2009 California Business and Professions Code - Section 850-855 :: Article 13. Standards For Licensure Or Certification

850.  No healing arts licensing board or examining committee under
the Department of Consumer Affairs shall by regulation require an
applicant for licensure or certification to be a member of, to be
certified by, to be eligible to be certified or registered by, or
otherwise meet the standards of a specified private voluntary
association or professional society except as provided for in this
article.

851.  A healing arts licensure board or examining committee may by
regulation require an applicant for licensure or certification to
meet the standards of a specified private voluntary association or
professional society when either of the following conditions is met:
   (a) There is direct statutory authority or requirement that the
board or examining committee utilize the standards of the specified
private voluntary association or professional society; or
   (b) The board or examining committee specifies in the regulation
the amount of education, training, experience, examinations, or other
requirements of the private voluntary association or professional
society, which standards shall be consistent with the provisions of
law regulating such licensees, and the board or examining committee
adopts such standards in public hearing. The board or examining
committee may, by regulation, require an applicant to successfully
complete an examination conducted by or created by a relevant
national certification association, testing firm, private voluntary
association, or professional society.
   Nothing in this section authorizes the Medical Board of California
to limit the licensure of physicians and surgeons by specialty.

852.  (a) The Task Force on Culturally and Linguistically Competent
Physicians and Dentists is hereby created and shall consist of the
following members:
   (1) The State Director of Health Services and the Director of
Consumer Affairs, who shall serve as cochairs of the task force.
   (2) The Executive Director of the Medical Board of California.
   (3) The Executive Director of the Dental Board of California.
   (4) One member appointed by the Senate Committee on Rules.
   (5) One member appointed by the Speaker of the Assembly.
   (b) Additional task force members shall be appointed by the
Director of Consumer Affairs, in consultation with the State Director
of Health Services, as follows:
   (1) Representatives of organizations that advocate on behalf of
California licensed physicians and dentists.
   (2) California licensed physicians and dentists that provide
health services to members of language and ethnic minority groups.
   (3) Representatives of organizations that advocate on behalf of,
or provide health services to, members of language and ethnic
minority groups.
   (4) Representatives of entities that offer continuing education
for physicians and dentists.
   (5) Representatives of California's medical and dental schools.
   (6) Individuals with experience in developing, implementing,
monitoring, and evaluating cultural and linguistic programs.
   (c) The duties of the task force shall include the following:
   (1) Developing recommendations for a continuing education program
that includes language proficiency standards of foreign language to
be acquired to meet linguistic competency.
   (2) Identifying the key cultural elements necessary to meet
cultural competency by physicians, dentists, and their offices.
   (3) Assessing the need for voluntary certification standards and
examinations for cultural and linguistic competency.
   (d) The task force shall hold hearings and convene meetings to
obtain input from persons belonging to language and ethnic minority
groups to determine their needs and preferences for having culturally
competent medical providers. These hearings and meetings shall be
convened in communities that have large populations of language and
ethnic minority groups.
   (e) The task force shall report its findings to the Legislature
and appropriate licensing boards within two years after creation of
the task force.
   (f) The Medical Board of California and the Dental Board of
California shall pay the state administrative costs of implementing
this section.
   (g) Nothing in this section shall be construed to require
mandatory continuing education of physicians and dentists.

853.  (a) The Licensed Physicians and Dentists from Mexico Pilot
Program is hereby created. This program shall allow up to 30 licensed
physicians specializing in family practice, internal medicine,
pediatrics, and obstetrics and gynecology, and up to 30 licensed
dentists from Mexico to practice medicine or dentistry in California
for a period not to exceed three years. The program shall also
maintain an alternate list of program participants.
   (b) The Medical Board of California shall issue three-year
nonrenewable licenses to practice medicine to licensed Mexican
physicians and the Dental Board of California shall issue three-year
nonrenewable permits to practice dentistry to licensed Mexican
dentists.
   (c) Physicians from Mexico eligible to participate in this program
shall comply with the following:
   (1) Be licensed, certified or recertified, and in good standing in
their medical specialty in Mexico. This certification or
recertification shall be performed, as appropriate, by the Consejo
Mexicano de Ginecologia y Obstetricia, A.C., the Consejo Mexicano de
Certificacion en Medicina Familiar, A.C., the Consejo Mexicano de
Medicina Interna, A.C., or the Consejo Mexicano de Certificacion en
Pediatria, A.C.
   (2) Prior to leaving Mexico, each physician shall have completed
the following requirements:
   (A) Passed the board review course with a score equivalent to that
registered by United States applicants when passing a board review
course for the United States certification examination in each of his
or her specialty areas and passed an interview examination developed
by the National Autonomous University of Mexico (UNAM) for each
specialty area. Family practitioners who shall include obstetrics and
gynecology in their practice shall also be required to have
appropriately documented, as specified by United States standards, 50
live births. Mexican obstetricians and gynecologists shall be
fellows in good standing of the American College of Obstetricians and
Gynecologists.
   (B) (i) Satisfactorily completed a six-month orientation program
that addressed medical protocol, community clinic history and
operations, medical administration, hospital operations and protocol,
medical ethics, the California medical delivery system, health
maintenance organizations and managed care practices, and
pharmacology differences. This orientation program shall be approved
by the Medical Board of California to ensure that it contains the
requisite subject matter and meets appropriate California law and
medical standards where applicable.
   (ii) Additionally, Mexican physicians participating in the program
shall be required to be enrolled in adult
English-as-a-second-language (ESL) classes that focus on both verbal
and written subject matter. Each physician participating in the
program shall have transcripts sent to the Medical Board of
California from the appropriate Mexican university showing enrollment
and satisfactory completion of these classes.
   (C) Representatives from the UNAM in Mexico and a medical school
in good standing or a facility conducting an approved medical
residency training program in California shall confer to develop a
mutually agreed upon distant learning program for the six-month
orientation program required pursuant to subparagraph (B).
   (3) Upon satisfactory completion of the requirements in paragraphs
(1) and (2), and after having received their three-year nonrenewable
medical license, the Mexican physicians shall be required to obtain
continuing education pursuant to Section 2190. Each physician shall
obtain an average of 25 continuing education units per year for a
total of 75 units for a full three years of program participation.
   (4) Upon satisfactory completion of the requirements in paragraphs
(1) and (2), the applicant shall receive a three-year nonrenewable
license to work in nonprofit community health centers and shall also
be required to participate in a six-month externship at his or her
place of employment. This externship shall be undertaken after the
participant has received a license and is able to practice medicine.
The externship shall ensure that the participant is complying with
the established standards for quality assurance of nonprofit
community health centers and medical practices. The externship shall
be affiliated with a medical school in good standing in California.
Complaints against program participants shall follow the same
procedures contained in the Medical Practice Act (Chapter 5
(commencing with Section 2000)).
   (5) After arriving in California, Mexican physicians participating
in the program shall be required to be enrolled in adult ESL classes
at institutions approved by the Bureau of Private Post Secondary and
Vocational Education or accredited by the Western Association of
Schools and Colleges. These classes shall focus on verbal and written
subject matter to assist a physician in obtaining a level of
proficiency in English that is commensurate with the level of English
spoken at community clinics where he or she will practice. The
community clinic employing a physician shall submit documentation
confirming approval of an ESL program to the board for verification.
Transcripts of satisfactory completion of the ESL classes shall be
submitted to the Medical Board of California as proof of compliance
with this provision.
   (6) (A) Nonprofit community health centers employing Mexican
physicians in the program shall be required to have medical quality
assurance protocols and either be accredited by the Joint Commission
on Accreditation of Health Care Organizations or have protocols
similar to those required by the Joint Commission on Accreditation of
Health Care Organizations. These protocols shall be submitted to the
Medical Board of California prior to the hiring of Mexican
physicians.
   (B) In addition, after the program participant successfully
completes the six-month externship program, a free standing health
care organization that has authority to provide medical quality
certification, including, but not limited to, health plans,
hospitals, and the Integrated Physician Association, is responsible
for ensuring and overseeing the compliance of nonprofit community
health centers medical quality assurance protocols, conducting site
visits when necessary, and developing any additional protocols,
surveys, or assessment tools to ensure that quality of care standards
through quality assurance protocols are being appropriately followed
by physicians participating in the program.
   (7) Participating hospitals shall have the authority to establish
criteria necessary to allow individuals participating in this
three-year pilot program to be granted hospital privileges in their
facilities.
   (8) The Medical Board of California shall provide oversight review
of both the implementation of this program and the evaluation
required pursuant to subdivision (j). The board shall consult with
the medical schools applying for funding to implement and evaluate
this program, executive and medical directors of nonprofit community
health centers wanting to employ program participants, and hospital
administrators who will have these participants practicing in their
hospital, as it conducts its oversight responsibilities of this
program and evaluation. Any funding necessary for the implementation
of this program, including the evaluation and oversight functions,
shall be secured from nonprofit philanthropic entities.
Implementation of this program may not proceed unless appropriate
funding is secured from nonprofit philanthropic entities. The board
shall report to the Legislature every January during which the
program is operational regarding the status of the program and the
ability of the program to secure the funding necessary to carry out
its required provisions. Notwithstanding Section 11005 of the
Government Code, the board may accept funds from nonprofit
philanthropic entities. The board shall, upon appropriation in the
annual Budget Act, expend funds received from nonprofit philanthropic
entities for this program.
   (d) (1) Dentists from Mexico eligible to participate in this
program shall comply with the following requirements or the
requirements contained in paragraph (2):
   (A) Be graduates from the National Autonomous University of Mexico
School of Faculty Dentistry (Facultad de Odontologia).
   (B) Meet all criteria required for licensure in Mexico that is
required and being applied by the National Autonomous University of
Mexico School of Faculty Dentistry (Facultad de Odontologia),
including, but not limited to:
   (i) A minimum grade point average.
   (ii) A specified English language comprehension and conversational
level.
   (iii) Passage of a general examination.
   (iv) Passage of an oral interview.
   (C) Enroll and complete an orientation program that focuses on the
following:
   (i) Practical issues in pharmacology that shall be taught by an
instructor who is affiliated with a California dental school approved
by the Dental Board of California.
   (ii) Practical issues and diagnosis in oral pathology that shall
be taught by an instructor who is affiliated with a California dental
school approved by the Dental Board of California.
   (iii) Clinical applications that shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
   (iv) Biomedical sciences that shall be taught by an instructor who
is affiliated with a California dental school approved by the Dental
Board of California.
   (v) Clinical history management that shall be taught by an
instructor who is affiliated with a California dental school approved
by the Dental Board of California.
   (vi) Special patient care that shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
   (vii) Sedation techniques that shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
   (viii) Infection control guidelines which shall be taught by an
instructor who is affiliated with a California dental school approved
by the Dental Board of California.
   (ix) Introduction to health care systems in California.
   (x) Introduction to community clinic operations.
   (2) (A) Graduate within the three-year period prior to enrollment
in the program, from a foreign dental school that has received
provisional approval or certification by November of 2003 from the
Dental Board of California under the Foreign Dental School Approval
Program.
   (B) Enroll and satisfactorily complete an orientation program that
focuses on the health care system and community clinic operations in
California.
   (C) Enroll and satisfactorily complete a course taught by an
approved foreign dental school on infection control approved by the
Dental Board of California.
   (3) Upon satisfactory completion to a competency level of the
requirements in paragraph (1) or (2), dentists participating in the
program shall be eligible to obtain employment in a nonprofit
community health center pursuant to subdivision (f) within the
structure of an extramural dental program for a period not to exceed
three years.
   (4) Dentists participating in the program shall be required to
complete the necessary continuing education units required by the
Dental Practice Act (Chapter 4 (commencing with Section 1600)).
   (5) The program shall accept 30 participating dentists. The
program shall also maintain an alternate list of program applicants.
If an active program participant leaves the program for any reason, a
participating dentist from the alternate list shall be chosen to
fill the vacancy. Only active program participants shall be required
to complete the orientation program specified in subparagraph (C) of
paragraph (1).
   (6) (A) Additionally, an extramural dental facility may be
identified, qualified, and approved by the board as an adjunct to,
and an extension of, the clinical and laboratory departments of an
approved dental school.
   (B) As used in this subdivision, "extramural dental facility"
includes, but is not limited to, any clinical facility linked to an
approved dental school for the purposes of monitoring or overseeing
the work of a dentist licensed in Mexico participating in this
program and that is employed by an approved dental school for
instruction in dentistry that exists outside or beyond the walls,
boundaries, or precincts of the primary campus of the approved dental
school, and in which dental services are rendered. These facilities
shall include nonprofit community health centers.
   (C) Dental services provided to the public in these facilities
shall constitute a part of the dental education program.
   (D) Approved dental schools shall register extramural dental
facilities with the board. This registration shall be accompanied by
information supplied by the dental school pertaining to faculty
supervision, scope of treatment to be rendered, arrangements for
postoperative care, the name and location of the facility, the date
operations shall commence at the facility, and a description of the
equipment and facilities available. This information shall be
supplemented with a copy of the agreement between the approved dental
school and the affiliated institution establishing the contractual
relationship. Any change in the information initially provided to the
board shall be communicated to the board.
   (7) The program shall also include issues dealing with program
operations, and shall be developed in consultation by representatives
of community clinics, approved dental schools, or the National
Autonomous University of Mexico School of Faculty Dentistry (Facultad
de Odontologia).
   (8) The Dental Board of California shall provide oversight review
of the implementation of this program and the evaluation required
pursuant to subdivision (j). The board shall consult with dental
schools in California that have applied for funding to implement and
evaluate this program and executive and dental directors of nonprofit
community health centers wanting to employ program participants, as
it conducts its oversight responsibilities of this program and
evaluation. Implementation of this program may not proceed unless
appropriate funding is secured from nonprofit philanthropic entities.
The board shall report to the Legislature every January during which
the program is operational regarding the status of the program and
the ability of the program to secure the funding necessary to carry
out its required provisions. Notwithstanding Section 11005 of the
Government Code, the board may accept funds from nonprofit
philanthropic entities.
   (e) Nonprofit community health centers that employ participants
shall be responsible for ensuring that participants are enrolled in
local English-language instruction programs and that the participants
attain English-language fluency at a level that would allow the
participants to serve the English-speaking patient population when
necessary and have the literacy level to communicate with appropriate
hospital staff when necessary.
   (f) Physicians and dentists from Mexico having met the applicable
requirements set forth in subdivisions (c) and (d) shall be placed in
a pool of candidates who are eligible to be recruited for employment
by nonprofit community health centers in California, including, but
not limited to, those located in the Counties of Ventura, Los
Angeles, San Bernardino, Imperial, Monterey, San Benito, Sacramento,
San Joaquin, Santa Cruz, Yuba, Orange, Colusa, Glenn, Sutter, Kern,
Tulare, Fresno, Stanislaus, San Luis Obispo, and San Diego. The
Medical Board of California shall ensure that all Mexican physicians
participating in this program have satisfactorily met the
requirements set forth in subdivision (c) prior to placement at a
nonprofit community health center.
   (g) Nonprofit community health centers in the counties listed in
subdivision (f) shall apply to the Medical Board of California and
the Dental Board of California to hire eligible applicants who shall
then be required to complete a six-month externship that includes
working in the nonprofit community health center and a corresponding
hospital. Once enrolled in this externship, and upon payment of the
required fees, the Medical Board of California shall issue a
three-year nonrenewable license to practice medicine and the Dental
Board of California shall issue a three-year nonrenewable dental
special permit to practice dentistry. For purposes of this program,
the fee for a three-year nonrenewable license to practice medicine
shall be nine hundred dollars ($900) and the fee for a three-year
nonrenewable dental permit shall be five hundred forty-eight dollars
($548). A licensee or permitholder shall practice only in the
nonprofit community health center that offered him or her employment
and the corresponding hospital. This three-year nonrenewable license
or permit shall be deemed to be a license or permit in good standing
pursuant to the provisions of this chapter for the purpose of
participation and reimbursement in all federal, state, and local
health programs, including managed care organizations and health
maintenance organizations.
   (h) The three-year nonrenewable license or permit shall terminate
upon notice by certified mail, return receipt requested, to the
licensee's or permitholder's address of record, if, in the Medical
Board of California or Dental Board of California's sole discretion,
it has determined that either:
   (1) The license or permit was issued by mistake.
   (2) A complaint has been received by either board against the
licensee or permitholder that warrants terminating the license or
permit pending an investigation and resolution of the complaint.
   (i) All applicable employment benefits, salary, and policies
provided by nonprofit community health centers to their current
employees shall be provided to medical and dental practitioners from
Mexico participating in this pilot program. This shall include
nonprofit community health centers providing malpractice insurance
coverage.
   (j) Beginning 12 months after this pilot program has commenced, an
evaluation of the program shall be undertaken with funds provided
from philanthropic foundations. The evaluation shall be conducted
jointly by one medical school and one dental school in California and
either UNAM or a foreign dental school approved by the Dental Board
of California, in consultation with the Medical Board of California.
If the evaluation required pursuant to this section does not begin
within 15 months after the pilot project has commenced, the
evaluation may be performed by an independent consultant selected by
the Director of the Department of Consumer Affairs. This evaluation
shall include, but not be limited to, the following issues and
concerns:
   (1) Quality of care provided by doctors and dentists licensed
under this pilot program.
   (2) Adaptability of these licensed practitioners to California
medical and dental standards.
   (3) Impact on working and administrative environment in nonprofit
community health centers and impact on interpersonal relations with
medical licensed counterparts in health centers.
   (4) Response and approval by patients.
   (5) Impact on cultural and linguistic services.
   (6) Increases in medical encounters provided by participating
practitioners to limited-English-speaking patient populations and
increases in the number of limited-English-speaking patients seeking
health care services from nonprofit community health centers.
   (7) Recommendations on whether the program should be continued,
expanded, altered, or terminated.
   (8) Progress reports on available data listed shall be provided to
the Legislature on achievable time intervals beginning the second
year of implementation of this pilot program. An interim final report
shall be issued three months before termination of this pilot
program. A final report shall be submitted to the Legislature at the
time of termination of this pilot program on all of the above data.
The final report shall reflect and include how other initiatives
concerning the development of culturally and linguistically competent
medical and dental providers within California and the United States
are impacting communities in need of these health care providers.
   (k) Costs for administering this pilot program shall be secured
from philanthropic entities.
   (l) Program applicants shall be responsible for working with the
governments of Mexico and the United States in order to obtain the
necessary three-year visa required for program participation.

854.  Criteria for issuing three-year nonrenewable medical licenses
and dental permits under this article shall not be utilized at any
time as the standard for issuing a license to practice medicine or a
permit to practice dentistry in California on a permanent basis.

855.  (a) Up to 70 international medical graduates who have passed
their United States medical license examination on the first attempt
and who have been working in the medical field in the capacity of a
medical assistant, a nurse practitioner, a nurse-midwife, a physician
assistant, a dental hygienist, or a quality assurance and peer
review specialist for not less than three years, shall be selected to
participate in a pilot program. Preference shall be given to
international medical graduates who are residents of California, have
experience working in communities whose language is other than
English and whose culture is not from the dominant society, and have
a proven level of literacy in the foreign language of a medically
underserved community.
   (b) If there are not 70 international medical graduates who meet
the criteria of subdivision (a), the remaining openings may be filled
by participants who have passed the United States medical license
examination on two or more attempts, have been working in the medical
field in the capacity of a medical assistant, a nurse practitioner,
a nurse-midwife, a physician assistant, a dental hygienist, or a
quality assurance and peer review specialist for not less than three
years, and who pass an additional test to be determined by the
medical facility and the medical school participating in the pilot
program. Preference shall be given to international medical graduates
who are residents of California, have experience working in
communities whose language is other than English and whose culture is
not from the dominant society, and have a proven level of literacy
in the foreign language of a medically underserved community.
   (c) An international medical graduate shall not be eligible for
this program if he or she has not graduated from a school in good
standing that is recognized by the Medical Board of California.
   (d) Upon selection for the pilot program, participants may submit
an application to the International Medical Graduate Liaison of the
Medical Board of California's Division of Licensing, with the
appropriate fee, to initiate the medical licensing review process,
providing the participant time to remediate any deficiency during the
three-year international medical graduates pilot program.
   (e) All program participants shall be required to have the foreign
language fluency and the cultural knowledge necessary to serve the
non-English-speaking community at the nonprofit community health
center where they practice.
   (f) The Medical Board of California shall issue an applicant
status letter to participating and qualifying international medical
graduates.
   (g) International medical graduates shall be required to
participate and satisfactorily complete a six-month orientation
program that will address medical protocol, community clinic history
and operations, medical administration, hospital operations and
protocol, medical ethics, the California medical delivery system,
health maintenance organizations and managed care practices, and
pharmacology differences. International medical graduates who have
passed the Educational Commission for Foreign Medical Graduates
(ECFMG) language exam shall not be required to be enrolled in English
language classes. However, if a participating international medical
graduate has not passed the ECFMG language exam, he or she shall be
enrolled in English language acquisition classes until he or she
obtains a level of English language proficiency equivalent to the
ECFMG language exam.
   (h) (1) Upon satisfactorily completing the orientation program and
the one-year residency training program, international medical
graduates shall be selected by nonprofit community health centers to
work in nonprofit community health centers and disproportionate share
hospitals whose service areas include federally designated Health
Professional Shortage Areas, Dental Professional Shortage Areas,
Medically Underserved Areas, and Medically Underserved Populations
for a period not to exceed three years.
   (2) There shall be two residency programs operated under the
auspices of a medical school in good standing, with one in southern
California and one in northern California. These residency programs
shall be in family practice, internal medicine, or obstetrics and
gynecology.
   (3) After successfully completing the one-year residency program,
the training institution for the one-year residency program for
international medical graduates may transfer the program participant
into an approved residency program.
   (i) (1) All program participants shall be required to satisfy the
medical curriculum requirements of Section 2089, the clinical
instruction requirements of Section 2089.5, and the examination
requirements of Section 2170 prior to being admitted into an approved
residency program.
   (2) Those international medical graduates who are transferred into
an approved residency program shall be required to work in nonprofit
community health centers or disproportionate share hospitals whose
service areas include federally designated Health Professional
Shortage Areas, Dental Professional Shortage Areas, Medically
Underserved Areas, and Medically Underserved Populations for not less
than three years after being fully licensed.
   (j) For individuals in this program as specified in this section,
the applicant status letter shall be deemed a license in good
standing pursuant to the provisions of this article for the purpose
of participation and reimbursement in all federal, state, and local
health programs, including managed care organizations and health
maintenance organizations.
   (k) (1) The Director of General Medical Education or an equivalent
position in the training institution of the one-year residency
program for international medical graduates shall have the authority
to make a recommendation to the Medical Board of California for the
full medical licensure of an international medical graduate who has
successfully completed the one-year residency program if the director
believes, based on the performance and competency of the
international medical graduate, that the international medical
graduate should be fully licensed.
   (2) After reviewing the recommendation for full licensure from the
director, the Medical Board of California shall have the authority
to issue a permanent license to practice medicine in this state to
the international medical graduate.
   (l) If an international medical graduate desires to secure a
permanent license to practice medicine from the board, he or she
shall, among other things, be required to be admitted into an
approved residency program.
   (m) The Medical Board of California, in consultation with medical
schools located in California, executive and medical directors of
nonprofit community health centers, and with hospital administrators,
shall provide oversight review of the implementation of this
program. The Medical Board of California shall ensure that funding
proposals by appropriate institutions to implement these provisions
meet the necessary funding thresholds to fulfill the intent of this
program. Implementation of this program may not proceed unless
appropriate funding is secured. The Medical Board of California shall
report to the Legislature every January the program is operational
regarding the status of the program and the ability of the program to
secure the funding necessary to carry out its required provisions.