Updated: 1/21/10
CONSUMER PROTECTION ENFORCEMENT INITIATIVE
“A Systematic Solution to a Systemic Problem”
The Department of Consumer Affairs (DCA) is the umbrella agency that oversees 19 healing arts
boards that protect and serve California consumers. The healing arts boards regulate a variety of
professions from doctors and nurses to physical therapists and optometrists. These licensees are
some of the best in the country and provide excellent care to Californians on a daily basis.
However, when a licensee violates the laws that govern his or her profession, enforcement action
must be taken to protect the public.
In recent years some of DCA’s healing arts boards have been unable to investigate and prosecute
consumer complaints in a timely manner. In fact, some boards take an average of three years to
investigate and prosecute these cases; this is an unacceptable timeframe that could put consumers’
safety at risk.
DCA reviewed the existing enforcement process and found systemic problems that limit the boards’
abilities to investigate and act on these cases in a timely manner. These problems range from legal
and procedural challenges to inadequate resources. In response, DCA launched the Consumer
Protection Enforcement Initiative (CPEI) to overhaul the enforcement process at the healing arts
boards. The CPEI is a systematic approach designed to address three specific areas:
• Administrative Improvements
• Staffing and IT Resources
• Legislative Changes
Once fully implemented, DCA expects the healing arts boards to reduce the average enforcement
completion timeline from 36 months to between 12 and 18 months. DEPARTMENT OF CONSUMER AFFAIRS 2
Consumer Protection Enforcement Initiative
I. Administrative Improvements
During the review of the enforcement process, DCA worked with the boards to identify areas that
could be improved administratively to better coordinate broad enforcement objectives, improve the
services provided to the healing arts boards, and establish streamlined enforcement processes and
procedures that can be used by all boards. The following are some of the efforts that emerged from
those discussions:
“365 Project”
DCA’s Division of Investigation (DOI) embarked on a project in 2009 to strategically focus on cases
that were one year or older. DOI worked closely with boards to identify the cases upon which they
should focus their resources. This project has produced impressive results, and in 2009 the DOI
closed 50% more cases than the comparable period in 2008.
Delegation of Subpoena Authority
One of the initial administrative changes implemented by DCA was delegating subpoena authority to
each executive officer as a tool to gather evidence and interview witnesses. DCA’s Legal Office
conducted subpoena training for board staff, and this authority has started being exercised by
boards. We expect to see increased use of subpoenas as a result of this change, and boards will be
able to pursue cases that they otherwise would not have pursued.
Process Improvement
DCA and the boards are working to identify best practices for a number of enforcement processes
and procedures, such as complaint intake, handling of anonymous complaints, vote by email
protocols, and adjudication procedures. This effort will take advantage of the most effective
practices utilized by the various boards, and entities in other states, and will ultimately shave time off
all aspects of the enforcement process.
Enforcement Academy
DCA’s Strategic Organization, Leadership, & Individual Development Division is developing
enhanced training programs for enforcement staff. The enforcement academy will teach
investigators and other enforcement staff key skills used in complaint intake, investigation
procedures, case management, database use, and other areas. Never before has DCA offered
such a comprehensive enforcement training program. An initial training was offered in November
2009, and the full enforcement academy will begin its regular cycle in April 2010.
Deputy Director for Enforcement and Compliance
DCA established an executive level position that reports to the Director and is responsible for
regularly examining each board’s enforcement program to monitor enforcement performance and
compliance with all applicable requirements. This position monitors performance measures so that
boards’ enforcement programs can be continuously assessed for improvement.
Performance Expectations with Other Agencies
DCA has been working with the Attorney General’s Office and the Office of Administrative Hearings
(OAH) to establish performance agreements that will expedite the prosecution of cases. DCA and
the AG’s Office are developing expectations for filing accusations, setting settlement conferences,
and filing continuance requests. Further, DCA is working with OAH to establish timelines for setting
cases for hearings, which, once implemented, could reduce a case timeline by months. DEPARTMENT OF CONSUMER AFFAIRS 3
Consumer Protection Enforcement Initiative
II. Enhancing Enforcement Resources
There are 36 licensing entities under the DCA (of which are 19 healing arts boards) and, with a few
exceptions, all of these programs share the resources of the Department, from Division of
Investigations (DOI), to Personnel to IT Support. While the healing arts boards fall under the
umbrella of DCA they are separate semi-autonomous groups overseen by board members
appointed by the Governor and the Legislature. Additionally, all of the licensing entities under DCA
are special fund agencies funded exclusively through fees collected through licensees with no
general fund support.
Enforcement Staff
DCA’s review of the enforcement process identified a need for more focused staff resources in the
areas of investigations and complaint intake. The majority of DCA’s licensing entities share the
resources of DCA’s overburdened DOI. Annually, DOI’s 48 investigative staff members receive over
1,300 cases, in topics ranging from nurses to repossessors to smog check stations. Having so
many investigations performed by DOI has resulted in a number of problems, including loss of
control over the investigation by the boards, a lack of investigators with expertise in specific
licensing areas, and excessive caseloads. These problems have led to excessive turn-around times
and growing backlogs. Through the 365 Project, the DOI has worked with boards to reduce the
case backlog, but the current structure has revealed a need for more significant changes.
In order to increase accountability in the investigative process, DCA is working to provide boards
with the authority to hire non-sworn investigators to be housed within each board. This will enhance
boards’ control over investigations, allow for more appropriate workload distribution, and enable
investigators to develop expertise. Additionally, to coincide with process improvement efforts, some
boards will increase complaint intake staff. DCA is seeking a total of approximately 140 new
enforcement positions (full year equivalent) across all healing arts boards. The vast majority of
these positions are investigators and investigative supervisors, and the remainder is mostly
complaint intake staff. In addition to increasing staffing, DCA will ensure that staff are properly
trained, monitored, and assessed so that cases are expedited as quickly as possible.
Because DCA’s boards are special fund agencies, new positions will not place a drain on the
General Fund and boards will pay for new staff with existing resources or with fee increases where
necessary. The number of positions requested is a result of an individual assessment of each
board, and assumes workload savings associated with DCA’s current process improvement efforts.
The Governor’s Budget includes the initial phase-in of these positions beginning July 2010.
Create a New Licensing and Enforcement Database
DCA’s current licensing and enforcement database systems are antiquated and impede the boards’
ability to meet their program goals and objectives. Over the past 25 years, these systems have
been updated and expanded, but system design and documentation have deteriorated to such an
extent that it has left the systems unstable and difficult to maintain. These systems have inadequate
performance measurement, data quality errors, an inability to quickly adapt to changing laws and
regulations, and a lack of available public self-service options. The CPEI relies on advanced
workflow capabilities and cross-entity external system communications that the aging system’s
technology cannot provide. DEPARTMENT OF CONSUMER AFFAIRS 4
Consumer Protection Enforcement Initiative
The implementation of a replacement system is needed to support enforcement monitoring,
automate manual processes, streamline processes, and integrate information about licensees. DCA
intends to procure a Modifiable Commercial Off-The-Shelf (or “MOTS”) enterprise licensing and
enforcement case management system. DCA’s research has shown various MOTS licensing and
enforcement systems exist that can provide intelligent case management to reduce enforcement
and licensing turnaround times, detailed performance measurements, increased data quality,
advanced configurability, and robust web presences for public self-service.
The Governor’s Budget authorizes DCA to redirect existing funds to begin implementation of this
system in FY 2010-11.
DEPARTMENT OF CONSUMER AFFAIRS 5
Consumer Protection Enforcement Initiative
III. Statutory Changes: Putting Consumers First
Each board within DCA has a statutory mandate to hold consumer protection as its paramount
objective. Over the years, boards’ enforcement authorities have been slow to keep up with legal
trends and changes in the professions regulated, and due process protections have grown to protect
licensees above consumers. DCA believes that now is the time to re-align consumer protection
laws so that they place public protection first. In 2010, the DCA will pursue legislation to help boards
carry out their critical missions of protecting consumers.
Increased Suspension Authority
One of the most important roles that professional licensing boards do to protect consumers is
preventing potentially dangerous individuals from practicing. The CPEI would strengthen the
boards’ ability to do this in a number of ways, including authorizing the DCA Director to issue an
order for a licensee to cease practice or restrict practice, upon the request of a board executive
officer. This authority is necessary in the most egregious cases because the standard enforcement
process can take a year to complete, at best, and even the expedited process in existing law
(interim suspension order) can take months to complete. This proposal would also seek the
statutory authority to revoke or deny a license to an individual for acts of sexual misconduct with a
patient or conviction as a felony sex offender. Additionally, the CPEI would provide for the
automatic suspension of convicted felons for the duration of their sentence.
Increased Access to Critical Information
The CPEI would make improvements to the information that boards receive, so they can investigate
possible violations of law. Specifically, it would prohibit the use of a gag clause in a civil settlement
that would prohibit consumers or their legal counsel from filing a complaint with the appropriate
board. Regulatory gag clauses are explicitly prohibited in legal malpractice settlements and there
have been numerous court decisions that describe a compelling public interest in voiding regulatory
gag clauses in other professions. The Center for Public Interest Law notes that the inclusion of gag
clauses is an alarmingly pervasive practice that thwarts the ability of boards to carry out their
consumer protection mission. The CPEI would also require court officials to report to the healing
arts boards convictions and felony charges filed against the boards’ licensees, and expand reporting
by employers and supervisors regarding individuals who were suspended or terminated for cause.
Adequate access to medical records can shave months off the process to investigate a licensee.
Medical records are used by healing arts boards’ to determine whether a licensee caused harmed to
a patient. Any delay in an investigation of a licensee may result in a potentially dangerous licensee
continuing to practice. Thus, it is essential that healing arts boards have quick access to medical
records. The CPEI gives all of the healing arts boards the authority to inspect and copy, as
applicable, any documents and records relevant to an investigation. In cases where a licensee fails
to cooperate with an investigation, the CPEI provides boards with additional authorities to ensure
compliance.
Enforcement Process Efficiencies
DCA proposes to remove unnecessary workload and costs from the enforcement process. This can
be done by streamlining the appeal process for citations, permitting boards to contract with
collection agencies to retrieve unpaid fines and fees, authorizing executive officers to sign default
decisions and certain stipulated settlements, and allowing licensees to agree to stipulated
settlements before a formal accusation is filed. These are relatively small changes that could result
in significant workload savings.
DEPARTMENT OF CONSUMER AFFAIRS 6
Consumer Protection Enforcement Initiative
Efficiency and accountability will also be improved by establishing a deadline for the Department of
Justice (DOJ) to notify healing arts boards of arrests and convictions of licensees, which would
greatly improve the board’s ability to pursue cases in a timely manner. Additionally, it requires DOJ
to serve accusations, default decisions and set hearing dates within a specified period of time.
Licensing Fees
Lastly, DCA is seeking to tie the maximum licensing fee amounts to the Consumer Price Index to
keep up with inflation and ensure the boards have the resources to adequately run their
enforcement programs.