Honorable Dave Cortese
1021 O Street, Room 6630
Sacramento, CA 95814
AB 636 - Utilization Review
Position - Co-Sponsorship
Dear Senator Cortese,
The California Neurology Society CNS) is proud to co-sponsor SB 636, your bill that will bring a new and much needed level of parity and safety to California’s utilization review system that has never been present before for employees in the private sector.
SB 636 will establish parity by requiring California licensure and oversight by the Medical Board of California to be the law of the land within California’s workers compensation utilization review system. For the first time, the safety net of California licensure and Medical Board oversight will be present for private sector employees when one of them is determined to be ill or injured because of their employment.
The California Supreme Court dealt with this issue in its King v CompPartners decision of 2018. Here, the Court decided against injured worker Kirk King, even though the utilization review process failed to protect King from catastrophic health emergencies caused by the sudden withdrawal of a vital prescription medicine due to a denial of said prescription ordered by an out-of-state licensed utilization review physician. Recognizing the constraint that current statute put upon its decision, the Court took great care to include a concurring opinion by Justice Liu wherein he wrote[1], “…the undisputed facts in this case suggest that the workers’ compensation system and the utilization review process in particular, may not be working as the Legislature intended.” Before closing his concurring remarks, Justice Liu repeated his suggestion by writing[2], “The limited record here raises doubts as to whether King’s utilization review was handled properly. The Legislature may wish to examine whether the existing safeguards provide sufficient incentives for competent and careful utilization review.”
Justice Cuѐllar, in his own concurring opinion providing an analysis of the statutory constraints within which the Court considered the King case, speaking to various safeguards, incentives and remedies made available by the Legislature, concluded[3], “Even now, those safeguards and remedies may not be set at optimal levels and the Legislature may find it makes sense to change them.”
SB 636 represents the opportunity to act on the Supreme Court’s explicit appeal by establishing the duty of care accountability lacking in California’s workers compensation utilization review system.
Cordially,
California Neurology Society
[1] “Concurring Opinion, Liu, J” page two
[2] “Concurring Opinion, Liu, J” page three
[3] “Concurring Opinion by Cuѐllar, J” page 6
