Senate Standing Committee on Rules

And I want to say good afternoon and welcome to my colleagues who are doing sometimes double and triple duty. And so we appreciate the fact that you got here so quickly. I know you just came from committee. We let people know. And we have one more colleague who's also making her way here from that committee. So few things I want to share.

We will continue to welcome the public in person and also via the Teleconference service. We're holding our committee hearing in the O Street building in room 2200 for individuals wishing to provide public comment via the Teleconference service. The participant toll free number and access code is posted on our committee website and it will be displayed on the screen as it is right now.

Today's participant number is 877-226-8163 And the access code is 694-8930. And on behalf of our court reporter, Ina, I want to ask all speakers, my colleagues and witnesses alike to speak slowly and clearly. Otherwise, you will see her telling you to slow down, or I will ask you to slow down. Before we begin our agenda, I want to thank Senator Roth for joining us today and filling in for Senator Laird, who couldn't be here.

He is a veteran of the Rules Committee, so we are thrilled to have him here with us today. With our appreciation. We need to establish a quorum. So a reminder, colleagues, you'll need to turn your microphone on for the roll call. And every time that we vote and with that, Madam Secretary, will you please call the roll?

Ochoa-Bogh. Ochoa Bogh here. Roth here. Roth here. Smallwood quavis. Grove here. Grove? Here. Atkins here. Atkins, here. Quorum?

A quorum is present. And, colleague, I think that's because you've been sitting in committee, so you're geared and ready to go. I think before we get into item number one, the governor's appointees who have been waiting patiently to be called forward, we're going to dispense with a number, of items on the agenda.

And that would be item number two, which is governor's appointees not required to appear. And we're going to separate out a vote on this one. I would entertain a motion for item two E, G and F. And that would be two Members I'm sorry, E, G, and H. I'm sorry, E-G-I need to learn the alphabet. E, G, and H. And that would be two appointees to the Board of Behavioral Sciences.

And one to the Member of off highway motor vehicle recreations. That would be two E, G and H. Thank you, Madam Vice Chair. And I will just repeat we aye taking item two, E, G, and H. Those are Members of two different boards we separated out F. So the motion is two E, G and H. Madam Secretary, will you call the Roll?

Ochoa-Bogh, aye. Ochoa Bogh aye. Roth aye. Roth aye Smallwood Cuevas, aye Smallwood Cuevas aye. Grove Aye Atkins aye. Atkins aye five to zero.

Five to zero. I would entertain a motion on item two F. Thank you, Senator. Roth moves. And that is the last Member of the Board of Behavioral Sciences. Madam Secretary, will you please call the roll? We separated a couple out at the request of a Member. Call the roll, please.

Ochoa Bogh not voting. Roth aye. Roth. Aye Smallwood Cuevas aye. Smallwood Cuevas? Aye. Grove? No. Grove? No. Atkins aye. Atkins Aye. Three to one.

Three to one. That is out. I would entertain a motion on item three. Reference of bills to committees. Okay. Thank you, Madam Vice Chair. Call the roll.

Ochoa Bogh. Aye. Ochoa Bogh. Aye Roth. Aye. Roth. Aye Smallwood, Cuevas. Aye. Smallwood Cuevas Aye. Grove Aye. Grove Aye Atkins Aye. Atkins aye. Five to zero.

Five to zero. Thank you, colleagues. Next, we have a number of floor acknowledgments, and that would be items four through eight. Thank you, Madam Vice Chair. Madam Secretary call roll.

Ochoa Bogh. Aye. Ochoa Bogh. Aye. Roth aye. Roth. aye Smallwood Cuevas aye. Smallwood, aye. Grove aye. Grove aye Atkins aye. Atkins aye. Five to zero.

Five to zero. Thank you, colleagues. So now we will turn to governor's appointees required to appear. And this is items one, A through D. And these are appointments of Members to the Medical Board of California. Let me welcome up and you can start to come up.

And again, with my appreciation for your patience, I want to acknowledge Dr. Michelle Bholat, Nicole Jeong, Kristina Lawson and Veling Tsai. Doctor. Excuse me. Tsai. And welcome, everyone. And what we will do is take up introductions in the order that I just stated, starting with Dr. Bholot. And after each of you, as we go down the line, have made your introductions, your opening comments.

Acknowledge anyone you would like to in your opening comments. And after each of you have had the chance to do that, we will then go to Members of the Committee for questions and comments.

And our colleagues, when we do individuals appointments, multiple appointments together, our colleagues will either ask directly for one person to answer the question if they want each of you two, then we'll just go in rotating order and let people answer the questions.

And my colleagues, we occasionally forget that. So we will remind each other, as we often do. And before I turn it over to you, Doctor, I will have to leave and come back. So, as always, the Vice Chair will then pick up and continue on with the meeting so there's no interruption. We also, I think, have Health Committee going on. So if you see people coming and going, it doesn't mean that we are inattentive. It means we're doing multiple things.

But I guarantee you staff and Members have read everything and we'll have questions and comments. And with that, let me again welcome you and say, Dr. Bholat, please start us off.

I think it's on okay, well, good afternoon and thank you. Senators. It is a privilege and an honor to be before you today for consideration for the appointment to the Medical Board of California. Many years ago, it was my dream to become a doctor and serve in the hospital where my ten year old great aunt died from complications of scarlet fever.

Each time I heard the story, I would ask more probing questions to contemplate why some recovered disinfection and others didn't. In my youth, I did not see differences or understand the profound barriers that lay ahead of me. As a girl of color, a teen mom with a GED and a dream, I believe that if I had the gift and the grit, then anything was possible.

Fortunately, I met Mr. Stan Berman, a man of color and my junior college counselor. Because of his mentorship, I was undeterred. He inspired me to become a mentor, and I have trained hundreds of amazing doctors and nurses and different people of many health professions and developed programs to diversify the physician workforce in the state since the age of 17.

I have never tired from the demands of being a student, be that a Medical Assisting, Diploma, nursing, medical school, or postgraduate. As a Member of the faculty of UCLA, I am committed to lifelong learning and educating our next generation of healthcare professionals. I am extremely proud to be here today and to confer my commitment to the Medical Board of California's mission of protecting California's healthcare consumers. And I thank you very much for this opportunity. Thank you all.

I'm so sorry, Ms. Jeong, go right ahead.

Thank you so much. Good afternoon, Senators. It's a pleasure to be here before you all today. My name is Nicole Jeong. I'm from South Pasadena, California. I'm a mother to an almost two year old toddler, and I work as a legal services attorney in Los Angeles County. I'm currently the Southern California Regional Director of Advocacy for Root and Rebound.

Root and Rebound's mission is to support people with criminal records to overcome the many legal and social barriers that they often face after the official end of their sentence and release from incarceration. In this roll, I oversee our direct services in Southern California and our partnerships with community-based organizations, including the Antirecidivism Coalition, which I have been embedded at for the last five years.

Through direct services, public education and policy advocacy, we work to help people with records to have the opportunity to build financial and social stability so they can build better lives for themselves and their families, interrupting the cycle of poverty and incarceration that runs through communities with the goal of making our communities safer as a whole.

I want to serve on the Medical Board because I'm committed to being of service to the community, looking to how I can continue to contribute to more just, equitable and safe society, even outside of my day to day job quality care from physicians is of the utmost importance and a priority for all people in our society.

I know that I am appreciative of the medical profession every day, and I also know that there are people who have suffered hart while receiving medical care, and that access to quality medical care can sometimes depend on your income, location, race, gender identity, disability status, immigration status, et cetera.

I want to be able to work with my colleagues on the Medical Board to ensure public protection for all patients. Thank you again for having me here today. I'm happy to answer any questions that you all might have.

Thank you so much, Ms. Lawson.

Thank you. Good afternoon, Chair Atkins and Members of the Rules Committee. It's an honor and privilege to be with you all today, and I appreciate the opportunity to formally introduce myself in connection with my reappointment to the Medical Board of California. My name is Kristina Lawson, and except for a brief stint away for college, I'm a lifelong Californian.

I was born and raised in Southern California, and for the past two decades have lived in the San Francisco Bay Area. My husband Matt and I are raising our three children in Walnut Creek, where we are all deeply involved in our local community. I previously served on the Walnut Creek City Council and as the City's Mayor.

Professionally, I am the Managing Partner and Chief Executive of Hanson Bridget, a California law firm that employs almost 400 lawyers and professionals in six offices throughout the state. While I'm no longer practicing law full time because of my Executive responsibilities, I am a land use and environmental attorney with an expertise in complex entitlement processing and the California Environmental Quality Act compliance.

CEQA as I'm sure you all know quite well, I've served on the Medical Board of California since 2015, and I've served as the Board's President since 2020. Serving on the Medical Board of California is a labor of love for me. My dad was a California licensed physician, and he loved practicing internal medicine and geriatrics.

After his sudden death in 2015, I was honored to be appointed to the Medical Board, and it's been a privilege to serve in this important role for the past seven years. I take my responsibility to serve and protect California's healthcare consumers extremely seriously, and I'm very proud of the work we've accomplished in advancement of the Board's mission.

In my final term on the Medical Board, I hope to build on this good work, especially during the sunset review year for the Board, in partnership with the Legislature, I hope that we can achieve a sustainable fiscal path forward so that the Board can maintain, solvency, repay its current and anticipated loans, and fully invest in our important mission.

I'm optimistic that the time I have invested in strengthening relationships with key stakeholders will cement a foundation of trust that is needed for the Board to do its important work. I'm particularly proud this year of our board's proactive approach to improving its operations and process. And as part of our sunset review report, the medical board has recommended proposals to ensure that we have adequate financial resources, robust enforcement tools, and appropriate standards.

We have a lot more work to do, and there are many circumstances where I wish the board would have had the tools to be more proactive to prevent harm before it occurred. I'm deeply appreciative of the legislature's partnership as we seek to make meaningful, positive changes that will enhance consumer protection and hopefully lead to reduced patient harm.

I'm grateful for the opportunity to continue to lead the Medical Board and to do my part to help protect California consumers by advancing high-quality, safe medical care. I sincerely appreciate your time today and look forward to answering any questions you may have.

Thank you. Dr. Tsai.

Good afternoon, honorable Members of the Senate. My name is Veling Tsai. I'm a private practice otolaryngologist in Alhambra, California. I'm also an attending physician at UCLA Olive View Medical Center in Sylmar, California. As a first generation immigrant, I grew up in the Bay area little village called San Lorenzo. And ever since I was in school, I've been involved with public service.

It's been sort of a passion of mine. In high school, I was paged to Congressman Pete Stark while working on his Stark anti-kickback statutes. While in college at UCLA, I interned with Senator Diane Feinstein during the President Clinton healthcare reform period. During graduate school, I worked at the FDA, serving as an extern, dealing with pharmaceutical regulations.

And so throughout my formal education, I've been involved with healthcare. And obviously, being as a physician, I deal with healthcare on a daily basis in healthcare. As a physician, I help one patient at a time. And I think serving on the medical board would allow me to help the entire Californians as a population to improve population health, population quality. And so this is an honor and privilege to be here before you.

And lastly, I just like to acknowledge that my parents, George and Regina, who's watching over the Internet, and my family, my wife, Angela, thank you for their support to allow me to do all the things that I'm a passionate about. Thank you.

Thank you very much for your introductions. We'll bring it back to the dias. Sir, if it's okay if you I'll start over here with Senator Smallwood Cuevas.

Thank you, Madam Chair. And thank you all for being with us today. I've had the opportunity to meet with Ms.. Lawson on a couple of occasions and last, being part of BNP and looking at the sunset review process. And I have to say, you all have your hands full with this board.

And sometimes when we haney a ship that has a lot of holes min it, folks have to be ready to bail water and really roll up sleeves and get involved. And so I'm really curious about I've talked with Ms..

Lawson, in a number of spaces, but for the other nominees to really hear why you are stepping and interested in stepping into this role at this particular moment of crisis where the board engagement is really necessary to be at an all time high, why have you decided to step into this role? And I want to start with Ms.. Jeong, if that's okay. And am I pronouncing your name correctly as well? Yes, Jeong. I want to thank you for correcting me.

I want to start with Ms. Jeong. I'm very familiar with your organization and the groups that you all work with, like the Anti Recidivism Coalition in addressing the reentry needs for the state of California and had the honor to work directly with many of your Members in my other role as founder of the LA black Worker Center.

And you're not a physician and you're coming at this from a very different kind of community health perspective, which you shared. So I'm curious to know how do you see your lived experience adding to real change for this board and then maybe for Ms.. Bholat and Mr. Tsai, just talking a little bit, why you all have decided to step in at this moment.

Thank you. So I think that in my work with folks who have recently been released from incarceration, one thing that has come to light in my conversations with people has been the lack of quality medical care that people received while incarcerated. And so when I was approached about potentially joining the medical board, that's something that I had in mind.

I thought about this group of people who I work with on a daily basis who have often felt powerless in their abilities to voice, discomfort in their abilities to voice, that they didn't feel like they were receiving quality medical care. And so my hope. And of course, I'm very new to the Medical Board, so really just trying to wrap my arms around what already exists.

And Commend President Lawson and the rest of our colleagues who have been on this board for a long time for all of the amazing work that they have done over the past several years. But my hope is that as I become more comfortable in my role as a medical board Member, that these are conversations that I can initiate and just be kind of a spokesperson for a set of people who, even in a space where there are a lot of people who are having trouble with lack of transparency and lack of communication, I think I am even more marginalized than your typical patient.

And so I think that is kind of what brings me to wanting to be able to serve on this medical board and especially in this time when we're doing a lot of self reflection and work on ourselves as a board.

Thank you very much for the question, and it's an important one, when I reflect on being asked to return to the board by a group that said, I think it would be a good time for you to reconsider. I'd been on the Board for four years, had been appointed by Governor Brown and then was off for just a little bit. And when I got the call, I was really thrilled to reengage.

Building public trust in our institutions is very important to me and my background. I'd been a Public Health Commissioner for Los Angeles County for a couple of million people. And so population, health and caring for people is very important to me. And the lived experience that you speak about, I think that also is important with the diversity of the workforce.

Just not physicians, but the nurses, the PAs and so on. And so I think that at this time with the challenges that we are facing, I'm up to the task. I want to wear all of the different hats that I've worn to bring to the ward my level of expertise in the area, which I'm a family physician.

I'm very interested in also the issue of addiction and started an addiction medicine program because long before we had addiction medicine, we always had people that were in vulnerable populations and when they were incarcerated, they couldn't get care and they were really in very challenging times.

So I'm looking forward, and I want to just mention that it is extremely gratifying to me to have an excellent President of our Medical Board, Ms. Lawson, who I always admired and she's been a great and effective leader. And I just hope to be able to learn and to continue on making change. That's really important to me.

Okay. Thank you for the question. I think in my role as a physician on a daily basis, my whole goal is to help people. And I think with this opportunity being presented as itself as, being Chinese, I think most of you have heard the adage that the character for crisis in Chinese is also the same character for opportunity. And I think in looking at this opportunity that confronts me, being on the Medical Board of California would allow me the opportunity to effectuate some positive changes along the way.

Now, with my experience on a daily basis, I hope that, with my knowledge and expertise, I can provide some sort of view for the entire board so that health care can be improved. I think that's why we in medicine help people. Medical Board of California is to protect the consumers of California, but boil it down to it's to help the Californians who seek medical care.

And so I think it's very, very important that we provide the same quality of care, access to care, whether you're in LA or in Bakersfield or in Fresno. And that applies to all sort of Californians. And I think that being on the board is what motivates me to help not only the patients I see on a daily basis, but to motivate, to help the Californians, of all of California.

I appreciate the character of crisis and opportunity in one, and certainly with sort of the financial insolvency issue, the sort of challenges around disproportionate discipline, this question around transparency, an opportunity, there are some overlapping, dense challenges that are before the board. And with folks returning, with folks who are new, with folks who are bringing that level of commitment to solving the crisis and helping to move the board towards solutions, I think is important in this moment.

And that sort of brings me to a number of questions, and I've talked with Ms. Lawson about that. I appreciate you getting back to me on some of the information just having to do with this question of Implicit bias and the status of how the board is ensuring that those trainings are moving forward and happening in a way that helps us address some of the public concern, the consumer sort of attitudes about the kinds of care that they're getting, and folks in communities particularly like mine feeling that in a disturbingly way, they're not getting the access to the quality care that they deserve.

In 2019, the World Health Organization looked at people's experiences during pregnancy and childbirth and really lifted up the disturbing number of patients of color who reported that healthcare providers ignored them, refused their requests for help, and failed to respond to those requests.

Most recently in Southern California, in my region, we had a Black woman die in childbirth, and certainly her concerns were not heard. Tragically, she lost her life and her family is searching for reasons why. My predecessor, Senator Kamlager, pushed for implicit bias training to happen be required with practitioners as part of their continuing education.

But I think I still want to understand, and this may be a question for Ms. Lawson and Ms. Bholat, because I know that you are all returning and existing leaders of the board. What is the status of the medical board in helping to create those continuing education standards for medical professions? And does all the board, Members themselves, also go through that training and requirement? And is that something that is going to be tracked and monitored, especially as we're looking at these disparities and seeing the impacts of that training on outcomes?

Yeah, thank you, Senator, for the question. With respect to the implicit bias training, all Members of the Medical Board of California do go through that training. It's not as specific to the medical profession as perhaps you might be speaking to, but we do go through implicit bias training. It's a lengthy training. I recently completed it for the, I think, second or third time during my time on the board. So that's an individual requirement.

We also, on a regular basis, have trainings on issues of cultural competency or the way that disparities may be reflected in outcomes at our board meetings. So, I think at our August board meeting, it might have been December, I might be misremembering, we had a presentation by a physician from UC Davis on LGTBQ plus issues. And again, disparities in health care really is an educational opportunity for all of us.

I did want to acknowledge the case that you're talking about, Ms. Valentine's case down in Southern California. That outcome was tragic. It should have never occurred. The board has opened its own investigation. Of course, during the investigation process, the board Members are not involved in that. It's either at HQIU or with our complaint unit, but the board has, on its own initiative, initiated an investigation there.

I do think that particular case also speaks to the need for us to work better across agencies, right, whether that's the Board of Registered Nursing or California Department of Public Health to make sure that, again, all of the state agencies that are tasked with evaluating what went wrong there and how we can do better and prevent patient harm in the future, it really speaks to needing to work together.

I also wanted to call your attention to something I learned about, frankly, just yesterday, and I will be happy to share more information with your office. We became aware yesterday of a program that I believe is a collaboration between the Department of Healthcare Access and Information and the California Community College Foundation. It's called the California Medical Scholars Program.

And so there was a news report about it, like I said just yesterday or the day before. But it's seeking to really capture students at a pre-med level, capture Black and Latinx students, Californians at that pre-med level so that we can get them in the pipeline and eventually have them become doctors here in California, so they can serve the the communities you're talking about. So, that's an interesting program.

The medical, it's not a Medical Board program, but I'm certainly hoping that our staff will look into it and then we can educate our board Members at some point in the future about that program. We'll make sure your office gets a copy of the news report on that.

Well, that's hard to follow, but let me try. But this is a really important question, and I think that the implicit bias in the multiple diversity, equity and inclusion committees that have sprung in all agencies, be them public or private, speak to a larger systemic issue that we are facing in California nationally, and right up front, physicians and nurses and licensed clinical social workers and so, on are meeting patients that are saying you don't hear me and you don't see me.

And so I've been a big advocate of always thinking about the way in which we communicate with our patients is something that if you go to MBA school, you'll learn how to communicate very effectively. But I'm not so sure that we're teaching that effectively for our physicians.

And, going back to what President Lawson mentioned, as a person who benefited from the junior college environment, I think that this idea of bringing people from the community and making sure that it is not allies separated by color, race, religion, but that ability to work together just as you work together here in your respective areas, physicians and nurses and others in the healthcare field. Healthcare is the biggest team sport there is, yet we don't necessarily treat it in that manner.

So, I am very happy to see the implicit bias. I actually just took the most recent one and I thought it was actually very well done. And the part that I particularly enjoyed of that one was a woman who had been a Yale professor and she had been a quilter, and, when she was in the emergency room, the doctor was sewing up her arm and thinking nothing of it until the student says, oh, doctor so and so, why are you here? And all of a sudden all these team of doctors and everybody came to her said and took her to the operating room.

And so that just gives us this idea that are there different levels in which we address people, how we hear them, how we see them? So I think the implicit biasness training is very important, but in addition to the training, it's our institutions and how we respect each other, and I think that's part of what we want to see more of.

And I appreciate both of those answers. And I'm just curious, because you've gone through the training and are requiring the training, how are you measuring the impact of that training? Because lessons learned do these approaches, how do we need to improve on the model, improve on the training? We only know that through our ability to evaluate the effectiveness. I appreciate it, both your answers, but that one point, I wasn't clear on how it's measured.

I'll be frank with you. I don't know that we're measuring it well. I don't know that we have a system that data stream that we could pull to show the correlation between the trainings, the education, the education we provide as part of our sort of education function to physicians and surgeons as well. I don't know that we have that data. It's certainly something that's very interesting.

And again, in collaboration with some of our partner agencies, whether it's CDPH, whether it's Board of Registered Nursing, or the Osteopathic Medical Board, for example, it would be interesting and compelling to figure out what data was relevant and then how we could make some sense of it to see if there really was a correlation or see if we're making progress in that respect, but I'm not sure we have that today.

I appreciate the candor and clarity on that and exploring ways to do that. I know there are a number of different tools, evaluative tools that are used: surveys, focus groups. There's a number of ways to measure that. So glad to hear that that's something that the board will explore.

A question that I have for Ms. Jeong and Mr. Tsai, is this question of discipline, and that's something that the board is charged with. And it's an issue that I've raised with Ms. Lawson in the past in terms of the disparities, in terms of Black and Latinx physicians and the disproportionate ways in which they are disciplined in comparison to their white counterparts. And do you see ways that the disciplinary process can be improved to address those kinds of disparities? And I'll start with Ms. Jeong and then Mr. Tsai.

Yeah, I've been thinking about mathis. I think maybe it was one of your, somebody from your office who asked about a report that was created a few years ago, sometime before I joined the board. And then I read the report and it didn't have a low of clarity as to what the reasons were. And this is relatedly, I think, about this issue kind of a lot because when we're thinking about the criminal justice system, of course in kind of similar ways people of color are disproportionately, convicted and sentenced. And so it's something I've wondered about too.

But I don't know. As somebody who's relatively new to the board, again, I've only just been in a few panel meetings and kind of trying to get my head around, okay, let's focus on these individual cases. Are we taking into account the public protection? How is this reaching public protection? I do know that there was an effort to not have included, at least in the Attorney General memos, people's education, where they went to school, as to not bias us in that way.

But to be honest, I'm not sure what the answer to your question is, and I think it is something important to look into maybe it's possible to have another entity do another study. Maybe we can find more data, find more correlations, get more information, so that we can figure out how to best address it.

And piggyback on that answer. I think going back to the Implicit Bias Training, obviously we need to have data to see how effective it is, but the exposure to make people aware that there is a problem, I think that's the first step. If you don't know that there is a problem, you're not going to a address it, make yourself more educated about it. So having this Implicit Bias Training and I think being serving at LA County hospitals w'ere required to do that, being on the medical board, we're required to do that.

Now, on the other hand, however, when serving on the panels, we look at each case as its individual merit. We don't look at how old is this physician, what ethnic background is he, what education level he has achieved or she has achieved. I think we look at the violation of the standard of care regarding to this particular case.

So regardless of whether this person is Asian, Caucasian, African American, I think we look at what the violation is. So, if somebody were to do something egregious that is in violation of what the basic level of standard is, and this person may have the potential to affect other consumers in the future, we sort of look at that as an individual case and say, okay, this person should not be practicing medicine, should not be endangering the public.

And then of course, the other part of enforcement is to say, okay, is this candidate rehabilitable? Okay, somebody may make a mistake, an error, but if this is the one error that they made in the last 30 years of practicing medicine, what other mitigating factors are involved? Have they been through all the courses? Did they acknowledge their deficiencies, and so, on panel for the last nine months now, I've been sort of going through each case individually.

And of course, that's why I think the Implicit Bias Training will allow us to say, okay, are we holding any implicit biases? Is this person an anesthesiologist practicing in San Juan Capistrano versus an anesthesiologist practicing in Salinas, California? Do we hold those standards to be different just because they're equipment, they're ancillary help? So, in, looking at each case, we look at, did the doctor do the right thing? And if he or she didn't, why? And is this something that never should happen event? Or is this something like a risk of the procedure that the doctor should have communicated to the patient, and so that there are some other issues involved?

I appreciate those answers, and I want to say that often, I understand that it is an individual case by case, but when the data shows a trend where you have a disproportionate disciplinary outcome for Latinx and Black physicians, I agree with Ms. Jeong that we have to have a process of looking at the data and trying to mine that data to see what is happening that is creating that outcome.

So I'm appreciating the individual review and process, but also recognizing the need to look at those trends and to figure out, okay, what are the ways that we may need to do more to make sure that our process is really and truly an objective one that is creating fairness in the system. And I really appreciate that analogy about disproportionate sentencing and how can that process of creating fairness be applied here.

So I'm glad to hear that there's an interest in data collection, in reviewing and focusing on that area to figure out ways to improve the process both for the patients ,but also in the medical professions, the workers who are doing this work. So thank you so much and thank you so much, Madam Chair.

Thank you, Senator Smallwood-Cuevas. Senator Ochoa Bogh.

Good afternoon. Such a pleasure to be here with you and an honor. Just in a light hearted note, you mentioned you had a little child at home and with your demeanor, I would have loved to have been your child. Let me just say, the way that you speak and your voice just makes you want to go and take a nap. But lucky and blessed child.

Wish my kid felt that way about taking a nap.

So having said that, so my question is, I know that you folks have already been speaking with my colleague on the business and professions, which I was privileged to sit on for the past two years with his leadership. And he was phenomenal in asking questions and addressing many of the concerns that I had.

So I'm not going to go through that process because I know you've already gone through thorough conversations with that aspect, but I do want something with regard or something to be addressed with regards to the enforcement actions against licensees and enforcement timelines.

So it's my understanding that the board received almost 10,000 complaints about licensees in '20 and '22, and also received complaints on other issues such as with regards to care and treatment, sexual misconduct, and unlicensed practice on medicine. Of the nine, of the almost 10,000 complaints, the board disciplined 438 licensees or 4% throughout the state of California.

And, there's been reports by media reports that document concerns from patients and board enforcement actions that they may have been too lenient and unsafe to continue or unsafe licensees to continue their practice. So I understand that, especially in the inland and area that I that I represent, we have an extreme shortage of doctors and anyone through the healthcare system. We are in desperate needs.

My concern is specifically within the enforcement timelines because, as you can imagine, when they are delayed, that's doctors who are kept out of the medical field. According to the data that I have in front of me, it said that the average investigative process involving sworn investigators took an average of 615 days between '21 and '22, an increase of 31 days, or 5% over the previous year.

That's a lot of time for doctors to be out of practice without a definitive, um, result of the case or or judgment on that. Can you give me some thoughts on how you feel? That this could be improved so that the process can be speeded, speed up, as well as ensuring that both the patients and the doctors receive their due diligence on both sides because they deserve to have that and ensure that we have those practicing decisions when duly, and if effectively able to do their job, can come back into the field and meet the needs of their communities.

I'm happy to start, if that's okay with you. So, Senator, thank you for the question. I'll be the first to tell you, our enforcement timelines are unacceptable. They're way too long, way too long by years, right? It's something that our staff, again, our partner agencies, whether that be DCA or the Attorney General's Office, others that we need to partner with as part of the process, hear from board Members routinely. And it's something that we're working really hard on.

I think Ms. Jeong referred to sort of the self reflection we've undertaken over the past several years to think about, well, how can we improve upon these timelines? So last year, in 2022, for the first time, we presented to the Legislature a suite of medical board initiated proposals, and that was something new that the Board had done to give us some tools so that we could help improve those timelines in the enforcement process.

Some of those are really sort of in the weeds, medical board process, stuff like subpoena enforcement, like being able to get patient medical records, again, without having to go through a Superior Court process, which often happens because there's often a real fight, if you will, during the process.

So there's a lot of tools where we think that and where we know if we had those tools from the Legislature, the timelines could potentially be improved. I also think it speaks to the need for greater collaboration and cooperation amongst the agencies that partner with us as part of our enforcement process, right?

S,o we receive the complaints. The complaints are investigated by the Department of Consumer Affairs, Department of Investigation, Health Quality Investigation Unit. And then once they're investigated and worked up, if you will, they are transferred, or transmitted, over to the Office of Attorney General. So there are a lot of different players as part of that process, and one of the areas of opportunity, areas of improvement for us is to really improve the collaboration between all of those people who are part of the process.

When I dig in ,and there's been a couple of cases of late where I've really dug in to try to figure out why is this the case at the panel, that this has taken three years to get to us and we still have a note that says, well, there's some incomplete part of the process. What's happening here? A lot of that is turnover in agencies. It's the fact that we have three agencies working on all these things at different points in the process and not coordinating as well as they could.

So there are a lot of opportunities for us to improve that timeline. It's something that's of great interest, I think I can speak for the entire board and everyone here. It's of great interest to us to figure out how to bring those timelines down. But Senator Roth has heard me like a broken record as part of Censor review talking about needing resources to be able to do that, right? I mean, we're almost insolvent. We are insolvent at this point, right? We don't have enough resources to prosecute and even do the work that we currently have on our plate.

And to your point, we have thousands and thousands of complaints that come across our central complaint units desks each year. So we do need the resources we've proposed as part of our sunset report, a suite of tools that we think will help improve those timelines. And then it's really important to me, I know, to our interim Executive Director as well, that we start to improve these relationships to help bring those timelines down.

Well, let me just end by, I'm excited to hear that it is perhaps a priority for you folks to ensure that we do have a more efficient manner in which to investigate these complaints for the benefit of everyone doctors, patients, and especially our communities as a whole, so thank you very much.

And I'll just end with my last comment with regards to I'm very excited to see such a diverse and what a skill set you all bring to the table and expertise and views and perspectives. And I'm very excited for all of you to serve and continue serving in your capacities. I'm extremely moved by your stories. Thank you for sharing them today, and for willing to serve.

Thank you, Senator Ochoa Bogh. Senator Roth?

Thank you, Madam Chair. I don't think I really have any questions. Ms. Lawson and I have spent hours of quality time together on either side of the dais, most recently about 5 hours last week or the week before on these issues. I will say that over the last, now starting three years, I've been extremely impressed by her focus on her obligations and consumer protection.

Frankly, contrary to what some witnesses say, her diligence and the hard work that she and the other board Members have put forth in trying to bring forward reforms to this Medical Board process, it's a difficult task because you're attempting to thread the needle between consumer protection and due process for physicians, depending on the disciplinary action involved, who could be forever prevented from exercising the tools of the trade that they spent many, many years acquiring. So, it's a very sensitive issue.

I think also we need to recognize that this process is one where we, the board and the Board Members are attempting to decide whether to impose disciplinary action in cases where the question is, for the most part, there are some others whether the standard of care and the practice of medicine has been violated. Not the issues that we deal with in a criminal court, which is punishment, or a civil court, which is damage and damages, word of damages.

And I think that's difficult sometimes for Members of the public and the consumers to understand that your role is simply limited to trying to figure out whether the standard of care has been breached and whether there's appropriate disciplinary action that should be imposed on the physician or physicians involved.

I think consumers and physicians alike really want the same thing. They want efficient and effective resolution of these complaints. It's just how to do it in this very complicated, convoluted, and byzantine thing we call the Medical Practice Act, where over the years, those of us who preceded us in this chamber along with those in the Green Zone, put together a Medical Practice Act that obviously has some consumer protections built in but has due process built in.

Plus, many of the cases that I think get to you all and your panels are standard of care cases and those, of course, require expert witnesses on both sides and a lot of debate as to what the standard of care is and whether the standard of care is violated in the civil side. In civil court, these cases take years to resolve.

And here we're complaining about the fact that it might, which is a legitimate complaint, that it might take 365 days or 425 days to resolve a medical board case involving standard of care where in the civil court system it could easily take four or five years. So maybe not so bad. Maybe we need to improve it, for sure, for both the consumers and the physicians.

But, for example, in cases that don't involve the standard of care where a physician has engaged in a criminal act, and perhaps is convicted, as I understand the Medical Practice Act, we still have to bring in expert witnesses to opine as to whether the act for which the physician is convicted is an unprofessional act related to the practice of medicine. Whether that's appropriate or not, I don't know.

But, it's certainly something that we need to take a look at and maybe we need to go dive a little deeper into the Medical Practice Act if what we're concerned about is efficient and effective disciplinary action to try to eliminate the inefficiencies and get right to the point. So that's a long statement without a question at the end, and they didn't teach me that in law school, but I do want to say how appreciative I am of the work of the board, in particular, Ms. Lawson. I know that the three of you who are joining Ms. Lawson will perform to the same standard. And I look forward to further conversations both in the Business and Professions and Economic Development Committee, and outside of that, as you work, and we work to help you, improve the Medical Practice Act and the Administration of the medical board. So, thank you, Madam Chair.

Thank you, Senator Roth. I appreciate all the statements and everything. And my colleagues have asked most of the questions that I had on my list to ask. But I do have one, and it's kind of a combination of what Senator Roth and Senator Smallwood-Cuevas had said.

Senator Roth brought up the criminal piece of prosecution and then also Senator Smallwood-Cuevas brought up a very good point that made me reflect on a past appointment we had a few weeks ago regarding parole board commissioners, and I only bring that up, not associating them with doctors in any way or your job, But I bring that up because during that confirmation hearing, Ms. Smallwood-Cuevas had asked about the implicit bias and the issues there and make determinations of who gets released, who doesn't get released, and the weight of those decisions.

And the reason why I bring that up is because I think it's similar that you guys carry the weight of those decisions as well. Your comments, quote, should this person be allowed to continue to practice medicine or do you pull their license? Are they creating harm? And if you as a board make the wrong decision, there could be additional harm or additional consequences to the person who maybe did not commit such an egregious act to have the license pulled and then there would be denied access to care. So I think it's weighted the same with the parole board:

Do they grant freedom and because someone is truly rehabilitated, or do they not? And then there's the risk on both sides, the risk of if they reoffend and you made the decision not you, but the board made the decision to let the freedom be granted, or do they continue to keep somebody in that should be granted freedom that has really changed and be a productive Member of society? One of the things we learned at that hearing or that I learned was that there is a fact based framework.

And I think, Ms. Lawson, you as the chair, and then also Dr. Tsai, you said something in the statement that you make decisions based on fact. Did they violate it? Was the license did they violate a standard of care you rattled off? And I mean rattled off, but you addressed that quite efficiently. Is there, in what you do as the chair, is there anything in there that gives a fact based, structured framework, so that I'm sure you will never get rid of all implicit bias. I'm sure that each person has their own, but if you don't have that fact-based, structured decision making process, would it be hard for you to put something in place? Do you have one? Let's start there.

Thank you, Senator. I think the answer to the question is no, because I'm not aware that we have one. And I guess if I'm not aware, then I don't think we do. And it's certainly something worth us looking into. As I was listening to your question, I was thinking about things like our disciplinary guidelines that provide us guidance about particular types of outcomes.

I also was thinking about the fact that our enforcement processes, while of course there's the types of cases where there's a complaint and it's taken through discipline, are panels. And we're split up for enforcement disciplinary purposes into two panels, panels A and--Panels A and B, and so I don't technically, as the board President, oversee either of those panels; they're chaired by other Members of the board.

But I did previously chair Panel B and in that regard. Again, we don't just review the initial discipline cases. We also review cases of potential reductions in probation, reinstatement of licensees whose licenses were revoked for one reason or another or surrendered in the past, and they want reinstatement. So in some sense, we actually go through much of that analysis.

I think it would be very interesting. It's certainly worth us all looking into whether we could put a system in place that resulted in that more systemized, fact-based approach that you're referencing. And I think it's a great idea and something for us to look into, but we don't have that in place today.

Okay, thank you. And I would appreciate you looking into that because like I said with the questions that we were asking the parole commissioners, their weighted decision is just like your weighted decision. And I know Dr. Tsai, in his comments said that they base it on what the violate the three things you rattled off. I only got one of them. I apologize when I was writing it down.

But if you could look in that because I think that no matter what background or what associations that you're associated with or no matter it doesn't matter. And I'm going to be sort of political: for the far right or the far left, if everything is fact based, then that should help eliminate a lot of the issues that come up with implicit bias or having a disproportionate effect on people of color with licenses, regardless of who's making the decision, because you're following all the same fact based framework that's required. So, I just challenge you to do that.

And then I do have a question I do want to ask you, and I only have these two questions. In January of this year, a federal court blocked the California from enforcing AB 2098, which the Governor signed last year to penalize doctors who spread misinformation or disinformation about COVID-19. The court said that the Bill violated free speech of the rights of doctors, who, number one, are to do no harm.

I'm curious to know, for each of you, just yes or no, or a brief statement for you to weigh in on that. And do you support speech restrictions for medical providers and doctors? I mean, the Legislature basically passed a speech restriction for doctors to have a difference of opinion from what was going out. So I'm just asking that question. I can hart with Dr. Bholat. I was just going down the line.

That's okay. No, thank you very much, Senator. Obviously, I can't speak to that Bill, but to answer your question directly, I would not be in support of restricting freedom of speech.

Would be or would not be?

Would not be. Thank you.

Yes, Ms. Jeong.

Thank you. I think, similar to Dr. Bholat, since we are all named as defendants, I think our council has advised us to not directly speak about the Bill that's pending litigation. But, like Dr. Bholat, of course, recognize people's constitutional right to free speech and do not want to restrict that. Thank you. Madam Chair? Or Ms. Lawson?

Yeah, and again, thank you for the question. As my colleagues on the board have noted, with respect to AB 2098, there are multiple lawsuits that are pending against the board and against us individually. And so, like Ms. Jeong said, unfortunately, we've been advised that we can't really talk about the specifics of that Bill. But like my colleagues, I have no intention or interest in infringing on anyone's free speech rights.

Thank you very much. And the only doctor on the panel?

I think, again, the disclaimer is that, pending litigation, I can't speak on it, but I think there's nothing more sacred than the First Amendment right to free speech. And whatever a doctor says to the patient is between them.

I appreciate that comment, too, because that's exactly how I feel, what happens between a doctor and an examination room, between the doctor and the patient. And I do truly believe that instinctively, medical providers, doctors, providers, do take an oath to have no, I don't think there are very many doctors out there, if at all, going out there and to intentionally harm patients. I don't think you would get into that profession if that was your intent. So thank you very much. That's the last question that I have.

What I'd like to do is go to our public comment now. We'll take public comments for these appointments as a reminder for witnesses wishing to provide public comment via phone. The participant toll free number is 877-226-8163 and the access code is 6948930. We're going to go to first before we go to the moderator, we'll go to support in room 2200. For any of those wishing to testify in support you're welcome to come to the microphone. Seeing none. Any in opposition in room 2200, you're welcome to come to the microphone. Seeing none.

Moderator, we are going to go to the teleconference line. If anyone wishing to speak in support or opposition could be queued up at this time. Moderator, will you please prompt individuals waiting to speak in support and opposition and let us know if there are any on the line and if we can begin?

Yes, to queue up, please press one, then zero. And first we go on to line number 33. Your line is open.

Yes. Can you hear me? Yes, ma'am. Okay. Hi, I am Tracy Dominguez, and I am calling from Bakersfield, California. I am a volunteer with Consumer Watchdog. Kristina Lawson does a great job of listening to the public and trying to support consumers' concerns, while also supporting physicians' licensing.

Christina has played a key role in bringing a quarterly board meeting to our area. The state will charge it. Left unheard, the Medical Board will bring the quarterly board meeting to the Central Valley in August. Due to her efforts, I fully support Christina Lawson's reappointment to the medical board. Thank you. Thank you.

Thank you. Next caller.

Next we'll be going to line 37. Please go ahead.

Thank you.

Good afternoon, Members of the committee. My name is Denise Johnson, and I'm from Tracy, California, and I am also a volunteer with Consumer Watchdog. I've been an advocate actively participating in Medical Board meetings for several years now. KristinaLawson has shown the public she is willing to listen to us. She tries to support some of our priorities while also balancing the interest of the physician licensing efforts as well. We support public board Members. Kristina Lawson has proven to be a board Member who communicates with the public. She plays a key role in guiding the physician and public board Members to see the public's point of view as well as the physician's community. I fully support Kristina Lawson's reappointment to the medical board. Thank you very much.

Thank you. Next caller. And as a reminder, please give us your name and state your position and a very, very brief comment, if possible.

Thank you. And next we go into line number 29. Please go ahead.

Hello. My name is Alka Airy, and I'm from San Francisco. I'm a volunteer patient advocate with Consumer Watchdog. I'd like to express support for the reappointment of Kristina Lawson to the Medical Board. Her thoughtfulness and willingness to listen to all sides set the standard that all DCA board Members may want to follow. Her leadership and demonstrated commitment to patient safety is greatly appreciated. Thank you.

Thank you. Next caller.

Next we go into line number 36. Please go ahead.

Hello? Can you hear me?

Yes, ma'am.

Hello.

Yes, ma'am.

My name is Vidula Vajramushti, and I'm calling from Orange County, California. I'm calling in regard to Senate Bill SB 403 Three, cost discrimination.

Ma'am, that is not before us in the committee. You may have the wrong committee. We're in the Rules Committee on governor's appointments.

Yeah, but this Bill was supposed to go to the Rules Committee, and that's why I'm calling. That's what the status shows. And so I'd like this Rules Committee to drop this Bill because it violates my civil rights as a person of South Asian ancestry.

Ma'am. But that item is not on the agenda, and we're only able to take up items on the agenda. So could I ask you to reach out when that item is before this committee?

Could you let me know when this item will be on the committee?

I don't have that information directly in front of me, but I can tell you that there is a website at the Senate Rules or excuse me, Senate--

Yes, yes, I'm aware of that, and it's not there, which is why I'm asking you.

No, she can email me.

Okay, hold on just 1 minute, ma'am. We'll try to assist you. Ma'am, what I'd like to do is direct you to the website at Senate.ca.gov, and there is a bar there that will allow you to research or type in that Bill number, which will give you the committee hearing date. Thank you very much for your participation in today's hearing, but it's not on the agenda. Moderator next caller.

And there is no more in queue. You may continue.

Thank you, Mr. Moderator.

Now that public comment is completed, I'll bring it back to the dais. Any other questions? Move the Bill. Sorry? Move the confirmations. Move the confirmations. Thank you, Senator Roth. Madam Secretary.

Ochoa Bogh? Aye. Ochoa Bogh, aye. Roth? Aye. Roth, aye. Smallwood-Cuevas? Aye. Smallwood-Cuevas, aye. Grove? Aye. Grove, aye. Atkins? 4 to zero.

So we'll place that on call until the end of the--no, we're done. I'm sorry. That you're out. You will go before the full Senate Floor in a few weeks. I'm sure that they'll keep you posted. Thank you guys very much, all of you, for being here. And have a wonderful day.

We did right? Yeah.

Thank you for all the support and opposition witnesses. Like I said, that called in. If you did not get your comments in, that you wanted to get min, please let us know. And I'd like to thank all the individuals who participated in the public testimony. Your comments and suggestions are important to us, and we want to include if you want to include your testimony in the official hearing records, you can do so by contacting or going to the Rules Committee or visiting our website for instructions. This concludes our public session, right? This concludes our public session, and we're going to go to the Executive session when the room is clear.