BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 2348
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 2348 (Mitchell)
          As Amended  August 20, 2012
          Majority vote
           
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          |ASSEMBLY:  |44-28|(May 31, 2012)  |SENATE: |23-15|(August 22,    |
          |           |     |                |        |     |2012)          |
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           Original Committee Reference:    B.,P. & C.P.  

           SUMMARY  :  Allows registered nurses (RNs) to dispense and 
          administer hormonal contraceptives under a standardized 
          procedure, as specified, and allows RNs to dispense drugs and 
          devices upon an order by a certified nurse-midwife (CNM), a 
          nurse practitioner (NP), or a physician assistant (PA) while 
          functioning within specified clinic settings.  

           The Senate amendments  :

          1)Expand the types of clinics in which an RN may dispense drugs 
            or devices upon an order by a physician and surgeon, a CNM, an 
            NP, or a PA to include intermittent clinics and student health 
            centers operated by public higher education institutions.

          2)Delete language limiting the settings in which RNs may 
            dispense hormonal contraceptives, thereby allowing RNs to 
            dispense hormonal contraceptives in any setting.

          3)Expand the components that must be included in the 
            standardized procedure under which RNs may dispense hormonal 
            contraceptives to include:

             a)   Successful completion of training and competency 
               assessment, on which the selection of RNs who may dispense 
               or administer hormonal contraceptives will be based;

             b)   Minimum training requirements regarding educating 
               patients on medical standards for ongoing women's 
               preventive health, contraception options education and 
               counseling, properly eliciting, documenting, and assessing 
               patient and family health history, and utilization of the 
               United States Medical Eligibility Criteria for 
               Contraceptive Use (USMEC);








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             c)   Demonstration of competency in providing the appropriate 
               prior examination comprised of checking blood pressure, 
               weight, and patient and family health history, including 
               medications taken by the patient;

             d)   Criteria and procedure for identification, 
               documentation, and referral of patients with 
               contraindications for hormonal contraceptives and patients 
               in need of a follow-up visit to a physician and surgeon, 
               NP, CNM, or PA;

             e)   Adherence to current law, which makes it unprofessional 
               conduct to prescribe, dispense or furnish dangerous drugs 
               without an appropriate examination and a medical 
               indication, in a manner developed through collaboration 
               with health care providers, including physicians and 
               surgeons, CNMs, NPs, PAs, and RNs.  The appropriate prior 
               examination shall be consistent with the evidence-based 
               practice guidelines adopted by the federal Centers for 
               Disease Control and Prevention in conjunction with the 
               USMEC; and,

             f)   If a patient has been seen exclusively by an RN for 
               three consecutive years, the patient shall be evaluated by 
               a physician and surgeon, NP, CNM, or PA prior to continuing 
               the dispensation or administration of hormonal 
               contraceptives.

          4)State that nothing in this bill shall be construed to affect 
            the sites or types of health care facilities at which drugs or 
            devices are authorized to be dispensed pursuant to California 
            Pharmacy Law.

           AS PASSED BY THE ASSEMBLY  , this bill allowed RNs to dispense 
          drugs and devices upon an order by a CNM, an NP, or a PA while 
          functioning within specified clinic settings, and allowed RNs to 
          dispense and administer hormonal contraceptives under a 
          standardized procedure while functioning within specified clinic 
          settings.

           FISCAL EFFECT  :  Unknown.  This bill is keyed non-fiscal by the 
          Legislative Counsel.

           COMMENTS  :  This bill was amended in the Senate, and is 








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          consistent with Assembly Actions.
           

          Analysis Prepared by  :    Angela Mapp / B.,P. & C.P. / (916) 
          319-3301 


          FN: 
          0005325