BILL NUMBER: AB 1436 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 17, 2007
AMENDED IN ASSEMBLY APRIL 9, 2007
INTRODUCED BY Assembly Member Hernandez
( Coauthors: Assembly Members
Emmerson and Niello )
FEBRUARY 23, 2007
An act to amend Sections 2725, 2725.1, 2835.5, 2836,
2836.1, 2836.2, 2836.3, 4024, 4040, 4060, 4061, 4076, 4170, 4174, and
4175 of, and to add Section 2835.7 to, the Business and Professions
Code, to amend Sections 11026 and 11150 of the Health and Safety
Code, and to amend Sections 14088, 14088.17, 14111, and 14111.5 of
the Welfare and Institutions Code, relating to nursing.
2835.5, 2836.1, 3502.1, 3502.5, and 3516 of, to add Sections
2835.7 and 3502.01 to, and to repeal Section 3516.1 of, the Business
and Professions Code, relating to the healing arts.
LEGISLATIVE COUNSEL'S DIGEST
AB 1436, as amended, Hernandez. Nurse practitioners:
scope of practice. Healing arts: scope of practice.
(1) Existing law, the Nursing Practice Act, provides for the
certification and regulation of nurse practitioners and
nurse-midwives by the Board of Registered Nursing and
requires the board to establish categories of, and standards for,
nurse practitioners in consultation with specified health care
practitioners, including physicians and surgeons with expertise in
the nurse practitioner field. Existing law requires nurse
practitioners to meet certain requirements, including educational
requirements, and authorizes a nurse practitioner who has been issued
a board number for the furnishing or ordering of drugs to furnish or
order drugs under certain conditions, including pursuant to
standardized procedures or protocols and under the supervision of a
physician and surgeon. Existing law prohibits a physician and surgeon
from supervising more than 4 nurse practitioners at one time. A
violation of the Nursing Practice Act is a crime and
specifies requirements for certification as a nurse practitioner.
Under the act, the practice of nursing is defined, in part, as
providing direct and indirect patient care service ordered by
specified healing arts practitioners, including dispensing of drugs
or devices upon their order in a clinic setting, as defined .
This bill would set forth the activities
specify that the practice of nursing includes those
actions taken pursuant to an order by a nurse practitioner
is authorized to engage in, and would delete the requirement
that the board consult with physicians and surgeons in establishing
categories of nurse practitioners or a nurse-midwife.
The bill would provide that a nurse practitioner is authorized to
perform comprehensive health care services for which he or she is
educationally prepared and competent to perform and to admit and
discharge patients from health facilities in collaboration, as
defined, with specified healing arts practitioners. The bill would
deem specified authorizations by a physician and surgeon to include
authorizations provided by a certified nurse practitioner. The bill
would require a certified nurse practitioner to consult or refer a
patient to another health care p rovider if a situation or
condition occurred beyond the nurse practitioner's knowledge and
experience . The bill would revise the educational requirements
for certification as a nurse practitioner and would require a nurse
practitioner to be certified by a nationally recognized certifying
body approved by the board. The bill would allow a nurse
practitioner to prescribe drugs and devices if he or she has been
certified by the board to have satisfactorily completed at least 6
months of supervised experience in the prescribing of drugs and
devices and if such prescribing is consistent with his or her
education or established clinical competency, would delete the
requirement of standardized procedures and protocols, and would
delete the requirement of physician supervision. The bill would
require that a nurse practitioner be issued a board number prior to
prescribing drugs and devices and would allow revocation or
suspension or denial of a board number for incompetence or gross
negligence. The bill would delete the prohibition against a physician
and surgeon supervising more than 4 nurse practitioners at one time.
Because this bill would impose additional requirements under the
Nursing Practice Act, the violation of which would be a crime, it
would impose a state-mandated local program.
(2) Existing law, the Medi-Cal Act, provides for the
Medi-Cal program under the jurisdiction of the State Department of
Health Services, pursuant to which medical benefits are provided to
public assistance recipients and certain other low-income persons.
The act defines a "primary care provider" and authorizes the
department to contract with professional organizations consisting of
specified health care providers, requiring such a contract to, among
other things, provide a beneficiary subject to certain restrictions
with a procedure to change primary care physicians with good cause.
The act also authorizes certain covered health care services provided
in a long-term health care facility to be delegated to a nurse
practitioner if specified conditions are met, including mandatory
supervision by a physician and surgeon Physician
Assistant Practice Act, provides for the licensure of physician
assistants by the Physician Assistant Committee of the Medical Board
of California. Under the act, a physician assistant is authorized to
perform medical services under the supervision of a physician and
surgeon who is limited to supervising no more than 2 physician
assistants at a time, except in certain circumstances. The act
prohibits a physician assistant from administering, providing, or
issuing a drug order for controlled substances, as specified, without
approval by the supervising physician and surgeon .
This bill would revise the definition of a primary care provider
to include a nurse practitioner, would also authorize the department
to contract with an established professional organization that
consists of nurse practitioners or nurse-midwives, and would require
a contract to provide a beneficiary subject to certain restrictions
with a procedure to change any primary care provider with good cause.
The bill would also remove the requirement of mandatory supervision
of the nurse practitioner by a physician and surgeon in order for the
services to be delegated to a nurse practitioner.
This bill would require a physician assistant and his or her
supervising physician and surgeon to establish written supervision
guidelines, as specified, and would require the supervising physician
and surgeon to review medical records of a sample of patients
treated by the physician assistant. The bill would delete the
requirement of advance approval by a supervising physician and
surgeon prior to a physician assistant administering, providing, or
issuing a drug order for a controlled substance, as specified, and
would delete the limitation on the number of physician assistants
that may be supervised by a physician and surgeon.
(3) 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 2725 of the Business and Professions Code is
amended to read:
2725. (a) In amending this section at the 1973-74 session, the
Legislature recognizes that nursing is a dynamic field, the practice
of which is continually evolving to include more sophisticated
patient care activities. It is the intent of the Legislature in
amending this section at the 1973-74 session to provide clear legal
authority for functions and procedures that have common acceptance
and usage. It is the legislative intent also to recognize the
existence of overlapping functions between physicians and registered
nurses and to permit additional sharing of functions within organized
health care systems that provide for collaboration between
physicians and registered nurses. These organized health care systems
include, but are not limited to, health facilities licensed pursuant
to Chapter 2 (commencing with Section 1250) of Division 2 of the
Health and Safety Code, clinics, home health agencies, physicians'
offices, and public or community health services.
(b) The practice of nursing within the meaning of this chapter
means those functions, including basic health care, that help people
cope with difficulties in daily living that are associated with their
actual or potential health or illness problems or the treatment
thereof, and that require a substantial amount of scientific
knowledge or technical skill, including all of the following:
(1) Direct and indirect patient care services that ensure the
safety, comfort, personal hygiene, and protection of patients; and
the performance of disease prevention and restorative measures.
(2) Direct and indirect patient care services, including, but not
limited to, the administration of medications and therapeutic agents,
necessary to implement a treatment, disease prevention, or
rehabilitative regimen ordered by and within the scope of licensure
of a physician, dentist, podiatrist, nurse practitioner,
nurse-midwife, or clinical psychologist, as defined by Section 1316.5
of the Health and Safety Code.
(3) The performance of skin tests, immunization techniques, and
the withdrawal of human blood from veins and arteries.
(4) Observation of signs and symptoms of illness, reactions to
treatment, general behavior, or general physical condition, and (A)
determination of whether the signs, symptoms, reactions, behavior, or
general appearance exhibit abnormal characteristics, and (B)
implementation, based on observed abnormalities, of appropriate
reporting, or referral, or standardized procedures, or changes in
treatment regimen in accordance with standardized procedures, or the
initiation of emergency procedures.
(c) "Standardized procedures," as used in this section, means
either of the following:
(1) Policies and protocols developed by a health facility licensed
pursuant to Chapter 2 (commencing with Section 1250) of Division 2
of the Health and Safety Code through collaboration among
administrators and health professionals including physicians and
nurses.
(2) Policies and protocols developed through collaboration among
administrators and health professionals, including physicians and
nurses, by an organized health care system that is not a health
facility licensed pursuant to Chapter 2 (commencing with Section
1250) of Division 2 of the Health and Safety Code.
The policies and protocols shall be subject to any guidelines for
standardized procedures that the Division of Licensing of the Medical
Board of California and the Board of Registered Nursing may jointly
promulgate. If promulgated, the guidelines shall be administered by
the Board of Registered Nursing.
(d) Nothing in this section shall be construed to require approval
of standardized procedures by the Division of Licensing of the
Medical Board of California, or by the Board of Registered Nursing.
(e) No state agency other than the board may define or interpret
the practice of nursing for those licensed pursuant to the provisions
of this chapter, or develop standardized procedures or protocols
pursuant to this chapter, unless so authorized by this chapter, or
specifically required under state or federal statute. "State agency"
includes every state office, officer, department, division, bureau,
board, authority, and commission.
SEC. 2. Section 2725.1 of the Business and Professions Code is
amended to read:
2725.1. Notwithstanding any other provision of law, a registered
nurse may dispense drugs or devices upon an order by a licensed
physician and surgeon, nurse practitioner, or nurse midwife if the
nurse is functioning within a licensed clinic as defined in
paragraphs (1) and (2) of subdivision (a) of Section 1204 of, or
within a clinic as defined in subdivision (b) or (c) of Section 1206,
of the Health and Safety Code.
No clinic shall employ a registered nurse to perform dispensing
duties exclusively. No registered nurse shall dispense drugs in a
pharmacy or keep a pharmacy, open shop, or drugstore for the
retailing of drugs or poisons. No registered nurse shall compound
drugs. Dispensing of drugs by a registered nurse, except a certified
nurse-midwife who functions pursuant to a standardized procedure or
protocol described in Section 2746.51 or a nurse practitioner
who functions pursuant to a standardized procedure described in
Section 2836.1, or protocol , shall not include substances
included in the California Uniform Controlled Substances Act
(Division 10 (commencing with Section 11000) of the Health and Safety
Code). Nothing in this section shall exempt a clinic from the
provisions of Article 13 (commencing with Section 4180) of Chapter 9.
SEC. 3. Section 2835.5 of the Business and Professions Code is
amended to read:
2835.5. (a) A registered nurse who is holding himself or herself
out as a nurse practitioner or who desires to hold himself or herself
out as a nurse practitioner shall, within the time prescribed by the
board and prior to his or her next license renewal or the issuance
of an initial license, submit educational, experience, and other
credentials and information as the board may require for it to
determine that the person qualifies to use the title "nurse
practitioner," pursuant to the standards and qualifications
established by the board.
(b) Upon finding that a person is qualified to hold himself or
herself out as a nurse practitioner, the board shall appropriately
indicate on the license issued or renewed, that the person is
qualified to use the title "nurse practitioner." The board shall also
issue to each qualified person a certificate evidencing that the
person is qualified to use the title "nurse practitioner."
(c) A person who has been found to be qualified by the board to
use the title "nurse practitioner" prior to the effective date of
this section, shall not be required to submit any further
qualifications or information to the board and shall be deemed to
have met the requirements of this section.
(d) On and after January 1, 2008, an applicant for initial
qualification or certification as a nurse practitioner under this
article who has not been qualified or certified as a nurse
practitioner in California or any other state shall meet the
following requirements:
(1) Hold a valid and active registered nursing license issued
under this chapter.
(2) Possess a master's degree in nursing or a doctoral degree in
(2) Possess a master's or doctoral
degree in nursing.
(3) Satisfactorily complete a nurse practitioner program approved
by the board.
(4) Be certified as a nurse practitioner by a nationally
recognized certifying body approved by the board.
SEC. 4. Section 2835.7 is added to the Business
and Professions Code, to read:
2835.7. (a) A nurse practitioner may do all of the following:
(1) Perform a comprehensive history and physical examination.
(2) Establish diagnoses for physical, mental, or emotional
ailments or potential ailments.
(3) Admit patients to hospitals and nursing facilities in
collaboration with a physician and surgeon or an osteopath.
(4) Order, perform, and interpret laboratory, radiographic, and
other diagnostic tests.
(5) Identify, develop, implement, and evaluate a plan of care for
a patient to promote, maintain, and restore health.
(6) Perform therapeutic procedures that the nurse practitioner is
qualified by education and experience to perform.
(7) Prescribe treatments.
(8) Prescribe and dispense medications when granted authority by
the board.
(9) Refer patients to appropriate licensed physician and surgeons
or other health care providers.
(10) Provide emergency care.
(11) Perform additional acts that the nurse practitioner is
educationally prepared and clinically competent to perform.
(12) Sign death certificates, return-to-work, school certificates,
and other related health certification forms.
(13) Certify incapacity for the purpose of activating a durable
power of attorney for health care.
(14) Sign handicapped parking applications.
(15) Order home health services.
(16) Order durable medical equipment.
(17) Order home schooling or tutoring.
(b) A nurse practitioner shall consult or refer a patient to a
physician and surgeon or another health care provider if the referral
will protect the health and welfare of the patient and if a
situation or condition occurs in a patient that is beyond the nurse
practitioner's knowledge and experience.
SEC. 5. 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 that are or
may be performed and the clinical and didactic education, experience,
or both needed to practice safely at those levels. In setting the
standards, the board shall consult with nurse practitioners and
health care organizations utilizing nurse practitioners. Established
standards shall apply to persons without regard to the date of
meeting such standards.
(b) Any regulations promulgated by a state department, board,
commission, or bureau that affect the scope of practice of a nurse
practitioner shall be developed in consultation with the board.
SEC. 6. Section 2836.1 of the Business and
Professions Code is amended to read:
2836.1. (a) A nurse practitioner may prescribe drugs and devices
when the drugs or devices prescribed are consistent with the
practitioner's educational preparation or for which clinical
competency has been established and maintained.
(b) Drugs or devices prescribed 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).
(2) When Schedule II controlled substances, as defined in Section
11055 of the Health and Safety Code, are prescribed by a nurse
practitioner, the controlled substances shall be prescribed in
collaboration with a physician and surgeon or an osteopath.
(c) A nurse practitioner may not prescribe drugs or devices under
this section unless the board has certified in accordance with
Section 2836.3 that the nurse practitioner has satisfactorily
completed at least six months' supervised experience in the
prescribing of drugs and devices.
SEC. 7. Section 2836.2 of the Business and
Professions Code is amended to read:
2836.2. All nurse practitioners who are authorized pursuant to
Section 2836.1 to prescribe for controlled substances shall register
with the United States Drug Enforcement Administration.
SEC. 8. Section 2836.3 of the Business and
Professions Code is amended to read:
2836.3. (a) The prescribing of drugs or devices by nurse
practitioners is conditional on issuance by the board of a number to
the nurse practitioner applicant who has successfully completed the
requirements of subdivision (c) of Section 2836.1. The number shall
be included on all prescriptions for drugs or devices by the nurse
practitioner. The board shall make the list of numbers issued
available to the Board of Pharmacy. The board may charge the
applicant a fee to cover all necessary costs to implement this
section.
(b) The number shall be renewable at the time of the applicant's
registered nurse license renewal.
(c) The board may revoke, suspend, or deny issuance of the numbers
for incompetence or gross negligence in the performance of functions
specified in Sections 2836.1 and 2836.2.
SEC. 9. Section 4024 of the Business and
Professions Code is amended to read:
4024. (a) Except as provided in subdivision (b), "dispense" means
the furnishing of drugs or devices upon a prescription from a
physician and surgeon, dentist, optometrist, podiatrist,
veterinarian, nurse practitioner, or naturopathic doctor pursuant to
Section 3640.7, or upon an order to furnish drugs or transmit a
prescription from a certified nurse-midwife, physician assistant,
naturopathic doctor pursuant to Section 3640.5, or pharmacist acting
within the scope of his or her practice.
(b) "Dispense" also means and refers to the furnishing of drugs or
devices directly to a patient by a physician and surgeon, dentist,
optometrist, podiatrist, or veterinarian, or by a certified
nurse-midwife, nurse practitioner, naturopathic doctor, or physician
assistant acting within the scope of his or her practice.
SEC. 10. Section 4040 of the Business and
Professions Code is amended to read:
4040. (a) "Prescription" means an oral, written, or electronic
transmission order that is both of the following:
(1) Given individually for the person or persons for whom ordered
that includes all of the following:
(A) The name or names and address of the patient or patients.
(B) The name and quantity of the drug or device prescribed and the
directions for use.
(C) The date of issue.
(D) Either rubber stamped, typed, or printed by hand or typeset,
the name, address, and telephone number of the prescriber, his or her
license classification, and his or her federal registry number, if a
controlled substance is prescribed.
(E) A legible, clear notice of the condition for which the drug is
being prescribed, if requested by the patient or patients.
(F) If in writing, signed by the prescriber issuing the order, or
the certified nurse-midwife, physician assistant, or naturopathic
doctor who issues a drug order pursuant to Section 2746.51, 3502.1,
or 3640.5, respectively, or the pharmacist who issues a drug order
pursuant to either subparagraph (D) of paragraph (4) of, or clause
(iv) of subparagraph (A) of paragraph (5) of, subdivision (a) of
Section 4052.
(2) Issued by a physician and surgeon, dentist, optometrist,
podiatrist, veterinarian, nurse practitioner, or naturopathic doctor
pursuant to Section 3640.7 or, if a drug order is issued pursuant to
Section 2746.51, 3502.1, or 3460.5, by a certified nurse-midwife,
physician assistant, or naturopathic doctor licensed in this state,
or pursuant to either subparagraph (D) of paragraph (4) of, or clause
(iv) of subparagraph (A) of paragraph (5) of, subdivision (a) of
Section 4052 by a pharmacist licensed in this state.
(b) Notwithstanding subdivision (a), a written order of the
prescriber for a dangerous drug, except for any Schedule II
controlled substance, that contains at least the name and signature
of the prescriber, the name and address of the patient in a manner
consistent with paragraph (3) of subdivision (b) of Section 11164 of
the Health and Safety Code, the name and quantity of the drug
prescribed, directions for use, and the date of issue may be treated
as a prescription by the dispensing pharmacist as long as any
additional information required by subdivision (a) is readily
retrievable in the pharmacy. In the event of a conflict between this
subdivision and Section 11164 of the Health and Safety Code, Section
11164 of the Health and Safety Code shall prevail.
(c) "Electronic transmission prescription" includes both image and
data prescriptions. "Electronic image transmission prescription"
means any prescription order for which a facsimile of the order is
received by a pharmacy from a licensed prescriber. "Electronic data
transmission prescription" means any prescription order, other than
an electronic image transmission prescription, that is electronically
transmitted from a licensed prescriber to a pharmacy.
(d) The use of commonly used abbreviations shall not invalidate an
otherwise valid prescription.
(e) Nothing in the amendments made to this section (formerly
Section 4036) at the 1969 Regular Session of the Legislature shall be
construed as expanding or limiting the right that a chiropractor,
while acting within the scope of his or her license, may have to
prescribe a device.
SEC. 11. Section 4060 of the Business and
Professions Code is amended to read:
4060. No person shall possess any controlled substance, except
that furnished to a person upon the prescription of a physician and
surgeon, dentist, podiatrist, optometrist, veterinarian, nurse
practitioner, or naturopathic doctor pursuant to Section 3640.7, or
furnished pursuant to a drug order issued by a certified
nurse-midwife pursuant to Section 2746.51, a physician assistant
pursuant to Section 3502.1, a naturopathic doctor pursuant to Section
3640.5, or a pharmacist pursuant to either subparagraph (D) of
paragraph (4) of, or clause (iv) of subparagraph (A) of paragraph (5)
of, subdivision (a) of Section 4052. This section shall not apply to
the possession of any controlled substance by a manufacturer,
wholesaler, pharmacy, pharmacist, physician and surgeon, podiatrist,
dentist, optometrist, veterinarian, naturopathic doctor, certified
nurse-midwife, nurse practitioner, or physician assistant, when in
stock in containers correctly labeled with the name and address of
the supplier or producer.
Nothing in this section authorizes a certified nurse-midwife, a
physician assistant, or a naturopathic doctor to order his or her own
stock of dangerous drugs and devices.
SEC. 12. Section 4061 of the Business and
Professions Code is amended to read:
4061. (a) No manufacturer's sales representative shall distribute
any dangerous drug or dangerous device as a complimentary sample
without the written request of a physician and surgeon, dentist,
podiatrist, optometrist, veterinarian, nurse practitioner, or
naturopathic doctor pursuant to Section 3640.7. However, a certified
nurse-midwife who functions pursuant to a standardized procedure or
protocol described in Section 2746.51, a physician assistant who
functions pursuant to a protocol described in Section 3502.1, or a
naturopathic doctor who functions pursuant to a standardized
procedure or protocol described in Section 3640.5 may sign for the
request and receipt of complimentary samples of a dangerous drug or
dangerous device that has been identified in the standardized
procedure, protocol, or practice agreement. Standardized procedures,
protocols, and practice agreements shall include specific approval by
a physician and surgeon. A review process, consistent with the
requirements of Section 3502.1 or 3640.5, of the complimentary
samples requested and received by a certified nurse-midwife,
physician assistant, or naturopathic doctor shall be defined within
the standardized procedure, protocol, or practice agreement.
(b) Each written request shall contain the names and addresses of
the supplier and the requester, the name and quantity of the specific
dangerous drug desired, the name of the physician and surgeon,
certified nurse-midwife, nurse practitioner, physician assistant, or
naturopathic doctor, if applicable, receiving the samples pursuant to
this section, the date of receipt, and the name and quantity of the
dangerous drugs or dangerous devices provided. These records shall be
preserved by the supplier with the records required by Section 4059.
(c) Nothing in this section is intended to expand the scope of
practice of a certified nurse-midwife, physician assistant, or
naturopathic doctor.
SEC. 13. Section 4076 of the Business and
Professions Code is amended to read:
4076. (a) A pharmacist shall not dispense any prescription except
in a container that meets the requirements of state and federal law
and is correctly labeled with all of the following:
(1) Except where the prescriber or the certified nurse-midwife who
functions pursuant to a standardized procedure or protocol described
in Section 2746.51, the physician assistant who functions pursuant
to Section 3502.1, the naturopathic doctor who functions pursuant to
a standardized procedure or protocol described in Section 3640.5, or
the pharmacist who functions pursuant to a policy, procedure, or
protocol pursuant to either subparagraph (D) of paragraph (4) of, or
clause (iv) of subparagraph (A) of paragraph (5) of, subdivision (a)
of Section 4052 orders otherwise, either the manufacturer's trade
name of the drug or the generic name and the name of the
manufacturer. Commonly used abbreviations may be used. Preparations
containing two or more active ingredients may be identified by the
manufacturer's trade name or the commonly used name or the principal
active ingredients.
(2) The directions for the use of the drug.
(3) The name of the patient or patients.
(4) The name of the prescriber or, if applicable, the name of the
certified nurse-midwife who functions pursuant to a standardized
procedure or protocol described in Section 2746.51, the physician
assistant who functions pursuant to Section 3502.1, the naturopathic
doctor who functions pursuant to a standardized procedure or protocol
described in Section 3640.5, or the pharmacist who functions
pursuant to a policy, procedure, or protocol pursuant to either
subparagraph (D) of paragraph (4) of, or clause (iv) of subparagraph
(A) of paragraph (5) of, subdivision (a) of Section 4052.
(5) The date of issue.
(6) The name and address of the pharmacy, and prescription number
or other means of identifying the prescription.
(7) The strength of the drug or drugs dispensed.
(8) The quantity of the drug or drugs dispensed.
(9) The expiration date of the effectiveness of the drug
dispensed.
(10) The condition for which the drug was prescribed if requested
by the patient and the condition is indicated on the prescription.
(11) (A) Commencing January 1, 2006, the physical description of
the dispensed medication, including its color, shape, and any
identification code that appears on the tablets or capsules, except
as follows:
(i) Prescriptions dispensed by a veterinarian.
(ii) An exemption from the requirements of this paragraph shall be
granted to a new drug for the first 120 days that the drug is on the
market and for the 90 days during which the national reference file
has no description on file.
(iii) Dispensed medications for which no physical description
exists in any commercially available database.
(B) This paragraph applies to outpatient pharmacies only.
(C) The information required by this paragraph may be printed on
an auxiliary label that is affixed to the prescription container.
(D) This paragraph shall not become operative if the board, prior
to January 1, 2006, adopts regulations that mandate the same labeling
requirements set forth in this paragraph.
(b) If a pharmacist dispenses a prescribed drug by means of a unit
dose medication system, as defined by administrative regulation, for
a patient in a skilled nursing, intermediate care, or other health
care facility, the requirements of this section will be satisfied if
the unit dose medication system contains the aforementioned
information or the information is otherwise readily available at the
time of drug administration.
(c) If a pharmacist dispenses a dangerous drug or device in a
facility licensed pursuant to Section 1250 of the Health and Safety
Code, it is not necessary to include on individual unit dose
containers for a specific patient, the name of the certified
nurse-midwife who functions pursuant
to a standardized procedure or protocol described in
Section 2746.51, the physician assistant who functions pursuant to
Section 3502.1, the naturopathic doctor who functions pursuant to a
standardized procedure or protocol described in Section 3640.5, or
the pharmacist who functions pursuant to a policy, procedure, or
protocol pursuant to either subparagraph (D) of paragraph (4) of, or
clause (iv) of subparagraph (A) of paragraph (5) of, subdivision (a)
of Section 4052.
(d) If a pharmacist dispenses a prescription drug for use in a
facility licensed pursuant to Section 1250 of the Health and Safety
Code, it is not necessary to include the information required in
paragraph (11) of subdivision (a) when the prescription drug is
administered to a patient by a person licensed under the Medical
Practice Act (Chapter 5 (commencing with Section 2000)), the Nursing
Practice Act (Chapter 6 (commencing with Section 2700)), or the
Vocational Nursing Practice Act (Chapter 6.5 (commencing with Section
2840)), who is acting within his or her scope of practice.
SEC. 14. Section 4170 of the Business and
Professions Code is amended to read:
4170. (a) No prescriber shall dispense drugs or dangerous devices
to patients in his or her office or place of practice unless all of
the following conditions are met:
(1) The dangerous drugs or dangerous devices are dispensed to the
prescriber's own patient, and the drugs or dangerous devices are not
furnished by a nurse or physician attendant.
(2) The dangerous drugs or dangerous devices are necessary in the
treatment of the condition for which the prescriber is attending the
patient.
(3) The prescriber does not keep a pharmacy, open shop, or
drugstore, advertised or otherwise, for the retailing of dangerous
drugs, dangerous devices, or poisons.
(4) The prescriber fulfills all of the labeling requirements
imposed upon pharmacists by Section 4076, all of the recordkeeping
requirements of this chapter, and all of the packaging requirements
of good pharmaceutical practice, including the use of childproof
containers.
(5) The prescriber does not use a dispensing device unless he or
she personally owns the device and the contents of the device, and
personally dispenses the dangerous drugs or dangerous devices to the
patient packaged, labeled, and recorded in accordance with paragraph
(4).
(6) The prescriber, prior to dispensing, offers to give a written
prescription to the patient that the patient may elect to have filled
by the prescriber or by any pharmacy.
(7) The prescriber provides the patient with written disclosure
that the patient has a choice between obtaining the prescription from
the dispensing prescriber or obtaining the prescription at a
pharmacy of the patient's choice.
(8) A certified nurse-midwife who functions pursuant to a
standardized procedure or protocol described in Section 2746.51, a
physician assistant who functions pursuant to Section 3502.1, or a
naturopathic doctor who functions pursuant to Section 3640.5, may
hand to a patient of the supervising physician and surgeon or nurse
practitioner a properly labeled prescription drug prepackaged by a
physician and surgeon, a manufacturer as defined in this chapter, a
nurse practitioner, or a pharmacist.
(b) The Medical Board of California, the State Board of Optometry,
the Bureau of Naturopathic Medicine, the Dental Board of California,
the Osteopathic Medical Board of California, the Board of Registered
Nursing, the Veterinary Medical Board, and the Physician Assistant
Committee shall have authority with the California State Board of
Pharmacy to ensure compliance with this section, and those boards are
specifically charged with the enforcement of this chapter with
respect to their respective licensees.
(c) "Prescriber," as used in this section, means a person, who
holds a physician and surgeon's certificate, a license to practice
optometry, a license to practice naturopathic medicine, a license to
practice dentistry, a license to practice veterinary medicine, a
certificate to practice podiatry, or a license and certification as a
nurse practitioner, and who is duly registered by the Medical Board
of California, the State Board of Optometry, the Bureau of
Naturopathic Medicine, the Dental Board of California, the Veterinary
Medical Board, the Board of Osteopathic Examiners, or the Board of
Registered Nursing of this state.
SEC. 15. Section 4174 of the Business and
Professions Code is amended to read:
4174. Notwithstanding any other provision of law, a pharmacist
may dispense drugs or devices upon the drug order of a certified
nurse-midwife functioning pursuant to Section 2746.51, a physician
assistant functioning pursuant to Section 3502.1, or a naturopathic
doctor functioning pursuant to Section 3640.5, or the order of a
pharmacist acting under Section 4052.
SEC. 16. Section 4175 of the Business and
Professions Code is amended to read:
4175. (a) The California State Board of Pharmacy shall promptly
forward to the appropriate licensing entity, including the Medical
Board of California, the Veterinary Medical Board, the Dental Board
of California, the State Board of Optometry, the Osteopathic Medical
Board of California, the Board of Registered Nursing, the Bureau of
Naturopathic Medicine, or the Physician Assistant Committee, all
complaints received related to dangerous drugs or dangerous devices
dispensed by a prescriber, certified nurse-midwife, naturopathic
doctor, or physician assistant pursuant to Section 4170.
(b) All complaints involving serious bodily injury due to
dangerous drugs or dangerous devices dispensed by prescribers,
certified nurse-midwives, naturopathic doctors, or physician
assistants pursuant to Section 4170 shall be handled by the Medical
Board of California, the Dental Board of California, the State Board
of Optometry, the Osteopathic Medical Board of California, the Bureau
of Naturopathic Medicine, the Board of Registered Nursing, the
Veterinary Medical Board, or the Physician Assistant Committee as a
case of greatest potential harm to a patient.
SEC. 17. Section 11026 of the Health and Safety
Code is amended to read:
11026. "Practitioner" means any of the following:
(a) A physician, dentist, veterinarian, podiatrist, or pharmacist
acting within the scope of a project authorized under Article 1
(commencing with Section 128125) of Chapter 3 of Part 3 of Division
107, a registered nurse acting within the scope of a project
authorized under Article 1 (commencing with Section 128125) of
Chapter 3 of Part 3 of Division 107, a certified nurse-midwife acting
within the scope of Section 2746.51 of the Business and Professions
Code, a nurse practitioner acting within the scope of Section 2835.7
of the Business and Professions Code, or a physician assistant acting
within the scope of a project authorized under Article 1 (commencing
with Section 128125) of Chapter 3 of Part 3 of Division 107 or
Section 3502.1 of the Business and Professions Code, or an
optometrist acting within the scope of Section 3041 of the Business
and Professions Code.
(b) A pharmacy, hospital, or other institution licensed,
registered, or otherwise permitted to distribute, dispense, conduct
research with respect to, or to administer, a controlled substance in
the course of professional practice or research in this state.
(c) A scientific investigator, or other person licensed,
registered, or otherwise permitted, to distribute, dispense, conduct
research with respect to, or administer, a controlled substance in
the course of professional practice or research in this state.
SEC. 18. Section 11150 of the Health and Safety
Code is amended to read:
11150. No person other than a physician and surgeon, dentist,
podiatrist, or veterinarian, or naturopathic doctor acting pursuant
to Section 3640.7 of the Business and Professions Code, or pharmacist
acting within the scope of a project authorized under Article 1
(commencing with Section 128125) of Chapter 3 of Part 3 of Division
107 or within the scope of either subparagraph (D) of paragraph (4)
of, or clause (iv) of subparagraph (A) of paragraph (5) of,
subdivision (a) of Section 4052 of the Business and Professions Code,
a registered nurse acting within the scope of a project authorized
under Article 1 (commencing with Section 128125) of Chapter 3 of Part
3 of Division 107, a certified nurse-midwife acting within the scope
of Section 2746.51 of the Business and Professions Code, a nurse
practitioner acting within the scope of Sections 2835.7 and 2836.1 of
the Business and Professions Code, a physician assistant acting
within the scope of a project authorized under Article 1 (commencing
with Section 128125) of Chapter 3 of Part 3 of Division 107 or
Section 3502.1 of the Business and Professions Code, a naturopathic
doctor acting within the scope of Section 3640.5 of the Business and
Professions Code, or an optometrist acting within the scope of
Section 3041 of the Business and Professions Code, or an out-of-state
prescriber acting pursuant to Section 4005 of the Business and
Professions Code shall write or issue a prescription.
SEC. 19. Section 14088 of the Welfare and
Institutions Code is amended to read:
14088. (a) It is the purpose of this article to ensure that the
Medi-Cal program shall be operated in the most cost-effective and
efficient manner possible with the optimum number of Medi-Cal
providers and shall assure quality of care and known access to
services.
(b) For the purposes of this article, the following definitions
shall apply:
(1) "Primary care provider" means either of the following:
(A) Any internist, general practitioner,
obstetrician/gynecologist, pediatrician, family practice physician,
or nurse practitioner or any primary care clinic, rural health
clinic, community clinic or hospital outpatient clinic holding a
valid and current Medi-Cal provider number, which agrees to provide
case management to Medi-Cal beneficiaries.
(B) A county or other political subdivision that employs,
operates, or contracts with, any of the primary care providers listed
in subparagraph (A), and that agrees to use that primary care
provider for the purposes of contracting under this article.
(2) "Primary care case management" means responsibility for the
provision of referral, consultation, ordering of therapy, admission
to hospitals, follow up care, and prepayment approval of referred
services.
(3) "Designation form" or "form" means a form supplied by the
department to be executed by a Medi-Cal beneficiary and a primary
care provider or other entity eligible pursuant to this article who
has entered into a contract with the department pursuant to this
article, setting forth the beneficiary's choice of contractor and an
agreement to be limited by the case management decisions of that
contractor and the contractor's agreement to be responsible for that
beneficiary's case management and medical care, as specified in this
article.
(4) "Emergency services" means health care services rendered by an
eligible Medi-Cal provider to a Medi-Cal beneficiary for those
health services required for alleviation of severe pain or immediate
diagnosis and treatment of unforeseen medical conditions which if not
immediately diagnosed and treated could lead to disability or death.
(5) "Modified primary care case management" means primary care
case management wherein capitated services are limited to primary
care physician office visits only.
(6) "Service area" means an area designated by either a single
federal Postal ZIP Code or by two or more Postal ZIP Codes that are
contiguous.
SEC. 20. Section 14088.17 of the Welfare and
Institutions Code is amended to read:
14088.17. (a) The department may contract under this article, on
an exclusive or nonexclusive basis, with an established professional
organization with a membership which consists of physicians and
surgeons, nurse practitioners, and nurse-midwives who engage in the
types of practices or who provide services in the locations set forth
in subdivision (a) of Section 14088.
(b) (1) A contract under this section shall be implemented in a
manner consistent with any federal waivers which are obtained by the
department to enable such an arrangement.
(2) Where federal waivers permit restrictions on beneficiary
freedom of choice, the contract shall provide covered Medi-Cal
beneficiaries with an initial choice of a primary care physician and
surgeon, nurse practitioners, or nurse-midwife and a procedure
through which a beneficiary may change primary care providers with
good cause.
(c) This section shall apply only to the provision of services to
beneficiaries who, for purposes of Medi-Cal eligibility
determination, are residents of Lake County, Mendocino County, or
Sonoma County.
SEC. 21. Section 14111 of the Welfare and
Institutions Code is amended to read:
14111. (a) As permitted by federal law or regulations, for health
care services provided in a long-term health care facility that are
reimbursed by Medicare, a physician and surgeon may delegate any of
the following to a nurse practitioner:
(1) Alternating visits required by federal law and regulations
with a physician and surgeon.
(2) Any duties consistent with federal law and regulations within
the scope of practice of nurse practitioners, so long as all of the
following conditions are met:
(A) A physician and surgeon approves, in writing, the admission of
the individual to the facility.
(B) A physician and surgeon performs the initial visit and
alternate required visits.
(b) This section does not authorize benefits not otherwise
authorized by federal law or regulation.
(c) No task that is required by federal law or regulation to be
performed personally by a physician and surgeon may be delegated to a
nurse practitioner.
(d) Nothing in this section shall be construed as limiting the
authority of a long-term health care facility to hire and employ
nurse practitioners so long as that employment is consistent with
federal law and within the scope of practice of a nurse practitioner.
SEC. 22. Section 14111.5 of the Welfare and
Institutions Code is amended to read:
14111.5. (a) As permitted by federal law or regulations, for
health care services provided in a long-term health care facility
that are reimbursed under this chapter, a nurse practitioner may, to
the extent consistent with his or her scope of practice, perform any
of the following tasks otherwise required of a physician and surgeon:
(1) With respect to visits required by federal law or regulations,
making alternating visits, or more frequent visits if the physician
and surgeon is not available.
(2) Any duty or task that is consistent with federal and state law
or regulation within the scope of practice of nurse practitioners,
so long as all of the following conditions are met:
(A) A physician and surgeon approves, in writing, the admission of
the individual to the facility.
(B) A physician and surgeon performs the initial visit and
alternate required visits.
(b) This section does not authorize benefits not otherwise
authorized by federal or state law or regulation.
(c) Except as provided in subdivisions (a) and (b), any task that
is required by federal law or regulation to be performed personally
by a physician and surgeon may be delegated to a nurse practitioner
who is not an employee of the long-term health care facility.
(d) Nothing in this section shall be construed as limiting the
authority of a long-term health care facility to hire and employ
nurse practitioners so long as that employment is consistent with
federal law and with the scope of practice of a nurse practitioner.
SEC. 4. Section 2835.7 is added to the
Business and Professions Code , to read:
2835.7. (a) A certificate to practice as a nurse practitioner
authorizes the holder to provide comprehensive health care services,
including, but not limited to, diagnosis, psychosocial assessment,
and management of health and illness needs, for which the nurse
practitioner has been educationally prepared and is clinically
competent to perform.
(b) Notwithstanding any other provision of law, a nurse
practitioner in collaboration with a physician and surgeon or doctor
of osteopathy, may admit patients to and discharge patients from
hospitals, skilled nursing facilities, nursing facilities, home
health care, hospice facilities, and other inpatient facilities.
"Collaboration," for the purposes of this section, is defined as a
relationship between a nurse practitioner and a physician and surgeon
that includes both autonomous and cooperative decisionmaking, with
the nurse practitioner and the physician and surgeon contributing
their respective expertise.
(c) Notwithstanding any other provision of law, whenever any law
or regulation requires a signature, certification, stamp,
verification, affidavit, or endorsement by a physician and surgeon,
it shall be deemed to include a signature, certification, stamp,
verification, affidavit, or endorsement by a nurse practitioner.
(d) A nurse practitioner shall consult or refer a patient to a
physician and surgeon or other health care provider if the referral
will protect the health and welfare of the patient and a situation or
condition occurs in a patient that is beyond the nurse practitioner'
s knowledge and experience.
(e) Nothing in this article shall be construed to limit, revise,
or expand the current scope of practice of a registered nurse as
defined in Section 2527.
(f) The board has sole authority to interpret the practice of
nurse practitioners.
SEC. 5. 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 when the drugs or devices furnished or ordered are
consistent with the practitioner's educational preparation or for
which clinical competency has been established and maintained.
(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 , as defined in Section 2835.7, 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 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. 6. Section 3502.01 is added to the
Business and Professions Code , to read:
3502.01. (a) A physician assistant and his or her supervising
physician and surgeon shall establish in writing, guidelines for the
adequate supervision of the physician assistant. The supervising
physician and surgeon may adopt protocols to satisfy this requirement
for the performance of tasks by a physician assistant.
(b) The minimum content for a protocol governing diagnosis and
management of a patient by a physician assistant shall include the
presence or absence of symptoms, signs, and other data necessary to
establish a diagnosis or assessment, any appropriate tests or studies
to order, medications to recommend to the patient, and education to
be provided to the patient. A protocol for procedures shall state the
information to be provided to
the patient, the nature of the consent to be obtained from the
patient, the preparation and technique of the procedure, and the
followup care for the patient.
(c) Protocols shall be developed by the physician and surgeon and
adopted from, or referenced to, texts or other sources. The physician
and surgeon and the physician assistant he or she supervises shall
sign and date the protocols.
(d) The physician and surgeon shall review, countersign, and date
a sample of medical records of patients treated within the last 30
days by the physician assistant he or she supervises and who
functions under the protocols developed pursuant to this section. The
size of the sample shall be determined by the supervising physician
and surgeon in his or her judgment. The physician and surgeon shall
select for review those cases that by diagnosis, problem, treatment,
or procedure represent, in his or her judgment, the most significant
risk to the patient.
SEC. 7. Section 3502.1 of the Business
and Professions Code is amended to read:
3502.1. (a) In addition to the services authorized in the
regulations adopted by the board, and except as prohibited by Section
3502, while under the supervision of a licensed physician and
surgeon or physicians and surgeons authorized by law to supervise a
physician assistant, a physician assistant may administer or provide
medication to a patient, or transmit orally, or in writing on a
patient's record or in a drug order, an order to a person who may
lawfully furnish the medication or medical device pursuant to
subdivisions (c) and (d).
(1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
(2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt, or adopt, a written, practice specific, formulary
and protocols that specify all criteria for the use of a particular
drug or device, and any contraindications for the selection. The
drugs listed shall constitute the formulary and shall include only
drugs that are appropriate for use in the type of practice engaged in
by the supervising physician and surgeon. When issuing a drug order,
the physician assistant is acting on behalf of and as an agent for a
supervising physician and surgeon.
(b) "Drug order" for purposes of this section means an order for
medication which that is dispensed to
or for a patient, issued and signed by a physician assistant acting
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 or
order of the supervising physician, (2) all references to
"prescription" in this code and the Health and Safety Code shall
include drug orders issued by physician assistants pursuant to
authority granted by their supervising physicians, and (3) the
signature of a physician assistant on a drug order shall be deemed to
be the signature of a prescriber for purposes of this code and the
Health and Safety Code.
(c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician before it is filled or carried
out.
(1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient. At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled prescription drug prepackaged by a physician and surgeon,
manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2) A physician assistant may not administer, provide or issue a
drug order for Schedule II through Schedule V controlled substances
without advance approval by a supervising physician and surgeon for
the particular patient.
(3)
(2) Any drug order issued by a physician assistant
shall be subject to a reasonable quantitative limitation consistent
with customary medical practice in the supervising physician and
surgeon's practice.
(d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility or medical practice, shall contain the printed name,
address, and phone number of the supervising physician and surgeon,
the printed or stamped name and license number of the physician
assistant, and the signature of the physician assistant. Further, a
written drug order for a controlled substance, except a written drug
order in a patient's medical record in a health facility or a medical
practice, shall include the federal controlled substances
registration number of the physician assistant. The requirements of
this subdivision may be met through stamping or otherwise imprinting
on the supervising physician and surgeon's prescription blank to show
the name, license number, and if applicable, the federal controlled
substances number of the physician assistant, and shall be signed by
the physician assistant. When using a drug order, the physician
assistant is acting on behalf of and as the agent of a supervising
physician and surgeon.
(e) The medical record of any patient cared for by a physician
assistant for whom the supervising physician and surgeon's Schedule
II drug order has been issued or carried out shall be reviewed and
countersigned and dated by a supervising physician and surgeon within
seven days.
(f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
(g) The committee shall consult with the Medical Board of
California and report during its sunset review required by Division
1.2 (commencing with Section 473) the impacts of exempting Schedule
III and Schedule IV drug orders from the requirement for a physician
and surgeon to review and countersign the affected medical record of
a patient.
SEC. 8. Section 3502.5 of the Business
and Professions Code is amended to read:
3502.5. Notwithstanding any other provision of law, a physician
assistant may perform those medical services permitted pursuant to
Section 3502 during any state of war emergency, state of emergency,
or state of local emergency, as defined in Section 8558 of the
Government Code, and at the request of a responsible federal, state,
or local official or agency, or pursuant to the terms of a mutual aid
operation plan established and approved pursuant to the California
Emergency Services Act (Chapter 7 (commencing with Section 8550) of
Division 1 of Title 2 of the Government Code), regardless of whether
the physician assistant's approved supervising physician is available
to supervise the physician assistant, so long as a licensed
physician is available to render the appropriate supervision.
"Appropriate supervision" shall not require the personal or
electronic availability of a supervising physician if that
availability is not possible or practical due to the emergency. The
local health officers and their designees may act as supervising
physicians during emergencies without being subject to approval by
the board. At all times, the local health officers or their designees
supervising the physician assistants shall be licensed physicians
and surgeons. Supervising physicians acting pursuant to this
section shall not be subject to the limitation on the number of
physician assistants supervised under Section 3516.
No responsible official or mutual aid operation plan shall invoke
this section except in the case of an emergency that endangers the
health of individuals. Under no circumstances shall this section be
invoked as the result of a labor dispute or other dispute concerning
collective bargaining.
SEC. 9. Section 3516 of the Business
and Professions Code is amended to read:
3516. Notwithstanding any other provision of law, any
a physician assistant licensed by the committee
shall be eligible for employment or supervision by any
a physician approved by the board
and surgeon who is qualified to supervise
physician assistants , except that: .
(a) No physician shall supervise more than two physician
assistants at any one time, except as provided in Sections 3502.5,
3516.1, and 3516.5.
(b) The
The board may restrict physicians
a physician and surgeon to supervising specific types of
physician assistants including, but not limited to, restricting
physicians a physician and surgeon from
supervising physician assistants outside of the physician's
field of specialty of the physician and surgeon
.
SEC. 10. Section 3516.1 of the Business
and Professions Code is repealed.
3516.1. (a) (1) Notwithstanding any other provision of law, a
physician who provides services in a medically underserved area may
supervise not more than four physician assistants at any one time.
(2) As used in this section, "medically underserved area" means a
"health professional(s) shortage area" (HPSA) as defined in Part 5
(commencing with Section 5.1) of Chapter 1 of Title 42 of the Code of
Federal Regulations or an area of the state where unmet priority
needs for physicians exist as determined by the California Healthcare
Workforce Policy Commission pursuant to Section 128225 of the Health
and Safety Code.
(b) This section shall become inoperative on July 1, 2011, and, as
of January 1, 2012, is repealed, unless a later enacted statute that
is enacted before January 1, 2012, deletes or extends the dates on
which it becomes inoperative and is repealed.
SEC. 23. SEC. 11. 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.