BILL NUMBER: SB 337	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Pavley

                        FEBRUARY 23, 2015

   An act to amend Sections 3501, 3502, and 3502.1 of the Business
and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 337, as introduced, Pavley. Physician assistants.
   Existing law, the Physician Assistant Practice Act, provides for
regulation of physician assistants and authorizes a physician
assistant to perform medical services as set forth by regulations
when those services are rendered under the supervision of a licensed
physician and surgeon, as specified. The act requires the supervising
physician and surgeon to review, countersign, and date a sample
consisting of, at a minimum, 5 percent of the medical records of
patients treated by the physician assistant functioning under adopted
protocols within 30 days of the date of treatment by the physician
assistant. The act requires the supervising physician and surgeon to
select for review those cases that by diagnosis, problem, treatment,
or procedure represent, in his or her judgment, the most significant
risk to the patient. A violation of those supervision requirements is
a misdemeanor.
   This bill would require that the medical record for each episode
of care for a patient, identify the physician and surgeon who is
responsible for the supervision of the physician assistant. The bill
would require a physician assistant who transmits an oral order to
identify the name of the supervising physician and surgeon
responsible for the patient. The bill would delete those medical
record review provisions, and, instead, require the supervising
physician and surgeon to use one or more of described review
mechanisms. By adding these new requirements, the violation of which
would be a crime, this bill would impose a state-mandated local
program by changing the definition of a crime.
   The act authorizes a physician assistant, while under prescribed
supervision of a physician and surgeon, to administer or provide
medication to a patient, or transmit orally, or in writing on a
patient's record or in a drug order, an order to a person who may
lawfully furnish the medication or medical device. The act prohibits
a physician assistant from administering, providing, or issuing a
drug order to a patient for Schedule II through Schedule V controlled
substances without advance approval by a supervising physician and
surgeon for that particular patient unless the physician assistant
has completed an education course that covers controlled substances
and that meets approved standards. The act requires that the medical
record of any patient cared for by a physician assistant for whom a
physician assistant's Schedule II drug order has been issued or
carried out to be reviewed, countersigned, and dated by a supervising
physician and surgeon within 7 days.
   This bill would delete that review and countersignature
requirement for a physician assistant's Schedule II drug order, and,
instead, require that the supervising physician and surgeon use one
of 2 described mechanisms to ensure adequate supervision of the
administration, provision, or issuance by a physician assistant of a
drug order to a patient for Schedule II controlled substances.
   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 3501 of the Business and Professions Code is
amended to read:
   3501.  (a) As used in this chapter:
   (1) "Board" means the Physician Assistant Board.
   (2) "Approved program" means a program for the education of
physician assistants that has been formally approved by the board.
   (3) "Trainee" means a person who is currently enrolled in an
approved program.
   (4) "Physician assistant" means a person who meets the
requirements of this chapter and is licensed by the board.
   (5) "Supervising physician" means a physician and surgeon licensed
by the Medical Board of California or by the Osteopathic Medical
Board of California who supervises one or more physician assistants,
who possesses a current valid license to practice medicine, and who
is not currently on disciplinary probation for improper use of a
physician assistant.
   (6) "Supervision" means that a licensed physician and surgeon
oversees the activities of, and accepts responsibility for, the
medical services rendered by a physician assistant.
   (7) "Regulations" means the rules and regulations as set forth in
Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the
California Code of Regulations.
   (8) "Routine visual screening" means uninvasive nonpharmacological
simple testing for visual acuity, visual field defects, color
blindness, and depth perception.
   (9) "Program manager" means the staff manager of the diversion
program, as designated by the executive officer of the board. The
program manager shall have background experience in dealing with
substance abuse issues.
   (10) "Delegation of services agreement" means the writing that
delegates to a physician assistant from a supervising physician the
medical services the physician assistant is authorized to perform
consistent with subdivision (a) of Section 1399.540 of Title 16 of
the California Code of Regulations.
   (11) "Other specified medical services" means tests or
examinations performed or ordered by a physician assistant practicing
in compliance with this chapter or regulations of the Medical Board
of California promulgated under this chapter. 
   (12) "Medical records review meeting" means a meeting between the
supervising physician and the physician assistant during which a
sample of medical records is reviewed to ensure adequate supervision
of the physician assistant functioning under protocols. The number of
medical records and the specific issues to be reviewed shall be
established in the delegation of services agreement. 
   (b) A physician assistant acts as an agent of the supervising
physician when performing any activity authorized by this chapter or
regulations adopted under this chapter.
  SEC. 2.  Section 3502 of the Business and Professions Code is
amended to read:
   3502.  (a) Notwithstanding any other  provision of
 law, a physician assistant may perform those medical
services as set forth by the regulations adopted under this chapter
when the services are rendered under the supervision of a licensed
physician and surgeon who is not subject to a disciplinary condition
imposed by the Medical Board of California prohibiting that
supervision or prohibiting the employment of a physician assistant.
 The medical record, for each episode of care for a patient,
shall identify the physician and surgeon who is responsible for the
supervision of the physician assistant   .   When a
physician assistant transmits an oral order, he or she shall also
identify the name of the supervising physician and surgeon
responsible for the patient. 
   (b)  (1)    Notwithstanding any other 
provision of  law, a physician assistant performing medical
services under the supervision of a physician and surgeon may assist
a doctor of podiatric medicine who is a partner, shareholder, or
employee in the same medical group as the supervising physician and
surgeon. A physician assistant who assists a doctor of podiatric
medicine pursuant to this subdivision shall do so only according to
patient-specific orders from the supervising physician and surgeon.

    The 
    (2)     The  supervising physician and
surgeon shall be physically available to the physician assistant for
consultation when  such   that  assistance
is rendered. A physician assistant assisting a doctor of podiatric
medicine shall be limited to performing those duties included within
the scope of practice of a doctor of podiatric medicine.
   (c) (1) A physician assistant and his or her supervising physician
and surgeon shall establish written guidelines for the adequate
supervision of the physician assistant. This requirement may be
satisfied by the supervising physician and surgeon adopting protocols
for some or all of the tasks performed by the physician assistant.
The protocols adopted pursuant to this subdivision shall comply with
the following requirements:
   (A) A protocol governing diagnosis and management shall, at a
minimum, include the presence or absence of symptoms, signs, and
other data necessary to establish a diagnosis or assessment, any
appropriate tests or studies to order, drugs to recommend to the
patient, and education to be provided to the patient.
   (B) A protocol governing procedures shall set forth the
information to be provided to the patient, the nature of the consent
to be obtained from the patient, the preparation and technique of the
procedure, and the followup care.
   (C) Protocols shall be developed by the supervising physician and
surgeon or adopted from, or referenced to, texts or other sources.
   (D) Protocols shall be signed and dated by the supervising
physician and surgeon and the physician assistant. 
   (2) The supervising physician and surgeon shall review,
countersign, and date a sample consisting of, at a minimum, 5 percent
of the medical records of patients treated by the physician
assistant functioning under the protocols within 30 days of the date
of treatment by the physician assistant. The physician and surgeon
shall select for review those cases that by diagnosis, problem,
treatment, or procedure represent, in his or her judgment, the most
significant risk to the patient.  
   (2) (A) The supervising physician and surgeon shall use one or
more of the following mechanisms to ensure adequate supervision of
the physician assistant functioning under the protocols:  
   (i) The supervising physician and surgeon reviews, countersigns,
and dates a sample consisting of, at a minimum, 5 percent of the
medical records of patients treated by the physician assistant
functioning under the protocols within 30 days of the date of
treatment by the physician assistant.  
   (ii) The supervising physician and surgeon and physician assistant
conduct and document a medical records review meeting at least once
each quarter during the calendar year.  
   (iii) The supervising physician and surgeon supervises the care
provided by the physician assistant through a review of those cases
or patients deemed appropriate by the supervising physician. The
review methods used shall be identified in the delegation of services
agreement, and may occur in person, by telephone, by electronic
messaging, or using video conferencing technology.  
   (B) In complying with subparagraph (A), the supervising physician
and surgeon shall select for review those cases that by diagnosis,
problem, treatment, or procedure represent, in his or her judgment,
the most significant risk to the patient. 
   (3) Notwithstanding any other  provision of law,
the Medical Board of California or  the  board may establish
other alternative mechanisms for the adequate supervision of the
physician assistant.
   (d) No medical services may be performed under this chapter in any
of the following areas:
   (1) The determination of the refractive states of the human eye,
or the fitting or adaptation of lenses or frames for the aid thereof.

   (2) The prescribing or directing the use of, or using, any optical
device in connection with ocular exercises, visual training, or
orthoptics.
   (3) The prescribing of contact lenses for, or the fitting or
adaptation of contact lenses to, the human eye.
   (4) The practice of dentistry or dental hygiene or the work of a
dental auxiliary as defined in Chapter 4 (commencing with Section
1600).
   (e) This section shall not be construed in a manner that shall
preclude the performance of routine visual screening as defined in
Section 3501. 
   (f) Compliance by a physician assistant and supervising physician
and surgeon with this section shall be deemed compliance with Section
1399.546 of Title 16 of the California Code of Regulations. 
  SEC. 3.  Section 3502.1 of the Business and Professions Code is
amended to read:
   3502.1.  (a) In addition to the services authorized in the
regulations adopted by the Medical Board of California, and except as
prohibited by Section 3502, while under the supervision of a
licensed physician and surgeon or physicians and surgeons authorized
by law to supervise a physician assistant, a physician assistant may
administer or provide medication to a patient, or transmit orally, or
in writing on a patient's record or in a drug order, an order to a
person who may lawfully furnish the medication or medical device
pursuant to subdivisions (c) and (d).
   (1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
   (2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt, or adopt, a written, practice specific, formulary
and protocols that specify all criteria for the use of a particular
drug or device, and any contraindications for the selection.
Protocols for Schedule II controlled substances shall address the
diagnosis of illness, injury, or condition for which the Schedule II
controlled substance is being administered, provided, or issued. The
drugs listed in the protocols shall constitute the formulary and
shall include only drugs that are appropriate for use in the type of
practice engaged in by the supervising physician and surgeon. When
issuing a drug order, the physician assistant is acting on behalf of
and as an agent for a supervising physician and surgeon.
   (b) "Drug order," for purposes of this section, means an order for
medication that is dispensed to or for a patient, issued and signed
by a physician assistant acting as an individual practitioner within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription or order of the supervising physician, (2)
all references to "prescription" in this code and the Health and
Safety Code shall include drug orders issued by physician assistants
pursuant to authority granted by their supervising physicians and
surgeons, and (3) the signature of a physician assistant on a drug
order shall be deemed to be the signature of a prescriber for
purposes of this code and the Health and Safety Code.
   (c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician and surgeon before it is filled
or carried out.
   (1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient. At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled prescription drug prepackaged by a physician and surgeon,
manufacturer as defined in the Pharmacy Law, or a pharmacist.
   (2) A physician assistant  may   shall 
not administer, provide, or issue a drug order to a patient for
Schedule II through Schedule V controlled substances without advance
approval by a supervising physician and surgeon for that particular
patient unless the physician assistant has completed an education
course that covers controlled substances and that meets standards,
including pharmacological content, approved by the board. The
education course shall be provided either by an accredited continuing
education provider or by an approved physician assistant training
program. If the physician assistant will administer, provide, or
issue a drug order for Schedule II controlled substances, the course
shall contain a minimum of three hours exclusively on Schedule II
controlled substances. Completion of the requirements set forth in
this paragraph shall be verified and documented in the manner
established by the board prior to the physician assistant's use of a
registration number issued by the United States Drug Enforcement
Administration to the physician assistant to administer, provide, or
issue a drug order to a patient for a controlled substance without
advance approval by a supervising physician and surgeon for that
particular patient.
   (3) Any drug order issued by a physician assistant shall be
subject to a reasonable quantitative limitation consistent with
customary medical practice in the supervising physician and surgeon's
practice.
   (d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility or medical practice, shall contain the printed name,
address, and telephone number of the supervising physician and
surgeon, the printed or stamped name and license number of the
physician assistant, and the signature of the physician assistant.
Further, a written drug order for a controlled substance, except a
written drug order in a patient's medical record in a health facility
or a medical practice, shall include the federal controlled
substances registration number of the physician assistant and shall
otherwise comply with  the provisions of  Section
11162.1 of the Health and Safety Code. Except as otherwise required
for written drug orders for controlled substances under Section
11162.1 of the Health and Safety Code, the requirements of this
subdivision may be met through stamping or otherwise imprinting on
the supervising physician and surgeon's prescription blank to show
the name, license number, and if applicable, the federal controlled
substances registration number of the physician assistant, and shall
be signed by the physician assistant. When using a drug order, the
physician assistant is acting on behalf of and as the agent of a
supervising physician and surgeon. 
   (e) The medical record of any patient cared for by a physician
assistant for whom the physician assistant's Schedule II drug order
has been issued or carried out shall be reviewed and countersigned
and dated by a supervising physician and surgeon within seven days.
 
   (e) The supervising physician and surgeon shall use either of the
following mechanisms to ensure adequate supervision of the
administration, provision, or issuance by a physician assistant of a
drug order to a patient for Schedule II controlled substances: 

   (1) The medical record of any patient cared for by a physician
assistant for whom the physician assistant's Schedule II drug order
has been issued or carried out shall be reviewed, countersigned, and
dated by a supervising physician and surgeon within seven days. 

   (2) If the physician assistant has documentation evidencing the
successful completion of an education course that covers controlled
substances, and that controlled substance education course (A) meets
the standards, including pharmacological content, approved by the
board, (B) is provided either by an accredited continuing education
provider or by an approved physician assistant training program, and
(C) satisfies Sections 1399.610 and 1399.612 of Title 16 of the
California Code of Regulations, the supervising physician and surgeon
shall review, countersign, and date, within seven days, a sample
consisting of the medical records of at least 20 percent of the
patients cared for by the physician assistant for whom the physician
assistant's Schedule II drug order has been issued or carried out.
Completion of the requirements set forth in this paragraph shall be
verified and documented in the manner established in Section 1399.612
of Title 16 of the California Code of Regulations. Physician
assistants who have a certificate of completion of the course
described in paragraph (2) of subdivision (c) shall be deemed to have
met the education course requirement of this subdivision. 
   (f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
   (g) The board shall consult with the Medical Board of California
and report during its sunset review required by  Division 1.2
(commencing with Section 473)   Article 7.5 (commencing
with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title
2 of the Government Code  the impacts of exempting Schedule III
and Schedule IV drug orders from the requirement for a physician and
surgeon to review and countersign the affected medical record of a
patient.
  SEC. 4.  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.