Amended in Assembly August 17, 2015

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 who renews his or her license on or after January 1, 2018, to complete a minimum of onebegin delete unitend deletebegin insert credit hourend insert of continuing education 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 andbegin delete Preventionend deletebegin insert Prevention, the federal Centers for Medicare and Medicaid Services,end insert 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.

P3    1(b) (1) Notwithstanding any other law, continuing education
2hours shall be earned by attending courses relevant to veterinary
3medicine and sponsored or cosponsored by any of the following:

4(A) American Veterinary Medical Association (AVMA)
5accredited veterinary medical colleges.

6(B) Accredited colleges or universities offering programs
7relevant to veterinary medicine.

8(C) The American Veterinary Medical Association.

9(D) American Veterinary Medical Association recognized
10specialty or affiliated allied groups.

11(E) American Veterinary Medical Association’s affiliated state
12veterinary medical associations.

13(F) Nonprofit annual conferences established in conjunction
14with state veterinary medical associations.

15(G) Educational organizations affiliated with the American
16Veterinary Medical Association or its state affiliated veterinary
17medical associations.

18(H) Local veterinary medical associations affiliated with the
19California Veterinary Medical Association.

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

21(J) Providers accredited by the Accreditation Council for
22Continuing Medical Education (ACCME) or approved by the
23American Medical Association (AMA), providers recognized by
24the American Dental Association Continuing Education
25Recognition Program (ADA CERP), and AMA or ADA affiliated
26state, local, and specialty organizations.

27(2) Continuing education credits shall be granted to those
28veterinarians taking self-study courses, which may include, but
29are not limited to, reading journals, viewing video recordings, or
30listening to audio recordings. The taking of these courses shall be
31limited to no more than six hours biennially.

32(3) The board may approve other continuing veterinary medical
33 education providers not specified in paragraph (1).

34(A) The board has the authority to recognize national continuing
35education approval bodies for the purpose of approving continuing
36education providers not specified in paragraph (1).

37(B) Applicants seeking continuing education provider approval
38shall have the option of applying to the board or to a
39board-recognized national approval body.

P4    1(4) For good cause, the board may adopt an order specifying,
2on a prospective basis, that a provider of continuing veterinary
3medical education authorized pursuant to paragraph (1) or (3) is
4no longer an acceptable provider.

5(5) Continuing education hours earned by attending courses
6sponsored or cosponsored by those entities listed in paragraph (1)
7between January 1, 2000, and January 1, 2001, shall be credited
8toward a veterinarian’s continuing education requirement under
9this section.

10(c) Every person renewing his or her license issued pursuant to
11Section 4846.4, or any person applying for relicensure or for
12reinstatement of his or her license to active status, shall submit
13proof of compliance with this section to the board certifying that
14he or she is in compliance with this section. Any false statement
15submitted pursuant to this section shall be a violation subject to
16Section 4831.

17(d) This section shall not apply to a veterinarian’s first license
18renewal. This section shall apply only to second and subsequent
19license renewals granted on or after January 1, 2002.

20(e) The board shall have the right to audit the records of all
21applicants to verify the completion of the continuing education
22requirement. Applicants shall maintain records of completion of
23required continuing education coursework for a period of four
24years and shall make these records available to the board for
25auditing purposes upon request. If the board, during this audit,
26questions whether any course reported by the veterinarian satisfies
27the continuing education requirement, the veterinarian shall provide
28information to the board concerning the content of the course; the
29name of its sponsor and cosponsor, if any; and specify the specific
30curricula that was of benefit to the veterinarian.

31(f) A veterinarian desiring an inactive license or to restore an
32inactive license under Section 701 shall submit an application on
33a form provided by the board. In order to restore an inactive license
34to active status, the veterinarian shall have completed a minimum
35of 36 hours of continuing education within the last two years
36preceding application. The inactive license status of a veterinarian
37shall not deprive the board of its authority to institute or continue
38a disciplinary action against a licensee.

39(g) Knowing misrepresentation of compliance with this article
40by a veterinarian constitutes unprofessional conduct and grounds
P5    1for disciplinary action or for the issuance of a citation and the
2imposition of a civil penalty pursuant to Section 4883.

3(h) The board, in its discretion, may exempt from the continuing
4education requirement any veterinarian who for reasons of health,
5military service, or undue hardship cannot meet those requirements.
6Applications for waivers shall be submitted on a form provided
7by the board.

8(i) The administration of this section may be funded through
9professional license and continuing education provider fees. The
10fees related to the administration of this section shall not exceed
11the costs of administering the corresponding provisions of this

13(j) For those continuing education providers not listed in
14paragraph (1) of subdivision (b), the board or its recognized
15national approval agent shall establish criteria by which a provider
16of continuing education shall be approved. The board shall initially
17review and approve these criteria and may review the criteria as
18 needed. The board or its recognized agent shall monitor, maintain,
19and manage related records and data. The board may impose an
20application fee, not to exceed two hundred dollars ($200)
21biennially, for continuing education providers not listed in
22paragraph (1) of subdivision (b).

23(k) (1) On or after January 1, 2018, a licensed veterinarian who
24renews his or her license shall complete a minimum of onebegin delete unitend delete
25begin insert credit hourend insert of continuing education on the judicious use of
26medically important antimicrobial drugs every four years as part
27of his or her continuing education requirements.

28(2) For purposes of this subdivision, “medically important
29antimicrobial drug” means an antimicrobial drug listed in Appendix
30A of the federal Food and Drug Administration’s Guidance for
31Industry #152, including critically important, highly important,
32and important antimicrobial drugs, as that appendix may be


SEC. 2.  

Section 1275.4 is added to the Health and Safety Code,
35to read:



(a) (1) On or before January 1, 2017, each skilled
37nursing facility, as defined in subdivision (c) of Section 1250, shall
38adopt and implement an antimicrobial stewardship policy.

39(2) Within three months of the establishment of antimicrobial
40stewardship guidelines specific to skilled nursing facilities by the
P6    1federal Centers for Disease Control and Prevention,begin insert the federal
2Centers for Medicare and Medicaid Services,end insert
the Society for
3Healthcare Epidemiology of America, or similar recognized
4professional organizations, each skilled nursing facility shall amend
5its antimicrobial stewardship policy to be consistent with those
6newly established antimicrobial stewardship guidelines.

7(b) All skilled nursing facilities, as defined in subdivision (c)
8of Section 1250, shall comply with this section. Failure to comply
9with the requirements of this section may subject the facility to
10the enforcement actions set forth in Section 1423.


SEC. 3.  

No reimbursement is required by this act pursuant to
12Section 6 of Article XIII B of the California Constitution because
13the only costs that may be incurred by a local agency or school
14district will be incurred because this act creates a new crime or
15infraction, eliminates a crime or infraction, or changes the penalty
16for a crime or infraction, within the meaning of Section 17556 of
17the Government Code, or changes the definition of a crime within
18the meaning of Section 6 of Article XIII B of the California


SEC. 4.  

This act is an urgency statute necessary for the
21immediate preservation of the public peace, health, or safety within
22the meaning of Article IV of the Constitution and shall go into
23immediate effect. The facts constituting the necessity are:

24In order to protect Californians from the burden and threats posed
25by the national security priority of antimicrobial-resistant
26infections, it is necessary that this act take effect immediately.