BILL NUMBER: SB 490	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Alpert

                        FEBRUARY 20, 2003

   An act to amend Section 4052 of the Business and Professions Code,
relating to pharmacy.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 490, as introduced, Alpert.  Pharmacy: prescriptions.
   Existing law regulates the practice of pharmacy by the California
State Board of Pharmacy.  Under existing law, a pharmacist may not,
in general, furnish a dangerous drug except upon the prescription of
a physician, dentist, podiatrist, optometrist, or veterinarian.
However, existing law authorizes a pharmacist to initiate emergency
contraception drug therapy in accordance with standardized protocols
developed by the pharmacist and an authorized prescriber acting
within his or her scope of practice.
   This bill would also authorize a pharmacist to initiate emergency
contraception drug therapy in accordance with a standardized
procedure or protocol approved by the board.
   Vote:  majority.  Appropriation:  no.  Fiscal committee:  yes.
State-mandated local program:  no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 4052 of the Business and Professions Code is
amended to read:
   4052.  (a) Notwithstanding any other provision of law, a
pharmacist may:
   (1) Furnish a reasonable quantity of compounded medication to a
prescriber for office use by the prescriber.
   (2) Transmit a valid prescription to another pharmacist.
   (3) Administer, orally or topically, drugs and biologicals
pursuant to a prescriber's order.
   (4) Perform the following procedures or functions in a licensed
health care facility in accordance with policies, procedures, or
protocols developed by health professionals, including physicians,
pharmacists, and registered nurses, with the concurrence of the
facility administrator:
   (A) Ordering or performing routine drug therapy-related patient
assessment procedures including temperature, pulse, and respiration.

   (B) Ordering drug therapy-related laboratory tests.
   (C) Administering drugs and biologicals by injection pursuant to a
prescriber's order (the administration of immunizations under the
supervision of a prescriber may also be performed outside of a
licensed health care facility).
   (D) Initiating or adjusting the drug regimen of a patient pursuant
to an order or authorization made by the patient's prescriber and in
accordance with the policies, procedures, or protocols of the
licensed health care facility.
   (5) (A) Perform the following procedures or functions as part of
the care provided by a health care facility, a licensed home health
agency, a licensed clinic in which there is a physician oversight, a
provider who contracts with a licensed health care service plan with
regard to the care or services provided to the enrollees of that
health care service plan, or a physician, in accordance, as
applicable, with policies, procedures, or protocols of that facility,
the home health agency, the licensed clinic, the health care service
plan, or that physician, in accordance with subparagraph (C):
   (i) Ordering or performing routine drug therapy-related patient
assessment procedures including temperature, pulse, and respiration.

   (ii) Ordering drug therapy-related laboratory tests.
   (iii) Administering drugs and biologicals by injection pursuant to
a prescriber's order (the administration of immunizations under the
supervision of a prescriber may also be performed outside of a
licensed health care facility).
   (iv) Initiating or adjusting the drug regimen of a patient
pursuant to a specific written order or authorization made by the
patient's prescriber for the individual patient, and in accordance
with the policies, procedures, or protocols of the health care
facility, home health agency, licensed clinic, health care service
plan, or physician.  Adjusting the drug regimen does not include
substituting or selecting a different drug, except as authorized by
the protocol.  The pharmacist shall provide written notification to
the patient's prescriber, or enter the appropriate information in an
electronic patient record system shared by the prescriber, of any
drug regimen initiated pursuant to this clause within 24 hours.
   (B) A patient's prescriber may prohibit, by written instruction,
any adjustment or change in the patient's drug regimen by the
pharmacist.
   (C) The policies, procedures, or protocols referred to in this
paragraph shall be developed by health care professionals, including
physicians, pharmacists, and registered nurses, and, at a minimum,
meet all of the following requirements:
   (i) Require that the pharmacist function as part of a
multidisciplinary group that includes physicians and direct care
registered nurses.  The multidisciplinary group shall determine the
appropriate participation of the pharmacist and the direct care
registered nurse.
   (ii) Require that the medical records of the patient be available
to both the patient's prescriber and the pharmacist.
   (iii) Require that the procedures to be performed by the
pharmacist relate to a condition for which the patient has first been
seen by a physician.
   (iv) Except for procedures or functions provided by a health care
facility, a licensed clinic in which there is physician oversight, or
a provider who contracts with a licensed health care plan with
regard to the care or services provided to the enrollees of that
health care service plan, require the procedures to be performed in
accordance with a written, patient-specific protocol approved by the
treating or supervising physician.  Any change, adjustment, or
modification of an approved preexisting treatment or drug therapy
shall be provided in writing to the treating or supervising physician
within 24 hours.
   (6) Manufacture, measure, fit to the patient, or sell and repair
dangerous devices or furnish instructions to the patient or the
patient's representative concerning the use of those devices.
   (7) Provide consultation to patients and professional information,
including clinical or pharmacological information, advice, or
consultation to other health care professionals.
   (8) Initiate emergency contraception drug therapy in accordance
with  standardized   either of the following:
   (A) Standardized  procedures or protocols developed by the
pharmacist and an authorized prescriber who is acting within his or
her scope of practice.  Prior  
   (B) A standardized procedure or protocol approved by the board.
   Prior  to performing any procedure authorized under this
paragraph, a pharmacist shall have completed a training program on
emergency contraception, which includes, but is not limited to,
conduct of sensitive communications, quality assurance, referral to
additional services, and documentation.
   (b) (1) Prior to performing any procedure authorized by paragraph
(4) of subdivision (a), a pharmacist shall have received appropriate
training as prescribed in the policies and procedures of the licensed
health care facility.
   (2) Prior to performing any procedure authorized by paragraph (5)
of subdivision (a), a pharmacist shall have either (A) successfully
completed clinical residency training or (B) demonstrated clinical
experience in direct patient care delivery.
   (3) For each emergency contraception drug therapy initiated
pursuant to paragraph (8) of subdivision (a), the pharmacist shall
provide the recipient of the emergency contraception drugs with a
standardized factsheet that includes, but is not limited to, the
indications for use of the drug, the appropriate method for using the
drug, the need for medical followup, and other appropriate
information.  The board shall develop this form in consultation with
the State Department of Health Services, the American College of
Obstetricians and Gynecologists, the California Pharmacists
Association, and other health care organizations.  The provisions of
this section do not preclude the use of existing publications
developed by nationally recognized medical organizations.
   (c) Nothing in this section shall affect the requirements of
existing law relating to maintaining the confidentiality of medical
records.
   (d) Nothing in this section shall affect the requirements of
existing law relating to the licensing of a health care facility.