Senate Standing Committee on Business, Professions and Economic Development

Good morning, everybody. Welcome to the Senate Business Professions and Economic Development Committee. I just wanna make a couple of announcements. We do not have quorum yet, so we are gonna be starting as a subcommittee. With that said, here are a couple of the ground rules.

Number one, we are gonna have witnesses speak at that microphone standing there. People will not be actually coming to the table. You will be timed at two minutes both in support and opposition, and we will take the me too's together as stating your name, your, you know, organization, and whether you support or oppose. I do wanna also highlight that today's consent calendar consists of a few items. File item number one, sb 1263.

File item number three, SB 1148 file item number five, SB 1376 and file item number six, SB 1391. With that said, we also have, a couple of our bills that we are going to have presented. Number one will be SB 1002 by Senator Nilo. Is that the one that we're gonna do? Okay.

Perfect. So, Senator Nilo, if you would like to just present this while we're still a subcommittee, the floor is yours. Whenever you're ready.

We need a gate over here, so I wouldn't have to walk. I

know. I I saw that long walk and I was like, why is he walking that way? Okay. So

I'm not that good a hurdler anymore. So, thank you, madam chair and members. SB 10 o two is a non controversial and modest expansion of current state law that was heard in this committee that is the equivalent of this bill, heard in this committee as SB five zero eight and was passed unanimously. That bill, because it didn't become law or it did not become law because it was gutted and amended for another purpose in the other house.

This bill expands upon AB thirteen sixty nine of 2023, known as the David Hall Act by Assemblymember Bauer Kahan, which allows for eligible patients to access out of state care via telehealth.

Under that act, an eligible patient is someone who, with an immediately life threatening diagnosis, meaning there's a reasonable likelihood that the patient will not survive beyond a matter of months. This bill seeks to allow those same patients, once they become in remission, to qualify for the same telehealth privileges. It is about access to care and continuum of care for these patients while preserving the existing safeguards. With that, I'd like to pass it on to, my, witnesses, and, I'll have, yes.

Can you hear me? Can you hear me okay?

Yes. And you will be timed at two minutes.

Okay. Thank you. So hello, everybody. I was wheeled into the Operating Room for thyroid surgery that was scheduled to take three hours. Nine and a half hours later, I was wheeled out to discover that my life would be forever changed.

I was diagnosed with a rare and aggressive type of thyroid cancer known as anaplastic. The typical survival time for this cancer is four to six months, and my daughter was expecting our first grandchild. I underwent seven weeks of simultaneous radiation and chemotherapy at Cedars Sinai in Los Angeles. When the cancer returned, my physician supported my decision to seek care at MD Anderson Cancer Center in Houston. I received a newly discovered targeted therapy that has been successful for me.

It's uncommon for a bill to undergo a test run-in public before enactment, but this is true for SB one zero zero two. The pandemic led to federal and state executive orders allowing telehealth visits, which enabled doctors and patients to communicate about health issues across state lines. These executive orders have expired, leaving patients like me without life saving expertise from specialists practicing outside of California.

There are times when I have been too ill or weak to travel, and because I'm immunosuppressed, I was at risk of exposure to other illnesses, and telehealth visits are truly a lifeline. Patients in my anaplastic thyroid cancer support groups are desperate to receive care from from specialists beyond California when needed.

Some of us are in remission or with no evidence of disease. This does not mean we are cured. We are still in jeopardy of recurrence and require careful continuity of care monitoring by our out of state specialist. I have survived over three years and now not only have a grandson, but have a granddaughter. So please allow Californians struggling with cancer, excuse me, and other life threatening diseases to receive the care that they need.

Thank you.

And, Robin, if you would identify yourself. What you didn't at the at the beginning, you didn't say who you were.

I am Robin Clough, c l o u g h. Thank you.

So do we have any other witnesses in support?

I have no other primary witness.

Okay. Then seeing opposition witnesses.

Thank you, Madam Chairman. Aaron Bone with the Medical Board of California. The board has an opposed position on SB 1,002 as the board believes that licensure is a vital form of consumer protection and helps ensure that physicians practicing here have met the requirements relevant to treat patients in this state. Without a license, the Board would be unable to discipline a physician who fails to treat California residents according to the standard of care.

In addition, as the analysis points out, current law allows an out of state physician to consult on the diagnosis and treatment alongside a California licensed physician.

We do, however, recognize the concerns of the author and the sponsors, and we desire to collaborate with them to see if we can identify potential law changes that will support access to care while still preserving appropriate consumer protections. In the meantime, however, the board is opposed to this version of SB 1002. Thank you. Thank you.

Good morning, chair and members. George Soares with the California Medical Association. We're respectfully opposed unless amended to s b 10 o two by Senator Nilo. We understand this legislation is well intended, but it would dangerously expand existing law, which is intended for people with life threatening diseases who have not been accepted into a clinical trial in California.

In general, granting licensure exemption risks, introducing physicians who may not be familiar with California laws, regulations, or standards of care, including critical mandates around informed consent, privacy, telehealth, and prescribing practices.

It would also make enforcement actions and disciplinary oversight much more difficult removing the medical board's ability to protect patients from substandard care or misconduct. As noted, out of state physicians who seek to provide care to California residents can apply for temporary licensure with the medical board. This bill creates unnecessary loophole to that process. We understand the desire for some patients in remission to continue dialogue with their out of state physician.

We believe that our proposed amendment would allow patients to consult with out of state physicians regarding medical opinions, such as receiving a second opinion, while protecting patients from a physician who would otherwise be, eligible to practice under the California law.

We appreciate the author and the dialogue we've had with him so far. However, with this bill in its current form, we would respectfully ask that you vote no. Thank you, and I'm happy to answer questions.

Thank you. If we can have Me Too's present themselves, again, state your name, your organization, whether you support or oppose.

Thank you, chair and members. Ryan Perini on behalf of ATA Action, the advocacy arm of the American Telemedicine Association in proud support. Thank you.

Reese Empey with Pacific Legal Foundation, and we are in proud support of SB 1,002 as well. Thank you.

Thank you. Seeing nobody else, any members on the committee would like to comment? Senator Caballero.

Thank you very much, madam chair. I appreciate you bringing this forward. This is, in my mind, a really narrowly crafted bill and I'm gonna be supporting your bill today. We we've just I I respect the medical association's position in regards to licensing, But there's a point at which it's it's it's form over access. And in particular for rural communities, they're they're it's just getting a physician to physician appointment, an appointment with a physician is impossible.

So we're gonna have to figure out ways to be able to get access where that is equal or at least as close as we can get. And and I I think we really need to rethink our medical system. When I have a hard time accessing medical care and I don't have medical issues, I just wanna get in and get a the yearly checkup done, it's very simple, then there's no access.

And the the what how you've defined life threatening disease and and and acts and care is is is pretty limited. And I think we can we can start expanding some of this.

At some point, it becomes protecting somebody protecting licensees in California as opposed to protecting patients and patient access to what can be very complicated medical procedures where there's not the expertise in in the in the region. So I'm gonna support your bill today.

Thank you.

Alright. Seeing nobody else, Senator, would you like to close?

Yes. Senator Caballero made some very good points relative to my close, but I just point out a couple of things with regard to the opposition. First of all, generally and overall, we've already passed the threshold of the concerns that they have with the Bauer Keihan bill, AB thirteen sixty nine, setting up the up this capability in the first place. And the any qualified medical professional has to be an eligible out of state physician or surgeon in good standing with no history of prior discipline.

So there are significant requirements for that as there is for the existing law.

And the medical association respect their concerns, but I challenge their use of the word dangerous with regard to this. If this is dangerous, then the a b the David Hall Act is dangerous and we've already passed it. I happen to disagree that it's certainly not dangerous. It's prudent. And this legislature is in record with the same opinion.

And to have a patient that receives this this care and advice while they are terminally ill to go into remission and say, you don't have that available to you anymore. That physician with whom you became comfortable, you can only get an opinion as opposed to the type of care that you received when you were terminally ill. And as my witness stated, just because you're in remission does not mean you're out of the woods. It's a common sense bill and I appreciate an aye vote.

Thank you. Because we do not have quorum, we're still in a subcommittee mode. I will highlight that we will take motions at the appropriate time. Gonna move on to file item number four, sb 1311. Myself, I will be presenting this followed by sb 1416 again, presented by myself.

If we can have the Senate sergeants request that all members of this committee show up.

Thank you. So the chair has put me in charge. You're all in trouble. Yeah. First, we've got SB 1311.

Madam chair, you may proceed when ready.

Thank you. SB 1311 makes various statutory updates

in order to ensure that unlicensed dental assistants are able to complete important infection control courses. I'd like to accept the amendments outlined in the analysis. The Dental Board of California does not license these individuals, so they are not subject to the same education and training requirements as registered training requirements as registered dental assistants. Unlicensed dental assistants are also supervised by their dentist employer.

to the Dental Practice Act

SB thirteen eleven allows an unlicensed dental assistant to either complete the dental assisting national board's infection control examination or complete a course offered by various entities to be in compliance with the law.

This bill is supported by the California Dental Association and California Association of Orthodontists. I understand that some dentists reached out late last week concerned about the fact that these individuals substitute coursework for passing a national exam. The dental assisting national board's infection control exam test, whether a person knows how to prevent infections and how to make decisions.

The exam covers hand hygiene techniques and protocols, how to select and use personal protective equipment, including the sequence for putting this on and taking this off, as well as cleaning and disinfecting treatment areas and OSHA and CDC requirements. A course teaches an exam verifies.

This standardized national exam serves as an important public protection tool for unlicensed people and allows them to get to work more quickly. My first witness, lead witness is Lawrence Gaiden with the California Dental Association here to testify in support.

Good morning. Lawrence Gain here on behalf of the California Dental Association representing over 27,000 dental professionals in the state, urging support for SB thirteen eleven, which would ensure unlicensed dental assistants can receive timely infection control course training via approved online courses. Just wanna take some time to thank the chair and staff on their commitment to this ongoing issue, for our industry.

Dental assistants really play a crucial role, in the dental team and really strengthening this, dental workforce will go a long way in improving patient care and patient access. We are really thankful, for this commitment to this issue, as I mentioned, and we urge your aye vote.

Do you have another primary No. Witness? So the opposition, I presume no. Okay. Or You're in support.

Okay. Let well, let's here at this point, for anybody else in the room who is in support, One person can take up to two minutes. The primary witness took up the first two minutes, and anybody else would just state your name and that you support.

So I have two minutes? Yes. Hi. I'm doctor Guy Acheson. I'm representing the California Academy of General Dentistry.

We represent all the general dentists in the state of California. First, I wanna say that I really appreciate how open you were to our position being support if amended. And the analysis of the bill seems to be and your speech indicated that you're accepting, our slight change in wording to make it a more comprehensive definition of what infection control includes. We do have a new concern.

We assume that an exam that has the title of the dental assistance national board exam would have the same requirements for taking that exam as our national boards for dentistry or medicine, where we've completed a certain amount of coursework.

And for this national dental assistance national board exam, there is no requirement for any coursework at all to qualify to take this exam. So there's no hands on training on how to do things like take gloves on and off properly, how to wear a mask, how to treat a respirator, how to clean a room. The hands on component is very important and it's missing with this exam. So that's my, that's our main concern.

So we think that qualification as an alternative to a hands on course is not acceptable.

So our position will still be support if our amendment is accepted. Thank you.

That being the case, I will label your testimony as primary opposition testimony, though qualified for an amendment. And I'll leave it to further discussion with the author on that. Do we have any other primary witness in favor of the bill? Do we have another primary witness, in opposition to the bill? And so now go on to what we call Me Too testimony.

Anybody else, in, support of the bill, state your name and who you represent.

Good morning. Michelle Rivas on behalf of the California Association of Oral and Maxillofacial Surgeons in support.

Good morning. Jasmine Asher representing the California Association of Orthodontists in support.

And are there any is there anybody in the room who is opposed, to the bill that would state, your name organization and position seeing none come forward bring it back to the committee. Any questions or comments? Senator Caballero.

Senator, could you address the issue that was raised? I'm confused as to exactly what's being asked and what you're taking. Yeah. I think this is a good bill. I was prepared to support it in its current form and do do with it what you would.

No. I appreciate that. Just to be clear, he was not a witness in lead support and I wanna be clear about that. The amendments that we are taking, the proposed amendments make various technical changes to reflect updates from the recent sunset review bills for the veterinary medical board and the bureau of security and investigative services. They also extend the time frame for applicants to the medical board's licensed physicians from Mexico program to apply.

One of the things I I do wanna explain is that this national exam is very, very targeted and geared towards a specific infectious control. And, you know, this is something that's already taught. The exam certifies that they understand this. And to our last bill that we also discussed is that we do need to understand that courses education has changed. A lot of it is online, and this is one of them that falls under that.

And those are the proposed amendments that we are accepting.

Are there other questions or comments? And, just to support one thing that you said, Senator Wahab, the second primary witness was not in support. That was my error, but his testimony clearly illustrated he is opposed unless amended. We'll leave that to, further discussions. You may close.

I respectfully ask for an aye vote. And again? We can't get a quorum. Oh, we have a quorum now. Let's grab it while we can.

Please call the roll.

Mohab. Hi. Mohab here. Choi? Archuleta?

Aye.

Archuleta here. Adegin? Caballero? Here. Caballero here.

Grayson? Here. Grayson here. Menjivar. Nilo?

Here.

Nilo here. Smallwood Cuevas? Yes. Smallwood Cuevas? Here.

Strickland? Hamburg?

We have a quorum. We have a quorum. So, do we have a motion for that bill? So moved by Senator Caballero, and please call the roll.

Motion is do passed as amended to Senate Appropriations Committee. Wahab. Aye. Wahab, I. Choi Archuleta.

Archuleta, I. Adegin Caballero. Aye. Caballero, I. Grayson.

Aye.

Aye. Grayson, I. Menjivar. Nilo.

Aye.

Nilo, I. Smallwood Cuevas. Aye. Smallwood Cuevas, I. Strickland, Anberg.

What is it? 60. 60. We'll leave that on call. And now, we will move to SB 1416. Also, Senator Wahab, proceed when ready.

Thank you. SB fourteen sixteen is a simple bill. It simply speeds up the time frame for a consumer to receive a refund from their physician or dentist in the event of duplicate payments. The bill reduces the refund window from thirty days to twenty one days to allow patients to regain access to their own funds sooner, which can be especially meaningful for families managing tight household budgets or ongoing medical expenses.

This is a small but meaningful affordability assistance measure ensuring that money that belongs to the patient returns to them more quickly.

A 21 day refund window reflects the realities of modern billing systems and is a reasonable update to a statute written in the nineteen nineties in a much less digitized healthcare environment. I have no witnesses with me, and I respectfully ask for an aye vote.

Are there is there anybody in the room, who is otherwise in support of this legislation?

Hello. Michelle Rivas on behalf of the California Association of Oral Maxio Facial Surgeons. We think this is a reasonable bill. We understand that people have financial constraints right now so we respectfully support the bill. Thank you.

Any other in support? Are Is there anyone in the room who is in opposition to the bill? Seeing no one coming forward, bring it back to the committee. Any questions or comments? Archil Senator Archuleta moves the bill, seeing no other comments, you may close.

Respectfully ask for an aye vote.

That's a great close. One of the best I've heard for a long time. Please call the roll.

Motion is do passed to Senate Appropriations Committee. Wahab? Aye. Wahab, aye. Choi Archuleta?

Aye.

Archuleta, aye. Adegin Caballero? Aye. Caballero, aye. Grayson?

Aye. Grayson, aye, Menjivar, Nilo? Aye. Nilo, aye, Smallwood Cuevas? Aye.

Smallwood Cuevas, aye, Strickland, Amberg?

That is 60, and we will hold that on call also. Now, turning it back over to our chair.

Thank you. Can I get a motion on the consent items just to repeat for those that weren't here? File item number one, SB 1263. File item number three, SB 1148. File item number five, SB 1376 and file item number six, SB 1391.

Motion.

Moved by Senator Archuleta. Can I get a roll call vote?

Wahab? Aye. Wahab, aye. Choi Archuleta?

Aye.

Archuleta, aye. Adegin Caballero? Aye. Caballero, Aye. Grayson.

Aye. Grayson, Aye. Menjivar. Nilo. Aye.

Nilo, aye. Smallwood Cuevas. Aye. Smallwood Cuevas, I. Strickland, Hamburg.

Alright. Consent will be held on file until all our other members are able to vote on it. Can I get a motion on file item number two, sb 1002?

Move the

bill. Senator Caballero moves the bill. Can we get a roll call vote, please?

Motion is do passed to Senate Appropriations Committee. Wahab. Aye. Wahab, Aye, Choi. Archuleta.

Archuleta, Aye, Adegine. Caballero. Aye. Caballero, Aye, Grayson. Aye.

Aye.

Grayson, Aye, Menjivar. Nilo.

Aye.

Nilo, Aye, Smallwood Cuevas. Smallwood Cuevas. Aye, Strickland,

That file item is on call. We are gonna wait for other members. Alright. So everything is on call. I appreciate everybody's support on this.

If we can have our other members show up. Alright. We're gonna go into recess for about ten minutes until the other members come. Thank you. An economic development committee will begin again and return from recess within thirty seconds.

Alright. We had a motion, on consent. So can we just get a roll call again for the absent members on consent?

On consent. Okay. Here we go. Ready? Sure.

Troy? This is

for consent. Aye.

Choi, aye. Adagine, Menjivar, Strickland? Aye. Strickland, aye. Amberg.

Aye. Amberg, aye. Okay. That's 90 that's out.

And 90 consent is out. File item number two, sb 1002 by Nilo. Pretty much everyone has voted aye. Motion is due

passed to Senate Appropriations Committee. Current vote, six to zero. Choi?

Which one? Item number one.

Number two. Two, I. I. Choi, I. Arguin, Menjivar, Strickland.

Aye. Strickland, I. Hamburg. Aye. Hamburg, I.

Alright. That bill is out as well. Final item number four, sb 1311. Which is do passes

to manage Senate Appropriations Committee current vote six to zero. Choi?

Aye.

Choi, aye. Who else have I done? Strickland?

Strickland, aye. Umberg? Aye.

Aye.

Umberg, aye. 90. 90. That bill is also out. We're moving on to file item number seven, SB 1416.

Motion is do passed Senate Appropriations Committee. Current vote six to zero. Choi?

Choi, aye. Adeghain Menjivar Strickland?

Aye.

Aye.

Strickland, aye. Amberg? Aye. Amberg, aye.

Alright. That bill is also out. Meeting is adjourned. Thank you all for your time.

Thank you.