Medical Board of California Annual Report 2023-2024

2 0 2 3/ 2 4 AN N U AL R E PO R T MEDICAL BO ARD OF CALIFORNIA Board Roster Executive Summary Licensing Program Enforcement Program Allied Healthcare Professionals 3 4 8 13 21

MED IC AL BOAR D OF CALIFORNIA Protecting co nsumers by advancing high qual ity, s afe medical care. E xecutive Office 2005 Ev ergreen Str eet, Suite 120 0 Sacramento, C A 9 5815 - 5401 Phone: (916) 263 - 23 8 2 Fax: (916) 263 - 2944 w w w.mbc.ca.gov Gavin N ewsom, G overnor, State o f C alifornia | B usiness, C onsumer S ervices a nd Ho using A gency | D epartment o f Consumer A ffairs TO: Members of the Cal ifornia S tate Le gisl ature Of fice of the Secret ary of the S enate Of fice of the Chief Clerk of the Assembly Of fice of the Legislativ e Counse l FROM: Reji Var ghese, E xecutiv e Direct or DATE: Oct ober 1, 202 4 RE: Fisc al Year 20 2 3 - 202 4 A nnual R eport of the Medical B oard of Califor nia Pursuant to Bus iness and P rofess ions Cod e se ction 2313 a nd Governm ent Code sect ion 9795, I am please d to submit the Fis cal Year 20 2 3- 202 4 Annu al Re port of t he Medical Bo ard of Calif ornia (Board). This r eport cont ains a summ ary of the Board’s key activit ies betwe en July 1, 20 2 3, and J une 30, 202 4, incl udi ng vari ous stat istics related to it s budget and the e nforc ement and lice nsing progra ms. This r eport discus ses var ious act ions taken re la ted, but not limited to, t he followi ng: • Implementation of the Board’s 2023 sunset review legislation, including related changes to the Board’s enforcement process. • Public discussions on possible revisions to impairment questions on physician- related initial applications. • Progress made towards a paperless licensing application process. • Update on the Licensed Physicians from Mexico Pilot Program, Physician Health and Wellness Program regulations, and the Board’s medical expert reviewer and consultant programs. • Reports of the enforcement monitor appointed pursuant to SB 806 (Roth) of 2021. • Public stakeholder meetings held during the fiscal year. • Changes to Board leadership. The Boar d’s annua l report s are av ailable f or vie wing and dow nload on line at htt ps:/ /www.mbc.ca. gov/Resourc es/Pu blic ations /Annual - repor ts.as px. To r equest a har d copy of t he report, please cal l the Board ’s execut ive offic e at (916) 263 - 2389. Medical Board of California Annual Report | 2023-2024 2

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 seven standing committees, seven task forces, two disciplinary panels, and the Midwifery Advisory Council that assist with the work of the Board. Kristina D. Lawson, J.D. Irving Ayala-Rodriguez, M.D. Marina Torres, J.D. President Anni Chung Veling Tsai, M.D. James M. Healzer, M.D. Vice President Michelle Anne Bholat, M.D. Secretary Asif Mahmood, M.D. Wendy Mitchell Richard E. Thorp, M.D. Eserick "TJ" Watkins Felix C. Yip, M.D. MISSION The mission of the Medical Board of California is to protect healthcare consumers and prevent harm through the proper licensing and regulation of physicians and surgeons and certain allied healthcare 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, policy, and regulatory functions. VISION The Medical Board of California's vision is to be the premier consumer protection agency by leading and partnering in the effort to prevent harm and advance high quality, safe medical care. VALUES Accountability, Consumer Protection, Empathy, Fairness, Integrity, and Trust Gavin Newsom Reji Varghese Governor Executive Director Medical Board of California Annual Report | 2023-2024 3

EXECUTIVE SUMMARY IMPLEMENTING 2023 SUNSET REVIEW LAW CHANGES Senate Bill (SB) 815, the Board’s most recent sunset legislation, was signed into law on September 30, 2023, and brought significant changes to the Board’s licensing and enforcement programs effective January 1, 2024. Notable changes in the law include increases to the Board’s physician-related fees, the transfer of the research psychoanalyst program to the Board of Psychology, establishment of a Complainant Liaison Unit, new requirements to conduct interviews prior to closing quality-of-care complaints, and the collection of patient impact statements related to complaints referred to a field investigation. The California state budget for Fiscal Year 2024-2025 included funding and authority for the Board to hire additional staff positions necessary to establish the Complainant Liaison Unit and conduct additional interviews related to quality-of-care complaints. The Board’s website will be updated to include information on these new functions when they take effect. TASK FORCE REVIEWED LICENSE APPLICATION IMPAIRMENT QUESTIONS Two Board members (Nicole Jeong, J.D., and Veling Tsai, M.D.) were appointed in May 2024 to conduct a public process to gather input from various stakeholders to consider possible changes to the impairment questions on the Board’s physician license applications. The Task Force held a public Interested Parties Meeting on July 30, 2024. BOARD MEMBER APPOINTMENTS AND CHANGES TO STAFF LEADERSHIP Governor Gavin Newsom appointed several members to the Board: Irving G. Ayala-Rodriguez, M.D., Anni Chung, Wendy Mitchell, Marina Torres, J.D., and Felix Yip, M.D. The following executive staff leadership positions were filled: Marina O’Connor as Deputy Director, Douglas Hock as Chief of Licensing, and Alexandria Schembra as Public Information Manager. ENFORCEMENT MONITOR FINAL REPORT Senate Bill 806 (Roth, Chapter 649, Statutes of 2021) required DCA’s director to approve an enforcement monitor for the Board. Alexan RPM Inc. was hired in July 2022 to monitor and report on the Board’s enforcement program. The enforcement monitor ’ s report released in August 2023, included recommendations related to: 1) The Board’s Central Complaint Unit; 2) Investigation and Discipline Process; 3) Physician and Surgeon Demographic Data Analysis; and, 4) Administrative matters affecting the enforcement program. The Board discussed this report during a public meeting on March 1, 2024, and looks forward to working with interested parties in its effort to continually improve the enforcement process. DID YOU KNOW? You can print your own wallet license using the Board's Wallet License Generator. To learn more, visit the Board's website at https://www.mbc.ca.gov/W alletCard Medical Board of California Annual Report | 2023-2024 4

P h ysician s and S u r geons ' Y ear i n Rev i ew 10, 47 9 12,9 7 3 Applications Lice nses Re ce ive d 1 Is sued 1 1 Includes Postgraduate Training Licenses 72,68 5 9, 7 1 5 Lice nses Complain ts Ren ewed Re ce ive d BOARD MEETING DISCUSSION ON MATERNAL MORTALITY The Board held an important public discussion in Bakersfield on maternal mortality, which included a focus on data and statistics related to Black maternal health, and how California compares to other states. The Board members and attendees heard from distinguished speakers and leaders who provided national, state, and local perspectives on this vital topic and, importantly, heard from the public. The meeting agenda, presentation materials, and a video recording of this discussion are available on the Board’s website. RENEW early Avoid potential lapses in licensure. Learn more by visiting the Board's website: https://www.mbc.ca.gov/Licensing/ PHYSICIAN HEALTH AND WELLNESS REGULATIONS WITHDRAWN During their public meeting on May 23- 24, 2024, the Board decided to no longer proceed with a rulemaking to establish a physician health and wellness program, as authorized under current law. Instead, the Board directed staff to develop a legislative proposal that is aligned with national best practices for the treatment of physicians with substance use disorders or other mental health issues, for Board approval at a future public meeting. UPDATE ON LICENSED PHYSICIANS FROM MEXICO PILOT PROGRAM (LPMPP) The 2nd Annual Progress Report on the LPMPP was released in October 2023 and discussed at the Board’s November 30-December 1, 2023, meeting. Later in the fiscal year, the Board supported two bills that would extend and expand this successful program. For more information, please see Assembly Bill (AB) 2860 and AB 2864. Medical Board of California Annual Report | 2023-2024 5

BUDGET SUMMARY Physicians' renewal fees are the primary source of revenue for the Board, as illustrated on the revenues and reimbursements chart on page 7. The budget distribution chart reflects the actual expenditures in each of the Board's programs. FY 2023-2024 marked the second complete year during which the Board possessed the authority to order cost recovery for case investigation and prosecution, following the reinstatement of that authority on January 1, 2022. The Board is also reimbursed for probation monitoring costs. Based on FY 2023-2024 expenditures, the Enforcement Program accounts for approximately 75 percent of the Board's overall expenditure; including legal services and probation monitoring costs. The Licensing Program accounts for about 14 percent of the Board's overall expenditure, while Executive and Administrative Services account for six percent, and the Information Systems Branch the remaining five percent. The Board is currently facing a financial structure imbalance and required a $6 million loan to ensure solvency at the conclusion of FY 2023-2024. The Board also required an $8 million loan in June 2023 and paid off a $10 million loan from FY 2021- 22. The Board currently owes $14 million to the Vehicle Inspection and Repair Fund. SB 815 was signed into law by Governor Newsom on September 30, 2023, which increased the Board’s biennial renewal and initial licensing fees to $1,151, effective January 1, 2024, with another increase to $1,255 effective January 1, 2027, and ongoing. While the Board works diligently to appropriately control its expenditures, it continues to monitor revenues to determine if the current fee structure is sufficient to repay its debts, build financial reserves, and support its operations. D O W N LOA D THE fo r i O S! Medic al Boa r d o f Ca l i fo r n ia App     Qui c k, Op tim ized A c cess t o W ebsit e Con t ent Fol low up t o 1 6 Doct ors’ Lic enses Im mediat e License Pr ofil e A c cess t o the Doct or s Being Fo llow ed Free, A ut omated Lic ense Al er t No tifi c ations When Pr ofil e is Updat ed Medical Board of California Annual Report | 2023-2024 6

BUDGET CHARTS AND TABLES The numbers shown in the associated charts and tables below are preliminary and do not reflect all revenues and expenses for FY 2023-2024. For the most recent data see the Executive management report included in the Board’s quarterly board meeting documents. Reve n u e s a n d Re i m b u r s e m e nt s 1 Budge t Distr ibution Re imbur s ements 7% Ap pl icat ion a nd In it ial L ice nse Fees 2 10 % Revenues and Reimbursements 1 Renewals 2 Application and Initial License Fees 2 Other³ Reimbursements Total Executiv e Other 3 3% 5% En forcem ent Operations 5 4 4% Administrativ e Se r vice s 3% Pro bati on Mo ni tor i ng 5 Ren ewal s 2 78% $64,498,371 78% $8,393,356 10% $4,043,480 5% $5,908,602 7% $82,843,809 100% 4% Information Sy ste m s 5% Leg al a nd He ar in g Ser v ices 4 27% Licensing 5 14 % Budget Distribution Enforcement Operations 5 $32,680,395 44% Legal & Hearing Services 4 $19,599,955 27% Licensing 5 $9,979,261 14% Probation Monitoring 5 $3,287,572 4% Information Systems $3,947,573 5% Executive $2,318,419 3% Administrative Services $2,136,123 3% Total $73,949,298 100% 1 Financials through period 12, as of August 14, 2024. Period 13 is not yet closed. 2 Physicians and Surgeons. 3 Regulatory Fees, Delinquency/Penalty/Reinstatement Fees, Interest on Fund, and Miscellaneous. 4 Includes Attorney General Services, Office of Administrative Hearings, Court Reporter Services, and Miscellaneous Legal Fees. 5 Excludes Attorney General Services, Office of Administrative Hearings, Court Reporter Services, and Miscellaneous Legal Fees. Medical Board of California Annual Report | 2023-2024 7

LICENSING SUMMARY The Board’s Licensing Program (Program) protects consumers by setting requirements for licensure consistent with statutory and regulatory law, including education, experience, and demonstrated competence, and issues licenses to individuals meeting those requirements. The Program also provides license verification services, issues fictitious name permits, special faculty permits, and approves accreditation agencies for the accreditation of outpatient surgery settings. In FY 23-24, the Program issued 28% more Physician’s and Surgeon’s licenses and 13% more Postgraduate Training Licenses than in FY 22-23. The Program continued its focus on transitioning to a paperless licensing process by requiring medical schools and postgraduate training programs to submit certain primary source documents through the Board’s Direct Online Certification Submission (DOCS) service. STREAMLINING THE PAPERLESS APPLICATION PROCESS In continuance of the Board’s transition to a paperless process, starting January 1, 2024, the Board began only accepting certain documents electronically through its DOCS portal or through any of the other Board-accepted third-party services. Making this change was one of the last major steps towards a completely paperless licensure process, which supports the efficient processing of licensing applications. DOCS is a secure, fast, and reliable online document delivery system that allows medical schools and postgraduate training programs to submit primary-source licensing documents to the Board. To further decrease workload and processing times, the Board introduced an option for applicants to authorize another individual to receive information about the status of their application and/or submit documentation to the Board on the applicant’s behalf. The Board often receives requests for application status information from third parties, such as postgraduate training programs, which require the applicants to email or mail a signed authorization to the Board. Allowing applicants to grant such authorization during the application process streamlines this step for the applicants and Board staff. Ph ysician ’ s and Surgeon ’ s Demog raphics Age Sex 14,639 35,494 29,260 22,522 11,325 2,166 38,056 Total Female 40,000 40% 61,346 Total Male 30,000 60% 20,000 92,026 Unreported/ Undisclosed 10,000 <1% 90 0 34 35- 4 4 45-54 55-64 65-74 75-84 85 and and under over Medical Board of California Annual Report | 2023-2024 8

CONTINUING MEDICAL EDUCATION (CME) AUDITS BY EMAIL The Board randomly audits five percent of its licensees and registrants to review their compliance with mandatory CME requirements. Starting March 2024, the Board began sending CME audit letters via email instead of by mail, saving staff time and resources. Additiona lly, the Board began accepting CME audit documents electronically to a designat ed CME email address. Moreove r, the Board’s partnership with the Accreditation Council for Continuing Medical Educatio n (ACCME) allows the Board to access their Program and Activity Reporting System, or PARS, which provides licensee CME completion records uploaded by participating CME providers. Licensees whose CME credits are uploaded to PARS do not need to submit CME verificatio n documents to the Board when audited. STAY IN THE KNOW! Like us on Facebook Download our mobile app Follow us on X Check out our Newsletter Follow us on YouTube Listen to our latest Podcast Medical Board of California Annual Report | 2023-2024 9

 PHYSICIANS AND SURGEONS BY COUNTY Del Norte Siskiyou Modoc Shasta Lassen Trinity Humboldt Tehama Plumas Mendocino Butte Glenn Sierra Nevada Colusa Yuba Lake Placer Sutter El Dorado Yolo  Sacramento Napa Alpine Sonoma Amador Solano Calaveras Marin San Tuolumne Contra Joaquin Costa San Francisco Alameda Stanislaus Mariposa Santa San Mateo Clara Madera Merced Santa Cruz Fresno San Benito Mono Inyo Monterey Kings Tulare San Luis Obispo Kern Santa Barbara Ventura Los Angeles San Bernardino Orange Riverside San Diego Imperial Medical Board of California Annual Report | 2023-2024 10

Ph ysic ians and Sur geons b y C ounty 1 County County County Alameda 5,772 Riverside 4,057 Stanislaus 1,055 Alpine 2 Sacramento 5,936 Sutter 181 Amador 66 San Benito 41 Tehama 49 Butte 426 Trinity 8 San Bernardino 4,823 Calaveras 45 Tulare 599 San Diego 12,638 Colusa 10 Tuolumne 113 San Francisco 7,648 Contra Costa 3,745 Ventura 2,167 San Joaquin 1,321 Del Norte 26 Yolo 532 San Luis Obispo 849 El Dorado 353 Yuba 51 San Mateo 3,318 Fresno 2,370 Total Santa Barbara 1,294 125,619 In State Address Glenn 10 Santa Clara 9,895 Total Humboldt 283 Santa Cruz 764 27,843 Out-of-State Address Imperial 126 Shasta 394 Total 153,462 Inyo 47 Sierra 0 1 Da t a i s for p hysi cia ns w ith a ren ewed Kern 1,241 Siskiyou 66 an d cur re nt lice nse e xclu di ng th ose i n an i na ctive, reti red, o r d isa ble d li cens e Kings 132 Solano 1,041 stat us. T he b reakd own of t he excl ude d l icen se stat uses i s: Ca lifo r nia - 3,242, Lake 66 Sonoma 1,539 Ou t- of- S tate - 4, 575, To ta l - 7,81 7. Lassen 20 Los Angeles 33,183 Madera 260 Marin 1,627 Mariposa 10 Mendocino 158 Merced 219 Modoc 10 Mono 43 Monterey 1,001 Napa 464 Nevada 261 Orange 11,620 Placer 1,619 Plumas 25 Ph y sician's and Surgeon 's Licenses P as t Fiv e F Y's 140,000 143,000 146,000 155,000 FY 23-24 FY 22-23 FY 21-22 FY 20-21 FY 19-20 145,318 153,462 145,358 148,769 146,509 149,000 152,000 Medical Board of California Annual Report | 2023-2024 11

Lic enses Physician Applications Received Physician Applications Received Physician Licenses Issued FLEX/USMLE 1 NBME 1 Reciprocity with Other States (BPC §2135) Total Physician Licenses Renewed Renewal Licenses Issued - Fee Renewal Licenses Issued - Fee Exempt 2 Total Physician Licenses In Effect 3 In-State Address Out-of-State Address Total Physician License Administrative Activity Licenses Issued with Public Letters of Rep rima nd Probationary Licenses Issued Licenses Denied (No Hearing Requested) Statements of Issues to Deny License Filed Statements of Issues Granted (License Denied) Statements of Issues Denied (License Granted) Statements of Issues Withdrawn Postgraduate Training Licenses (PTL) PTL Applications Received Issued In Effect FY 22-23 8,649 6,086 179 1,374 7,639 67,033 6,230 73,263 121,714 27,055 148,769 4 5 17 0 1 0 1 0 2,145 2,810 7,552 FY 23-24 7,453 7,835 233 1,738 9,806 66,245 6,440 72,685 125,619 27,843 153,462 5 13 10 3 5 1 1 2 3,026 3,167 5,513 1 FLEX: Federation Licensing Exam. USMLE: United States Medical Licensing Exam. NBME: National Board Medical Examiners. 2 Includes physicians with disabled, retired, military, or voluntary services license status. 3 Excludes physicians with inactive, retired, or disabled license status. 4 Total physician licenses in effect including inactive, retired, or disabled license status - 156,418. 5 Total physician licenses in effect including inactive, retired, or disabled license status - 161,279. NEED YOUR LICENSE? Apply early and check the License Application Processing Times on the Board's website P er mits and Specia l Pr og rams FY 22-23 FY 23-24 Fictitio us Name Permits Issued 1,761¹ 1,736² Renewed 5,414 5,280 In Effect 13,444 13,319 Special Faculty Permits Issued 3 2 Renewed 13 10 In Effect 26 26 Special Programs Applications Received 57 60 Licenses Issued 58 57 Licenses Renewed 100 66 In Effect 132 138 1 Includes 29 Fictitious Name Permits issued on behalf of the Board of Podiatric Medicine. 2 Includes 23 Fictitious Name Permits issued on behalf of the Board of Podiatric Medicine. V e rifi c ation a nd R epo r ting FY 22-23 FY 23-24 License Status Verifications Telephone Verifications 1,028 1,095 Non-Verification Telephone Calls 47,012 1 42,542 2 Authorized License Verification 793 System (LVS) Internet Users Web License Look-Up 3 3,178,683 3,520,030 Certification Letters and Letters of Good 12,765 9,773 Standing Verifications Reporting Activities Disciplinary Reports Mailed to Health Facilities Upon Written Request Pursuant to 996 1,540 BPC §805.5 Adverse Actions Reported to the National 465 4 601 5 Practitioner Data Bank (NPDB) BPC §805 / §805.01 Reports of Health 97 / 3 92 / 1 Facility Discipline Received 1 Excludes the 14,401 listed under Consumer Inquiries on page 14. 2 Excludes the 11,145 listed under Consumer Inquiries on page 14. 3 Statistics from the Board’s BreEZe Online License Verification webpage. 4 Includes 457 MD's, 1 Polysomnographic Technologist, 1 Polysomnographic Trainee, and and 6 Licensed Midwives. 5 Includes 593 MD's, 1 Polysomnographic Technologist, 1 Polysomnographic Trainee, and 6 Licensed Midwives. Medical Board of California Annual Report | 2023-2024 12 834

ENFORCEMENT SUMMARY The Board’s Enforcement Program is responsible for reviewing thousands of complaints the Board receives each fiscal year and managing them through the investigatory and disciplinary processes. During FY 23-24, the Board received 9,715 complaints, compared to 9,521 complaints received in FY 22-23. COMMUNICATION AND PROCESS IMPROVEMENTS Effective January 1, 2024, BPC section 2220.2(b)(1) was implemented providing the relevant complainant, patient, or patient representative (referred to here as “complainant”) the option to provide a statement relative to the harm they experienced (“impact statement”). BPC section 2220.2(b)(2) further states, the complainant shall have up to 60 days following the receipt of notification to provide a statement to the Board. To implement this new process, the Board updated its letters informing the complainant when their complaint is referred to the Division of Investigation, Health Quality Investigation Unit (HQIU) for further investigation (January 1, 2024 and thereafter) and include information about the opportunity to provide a complainant impact statement. The Board also created an email address specifically for receiving the complainant’s impact statement. Finally, the Board updated its website regarding complainant impact statements, the enforcement process (to include information about impact statements), updated template letters to consumers, licensees, and other stakeholders, and created letters acknowledging receipt of impact statements. In November 2023, the Board received data from the California Department of Public Health regarding deaths related to opioids in 2022. The Board is working with medical consultant staff to review the data as part of the Prescription Review Program to identify deaths related to prescribed medication and determine whether to initiate a complaint. Ph y sician's and Surgeon 's Compla ints P as t Fiv e F Y's 10,103 9,943 10,868 9,715 9,521 9,000 10,000 11,000 FY 23-24 FY 22-23 FY 21-22 FY 20-21 FY 19-20 Medical Board of California Annual Report | 2023-2024 13

EXPERT REVIEWER/MEDICAL CONSULTANT PROGRAMS During FY 2023-2024, the Board continued to focus on the recruitment of new medical experts and consultants and established a new process to increase the retention of existing reviewers. Staff continue to conduct outreach to professional societies and organizations to assist in the recruitment of specialty practitioners to serve as experts and consultants. Additionally, recruitment advertisements were included in the Board’s quarterly newsletters, highlighting the need for reviewers in various specialties, including Licensed Midwives. Staff worked to identify individuals available to act as both expert reviewers and medical consultants and created a new report to facilitate locating evaluators by county, to accelerate selecting experts for cases requiring physical or mental evaluations. THE BOARD NEEDS YOU! If you a re cur rently p ractic ing i n Cali f o rn ia, the B oard ne eds your h elp a s an E xpe r t Re vi ew e r. Th e Board i s look in g f o r physi c al and men tal e xaminers, clinical diagnostic exami ne rs, an d psycho log ist s. Fo r infor mat ion an d how t o ap ply, p lea se vis it ou r E xp er t Revi ewer webp age, o r c o n tact the B oard’ s E x per t Reviewer P r og ram at: MBCMe dicalE xpertProgram @mbc. ca. go v The Board also obtained the necessary software to transition the quarterly expert training sessions to a self-paced virtual platform. Staff completed the initial training needed to use the software, and efforts to pilot the training with a small group of medical consultants are in progress. In April and August 2024, staff successfully conducted expert training sessions via WebEx, attracting over 60 attendees in total. Ph y sician's and Surgeon 's Enf o r cement S um mar y FY 22-23 FY 23-24 Complaints 1 Complaints Received 9,521 9,715 Complaints Closed by Complaint 9,009 8,950 Unit Closed 1 7,850 7,813 2 Referred to Cite and Fine 79 131 Referred to Investigations 1,080 1,006 Investigations Opened 1,099 1,023 CIO 287 287 HQIU 812 736 Closed 1,142 1,024 CIO 238 282 HQIU 904 742 Investigation Referrals Referred to the AG 448 406 MBC 113 107 HQIU 335 299 Cases Referred for Criminal Action 17 19 Probation Violation Reports 42 30 Referred to the AG Consumer Inquiries Consumer Telephone Inquiries 14,401 11,145 Consumer Jurisdictional Inquiries 7,921 6,130 1 FY 22/23 - 2,341 complaints closed were received in a prior fiscal year. FY 23/24 - 2,484 complaints closed were received in a prior fiscal year. 2 Represented as total closures in the "Complaints Closed by Complaint Unit" Chart on page 15. Medical Board of California Annual Report | 2023-2024 14

Ph y sician and Surgeon Compl aints R eceiv ed by C omp laint T ype and Sou r ce Business and Licensee/ Total Type Professions Professional Government Complaints Public Code 1 Group 2 Agency 3 Anonymous Received Fraud 53 2 4 8 9 76 Health and Safety 4 142 1 6 55 54 258 Non-Jurisdictional 5 1,021 9 49 51 578 1,708 Gross Negligence/Incompetence 6 3,506 577 32 468 302 4,885 Personal Conduct 7 47 39 10 208 54 358 Unprofessional Conduct 8 922 119 71 689 234 2,034 Unlicensed/Unregistered 118 0 10 100 167 396 Total Source Complaints Received 5,809 747 182 1,579 1,398 9,715 1 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. 2 Includes the following complaint sources: other Licensee, Professional Society or Association. 3 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. 4 Includes excessive prescribing, sale of dangerous drugs, etc. 5 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. 6 Includes complaints related to the quality of care provided by licensees. 7 Includes licensee self-abuse of drugs/alcohol, conviction of a crime, etc. 8 Includes sexual misconduct with patients, failure to release medical records, violation of BPC §805 reporting, etc. Fi sc a l Y ear 20 23 - 2 024 C ompl aints Closed b y Compla in t Un it Medical Board of California Annual Report | 2023-2024 15

A dmin istr ativ e A ctions P eti tion A ctivity Administrative Actions Accusation Petition to Revoke Probation/Accusation and Petition to Revoke Amended Accusation/Petition to Revoke Completed Investigations Referred to the AG and Awaiting the Filing of Accusation as of June 30, 2021 Cases Over 6 Months Old that Resulted in the Filing of Accusation Administrative Outcomes License Revoked License Surrendered (in Lieu of Accusation or with Accusation Pending) License Placed on Probation with Suspension License Placed on Probation Probationary License Issued Public Reprimand Other Actions (e.g., Exam Required, Educational Course, etc.) Accusation Withdrawn Accusation Dismissed Probation Violation Outcomes License Revoked License Surrendered Additional Suspension and Probation Additional Probation Public Reprimand Other Actions (e.g., Exam Required, Educational Course, etc.) Petition Withdrawn Petition Dismissed Referral and Compliance Actions Citation and Administrative Fines Issued FY 22-23 230 23 85 91 196 22 63 4 142 17 75 3 7 9 14 26 0 6 1 1 0 1 195 FY 23-24 249 27 49 81 251 15 66 2 130 10 97 1 14 7 8 36 0 7 0 2 3 0 135 FY 22-23 FY 23-24 Petitions for Reinstatement of License Filed 6 13 Granted 7 2 Denied 9 7 Petitions for Penalty Relief 1 Granted 24 19 Denied 6 1 Petitions to Compel Exam Filed 24 35 Granted 21 39 Denied 0 0 1 Penalty Relief includes: Petitions for Modifcation of Penalty and Petitions for Termination of Probation. License Restrictions/Suspensions and Temporary Restraining Orders FY 22-23 FY 23-24 Imposed while Administrative Action Pending Interim Suspension Order (ISO) 17 13 1 Temporary Restraining Order (TRO) 0 0 Other Suspension Orders 30 31 2 Sought and Granted by Sought Granted 3 Case Type for FY 23-24 Gross Negligence/Incompetence 8 5 Inappropriate Prescribing 2 1 Unlicensed Activity 0 0 Sexual Misconduct 4 6 Mental/Physical Illness 15 11 Self-Abuse of Drugs/Alcohol 16 6 Fraud 2 1 Criminal Charges/Conviction 4 1 Unprofessional Conduct 15 13 Total 66 44 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; 0 - drug or alcohol abuse involving death or serious bodily injury; 0 - excessive prescribing; 0 - excessive recommending of medical cannabis; 0 - sexual misconduct with a patient; 0 - practicing under the influence of drugs/alcohol; and 0 - excessive prescribing to a minor. 2 Includes 2 - Automatic Suspension Orders per BPC §2236; 5 - license restrictions per Penal Code §23; 2 - license restrictions pursuant to court order; 0 - out-of-state suspension orders per BPC §2310; 0 - stipulated agreements to suspend or restrict the practice of medicine; and 22 - cease practice orders issued for violation of probation condition or violation of interim suspension order. 3 Some orders granted were sought in prior FY. Medical Board of California Annual Report | 2023-2024 16

Reports 1 Malp r actice Se t tlement R epo r ts R eceiv ed R epo rt s R eceiv ed per B P C § § 8 05 and 8 0 5.0 1 per BPC §80 1.0 1 by Specialt y Pr actic e and Repor t Outc omes Physicians 2 Specialty/Subspecialty Anesthesiology Cardiology Colon and Rectal Critical Care Dermatology Diagnostic Radiology Emergency Medicine Endocrinology Forensic Pathology Gastroenterology General/Family Practice Gynecologic Oncology Gynecology Hematology Infectious Disease Internal Medicine Interventional Radiology Neurological Surgery Neurology Nuclear Medicine Obstetrics Occupational Medicine Ophthalmology Orthopedic Surgery Otolaryngology Pain Medicine Pathology Pediatrics Physical Medicine & Rehabilitation Plastic Surgery Preventive Medicine Psychiatry Pulmonary Disease Radiology Rheumatology Surgery Thoracic Surgery Urology Vascular Surgery 1 The procedure was performed in the practice specialty/ subspecialty; however, the physician may or may not have been certified in the specialty/subspecialty area. 2 California physicians certified in specialty according to the 2022-2023 American Board of Medical Specialties Certification Statistics Report. 805 805.01 Total Reports Received Total Reports Received 91 1 Peer Review Body Type Health Care Facility/Clinic 64 1 Surgical Center 3 0 Health Care Services Plan 11 0 Professional Society 0 0 Medical Group/Employer 13 0 Outcomes of Reports Received Pending Disposition 62 1 Cases Closed 29 0 R epo rt s R eceiv ed Based Upon Legal R equi remen ts for Ph ysician s and Surgeons FY 22-23 FY 23-24 Medical Malpractice Insurers 1 415 322 Attorneys/Self-Reported/Employers 1 131 196 Courts 2 0 0 Total 546 518 Other Required Reporting Coroners’ Reports 3 0 1 Criminal Charges and Convictions 4 54 37 Health Facility Discipline Reports 97 91 Medical Cause or Reason 5 Health Facility Reports 6 3 1 Health Facility Report Sexual Abuse/ 67 56 Misconduct Allegation 7 Outpatient Surgery Settings Reports 4 7 Patient Death 8 Total 225 193 Stem Cell Therapy Complaints and Action Taken 9 Complaints Received 3 3 Disciplinary Actions Taken 1 3 Administrative Actions Taken 0 0 Medical Board of California Annual Report | 2023-2024 28 12 1 2 6 9 29 1 2 8 32 5 22 1 1 39 1 8 12 1 47 1 10 34 11 4 4 7 2 29 1 8 7 45 1 43 4 13 8 8,055 4,544 260 2,397 2,449 4,898 6,097 1,188 188 2,124 12,281 160 7,307 1,580 1,264 26,492 440 751 3,073 623 7,307 507 3,160 3,741 2,012 894 4,933 13,973 1,572 1,377 2,655 10,440 2,185 1,529 862 4,944 668 1,575 424 1 Per BPC §801.01. 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 §805.8. 8 Per BPC §2240(a). 9 Physicians and surgeons, licensed midwives, research psychoanalysts, and polysomnographic program. 17

A dm inis tr ativ e and Probation Vi olation Outc o mes b y Case T ype 1 Revocation Surrender Probation with Suspension Probation Probationary License Issued Public Reprimand Other Total Actions Gross Negligence/ Incompetence Inappropriate Prescribing Unlicensed Activity Sexual Misconduct Mental/Physical Illness Self-Abuse of Drugs/Alcohol Fraud Conviction of a Crime Unprofessional Conduct Total Administrative Actions 4 40 0 70 1 49 1 165 0 15 0 20 0 3 1 39 0 3 0 2 0 2 0 7 2 11 1 2 0 4 0 20 3 14 0 6 0 0 1 24 2 10 1 26 1 15 0 55 3 3 0 2 0 1 0 9 2 1 0 1 0 2 0 6 7 5 0 8 8 21 0 49 23 102 2 137 10 97 3 374 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; 35 - excessive prescribing; 0 - excessive recommending of medical cannabis; 13 - sexual misconduct with a patient; 4 - practicing under the influence of drugs/alcohol; and 0 - excessive prescribing to a minor. A v erage Enforc ement Proc es sing T ime Frames 1 Enf o r cement Pr og r a m C aseload FY 22-23 FY 23-24 Per Investigator/ Statewide Inspector 579 582 Health Quality Investigation Unit 487 439 (Department of Consumer Affairs) 4 Active Investigations 1,040 11 5 275 254 AG Cases Assigned 6 370 112 4 123 120 Probation Unit 7 101 Monitoring Cases 8 518 32 Complaint Investigation Investigation AG Other Process Process Process Filing Legal (Non-Sworn) (Sworn) Process 2 Process 3 1 Average and median time (calendar days) in processing complaints during the fiscal year, for all cases, from date of Median E nf o r cemen t Proce ss ing T ime Frames 1 original receipt of the complaint, for each stage of discipline, through completion of judicial review. FY 22-23 FY 23-24 2 Days from case transmittal to initial pleading filed. 563 556 3 Days from filing to final case disposition. 4 432 392 Includes physicians and surgeons, licensed midwives, and polysomnographic program. 5 Average is determined by using the total number of authorized positions, including vacant positions. 6 Cases are at various stages of AG processing and may require 240 210 supplemental investigative work, such as subpoena services, interviewing new victims or witnesses, testifying at hearings, etc. 7 Includes physicians and surgeons, licensed midwives, and 94 81 63 52 poloysomnographic program probationers. 8 59 additional monitoring cases were inactive because the probationer was out of state as of June 30, 2024. Complaint Investigation Investigation AG Other Process Process Process Filing Legal (Non-Sworn) (Sworn) Process 2 Process 3 Medical Board of California Annual Report | 2023-2024 18

Substance-Abusing Licensees FY 22-23 FY 23-24 FY 22-23 FY 23-24 Probationers Probationers Whose Conduct was Related to a Substance-Abuse Problem Substances Involved 1 Alcohol Ambien Amphetamine Benzodiazepine Cannabis Cocaine Demerol Fentanyl Fioricet Methamphetamines Opiates Propofol Psilocybin Multiple Controlled Substances Probation Completion Probation Successfully Completed 2 (Y) Failed to Complete Probation (N) Substances Involved 1 Alcohol Cannabis Cocaine Fentanyl Opiates Psilocybin Methamphetamines Multiple Controlled Substances Relapses Probationers who Relapsed Substances Involved 1 Alcohol Amphetamine Cocaine Fentanyl Meprobamate Methamphetamines Methaqualone Opiates Tramadol 145 141 102 1 1 2 5 3 1 1 1 3 2 2 0 53 100 1 2 1 4 2 1 1 1 4 1 2 0 49 Y 21 14 N Y 16 9 N 13 1 1 0 0 0 1 8 11 0 0 0 1 0 0 7 10 0 0 0 0 1 3 5 7 1 1 0 0 0 0 3 6 3 5 2 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 Cease Practice Orders Probationers Issued a Cease Practice Order 9 5 Substances Involved/Reason for Order 1 Alcohol 5 2 Amphetamine 0 1 Cocaine 0 0 Fentanyl 0 0 Meprobamate 0 0 Methamphetamines 1 0 Methaqualone 0 0 Opiates 0 0 Tramadol 0 0 Failed to Appear for a Biological Fluid Test (BF T) 3 1 Failed to Cooperate with BFT 0 1 Failed to Successfully Complete a Clinical Competence Assessment Program 0 1 Multiple probation violations 0 0 Suspensions Probationers Issued a Suspension 0 0 Substance Involved N/A 0 0 Petitions to Revoke Petitions to Revoke 7 4 Substances Involved/Reason for Action 1 Alcohol 3 2 Cocaine 0 0 Fentanyl 0 0 Methamphetamines 1 0 Methaqualone 0 0 Opiates 0 0 Tramadol 0 0 Failed to Appear for a BFT 2 1 Failed to Successfully Complete a Clinical Competence Assessment Program 0 0 Multiple Probation Violations 1 1 Non-Practice Over 2 Years 0 1 Obey All Laws 0 0 Practicing Medicine in Own Home 0 0 1 Some probationers had more than one substance involved. 2 Those who successfully completed probation or a petition for termination of probation was granted. Medical Board of California Annual Report | 2023-2024 19

Substance-Abusing Licensees Major Violations by Substance 1 Alcohol FY 23-24 FY 22-23 Amphetamine FY 23-24 FY 22-23 Benzodiazepine FY 23-24 FY 22-23 Cannabis FY 23-24 FY 22-23 Cocaine FY 23-24 FY 22-23 Methamphetamine FY 23-24 FY 22-23 Opiates FY 23-24 FY 22-23 FY 22-23 Multiple Controlled Substances FY 23-24 Total Major Violations FY 23-24 FY 22-23 Failed to Undergo a Required Clinical Diagnostic Evaluation - 1 - - - - - - - - - - - - - - 0 1 Committed Multiple Minor Violations of Probation Conditions and Terms 3 2 - - - - - - - 1 1 - - - 2 - 4 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 - - - - - - - - - - - - - - - - 0 0 Failed to Undergo Biological Fluid Testing (BFT) when Ordered 12 9 1 - 1 - - 1 - 1 1 - 1 - 7 4 16 12 Used, Consumed, Ingested, or Administered to Himself or Herself a Prohibited Substance 2 6 2 - 1 1 - - - - - 1 - 3 - - - 11 3 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 2 - - - - - - - - - - - - - - - - 0 0 Substances Involved 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Per 16 CCR §1361.52(a)(1-8). 2 The categorized substance is the substance the individual used, consumed, ingested, or administered to themselves, not the substance involved in the original discipline. DID YOU KNOW? The initial application and renewal fee includes a mandatory $25 fee for the Steven M. Thompson Physician Corps Loan Repayment Program — a statewide scholarship and loan repayment program for a wide range of health- professions, students, and recent graduates. Visit the California Department of Health Care Access and Information website for more Information. Medical Board of California Annual Report | 2023-2024 20 0

ALLIED HEALTHCARE PROFESSIONALS Allied healthcare professionals under the Board’s authority include licensed midwives, research psychoanalysts, and the polysomnographic program, consisting of polysomnographic trainees, technicians, and technologists. In addition, the Board approves accreditation agencies for the accreditation of outpatient surgery settings. Issued Current Licenses and Registrations Licensed Midwives 26 491 Research Psychoanalyst 5 86 Polysomnographic Trainee 54 117 Polysomnographic Technician 25 149 Polysomnographic Technologist 37 624 Accreditation Agencies for Outpatient Surgery Settings 0 4 FY 22-23 FY 23-24 Complaints Complaints Received 25 49 Complaints Closed by Complaint Unit 20 50 Investigations Cases Opened 11 16 Cases Closed 11 12 Cases Referred to the Attorney General (AG) 5 3 Cases Referred for Criminal Action 2 1 Probation Violation Reports Referred to the AG 0 0 Reports Received Based Upon Legal Requirements Midwife Hospital Transfer Forms 1 230 219 Outpatient Adverse Event Reports 2 41 36 Referral and Compliance Actions Citation and Administrative Fines Issued 4 2 License Restrictions/Suspensions Imposed while Administrative Action Pending Interim Suspension Order 0 0 Other Suspension Orders 1 1 1 Per BPC §2510. 2 Per BPC §2216.3. 3 Penalty Relief includes Petitions for Modification of Penalty and Petitions for Termination of Probation. FY 22-23 FY 23-24 Administrative Actions Accusation 3 3 Petition to Revoke Probation 0 0 Amended Accusation/Petition to Revoke 1 2 Statement of Issues to Deny Application 0 1 Completed Investigations Referred to the AG and Awaiting the Filing of Accusation 0 0 as of June 30, 2021 Administrative Outcomes License Revoked 1 1 License Surrendered (in Lieu of Accusation or with Accusation Pending) 2 3 License Placed on Probation with Suspension 0 0 License Placed on Probation 4 2 Probationary License Issued 1 0 Public Reprimand 2 0 Other Actions (e.g., Exam Required, Educational Course, etc.) 0 0 Statements of Issues Denied (License Granted) 0 0 Statements of Issues Granted (License Denied) 0 0 Accusation/Statements of Issues Withdrawn 0 0 Accusation Dismissed 0 0 Probation Violation Outcomes License Revoked or License Surrendered 2 2 Additional Suspension or Probation 0 0 Petition Withdrawn or Dismissed 0 0 Petitions for Reinstatement of License Filed/Granted/Denied 0 / 0 / 0 0 / 0 / 0 Petitions for Penalty Relief 3 Granted/Denied 0 / 0 0 / 1 Petitions to Compel Exam Filed/Granted/Denied 0 / 0 / 0 0 / 0 / 0 Medical Board of California Annual Report | 2023-2024 21

2022 2023 Licensed Midwife Annual Report Summary 1 Clients Served as Primary Caregiver at the Onset of Care 7,568 7,444 Planned Out-of-Hospital Births at the Onset of Labor 5,123 4,958 Planned Out-of-Hospital Births Completed in an Out-of-Hospital Setting 2 4,339 4,174 Sets of Twin Births 1 4 Sets of Multiple Births (Other Than Twin Births) 0 0 Breech Births 132 89 VBAC (Vaginal Birth After Cesarean Section) 216 230 Complications Resulting in the Mortality of the Mother Prior to Transfer 0 1 Resulting in the Mortality of the Mother After Transfer 0 0 Resulting in the Mortality of the Infant Prior to Transfer 0 1 Resulting in the Mortality of the Infant After Transfer 8 3 Resulting in Fetal Demise Prior to the Mother Being Transferred 10 8 Resulting in Fetal Demise After the Mother was Transferred 5 12 Antepartum Transfers Primary Care Transferred to Another Health Care Practitioner (Elective) 329 Urgent or Emergency Transport of Expectant Mother 118 Intrapartum Transfers Elective Hospital Transfer 632 Urgent or Emergency Transfer of an Infant or Mother 156 Postpartum Transfers Elective Hospital Transfer of Mother 21 29 Elective Hospital Transfer of Infant 16 20 Urgent or Emergency Transfer of Mother 60 45 Urgent or Emergency Transfer of Infant 49 36 1 Conclusions should not be drawn from this summary as data does not specify whether the death is 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. 2 Clients delivering multiples is counted as one birth. New File Format for Reporting to CURES! Please visit the Office of the Attorney General's CURES Website to access the Data Submission guide for Dispensers and for additional updates and informational bulletins. For information about CURES, visit DCA's CURES information page. Medical Board of California Annual Report | 2023-2024 22 322 107 647 140