Amended in Assembly July 2, 2015

Amended in Senate April 14, 2015

Senate Bill No. 361

Introduced by Senator Hill

(Coauthor: Senator Nielsen)

(Coauthors: Assembly Members Rodriguez and Waldron)

February 24, 2015

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

LEGISLATIVE COUNSEL’S DIGEST

SB 361, as amended, Hill. begin delete Skilled nursing facilities: antimicrobial stewardship guidelines. end delete begin insert Antimicrobial 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 or begin insert specified end 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: ²⁄₃. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 4846.5 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

4846.5.  

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

(b) (1) Notwithstanding any other begin delete provision of end delete law, continuing
education hours shall be earned by attending courses relevant to
veterinary medicine and sponsored or cosponsored by any of the
following:

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

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

(C) The American Veterinary Medical Association.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

begin insert

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

end insert begin insert

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

end insert

begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

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

1275.4.  

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

(2) Within three months of the begin insert establishment of antimicrobial
stewardship guidelines specific to skilled nursing facilities by the end insert
federal Centers for Disease Control and begin delete Prevention (CDC) or end delete
begin insert Prevention, the Society for Healthcare Epidemiology of America,
or similar recognized end insert professional organizations, begin delete including the
Society for Healthcare Epidemiology of America (SHEA),
establishing antimicrobial stewardship guidelines specific to skilled
nursing facilities, end delete each skilled nursing facility shall amend its
antimicrobial stewardship policy to be consistent with those newly
established antimicrobial stewardship guidelines.

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

begin delete SEC. 2. end delete
begin insert SEC. 3. end insert   

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.

begin delete SEC. 3. end delete
begin insert SEC. 4. end insert   

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

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