Amended in Assembly July 16, 2015

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 to amend Section 4846.5 of the Business and Professions Code, and to 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. Antimicrobial stewardship: education and policies.

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.

This bill would require a veterinarian whobegin delete receivesend deletebegin insert renewsend insert his or her license on or after January 1, 2018, to completebegin delete an approved courseend deletebegin insert a minimum of one unit of continuing educationend insert on the judicious use of medically important antimicrobial drugs, as defined, every 4 years as part of the continuing education requirement.

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 specified 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    1


Section 4846.5 of the Business and Professions
is amended to read:



(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 other law, continuing education
8hours shall be earned by attending courses relevant to veterinary
9medicine and sponsored or cosponsored by any of the following:

P3    1(A) American Veterinary Medical Association (AVMA)
2accredited veterinary medical colleges.

3(B) Accredited colleges or universities offering programs
4relevant to veterinary medicine.

5(C) The American Veterinary Medical Association.

6(D) American Veterinary Medical Association recognized
7specialty or affiliated allied groups.

8(E) American Veterinary Medical Association’s affiliated state
9veterinary medical associations.

10(F) Nonprofit annual conferences established in conjunction
11with state veterinary medical associations.

12(G) Educational organizations affiliated with the American
13Veterinary Medical Association or its state affiliated veterinary
14medical associations.

15(H) Local veterinary medical associations affiliated with the
16California Veterinary Medical Association.

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

18(J) Providers accredited by the Accreditation Council for
19Continuing Medical Education (ACCME) or approved by the
20American Medical Association (AMA), providers recognized by
21the American Dental Association Continuing Education
22Recognition Program (ADA CERP), and AMA or ADA affiliated
23state, local, and specialty organizations.

24(2) Continuing education credits shall be granted to those
25veterinarians taking self-study courses, which may include, but
26are not limited to, reading journals, viewing video recordings, or
27listening to audio recordings. The taking of these courses shall be
28limited to no more than six hours biennially.

29(3) The board may approve other continuing veterinary medical
30 education providers not specified in paragraph (1).

31(A) The board has the authority to recognize national continuing
32education approval bodies for the purpose of approving continuing
33education providers not specified in paragraph (1).

34(B) Applicants seeking continuing education provider approval
35shall have the option of applying to the board or to a
36board-recognized national approval body.

37(4) For good cause, the board may adopt an order specifying,
38on a prospective basis, that a provider of continuing veterinary
39medical education authorized pursuant to paragraph (1) or (3) is
40no longer an acceptable provider.

P4    1(5) Continuing education hours earned by attending courses
2sponsored or cosponsored by those entities listed in paragraph (1)
3between January 1, 2000, and January 1, 2001, shall be credited
4toward a veterinarian’s continuing education requirement under
5this section.

6(c) Every person renewing his or her license issued pursuant to
7Section 4846.4, or any person applying for relicensure or for
8reinstatement of his or her license to active status, shall submit
9proof of compliance with this section to the board certifying that
10he or she is in compliance with this section. Any false statement
11submitted pursuant to this section shall be a violation subject to
12Section 4831.

13(d) This section shall not apply to a veterinarian’s first license
14renewal. This section shall apply only to second and subsequent
15license renewals granted on or after January 1, 2002.

16(e) The board shall have the right to audit the records of all
17applicants to verify the completion of the continuing education
18requirement. Applicants shall maintain records of completion of
19required continuing education coursework for a period of four
20years and shall make these records available to the board for
21auditing purposes upon request. If the board, during this audit,
22questions whether any course reported by the veterinarian satisfies
23the continuing education requirement, the veterinarian shall provide
24information to the board concerning the content of the course; the
25name of its sponsor and cosponsor, if any; and specify the specific
26curricula that was of benefit to the veterinarian.

27(f) A veterinarian desiring an inactive license or to restore an
28inactive license under Section 701 shall submit an application on
29a form provided by the board. In order to restore an inactive license
30to active status, the veterinarian shall have completed a minimum
31of 36 hours of continuing education within the last two years
32preceding application. The inactive license status of a veterinarian
33shall not deprive the board of its authority to institute or continue
34a disciplinary action against a licensee.

35(g) Knowing misrepresentation of compliance with this article
36by a veterinarian constitutes unprofessional conduct and grounds
37for disciplinary action or for the issuance of a citation and the
38imposition of a civil penalty pursuant to Section 4883.

39(h) The board, in its discretion, may exempt from the continuing
40education requirement any veterinarian who for reasons of health,
P5    1military service, or undue hardship cannot meet those requirements.
2Applications for waivers shall be submitted on a form provided
3by the board.

4(i) The administration of this section may be funded through
5professional license and continuing education provider fees. The
6fees related to the administration of this section shall not exceed
7the costs of administering the corresponding provisions of this

9(j) For those continuing education providers not listed in
10paragraph (1) of subdivision (b), the board or its recognized
11national approval agent shall establish criteria by which a provider
12of continuing education shall be approved. The board shall initially
13review and approve these criteria and may review the criteria as
14 needed. The board or its recognized agent shall monitor, maintain,
15and manage related records and data. The board may impose an
16application fee, not to exceed two hundred dollars ($200)
17biennially, for continuing education providers not listed in
18paragraph (1) of subdivision (b).

19(k) (1) begin deleteA veterinarian who receives his or her license on end deletebegin insertOn end insertor
20after January 1, 2018,begin insert a licensed veterinarian who renews his or
21her licenseend insert
shall completebegin delete an approved courseend deletebegin insert a minimum of one
22unit of continuing educationend insert
on the judicious use of medically
23important antimicrobial drugs every four years as part of his or
24her continuing education requirements.

25(2) For purposes of this subdivision, “medically important
26antimicrobial drug” means an antimicrobial drug listed in Appendix
27A of the federal Food and Drug Administration’s Guidance for
28Industry #152, including critically important, highly important,
29and important antimicrobial drugs, as that appendix may be


SEC. 2.  

Section 1275.4 is added to the Health and Safety Code,
32to read:



(a) (1) On or before January 1, 2017, each skilled
34nursing facility, as defined in subdivision (c) of Section 1250, shall
35adopt and implement an antimicrobial stewardship policy.

36(2) Within three months of the establishment of antimicrobial
37stewardship guidelines specific to skilled nursing facilities by the
38federal Centers for Disease Control and Prevention, the Society
39for Healthcare Epidemiology of America, or similar recognized
40professional organizations, each skilled nursing facility shall amend
P6    1its antimicrobial stewardship policy to be consistent with those
2newly established antimicrobial stewardship guidelines.

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


SEC. 3.  

No reimbursement is required by this act pursuant to
8Section 6 of Article XIII B of the California Constitution because
9the only costs that may be incurred by a local agency or school
10district will be incurred because this act creates a new crime or
11infraction, eliminates a crime or infraction, or changes the penalty
12for a crime or infraction, within the meaning of Section 17556 of
13the Government Code, or changes the definition of a crime within
14the meaning of Section 6 of Article XIII B of the California


SEC. 4.  

This act is an urgency statute necessary for the
17immediate preservation of the public peace, health, or safety within
18the meaning of Article IV of the Constitution and shall go into
19immediate effect. The facts constituting the necessity are:

20In order to protect Californians from the burden and threats posed
21by the national security priority of antimicrobial-resistant
22infections, it is necessary that this act take effect immediately.