Amended IN Assembly April 03, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 1790Introduced by Assembly Members Salas and Fong(Principal coauthor: Senator Fuller)(Coauthors: Assembly Members Acosta, Aguiar-Curry, Bigelow, Bonta, Caballero, Cooper, Cunningham, Flora, Gallagher, Gray, Mathis, Medina, and Patterson)January 08, 2018 An act to add Section 2190.6 to the Business and Professions Code, relating to healing arts. Sections 1233.6 and 1257.4 to the Health and Safety Code, relating to health facilities.LEGISLATIVE COUNSEL'S DIGESTAB 1790, as amended, Salas. Physician and surgeons: continuing education: Clinics and hospitals: Valley Fever. fever.Under existing law, the State Department of Public Health licenses and regulates health facilities, including primary health clinics and general acute care hospitals. Under existing law, primary health clinics and general acute care hospitals are required to develop and implement various policies and procedures, including security and safety assessments for health facilities screening patients for spousal or partner abuse.This bill would require primary health clinics and general acute care hospitals to develop, adopt, and implement policies and procedures for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections no later than January 1, 2020. The bill would require primary health clinics and general acute care hospitals to ensure that medical professionals and other personnel providing patient care receive sufficient training regarding those policies and procedures. This bill would authorize the department to review the established policies and procedures and to ensure compliance.The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. The act requires the board to adopt and administer standards for the continuing education of those licensees. The act, with certain exceptions, requires physicians and surgeons to complete a continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients.This bill would require a physician and surgeon to complete a continuing educational training course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever, by January 1, 2020. This bill would require a physician and surgeon licensed on or after January 1, 2019, to complete that requirement within 2 years of his or her initial license. The bill would authorize the board to exempt physicians and surgeons by practice status category from the requirement for specified reasons.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1233.6 is added to the Health and Safety Code, to read:1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.(e) The penalties of Section 1235 shall not apply to this section.SEC. 2. Section 1257.4 is added to the Health and Safety Code, to read:1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.(e) The penalties of Section 1290 shall not apply to this section.SECTION 1.Section 2190.6 is added to the Business and Professions Code, to read:2190.6.(a)A physician and surgeon shall, by January 1, 2020, complete a one-time mandatory continuing education course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever. A physician and surgeon licensed on or after January 1, 2019, shall complete this mandatory training requirement within two years of his or her initial licensure. The board shall verify completion of this mandatory training requirement on a renewal application form.(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
Amended IN Assembly April 03, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 1790Introduced by Assembly Members Salas and Fong(Principal coauthor: Senator Fuller)(Coauthors: Assembly Members Acosta, Aguiar-Curry, Bigelow, Bonta, Caballero, Cooper, Cunningham, Flora, Gallagher, Gray, Mathis, Medina, and Patterson)January 08, 2018 An act to add Section 2190.6 to the Business and Professions Code, relating to healing arts. Sections 1233.6 and 1257.4 to the Health and Safety Code, relating to health facilities.LEGISLATIVE COUNSEL'S DIGESTAB 1790, as amended, Salas. Physician and surgeons: continuing education: Clinics and hospitals: Valley Fever. fever.Under existing law, the State Department of Public Health licenses and regulates health facilities, including primary health clinics and general acute care hospitals. Under existing law, primary health clinics and general acute care hospitals are required to develop and implement various policies and procedures, including security and safety assessments for health facilities screening patients for spousal or partner abuse.This bill would require primary health clinics and general acute care hospitals to develop, adopt, and implement policies and procedures for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections no later than January 1, 2020. The bill would require primary health clinics and general acute care hospitals to ensure that medical professionals and other personnel providing patient care receive sufficient training regarding those policies and procedures. This bill would authorize the department to review the established policies and procedures and to ensure compliance.The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. The act requires the board to adopt and administer standards for the continuing education of those licensees. The act, with certain exceptions, requires physicians and surgeons to complete a continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients.This bill would require a physician and surgeon to complete a continuing educational training course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever, by January 1, 2020. This bill would require a physician and surgeon licensed on or after January 1, 2019, to complete that requirement within 2 years of his or her initial license. The bill would authorize the board to exempt physicians and surgeons by practice status category from the requirement for specified reasons.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
Amended IN Assembly April 03, 2018
Amended IN Assembly April 03, 2018
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
Assembly Bill No. 1790
Introduced by Assembly Members Salas and Fong(Principal coauthor: Senator Fuller)(Coauthors: Assembly Members Acosta, Aguiar-Curry, Bigelow, Bonta, Caballero, Cooper, Cunningham, Flora, Gallagher, Gray, Mathis, Medina, and Patterson)January 08, 2018
Introduced by Assembly Members Salas and Fong(Principal coauthor: Senator Fuller)(Coauthors: Assembly Members Acosta, Aguiar-Curry, Bigelow, Bonta, Caballero, Cooper, Cunningham, Flora, Gallagher, Gray, Mathis, Medina, and Patterson)
January 08, 2018
An act to add Section 2190.6 to the Business and Professions Code, relating to healing arts. Sections 1233.6 and 1257.4 to the Health and Safety Code, relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1790, as amended, Salas. Physician and surgeons: continuing education: Clinics and hospitals: Valley Fever. fever.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including primary health clinics and general acute care hospitals. Under existing law, primary health clinics and general acute care hospitals are required to develop and implement various policies and procedures, including security and safety assessments for health facilities screening patients for spousal or partner abuse.This bill would require primary health clinics and general acute care hospitals to develop, adopt, and implement policies and procedures for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections no later than January 1, 2020. The bill would require primary health clinics and general acute care hospitals to ensure that medical professionals and other personnel providing patient care receive sufficient training regarding those policies and procedures. This bill would authorize the department to review the established policies and procedures and to ensure compliance.The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. The act requires the board to adopt and administer standards for the continuing education of those licensees. The act, with certain exceptions, requires physicians and surgeons to complete a continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients.This bill would require a physician and surgeon to complete a continuing educational training course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever, by January 1, 2020. This bill would require a physician and surgeon licensed on or after January 1, 2019, to complete that requirement within 2 years of his or her initial license. The bill would authorize the board to exempt physicians and surgeons by practice status category from the requirement for specified reasons.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including primary health clinics and general acute care hospitals. Under existing law, primary health clinics and general acute care hospitals are required to develop and implement various policies and procedures, including security and safety assessments for health facilities screening patients for spousal or partner abuse.
This bill would require primary health clinics and general acute care hospitals to develop, adopt, and implement policies and procedures for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections no later than January 1, 2020. The bill would require primary health clinics and general acute care hospitals to ensure that medical professionals and other personnel providing patient care receive sufficient training regarding those policies and procedures. This bill would authorize the department to review the established policies and procedures and to ensure compliance.
The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. The act requires the board to adopt and administer standards for the continuing education of those licensees. The act, with certain exceptions, requires physicians and surgeons to complete a continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients.
This bill would require a physician and surgeon to complete a continuing educational training course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever, by January 1, 2020. This bill would require a physician and surgeon licensed on or after January 1, 2019, to complete that requirement within 2 years of his or her initial license. The bill would authorize the board to exempt physicians and surgeons by practice status category from the requirement for specified reasons.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1233.6 is added to the Health and Safety Code, to read:1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.(e) The penalties of Section 1235 shall not apply to this section.SEC. 2. Section 1257.4 is added to the Health and Safety Code, to read:1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.(e) The penalties of Section 1290 shall not apply to this section.SECTION 1.Section 2190.6 is added to the Business and Professions Code, to read:2190.6.(a)A physician and surgeon shall, by January 1, 2020, complete a one-time mandatory continuing education course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever. A physician and surgeon licensed on or after January 1, 2019, shall complete this mandatory training requirement within two years of his or her initial licensure. The board shall verify completion of this mandatory training requirement on a renewal application form.(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1233.6 is added to the Health and Safety Code, to read:1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.(e) The penalties of Section 1235 shall not apply to this section.
SECTION 1. Section 1233.6 is added to the Health and Safety Code, to read:
### SECTION 1.
1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.(e) The penalties of Section 1235 shall not apply to this section.
1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.(e) The penalties of Section 1235 shall not apply to this section.
1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.(e) The penalties of Section 1235 shall not apply to this section.
1233.6. (a) No later than January 1, 2020, clinics licensed pursuant to paragraph (1) of subdivision (b) of Section 1200 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Clinics shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.
(b) Clinics shall ensure that the members of the medical staff of each clinic and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training regarding the policies and procedures of subdivision (a).
(c) Clinics shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.
(d) The department shall, in its discretion, review the policies and procedures established by the clinics to ensure compliance.
(e) The penalties of Section 1235 shall not apply to this section.
SEC. 2. Section 1257.4 is added to the Health and Safety Code, to read:1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.(e) The penalties of Section 1290 shall not apply to this section.
SEC. 2. Section 1257.4 is added to the Health and Safety Code, to read:
### SEC. 2.
1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.(e) The penalties of Section 1290 shall not apply to this section.
1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.(e) The penalties of Section 1290 shall not apply to this section.
1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.(e) The penalties of Section 1290 shall not apply to this section.
1257.4. (a) No later than January 1, 2020, hospitals licensed pursuant to subdivision (a) of Section 1250 shall develop, adopt, and implement policies and procedures, including an education and training component, for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley fever. Hospitals shall develop policies and procedures in accordance with environmental infection control guidelines or standards either recommended or established by the federal Centers for Disease Control and Prevention and professional organizations.
(b) The hospitals shall ensure that the members of the medical staff of each hospital and all other practitioners, including, but not limited to, physicians, nurse practitioners, physician assistants, and other personnel, who are regularly assigned to providing direct patient care services, receive sufficient training under the policies and procedures of subdivision (a).
(c) Hospitals shall periodically review, and update as may be appropriate, their policies and procedures established pursuant to this section. The review need not occur more frequently than every two years.
(d) The department shall, in its discretion, review the policies and procedures established by the hospitals to ensure compliance.
(e) The penalties of Section 1290 shall not apply to this section.
(a)A physician and surgeon shall, by January 1, 2020, complete a one-time mandatory continuing education course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever. A physician and surgeon licensed on or after January 1, 2019, shall complete this mandatory training requirement within two years of his or her initial licensure. The board shall verify completion of this mandatory training requirement on a renewal application form.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.