BILL NUMBER: AB 1643 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Niello
(Coauthors: Assembly Members Benoit, Huff, Smyth, Strickland,
Tran, and Villines)
FEBRUARY 23, 2007
An act to amend Sections 2836.1, 2836.3, and 3640.5 of the
Business and Professions Code, relating to nurse practitioners.
LEGISLATIVE COUNSEL'S DIGEST
AB 1643, as introduced, Niello. Nurse practitioners.
Existing law does not prohibit a nurse practitioner from
furnishing or ordering drugs or devices under conditions that require
physician and surgeon supervision. For purposes of these conditions,
a physician and surgeon is prohibited from supervising more than 4
nurse practitioners at one time.
This bill would repeal the prohibition against a physician and
surgeon supervising more than 4 nurse practitioners at one time. It
would also make conforming changes.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 2836.1 of the Business and Professions Code is
amended to read:
2836.1. Neither this chapter nor any other provision of law shall
be construed to prohibit a nurse practitioner from furnishing or
ordering drugs or devices when all of the following apply:
(a) The drugs or devices are furnished or ordered by a nurse
practitioner in accordance with standardized procedures or protocols
developed by the nurse practitioner and the supervising physician and
surgeon 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 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.
(e) (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)
(f) (1) The board has certified in accordance with
Section 2836.3 that the nurse practitioner has satisfactorily
completed (1) (A) at least six
month's months' physician and
surgeon-supervised experience in the furnishing or ordering of drugs
or devices and (2) (B) 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)
(g) 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)
(h) "Drug order" or "order" for purposes of this
section means an order for medication which is dispensed to or for an
ultimate user, issued by a nurse practitioner as an individual
practitioner, within the meaning of Section 1306.02 of Title 21 of
the Code of Federal Regulations. Notwithstanding any other provision
of law, (1) a drug order issued pursuant to this section shall be
treated in the same manner as a prescription of the supervising
physician; (2) all references to "prescription" in this code and the
Health and Safety Code shall include drug orders issued by nurse
practitioners; and (3) the signature of a nurse practitioner on a
drug order issued in accordance with this section shall be deemed to
be the signature of a prescriber for purposes of this code and the
Health and Safety Code.
SEC. 2. Section 2836.3 of the Business and Professions Code is
amended to read:
2836.3. (a) The furnishing of drugs or devices by nurse
practitioners is conditional on issuance by the board of a number to
the nurse applicant who has successfully completed the requirements
of subdivision (g) (f) of Section
2836.1. The number shall be included on all transmittals of orders
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. 3. Section 3640.5 of the Business and Professions Code is
amended to read:
3640.5. Nothing in this chapter or any other provision of law
shall be construed to prohibit a naturopathic doctor from furnishing
or ordering drugs when all of the following apply:
(a) The drugs are furnished or ordered by a naturopathic doctor in
accordance with standardized procedures or protocols developed by
the naturopathic doctor and his or her supervising physician and
surgeon.
(b) The naturopathic doctor is functioning pursuant to
standardized procedure, as defined by subdivisions (a), (b), (d)
, (e) (g) , and (h),
and (i) of Section 2836.1 and paragraph (1) of
subdivision (c) of Section 2836.1, or protocol. The standardized
procedure or protocol shall be developed and approved by the
supervising physician and surgeon, the naturopathic doctor, and,
where applicable, the facility administrator or his or her designee.
(c) The standardized procedure or protocol covering the furnishing
of drugs shall specify which naturopathic doctors may furnish or
order drugs, which drugs may be furnished or ordered under what
circumstances, the extent of physician and surgeon supervision, the
method of periodic review of the naturopathic doctor's competence,
including peer review, and review of the provisions of the
standardized procedure.
(d) The furnishing or ordering of drugs by a naturopathic doctor
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 all of the following:
(1) Collaboration on the development of the standardized
procedure.
(2) Approval of the standardized procedure.
(3) Availability by telephonic contact at the time of patient
examination by the naturopathic doctor.
(e) For purposes of this section, a physician and surgeon shall
not supervise more than four naturopathic doctors at one time.
(f) Drugs furnished or ordered by a naturopathic doctor may
include Schedule III through Schedule V controlled substances under
the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) and
shall be further limited to those drugs agreed upon by the
naturopathic doctor and physician and surgeon as specified in the
standardized procedure. When Schedule III controlled substances, as
defined in Section 11056 of the Health and Safety Code, are furnished
or ordered by a naturopathic doctor, 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 naturopathic doctor's standardized procedure
relating to controlled substances shall be provided upon request, to
a licensed pharmacist who dispenses drugs, when there is uncertainty
about the naturopathic doctor furnishing the order.
(g) The bureau has certified that the naturopathic doctor has
satisfactorily completed adequate coursework in pharmacology covering
the drugs to be furnished or ordered under this section. The bureau
shall establish the requirements for satisfactory completion of this
subdivision.
(h) Use of the term "furnishing" in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of
Section 1250 of the Health and Safety Code, shall include both of the
following:
(1) Ordering a drug in accordance with the standardized procedure.
(2) Transmitting an order of a supervising physician and surgeon.
(i) For purposes of this section, "drug order" or "order" means an
order for medication which is dispensed to or for an ultimate user,
issued by a naturopathic doctor as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations.
(j) Notwithstanding any other provision of law, the following
apply:
(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 naturopathic
doctors.
(3) The signature of a naturopathic doctor 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.