Friday, May 22, 2009

AB 933 (Fong) Wins Assembly Vote: Will Governor Arnie Schwarzenegger Continue his Gift Program to Insurance Companies? by Robert L. Weinmann, MD

AB 933 (Fong) won a resounding victory in the Assembly on Wednesday, 20 May 2009, on a 49 to 30 vote. The bill now goes to the Senate.

If AB 933 (Fong) becomes law it'll put a stop to the perfidious practice of some insurance companies that use non-California licensed physicians to do utilizatiion review in Workers' Compensation cases. These doctors who are not licensed to practice medicine in California are not responsible to the Medical Board of California for harmful decisions even though the Medical Board of California says that Utilization Review is part of medical practice and that doctors doing Utilization Review for California's injured workers should be licensed in California.

These exempt doctors are also not responsible to their own state boards since their own state boards don't have jurisdiction in California. In the meanwhile, cash-strapped California takes another body blow. Since these doctors aren't required to be licensed in California, they don't pay fees to the Medical Board of California. They get a free ride. Their share is paid by properly licensed doctors in California whose legal medical decisions are often blocked, delayed, and denied by the non-paying free-ride non-California licensed doctors. How d'ya like them apples, reader!?

Here's the rub: the propositions just got wiped out in the May 19th Special Election. Governor Schwarzenegger said that the people have spoken and now he'll have to teach them a lesson by cutting services right and left. Meanwhile, the Governor continues to give insurance companies a free ride by allowing them to employ Utilization Review doctors who don't pay license fees to the State of California. If only 1,000 non-California licensed doctors enjoy this benefit, the Medical Board of California is deprived of $808,000 (the real number has never been disclosed).

Governor Schwarzenegger is about to punish the public for not trusting political hypocrisy and for voting down his propositions. Meanwhile, he continues to reward insurance companies that hire non-California licensed doctors whose decisions often deprive injured workers and sick patients from the medical care they deserve.

Readers who have strong enough feelings on this issue need to make contact with their State Senators. So far the issue has been largely partisan, Democrats voting for the bill, Republicans, against. It is hard to believe that we're giving gifts to insurance companies while the public unnecessarily pays the piper


Thursday, May 7, 2009


On a strictly party line vote, AB 933 (Fong) cleared the Assembly Insurance Committee by a 7 to 3 vote: the aye votes were Joe Coto, chair; Charles Calderon, Wilmer Carter, Mike Feuer, Mary Hayashi, Jerry Hill, and Norma Torres. The nay votes were Martin Garrick, Sam Blakeslee, and Roger Niello.

AB 933 (Fong) will require doctors who do utilization review for injured workers in California to be licensed in California and pay fees to the Medical Board of California. The idea is to make sure that doctors who can delay, deny, approve, or modify treatment have the same licensure and are subject to the same discipline as are the injured workers' treating physicians.

Opponents argue that all physicians have the same training and education so licensure in any state should suffice. This assertion ignores the fact that California has specific rules, regulations, and educational requirements about pain management that are not required of non-California licensed doctors. Insurance companies use these doctors in part because under current law non-California licensed doctors may deny care, cause increased pain and suffering to injured workers, and suffer no recriminations for wrong or harmful decisions. Fong's utilization review bill will change all that -- treating, consulting, and utilization review doctors will all become responsible to the same state authority. It will put an end to the get-out-of-jail free cards that non-California licensed doctors now enjoy.

Opponents also incorrectly argue that there are not enough California doctors willing to do utilization review. By now the oppostion knows that this argument is false; nevertheless, they continue to hope this specious argument will convince someone. The fact is that there are so many more California-licensed doctors willing and able to do utilization review that they cannot all be hired. That is why one utilization review company has a waiting list of applicants for physicians who have applied for utilization review positions.

This question then arises: if there are enough California licensed doctors to do the job, why hire non-California licensed doctors? One answer is that the non-California licensed doctors aren't responsible to the Medical Board of California and are also not responsible to their own state medical board since an out-of-state medical board doesn't have jurisdiction in California. If the non-California doctor wrongfully denies care and harms an injured worker, that doctor is not subject to discipline by any state board at all. Such doctors are only responsible to their employers, the utilization review companies owned or retained by insurance companies, many known for spurious denials of indicated medical care. The not-so-silent accusation is that insurance companies seek to avoid medical costs by asserting that prescribed care isn't needed -- non-California licensed doctors are felt more likely to comply with this perversion of utilization review than doctors who are subject to medical discipline by specific state medical boards. Utilization review by non-California doctors is the latest health-care epidemic. It needs to be stopped.

Since AB 933 (Fong) is now ready for a floor vote in the Assembly, one can expect that the insurance companies will lay down the law to their Assembly allies, to their friends in the state senate, and to Governor Schwarzenegger (last year Gov. Schwarzenegger vetoed a similar bill thereby saving the necks of the insurance companies). The question this year is who will listen to arguments that have been shown to be bereft of truth.