Amended in Assembly July 2, 2015

Amended in Senate April 14, 2015

Senate BillNo. 361

Introduced by Senator Hill

(Coauthor: Senator Nielsen)

(Coauthors: Assembly Members Rodriguez and Waldron)

February 24, 2015

An act tobegin insert amend Section 4846.5 of the Business and Professions Code, and toend insert add Section 1275.4 to the Health and Safety Code, relating to public health, and declaring the urgency thereof, to take effect immediately.


SB 361, as amended, Hill. begin deleteSkilled nursing facilities: antimicrobial stewardship guidelines. end deletebegin insertAntimicrobial stewardship: education and policies.end insert

begin insert

Under the Veterinary Medical Practice Act, the Veterinary Medical Board licenses veterinarians and regulates the practice of veterinary medicine. The act requires an applicant for a renewal license to complete 36 hours of continuing education in the preceding 2 years.

end insert
begin insert

This bill would require a veterinarian who receives his or her license on or after January 1, 2018, to complete an approved course on the judicious use of medically important antimicrobial drugs, as defined, every 4 years as part of the continuing education requirement.

end insert

Existing law provides for the licensure and regulation of skilled nursing facilities by the State Department of Public Health. Under existing law, a violation of the provisions governing skilled nursing facilities constitutes a crime. Existing law also establishes the Hospital Infectious Disease Control Program, which requires the department and general acute care hospitals to implement various measures relating to the prevention of health care associated infection. The program requires, by July 1, 2015, that each general acute care hospital adopt and implement an antimicrobial stewardship policy, in accordance with guidelines established by the federal government and professional organizations, that includes a process to evaluate the judicious use of antibiotics, as specified.

This bill would require all skilled nursing facilities, as defined, by no later than January 1, 2017, to adopt and implement an antimicrobial stewardship policy. The bill would also require each skilled nursing facility, within 3 months of the establishment of antimicrobial stewardship guidelines by the federal Centers for Disease Control and Prevention orbegin insert specifiedend insert professional organizations, to amend its policy to be consistent with those antimicrobial stewardship guidelines.

By expanding the scope of an existing crime, this bill would impose a state-mandated local program.

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.

This bill would declare that it is to take effect immediately as an urgency statute.

Vote: 23. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

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

P2    1begin insert

begin insertSECTION 1.end insert  

end insert

begin insertSection 4846.5 of the end insertbegin insertBusiness and Professions
end insert
begin insert is amended to read:end insert



(a) Except as provided in this section, the board shall
4issue renewal licenses only to those applicants that have completed
5a minimum of 36 hours of continuing education in the preceding
6two years.

7(b) (1) Notwithstanding any otherbegin delete provision ofend delete law, continuing
8education hours shall be earned by attending courses relevant to
9veterinary medicine and sponsored or cosponsored by any of the

11(A) American Veterinary Medical Association (AVMA)
12accredited veterinary medical colleges.

P3    1(B) Accredited colleges or universities offering programs
2relevant to veterinary medicine.

3(C) The American Veterinary Medical Association.

4(D) American Veterinary Medical Association recognized
5specialty or affiliated allied groups.

6(E) American Veterinary Medical Association’s affiliated state
7veterinary medical associations.

8(F) Nonprofit annual conferences established in conjunction
9with state veterinary medical associations.

10(G) Educational organizations affiliated with the American
11Veterinary Medical Association or its state affiliated veterinary
12medical associations.

13(H) Local veterinary medical associations affiliated with the
14California Veterinary Medical Association.

15(I) Federal, state, or local government agencies.

16(J) Providers accredited by the Accreditation Council for
17Continuing Medical Education (ACCME) or approved by the
18American Medical Association (AMA), providers recognized by
19the American Dental Association Continuing Education
20Recognition Program (ADA CERP), and AMA or ADA affiliated
21state, local, and specialty organizations.

22(2) Continuing education credits shall be granted to those
23veterinarians taking self-study courses, which may include, but
24are not limited to, reading journals, viewing video recordings, or
25listening to audio recordings. The taking of these courses shall be
26limited to no more than six hours biennially.

27(3) The board may approve other continuing veterinary medical
28 education providers not specified in paragraph (1).

29(A) The board has the authority to recognize national continuing
30education approval bodies for the purpose of approving continuing
31education providers not specified in paragraph (1).

32(B) Applicants seeking continuing education provider approval
33shall have the option of applying to the board or to a
34board-recognized national approval body.

35(4) For good cause, the board may adopt an order specifying,
36on a prospective basis, that a provider of continuing veterinary
37medical education authorized pursuant to paragraph (1) or (3) is
38no longer an acceptable provider.

39(5) Continuing education hours earned by attending courses
40sponsored or cosponsored by those entities listed in paragraph (1)
P4    1between January 1, 2000, and January 1, 2001, shall be credited
2toward a veterinarian’s continuing education requirement under
3this section.

4(c) Every person renewing his or her license issued pursuant to
5Sectionbegin delete 4846.4end deletebegin insert 4846.4,end insert or any person applying for relicensure or
6for reinstatement of his or her license to active status, shall submit
7proof of compliance with this section to the board certifying that
8he or she is in compliance with this section. Any false statement
9submitted pursuant to this section shall be a violation subject to
10Section 4831.

11(d) This section shall not apply to a veterinarian’s first license
12renewal. This section shall apply only to second and subsequent
13license renewals granted on or after January 1, 2002.

14(e) The board shall have the right to audit the records of all
15applicants to verify the completion of the continuing education
16requirement. Applicants shall maintain records of completion of
17required continuing education coursework for a period of four
18years and shall make these records available to the board for
19auditing purposes upon request. If the board, during this audit,
20questions whether any course reported by the veterinarian satisfies
21the continuing education requirement, the veterinarian shall provide
22information to the board concerning the content of the course; the
23name of its sponsor and cosponsor, if any; and specify the specific
24curricula that was of benefit to the veterinarian.

25(f) A veterinarian desiring an inactive license or to restore an
26inactive license under Section 701 shall submit an application on
27a form provided by the board. In order to restore an inactive license
28to active status, the veterinarian shall have completed a minimum
29of 36 hours of continuing education within the last two years
30preceding application. The inactive license status of a veterinarian
31shall not deprive the board of its authority to institute or continue
32a disciplinary action against a licensee.

33(g) Knowing misrepresentation of compliance with this article
34by a veterinarian constitutes unprofessional conduct and grounds
35for disciplinary action or for the issuance of a citation and the
36imposition of a civil penalty pursuant to Section 4883.

37(h) The board, in its discretion, may exempt from the continuing
38education requirement any veterinarian who for reasons of health,
39military service, or undue hardship cannot meet those requirements.
P5    1Applications for waivers shall be submitted on a form provided
2by the board.

3(i) The administration of this section may be funded through
4professional license and continuing education provider fees. The
5fees related to the administration of this section shall not exceed
6the costs of administering the corresponding provisions of this

8(j) For those continuing education providers not listed in
9paragraph (1) of subdivision (b), the board or its recognized
10national approval agent shall establish criteria by which a provider
11of continuing education shall be approved. The board shall initially
12review and approve these criteria and may review the criteria as
13needed. The board or its recognized agent shall monitor, maintain,
14and manage related records and data. The board may impose an
15application fee, not to exceed two hundred dollars ($200)
16biennially, for continuing education providers not listed in
17paragraph (1) of subdivision (b).

begin insert

18(k) (1) A veterinarian who receives his or her license on or
19after January 1, 2018, shall complete an approved course on the
20judicious use of medically important antimicrobial drugs every
21four years as part of his or her continuing education requirements.

end insert
begin insert

22(2) For purposes of this subdivision, “medically important
23antimicrobial drug” means an antimicrobial drug listed in
24Appendix A of the federal Food and Drug Administration’s
25Guidance for Industry #152, including critically important, highly
26important, and important antimicrobial drugs, as that appendix
27may be amended.

end insert

begin deleteSECTION 1.end delete
29begin insertSEC. 2.end insert  

Section 1275.4 is added to the Health and Safety Code,
30to read:



(a) (1) On or before January 1, 2017, each skilled
32nursing facility, as defined in subdivision (c) of Section 1250, shall
33adopt and implement an antimicrobial stewardship policy.

34(2) Within three months of thebegin insert establishment of antimicrobial
35stewardship guidelines specific to skilled nursing facilities by theend insert

36 federal Centers for Disease Control andbegin delete Prevention (CDC) orend delete
37begin insert Prevention, the Society for Healthcare Epidemiology of America,
38or similar recognizedend insert
professional organizations,begin delete including the
39Society for Healthcare Epidemiology of America (SHEA),
40establishing antimicrobial stewardship guidelines specific to skilled
P6    1nursing facilities,end delete
each skilled nursing facility shall amend its
2antimicrobial stewardship policy to be consistent with those newly
3established antimicrobial stewardship guidelines.

4(b) All skilled nursing facilities, as defined in subdivision (c)
5of Section 1250, shall comply with this section. Failure to comply
6with the requirements of this section may subject the facility to
7the enforcement actions set forth in Section 1423.


begin deleteSEC. 2.end delete
9begin insertSEC. 3.end insert  

No reimbursement is required by this act pursuant to
10Section 6 of Article XIII B of the California Constitution because
11the only costs that may be incurred by a local agency or school
12district will be incurred because this act creates a new crime or
13infraction, eliminates a crime or infraction, or changes the penalty
14for a crime or infraction, within the meaning of Section 17556 of
15the Government Code, or changes the definition of a crime within
16the meaning of Section 6 of Article XIII B of the California


begin deleteSEC. 3.end delete
19begin insertSEC. 4.end insert  

This act is an urgency statute necessary for the
20immediate preservation of the public peace, health, or safety within
21the meaning of Article IV of the Constitution and shall go into
22immediate effect. The facts constituting the necessity are:

23In order to protect Californians from the burden and threats posed
24by the national security priority of antimicrobial-resistant
25infections, it is necessary that this act take effect immediately.