Amended in Senate April 10, 2013

Senate Bill No. 352

Introduced by Senator Pavley

(Principal coauthor: Senator Hernandez)

February 20, 2013

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

LEGISLATIVE COUNSEL’S DIGEST

SB 352, as amended, Pavley. Medical assistants: supervision.

Existing law authorizes a medical assistant to perform specified services relating to the administration of medication and performance of skin tests and simple routine medical tasks and procedures upon specific authorization from and under the supervision of a licensed physician and surgeon or podiatrist, or in a specified clinic upon specific authorization of a physician assistant, nurse practitioner, or nurse-midwife. begin insert Existing law requires the Board of Registered Nursing to issue a certificate to practice nurse-midwifery to a qualifying applicant who is licensed pursuant to the Nursing Practice Act. end insert

This bill would delete the requirement that the services performed by the medical assistant be in a specified clinic when under the specific authorization of a physician assistant, nurse practitioner, or begin insert certified end insert nurse-midwife. The bill would also delete several obsolete references and make other begin insert conforming, end insert technical, begin insert and end insert nonsubstantive changes.

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

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 2069 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

2069.  

(a) (1) Notwithstanding any other begin delete provision of end delete law, a
medical assistant may 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 a licensed podiatrist. A medical assistant may also perform all
these tasks and services begin delete in a clinic licensed pursuant to subdivision
(a) of Section 1204 of the Health and Safety Code end delete upon the specific
authorization of a physician assistant, a nurse practitioner, or a
begin insert certified end insert nurse-midwife.

(2) The supervising physician and surgeon begin delete at a clinic described
in paragraph (1) end delete may, at his or her discretion, in consultation with
the nurse practitioner, begin insert certified end insert nurse-midwife, or physician
assistant begin insert , end insert provide written instructions to be followed by a medical
assistant in the performance of tasks or supportive services. These
written instructions may provide that the supervisory function for
the medical assistant for these tasks or supportive services may be
delegated to the nurse practitioner, begin insert certified end insert nurse-midwife, or
physician assistant within the standardized procedures or protocol,
and that tasks may be performed when the supervising physician
and surgeon is not onsite, begin delete so long as end delete begin insert if either of end insert the following apply:

(A) The nurse practitioner or begin insert certified end insert nurse-midwife is
functioning pursuant to standardized procedures, as defined by
Section 2725, or protocol. The standardized procedures or protocol
shall be developed and approved by the supervising physician and
begin delete surgeon, end delete begin insert surgeon and end insert the nurse practitioner or begin insert certified end insert
nurse-midwife begin delete , and the facility administrator or his or her designee end delete .

(B) The physician assistant is functioning pursuant to regulated
services defined in Section 3502 and is approved to do so by the
supervising physician begin delete or end delete begin insert and end insert surgeon.

(b) As used in this section and Sections 2070 and 2071, the
following definitions begin delete shall end delete apply:

(1) “Medical assistant” means a person who may be unlicensed,
who performs basic administrative, clerical, and technical
supportive services in compliance with this section and Section
2070 for a licensed physician and surgeon or a licensed podiatrist,
or group thereof, for a medical or podiatry corporation, for a
physician assistant, a nurse practitioner, or a begin insert certified end insert
nurse-midwife as provided in subdivision (a), or for a health care
service plan, who is at least 18 years of age, and who has had at
least the minimum amount of hours of appropriate training pursuant
to standards established by the begin delete Division of Licensing end delete begin insert board end insert . The
medical assistant shall be issued a certificate by the training
institution or instructor indicating satisfactory completion of the
required training. A copy of the certificate shall be retained as a
record by each employer of the medical assistant.

(2) “Specific authorization” means a specific written order
prepared by the supervising physician and surgeon or the
supervising podiatrist, or the physician assistant, the nurse
practitioner, or the begin insert certified end insert nurse-midwife as provided in
subdivision (a), authorizing the procedures to be performed on a
patient, which shall be placed in the patient’s medical record, or
a standing order prepared by the supervising physician and surgeon
or the supervising podiatrist, or the physician assistant, the nurse
practitioner, or the begin insert certified end insert nurse-midwife as provided in
subdivision (a), authorizing the procedures to be performed, the
duration of which shall be consistent with accepted medical
practice. A notation of the standing order shall be placed on the
patient’s medical record.

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

(A) A licensed physician and surgeon.

(B) A licensed podiatrist.

(C) A physician assistant, nurse practitioner, or begin insert certified end insert
nurse-midwife as provided in subdivision (a).

(4) “Technical supportive services” means 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 or a licensed
podiatrist, or a physician assistant, a nurse practitioner, or a
begin insert certified end insert nurse-midwife as provided in subdivision (a).

(c) Nothing in this section shall be construed as authorizing begin delete the end delete
begin insert any of the following: end insert

begin insert (1) end insert begin insert   end insert begin insert The end insert licensure of medical assistants. begin delete Nothing in this section
shall be construed as authorizing the end delete

begin insert (2) end insert begin insert   end insert begin insert The end insert administration of local anesthetic agents by a medical
assistant. begin delete Nothing in this section shall be construed as authorizing
the division to end delete

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

begin insert

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

end insert begin insert

(5) A nurse practitioner, certified nurse-midwife, or physician
assistant to be a laboratory director of a clinical laboratory, as
those terms are defined in paragraph (8) of subdivision (a) of
Section 1206 and subdivision (a) of Section 1209.

end insert

(d) Notwithstanding any other begin delete provision of end delete law, a medical
assistant begin delete may end delete begin insert shall end insert not be employed for inpatient care in a licensed
general acute care hospital begin insert , end insert as defined in subdivision (a) of Section
1250 of the Health and Safety Code.

begin delete

(e) Nothing in this section shall be construed as authorizing a
medical assistant to perform any clinical laboratory test or
examination for which he or she is not authorized by Chapter 3
(commencing with Section 1206.5). Nothing in this section shall
be construed as authorizing a nurse practitioner, nurse-midwife,
or physician assistant to be a laboratory director of a clinical
laboratory, as those terms are defined in paragraph (8) of
subdivision (a) of Section 1206 and subdivision (a) of Section
1209.

end delete

begin delete

SECTION 1.  

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

2069.  

(a) (1) Notwithstanding any other law, a medical
assistant may 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 a licensed podiatrist. A medical assistant may also perform all
these tasks and services upon the specific authorization of a
physician assistant, a nurse practitioner, or a nurse-midwife.

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

(A) The nurse practitioner or nurse-midwife is functioning
pursuant to standardized procedures, as defined by Section 2725,
or protocol. The standardized procedures or protocol shall be
developed and approved by the supervising physician and surgeon,
the nurse practitioner or nurse-midwife, and the facility
administrator or his or her designee.

(B) The physician assistant is functioning pursuant to regulated
services defined in Section 3502 and is approved to do so by the
supervising physician and surgeon.

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

(1) “Medical assistant” means a person who may be unlicensed,
who performs basic administrative, clerical, and technical
supportive services in compliance with this section and Section
2070 for a licensed physician and surgeon or a licensed podiatrist,
or group thereof, for a medical or podiatry corporation, for a
physician assistant, a nurse practitioner, or a nurse-midwife as
provided in subdivision (a), or for a health care service plan, who
is at least 18 years of age, and who has had at least the minimum
amount of hours of appropriate training pursuant to standards
established by the board. The medical assistant shall be issued a
certificate by the training institution or instructor indicating
satisfactory completion of the required training. A copy of the
certificate shall be retained as a record by each employer of the
medical assistant.

(2) “Specific authorization” means a specific written order
prepared by the supervising physician and surgeon or the
supervising podiatrist, or the physician assistant, the nurse
practitioner, or the nurse-midwife as provided in subdivision (a),
authorizing the procedures to be performed on a patient, which
shall be placed in the patient’s medical record, or a standing order
prepared by the supervising physician and surgeon or the
supervising podiatrist, or the physician assistant, the nurse
practitioner, or the nurse-midwife as provided in subdivision (a),
authorizing the procedures to be performed, the duration of which
shall be consistent with accepted medical practice. A notation of
the standing order shall be placed on the patient’s medical record.

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

(A) A licensed physician and surgeon.

(B) A licensed podiatrist.

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

(4) “Technical supportive services” means 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 or a licensed
podiatrist, or a physician assistant, a nurse practitioner, or a
nurse-midwife as provided in subdivision (a).

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

(1) The licensure of medical assistants.

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

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

(e) Nothing in this section shall be construed as authorizing a
medical assistant to perform any clinical laboratory test or
examination for which he or she is not authorized by Chapter 3
(commencing with Section 1206.5). Nothing in this section shall
be construed as authorizing a nurse practitioner, nurse-midwife,
or physician assistant to be a laboratory director of a clinical
laboratory, as those terms are defined in paragraph (8) of
subdivision (a) of Section 1206 and subdivision (a) of Section
1209.

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

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

(5) A nurse practitioner, nurse-midwife, or physician assistant
to be a laboratory director of a clinical laboratory, as those terms
are defined in paragraph (8) of subdivision (a) of Section 1206
and subdivision (a) of Section 1209.

end delete