ANNUAL 2017 2018 REPORT Board Roster Executive Summary Licensing Program Enforcement Program Allied Health Care Professionals 2 3 6 11 18 California State Capitol Rotunda MEDICAL BOARD OF CALIFORNIA BOARD ROSTER The Medical Board of California (Board) is comprised of fifteen members: eight physician members and five public members appointed by the Governor, one public member appointed by the Speaker of the Assembly, and one public member appointed by the Senate Rules Committee. The Board has six standing committees, five two-member task forces, two disciplinary panels, and a Midwifery Advisory Council, that assist with the work of the Board. Denise Pines President Ronald H. Lewis, M.D. Vice President Michelle Anne Bholat, M.D. Dev GnanaDev, M.D. Sharon Levine, M.D. Randy W. Hawkins, M.D. Brenda Sutton-Wills, J.D. Howard R. Krauss, M.D. David Warmoth Kristina D. Lawson, J.D. Jamie Wright, J.D. Felix C. Yip, M.D. Secretary MISSION The mission of the Medical Board of California is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professionals and through the vigorous, objective enforcement of the Medical Practice Act, and to promote access to quality medical care through the Board’s licensing and regulatory functions. VISION To be the premier consumer protection agency leading the effort to advance high quality, safe medical care. Edmund G. Brown, Jr. Governor Kimberly Kirchmeyer Executive Director Christine Lally Deputy Director Medical Board of California Annual Report 2017-2018 2 EXECUTIVE SUMMARY The Board was the first board within the Department of Consumer Affairs and is the consumer protection agency that licenses and regulates allopathic physicians and surgeons; licensed midwives; polysomnographic technologists, technicians, and trainees; and research psychoanalysts. The Board also approves accreditation agencies for the accreditation of outpatient surgery settings and issues fictitious name permits. SUNSET REVIEW LICENSE ALERT MOBILE APP The Board’s mission of consumer protection was The development of the Board’s License Alert Mobile enhanced with the passage of Senate Bill (SB) 798 App for Apple iOS devices continued the Board’s (Hill, Chapter 77), which extended the regulatory and outreach efforts and enhanced transparency to administrative functions of the Board for four years. The consumers. Developed entirely by Board staff, the bill gave the Board the authority to automatically revoke mobile app allows consumers to ‘follow’ the licenses the licenses of physicians who are required to register as of up to 16 physicians and receive notifications sex offenders; authorized the Board to issue penalties for when there has been an update to any of those failure to file certain mandatory reports; and increased physician’s license profile. The app sends alerts to current postgraduate training requirements for physician users whenever a physician’s name, address, practice and surgeon applicants beginning in January 2020. status, license expiration, or survey data changes, or when disciplinary actions or enforcement documents STRATEGIC PLAN are added to the physician’s profile. With the release The Board completed its Strategic Plan for 2018-2021, medical board in the nation to utilize such technology providing a road map to guide its efforts to protect California consumers for the next four years. Using feedback gathered from the public, the ambitious strategic plan establishes goals for licensing, enforcement, legislation and regulation, outreach, and Board administration that will strengthen consumer protection in California. CANNABIS GUIDELINES The Board also updated and expanded its Guidelines of this new mobile app, the Board became the first to notify patients about their physicians. To date thousands of consumers have downloaded the app. A version for Android smart phones is forthcoming. it’s AS EASY AS 1 2 3 for the Recommendation of Cannabis for Medical Purposes. The purpose of the guidelines is to provide guidance and information to physicians who choose to recommend cannabis for medical purposes to their patients. This update was done in collaboration with the Center for Medicinal Cannabis Research at the University of California, San Diego, and in accordance with SB 643 (McGuire, Chapter 719). Medical Board of California Annual Report 2017-2018 3 BRAND MODERNIZATION MEDICAL BOARD CHAT The Board modernized the look and feel of its publications with the design of a new seal and logo. The new design replaced the caduceus, a short staff entwined by two serpents under a set of wings, with the Rod of Asclepius, which traditionally represents healing and medicinal arts. The Board launched its first podcast titled “Medical Board Chat,” becoming the first licensing board under the Department of Consumer Affairs to use this form of outreach. The podcast offers a new and innovative way to bring information about the Board to the public. The Board plans to produce one podcast per month covering a wide variety of topics of interest to licensees and consumers. AR D OF C A FO M E D I CA L LI BO RNIA EST 1876 Old New at rd Ch Medical Boa Death edical Board Episode 1 - M roject Certificate P hmeyer, SOCIAL MEDIA EXPANSION The Board developed a new communications plan expanding its outreach to consumers through multiple social media platforms including Facebook, Twitter, and YouTube. As part of this plan, the Board began posting administrative actions on its Twitter and Facebook feeds, and has significantly increased the amount of posts on all social media channels. With these combined efforts, the Board had nearly 2,000,000 unique visits to its website, www.mbc.ca.gov. mberly Ki rc W ith Guest Ki irector Executive D of edical Board Episode 2 - M App leases Mobile California Re S Devices for Apple iO t, an Eichel krau W ith Guest Se er ag an M Systems Info rmation Year in Review* D WE E N RE 8,031 6,694 70,297 10,888 Applications Received Licenses Issued Licenses Renewed Complaints Received Physicians and Surgeons * Medical Board of California Annual Report 2017-2018 4 BUDGET SUMMARY Physicians’ renewal fees are the primary source of revenue for the Board, as illustrated below in the revenues and reimbursements chart. The budget distribution chart reflects the budgeted (not actual) expenditures in each of the Board’s programs. The Enforcement Program accounts for 75 percent of the Board’s overall expenditures. Although the Board cannot order cost recovery for the investigation and prosecution of a case, the Board can order probation monitoring costs be reimbursed. The Licensing Program accounts for 13 percent of the Board’s expenditures, while the Executive and Administrative Programs account for 7 percent. The Information Systems Branch accounts for the remaining 5 percent of the Board’s overall expenditures. Revenues and Reimbursements1 Reimbursements Budget Distribution Other3 4% 5% 2% 4% Administrative Services5 Probation Monitoring4 Executive 3% Information Services 5% Licensing4 13% Application and Initial License Fees2 Renewals2 82% 12% Revenues and Reimbursements1 Legal and Hearing Services5 Enforcement Operations4 24% 46% Budget Distribution Renewals2 $50,278,000 Enforcement Operations4 $30,749,000 Application and Initial License Fees $7,218,000 Legal and Hearing Services Reimbursements $2,589,000 Licensing Other3 $1,454,000 2 Total $61,539,000 5 $15,925,000 $8,577,000 4 Information Systems $3,579,000 Probation Monitoring $3,303,000 Administrative Services $2,351,000 Executive $1,928,000 4 Total 1 Revenues and Reimbursements excludes repayment of the General Fund loan and corresponding interest. 2 Physicians and Surgeons. 3 Regulatory Fees, Delinquency/Penalty/Reinstatement Fees, Interest on Fund, and Miscellaneous. 4 Excludes Attorney General Services, Office of Administrative Hearings, and Court Reporter Services. 5 Includes Attorney General Services, Office of Administrative Hearings, and Court Reporter Services. $66,412,000 Medical Board of California Annual Report 2017-2018 5 LICENSING PROGRAM The Board’s Licensing Program protects consumers by setting requirements for licensure, including education, experience, and demonstrated competence, and issues licenses to individuals meeting those requirements. The Licensing Program also provides license verification services, issues fictitious name permits, and approves accreditation agencies for the accreditation of outpatient surgery settings. To ensure timely licensure of residents, the Licensing Program provides outreach activities throughout the state to assist with the application process. POSTGRADUATE TRAINING REQUIREMENT CHANGES The Licensing Program is preparing for its most significant change in decades as a result of the Board’s sunset bill, SB 798 (Hill, Chapter 77). Effective January 1, 2020, physician applicants will be required to complete three years of Board-approved postgraduate training, regardless of where the applicant attended medical school. The new law also creates a postgraduate training license for residents that participate in an approved postgraduate training program in California. These changes will require significant internal coordination of Board staff working diligently on an implementation plan that will include revised applications, forms, policies, procedures, and updates to the BreEZe online system. Most importantly, the changes will require detailed communications and outreach to the Board’s stakeholders, which have already been initiated. Licensee Age* 40,000 33,605 31,706 30,000 28,562 21,830 20,000 15,676 7,878 10,000 1,491 0 34 35-44 and under 45-54 55-64 65-74 75-84 85 and over Licensee Sex* Total Female 36% 51,018 LICENSING ACTIVITY The Licensing Program is mandated to conduct an initial review of all physician’s and surgeon’s applications within 60 working days. The Licensing Program’s strategic goal for reviewing physician’s and surgeon’s applications and Postgraduate Training Authorization Letter (PTAL) applications is 45 calendar days. Since November 2016, the Licensing Program has reviewed applications within 28 days of receipt. Total Male 64% 89,730 Physicians and Surgeons * Medical Board of California Annual Report 2017-2018 6 Physicians and Surgeons by County Del Norte Siskiyou Modoc Legend 0-30 31-100 Shasta Humboldt 101-250 Lassen Trinity 251-500 501-1,000 Tehama Mendocino 1,001-5,000 Plumas Butte Glenn 5,001-10,000 10,001-15,000 Sierra 15,001+ Nevada Lake Sonoma Colusa Placer Yuba Sutter Napa Marin San Francisco San Mateo Yolo El Dorado Alpine  Sacramento Amador Solano San Joaquin Contra Costa Alameda Santa Clara Calaveras Tuolumne Mono Mariposa Stanislaus Madera Merced Santa Cruz Fresno San Benito Monterey Kings Inyo Tulare San Luis Obispo Kern San Bernardino Santa Barbara Ventura Los Angeles Orange Riverside San Diego Imperial Medical Board of California Annual Report 2017-2018 7 Physicians and Surgeons by County1 County Alameda Alpine Amador Butte County 5,433 4 64 499 County Modoc 11 Sonoma 1,557 Mono 33 Stanislaus 1,043 Monterey 965 Sutter Napa 522 Tehama 177 50 Calaveras 45 Nevada 256 Trinity 8 Colusa 10 Orange 10,452 Tulare 550 Tuolumne 122 Contra Costa 3,553 Del Norte 30 El Dorado 348 Fresno 2,104 Glenn 10 Placer Plumas 521 Sacramento 5,193 Yuba 49 San Benito Imperial 143 San Diego 1,171 46 4,304 11,293 San Francisco 6,928 San Joaquin 1,152 San Luis Obispo 826 Kings 145 Lake 68 San Mateo 3,296 Lassen 35 Santa Barbara 1,303 Santa Clara 8,509 Los Angeles Madera Marin Mariposa 30,848 216 1,574 14 2,060 Yolo San Bernardino Kern Ventura 3,401 283 52 28 Riverside Humboldt Inyo 1,373 Santa Cruz 772 Shasta 416 Sierra Total In State Total Out-of-State Total 1 115,378 25,370 140,748 Data is for physicians with a renewed and current license excluding those in an inactive, retired, or disabled license status. The breakdown of those license statuses is: California - 2,266; Out-of-State - 4,480; Total - 6,746. 0 Mendocino 183 Siskiyou 76 Merced 231 Solano 1,023 Medical Board of California Annual Report 2017-2018 8 Physicians and Surgeons by State1 Washington Vermont Montana North Dakota Minnesota Oregon New York Wisconsin South Dakota Idaho Michigan Wyoming Nebraska Nevada Utah Pennsylvania Iowa Illinois Colorado Kansas California Indiana Missouri Oklahoma West Virginia Virginia Kentucky New Mexico Missis- Alabama sippi Rhode Island Connecticut New Jersey Maryland District of Columbia North Carolina South Carolina Arkansas New Hampshire Massachusetts Delaware Ohio Tennessee Arizona Maine Legend 0-5,000 Georgia 5,001-10,000 10,001-15,000 Texas 15,001-20,000 Louisiana Florida Alaska 20,001-30,000 30,001-40,000 Hawaii 40,001-50,000 50,001-100,000 100,001+ State Alabama State 15,947 Maryland 30,188 South Carolina 18,999 Massachusetts 34,847 South Dakota 3,806 25,344 Michigan 47,284 Tennessee 23,039 9,967 Minnesota 23,494 Texas 77,894 10,751 Alaska 4,049 Arizona Arkansas State California 149,283 Mississippi 10,249 Utah Colorado 21,897 Missouri 25,763 Vermont Connecticut 17,414 Montana 5,244 Virginia 37,820 5,269 Nebraska 9,316 Washington 28,747 Delaware 3,540 District of Columbia 12,520 Nevada 8,861 West Virginia Florida 74,012 New Hampshire 7,262 Wisconsin 26,755 Georgia 35,951 New Jersey 37,181 Wyoming 3,775 9,464 New Mexico 9,235 Idaho 5,969 New York 93,951 Illinois 49,513 North Carolina 38,716 Indiana 28,251 North Dakota 3,895 Iowa 11,931 Ohio 46,631 Hawaii Kansas Oklahoma 13,141 Kentucky 18,526 Oregon 15,165 Louisiana 16,894 Pennsylvania 56,337 6,779 Rhode Island 5,432 Maine 9,566 Total 1 7,943 1,293,807 State counts are based on allopathic and osteopathic physician data recorded by the Federation of State Medical Boards (FSMB) using state medical board license files from 2016 and reflect the number of physicians with an active license. Source: 2016 FSMB Census of Licensed Physicians Medical Board of California Annual Report 2017-2018 9 Physician’s and Surgeon’s Licenses1 142,000 Licenses and Permits FY 16-17 FY 17-18 7,978 8,031 5,339 5,245 Physician Applications Received 140,748 Physician Applications Received Physician Licenses Issued 137,967 138,000 FLEX/USMLE1 NBME 135,375 134,000 1 330 1,139 1,119 Total 6,802 6,694 62,260 64,572 5,072 5,725 67,332 70,297 113,100 115,378 24,867 25,370 Physician Licenses Renewed Renewal Licenses Issued - Fee 132,370 Renewal Licenses Issued - Fee Exempt2 130,726 130,000 324 Reciprocity with Other States (BPC §2135) 1 Total Physician Licenses In Effect 3 FY 13-14 FY 14-15 FY 15-16 FY 16-17 FY 17-18 Excludes physicians with an inactive, retired, or disabled license status. California Address Out-of-State Address Total 137,967 Probationary Licenses Issued FY 16-17 FY 17-18 140,7485 0 7 12 16 3 96 Physician License Administrative Activity Licenses Issued with Public Letters of Reprimand Verification and Reporting 4 Licenses Denied (No Hearing Requested) License Status Verifications Statements of Issues to Deny License Filed 3 22 Telephone Verifications 3 2 Non-Verification Telephone Calls Authorized License Verification System (LVS) Internet Users Web License Look-Up 3 Certification Letters and Letters of Good Standing Verifications 2,432 1,715 Statements of Issues Granted (License Denied) 56,3061 54,1452 Statements of Issues Denied (License Granted) 1 1 799 928 Statements of Issues Withdrawn 0 3 1,166,382 1,181,554 1,2427 1,3848 11,016 10,867 5,303 5,703 12,131 12,504 2 2 Renewed 14 7 In Effect 25 25 Issued Renewed In Effect Special Faculty Permits Reporting Activities Issued Disciplinary Reports Mailed to Health Facilities Upon Written Request Pursuant to BPC §805.5 160 Adverse Actions Reported to the National Practitioner Data Bank (NPDB) 6574 6405 91 / 8 141 / 5 BPC §805 / §805.01 Reports of Health Facility Discipline Received Fictitious Name Permits 411 1 FLEX: Federation Licensing Exam. USMLE: United States Medical Licensing Exam. NBME: National Board Medical Exam. 2 Includes physicians with disabled, retired, military, or voluntary services license status. 3 Excludes physicians with an inactive, retired, or disabled license status. 4 Total physician licenses in effect including inactive, retired or disabled license status - 144,441. 1 Excludes the 14,955 listed under Consumer Inquiries on page 11. 2 Excludes the 12,393 listed under Consumer Inquiries on page 11. 3 Statistics from the Board’s BreEZe Online License Verification web page. 5 Includes 651 MDs, 1 Licensed Midwife, and 5 Polysomnographic Technologists. Total physician licenses in effect including inactive, retired or disabled license status - 147,494. 6 Includes 2 PTAL denials. 7 Includes 21 Fictitious Name Permits issued on behalf of the Board of Podiatric Medicine. 8 Includes 34 Fictitious Name Permits issued on behalf of the Board of Podiatric Medicine. 4 5 Includes 639 MDs and 1 Polysomnographic Technologist. Medical Board of California Annual Report 2017-2018 10 ENFORCEMENT PROGRAM The Board’s Enforcement Program investigates allegations to determine if a violation of the Medical Practice Act or other laws has occurred and takes action as appropriate. In addition, the Enforcement Program monitors licensees’ compliance with the terms and conditions of a disciplinary order. During fiscal year 2017-2018, the Enforcement Program received 10,888 complaints against physicians and surgeons and unlicensed individuals. This was an increase of 1,269 complaints from the prior fiscal year. FIGHTING THE OPIOID EPIDEMIC On average, 115 Americans die every day from an opioid overdose. To combat this epidemic the Board continued its work on the death certificate project. Born out of vetoed legislation that would have required coroners in California to report deaths when the cause of death is the result of prescription drug use, the Board’s death certificate project utilizes California death record data to identify physicians that may be inappropriately prescribing opioids to their patients. Based upon this information, the Board has been investigating physicians who may have violated the law. The Board understands that just because a patient death occurred it does not automatically mean the physician deviated from the standard of care or violated the Medical Practice Act. However, in cases where the Board determines a violation occurred, the Board takes appropriate action. CITATION AND FINE AUTHORITY The Board is authorized to issue citations and fines for certain technical violations of laws and regulations. To further consumer protection, the Board adopted regulations that authorized it to issue citations with orders of abatement and fines to licensed midwives and polysomnographic technologists, technicians, and trainees, and added additional provisions from the Business and Professions Code, Health and Safety Code, and California Code of Regulations to the list of citable offenses. A complete list of citable offenses is available in the Board’s regulations. During this fiscal year, the Board issued a total of 150 citations. Program Summary FY 16-17 FY 17-18 Complaints 1 9,619 10,888 10,2022 9,4213 1,4654 1,6275 1,284 1,414 425 504 Cases Referred for Criminal Action 43 36 Probation Violation Reports Referred to the AG 58 40 14,955 12,393 8,225 6,816 Complaints Received Complaints Closed by Complaint Unit Investigations Cases Opened Cases Closed Cases Referred to the Attorney General (AG) Consumer Inquiries Consumer Telephone Inquiries Consumer Jurisdictional Inquiries 1 Some cases closed were opened in a prior fiscal year. 2 Includes 8,558 complaints closed, 89 referred to Cite and Fine Program, and 1,555 referred to investigations. 3 Includes 7,539 complaints closed, 146 referred to Cite and Fine Program, and 1,736 referred to investigations. 4 Includes 331 complaints opened by CIO, and 1,134 opened by HQIU. 5 Includes 270 complaints opened by CIO, and 1,357 opened by HQIU. DID YOU KNOW? Data annotated as “Physician and Surgeon” includes the license types Physicians and Surgeons, Special Faculty Permits, and Special ProgramsIndividuals. Learn more about license types on the Board’s website. Medical Board of California Annual Report 2017-2018 11 CURES The Board developed a fact sheet detailing the Controlled Substance Utilization Review and Evaluation System (CURES) new mandatory use requirement, which became effective October 2, 2018. The Board has continued to assist physicians with registration and consultation of the CURES database as mandated by law. The CURES database is maintained by the Department of Justice (DOJ) and tracks all Schedule II, III, and IV controlled substances prescriptions dispensed in California. This database is used by State public health, regulatory oversight, and law enforcement agencies to reduce prescription drug abuse and diversion. As of October 2, 2018, all licensed healthcare providers who prescribe controlled substances Schedules II-IV are required to consult CURES within 24 hours before prescribing, ordering, administering, or furnishing a controlled substance for the first time to any patient, unless an exemption applies. Additionally, prescribers must consult CURES at least once every four months thereafter if the controlled substance remains part of the patient’s treatment. Other resources are available on the Board’s website to assist physicians in understanding the CURES program. Physician and Surgeon Complaints 10,888 11,000 10,000 9,619 9,000 8,000 8,679 8,329 8,267 FY 13-14 FY 14-15 FY 15-16 FY 16-17 FY 17-18 Physician and Surgeon Complaints Received by Complaint Type and Source Public Business and Professions Code6 Licensee/ Professional Group7 Government Agency8 Miscellaneous/ Anonymous Total Type Complaints Received 85 3 12 13 43 156 225 7 24 427 112 795 888 16 143 7 175 1,229 3,563 945 46 112 290 4,956 74 105 14 182 71 446 Unprofessional Conduct 1,628 27 114 829 287 2,885 Unlicensed/Unregistered 169 - 19 83 150 421 6,632 1,103 372 1,653 1,128 10,888 Fraud Health and Safety 1 Non-Jurisdictional 2 Gross Negligence/Incompetence 3 Personal Conduct 4 5 Total Source Complaints Received 1 Includes excessive prescribing, sale of dangerous drugs, etc. 2 Includes complaints not under the authority of the Board and are referred to other agencies such as the Department of Health Care Services, Department of Managed Health Care, etc. 3 Includes complaints related to the quality of care provided by licensees. 4 Includes licensee self-abuse of drugs/alcohol, conviction of a crime, etc. 5 Includes sexual misconduct with patients, failure to release medical records, violation of BPC §805 reporting, etc. 6 Includes complaints received pursuant to BPC §§800 and 2240(a), and includes complaints initiated based upon reports submitted to the Board by hospitals, insurance companies and others, as required by law, regarding instances of health facility discipline, malpractice judgments/settlements, or other reportable activities. 7 Includes the following complaint sources: other Licensee, Professional Society or Association. 8 Includes the following complaint sources: Internal, Law Enforcement Agency, other California State Agency, other State Agency, other boards within the Department of Consumer Affairs, and Federal or other Government Agency. Medical Board of California Annual Report 2017-2018 12 Malpractice Settlement Reports Received per BPC §801.01 by Specialty Practice Reports1 Physicians2 805 1 704 Total Reports Received Anesthesiology 22 6,818 Peer Review Body Type Cardiology 17 3,484 Critical Care 2 1,694 Dermatology 4 2,296 38 4,796 Endocrinology 1 1,005 Gastroenterology 5 1,888 General/Family Practice 47 9.891 Gynecology 27 6,357 License Revoked Hematology 4 1,224 Infectious Disease 2 1,016 Internal Medicine Emergency Medicine 805.01 Total Reports Received Specialty/Subspecialty Allergy and Immunology Reports Received per BPC §§805 and 805.01 and Report Outcomes 141 5 78 2 3 0 37 1 0 0 23 2 1 0 Pending Disposition 88 3 Cases Closed 52 2 Health Care Facility/Clinic Surgical Center Health Care Services Plan Professional Society Medical Group/Employer Outcomes of Reports Received 48 24,378 Neonatal/Perinatal 7 728 Nephrology 3 1,335 17 615 Neurology 8 2,390 Medical Malpractice Obstetrics 50 6,357 Insurers1 533 455 9 3,052 Attorneys/Self-Reported/Employers1 107 84 36 3,326 Courts 0 0 Otolaryngology 9 1,757 Total 640 539 Pain Medicine 5 686 Pathology 9 1,998 12 5 Pediatrics 11 10,940 Criminal Charges and Convictions 96 84 91 141 8 5 13 15 220 250 Neurological Surgery Opthalmology Orthopedic Surgery Physical Medicine and Rehabilitation Reports Received Based Upon Legal Requirements for Physicians and Surgeons FY 16-17 2 Other Required Reporting Coroners’ Reports3 4 2 1,245 24 1,250 Health Facility Discipline Reports Medical Cause or Reason5 Psychiatry 4 8,594 Health Facility Reports6 Pulmonology 3 1,727 44 6,808 Outpatient Surgery Settings Reports Patient Death7 Rheumatology 1 758 Sports Medicine 1 614 38 4,366 1 Per BPC §801.01. 611 2 Per BPC §803. 3 Per BPC §802.5. 4 Per BPC §§802.1 and 803.5. 5 Per BPC §805. 6 Per BPC §805.01. 7 Per BPC §2240(a). Plastic Surgery Radiology Surgery Thoracic Surgery Urology Vascular Surgery 1 2 9 14 5 1,520 324 The procedure was performed in the practice specialty/ subspecialty; however, the physician may or may not have been certified in the specialty/subspecialty area. California physicians certified in specialty according to the 2016-2017 American Board of Medical Specialties Certification Statistics Report. FY 17-18 Total DID YOU KNOW? Mandatory Reporting requirements and forms are easily accessible on the Board’s website. Medical Board of California Annual Report 2017-2018 13 Administrative Actions FY 16-17 FY 17-18 314 378 Petition to Revoke Probation/Accusation and Petition to Revoke 55 37 Amended Accusation/Petition to Revoke 44 63 Completed Investigations Referred to the AG and Awaiting the Filing of Accusation as of June 30th 89 Cases Over 6 Months Old that Resulted in the Filing of Accusation 344 64 License Surrendered (in Lieu of Accusation or with Accusation Pending) License Placed on Probation with Suspension License Placed on Probation Probationary License Issued FY 17-18 18 16 4 5 10 5 Granted 21 16 Denied 2 5 Filed Granted Denied Petitions for Penalty Relief 1 Petitions to Compel Exam 389 Administrative Outcomes License Revoked FY 16-17 Petitions for Reinstatement of License Administrative Actions Accusation Petition Activity 42 Filed 27 24 Granted 27 22 Denied 0 0 43 1 101 87 6 5 171 122 Penalty Relief includes Petitions for Modification of Penalty and Petitions for Termination of Probation. License Restrictions/Suspensions and Temporary Restraining Orders FY 16-17 FY 17-18 Imposed while Administrative Action Pending 12 16 871 133 Other Actions (e.g., Exam Required, Educational Course, etc.) 2 0 Accusation Withdrawn 4 9 Sought and Granted by Case Type 16 7 Gross Negligence/Incompetence 5 7 Inappropriate Prescribing 7 7 2 2 Public Reprimand Accusation Dismissed Probation Violation Outcomes Interim Suspension Order (ISO) Temporary Restraining Order (TRO) Other Suspension Orders Probation Revoked 15 16 Unlicensed Activity Probation Surrendered 10 11 Sexual Misconduct 1 0 Additional Probation 19 17 Public Reprimand 1 1 0 Other Actions (e.g., Exam Required, Educational Course, etc.) 1 0 Petition Withdrawn 0 1 Petition Dismissed 1 0 Additional Suspension and Probation Referral and Compliance Actions Citation and Administrative Fines Issued 1 137 YOU KNOW? 391 0 01 68 562 Sought Granted3 6 9 Mental/Physical Illness 15 13 Self-Abuse of Drugs/Alcohol 26 28 Fraud 16 10 Criminal Charges/Conviction Unprofessional Conduct Total 6 3 17 16 100 95 1 Pursuant to BPC §2220.05(c), ISOs and TROs were granted in the following priority categories: 1 - gross negligence/incompetence resulting in death or serious bodily injury; 1 - drug or alcohol abuse involving death or serious bodily injury; 2 - excessive prescribing; 0 - excessive recommending of medical cannabis; 4 - sexual misconduct with a patient; 1 - practicing under the influence of drugs/alcohol; and 0 - excessive prescribing to a minor. 2 Includes 4 - Automatic Suspension Orders per BPC §2236; 15 license restrictions per Penal Code §23; 3 - license restrictions pursuant to court order; 11 - out-of-state suspension orders per BPC §2310; 0 - stipulated agreements to suspend or restrict the practice of medicine; and 23 - cease practice orders issued for violation of probation condition. 3 Some orders granted were sought in prior FY. 150 One public reprimand was issued in FY 16-17 and not previously reported. DID 36 Check up on your doctor’s license! Public Documents detailing actions taken by the Board are available on its website. Medical Board of California Annual Report 2017-2018 14 Administrative and Probation Violation Outcomes by Case Type1 Revocation Surrender Probation with Suspension Gross Negligence/ Incompetence 7 24 1 53 2 69 156 Inappropriate Prescribing 4 6 1 23 - 6 40 Probation Probationary License Issued Public Reprimand Total Actions Unlicensed Activity - - - 4 - 2 6 Sexual Misconduct 7 8 - 6 - - 21 Mental/Physical Illness 8 15 - 5 - - 28 Self-Abuse of Drugs/Alcohol 9 17 1 26 3 3 59 Fraud 5 3 1 5 - 1 15 Conviction of a Crime 3 4 - 1 - 6 14 Unprofessional Conduct 16 21 1 16 11 46 111 Total Administrative Actions 59 98 5 139 16 133 450 1 Pursuant to BPC §2220.05(c), disciplinary actions were taken in the following priority categories: 2 - gross negligence/incompetence resulting in death or serious bodily injury; 0 - practicing under the influence resulting in death or serious bodily injury; 26 - excessive prescribing; 0 - excessive recommending of medical cannabis; 16 - sexual misconduct with a patient; 2 - practicing under the influence of drugs/alcohol; and 0 - excessive prescribing to a minor. Enforcement Program Caseload Average Enforcement Processing Time Frames6 FY 17-18 Statewide Per Investigator/ Inspector FY 16-17 Health Quality Investigation Unit (Department of Consumer Affairs)1 Active Investigations 1,935 252 AG Cases Assigned 417 5 606 40 3 467 2 258 Probation Unit4 Monitoring Cases5 1 Includes physicians and surgeons, licensed midwives, research psychoanalysts, outpatient surgery settings, and polysomnographic program. 2 Average is determined by using the total number of authorized positions, including vacant positions. 3 Cases are at various stages of AG processing and may require supplemental investigative work, such as subpoena services, interviewing new victims or witnesses, testifying at hearings, etc. 4 Includes physicians and surgeons. 5 109 additional monitoring cases were inactive because the probationer was out of state as of June 30, 2018. 6 Average and median time (calendar days) in processing complaints during the fiscal year, for all cases, from date of original receipt of the complaint, for each stage of discipline, through completion of judicial review. 7 Days from case transmittal to initial pleading filed. 8 Days from filing to final case disposition. FY 17-18 510 455 322 316 123 98 Complaint Process 77 Investigation Process (Non-Sworn) Investigation Process (Sworn) 63 AG Filing Process7 Other Legal Process8 Median Enforcement Processing Time Frames6 FY 16-17 431 203 89 FY 17-18 483 285 251 62 58 Complaint Process 368 Investigation Process (Non-Sworn) Investigation Process (Sworn) 51 AG Filing Process7 Medical Board of California Annual Report 2017-2018 Other Legal Process8 15 Substance-Abusing Licensees FY 16-17 FY 17-18 Probationers FY 16-17 FY 17-18 23 12 Alcohol 8 4 Cannabis 0 1 Cease Practice Orders Probationers Whose Conduct was Related to a Substance-Abuse Problem Probationers Issued a Cease Practice Order 251 212 125 136 Amphetamines 1 1 Methamphetamines 2 2 Ativan 1 1 Opiates 0 2 Benzodiazepine 0 1 Tramadol 2 1 Cocaine 5 5 Demerol 2 1 Failed to Enroll in a Clinical Competence Assessment Program 0 1 Fentanyl 3 2 Hydrocodone 1 0 Failed to Complete a Clinical Competence Assessment Program 1 0 Ketamine 0 1 5 1 Inhalants2 1 1 Failed to Appear for a Biological Fluid Test (BFT) Cannabis 3 2 Failed to Call In for a BFT 2 0 Methamphetamines 3 3 Failed to Obtain a Worksite Monitor 2 0 Opiates 5 5 Solo Practice Violation 1 0 Psilocybin 1 0 103 91 0 1 0 1 8 15 Substances Involved/Reason for Order Substances Involved1 Alcohol Multiple Controlled Substances Suspensions Probationers Issued a Suspension Substance Involved Probation Completion Cocaine Probation Successfully Completed3 (Y) 35 15 Failed to Complete Probation (N) 33 16 Petitions to Revoke Y N Y N Petitions to Revoke Alcohol 23 18 10 11 Substances Involved/Reason for Action Cocaine 2 0 0 2 Alcohol 3 2 Demerol 1 0 0 0 Cocaine 0 1 Fentanyl 1 0 0 0 Methamphetamines 0 1 Methamphetamines 1 1 1 0 Cannabis 0 1 Opiates 0 1 1 0 Multiple Controlled Substances 2 1 Multiple Controlled Substances 9 14 5 10 Failed to Complete a Clinical Competence Assessment Program 1 1 Failed to Appear for a BFT 1 1 Failed to Call In for a BFT 1 0 Multiple Probation Violations 0 3 Non-Practice Over 2 Years 0 4 Substances Involved1 Relapses Probationers who Relapsed 19 14 Alcohol 12 7 Cocaine 0 1 Demerol 1 0 1 Fentanyl 1 0 Some probationers had more than one substance involved. 2 Containing Isobutyl Nitrites and/or Ethyl Chloride. Cannabis 0 1 3 Methamphetamines 0 2 Those who successfully completed probation or a petition for termination of probation was granted. Opiates 1 2 Tramadol 0 1 Multiple Controlled Substances 4 0 Substances Involved1 Medical Board of California Annual Report 2017-2018 16 FY 16-17 FY 17-18 FY 16-17 FY 17-18 FY 16-17 FY 17-18 FY 16-17 FY 17-18 FY 16-17 FY 17-18 FY 16-17 FY 17-18 FY 16-17 FY 17-18 FY 16-17 FY 17-18 Total Major Violations Multiple Controlled Substances FY 17-18 Opiates Cannabis Inhalants2 FY 16-17 Fentanyl Demerol FY 17-18 Ativan FY 16-17 Alcohol Amphetamines Individual Probationers with Major Violations by Substance1 Failed to Undergo a Required Clinical Diagnostic Evaluation - - - - - - - - - - 1 - - - 1 - - - 2 0 Committed Multiple Minor Violations of Probation Conditions and Terms - - - - - - - - - - - - - - - - - 2 0 2 Treated a Patient(s) while Under the Influence of a Prohibited Substance - - - - - - - - - - - - - - - - - - 0 0 Engaged in Any Drug or Alcohol Related Act that is a Violation of State or Federal Law or Regulation 8 2 - - - - 1 - - - - - - - - - 6 - 15 2 Failed to Undergo BFT when Ordered 27 5 1 - 1 - - - 1 - 1 - 1 - 1 - 13 7 46 12 Used, Consumed, Ingested, or Administered to Himself or Herself a Prohibited Substance - 5 - - - - 1 - - - - - - - - - - 4 1 9 Knowingly Used, Made, Altered, or Possessed any Object or Product in Such a Way as to Defraud or Attempt to Defraud a BFT Designed to Detect the Presence of a Prohibited Substance - - - - - - - - - - - - - - - - - - 0 0 Failed to Comply with any Term or Condition of Probation that Impairs Public Safety 1 5 - - - - - - - - - - - - 1 - 1 4 3 9 Total Instances of Substance Involvement 36 17 1 0 1 0 2 0 1 0 2 0 1 0 3 0 20 17 67 34 1 Per 16 CCR §1361.52(a)(1-8). 2 Containing Isobutyl Nitrites and/or Ethyl Chloride. Medical Board of California Annual Report 2017-2018 17 ALLIED HEALTH CARE PROFESSIONALS Allied health care professionals under the Board’s authority include licensed midwives, research psychoanalysts, and the polysomnographic program, consisting of polysomnographic trainees, technicians, and technologists. Issued Current Licenses and Registrations FY 16-17 FY 17-18 Accusation 2 1 Administrative Actions Licensed Midwives 36 418 5 86 Petition to Revoke Probation 1 0 Polysomnographic Trainee 19 58 Amended Accusation/Petition to Revoke 0 0 Polysomnographic Technician 34 123 Statement of Issues to Deny Application 1 0 Polysomnographic Technologist 63 663 0 5 Completed Investigations Referred to the AG and Awaiting the Filing of Accusation as of June 30th 0 2 License Revoked 1 0 License Surrendered (in Lieu of Accusation or with Accusation Pending) 1 0 Research Psychoanalyst Accreditation Agencies for Outpatient Settings Administrative Outcomes FY 16-17 FY 17-18 Complaints Complaints Received 37 39 Complaints Closed by Complaint Unit 53 36 License Placed on Probation with Suspension 0 0 Cases Opened 20 13 License Placed on Probation 1 0 Cases Closed 17 10 Probationary License Issued 0 0 Cases Referred to the Attorney General (AG) 1 3 Public Reprimand 0 0 Cases Referred for Criminal Action 0 2 Other Actions (e.g., Exam Required, Educational Course, etc.) 0 0 Probation Violation Reports Referred to the AG 1 0 Statements of Issues Denied (License Granted) 1 0 Statements of Issues Granted (License Denied) 0 0 Accusation/Statements of Issues Withdrawn 0 0 0 0 Probation Revoked or License Surrendered 1 0 Additional Suspension or Probation 0 0 Petition Withdrawn or Dismissed 0 0 0/0/0 0/0/0 0/0 0/0 0/0/0 0/0/0 Investigations Reports Received Based Upon Legal Requirements Midwife Hospital Transfer Forms1 208 164 Accusation Dismissed Outpatient Adverse Events Reports2 118 165 Probation Violation Outcomes Referral and Compliance Actions Citation and Administrative Fines Issued 0 0 License Restrictions/Suspensions Imposed while Administrative Action Pending Petitions for Reinstatement of License Interim Suspension Order (ISO) 0 0 Filed / Granted / Denied Other Suspension Orders 1 0 Petitions for Penalty Relief3 Granted / Denied 1 Per BPC §2510. 2 Per BPC §2216.3. 3 Penalty Relief includes Petitions for Modification of Penalty and Petitions for Termination of Probation. Petitions to Compel Exam Filed / Granted / Denied Medical Board of California Annual Report 2017-2018 18 2016 2017 Licensed Midwife Annual Report Summary 1 Clients Served as Primary Caregiver at the Onset of Care 5,420 5,932 Clients Served with Collaborative Care Available Through or Given by a Licensed Physician and Surgeon 2,480 2,665 171 228 Planned Out-of-Hospital Births at the Onset of Labor 3,664 3,981 Planned Out-of-Hospital Births Completed in an Out-of-Hospital Setting: 3,018 3,297 Twin Births 1 0 Multiple Births (Other Than Twin Births) 6 0 11 12 159 152 Resulting in the Mortality of the Mother Prior to Transfer 0 0 Resulting in the Mortality of the Mother After Transfer 0 0 Resulting in the Mortality of the Infant Prior to Transfer 3 2 Resulting in the Mortality of the Infant After Transfer 5 5 Primary Care Transferred to Another Health Care Practitioner (Elective) 407 465 Urgent or Emergency Transport of Expectant Mother 117 111 467 521 78 70 Clients Served Under the Supervision of a Licensed Physician and Surgeon Breech Births VBAC (Vaginal Births After the Performance of a Cesarean Section) Complications Antepartum Intrapartum Elective Hospital Transfer Urgent or Emergency Transfer of an Infant or Mother Postpartum Elective Hospital Transfer of Mother 63 69 Elective Hospital Transfer of Infant 39 31 Urgent or Emergency Transfer of Mother 34 41 Urgent or Emergency Transfer of Infant 48 56 1 Conclusions should not be drawn from this summary as data does not specify whether the death is fetal, intrapartum or neonatal; whether the affected perinate had congenital anomalies incompatible with life; or whether the perinate was born in or out of a hospital. Births are attended by the licensed midwife as the primary caregiver. Medical Board of California Annual Report 2017-2018 19 NEW INTRODUCING Medical Board of California App for iOS! Quick, Optimized Access to Website Content Follow up to 16 Doctors’ Licenses Immediate License Profile Access to the Doctors Being Followed Free, Automated License Alert Notifications When Profile is Updated it’s AS EASY AS 1 2 3 Receive notifications when a doctor’s name, address, practice status, license expiration, or survey data changes, or when administrative actions or enforcement documents are added to a doctor’s profile. This information includes notification when a doctor is suspended, revoked, or placed on probation. OF CALIFORNIA 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815 (916) 263-2382 www.mbc.ca.gov webmaster@mbc.ca.gov FOLLOW MEDICAL BOARD CONTACT Get yours now! @MedboardOfCA @MedicalBoardCA CAMedicalBoard The Medical Board of California’s Public Affairs office is available to discuss information and data contained in this report. Contact the office for assistance with questions, data requests, and other needs. Carlos Villatoro, Public Information Manager Carlos.Villatoro@mbc.ca.gov (916) 263-2394 State of California Department of Consumer Affairs