BILL NUMBER: AB 1777 CHAPTERED 09/29/03 CHAPTER 586 FILED WITH SECRETARY OF STATE SEPTEMBER 29, 2003 APPROVED BY GOVERNOR SEPTEMBER 28, 2003 PASSED THE ASSEMBLY SEPTEMBER 9, 2003 PASSED THE SENATE SEPTEMBER 4, 2003 AMENDED IN SENATE AUGUST 29, 2003 AMENDED IN SENATE JUNE 26, 2003 AMENDED IN ASSEMBLY MAY 20, 2003 INTRODUCED BY Committee on Business and Professions (Correa (Chair), Corbett, Koretz, Leno, Nation, Vargas, and Yee) MARCH 18, 2003 An act to amend Sections 2475.3, 2481, 2483, 2878.5, 3732, 3750, 3750.6, 3760, 3761, 3775, 3775.2, 3777, and 4521 of, to add Sections 3775.6 and 3778 to, and to repeal Sections 3714, 3721, 3733, 3736.5, 3737, and 3751.1 of, the Business and Professions Code, relating to healing arts. LEGISLATIVE COUNSEL'S DIGEST AB 1777, Committee on Business and Professions. Health care practitioners. (1) Existing law creates the Board of Podiatric Medicine under the Medical Board of California. Under existing law, the board is required to approve podiatric residency programs, and specifies requirements in this regard. Existing law requires applicants to provide an official transcript or other evidence to the board as evidence that he or she has completed certain educational requirements, and requires an applicant to complete 4 academic years in an approved school or college. This bill would revise the requirements for the education and training of podiatrists. The bill would require an applicant to practice podiatry to show the completion of specified curriculum requirements by a transcript submitted directly to the board by the academic institution. The bill would specify that the applicant may complete 32 months of actual instruction in an approved school or college instead of 4 years. (2) Existing law, the Respiratory Care Practice Act, creates the Respiratory Care Board of California and regulates the practice of respiratory care. The act provides for notice requirements for the board's meetings and generally prohibits the practice of respiratory care without a license issued by the board. This bill would delete the notice requirements for the board's meetings. The bill would prohibit a person whose license is invalid from practicing respiratory care and an unlicensed person from representing himself or herself as a respiratory care practitioner. (3) Existing law provides for license and examination requirements after payment of specified fees for respiratory care practitioners. This bill would revise the education, training, and license requirements for respiratory care practitioners. The bill would authorize a licensee to be placed in a retired status if certain requirements are met. The bill would authorize the board to contract with a collection service for the purpose of collecting outstanding fees, fines, or cost recovery amounts from applicants or licensees. (4) The bill would delete obsolete provisions relating to healing arts licensees. (5) Because a violation of the bill's provisions in the Respiratory Care Practice Act would be a misdemeanor, the bill imposes a state-mandated local program. (6) 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. (7) This bill would incorporate additional changes in Section 4521 of the Business and Professions Code, contingent upon the prior enactment of SB 358. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 2475.3 of the Business and Professions Code is amended to read: 2475.3. (a) The board shall approve podiatric residency programs, as defined in Section 2475.2, in the field of podiatric medicine, for persons who are applicants for or have been issued a certificate to practice podiatric medicine pursuant to this article. (b) The board may only approve a podiatric residency that it determines meets all of the following requirements: (1) Reasonably conforms with the Accreditation Council for Graduate Medical Education's Institutional Requirements of the Essentials of Accredited Residencies in Graduate Medical Education: Institutional and Program Requirements. (2) Is approved by the Council on Podiatric Medical Education. (3) Complies with the requirements of this state. SEC. 2. Section 2481 of the Business and Professions Code is amended to read: 2481. Each applicant who commenced professional instruction in podiatric medicine after September 1, 1959, shall show by an official transcript or other official evidence submitted directly to the board by the academic institution that he or she has completed two years of preprofessional postsecondary education, or its equivalent, including the subjects of chemistry, biology or other biological science, and physics or mathematics, before completing the resident course of professional instruction. SEC. 3. Section 2483 of the Business and Professions Code is amended to read: 2483. (a) Each applicant for a certificate to practice podiatric medicine shall show by an official transcript or other official evidence satisfactory to the board that is submitted directly to the board by the academic institution that he or she has successfully completed a medical curriculum extending over a period of at least four academic years, or 32 months of actual instruction, in a college or school of podiatric medicine approved by the board. The total number of hours of all courses shall consist of a minimum of 4,000 hours. The board, by regulation, shall adopt standards for determining equivalent training authorized by this section. (b) The curriculum for all applicants shall provide for adequate instruction related to podiatric medicine in the following: Alcoholism and other chemical substance detection Local anesthesia Anatomy, including embryology, histology, and neuroanatomy Behavioral science Biochemistry Biomechanics-foot and ankle Child abuse detection Dermatology Geriatric medicine Human sexuality Infectious diseases Medical ethics Neurology Orthopedic surgery Pathology, microbiology, and immunology Pediatrics Pharmacology, including materia medica and toxicology Physical and laboratory diagnosis Physical medicine Physiology Podiatric medicine Podiatric surgery Preventive medicine, including nutrition Psychiatric problem detection Radiology and radiation safety Spousal or partner abuse detection Therapeutics Women's health SEC. 4. Section 2878.5 of the Business and Professions Code is amended to read: 2878.5. In addition to other acts constituting unprofessional conduct within the meaning of this chapter, it is unprofessional conduct for a person licensed under this chapter to do any of the following: (a) Obtain or possess in violation of law, or prescribe, or except as directed by a licensed physician and surgeon, dentist or podiatrist administer to himself or herself or furnish or administer to another, any controlled substance as defined in Division 10 of the Health and Safety Code, or any dangerous drug as defined in Section 4022. (b) Use any controlled substance as defined in Division 10 of the Health and Safety Code, or any dangerous drug as defined in Section 4022, or alcoholic beverages, to an extent or in a manner dangerous or injurious to himself or herself, any other person, or the public, or to the extent that the use impairs his or her ability to conduct with safety to the public the practice authorized by his or her license. (c) Be convicted of a criminal offense involving possession of any narcotic or dangerous drug, or the prescription, consumption, or self-administration of any of the substances described in subdivisions (a) and (b) of this section, in which event the record of the conviction is conclusive evidence thereof. (d) Be committed or confined by a court of competent jurisdiction for intemperate use of or addiction to the use of any of the substances described in subdivisions (a) and (b) of this section, in which event the court order of commitment or confinement is prima facie evidence of that commitment or confinement. (e) Falsify, or make grossly incorrect, grossly inconsistent, or unintelligible entries in any hospital, patient, or other record pertaining to narcotics or dangerous drugs as specified in subdivision (b). SEC. 5. Section 3714 of the Business and Professions Code is repealed. SEC. 6. Section 3721 of the Business and Professions Code is repealed. SEC. 7. Section 3732 of the Business and Professions Code is amended to read: 3732. (a) The board shall investigate an applicant for a license, before a license is issued, in order to determine whether or not the applicant has the qualifications required by this chapter. (b) The board may deny an application, or may order the issuance of a license with terms and conditions, for any of the causes specified in this chapter for suspension or revocation of a license, including, but not limited to, those causes specified in Sections 3750, 3750.5, 3752.5, 3752.6, 3755, 3757, 3760, and 3761. SEC. 8. Section 3733 of the Business and Professions Code is repealed. SEC. 9. Section 3736.5 of the Business and Professions Code is repealed. SEC. 10. Section 3737 of the Business and Professions Code is repealed. SEC. 11. Section 3750 of the Business and Professions Code is amended to read: 3750. The board may order the denial, suspension, or revocation of, or the imposition of probationary conditions upon, a license issued under this chapter, for any of the following causes: (a) Advertising in violation of Section 651 or Section 17500. (b) Fraud in the procurement of any license under this chapter. (c) Knowingly employing unlicensed persons who present themselves as licensed respiratory care practitioners. (d) Conviction of a crime that substantially relates to the qualifications, functions, or duties of a respiratory care practitioner. The record of conviction or a certified copy thereof shall be conclusive evidence of the conviction. (e) Impersonating or acting as a proxy for an applicant in any examination given under this chapter. (f) Negligence in his or her practice as a respiratory care practitioner. (g) Conviction of a violation of any of the provisions of this chapter or of any provision of Division 2 (commencing with Section 500), or violating, or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any provision or term of this chapter or of any provision of Division 2 (commencing with Section 500). (h) The aiding or abetting of any person to violate this chapter or any regulations duly adopted under this chapter. (i) The aiding or abetting of any person to engage in the unlawful practice of respiratory care. (j) The commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, or duties of a respiratory care practitioner. (k) Falsifying, or making grossly incorrect, grossly inconsistent, or unintelligible entries in any patient, hospital, or other record. (l) Changing the prescription of a physician and surgeon, or falsifying verbal or written orders for treatment or a diagnostic regime received, whether or not that action resulted in actual patient harm. (m) Denial, suspension, or revocation of any license to practice by another agency, state, or territory of the United States for any act or omission that would constitute grounds for the denial, suspension, or revocation of a license in this state. (n) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of blood-borne infectious diseases from licensee to patient, from patient to patient, and from patient to licensee. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Health Services developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, regulations, and guidelines pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. As necessary, the board shall consult with the California Medical Board, the Board of Podiatric Medicine, the Board of Dental Examiners, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision. The board shall seek to ensure that licensees are informed of the responsibility of licensees and others to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of blood-borne infectious diseases. (o) Incompetence in his or her practice as a respiratory care practitioner. (p) A pattern of substandard care. SEC. 12. Section 3750.6 of the Business and Professions Code is amended to read: 3750.6. Upon request, every holder of a pocket license shall produce for inspection the original pocket license issued by the board. A facsimile of the license is not sufficient for that purpose. Upon request, every applicant issued a work permit shall produce for inspection the original permit issued by the board. A facsimile of the work permit is not sufficient for that purpose. SEC. 13. Section 3751.1 of the Business and Professions Code is repealed. SEC. 14. Section 3760 of the Business and Professions Code is amended to read: 3760. (a) Except as otherwise provided in this chapter, no person shall engage in the practice of respiratory care, respiratory therapy, or inhalation therapy. For purposes of this section, engaging in the practice of respiratory care includes, but is not limited to, representations by a person whether through verbal claim, sign, advertisement, letterhead, business card, or other representation that he or she is able to perform any respiratory care service, or performance of any respiratory care service. (b) No person who is unlicensed or whose respiratory care practitioner license has been revoked or suspended, or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation, even though the person may continue to hold a certificate or registration issued by a private certifying entity. (c) Except as otherwise provided in this chapter, no person may represent himself or herself to be a respiratory care practitioner, a respiratory therapist, a respiratory care technician, or an inhalation therapist, or use the abbreviation or letters "R.C.P.," "R.P.," "R.T.," or "I.T.," or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter. (d) No respiratory care practitioner applicant shall begin practice as a "respiratory care practitioner applicant" pursuant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit. SEC. 15. Section 3761 of the Business and Professions Code is amended to read: 3761. (a) No person may practice respiratory care or represent himself or herself to be a respiratory care practitioner in this state, without a valid license granted under this chapter, except as otherwise provided in this chapter. (b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter, except as otherwise provided in this chapter. SEC. 16. Section 3775 of the Business and Professions Code is amended to read: 3775. The amount of fees provided in connection with licenses or approvals for the practice of respiratory care shall be as follows: (a) The application fee shall be established by the board at not more than three hundred dollars ($300). The application fee for the applicant under subdivision (c) of Section 3740 shall be established by the board at not more than three hundred fifty dollars ($350). (b) The fees for any examination or reexamination required by the board shall be the actual cost to the board for developing, purchasing, grading, and administering each examination or reexamination. (c) The initial license fee for a respiratory care practitioner shall be no more than three hundred dollars ($300). (d) For any license term beginning on or after January 1, 1999, the renewal fee shall be established at two hundred thirty dollars ($230). The board may increase the renewal fee, by regulation, to an amount not to exceed three hundred thirty dollars ($330). The board shall fix the renewal fee so that, together with the estimated amount from revenue, the reserve balance in the board's contingent fund shall be equal to approximately six months of annual authorized expenditures. If the estimated reserve balance in the board's contingent fund will be greater than six months, the board shall reduce the renewal fee. In no case shall the fee in any year be more than 10 percent greater than the amount of the fee in the preceding year. (e) The delinquency fee shall be established by the board at not more than the following amounts: (1) If the license is renewed not more than two years from the date of its expiration, the delinquency fee shall be 100 percent of the renewal fee in effect at the time or renewal. (2) If the license is renewed after two years, but not more than three years, from the date of expiration of the license, the delinquency fee shall be 200 percent of the renewal fee in effect at the time of renewal. (f) The duplicate license fee shall not exceed seventy-five dollars ($75). (g) The endorsement fee shall not exceed one hundred dollars ($100). (h) Costs incurred by the board in order to obtain and review documents or information related to the criminal history of, rehabilitation of, disciplinary actions taken by another state agency against, or acts of negligence in the practice of respiratory care by, an applicant or licensee, shall be paid by the applicant or licensee before a license will be issued or a subsequent renewal processed. (i) Fees paid in any form other than check, money order, or cashier's check shall be subject to an additional processing charge equal to the board's actual processing costs. (j) Fees incurred by the board to process return mail shall be paid by the applicant or licensee for whom the charges were incurred. (k) Notwithstanding any other provision of this chapter, the board, in its discretion, may reduce the amount of any fee otherwise prescribed by this section. SEC. 17. Section 3775.2 of the Business and Professions Code is amended to read: 3775.2. (a) The fee for approval of providers of continuing education shall be established by the board at not more than the following: (1) The initial application approval fee shall not exceed seven hundred dollars ($700). (2) The annual renewal fee shall not exceed three hundred fifty dollars ($350). (3) The fee for rereview or additional approval of any amendments to existing providers shall not exceed three hundred fifty dollars ($350). (b) The delinquency fee for the annual renewal fee shall be 50 percent of the annual renewal fee. SEC. 18. Section 3775.6 is added to the Business and Professions Code, to read: 3775.6. (a) A licensee may request that his or her license be placed in a "retired" status at any time, provided the license has not been canceled, and any outstanding fines, cost recovery, and monthly probation monitoring costs are paid in full. (b) An individual with retired status is not subject to any renewal or reporting requirements. (c) Once an individual is placed on retired status, all privileges to practice respiratory care are rescinded. If an individual practices with a "retired" license, the individual will be subject to discipline as prescribed by this chapter for the unlicensed practice of respiratory care. SEC. 19. Section 3777 of the Business and Professions Code is amended to read: 3777. Where an applicant is issued a license to practice respiratory care, and it is later discovered that all required fees have not been paid, approved continuing education is not reported or completed, employer information is not reported, or any other requirements as prescribed by this chapter are not met, the license shall not be renewed or reinstated unless all past and current required fees have been paid and all requirements are met. SEC. 20. Section 3778 is added to the Business and Professions Code, to read: 3778. Notwithstanding any other provision of law, the board may contract with a collection service for the purpose of collecting outstanding fees, fines, or cost recovery amounts, and may release personal information, including the birth date, telephone number, and social security number of any applicant or licensee for this purpose. The contractual agreement shall provide that the collection service shall not inappropriately use or release personal information, and shall provide safeguards to ensure that the information is protected from inappropriate disclosure. The contractual agreement shall hold the collection service liable for inappropriate use or disclosure of personal information. SEC. 21. Section 4521 of the Business and Professions Code is amended to read: 4521. The board may suspend or revoke a license issued under this chapter for any of the following reasons: (a) Unprofessional conduct, which includes but is not limited to any of the following: (1) Incompetence or gross negligence in carrying out usual psychiatric technician functions. (2) A conviction of practicing medicine without a license in violation of Chapter 5 (commencing with Section 2000) of Division 2, the record of conviction being conclusive evidence thereof. (3) The use of advertising relating to psychiatric technician services which violates Section 17500. (4) Obtain or possess in violation of law, or prescribe, or, except as directed by a licensed physician and surgeon, dentist, or podiatrist, administer to himself or herself or furnish or administer to another, any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code or any dangerous drug as defined in Section 4022. (5) Use any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code, or any dangerous drug as defined in Section 4022, or alcoholic beverages, to an extent or in a manner dangerous or injurious to himself or herself, any other person, or the public or to the extent that the use impairs his or her ability to conduct with safety to the public the practice authorized by his or her license. (6) Be convicted of a criminal offense involving the falsification of records concerning prescription, possession, or consumption of any of the substances described in paragraphs (4) and (5), in which event the record of the conviction is conclusive evidence of the conviction. The board may inquire into the circumstances surrounding the commission of the crime in order to fix the degree of discipline. (7) Be committed or confined by a court of competent jurisdiction for intemperate use of or addiction to the use of any of the substances described in paragraphs (4) and (5), in which event the court order of commitment or confinement is prima facie evidence of the commitment or confinement. (8) Falsify, or make grossly incorrect, grossly inconsistent, or unintelligible entries in any hospital, patient, or other record pertaining to the substances described in paragraph (4). (b) Procuring a certificate or license by fraud, misrepresentation, or mistake. (c) Procuring, or aiding, or abetting, or attempting, or agreeing or offering to procure or assist at a criminal abortion. (d) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any provision or terms of this chapter. (e) Giving any false statement or information in connection with an application. (f) Conviction of any offense substantially related to the qualifications, functions, and duties of a psychiatric technician, in which event the record of the conviction shall be conclusive evidence of the conviction. The board may inquire into the circumstances surrounding the commission of the crime in order to fix the degree of discipline. (g) Impersonating any applicant or acting as proxy for an applicant in any examination required by this chapter. (h) Impersonating another practitioner, or permitting another person to use his or her certificate or license. (i) The use of excessive force upon or the mistreatment or abuse of any patient. (j) Aiding or assisting, or agreeing to aid or assist any person or persons, whether a licensed physician or not, in the performance of or arranging for a violation of any of the provisions of Article 12 (commencing with Section 2220) of Chapter 5 of Division 2. (k) Failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law. (l) The commission of any act punishable as a sexually related crime, if that act is substantially related to the duties and functions of the licensee. (m) The commission of any act involving dishonesty, when that action is substantially related to the duties and functions of the licensee. (n) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines, thereby risking transmission of blood-borne infectious diseases from licensee to patient, from patient to patient, and from patient to licensee. In administering this subdivision, the board shall consider the standards, regulations, and guidelines of the State Department of Health Services developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. As necessary, the board shall consult with the California Medical Board, the Board of Dental Examiners, and the Board of Registered Nursing, to encourage appropriate consistency in the implementation of this section. The board shall seek to ensure that licentiates and others regulated by the board are informed of the responsibility of licentiates and others to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of blood-borne infectious diseases. SEC. 21.5. Section 4521 of the Business and Professions Code is amended to read: 4521. The board may suspend or revoke a license issued under this chapter for any of the following reasons: (a) Unprofessional conduct, which includes, but is not limited to, any of the following: (1) Incompetence or gross negligence in carrying out usual psychiatric technician functions. (2) A conviction of practicing medicine without a license in violation of Chapter 5 (commencing with Section 2000) of Division 2, the record of conviction being conclusive evidence thereof. (3) The use of advertising relating to psychiatric technician services which violates Section 17500. (4) Obtain or possess in violation of law, or prescribe, or, except as directed by a licensed physician and surgeon, dentist, or podiatrist, administer to himself or herself or furnish or administer to another, any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code or any dangerous drug as defined in Section 4022. (5) Use any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code, or any dangerous drug as defined in Section 4022, or alcoholic beverages, to an extent or in a manner dangerous or injurious to himself or herself, any other person, or the public or to the extent that the use impairs his or her ability to conduct with safety to the public the practice authorized by his or her license. (6) Be convicted of a criminal offense involving the falsification of records concerning prescription, possession, or consumption of any of the substances described in paragraphs (4) and (5), in which event the record of the conviction is conclusive evidence of the conviction. The board may inquire into the circumstances surrounding the commission of the crime in order to fix the degree of discipline. (7) Be committed or confined by a court of competent jurisdiction for intemperate use of or addiction to the use of any of the substances described in paragraphs (4) and (5), in which event the court order of commitment or confinement is prima facie evidence of the commitment or confinement. (8) Falsify, or make grossly incorrect, grossly inconsistent, or unintelligible entries in any hospital, patient, or other record pertaining to the substances described in paragraph (4). (b) Procuring a certificate or license by fraud, misrepresentation, or mistake. (c) Procuring, or aiding, or abetting, or attempting, or agreeing or offering to procure or assist at a criminal abortion. (d) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any provision or terms of this chapter. (e) Giving any false statement or information in connection with an application. (f) Conviction of any offense substantially related to the qualifications, functions, and duties of a psychiatric technician, in which event the record of the conviction shall be conclusive evidence of the conviction. The board may inquire into the circumstances surrounding the commission of the crime in order to fix the degree of discipline. (g) Impersonating any applicant or acting as proxy for an applicant in any examination required by this chapter. (h) Impersonating another practitioner, or permitting another person to use his or her certificate or license. (i) The use of excessive force upon or the mistreatment or abuse of any patient. (j) Aiding or assisting, or agreeing to aid or assist any person or persons, whether a licensed physician or not, in the performance of or arranging for a violation of any of the provisions of Article 12 (commencing with Section 2220) of Chapter 5 of Division 2. (k) Failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law. (l) Failure to report the commission of any act prohibited by this section. (m) The commission of any act punishable as a sexually related crime, if that act is substantially related to the duties and functions of the licensee. (n) The commission of any act involving dishonesty, when that action is substantially related to the duties and functions of the licensee. (o) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines, thereby risking transmission of blood-borne infectious diseases from licensee to patient, from patient to patient, and from patient to licensee. In administering this subdivision, the board shall consider the standards, regulations, and guidelines of the State Department of Health Services developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. As necessary, the board shall consult with the California Medical Board, the Board of Dental Examiners, and the Board of Registered Nursing, to encourage appropriate consistency in the implementation of this section. The board shall seek to ensure that licentiates and others regulated by the board are informed of the responsibility of licentiates and others to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of blood-borne infectious diseases. SEC. 22. 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. SEC. 23. Section 21.5 of this bill incorporates amendments to Section 4521 of the Business and Professions Code proposed by both this bill and SB 358. It shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2004, (2) each bill amends Section 4521 of the Business and Professions Code, and (3) this bill is enacted after SB 358, in which case Section 21 of this bill shall not become operative.