(a)A hospital as defined in subdivision (a) or (f) of Section 1250 that provides perinatal care, and an alternative birth center or primary care clinic subject to Section 1204.3, shall implement an evidence-based implicit bias program for all health care providers involved in the perinatal care of patients within those facilities, including:
(1)All persons licensed under Division 2 of the Business and Professions Code (commencing with Section 500) who are regularly assigned to provide perinatal care, including, but not limited to, those in primary care clinics, alternative birthing centers, outpatient clinics, or emergency departments.
(2)All persons who are regularly assigned to positions where they interact with perinatal patients, including, but not limited to, physician assistants,
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(a)
A hospital as defined in subdivision (a) or (f) of Section 1250 that provides perinatal care, and an alternative birth center or primary care clinic subject to Section 1204.3, shall implement an evidence-based implicit bias program for all health care providers involved in the perinatal care of patients within those facilities, including:
(1)
All persons licensed under Division 2 of the Business and Professions Code (commencing with Section 500) who are regularly assigned to provide perinatal care, including, but not limited to, those in primary care clinics, alternative birthing centers, outpatient clinics, or emergency departments.
(2)
All persons who are regularly assigned to positions where they interact with perinatal patients, including, but not limited to, physician assistants, medical assistants, licensed vocational nurses, doctors, or those who facilitate, control, or coordinate access to timely and appropriate medical treatment, as well as any others who provide medical and ancillary treatment.
(b)
An implicit bias program implemented pursuant to subdivision (a) shall include all of the following:
(1)
Identification of previous or current unconscious biases and misinformation.
(2)
Identification of personal, interpersonal, institutional, structural, and cultural barriers to inclusion.
(3)
Corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose.
(4)
Information on the effects, including, but not limited to, ongoing personal effects, of historical and contemporary exclusion and oppression of minority communities.
(5)
Information about cultural identity across racial or ethnic groups.
(6)
Information about communicating more effectively across identities, including racial, ethnic, religious, and gender identities.
(7)
Discussion on power dynamics and organizational decisionmaking.
(8)
Discussion on health inequities within the perinatal care field, including information on how implicit bias impacts maternal and infant health outcomes.
(9)
Perspectives of diverse, local constituency groups and experts on particular racial, identity, cultural, and provider-community relations issues in the community.
(10)
Information on reproductive justice.
(11)
Recognition of intersecting identities, including, but not limited to, nonbinary persons and persons of transgender experience, and the multiple layers of potential biases that could come into play, resulting in harm to patients and their infants.
(c)
(1)
A health care
provider described in subdivision (a) shall complete initial basic training through the implicit bias program based on the components described in subdivision (b). This initial basic training must be completed by June 1, 2025, for all current health care providers. The initial basic training must be provided to new health care providers at all facilities within six months of their start at the new facility unless subdivision (d) applies.
(2)
Upon completion of the initial basic training, a health care provider shall complete a refresher course under the implicit bias program every two years thereafter, or on a more frequent basis if deemed necessary by the facility, in order to keep current with changing racial, identity, and cultural trends and best practices in decreasing interpersonal and institutional implicit bias.
(3)
The training shall be provided during paid work time.
(d)
A facility described in subdivision (a) shall provide a certificate of training completion to another facility or a training attendee upon request. A facility may accept a certificate of completion from another facility described in subdivision (a) to satisfy the training requirement described in subdivision (c) for a health care provider who works in more than one facility.
(e)
Notwithstanding subdivisions (a) to (d), inclusive, if a physician involved in the perinatal care of patients is not directly employed by a facility, the facility shall offer the training to the physician.
(f)
By February 1 of
each year, commencing in 2026, a facility described in subdivision (a) shall provide the Attorney General with proof of compliance. Proof of compliance shall include all of the following:
(1)
A list of all of the health care providers described in paragraph (1) of subdivision (a) who completed the training requirements outlined in subdivision (c).
(2)
The dates that each health care provider completed their training.
(3)
The written materials used in the training.
(4)
A description of the training, including substance, format, and duration.
(5)
A list that outlines the categories by job title of
the health care providers described in paragraph (1) of subdivision (a) who did not participate in the training, if any. Each category shall include both of the following:
(A)
A delineation of the respective health care provider or providers by employee status.
(B)
The number and percentage of the health care providers who failed to complete the training out of the total relevant health care providers within the respective category.
(g)
A facility described in subdivision (a) that violates the requirement to implement an implicit bias program pursuant to subdivision (a) of this section, or fails to submit proof of compliance to the Attorney General pursuant to subdivision (f) of this section shall be liable for a
civil penalty of five thousand dollars ($5,000) for the first violation and
fifteen thousand dollars ($15,000) for the second and each subsequent violation. In the event a facility’s proof of compliance submitted to the Attorney General reveals systemic failure of providers to complete the training requirements outlined in subdivision (c), the facility shall be liable for a civil penalty of five thousand dollars ($5,000) for the first violation, and fifteen thousand dollars ($15,000) for the second and each subsequent violation. Civil penalties specified in this subdivision shall be assessed and recovered in a civil action brought in the name of the people of the State of California by the Attorney General in any court of competent jurisdiction. The Attorney General shall be awarded all attorney’s fees and costs in any civil action in which a court imposes any of the penalties described in this section.
The penalties provided by this subdivision are not exclusive and do not limit other remedies available in law for such violations.
(h)
(1)
For purposes of subdivision (g), “systemic failure” means the lesser of the following:
(A)
Ten percent or more of providers failing to complete the training, provided that if only one or two providers did not receive the training, the facility was provided a reasonable opportunity to cure before a penalty is pursued.
(B)
Twenty-five providers failing to complete the required training.
(2)
For purposes of the definition of “systemic failure,” failure by a physician who is not directly
employed by the facility shall not be counted toward the percentage of providers failing to complete the required training where the facility demonstrates that the required training was offered to the physician, pursuant to subdivision (e).
(i)
The Attorney General may post on their website a list of all facilities that did not timely submit proof of compliance pursuant to subdivision (f) or that were assessed penalties pursuant to subdivision (g). The Attorney General may include all of the following information when listing the facilities that were assessed penalties:
(1)
The date the penalty was issued.
(2)
The amount of the penalty.
(3)
The
reason the penalty was issued.
(4)
The percentage of untrained providers.
(5)
The date of facility noncompliance.
(j)
The Attorney General may post on their internet website any other compliance data related to this article they deem appropriate.
(k)
This section shall not be construed to limit the Attorney General from disclosing, on their internet website or otherwise, any information that they are otherwise not restricted from disclosing by any other provision of law.