Amended in Assembly June 18, 2014

Amended in Assembly June 5, 2014

Amended in Senate May 5, 2014

Amended in Senate April 10, 2014

Amended in Senate March 28, 2014

Senate Bill No. 1039

Introduced by Senator Hernandez

February 18, 2014

An act to amend Sections 4052.6 and 4115 of, and to add Sections 4119.6 and 4119.7 to, the Business and Professions Code, and to amend Sections 11150 and 11210 of, and to add Section 1250.06 to, the Health and Safety Code, relating to pharmacy.

LEGISLATIVE COUNSEL’S DIGEST

SB 1039, as amended, Hernandez. Pharmacy.

(1) Existing law, the Pharmacy Law, the violation of which is a crime, provides for the licensure and regulation of pharmacies, pharmacists, intern pharmacists, and pharmacy technicians by the California State Board of Pharmacy. The Pharmacy Law authorizes an intern pharmacist to perform all functions of a pharmacist, and authorizes a pharmacy technician to perform packaging, manipulative, repetitive, or other nondiscretionary tasks, in each case under supervision of a pharmacist, as specified.

This bill would authorize a pharmacy technician to perform packaging begin delete , including emergency supply packaging and sealing in or for hospitals, hospital unit inspections, and other physical end delete , manipulative, repetitive, or other nondiscretionary tasks begin delete under supervision end delete begin insert only while assisting and while under the direct supervision and control end insert of a pharmacist, as specified. begin insert This bill would also authorize, in a licensed health care facility, as defined, a pharmacy technician’s duties to include, among other things, sealing emergency containers for use in the health care facility. end insert

(2) Existing law authorizes a pharmacy to furnish a dangerous drug or dangerous device to a licensed health care facility for storage in a secured emergency pharmaceutical supplies container maintained within the facility in accordance with facility regulations of the State Department of Public Health and other existing law requirements, as specified.

This bill would authorize begin delete a pharmacy to furnish a dangerous drug or dangerous device to the emergency medical services system of a licensed general acute care hospital, as defined, for storage in a secured emergency pharmaceutical supplies container maintained within the hospital in accordance with the hospital’s policies and procedures. The bill would require both the hospital and the dispensing pharmacy to maintain records pertaining to the dangerous drugs or dangerous devices furnished to the hospital’s emergency medical services system for at least 3 years. The bill would also authorize a pharmacy to furnish a dangerous drug or dangerous device to a licensed general acute care hospital pursuant to preprinted or electronic standing orders, order sets, and protocols established under the policies and procedures of a licensed general acute care hospital under specified conditions. The bill would require a pharmacist, a pharmacy technician, or end delete an intern pharmacist, under the direct supervision and control of a pharmacist, to begin insert stock, replenish, and end insert inspect the drugs maintained in the begin delete hospital at least once per month, and to report any irregularities, as specified. end delete begin insert emergency pharmaceutical supplies container and the emergency medical system supplies of a licensed general acute care hospital, as defined. end insert

begin insert This bill would end insert begin insert authorize an intern pharmacist to inspect the drugs maintained in a licensed health care facility, as defined, pursuant to policies and procedures of the health care facility. This bill would also authorize a licensed health care facility to dispense or furnish dangerous drugs and dangerous devices to inpatients and patients upon discharge pursuant to preprinted or electronic standing orders, order sets, and protocols, as specified. This bill would require licensed health care facilities to store and maintain drugs in accordance with national standards regarding the storage area and refrigerator or freezer temperature and in accordance with the manufacturers’ guidelines. end insert

Because a violation of certain provisions of the bill would be a crime, the bill would create a state-mandated local program.

(3) Existing law authorizes a pharmacist recognized by the board as an advanced practice pharmacist to perform specified functions, including performing patient assessments.

This bill would also authorize a pharmacist recognized by the board as an advanced practice pharmacist to order patient assessments.

(4) Existing law authorizes a pharmacist to initiate or adjust the drug regimen of a patient under specified circumstances. Existing law authorizes specified practitioners, including a pharmacist acting within the scope of an authorized pilot project, to prescribe, furnish, or administer controlled substances to a patient suffering from a disease, ailment, injury, or infirmity, but only when in good faith he or she believes the disease, ailment, injury, or infirmity requires the treatment, and only in the quantity and for the length of time as reasonably necessary.

This bill would modify that list of practitioners to include a pharmacist initiating or adjusting the drug regimen of a patient as authorized under existing law.

(5) Existing law provides for the licensure and inspection of health facilities, including general acute care hospitals, by the State Department of Public Health. Existing regulations require a hospital to have a pharmacy on the premises or a pharmacy license, as specified. Existing regulations also require the hospital to consult the pharmacist on the proper methods of, among other things, repackaging and labeling bulk cleaning agents.

This bill would instead provide that a licensed general acute care hospital or an acute psychiatric hospital, as defined, is not required to consult a pharmacist regarding repackaging and labeling of bulk cleaning agents, solvents, chemicals, and nondrug hazardous substances begin insert except for areas where sterile compounding is performed end insert .

(6) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

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

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

SECTION 1.  

Section 4052.6 of the Business and Professions
Code is amended to read:

4052.6.  

(a) A pharmacist recognized by the board as an
advanced practice pharmacist may do all of the following:

(1) Order and perform patient assessments.

(2) Order and interpret drug therapy-related tests.

(3) Refer patients to other health care providers.

(4) Participate in the evaluation and management of diseases
and health conditions in collaboration with other health care
providers.

(5) Initiate, adjust, or discontinue drug therapy in the manner
specified in paragraph (4) of subdivision (a) of Section 4052.2.

(b) A pharmacist who adjusts or discontinues drug therapy shall
promptly transmit written notification to the patient’s diagnosing
prescriber or enter the appropriate information in a patient record
system shared with the prescriber, as permitted by that prescriber.
A pharmacist who initiates drug therapy shall promptly transmit
written notification to, or enter the appropriate information into,
a patient record system shared with the patient’s primary care
provider or diagnosing provider, as permitted by that provider.

(c) This section shall not interfere with a physician’s order to
dispense a prescription drug as written, or other order of similar
meaning.

(d) Prior to initiating or adjusting a controlled substance therapy
pursuant to this section, a pharmacist shall personally register with
the federal Drug Enforcement Administration.

(e) A pharmacist who orders and interprets tests pursuant to
paragraph (2) of subdivision (a) shall ensure that the ordering of
those tests is done in coordination with the patient’s primary care
provider or diagnosing prescriber, as appropriate, including
promptly transmitting written notification to the patient’s
diagnosing prescriber or entering the appropriate information in a
patient record system shared with the prescriber, when available
and as permitted by that prescriber.

SEC. 2.  

Section 4115 of the Business and Professions Code is
amended to read:

4115.  

(a) A pharmacy technician may perform packaging,
begin delete including emergency supply packaging and sealing in or for
hospitals, hospital unit inspections, and other physical, end delete
manipulative, repetitive, or other nondiscretionary tasks, only while
assisting, and while under the direct supervision and control of a
pharmacist. begin insert The pharmacist shall be responsible for the duties
performed under his or her supervision by a technician. end insert

(b) This section does not authorize the performance of any tasks
specified in subdivision (a) by a pharmacy technician without a
pharmacist on duty.

(c) This section does not authorize a pharmacy technician to
perform any act requiring the exercise of professional judgment
by a pharmacist.

(d) The board shall adopt regulations to specify tasks pursuant
to subdivision (a) that a pharmacy technician may perform under
the supervision of a pharmacist. Any pharmacy that employs a
pharmacy technician shall do so in conformity with the regulations
adopted by the board.

(e) No person shall act as a pharmacy technician without first
being licensed by the board as a pharmacy technician.

(f) (1) A pharmacy with only one pharmacist shall have no
more than one pharmacy technician performing the tasks specified
in subdivision (a). The ratio of pharmacy technicians performing
the tasks specified in subdivision (a) to any additional pharmacist
shall not exceed 2:1, except that this ratio shall not apply to
personnel performing clerical functions pursuant to Section 4116
or 4117. This ratio is applicable to all practice settings, except for
an inpatient of a licensed health facility, a patient of a licensed
home health agency, as specified in paragraph (2), an inmate of a
correctional facility of the Department of Corrections and
Rehabilitation, and for a person receiving treatment in a facility
operated by the State Department of State Hospitals, the State
Department of Developmental Services, or the Department of
Veterans Affairs.

(2) The board may adopt regulations establishing the ratio of
pharmacy technicians performing the tasks specified in subdivision
(a) to pharmacists applicable to the filling of prescriptions of an
inpatient of a licensed health facility and for a patient of a licensed
home health agency. Any ratio established by the board pursuant
to this subdivision shall allow, at a minimum, at least one pharmacy
technician for a single pharmacist in a pharmacy and two pharmacy
technicians for each additional pharmacist, except that this ratio
shall not apply to personnel performing clerical functions pursuant
to Section 4116 or 4117.

(3) A pharmacist scheduled to supervise a second pharmacy
technician may refuse to supervise a second pharmacy technician
if the pharmacist determines, in the exercise of his or her
professional judgment, that permitting the second pharmacy
technician to be on duty would interfere with the effective
performance of the pharmacist’s responsibilities under this chapter.
A pharmacist assigned to supervise a second pharmacy technician
shall notify the pharmacist in charge in writing of his or her
determination, specifying the circumstances of concern with respect
to the pharmacy or the pharmacy technician that have led to the
determination, within a reasonable period, but not to exceed 24
hours, after the posting of the relevant schedule. No entity
employing a pharmacist may discharge, discipline, or otherwise
discriminate against any pharmacist in the terms and conditions
of employment for exercising or attempting to exercise in good
faith the right established pursuant to this paragraph.

(g) Notwithstanding subdivisions (a) and (b), the board shall
by regulation establish conditions to permit the temporary absence
of a pharmacist for breaks and lunch periods pursuant to Section
512 of the Labor Code and the orders of the Industrial Welfare
Commission without closing the pharmacy. During these temporary
absences, a pharmacy technician may, at the discretion of the
pharmacist, remain in the pharmacy but may only perform
nondiscretionary tasks. The pharmacist shall be responsible for a
pharmacy technician and shall review any task performed by a
pharmacy technician during the pharmacist’s temporary absence.
Nothing in this subdivision shall be construed to authorize a
pharmacist to supervise pharmacy technicians in greater ratios
than those described in subdivision (f).

(h) The pharmacist on duty shall be directly responsible for the
conduct of a pharmacy technician supervised by that pharmacist.

begin insert

(i) In a health care facility licensed under subdivision (a) of
Section 1250 of the Health and Safety Code, a pharmacy
technician’s duties may include any of the following.

end insert begin insert

(1) Packaging emergency supplies for use in the health care
facility and the hospital’s emergency medical system as authorized
under Section 4119.

end insert begin insert

(2) Sealing emergency containers for use in the health care
facility.

end insert begin insert

(3) Performing monthly checks of the drug supplies stored
throughout the health care facility. Irregularities shall be reported
within 24 hours to the pharmacist in charge and the director or
chief executive officer of the health care facility in accordance
with the health care facility’s policies and procedures.

end insert

SEC. 3.  

Section 4119.6 is added to the Business and Professions
Code, to read:

begin delete

4119.6.  

(a) Notwithstanding any other law, a pharmacy may
furnish a dangerous drug or dangerous device to the emergency
medical services system of a licensed general acute care hospital,
as defined in subdivision (a) of Section 1250 of the Health and
Safety Code, for storage in a secured emergency pharmaceutical
supplies container maintained within the hospital in accordance
with the hospital’s policies and procedures. A pharmacy technician
or

end delete

begin insert

begin insert 4119.6. end insert   

end insert

begin insert An end insert intern pharmacist under the direct supervision and
control, as defined in Section 4023.5, of a pharmacist may stock,
replenish, and inspect the begin delete hospital’s end delete emergency pharmaceutical
supplies container begin insert and the emergency medical system supplies of
a licensed general acute care end insert begin insert hospital, as defined in subdivision
(a) of Section 1250 of the Health and Safety Code end insert .

begin delete

(b) Both the hospital and the dispensing pharmacy acting under
this section shall maintain records of each request by, and
dangerous drugs or dangerous devices furnished to, the hospital’s
emergency medical services system, for at least three years.

(c) Controlled substances shall be furnished to the hospital’s
emergency medical services system under this section in
accordance with the California Uniform Controlled Substances
Act (Division 10 (commencing with Section 11000) of the Health
and Safety Code).

end delete

SEC. 4.  

Section 4119.7 is added to the Business and Professions
Code, to read:

4119.7.  

(a)  begin delete Notwithstanding any other law, a pharmacy may
furnish a dangerous drug or dangerous device to a licensed general
acute care hospital, as defined in end delete begin insert A health care facility licensed
under end insert subdivision (a) of Section 1250 of the Health and Safety
Code, begin insert may administer, dispense, or furnish dangerous drugs and
dangerous devices to inpatients or patients upon discharge end insert
pursuant to preprinted or electronic standing orders, order sets,
and protocols established under the policies and procedures of the
begin delete hospital, as approved according to the policies of the hospital’s
governing body, end delete begin insert health care facility, end insert if the order is begin delete promptly end delete dated,
timed, and authenticated in the medical record of the patient to
whom the dangerous drug or dangerous device begin delete is dispensed by the
ordering practitioner or another practitioner responsible for the
care of that patient and authorized by the hospital’s policies and
procedures to write orders. end delete begin insert will be provided. end insert

(b)  begin delete The hospital end delete begin insert A health care facility licensed under subdivision
(a) of Section 1250 of the Health and Safety Code end insert shall store and
maintain drugs in accordance with national standards regarding
the storage area and refrigerator or freezer temperature, and
otherwise pursuant to the manufacturer’s guidelines. begin insert The health
care facility’s policies and procedures shall specify these storage
parameters. end insert

(c)  begin delete (1) end delete begin delete   end delete begin delete A pharmacist, pharmacy technician, or an end delete begin insert An end insert intern
pharmacist under the direct supervision and control, as defined in
Section 4023.5, of a pharmacist, shall inspect the drugs maintained
in the begin delete hospital end delete begin insert health care facility end insert at least once per month. The
begin delete hospital end delete begin insert health care facility end insert shall establish specific written policies
and procedures for inspections pursuant to this paragraph.

begin delete

(2) The person conducting the inspection pursuant to paragraph
(1) shall report any irregularities to the director or chief executive
officer of the hospital, or other person holding an equivalent
position, and in accordance with the hospital’s policy.

end delete

SEC. 5.  

Section 1250.06 is added to the Health and Safety
Code, immediately following Section 1250.05, to read:

1250.06.  

A licensed general acute care hospital, as defined
pursuant to subdivision (a) of Section 1250, or an acute psychiatric
hospital, as defined pursuant to subdivision (b) of Section 1250,
is not required to consult a pharmacist regarding repackaging and
labeling of bulk cleaning agents, solvents, chemicals, and nondrug
hazardous substances used throughout the begin delete hospital. end delete begin insert hospital except
for areas where sterile compounding is performed. end insert

SEC. 6.  

Section 11150 of the Health and Safety Code is
amended to read:

11150.  

No person other than a physician, dentist, podiatrist,
or veterinarian, or naturopathic doctor acting pursuant to Section
3640.7 of the Business and Professions Code, or pharmacist acting
within the scope of a project authorized under Article 1
(commencing with Section 128125) of Chapter 3 of Part 3 of
Division 107 or within the scope of Section 4052.1, 4052.2, or
4052.6 of the Business and Professions Code, a registered nurse
acting within the scope of a project authorized under Article 1
(commencing with Section 128125) of Chapter 3 of Part 3 of
Division 107, a certified nurse-midwife acting within the scope of
Section 2746.51 of the Business and Professions Code, a nurse
practitioner acting within the scope of Section 2836.1 of the
Business and Professions Code, a physician assistant acting within
the scope of a project authorized under Article 1 (commencing
with Section 128125) of Chapter 3 of Part 3 of Division 107 or
Section 3502.1 of the Business and Professions Code, a
naturopathic doctor acting within the scope of Section 3640.5 of
the Business and Professions Code, or an optometrist acting within
the scope of Section 3041 of the Business and Professions Code,
or an out-of-state prescriber acting pursuant to Section 4005 of the
Business and Professions Code shall write or issue a prescription.

SEC. 7.  

Section 11210 of the Health and Safety Code is
amended to read:

11210.  

A physician, surgeon, dentist, veterinarian, naturopathic
doctor acting pursuant to Section 3640.7 of the Business and
Professions Code, or podiatrist, or pharmacist acting within the
scope of a project authorized under Article 1 (commencing with
Section 128125) of Chapter 3 of Part 3 of Division 107 or within
the scope of Section 4052.1, 4052.2, or 4052.6 of the Business and
Professions Code, or registered nurse acting within the scope of a
project authorized under Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107, or physician
assistant acting within the scope of a project authorized under
Article 1 (commencing with Section 128125) of Chapter 3 of Part
3 of Division 107, or naturopathic doctor acting within the scope
of Section 3640.5 of the Business and Professions Code, or an
optometrist acting within the scope of Section 3041 of the Business
and Professions Code may prescribe for, furnish to, or administer
controlled substances to his or her patient when the patient is
suffering from a disease, ailment, injury, or infirmities attendant
upon old age, other than addiction to a controlled substance.

The physician, surgeon, dentist, veterinarian, naturopathic doctor
acting pursuant to Section 3640.7 of the Business and Professions
Code, or podiatrist, or pharmacist acting within the scope of a
project authorized under Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107 or within the scope
of Section 4052.1, 4052.2, or 4052.6 of the Business and
Professions Code, or registered nurse acting within the scope of a
project authorized under Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107, or physician
assistant acting within the scope of a project authorized under
Article 1 (commencing with Section 128125) of Chapter 3 of Part
3 of Division 107, or naturopathic doctor acting within the scope
of Section 3640.5 of the Business and Professions Code, or an
optometrist acting within the scope of Section 3041 of the Business
and Professions Code shall prescribe, furnish, or administer
controlled substances only when in good faith he or she believes
the disease, ailment, injury, or infirmity requires the treatment.

The physician, surgeon, dentist, veterinarian, or naturopathic
doctor acting pursuant to Section 3640.7 of the Business and
Professions Code, or podiatrist, or pharmacist acting within the
scope of a project authorized under Article 1 (commencing with
Section 128125) of Chapter 3 of Part 3 of Division 107 or within
the scope of Section 4052.1, 4052.2, or 4052.6 of the Business and
Professions Code, or registered nurse acting within the scope of a
project authorized under Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107, or physician
assistant acting within the scope of a project authorized under
Article 1 (commencing with Section 128125) of Chapter 3 of Part
3 of Division 107, or a naturopathic doctor acting within the scope
of Section 3640.5 of the Business and Professions Code, or an
optometrist acting within the scope of Section 3041 of the Business
and Professions Code shall prescribe, furnish, or administer
controlled substances only in the quantity and for the length of
time as are reasonably necessary.

SEC. 8.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.