BILL NUMBER: AB 1196 CHAPTERED
BILL TEXT
CHAPTER 748
FILED WITH SECRETARY OF STATE OCTOBER 10, 2003
APPROVED BY GOVERNOR OCTOBER 9, 2003
PASSED THE ASSEMBLY SEPTEMBER 8, 2003
PASSED THE SENATE SEPTEMBER 4, 2003
AMENDED IN SENATE AUGUST 18, 2003
AMENDED IN SENATE JULY 15, 2003
AMENDED IN SENATE JUNE 24, 2003
AMENDED IN SENATE JUNE 16, 2003
AMENDED IN ASSEMBLY APRIL 10, 2003
AMENDED IN ASSEMBLY APRIL 3, 2003
INTRODUCED BY Assembly Member Montanez
(Coauthors: Assembly Members Koretz and Lieber)
FEBRUARY 21, 2003
An act to amend Section 2836.1 of the Business and Professions
Code, and to amend, repeal, and add Section 11165 of the Health and
Safety Code, relating to drugs.
LEGISLATIVE COUNSEL'S DIGEST
AB 1196, Montanez. Drugs.
Existing law, the Nursing Practice Act, licenses and regulates
nurse practitioners and authorizes a nurse practitioner to furnish
drugs or devices that are classified as Schedule III to Schedule V
controlled substances under the California Uniform Controlled
Substances Act, subject to certain conditions. Existing law makes a
violation of the act a misdemeanor.
This bill would expand these provisions to include drugs or
devices that are classified as Schedule II controlled substances
under the California Uniform Controlled Substances Act. The bill
would establish additional requirements for a nurse practitioner who
is authorized to furnish drugs or devices. The bill would require
nurse practitioners to complete a continuing education course
including Schedule II controlled substances based on standards
developed by the board.
Existing law provides for the electronic monitoring of prescribing
and dispensing of Schedule II controlled substances pursuant to the
Controlled Substance Utilization Review and Evaluation System (CURES)
program. The program is contingent upon the availability of
adequate funds from the Contingent Fund of the Medical Board of
California, the Pharmacy Board Contingent Fund, the State Dentistry
Fund, and the Osteopathic Medical Board of California Contingent
Fund.
This bill would add the Board of Registered Nursing Fund to the
fund list.
By increasing the scope of the Nursing Practice Act, the violation
of which is a misdemeanor, the bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
This bill would incorporate additional changes to Section 11165 of
the Health and Safety Code proposed by SB 151, to be operative only
if this bill and SB 151 are both enacted and become effective on or
before January 1, 2004, and this bill is enacted last.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. 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 the 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 the designee.
(c) (1) 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.
(2) In addition to the requirements in paragraph (1), for Schedule
II controlled substance protocols, the provision for furnishing
Schedule II controlled substances shall address the diagnosis of the
illness, injury, or condition for which the Schedule II controlled
substance is to be furnished.
(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) (1) Drugs or devices furnished or ordered by a nurse
practitioner may include Schedule II 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.
(2) When Schedule II or III controlled substances, as defined in
Sections 11055 and 11056, respectively, 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) (1) 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.
(2) Nurse practitioners who are certified by the board and hold an
active furnishing number, who are authorized through standardized
procedures or protocols to furnish Schedule II controlled substances,
and who are registered with the United States Drug Enforcement
Administration, shall complete, as part of their continuing education
requirements, a course including Schedule II controlled substances
based on the standards developed by the board. 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.
SEC. 2. Section 11165 of the Health and Safety Code is amended to
read:
11165. (a) To assist law enforcement and regulatory agencies in
their efforts to control the diversion and resultant abuse of
Schedule II controlled substances, and for statistical analysis,
education, and research, the Department of Justice shall, contingent
upon the availability of adequate funds from the Contingent Fund of
the Medical Board of California, the Pharmacy Board Contingent Fund,
the State Dentistry Fund, the Board of Registered Nursing Fund, and
the Osteopathic Medical Board of California Contingent Fund,
establish the Controlled Substance Utilization Review and Evaluation
System (CURES) for the electronic monitoring of the prescribing and
dispensing of Schedule II controlled substances by all practitioners
authorized to prescribe or dispense these controlled substances.
CURES shall be implemented as a pilot project, commencing on July 1,
1997, to be administered concurrently with the existing triplicate
prescription process, to examine the comparative efficiencies between
the two systems.
(b) The CURES pilot project shall operate under existing
provisions of law to safeguard the privacy and confidentiality of
patients. Data obtained from CURES shall only be provided to
appropriate state, local, and federal persons or public agencies for
disciplinary, civil, or criminal purposes and to other agencies or
entities, as determined by the Department of Justice, for the purpose
of educating practitioners and others in lieu of disciplinary,
civil, or criminal actions. Data may be provided to public or
private entities, as approved by the Department of Justice, for
educational, peer review, statistical, or research purposes, provided
that patient information, including any information that may
identify the patient, is not compromised. Further, data disclosed to
any individual or agency as described in this subdivision, shall not
be disclosed, sold, or transferred to any third party.
(c) This section shall become inoperative on July 1, 2008, and, as
of January 1, 2009, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2009, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 3. Section 11165 of the Health and Safety Code is amended to
read:
11165. (a) To assist law enforcement and regulatory agencies in
their efforts to control the diversion and resultant abuse of
Schedule II and Schedule III controlled substances, and for
statistical analysis, education, and research, the Department of
Justice shall, contingent upon the availability of adequate funds
from the Contingent Fund of the Medical Board of California, the
Pharmacy Board Contingent Fund, the State Dentistry Fund, the Board
of Registered Nursing Fund, and the Osteopathic Medical Board of
California Contingent Fund, maintain the Controlled Substance
Utilization Review and Evaluation System (CURES) for the electronic
monitoring of the prescribing and dispensing of Schedule II and
Schedule III controlled substances by all practitioners authorized to
prescribe or dispense these controlled substances.
(b) The reporting of Schedule III controlled substance
prescriptions to CURES shall be contingent upon the availability of
adequate funds from the Department of Justice. The Department of
Justice may seek and use grant funds to pay the costs incurred from
the reporting of controlled substance prescriptions to CURES. Funds
shall not be appropriated from the Contingent Fund of the Medical
Board of California, the Pharmacy Board Contingent Fund, the State
Dentistry Fund, the Board of Registered Nursing Fund, or the
Osteopathic Medical Board of California Contingent Fund to pay the
costs of reporting Schedule III controlled substance prescriptions to
CURES.
(c) CURES shall operate under existing provisions of law to
safeguard the privacy and confidentiality of patients. Data obtained
from CURES shall only be provided to appropriate state, local, and
federal persons or public agencies for disciplinary, civil, or
criminal purposes and to other agencies or entities, as determined by
the Department of Justice, for the purpose of educating
practitioners and others in lieu of disciplinary, civil, or criminal
actions. Data may be provided to public or private entities, as
approved by the Department of Justice, for educational, peer review,
statistical, or research purposes, provided that patient information,
including any information that may identify the patient, is not
compromised. Further, data disclosed to any individual or agency as
described in this subdivision shall not be disclosed, sold, or
transferred to any third party.
(d) For each prescription for a Schedule II controlled substance,
the dispensing pharmacy shall provide the following information to
the Department of Justice in a frequency and format specified by the
Department of Justice:
(1) Full name, address, gender, and date of birth of the patient.
(2) The prescriber's category of licensure and license number;
federal controlled substance registration number; and the state
medical license number of any prescriber using the federal controlled
substance registration number of a government-exempt facility.
(3) Pharmacy prescription number, license number, and federal
controlled substance registration number.
(4) NDC (National Drug Code) number of the controlled substance
dispensed.
(5) Quantity of the controlled substance dispensed.
(6) ICD-9 (diagnosis code), if available.
(7) Date of issue of the prescription.
(8) Date of dispensing of the prescription.
(e) This section shall remain in effect only until January 1,
2005, and as of that date is repealed.
SEC. 4. Section 11165 is added to the Health and Safety Code, to
read:
11165. (a) To assist law enforcement and regulatory agencies in
their efforts to control the diversion and resultant abuse of
Schedule II and Schedule III controlled substances, and for
statistical analysis, education, and research, the Department of
Justice shall, contingent upon the availability of adequate funds
from the Contingent Fund of the Medical Board of California, the
Pharmacy Board Contingent Fund, the State Dentistry Fund, the Board
of Registered Nursing Fund, and the Osteopathic Medical Board of
California Contingent Fund, maintain the Controlled Substance
Utilization Review and Evaluation System (CURES) for the electronic
monitoring of the prescribing and dispensing of Schedule II and
Schedule III controlled substances by all practitioners authorized to
prescribe or dispense these controlled substances.
(b) The reporting of Schedule III controlled substance
prescriptions to CURES shall be contingent upon the availability of
adequate funds from the Department of Justice. The Department of
Justice may seek and use grant funds to pay the costs incurred from
the reporting of controlled substance prescriptions to CURES. Funds
shall not be appropriated from the Contingent Fund of the Medical
Board of California, the Pharmacy Board Contingent Fund, the State
Dentistry Fund, the Board of Registered Nursing Fund, or the
Osteopathic Medical Board of California Contingent Fund to pay the
costs of reporting Schedule III controlled substance prescriptions to
CURES.
(c) CURES shall operate under existing provisions of law to
safeguard the privacy and confidentiality of patients. Data obtained
from CURES shall only be provided to appropriate state, local, and
federal persons or public agencies for disciplinary, civil, or
criminal purposes and to other agencies or entities, as determined by
the Department of Justice, for the purpose of educating
practitioners and others in lieu of disciplinary, civil, or criminal
actions. Data may be provided to public or private entities, as
approved by the Department of Justice, for educational, peer review,
statistical, or research purposes, provided that patient information,
including any information that may identify the patient, is not
compromised. Further, data disclosed to any individual or agency as
described in this subdivision shall not be disclosed, sold, or
transferred to any third party.
(d) For each prescription for a Schedule II or Schedule III
controlled substance, the dispensing pharmacy shall provide the
following information to the Department of Justice in a frequency and
format specified by the Department of Justice:
(1) Full name, address, gender, and date of birth of the patient.
(2) The prescriber's category of licensure and license number;
federal controlled substance registration number; and the state
medical license number of any prescriber using the federal controlled
substance registration number of a government-exempt facility.
(3) Pharmacy prescription number, license number, and federal
controlled substance registration number.
(4) NDC (National Drug Code) number of the controlled substance
dispensed.
(5) Quantity of the controlled substance dispensed.
(6) ICD-9 (diagnosis code), if available.
(7) Date of issue of the prescription.
(8) Date of dispensing of the prescription.
(e) This section shall become operative on January 1, 2005.
SEC. 5. Sections 3 and 4 of this bill incorporate amendments to
Section 11165 of the Health and Safety Code proposed by both this
bill and SB 151. They shall only become operative if (1) both bills
are enacted and become effective on or before January 1, 2004, (2)
each bill amends or makes other changes to Section 11165 of the
Health and Safety Code, and (3) this bill is enacted after SB 151, in
which case Section 2 of this bill and Section 17 of SB 151 shall not
become operative.
SEC. 6. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.