Report 2009-043 Recommendation 2 Responses

Report 2009-043: Board of Pilot Commissioners for the Bays of San Francisco, San Pablo and Suisun: It Needs to Develop Procedures and Controls Over Its Operations and Finances to Ensure That It Complies With Legal Requirements (Release Date: November 2009)

Recommendation #2 To: Pilot Commissioners for the Bays of San Francisco, San Pablo and Suisun, Board of

To ensure that its expenditures are appropriate, the board should competitively bid contracts with physicians who perform physical examinations of pilots.

Annual Follow-Up Agency Response From September 2015

The Board continues to agree with the intent of this recommendation. As explained in the Board's previous response submitted on 5/12/2015, the Board entered into a non-competitive interagency agreement with The Regents of the University of California, San Francisco Campus (UCSF) for the provision of pilot and trainee medical examinations and fitness determination services . The Board determined that a negotiated contract with UCSF, another state entity, was an efficient and cost effective method to procure medical examination services and remain in compliance with Government Code section 19130. Although the contract with UCSF was not entered into through a competitive process,the Board believes that it has complied with the primary guiding principle of this recommendation, which was for the Board to contract for physician services to ensure that it expenditures are appropriate. The Board's contract with UCSF successfully implements this recommendation.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

We agree with the board's assertion that it has fully implemented the intent of this recommendation. The original recommendation to competitively bid for physician services was based on the fact that, at the time, the board was using different physicians at different clinics. However, subsequent to our audit report, the board enacted new regulations dealing with pilot physicals and pilot fitness. The board's agreement with a single entity, the University of California San Francisco, will enable it to ensure it receives appropriate services and monitor costs.

Annual Follow-Up Agency Response From May 2014

While the Board agrees with the intent of this recommendation, the Board will not implement this recommendation as specifically stated.

Instead of conducting a competitive procurement process with multiple private-sector physicians, the Board determined that it could efficiently and cost-effectively procure pilot medical assessments and fitness determinations with a single State entity, and entered into an interagency agreement with the University of California, San Francisco Campus for its physicians at the School of Medicine, Division of Occupational and Environmental Medicine to deliver the mandated medical assessments and fitness determinations required in regulations at 7 CCR, 217.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

Annual Follow-Up Agency Response From October 2013

A 101-page study entitled, "Pilot Fitness Study for the Board of Pilot Commissioners for the Bays of San Francisco, San Pablo, and Suisun," prepared by Dr. Robert Kosnik, MD of the University of California, San Francisco Medical Center, was delivered to the Board on May 26, 2011. The Board formally accepted the study on that day. The study provides 20 recommendations, most of which were adopted by the Board. These recommendations, once put into regulation, make substantial changes to Board procedures for pilot fitness determinations, including establishment of a two-physician fitness determination in a clinic setting.

The Board directed its Pilot Fitness Committee and Rules and Regulations Committee jointly to begin a series of public workshops that addressed the full range of recommendations from the study. The first workshop was held on July 19, 2011.

The Board had planned to commence administrative rulemaking to facilitate establishment and implementation of a procedure for approving and monitoring Board-appointed physicians in November 2012, followed by a competitive procurement for Board physician services. The public workshops took longer than anticipated and a draft of the proposed regulation entered formal public comment period on July 26, 2013. The 45- day public comment period ended on September 9, 2013, with one comment received and responded to in the "Final Statement of Reasons".

The final regulation is expected to be submitted to the Office of Administrative Law by the end of October 2013 (currently clearing the Department of Finance). An additional appropriation may be required in order for the Board to implement these changes by contracting with a clinic or medical group. Please see attached draft regulation.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

The Board of Pilot Commissioners' (board) draft regulations regarding the qualifications of board-appointed physicians include language which require the physicians to carry out their functions according to contracts with the board. However, as the board's response states, these regulations are not yet final and therefore the board has not yet contracted with physicians under these rules.

Annual Follow-Up Agency Response From September 2012

A 101-page study entitled, “Pilot Fitness Study for the Board of Pilot Commissioners for the Bays of San Francisco, San Pablo, and Suisun,” prepared by Dr. Robert Kosnik, MD of the University of California, San Francisco Medical Center, was delivered to the Board on May 26, 2011. The Board formally accepted the study on that day. The study provides 20 recommendations that, if adopted by the Board, will make substantial changes to Board procedures for pilot fitness determinations, including recommendations that would establish a two-physician fitness determination in a clinic setting. The Board also directed staff to initiate the preliminary stages by contracting with a consultant to prepare a market survey of costs and other matters necessary. The Board has also directed its Pilot Fitness Committee and Rules and Regulations Committee jointly to begin a series of public workshops that will address the full range of recommendations from the study. The first workshop was held on July 19, 2011. The Board plans to commence administrative rulemaking to facilitate establishment and implementation of a procedure for approving and monitoring Board-appointed physicians in November 2012, followed by a competitive procurement for Board physician services. An additional appropriation may be required in order for the Board to implement these changes.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

All Recommendations in 2009-043

Agency responses received after June 2013 are posted verbatim.