Amended in Assembly April 21, 2014

California Legislature—2013–14 Regular Session

Assembly BillNo. 1841


Introduced by Assembly Member Mullin

(Coauthor: Senator Hernandez)

February 18, 2014


An act to amend Section 2069 of the Business and Professions Code, relating to medicine.

LEGISLATIVE COUNSEL’S DIGEST

AB 1841, as amended, Mullin. Medical assistants.

Existing law, the Medical Practice Act, provides for the licensure and regulation of the practice of medicine by the Medical Board of California. The act authorizes a medical assistant to administer medication only by intradermal, subcutaneous, or intramuscular injections and to perform skin tests and additional technical supportive services upon the specific authorization and supervision of a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife. Existing law defines the term “technical supportive services” to mean simple routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife. Existing law, the Pharmacy Law, prohibits a prescriber, as defined, from dispensing drugs to patients in his or her office unless specified conditions are satisfied, and authorizes a certified nurse-midwife, a nurse practitioner, a physician assistant, or a naturopathic doctor who functions pursuant to a specified protocol or procedure to hand to a patient of his or her supervising physician a properly labeled and prepackaged prescription drug.

This bill would specify that the “technical supportive services” a medical assistant may perform also includes handing to a patient a properly labeled and prepackaged prescription drug, other than a controlled substance, ordered by a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwifebegin insert, as specifiedend insert.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 2069 of the Business and Professions
2Code
is amended to read:

3

2069.  

(a) (1) Notwithstanding any other law, a medical
4assistant may administer medication only by intradermal,
5subcutaneous, or intramuscular injections and perform skin tests
6and additional technical supportive services upon the specific
7authorization and supervision of a licensed physician and surgeon
8or a licensed podiatrist. A medical assistant may also perform all
9these tasks and services upon the specific authorization of a
10physician assistant, a nurse practitioner, or a certified
11nurse-midwife.

12(2) The supervising physician and surgeon may, at his or her
13discretion, in consultation with the nurse practitioner, certified
14nurse-midwife, or physician assistant, provide written instructions
15to be followed by a medical assistant in the performance of tasks
16or supportive services. These written instructions may provide that
17the supervisory function for the medical assistant for these tasks
18or supportive services may be delegated to the nurse practitioner,
19certified nurse-midwife, or physician assistant within the
20standardized procedures or protocol, and that tasks may be
21performed when the supervising physician and surgeon is not
22onsite, if either of the following apply:

23(A) The nurse practitioner or certified nurse-midwife is
24functioning pursuant to standardized procedures, as defined by
25Section 2725, or protocol. The standardized procedures or protocol,
26including instructions for specific authorizations, shall be
P3    1developed and approved by the supervising physician and surgeon
2and the nurse practitioner or certified nurse-midwife.

3(B) The physician assistant is functioning pursuant to regulated
4services defined in Section 3502, including instructions for specific
5authorizations, and is approved to do so by the supervising
6physician and surgeon.

7(b) As used in this section and Sections 2070 and 2071, the
8following definitions apply:

9(1) “Medical assistant” means a person who may be unlicensed,
10who performs basic administrative, clerical, and technical
11supportive services in compliance with this section and Section
122070 for a licensed physician and surgeon or a licensed podiatrist,
13or group thereof, for a medical or podiatry corporation, for a
14physician assistant, a nurse practitioner, or a certified
15nurse-midwife as provided in subdivision (a), or for a health care
16service plan, who is at least 18 years of age, and who has had at
17least the minimum amount of hours of appropriate training pursuant
18to standards established by the board. The medical assistant shall
19be issued a certificate by the training institution or instructor
20indicating satisfactory completion of the required training. A copy
21of the certificate shall be retained as a record by each employer of
22the medical assistant.

23(2) “Specific authorization” means a specific written order
24prepared by the supervising physician and surgeon or the
25supervising podiatrist, or the physician assistant, the nurse
26practitioner, or the certified nurse-midwife as provided in
27subdivision (a), authorizing the procedures to be performed on a
28patient, which shall be placed in the patient’s medical record, or
29a standing order prepared by the supervising physician and surgeon
30or the supervising podiatrist, or the physician assistant, the nurse
31practitioner, or the certified nurse-midwife as provided in
32subdivision (a), authorizing the procedures to be performed, the
33duration of which shall be consistent with accepted medical
34practice. A notation of the standing order shall be placed on the
35 patient’s medical record.

36(3) “Supervision” means the supervision of procedures
37authorized by this section by the following practitioners, within
38the scope of their respective practices, who shall be physically
39present in the treatment facility during the performance of those
40procedures:

P4    1(A) A licensed physician and surgeon.

2(B) A licensed podiatrist.

3(C) A physician assistant, nurse practitioner, or certified
4nurse-midwife as provided in subdivision (a).

5(4) (A) “Technical supportive services” means simple routine
6medical tasks and procedures that may be safely performed by a
7medical assistant who has limited training and who functions under
8the supervision of a licensed physician and surgeon or a licensed
9podiatrist, or a physician assistant, a nurse practitioner, or a
10certified nurse-midwife as provided in subdivision (a).

11(B) Notwithstanding any other law, “technical supportive
12services” includes handing to a patient a properly labeled and
13prepackaged prescription drug, excluding a controlled substance,
14ordered by a licensed physician and surgeon, a licensed podiatrist,
15a physician assistant, a nurse practitioner, or a certified
16nurse-midwifebegin delete operativeend delete in accordance with subdivision (a).begin insert In
17every instance, prior to handing the medication to a patient, the
18 properly labeled and prepackaged prescription drug shall have
19the patient’s name affixed to the package and a licensed physician
20and surgeon, a licensed podiatrist, a physician assistant, a nurse
21practitioner, or a certified nurse-midwife shall verify that it is the
22correct medication and dosage for that specific patient.end insert

23(c) Nothing in this section shall be construed as authorizing any
24of the following:

25(1) The licensure of medical assistants.

26(2) The administration of local anesthetic agents by a medical
27assistant.

28(3) The board to adopt any regulations that violate the
29prohibitions on diagnosis or treatment in Section 2052.

30(4) A medical assistant to perform any clinical laboratory test
31or examination for which he or she is not authorized by Chapter
323 (commencing with Section 1200).

33(5) A nurse practitioner, certified nurse-midwife, or physician
34assistant to be a laboratory director of a clinical laboratory, as those
35terms are defined in paragraph (8) of subdivision (a) of Section
361206 and subdivision (a) of Section 1209.

begin delete

37(6) A medical assistant to dispense dangerous drugs or devices
38to a patient, except as may be authorized by subdivision (a) or by
39the board in regulations adopted pursuant to Section 2071.

end delete

P5    1(d) A nurse practitioner, certified nurse-midwife, or physician
2assistant shall not authorize a medical assistant to perform any
3clinical laboratory test or examination for which the medical
4assistant is not authorized by Chapter 3 (commencing with Section
51200). A violation of this subdivision constitutes unprofessional
6conduct.

7(e) Notwithstanding any other law, a medical assistant shall not
8be employed for inpatient care in a licensed general acute care
9hospital, as defined in subdivision (a) of Section 1250 of the Health
10and Safety Code.



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