BILL NUMBER: SB 993 CHAPTERED
BILL TEXT
CHAPTER 764
FILED WITH SECRETARY OF STATE SEPTEMBER 21, 2002
APPROVED BY GOVERNOR SEPTEMBER 20, 2002
PASSED THE SENATE AUGUST 31, 2002
PASSED THE ASSEMBLY AUGUST 23, 2002
AMENDED IN ASSEMBLY JUNE 10, 2002
AMENDED IN ASSEMBLY APRIL 2, 2002
AMENDED IN SENATE JUNE 4, 2001
AMENDED IN SENATE APRIL 25, 2001
AMENDED IN SENATE APRIL 16, 2001
INTRODUCED BY Senator Figueroa
FEBRUARY 23, 2001
An act to amend Sections 2746.5, 2746.51, 2836, and 2836.1 of the
Business and Professions Code, relating to nursing.
LEGISLATIVE COUNSEL'S DIGEST
SB 993, Figueroa. Nursing.
Existing law, the Nursing Practice Act, provides for the issuance
of a certificate by the Board of Registered Nursing to practice
nurse-midwifery or to practice as a nurse practitioner, and describes
the scope of practice authorized by the certificate. The act
specifies in this regard that a certified nurse-midwife or a nurse
practitioner may order or furnish drugs or devices pursuant to a
standardized procedure, unless the certified nurse-midwife or nurse
practitioner is in solo practice.
This bill would require a state department to consult with the
board in promulgating regulations that affect the scope of practice
of a certified nurse-midwife or nurse practitioner. The bill would
also delete the practice restriction on the furnishing of drugs or
devices applicable to a certified nurse-midwife or nurse practitioner
in solo practice.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 2746.5 of the Business and Professions Code is
amended to read:
2746.5. (a) The certificate to practice nurse-midwifery
authorizes the holder, under the supervision of a licensed physician
and surgeon, to attend cases of normal childbirth and to provide
prenatal, intrapartum, and postpartum care, including family-planning
care, for the mother, and immediate care for the newborn.
(b) As used in this chapter, the practice of nurse-midwifery
constitutes the furthering or undertaking by any certified person,
under the supervision of a licensed physician and surgeon who has
current practice or training in obstetrics, to assist a woman in
childbirth so long as progress meets criteria accepted as normal.
All complications shall be referred to a physician immediately. The
practice of nurse-midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version.
(c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician.
(d) A certified nurse-midwife is not authorized to practice
medicine and surgery by the provisions of this chapter.
(e) Any regulations promulgated by a state department that affect
the scope of practice of a certified nurse-midwife shall be developed
in consultation with the board.
SEC. 2. Section 2746.51 of the Business and Professions Code is
amended to read:
2746.51. (a) Neither this chapter nor any other provision of law
shall be construed to prohibit a certified nurse-midwife from
furnishing or ordering drugs or devices, including controlled
substances classified in Schedule III, IV, or V under the California
Uniform Controlled Substances Act (Division 10 (commencing with
Section 11000) of the Health and Safety Code), when all of the
following apply:
(1) The drugs or devices are furnished or ordered incidentally to
the provision of any of the following:
(A) Family planning services, as defined in Section 14503 of the
Welfare and Institutions Code.
(B) Routine health care or perinatal care, as defined in
subdivision (d) of Section 123485 of the Health and Safety Code.
(C) Care rendered to essentially healthy persons within a facility
specified in subdivision (a), (b), (c), (d), (i), or (j) of Section
1206 of the Health and Safety Code, a clinic as specified in Section
1204 of the Health and Safety Code, a general acute care hospital as
defined in subdivision (a) of Section 1250 of the Health and Safety
Code, a licensed birth center as defined in Section 1204.3 of the
Health and Safety Code, or a special hospital specified as a
maternity hospital in subdivision (f) of Section 1250 of the Health
and Safety Code.
(2) The drugs or devices are furnished or ordered by a certified
nurse-midwife in accordance with standardized procedures or
protocols. For purposes of this section, standardized procedure
means a document, including protocols, developed and approved by the
supervising physician and surgeon, the certified nurse-midwife, and
the facility administrator or his or her designee. The standardized
procedure covering the furnishing or ordering of drugs or devices
shall specify all of the following:
(A) Which certified nurse-midwife may furnish or order drugs or
devices.
(B) Which drugs or devices may be furnished or ordered and under
what circumstances.
(C) The extent of physician and surgeon supervision.
(D) The method of periodic review of the certified nurse-midwife's
competence, including peer review, and review of the provisions of
the standardized procedure.
(3) If Schedule III controlled substances, as defined in Section
11056 of the Health and Safety Code, are furnished or ordered by a
certified nurse-midwife, the controlled substances shall be furnished
or ordered in accordance with a patient-specific protocol approved
by the treating or supervising physician and surgeon.
(4) The furnishing or ordering of drugs or devices by a certified
nurse-midwife occurs under physician and surgeon supervision. For
purposes of this section, no physician and surgeon shall supervise
more than four certified nurse-midwives at one time. Physician and
surgeon supervision shall not be construed to require the physical
presence of the physician, but does include all of the following:
(A) Collaboration on the development of the standardized procedure
or protocol.
(B) Approval of the standardized procedure or protocol.
(C) Availability by telephonic contact at the time of patient
examination by the certified nurse-midwife.
(b) (1) The furnishing or ordering of drugs or devices by a
certified nurse-midwife is conditional on the issuance by the board
of a number to the applicant who has successfully completed the
requirements of paragraph (2). The number shall be included on all
transmittals of orders for drugs or devices by the certified
nurse-midwife. The board shall maintain a list of the certified
nurse-midwives that it has certified pursuant to this paragraph and
the number it has issued to each one. The board shall make the list
available to the California State Board of Pharmacy upon its request.
Every certified nurse-midwife who is authorized pursuant to this
section to furnish or issue a drug order for a controlled substance
shall register with the United States Drug Enforcement
Administration.
(2) The board has certified in accordance with paragraph (1) that
the certified nurse-midwife has satisfactorily completed at least six
months of physician and surgeon supervised experience in the
furnishing or ordering of drugs or devices and a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section. The board shall establish the requirements for
satisfactory completion of this paragraph.
(3) A copy of the standardized procedure or protocol relating to
the furnishing or ordering of controlled substances by a certified
nurse-midwife shall be provided upon request to any licensed
pharmacist who is uncertain of the authority of the certified
nurse-midwife to perform these functions.
(c) Drugs or devices furnished or ordered by a certified
nurse-midwife may include Schedule II controlled substances under the
California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) under
the following conditions:
(1) The drugs and devices are furnished or ordered in a hospital
as described in subdivision (a) of Section 1250 of the Health and
Safety Code and are furnished or ordered in accordance with
requirements referenced in paragraphs (2) to (4), inclusive, of
subdivision (a) and in paragraphs (1) to (3), inclusive, of
subdivision (b).
(2) When Schedule II controlled substances, as defined in Section
11055 of the Health and Safety Code, are furnished or ordered by a
certified nurse-midwife, the controlled substances shall be furnished
or ordered in accordance with a patient-specific protocol approved
by the treating or supervising physician and surgeon.
(d) Furnishing of drugs or devices by a certified nurse-midwife
means the act of making a pharmaceutical agent or agents available to
the patient in strict accordance with a standardized procedure or
protocol. Use of the term "furnishing" in this section shall include
the following:
(1) The ordering of a drug or device in accordance with the
standardized procedure or protocol.
(2) Transmitting an order of a supervising physician and surgeon.
(e) "Drug order" or "order" for purposes of this section means an
order for medication or for a drug or device that is dispensed to or
for an ultimate user, issued by a certified nurse-midwife as an
individual practitioner, within the meaning of Section 1306.03 of
Title 21 of the Code of Federal Regulations. Notwithstanding any
other provision of law, (1) a drug order issued pursuant to this
section shall be treated in the same manner as a prescription of the
supervising physician; (2) all references to "prescription" in this
code and the Health and Safety Code shall include drug orders issued
by certified nurse-midwives; and (3) the signature of a certified
nurse-midwife on a drug order issued in accordance with this section
shall be deemed to be the signature of a prescriber for purposes of
this code and the Health and Safety Code.
SEC. 3. Section 2836 of the Business and Professions Code is
amended to read:
2836. (a) The board shall establish categories of nurse
practitioners and standards for nurses to hold themselves out as
nurse practitioners in each category. Such standards shall take into
account the types of advanced levels of nursing practice which are
or may be performed and the clinical and didactic education,
experience, or both needed to practice safely at those levels. In
setting such standards, the board shall consult with nurse
practitioners, physicians and surgeons with expertise in the nurse
practitioner field, and health care organizations utilizing nurse
practitioners. Established standards shall apply to persons without
regard to the date of meeting such standards. If the board sets
standards for use of nurse practitioner titles which include
completion of an academically affiliated program, it shall provide
equivalent standards for registered nurses who have not completed
such a program.
(b) Any regulations promulgated by a state department that affect
the scope of practice of a nurse practitioner shall be developed in
consultation with the board.
SEC. 4. Section 2836.1 of the Business and Professions Code is
amended to read:
2836.1. Neither this chapter nor any other provision of law shall
be construed to prohibit a nurse practitioner from furnishing or
ordering drugs or devices when all of the following apply:
(a) The drugs or devices are furnished or ordered by a nurse
practitioner in accordance with standardized procedures or protocols
developed by the nurse practitioner and his or her supervising
physician and surgeon under any of the following circumstances:
(1) When furnished or ordered incidental to the provision of
family planning services.
(2) When furnished or ordered incidental to the provision of
routine health care or prenatal care.
(3) When rendered to essentially healthy persons.
(b) The nurse practitioner is functioning pursuant to standardized
procedure, as defined by Section 2725, or protocol. The
standardized procedure or protocol shall be developed and approved by
the supervising physician and surgeon, the nurse practitioner, and
the facility administrator or his or her designee.
(c) The standardized procedure or protocol covering the furnishing
of drugs or devices shall specify which nurse practitioners may
furnish or order drugs or devices, which drugs or devices may be
furnished or ordered, under what circumstances, the extent of
physician and surgeon supervision, the method of periodic review of
the nurse practitioner's competence, including peer review, and
review of the provisions of the standardized procedure.
(d) The furnishing or ordering of drugs or devices by a nurse
practitioner occurs under physician and surgeon supervision.
Physician and surgeon supervision shall not be construed to require
the physical presence of the physician, but does include (1)
collaboration on the development of the standardized procedure, (2)
approval of the standardized procedure, and (3) availability by
telephonic contact at the time of patient examination by the nurse
practitioner.
(e) For purposes of this section, no physician and surgeon shall
supervise more than four nurse practitioners at one time.
(f) Drugs or devices furnished or ordered by a nurse practitioner
may include Schedule III through Schedule V controlled substances
under the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) and
shall be further limited to those drugs agreed upon by the nurse
practitioner and physician and surgeon and specified in the
standardized procedure. When Schedule III controlled substances, as
defined in Section 11056 of the Health and Safety Code, are furnished
or ordered by a nurse practitioner, the controlled substances shall
be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician. A copy
of the section of the nurse practitioner's standardized procedure
relating to controlled substances shall be provided upon request, to
any licensed pharmacist who dispenses drugs or devices, when there is
uncertainty about the nurse practitioner furnishing the order.
(g) The board has certified in accordance with Section 2836.3 that
the nurse practitioner has satisfactorily completed (1) at least six
month's physician and surgeon-supervised experience in the
furnishing or ordering of drugs or devices and (2) a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section. The board shall establish the requirements for
satisfactory completion of this subdivision.
(h) Use of the term "furnishing" in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of
Section 1250 of the Health and Safety Code, shall include (1) the
ordering of a drug or device in accordance with the standardized
procedure and (2) transmitting an order of a supervising physician
and surgeon.
(i) "Drug order" or "order" for purposes of this section means an
order for medication which is dispensed to or for an ultimate user,
issued by a nurse practitioner as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription of the supervising physician; (2) all
references to "prescription" in this code and the Health and Safety
Code shall include drug orders issued by nurse practitioners; and (3)
the signature of a nurse practitioner on a drug order issued in
accordance with this section shall be deemed to be the signature of a
prescriber for purposes of this code and the Health and Safety Code.