BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1841
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 1841 (Mullin)
          As Amended  June 2, 2014
          Majority vote
           
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          |ASSEMBLY:  |76-0 |(May 19, 2014)  |SENATE: |35-0 |(August 11,    |
          |           |     |                |        |     |2014)          |
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           Original Committee Reference:    B., P. & C.P.  

           SUMMARY  :  Clarifies that medical assistants (MAs) may hand out  
          properly labeled and prepackaged prescription drugs to patients  
          as part of their existing authorization to provide "technical  
          supportive services."  

           The Senate amendments  :

          1)Permit MAs to hand out prescription drugs in the following  
            non-state operated facilities licensed by the Board of  
            Pharmacy:

             a)   A nonprofit community clinic or free clinic as  
               specified, 

             b)   A primary care clinic owned or operated by a county;

             c)   A clinic operated by a federally recognized Indian tribe  
               or tribal organization;

             d)   A clinic operated by a primary care community or free  
               clinic, operated on separate premises from a licensed  
               clinic, and that is open no more than 20 hours per week;

             e)   A student health center clinic operated by a public  
               institution of higher education;

             f)   A nonprofit multispecialty clinic; or,

             g)   A surgical clinic. 

          2)Require that a licensed physician and surgeon, a licensed  
            podiatrist, a physician assistant, a nurse practitioner, or a  
            certified nurse-midwife provide the appropriate patient  








                                                                  AB 1841
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            consultation regarding use of the drug.

           FISCAL EFFECT :  None.  This bill is keyed non-fiscal by the  
          Legislative Counsel.

           COMMENTS  :   

          1)This bill clarifies that MAs may hand out properly labeled and  
            prepackaged prescription drugs to patients as part of their  
            existing scope of practice under "technical supportive  
            services" in certain non-state operated clinics.  This bill is  
            sponsored by Planned Parenthood.  

           2)According to the author's office, "Providing MAs this  
            authority will help reduce waiting times, expand access, and  
            improve patient care and satisfaction in community clinics,  
            including Planned Parenthoods.  Allowing an MA to hand over  
            medication and provide follow up instruction will ensure that  
            a patient has received counseling on their medication twice  
            and will provide them an additional opportunity to ask  
            questions.  This will also free up the clinician, allowing  
            them to spend more time with the patient answering questions  
            because they are not rushing to perform additional duties." 

          3)MAs are unlicensed, but certificated, individuals.  An MA must  
            have a high school diploma or general educational development  
            (GED) equivalent and take a certificate course at an approved  
            school.  The exact duration of these programs vary, but San  
            Francisco State University, for example, requires 140  
            classroom hours and a clinical externship.  MAs also must  
            complete a minimum of 60 hours of continuing education over  
            five years. 

            An MA may perform the following specific functions as part of  
            "technical supportive" services in addition to administrative  
            functions:

             a)   Administer medication orally, sublingually, topically,  
               vaginally or rectally, or by providing a single dose to a  
               patient for immediate self-administration; 

             b)   Administer medication by inhalation if the medications  
               are patient-specific and have been or will be routinely and  
               repetitively administered to that patient; 









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             c)   Perform electrocardiogram, electroencephalogram, or  
               plethysmography tests (used to measure changes in volume in  
               different parts of the body); 

             d)   Apply and remove bandages and dressings;

             e)   Remove sutures or staples from superficial incisions or  
               lacerations; 

             f)   Collect by non-invasive techniques and preserve  
               specimens for testing, including urine, sputum, semen, and  
               stool;

             g)   Prepare patients for and assist the physician,  
               podiatrist, physician assistant or registered nurse in  
               examinations or procedures including positioning, draping,  
               shaving and disinfecting treatment sites; and prepare a  
               patient for gait analysis testing;

             h)   As authorized by the physician or podiatrist, provide  
               patient information and instructions;

             i)   Collect and record patient data including height,  
               weight, temperature, pulse, respiration rate, and blood  
               pressure; and,

             j)   Perform simple laboratory and screening tests  
               customarily performed in a medical office.

          This bill simply clarifies that MAs may hand out properly  
          labeled and prepackaged prescription drugs to patients as part  
          of "technical supportive services."  Based on their current  
          abilities, this appears to be well within their scope of  
          practice.  This bill limits the practice settings in which MAs  
          may do this to non-state operated clinics.    

          This clarification is consistent with the work of similarly  
          unlicensed "pharmacy clerks" or "pharmacy assistants."  This is  
          a traditional title used in the pharmacy industry and is  
          included under regulations for "ancillary personnel" in pharmacy  
          regulations.  A pharmacy clerk may also perform various  
          "non-discretionary" tasks that do not require the abilities and  
          authorities of either a pharmacist or a Licensed Pharmacy  
          Technician.
              








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          These unlicensed individuals work in a pharmacy under the  
          supervision of a pharmacist and cannot "dispense" prescriptions  
          as that term is understood in current law, but they can "hand"  
          the patient filled prescriptions that have been approved by a  
          pharmacist for dispensing.  
           

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


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