill is extremely important. We ask for your support as it will be a lifeline for social equity applicants to have the space in order to get their businesses together and open their doors. We thank you for your support for SB 51.

Thank you very much. Any primary witnesses in opposition to the bill? Seeing none. Anyone who wants to add on in support, please provide your name, organization you're with, if any, and position on the bill.

Good morning, Mr. Chair and Members. Tim Cromartie on behalf of the Institute for More, a program of the California Urban Partnership, in support of the bill.

Thank you.

Good morning. Mel Assagai for the California African American Chamber of Commerce and the Greater Sacramento Urban League. In strong support.

Thank you.

Good morning. Amy Jenkins, on behalf of the California Cannabis Industry Association, in support, thank you.

Thank you.

Jonathan Clay, on behalf of the County of San Diego, in support.

Thank you.

Alicia Priego, on behalf of the California Cannabis Manufacturers Association and also Kiva Confections, in support.

Thank you.

Pamela Lopez, on behalf of Stiiizy and California Norml, in support.

Thank you.

Max Perry with the City of Long Beach, in support.

Thank you.

Mark Isidro, on behalf of the County of Los Angeles, in support.

Thank you.

Dr. Ashley Ridley Sterlin, a member of the Hood incubator, and a resident here of Sacramento County. I am in support.

Thank you.

I'm Angenee Tenette, patient and advocate with Supernova Women, in support.

Thanks.

Ross Gordon on behalf of Origins Council, in support.

Thank you.

Alphonso Tucky Blunt, owner of the first social equity retailer anywhere in the world. Blunts and Moore, in full support.

Thank you.

Mr. Chair and Members. Andrew Antwih, with Shaw, Yoder, Antwih, Schmelzer, and Lange, here today on behalf of the City of Los Angeles, in support.

Thank you.

Mr. Chair and Members. Rand Martin, on behalf of the Parent Company, in strong support of this bill. Thank you.

Thank you.

Chaney Turner, founder of Beyond Equity, chair of the City of Oakland Cannabis Commission, and ADEM 18 delegate here, in support of SB 51.

Thank you.

Good morning, wonderful Committee. My name is Alfred Torregano. I'm the founder of Space Flyt. It's a retail dispensary in Los Angeles, as well as a board member of SEOWA and CEPC as well. In full support. Thank you, Senator.

Thank you.

Hello. Jasmine Stevens, representing Space Flyt, and I'm in support.

Thank you.

Hello, I'm Laura Herrera. I'm a community based researcher with the UC Berkeley Cannabis Research Center, in full support.

Thank you.

Sheila Borrome, here on behalf of Life Development Group, SEOWA, and Gorilla RX Wellness, in full support of the bill.

Thank you.

Greetings. Ignite Daniel, on behalf of Life Development Group, Gorilla RX, SEOWA, Goverde Delivery Incubator, Flower Policy, Equity United, Love's Connection, and a host of other social equity applicants that are trying and need this provisional license, in full support.

Thank you.

Good morning. My name is Rhonda Ernest. I am the CEO of Natrl Hi, NH Logistics here in Sacramento. That's delivery, manufacturing, distribution. Also a hairstylist here for 35 years.

Thank you.

Yarrow Kubrin, board member, Sonoma County Cannabis Alliance, SEOWA, owner of Forge Distribution in San Francisco, in full support.

Thank you.

Hello. My name is Valerie Byrd. Good morning everyone. And I am full support. I'm CEO of Smooth Elevations Wellness Gear, and having the equity helped me get in and get my provisional license. Thank you very much.

Thank you.

Good afternoon, Committee. My name is Mike Snell. I am owner of Off the Charts here in Sacramento, Sacramento's first equity and black owned dispensary, and I'm full support of SB 51.

Thank you. Senator Bradford, if it wasn't for your bill, we'd have an empty hearing room. Did anybody want to add on in opposition to the bill? Seeing none. Bring it back to colleagues for questions or comments. Assembly Member Bonta.

I just want to thank the author for bringing forward this bill and for the testimony. The primary testimony that we heard, as well as the representation of the City of Oakland and the Commission of the City of Oakland in this work year. Want to appreciate that, one, in our district, it's incredibly important for this to be something that we actually invest in and ensure that our equity partners are able to have more than 10% of these opportunities because that's what it was intended for. So thank you author, for bringing this forward. I'll be supporting the bill.

Yeah. Thank you, Assembly Member Bonta. Assembly Member Gipson.

Thank you very much, Mr. Chairman. I want to thank the author for bringing this bill forward. Mr. Bradford certainly has been in this space for a long time and is trying to fight to make sure that we have a place for, especially African Americans, and just level to the playing field. And so I want to say thank you very much for one, always being a drum major for justice and equity in this space.

And, certainly, you in the leadership position to bring thoughtful bills based on your district that we share together. And I want to be considered as a co author of the bill. No, a principal co.

If the Senator is willing to have you a principal co. That's rarified air. Any additional questions or comments from colleagues? We have a second, motion. We have a second second. Any additional questions or comments? Seeing none. Senator, would you like to close?

I'm going to thank all my witnesses who came here today to testify, especially these two amazing young women who exemplify what this industry could be and should be. Again, as the author of 1294, six years ago, we saw the lack of diversity in the space. And here we are, six years later, and it's an industry that's 85% white male dominated. And if it's going to be successful, it has to look like California. And this provisional license is allowing individuals like Ms. Keef to stand up her operation, as well as many of the folks who testified here today. So I respectfully ask for your aye vote.

Thank you, Senator Bradford, for all the years of work you've done on these issues and for working with the Committee on the amendments that you've accepted today. I definitely understand that the challenges equity retailers face aren't going to go away in seven years. But with the department's reporting requirement, we can reevaluate whether provisional licensing is still the best solution at that time. In the meantime, I'm more than happy to support the bill today. Madam Secretary, please call the vote.

SB 51, Bradford, the motion is due pass as amended to the Committee on Appropriations. Berman? Aye. Berman, aye. Flora? Flora, aye. Aguiar-Curry? Alanis? Bains? Bains, aye. Bonta? Aye. Bonta, aye. Chen? Chen, aye. Dixon? Dixon, not voting. Gipson? Gipson, aye. Grayson? Irwin? Irwin, aye. Jackson? Lee? Lee, aye. Lowenthal? Lowenthal, aye. McCarty? McCarty, aye. Mckinnor? Nguyen? Nguyen, aye. Patterson? Patterson, not voting. Ting?

Congratulations. That Bill is out. Thank you very much. We'll leave the roll open for absent Members. Thank you. Senator Wiener, we're ready for you when you are. Agenda item number 2, SB 339. Yeah. And a reminder for colleagues on the Committee, there is still one there's one more Bill that we haven't had a motion second on that we'll do after Senator Wiener's Bill. So don't run away too quickly, please. Thank you, Senator Wiener. Right, everyone, you are?

Thank you very much, Mr. Chair and colleagues, today I'm presenting Senate Bill 339, which is a revision to a previous law that I authored and this Legislature passed in 2019, SB 159. After four years of implementation, we have, through data collection, been able to determine two serious flaws in SB 159 that have prevented it from being fully implemented, while other states have now gone ahead of us because they did not adopt those flaws.

And so we want to fix this Bill. SB 339 and SB 159, before it is about expanding access to preexposure prophylaxis and post exposure prophylaxis, PrEP and PEP. These are two of the absolutely game changer, end the HIV crisis interventions. PrEP is a once a day pill that you take, and I've been very public that I take it, that almost entirely eliminates your risk of contracting HIV. Almost 100% reduction.

If everyone at risk for HIV were taking PrEP, we would very promptly eliminate new infections on the globe. And then we could focus on making sure that people living with HIV have the care that they need, and we could end this epidemic, literally. But the problem is that the vast majority of people at risk of HIV are not taking PrEP.

And once you get outside of places like a San Francisco or a Long Beach, or a Chicago, or New York City, and you don't have to get that far out, the rates of PrEP usage drop. When you get into rural areas, when you get into especially low-income, communities of color, the rates dramatically drop. And this is now 11 years since this was approved and we still are not doing what we need to do.

And one of the barriers is that people currently, or before SB 159, could only get it through their doctor. So unlike birth control, where you could go to your pharmacist and get it, and we make it easy for women to go in and get birth control, not have to have an appointment every time, even if they don't have a primary care physician, they can get access to birth control. That's what we want to do with PrEP.

And that's why we passed SB 159. It allows pharmacists to provide this game-changing HIV preventative without a physician prescription just like birth control. The Bill has guardrails in it. The pharmacists have to go through training. In addition, they have to ensure that the person has a negative HIV test, because if you're HIV positive you should not be taking PrEP, and other guardrails.

What we've learned is that the reason why SB 159 has not been more effective is that when that went through the process, including this Committee back in 2019, we agreed to an amendment capping the amount of PrEP that a pharmacist could provide at 60 days every two years. In addition, pharmacists do not receive insurance reimbursement for the time that they spend doing everything they have to do to comply with the law. And as a result, pharmacies are generally not participating.

We spoke with the major pharmacy chains, we spoke with pharmacists and these two barriers, the 60 day limitation every two years and the lack of insurance reimbursement rose to the top as the two biggest barriers. So this Bill requires insurance reimbursement and then it allows for beyond the 60 days. It's really going to be an initial 90 days.

And you can keep going as long as the pharmacist keeps ensuring that the person is HIV negative, orders labs to make sure there's no renal problems and so forth. We think that this will be an absolute game changer. I want to note that since we passed SB 159 in 2019, Colorado, Illinois, Nevada, Oregon, Virginia and Utah have all adopted, followed our lead, and the analysis talks about a few of those states.

These states do not have the time limitation and they have thus not had the challenges that we've had implementing the laws. So we tried it, it didn't work. Other states have gone in another direction and it has worked. And so we want to go in that better direction. And I respectfully ask for your aye vote.

With me today to testify are Dr. Veronica Bandy, a community pharmacist and faculty of the University of the Pacific School of Pharmacy, and Laura Thomas, the Director of HIV and Harm Reduction Policy at the San Francisco AIDS Foundation.

Great. Ready when you are. Two minutes each.

Thank you, Mr. Chair and Members of the Committee today. So, as previously stated, I am Dr. Veronica Bandy. I currently are employed at the University of the Pacific School of Pharmacy, and I'm a practicing community pharmacist here in California. Thank you for the opportunity to address you today in support of SB 339. Pharmacist training consists of four years professional, graduate-level study to earn a Doctor of Pharmacy degree in California.

During these years, student pharmacists are required to complete a minimum of 1500 hours in clinical practice experience on top of and in conjunction with their formal didactic education. It is important to note that pharmacy students are required to interpret laboratory tests prior to graduation. Once didactic and clinical hours are completed, pharmacist candidates must successfully pass two board exams to be licensed in the State of California. Interpretation of laboratory results is in the content outline of both of these exams.

We are required to complete a minimum of 30 hours of continuing education every two years in order to renew our licenses. In addition to our clinical training, pharmacists are committed to ensuring that we are able to provide culturally competent care. It is with this in mind that we have worked with the LGBTQ community plus advocates to pass legislation requiring pharmacists and pharmacy technicians to complete training and continuing education and cultural competency courses focused on LGBTQ+ patients.

When sponsoring the initial Bill granting us the authority to independently initiate and provide PrEP and PEP, there was language added requiring pharmacists to receive additional updated training in order to provide this medication. Important to note, HIV disproportionately affects people of color, with African Americans and Hispanics compromising two thirds of all new infections in the United States. It is also very important to note that more than 18% of new infections reported in 2020 were in women.

California has been the leader in addressing this issue of health equity. SB 339 will remove barriers that currently prevent pharmacists for expanding access to these life saving medications, particularly in underserved communities. I respectfully request your support on this important public health Bill. Thank you.

Thank you very much. And I think you just need to hit the button. There it is.

Thank you very much. Thank you, Committee, for hearing this Bill, and thank you to Senator Wiener for his long standing leadership on this issue. My name is Laura Thomas. I'm the Senior Director of HIV and Harm Reduction Policy at the San Francisco AIDS Foundation in San Francisco. We are one of the largest prescribers of PrEP in the State of California, and we have seen firsthand the impact that access to PrEP can have on dramatically reducing HIV transmission.

In San Francisco, it is a key part of our overall strategy of getting to zero new HIV transmissions. We have been proud to come on as a co-sponsor of this Bill, as we co-sponsored the earlier Bill, SB 159 because we support the broadest possible access for anyone at risk of HIV to PrEP. We would like everyone to have the same level of culturally competent and high-quality care that we provide in San Francisco.

But we are fully aware that that doesn't exist everywhere across the state. We are concerned about ensuring that there is equitable access to PrEP across the state, and that we're able to achieve racial, economic and geographic equity in access.

And we know that for places where people do not have easy access to a primary care provider, where it may take six months to access an appointment with a primary care provider, we understand the urgency of being able to access PrEP, similar to the urgency around accessing emergency contraception, for example. And that is where we know that community pharmacies and pharmacists generally can play a role in ensuring immediate access to this life changing medication for people. And that is why we strongly support expanding pharmacy access.

As Senator Wiener mentioned, we've been the beneficiaries of some really fantastic evaluation of SB 159. The California HIV AIDS Policy Research Center, which is a consortium of a number of different California universities, was able to survey pharmacists across the state who, by and large, strongly supported access to this, felt like this was an important part of the pharmacist role. But because of these barriers, including reimbursement in particular, they were unable to take on the additional work required here.

So this Bill will fix some of those gaps and address these barriers so that we can achieve the full promise of SB 159 and move California that much closer to getting to zero in new HIV transmissions. Thank you for your support.

Thank you very much. Any primary witnesses in opposition to the Bill?

Thank you, Mr. Chair. Ryan Spencer on behalf of the American College of OBGYNs District IX, and the California Medical Association. I'd first like to emphasize CMA and ACOG's appreciation of the author's intent and his commitment, his long term, strong commitment to this issue. Expanding safe access to PrEP and PEP for individuals at the highest risk of HIV and acquisition is incredibly important.

This is why in 2019, ACOG and CMA colleagues worked with the author on SB 159 that authorized pharmacists to dispense a limited supply of PrEP and PEP for a limited time without a prescription. The final Bill that was a compromise provided appropriate safeguards, which included appropriate follow-up care and a prescription to continue coverage of the medication.

Unfortunately, SB 339 now removes these important patient protections, seemingly allowing a pharmacist to continuously dispense both PrEP or PEP in perpetuity without prescription or ever seeing a primary care provider. Earlier this year, we offered amendments which would have extended the length of time that a pharmacist may furnish beyond the 90 days, but would still ensure a prescription we made at some point in the future. Those amendments were declined.

While we still contend that a prescription is necessary to ensure patient safety and we still hope that they will receive such a prescription, this is not what we're asking for today. We're equally, if not more, concerned about provisions related to the appropriate fault care that allows the furnishing to continue and who will be providing the care, whether it's related or not related to the furnishing of PrEP.

While pharmacists are authorized to perform certain tests, their current scope of practice as well as their existing medical knowledge does not afford them the ability to perform all tests or interpret all results. And their scope of practice definitely doesn't authorize them to treat conditions or provide medical care.

Our amendments simply clarify that any test or follow up that is necessary for a pharmacist to continue furnishing PrEP can still be formed by a pharmacist, but only as long as it is within their existing scope of practice and all test results are verified and not just insured. Again, we share in the author's goal to improve access to PrEP and welcome additional ideas to improve or highlight access to medications, such as through telehealth. But for today, unless our amendments are adopted, we must respectfully remain opposed.

Thank you. Thank you very much. Any folks you want to add on in support or opposition to the Bill, please provide your name, organization you're with, if any, and position on the Bill.

Thank you, Mr. Chair. Matt Robinson on behalf of the City and County of San Francisco as well as the City of West Hollywood, in support.

Thank you.

Good morning. Lindsay Gullahorn with the California Community Pharmacy Coalition, which is a project of the California Retailers Association, in support.

Thank you.

Good morning. Michelle Rivas with the California Pharmacists Association proud co-sponsor in support.

Thank you.

Greg Pulsifer on behalf of Equality California, proud co-sponsor in support.

Thank you.

Chair and Members, Kathy Mossberg on behalf of APLA Health and Essential Access health also in support.

Thank you.

Mr. Chairman, Members. Moira Topp on behalf of Biocom California in support.

Thank you.

Max Perry on behalf of the City of Long Beach in support.

Thank you.

Noah Bartelt on behalf of ACLU California action in support. Thank you.

Thank you.

Josh Gogger on behalf of the County Health Executives Association of California and the Santa Clara County Board of Supervisors, in support. Thanks.

Thank you.

Good morning. Sandra Poole on behalf of Western Center on Law and Poverty in support.

Thank you very much.

Aaron Bone with the Medical Board of California in support.

Thank you. Bringing it back to colleagues for questions, comments, motion, seconds. Assemblymember Gipson.

Has a motion already been made?

Not yet, sir.

I'll move the Bill and want to thank the author. Thank you very much, Senator Wiener, for bringing this Bill. Okay, thank you. Thank you very much.

Certainly even before I was elected to any office, whether City Council or the State of Legislature, I've been working in this space because of Los Angeles, because of the HIV. And I shared my own personal testimony, lost some dear family and friends to HIV. And trying to make sure that we get to zero is absolutely important in California. And when you look at the numbers, African Americans continue to be the highest case, I think, in the country.

And so we need to make it not only possible, but also do everything we can to tear down barriers that exist. And thank you very much for, one, recognizing the shortcomings in the previous Bill and strengthening this Bill moving forward so California can again lead the way in this space. And I would like to be considered as a co-principal of this Bill.

Thank you.

Yeah, thank you, Assemblymember Gipson. Any additional questions or comments from colleagues? Seeing none, Senator, would you like to close?

We've received strong bipartisan support for this Bill from the get-go, and I respectfully ask for your support.

Thank you, Senator, for your continued effort to increase access points for individuals seeking this preventative, life saving medication. I support efforts to increase and expand access to PrEP while simultaneously maintaining safety protocols included in your previous Bill, SB 159, which I was happy to support in 2019.

In an ideal situation, a patient receiving PrEP would also have access to consistent care and treatment from the patient's primary care provider. Unfortunately, that isn't feasible for everyone. As we know, HIV is a major public health challenge in California, with almost 4000 new HIV diagnoses every year. And with that dire statistic in mind, I'm happy to support the Bill. I do want to encourage you to continue working with the opposition.

It seems like there's been better engagement over the past five days than the previous five months. Did you want to?

Perhaps when you're done, I can.

Sure, gladly. But continue working with the opposition to reach a balanced agreement on amendments that expand access to this medication, while confirming the patient receives ongoing follow-up care and treatment from the pharmacist or the patient's primary care provider as appropriate. But appreciate your work on this issue and please feel free to add anything you'd like.

Thank you very much, Mr. Chairman. I appreciate that. I just want you to know, I have had several conversations recently with ACOG and CMA, and to be clear, I think we all agree that ideally, we want people to have primary care physician. I think pharmacists, everyone agrees on that. And the Bill does have requirements about asking, and if they don't have one, giving them a list of primary care physicians in the area they can go to.

But of course, we know that you can't force someone to do it. And unfortunately, it is sometimes not that easy to even get a primary care physician. And it could take months to even get an appointment. The amendments that CMA, ACOG have been circulating in various iterations, what they have said to me is they just want to make sure that if there is a problem that goes beyond the pharmacist's scope--the person tests positive for HIV, the person has an abnormal renal blood test, some other problem that, of course, we want the pharmacist to recognize that and say, "hey, you need to see a doctor."

Of course I support that. But the amendments that they've drafted go dramatically beyond that and basically provide that you have to have another qualified healthcare professional look at the person, and then you're not allowed to give anything beyond the 90 days.

Senator?

Yeah.

So, there's debate about the initial set of amendments that were circulated.

Another set of amendments was circulated, granted late last night, which is why we're not asking for anything in the Committee today. We're encouraging you to keep on working with ACOG and CMA. There seems to be agreement on generally what folks are trying to accomplish. Let's leave it there. Yes, there is agreement when we talk to each other, and we're absolutely committed to working with them.

But I just want to also just note, in terms of how things are drafted, it's not what it does, but you know me, I'm an open door, and I've had multiple conversations, including on Sunday. We had a good conversation, and we'll continue to talk.

Perfect. I appreciate that openness. Thank you very much. Madam Secretary, please call the vote.

SB 339 Wiener. The motion is do pass to the Committee on Appropriations. Berman? Berman aye. Flora? Aguiar-Curry? Alanis? Alanis aye. Bains? Bains not voting. Bonta? Bonta aye. Chen? Dixon? Dixon aye. Gipson? Gipson aye. Grayson? Grayson aye. Irwin? Irwin aye. Jackson? Lee? Lee aye. Lowenthal? Lowenthal aye. McCarty? McKinnor? Nguyen? Nguyen aye. Patterson? Patterson aye. Ting?

Congratulations, Andrew. That Bill is out. Thank you, Mr. Chair. Thank you, colleagues. Thank you. So if I get a motion in a second on SB 817 have a motion in a second. Madam Secretary, please call the vote.

SB 817. Roth. The motion is due passed to the Committee on Appropriations. Berman aye. Flora. Aguiar-Curry. Alanis SB 817. Roth. Alanis ya.e Bains, Bonta aye. Chen. Dixon aye. Gipson aye. Grayson aye. Irwin aye. Jackson. Lee aye. Lowenthal aye. McCarty. McKinnor. Nguyen aye. Patterson aye. Ting.

That Bill is out. That is all the bills. If you were here to vote for all of them if you weren't here to vote for all of them, stick around. Yeah. Why don't we take it from the top, starting with gen. Item one. SB 51 or consent in consent. Let's start with consent on the consent calendar.

Alanis aye. Grayson aye. Irwin aye. Jackson. McCarty. McKinney. Ting

This is consent.

Ting aye on SB 51. Bradford. Alanis aye. Grayson. Grayson aye. Jackson. Mckinnor Ting. Ting aye on SB 339. Wiener. Flora. Flora. McCarty aye.

On consent. Mckinnor aye. Mckinnor aye.

On SB 51. Bradford. Aguiar-Curry aye. McKinnor aye. On SB 399. Wiener. Aguiar-Curry aye. Chen. Jackson. McKinnor aye. On SB 812 McKinnor. SB 814. Roth McKinnor aye. On SB 816 Roth. McKinnor aye. On SB 817. Roth. Flora. Aguiar-Curry. McKinnor. On the consent calendar. Jackson aye. SB 51. Bradford. Jackson aye.

SB 339 Weiner. Jackson aye. SB 812 Roth. Jackson aye. SB 814. Roth. Jackson aye. On SB 815. Roth. Jackson aye. On SB 816 Roth. Jackson aye. On SB 817. Jackson aye.

Thank you. And SB 815 is out. Thank you, everybody. The hearing is adjourned.