BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                   SB 360|
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                              UNFINISHED BUSINESS


          Bill No:  SB 360
          Author:   DeSaulnier (D)
          Amended:  7/7/11
          Vote:     21

           
           SENATE PUBLIC SAFETY COMMITTEE  :  7-0, 5/3/11
          AYES:  Hancock, Anderson, Calderon, Harman, Liu, Price, 
            Steinberg

           SENATE APPROPRIATIONS COMMITTEE  :  9-0, 5/26/11
          AYES:  Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley, 
            Price, Runner, Steinberg

           SENATE FLOOR  :  39-0, 6/2/11 (Consent)
          AYES:  Alquist, Anderson, Berryhill, Blakeslee, Calderon, 
            Cannella, Corbett, Correa, De León, DeSaulnier, Dutton, 
            Emmerson, Evans, Fuller, Gaines, Hancock, Harman, 
            Hernandez, Huff, Kehoe, La Malfa, Leno, Lieu, Liu, 
            Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio, 
            Simitian, Steinberg, Strickland, Vargas, Walters, Wolk, 
            Wright, Wyland, Yee
          NO VOTE RECORDED:  Runner

           ASSEMBLY FLOOR  :  78-0, 9/7/11 - See last page for vote


           SUBJECT  :    Controlled substances 

           SOURCE  :     Attorney General


           DIGEST  :    This bill makes certain changes to the law 
                                                           CONTINUED





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          regarding security printers for prescription forms for 
          controlled substance prescriptions, as specified.  This 
          bill establishes the Controlled Substance Utilization 
          Review and Evaluation System revise Prescription Drug 
          Monitoring Program to allow controlled substance 
          subscribers and pharmacists to have Internet access to the 
          controlled substance prescription history of persons under 
          their care, as specified.

           Assembly Amendments  add language relative to reporting the 
          theft or loss of prescription forms.

           ANALYSIS  :    Existing law includes the Controlled Substance 
          Utilization Review and Evaluation System (CURES) system of 
          electronic monitoring of Schedule II, III and IV controlled 
          substance prescriptions.  CURES provide for the electronic 
          transmission of Schedule II, III and IV prescription data 
          to the Department of Justice (DOJ) at the time 
          prescriptions are dispensed.  (Health & Safety Code Section 
          11165.)

          Existing law states that the purpose of CURES is to assist 
          law enforcement and regulatory agencies in controlling 
          diversion and abuse of Schedule II, III and IV controlled 
          substances and for statistical analysis, education and 
          research.  (Health & Safety Code Section 11165, subdivision 
          (a).)

          Existing law provides that pharmacists, in filling a 
          controlled substance prescription, shall provide to DOJ the 
          patient's name, date of birth, the name, form, strength and 
          quantity of the drug, and the pharmacy name, pharmacy 
          number and the prescribing physician information.  (Health 
          & Safety Code Section 11165, subdivision (d).)

          Existing law provides that a licensed health care 
          practitioner eligible to prescribe Schedule II, III or IV 
          controlled substances, or a pharmacist, may make a written 
          request to the DOJ for the history of controlled substances 
          dispensed to an individual based on the data in CURES.  
          (Health & Safety Code Section 11165.1, subdivision (a).)

          Existing law provides that the DOJ may initiate the 
          referral of the history controlled substances dispensed to 







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          an individual, based on the CURES data, to licensed health 
          care practitioners and pharmacists, as specified.  (Health 
          & Safety Code Section 11165.1, subdivision (b).)

          Existing law provides that the history of controlled 
          substances dispensed to a patient based on CURES data that 
          is received by a practitioner or pharmacist shall be 
          considered medical information, as specified.  (Health & 
          Safety Code Section 11165.1, subdivision (c).)

          Existing law provides that CURES data "shall only be 
          provided to appropriate state, local and federal persons or 
          public agencies for disciplinary, civil or criminal 
          purposes."  CURES data shall also only be provided, as 
          determined by DOJ, to other agencies or entities for 
          educating practitioners and others, in lieu of 
          disciplinary, civil or criminal actions.  (Health & Safety 
          Code Section 11165 subdivision (b).)

          Existing law allows non-identifying CURES data to be 
          provided to public and private entities for education, 
          research, peer review and statistical analysis.  (Health & 
          Safety Code Section 11165, subdivision (c).)

          Existing law provides that prescriptions for controlled 
          substances must be made on special security forms to 
          prevent copying or forgery of prescriptions.  (Health & 
          Safety Code Section 11162.1.)

          Existing law requires health practitioners who prescribe or 
          administer a controlled substance classified in Schedule II 
          to make a record containing the name and address of the 
          patient, date, and the character, name, strength, and 
          quantity of the controlled substance prescribed, as well as 
          the pathology and purpose for which the controlled 
          substance was administered or prescribed.  (Health & Safety 
          Code Section 11190, subdivision (a)-(b).)

          Existing law requires prescribers who are authorized to 
          dispense Schedule II, III  or IV controlled substance in 
          their office or place of practice to record and maintain 
          information for each such prescription that includes the 
          patient's name, address, gender, and date of birth,  
          prescriber's license and license number, federal controlled 







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          substance registration number, state medical license 
          number, National Drug Code number of the controlled 
          substance dispensed, quantity dispensed, diagnosis code, if 
          available, and original date of dispensing.  This 
          information shall be provided to DOJ on a monthly basis.  
          (Health & Safety Code Section 11190 subd. (c).)

          This bill provides that any security prescription form 
          printer shall provide DOJ with the following information: 
          the names and addresses of an owner, partner, corporate 
          officer, manager, agent, representative, employee or 
          subcontractor with direct access to, management of, or 
          control over controlled substance prescription forms.

          This bill provides that a security printer shall inform DOJ 
          if any owner, partner, corporate officer, manager, agent, 
          representative, employee or subcontractor with direct 
          access to, management of, or control over controlled 
          substance prescription forms has been convicted of, or 
          pleaded no contest, any crime.

          This bill directs DOJ to inform any owner, partner, 
          corporate officer, manager, agent, representative, employee 
          or subcontractor with direct access to, management of, or 
          control over controlled substance prescription forms how to 
          provide fingerprints and other required information to DOJ 
          for criminal background checks.

          This bill requires that controlled substance forms shall be 
          provided in person only to established customers.  The 
          printer shall obtain the customer's photo identification 
          and log the information.  Controlled substance forms shall 
          only be mailed to an address verified by the Drug 
          Enforcement Agency (DEA) or Medical Board of California.

          This bill requires security printers to report theft of 
          loss of controlled substance prescription forms to DOJ by 
          fax or e-mail within 24 hours.

          This bill requires DOJ to impose sanctions on security 
          printers who violate applicable statutes and regulations, 
          as specified.  

          This bill provides that the following security printer 







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          violations are subject to a fine of up to $1,000 for a 
          first violation, a fine of up to $2,500 for each subsequent 
          violation; a printer who violates these rules for a third 
          time is subject to disciplinary proceeding for suspension 
          or revocation of security printer status:

             Failure to comply with guidelines.

             Failure to take reasonable precautions to prevent 
             dishonest or illegal actions concerning control of 
             controlled substance forms.

             Theft or fraudulent use of a prescriber's identity to 
             obtain forms.

          This bill establishes the Prescription Drug Monitoring 
          Program (PDMP), with the following features:

             Any practitioner licensed to prescribe Schedules II 
             through IV controlled substances or pharmacist may apply 
             to participate in the PMDP, as specified.

             Under the PMDP the participating practitioner or 
             pharmacist (subscriber) may access, using the Internet, 
             the electronic history of controlled substances 
             dispensed to an individual under his or her care based 
             on data contained in CURES.

             A practitioner or pharmacist PDMP subscriber may access 
             through the PDMP the number, amount, and type of 
             controlled substances being dispensed to an individual 
             under his or her care, in order to control the diversion 
             and resultant abuse of, and to ensure the safe and 
             lawful dispensing of, Schedule II, Schedule III, and 
             Schedule IV controlled substances.

             DOJ may release to the subscribing practitioner or 
             pharmacist the electronic history of controlled 
             substances dispensed to a person under the care of the 
             practitioner or pharmacist based on data in the CURES 
             Prescription Drum Monitoring Program (PDMP). 

          This bill provides that an application may be denied, or a 
          subscriber suspended, for any of the following:







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             Materially falsifying an application.
             Failing to maintain effective controls for access to 
             the patient activity report.
             Suspended or revoked DEA registration.
             Arrest of a subscriber for a controlled substance 
             offense.
             Accessing information for any reason except patient 
             care.

          This bill provides that an authorized subscriber shall 
          notify DOJ within 10 days of any changes to the subscriber 
          account.
            
          This bill allows, until July 12, 2012, a health care 
          practitioner or pharmacist to make a written request for 
          controlled substance history information about a person 
          under the care of the practitioner or pharmacist, in order 
          to provide sufficient time for subscribers to apply for 
          access to PDMP.
            
          This bill provides that DOJ may audit the PDMP system and 
          its users.
            
          This bill provides that DOJ may establish, by regulation, a 
          system for issuing a citation to a PDMP subscriber.

          This bill provides that the citation may contain an order 
          or abatement or to pay a fine if the subscriber is in 
          violation of the CURES-PDMP statutes or corresponding 
          regulations:

             Citations shall be written and particularly describe 
             the violation, including a specific citation of the 
             statute or regulation violated.

             When appropriate, the citation shall include a 
             reasonable time for abatement of the violation.

             An administrative fine shall not exceed $2,500 for each 
             violation and shall be based on the gravity of the 
             violation, the good faith of the subscriber and any 
             previous violations.








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             The citation shall inform the subscriber that he/she 
             may, within 30 days of receiving a citation, request a 
             hearing.  

             A subscriber may, within 10 days of receiving a 
             citation, request in writing an informal conference with 
             DOJ.  DOJ may, pursuant to the conference, affirm, 
             modify or dismiss the citation. 

             If the citation is affirmed, the subscriber may request 
             a formal hearing.

             If the citation is modified, the original citation 
             shall be deemed withdrawn and a new citation issued.  
             The subscriber may request a formal hearing on the 
             subsequent citation.

             Failure to pay a fine within 30 days, or to comply with 
             an order of abatement within the time prescribed to do 
             so, may result in disciplinary action by DOJ, unless the 
             citation is being appealed.

             If the citation is not contested and the fine is not 
             paid, the subscriber's account will be terminated.

             A citation may be issued without a fine.

             Fines may be limited to particular violations.

             If a fine is paid, payment shall represent satisfactory 
             resolution of the matter for public disclosure.

             Administrative fines shall be deposited in the CURES 
             Program Special Fund and "shall provide support for 
             costs association with hearings, maintenance, and 
             updates to the ÝPDMP]."  

             These sanctions shall be in separate form and in 
             addition to any other administrative, civil or criminal 
             remedies.

             A criminal action may not be initiated for a specific 
             offense if a citation has been issued for that matter.  
             A citation may not be issued for a specific offense, if 







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             a criminal action has been filed for that violation.  
             However, nothing in the citation provisions shall 
             prevent DOJ from prosecuting a suspension or revocation 
             of a subscriber.

             Provides that the theft or loss of prescription forms 
             must be reported immediately by the security printer or 
             affected prescriber to the CURES Prescription Drug 
             Monitoring Program.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  Yes

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

           Major Provisions                2011-12     2012-13    
           2013-14   Funds  

          Regulation development                            Unknown; 
          significant costs in the                          General
          and establishment of                              hundreds 
          of thousands; future offset                       Special*
          system for regulation of in whole or in part by fine/fee 
          revenue
          PDMP access

          Expanded security                            Unknown, 
          enforcement costs fully                      Special*
          printer requirementsoffset by fee/fine revenue
          and fines

          PDMP maintenance                        Potential minor 
          cost pressure to                             Special**
          contracts           existing contracts

          *CURES Program Special Fund
          **Contingent Fund of Medical Board, Pharmacy Board 
          Contingent Fund, State Dentistry Fund, Board of Registered 
          Nursing Fund, Osteopathic Medical Board Contingent Fund

           SUPPORT  :   (Verified  9/7/11)








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          Attorney General (source)
          California Narcotic Officers Association
          California Peace Officers Research Association
          California Police Chiefs Association
          California State Sheriffs' Association
          California Statewide Law Enforcement Association
          Consumer Attorneys of California
          Los Angeles County District Attorney's Office

           ARGUMENTS IN SUPPORT  :    According to the author's office, 
          due to the rise in prescription drug abuse, controlled 
          drugs prescription history information is available and 
          maintained by the DOJ CURES program.  In 2009, the DOJ 
          launched an automated PDMP.  The program allows licensed 
          health care practitioners eligible to prescribe controlled 
          substances access to patient controlled substance 
          prescription information.  Prescribers and pharmacists can 
          now make informed decisions about patient care and detect 
          patients who may be abusing controlled substances by 
          obtaining multiple prescriptions from various 
          practitioners.  Current efforts at maintaining privacy and 
          control of CURES data are inadequate to protect 
          confidential patient information and to deter its misuse.

          The DOJ also manages the California Security Prescription 
          Printer Program.  While DOJ has established guidelines for 
          the security of prescription forms, current law lacks 
          sufficient safeguards against theft and fraudulent use of 
          prescription pads.  The DOJ has seen an increase in 
          criminal enterprises involved in prescription theft and 
          fraud.


           ASSEMBLY FLOOR  :  78-0, 9/7/11
          AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill 
            Berryhill, Block, Blumenfield, Bonilla, Bradford, 
            Brownley, Buchanan, Butler, Charles Calderon, Campos, 
            Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson, 
            Donnelly, Eng, Feuer, Fletcher, Fong, Fuentes, Beth 
            Gaines, Galgiani, Garrick, Gatto, Gordon, Grove, Hagman, 
            Halderman, Hall, Harkey, Hayashi, Roger Hernández, Hill, 
            Huber, Hueso, Huffman, Jeffries, Jones, Knight, Lara, 
            Logue, Bonnie Lowenthal, Ma, Mansoor, Mendoza, Miller, 
            Mitchell, Monning, Morrell, Nestande, Nielsen, Norby, 







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            Olsen, Pan, Perea, V. Manuel Pérez, Portantino, Silva, 
            Skinner, Smyth, Solorio, Swanson, Torres, Valadao, 
            Wagner, Wieckowski, Williams, Yamada, John A. Pérez
          NO VOTE RECORDED: Furutani, Gorell


          RJG:do  9/8/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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