October 10th 1997
Mr. Jay DeFuria
Consultant Joint Legislative Sunset Review Committee
State Capital, Room 2139
Sacramento, CA ** 95814
RE: Sunset Review of Medical Board of California -- A request for legislative modifications in the statutory scheme of this regulatory agency
Dear Mr. DeFuria,
As a California-licensed midwife I am a current licentiate of the Medical Board. I am also trained as a nurse and worked in acute care hospital setting (emergency department and labor & delivery room) for 20 years prior to entering the field of midwifery. For the last 2 years I have been a volunteer with the citizens action group "Citizens for Health". Due to an unfortunate experience with the Medical Board (1991-1993) I have assumed a voluntary role of "citizen oversight" of the MBC and regularly attend the quarterly Board meetings and frequently make requests for a specific change in policy.
Im happy to report that some of my requests and suggestions have been implemented. I have no quarrel with any of the individuals on the governing Board or who work for the regulatory agency -- they are good people doing a hard job and for the most part, doing it very well. However, it is my opinion the right hand does not always know what the left is doing (policy-wise) and that some major structural changes are in order, both to prevent overzealous and inappropriate pursuit of "unorthodox" caregivers (especially in regard to non-allopathic treatments) and to better protect the public from the few careproviders who are acting out of anger or indifference, to the determent of public safety.
My experiences as a hospital nurse, parent of three now adult children, patient-advocate, non-nurse midwife and most recently, a grandmother, has exposed me to both the highs and the lows of medical care over the course of 36 years. I am not anti-medical -- in fact, I believe that providing medical care is a very difficult job which is getting harder as a result of recent changes in healthcare and the deleterious influence of malpractice litigation. I greatly admire and appreciate those physicians who take on this hard and frequently thankless task.
However, I have noticed a theme in regard to the regulation and discipline of healthcare providers by regulatory agencies. That theme is the overzealous persecution of unorthodox careproviders (both physicians and non-physicians) and too-little, too late (or never) in regard to many glaring acts of repeated malfeasance by "orthodox" physicians. This is not to say that physician discipline by the MBC has never been appropriate. Obviously it has and the MBC and the employees of the agency are to be commended in those many instances. But the spectrum of "appropriate" seems to be more narrow than one would expect while the extremes remain very large. When vigorous actions are taken by medical boards it is frequently for the wrong reasons. When inaction or foot dragging occurs it is rarely for the right reasons. We wish to see these inequities rectified through changes in the agencys legislative mandate.
As a result of my experience with the MBC I have been contacted over the years by several other caregivers -- physicians, midwives and other allied health practitioners -- who have been the victim of an unjust system. What they report are problems falling into four basic categories:
(a) A lack of democratic principles in the current administrative code, absence of a scientifically-based system to establish quality of care parameters and no accountability to the public in the enforcement arm of the agency; (b) Absence of a functional "middle ground" such as citizen-initiated "incident reports" and other mechanisms to modify the outrageous (but non-lethal) behavior of a small number of doctors for whom revocation of licensure is too severe or too late; (c) general lack of citizen input and oversight of agency activities (d) lack of non-allopathic practitioners on the governing board, resulting in a built in bias toward orthodox allopathy and against alternative or (complimentary) medicine and non-physicians of all disciplines.
My request for the Legislature is to set up a "Citizens Advocacy Committee" so that The People who are the theoretical benefactors of the agencys activities have on-going input into those activities. For this same reason I would also like to see the quarterly board meeting broadcast over cable to increase citizen participation and reduce travel time (and unnecessary air pollution!) as the quarterly meetings rotate between Sacramento, San Francisco, San Diego and LA.
Additional suggestions are: (1) That the role of Medical Board of California either be legislatively restricted to regulating only allopathic physicians OR that non-allopathic practitioners be appropriately represented on the 19 member governing board. Currently the Board has 12 MDs and 7 public members who by law cannot be healthcare providers regulated by the MBC. According to the latest statistics, their are 79,048 physician licenses in effect in California and 77,766 Allied Health practitioner licenses. In spite of a nearly 50-50 mix, no one other than MDs can sit on the Board according to the current legislative scheme. For instance, there are no midwives on the Board which regulates midwifery. This results in regulation without representation. and is and unacceptable way to govern in a state where more than half of all healthcare visits are to non-allopaths practitioners.
(2) Restructuring of Administrative Law Code. Mr. Cuny of CfH has already given you information about the types of specific changes necessary. Suffice it so say that healthcare practitioners should not be forced to surrender their civil rights simply because they are licentiates of a regulatory agency. As friend of mine noted that "You couldnt even get someone fired from the phone company that way".
I apologize for the quantify of information accompanying this letter. As you can easily tell, it is a subject which is very important to me. I would be happy to travel to Sacramento to speak with you in person.
faith gibson, LM, CPM, community midwife
Enclosures: Newspaper article on US Health Care
General Background Information & Specific Requests for Legislative changes
Letter of Public Reprimand A Balanced Approach to Medical Board Discipline
List of 15 Recommendations for Medical Board Oversight
cc: Mr. Ron Joseph, Executive Director, MBC/agency
Stewart Hsieh, Pres. MBC/governing board
Bruce Hasenkemp, Division of Licensing , MBC/governing board
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