BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1841|
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THIRD READING
Bill No: AB 1841
Author: Mullin (D), et al.
Amended: 6/2/14 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON DEVELOP COMM .: 8-0, 6/23/14
AYES: Lieu, Wyland, Berryhill, Corbett, Galgiani, Hernandez,
Hill, Torres
NO VOTE RECORDED: Block
ASSEMBLY FLOOR : 76-0, 5/19/14 - See last page for vote
SUBJECT : Medical assistants
SOURCE : Planned Parenthood Affiliates of California
DIGEST : This bill authorizes a medical assistant (MA) to hand
out properly labeled and prepackaged prescription drugs to
patients as part of their existing authorization to provide
technical supportive services.
ANALYSIS :
Existing law:
1. Establishes the Medical Practice Act (Act) which licenses
and regulates physicians and surgeons as well as regulating
MAs by the Medical Board of California (MBC).
2. Defines an MA as a person who may be unlicensed, who
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performs basic administrative, clerical, and technical
supportive services, as specified, for a licensed physician
and surgeon or a licensed podiatrist, a physician or
podiatrist group, a medical or podiatry corporation, a
physician assistant (PA), a nurse practitioner (NP), a
certified nurse-midwife (CNM) or for a health care service
plan.
3. Requires an MA to be at least 18 years of age and have at
least the minimum amount of hours of appropriate training
pursuant to established MBC standards, and further requires
an MA to have a certificate by the training institution or
instructor indicating satisfactory completion of the required
training, and for each employer to retain a copy of this
certificate.
4. Authorizes an MA to administer medication only by
intradermal, subcutaneous, or intramuscular injections and
perform skin tests and additional technical supportive
services upon the specific authorization and supervision of a
licensed physician and surgeon or podiatrist. An MA may also
perform all these tasks and services upon the specific
authorization of a PA, NP, or CNM.
5. Permits a supervising physician and surgeon to provide
written instructions to be followed by an MA in performing
tasks or supportive services. The written instructions may
delegate the supervision of the MA in performing the tasks or
services to an NP, CNM, or PA within the standardized
procedures or protocols.
6. Defines "technical supportive services" as simple routine
medical tasks and procedures that may be safely performed by
an MA who has limited training and who functions under the
supervision of a licensed physician and surgeon, podiatrist,
PA, NP, or a CNM, as specified.
7. Permits an MA to perform venipuncture or skin puncture for
the purposes of withdrawing blood upon specific authorization
and supervision of a licensed physician and surgeon,
podiatrist, PA, NP, or a CNM if the MA has met minimum
training requirements established by the MBC.
8. Establishes the Pharmacy Law which provides for the
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licensure and regulation of pharmacies, pharmacists and
wholesalers of dangerous drugs or devices by the Board of
Pharmacy (BOP).
9. Governs the prescribing, dispensing, or furnishing of
dangerous drugs by prescribers, defined to include a
physician and surgeon, podiatrist and CNM, as specified.
10.Authorizes a pharmacy to employ a non-licensed person to
type a prescription label or otherwise enter prescription
information into a computer record system, but the
responsibility for the accuracy of the prescription
information and the prescription as dispensed lies with the
registered pharmacist who initials the prescription or
prescription record. At the direction of the registered
pharmacist, a non-licensed person may also request and
receive refill authorization.
11.Authorizes a licensed nonprofit community clinic or free
clinic, a county owned or operated primary care clinic, a
clinic operated by a federally recognized Indian tribe or
tribal organization, a clinic operated by primary care
community or free clinic, a student health center, a
nonprofit multispecialty clinic, as specified, to be licensed
by the BOP to purchase drugs at wholesale for administration
or dispensing, under the direction of a physician and
surgeon, to patients registered for care at the clinic, as
specified.
12.Authorizes a surgical clinic, as specified, to be licensed
by the BOP to purchase drugs to purchase drugs at wholesale
for administration or dispensing, under the direction of a
physician and surgeon, to patients registered for care at the
clinic, as specified.
This bill expands the definition of "technical supportive
services" carried out by an MA in a specified clinic, other than
a facility operated by the state, to include the following:
1.Handing a patient a properly labeled and prepackaged
prescription drug, excluding a controlled substance, labeled
in compliance, as specified, ordered by a licensed physician
and surgeon, podiatrist, PA, NP, or CNM, as specified.
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2.Requires that prior to an MA handing the medication to a
patient, a licensed physician and surgeon, podiatrist, PA, NP,
or CNM shall verify that the medication and dosage for that
specific patient is correct, that the patient's name is
affixed to the package and shall provide the appropriate
patient consultation regarding the use of the drug.
Background
MAs are unlicensed, but certificated, individuals. MAs must
have a high school diploma or GED equivalent and take a
certificate course at an approved school. Prior to performing
technical supportive services, a medical assistant must receive
training, as necessary, and it is the responsibility of the
supervising physician, podiatrist or instructor to assure the
MA's competence in performing that service at the appropriate
standard of care.
The MBC regulations establish the requirements which allow
certifying organizations to certify medical assistants.
According to the MBC, the training may be administered under a
licensed physician, podiatrist, registered nurse, licensed
vocational nurse, physician assistant or qualified medical
assistant, or in a secondary, post-secondary, or adult education
program in a public school authorized by the Department of
Education, in a community college program, or a post-secondary
institution accredited or approved by the Bureau for Private
Postsecondary Education. To administer medications by
intramuscular, subcutaneous and intradermal injections, perform
skin tests, perform venipuncture or skin puncture to withdraw
blood, an MA must complete specified training prescribed by the
MBC regulations.
MAs may perform specific functions as part of "technical
supportive" services in addition to administrative functions,
including:
1. Administering medications orally, sublingually, topically,
vaginally or rectally, or by providing a single dose to a
patient for immediate self-administration;
2. Administering medication by inhalation;
3. Performing electrocardiogram, electroencephalogram, or
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plethysmography tests;
4. Applying and removing bandages and dressings;
5. Removing sutures or staples from superficial incisions or
lacerations;
6. Collecting by non-invasive techniques and preserving
specimens for testing, including urine, sputum, semen and
stool;
7. Preparing patients for, and assisting the physician,
podiatrist, PA or registered nurse in, examinations or
procedures including positioning, draping, shaving and
disinfecting treatment sites, and preparing a patient for
gait analysis testing;
8. Providing patient information and instructions, as
authorized by the physician or podiatrist;
9. Collecting and recording patient data including height,
weight, temperature, pulse, respiration rate and blood
pressure, and basic information about the presenting and
previous conditions; and
10.Performing simple laboratory and screening tests customarily
performed in a medical office.
This bill clarifies that MAs may hand out properly labeled and
prepackaged prescription drugs to patients as part of "technical
supportive services" in specified types of clinics. Based upon
currently authorized abilities, this appears to be well within
an MA's scope of practice.
Comments
According to the author, "Medical Assistants are currently
allowed to provide a range of supportive and medical services
like administer medication (including narcotics) orally,
topically, or through injection; perform skin tests; apply
bandages, remove casts and stitches, perform simple lab/
screening tests; and perform technical supportive services upon
training and authorization of a licensed physician and surgeon.
MAs cannot dispense and are not allowed to hand over medication
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of any kind to patients."
The author further states that current practice in community
health centers relies on the use of MAs to support physicians
and clinicians (nurse practitioners, certified nurse-midwives,
and physician assistants). Since MAs are not permitted to hand
medication to a patient, that administrative task must be done
by the physician or clinician, taking their time away from
seeing more patients and focusing on the care they have been
trained to provide. The author states, "After examining a
patient, diagnosing them, discussing options and providing
education on any recommended medication, the clinician must go
back to the locked pharmacy closet to select, package and label
the appropriate medication and then returns to the patient exam
room to physically hand the patient the medication. This bill
would allow an MA to take the medication, after it has been
pulled, packaged, and labeled, and physically hand it to the
patient."
The author indicates that although this takes only several
minutes for each patient, it adds up significantly over time
ultimately limiting patient access. "This minor increase in MAs
ability to hand over medication will free up other providers to
see additional patients. More fully utilizing the abilities of
[MAs] will increase efficiency in health facilities like
community health centers and by seeing more patients, health
facilities will be able to reduce waiting times and expand
patient access to care.
With millions of Californians newly enrolled in health care
coverage under the ACA [Affordable Care Act] and millions more
eligible for coverage, expanding access to care is essential to
ensuring that these individuals have meaningful coverage.
California needs to utilize all health care professionals and
those that assist them to the fullest extent of their abilities
and potential to increase access, improving our health care
delivery system to better serve the newly enrolled population
and providing coverage for the remaining uninsured."
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
SUPPORT : (Verified 6/23/14) (per Senate Business, Professions
and Economic Development Committee analysis - unable to reverify
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at time of writing)
Planned Parenthood Affiliates of California (source)
Association of California Healthcare Districts
California Association for Nurse Practitioners
Medical Board of California
OPPOSITION : (Verified 6/23/14) (per Senate Business,
Professions and Economic Development Committee analysis - unable
to reverify at time of writing)
California Right to Life Committee, Inc.
California Society of Health-System Pharmacists
ARGUMENTS IN SUPPORT : In sponsoring this bill, Planned
Parenthood Affiliates of California writes that this minor
expansion of MA duties will increase access to care in health
care settings, including Planned Parenthood, by reducing waiting
times caused, in part, by clinicians who must package the
medications and then themselves hand it to the patient.
"Authorizing MAs to hand over pre-packaged/pre-labeled
medication is consistent with (if not less complicated than) the
level and complexity and range of medical and technical support
services they are already authorized to perform, including
administering narcotics and giving injections." Finally,
Planned Parenthood argues that authorizing MAs to hand over
medication frees up the clinician from this administrative duty
and allows them to see more patients and spend more time with
each patient answering questions.
The Medical Board of California believes this bill will help
further the Board's mission of increasing access to care, and
writes that allowing MAs to hand over properly labeled,
pre-packaged medication is a minor increase in the MAs duties,
and one that does not compromise consumer protection, since the
physician would have to label the medication for the patient,
package the medication, and provide the appropriate
consultation.
ARGUMENTS IN OPPOSITION : California Right to Life Committee,
Inc. argues that allowing unlicensed healthcare professionals to
hand a patient "a properly labeled and prepackaged prescription
drug," creates a completely unnecessary barrier to Doctor/
patient communication. They state, "Even the most educated
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Medical Assistants with the highest certifications do not
receive pharmacy training, neither are Medical Assistants
allowed to diagnose or to perform any task that requires
assessment - including commenting on the safety and/or efficacy
of a prescribed drug. This bill makes it much harder for a
patient to obtain a consultation with a professional qualified
to address their questions and assess their health needs."
ASSEMBLY FLOOR : 76-0, 5/19/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández,
Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Medina, Melendez, Mullin, Muratsuchi, Olsen, Pan,
Patterson, Perea, John A. Pérez, V. Manuel Pérez, Quirk,
Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, Atkins
NO VOTE RECORDED: Mansoor, Nazarian, Nestande, Vacancy
MW:nl 6/25/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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