BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1841| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 CONTINUED AB 1841 Page 2 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 AB 1841 Page 3 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. AB 1841 Page 4 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 AB 1841 Page 5 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 AB 1841 Page 6 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 6/27/14) AB 1841 Page 7 Planned Parenthood Affiliates of California (source) Association of California Healthcare Districts California Academy of Physician Assistants California Association for Nurse Practitioners California Family Health Council California Nurse-Midwives Association California Primary Care Association Medical Board of California Planned Parenthood Advocacy Project Los Angeles County Planned Parenthood Mar Monte Planned Parenthood of Orange and San Bernardino Counties Planned Parenthood of Santa Barbara, Ventura, and San Luis Obispo Counties, Inc. Planned Parenthood of the Pacific Southwest Planned Parenthood Pasadena and San Gabriel Valley Planned Parenthood Shasta Pacific Action Fund Six Rivers Planned Parenthood OPPOSITION : (Verified 6/27/14) 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 AB 1841 Page 8 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 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 6/27/14 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END ****