SB 809 Senate Bill

BILL NUMBER: SB 809	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 26, 2007

INTRODUCED BY    Senator   Ashburn 
 Senators   Ashburn   and Runner 

                        FEBRUARY 23, 2007

    An act relating to primary care services.  
An act to amend Sections 2725.1, 2835.5, 2836, 2836.1, 2836.2,
2836.3, 3640, 3640.5, 4024, 4040, 4060, 4061, 4076, 4170, and 4174
of, and to add Section 2835.7 to, the Business and Professions Code,
to amend Sections 11150 and 120582 of the Health and Safety Code, and
to amend Sections 14111, 14111.5, and 16952 of the Welfare and
Institutions Code, relating to nursing. 


	LEGISLATIVE COUNSEL'S DIGEST


   SB 809, as amended, Ashburn.  Primary care clinics:
underserved areas: improved access.   Nurse
practitioners: 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.  
   This bill would set forth the activities that 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. 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, pursuant to which medical benefits are provided to public
assistance recipients and certain other low-income persons. The act
authorizes certain covered health care services provided under 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.  
   This bill would 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.  
   (3) Existing law, the Emergency Medical Services System and
Prehospital Emergency Medical Care Personnel Act, authorizes a county
to establish an emergency medical services fund for reimbursement of
emergency medical service related costs. Existing law makes
physician and surgeons eligible to receive payment from the fund for
patient care services, as specified, performed by a nurse
practitioner or nurse-midwife under the direct supervision of a
physician and surgeon. 
   This bill would also make a nurse practitioner eligible to receive
payment for those patient care services and would remove the
requirement of supervision of the services by a physician and
surgeon. The bill would authorize a nurse practitioner to receive
reimbursement for emergency services and inpatient and outpatient
obstetric pediatric services that the nurse practitioner determines
to be medically necessary.  
   (4) 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.  
   Existing law provides for licensing of clinics by the State
Department of Health Services, and establishes the Primary Clinic
Revolving Fund for the purposes of providing payments to clinics.
Effective July 1, 2007, these duties will be transferred to the State
Department of Public Health.  
   This bill would declare the intent of the Legislature to
subsequently amend this bill to include provisions that would improve
access to primary care in underserved areas by encouraging
establishment of additional clinics by allowing registered nurse
practitioners greater flexibility to operate clinics. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program:  no
  yes  .


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

   SECTION 1.    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. 2.    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  , a master's
degree in a clinical field related to nursing,  or a
 graduate   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. 3.    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.
   (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 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. 4.    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 
which   that  are or may be performed and the
clinical and didactic education, experience, or both needed to
practice safely at those levels. In setting  such 
 the  standards, the board shall consult with nurse
practitioners  , physicians and surgeons with expertise in
the nurse practitioner field,  and health care organizations
utilizing nurse practitioners. Established standards shall apply to
persons without regard to the date of meeting such standards.
 If the board sets standards for use of nurse practitioner
titles which include completion of an academically affiliated
program, it shall provide equivalent standards for registered nurses
who have not completed such a program. 
   (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. 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 
    2836.1.    (a)     A nurse
practitioner may prescribe drugs and devices  when the drugs or
devices  furnished or ordered   prescribed 
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. 

   (f) (1) 
    (b)  Drugs or devices  furnished or ordered
  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)  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 
    (c)     A nurse practitioner may not
prescribe drugs or devices under thi   s section unless 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   months' supervised  experience
in the  furnishing or ordering   prescribing
 of drugs  or   and  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 2836.2 of the   Business
and Professions Code   is amended to read: 
   2836.2.   Furnishing or ordering of drugs or devices by
nurse practitioners is defined to mean the act of making a
pharmaceutical agent or agents available to the patient in strict
accordance with a standardized procedure.  All nurse
practitioners who are authorized pursuant to Section  2831.1
  2836.1  to  furnish or issue drug orders
  prescribe  for controlled substances shall
register with the United States Drug Enforcement Administration.
   SEC. 7.    Section 2836.3 of the   Business
and Professions Code   is amended to read: 
   2836.3.  (a) The  furnishing   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  (g)   (c)  of Section 2836.1.
The number shall be included on all  transmittals of orders
  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. 8.    Section 3640 of the   Business
and Professions Code   is amended to read: 
   3640.  (a) A naturopathic doctor may order and perform physical
and laboratory examinations for diagnostic purposes, including, but
not limited to, phlebotomy, clinical laboratory tests, speculum
examinations, orificial examinations, and physiological function
tests.
   (b) A naturopathic doctor may order diagnostic imaging studies,
including X-ray, ultrasound, mammogram, bone densitometry, and
others, consistent with naturopathic training as determined by the
bureau, but shall refer the studies to an appropriately licensed
health care professional to conduct the study and interpret the
results.
   (c) A naturopathic doctor may dispense, administer, order, and
prescribe or perform the following:
   (1) Food, extracts of food,  nutraceuticals  
neutraceuticals  , vitamins, amino acids, minerals, enzymes,
botanicals and their extracts, botanical medicines, homeopathic
medicines, all dietary supplements and nonprescription drugs as
defined by the federal Food, Drug, and Cosmetic Act, consistent with
the routes of administration identified in subdivision (d).
   (2) Hot or cold hydrotherapy; naturopathic physical medicine
inclusive of the manual use of massage, stretching, resistance, or
joint play examination but exclusive of small amplitude movement at
or beyond the end range of normal joint motion; electromagnetic
energy; colon hydrotherapy; and therapeutic exercise.
   (3) Devices, including, but not limited to, therapeutic devices,
barrier contraception, and durable medical equipment.
   (4) Health education and health counseling.
   (5) Repair and care incidental to superficial lacerations and
abrasions, except suturing.
   (6) Removal of foreign bodies located in the superficial tissues.
   (d) A naturopathic doctor may utilize routes of administration
that include oral, nasal, auricular, ocular, rectal, vaginal,
transdermal, intradermal, subcutaneous, intravenous, and
intramuscular.
   (e) The bureau may establish regulations regarding ocular or
intravenous routes of administration that are consistent with the
education and training of a naturopathic doctor.
   (f) Nothing in this section shall exempt a naturopathic doctor
from meeting applicable licensure requirements for the performance of
clinical laboratory tests. 
   (g) The authority to use all routes for furnishing prescription
drugs as described in Section 3640.5 shall be consistent with the
oversight and supervision requirements of Section 2836.1. 
   SEC. 9.    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), (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.
   SEC. 10.    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, 
nurse practitioner,  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. 11.    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,  nurse practitioner, 
physician assistant, or naturopathic doctor who issues a drug order
pursuant to Section 2746.51,  2836.1,  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,  2836.1,
 3502.1, or 3460.5, by a certified nurse-midwife, 
nurse practitioner,  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. 12.    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 nurse practitioner pursuant to Section 2836.1,  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 nurse practitioner,  a physician assistant, or a
naturopathic doctor  ,  to order his or her own
stock of dangerous drugs and devices.
   SEC. 13.    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 nurse practitioner who functions pursuant to a
standardized procedure described in Section 2836.1, or protocol,
 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 2725, 3502.1, or 3640.5, of the complimentary samples
requested and received by a  nurse practitioner, 
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 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,  nurse practitioner,
 physician assistant, or naturopathic doctor.
   SEC. 14.    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 nurse practitioner who functions
pursuant to a standardized procedure described in Section 2836.1, or
protocol,  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
nurse practitioner who functions pursuant to a standardized procedure
described in Section 2836.1, or protocol,  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 nurse
practitioner who functions pursuant to a standardized procedure
described in Section 2836.1, or protocol,  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. 15.    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 nurse practitioner who functions pursuant to a
standardized procedure described in Section 2836.1, or protocol,
 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's   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,  or  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,  or  the Board of
Osteopathic Examiners  , or the Board of Registered Nursing 
of this state.
   SEC. 16.    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 nurse
practitioner functioning pursuant to Section 2836.1 or  a
certified nurse-midwife functioning pursuant to Section 2746.51,
 a drug order of  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. 17.    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 
Section   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. 18.    Section 120582 of the   Health
and Safety Code   is amended to read: 
   120582.  (a) Notwithstanding any other provision of law, a
physician and surgeon  or a nurse practitioner  who
diagnoses a sexually transmitted chlamydia, gonorrhea, or other
sexually transmitted infection, as determined by the department, in
an individual patient may prescribe, dispense, furnish, or otherwise
provide prescription antibiotic drugs to that patient's sexual
partner or partners without examination of that patient's partner or
partners. The department may adopt regulations to implement this
section.
   (b) Notwithstanding any other provision of law,  a nurse
practitioner pursuant to Section 2836.1 of the Business and
Professions Code,  a certified nurse-midwife pursuant to
Section 2746.51 of the Business and Professions Code  ,
 and a physician assistant pursuant to Section 3502.1 of the
Business and Professions Code may dispense, furnish, or otherwise
provide prescription antibiotic drugs to the sexual partner or
partners of a patient with a diagnosed sexually transmitted
chlamydia, gonorrhea, or other sexually transmitted infection, as
determined by the department, without examination of the patient's
sexual partner or partners.
   SEC. 19.    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) The medical care of each resident is supervised by a physician
and surgeon.  
   (C) 
    (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) All responsibilities delegated to a nurse practitioner
pursuant to this section shall be performed under the supervision of
the physician and surgeon and pursuant to a standardized procedure
among the physician and surgeon, nurse practitioner, and facility.
 
   (d) 
    (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. 
   (e) 
    (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. 20.    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) The medical care of each resident is supervised by a physician
and surgeon.  
   (C) 
    (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) All responsibilities undertaken by a nurse practitioner
pursuant to this section shall be performed in collaboration with the
physician and surgeon and pursuant to a standardized procedure among
the physician and surgeon, nurse practitioner, and facility.
 
   (d) 
    (c)  Except as provided in subdivisions (a)  to
(c), inclusive   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. 
   (e) 
    (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. 21.    Section 16952 of the   Welfare
and Institutions Code   is amended to read: 
   16952.  (a) (1) Each county shall establish within its emergency
medical services fund a Physician Services Account. Each county shall
deposit in the Physician Services Account those funds appropriated
by the Legislature for the purposes of the Physician Services Account
of the fund.
   (2) (A) Each county may encumber sufficient funds to reimburse
physician  and surgeon  losses incurred during the fiscal
year for which bills will not be received until after the fiscal
year.
   (B) Each county shall provide a reasonable basis for its estimate
of the necessary amount encumbered.
   (C) All funds that are encumbered for a fiscal year shall be
expended or disencumbered prior to the submission of the report of
actual expenditures required by Sections 16938 and 16980.
   (b) (1) Funds deposited in the Physician Services Account in the
county emergency medical services fund shall be exempt from the
percentage allocations set forth in subdivision (a) of Section
1797.98. However, funds in the county Physician Services Account
shall not be used to reimburse for physician  and surgeon 
services provided by  physicians   physician and
surgeons  employed by county hospitals.
   (2) No physician  and surgeon  who provides physician
 and surgeon  services in a primary care clinic which
receives funds from this act shall be eligible for reimbursement from
the Physician Services Account for any losses incurred in the
provision of those services.
   (c) The county  physician services account  
Physician Services Account  shall be administered by each
county, except that a county electing to have the state administer
its medically indigent adult program as authorized by Section 16809,
may also elect to have its county physician services account
administered by the state in accordance with Section 16954.
   (d) Costs of administering the account, whether by the county or
by the department through the emergency medical services
contract-back program, shall be reimbursed by the account based on
actual administrative costs, not to exceed 10 percent of the amount
of the account.
   (e) For purposes of this article "administering agency" means the
agency designated by the board of supervisors to administer this
article, or the department, in the case of those CMSP counties
electing to have the state administer this article on their behalf.
   (f) The county Physician Services Account shall be used to
reimburse  physicians   physician and surgeons
 for losses incurred for services provided during the fiscal
year of allocation due to patients who do not have health insurance
coverage for emergency services and care, who cannot afford to pay
for those services, and for whom payment will not be made through any
private coverage or by any program funded in whole or in part by the
federal government with the exception of claims submitted for
reimbursement through Section 1011 of the federal Medicare
Prescription Drug, Improvement and Modernization Act of 2003. 
   (g) Nurse practitioners shall be eligible to receive payment for
patient care services. Payment shall be limited to those claims that
are substantiated by a medical record.  
   (g) Physicians 
    (h)     Physician and surgeons  shall
be eligible to receive payment for patient care services provided by,
or in conjunction with, a  properly credentialed nurse
practitioner or   licensed  physician's assistant
for care rendered under the direct supervision of a physician and
surgeon who is present in the facility where the patient is being
treated and who is available for immediate consultation. Payment
shall be limited to those claims that are substantiated by a medical
record and that have been reviewed and countersigned by the
supervising physician and surgeon in accordance with regulations
established for the supervision of  nurse practitioners and
 physician assistants in California. 
   (h) 
    (i)  (1) Reimbursement for losses shall be limited to
emergency services as defined in Section 16953, obstetric, and
pediatric services as defined in Sections 16905.5 and 16907.5,
respectively.
   (2) It is the intent of this subdivision to allow reimbursement
for all of the following:
   (A) All inpatient and outpatient obstetric services  which
  that  are medically necessary, as determined by
the attending physician  and surgeon or nurse practitioner 
.
   (B) All inpatient and outpatient pediatric services  which
  that  are medically necessary, as determined by
the attending physician  and surgeon or nurse practitioner 
. 
   (i) 
    (j)  Any physician  and surgeon or nurse
practitioner  may be reimbursed for up to 50 percent of the
amount claimed pursuant to Section 16955 for the initial cycle of
reimbursements made by the administering agency in a given year. All
funds remaining at the end of the fiscal year shall be distributed
proportionally, based on the dollar amount of claims submitted and
paid to all  physicians   physician and surgeons
and nurse practitioners  who submitted qualifying claims during
that year. The administering agency shall not disburse funds in
excess of the total amount of a qualified claim.
   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.  
  SECTION 1.    It is the intent of the Legislature
to subsequently amend this act to include provisions that would
improve access to primary care in underserved areas by encouraging
establishment of additional clinics by allowing registered nurse
practitioners greater flexibility to operate clinics.