Amended in Assembly August 27, 2015

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

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(Coauthor: Senator Nielsen)

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(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 one credit hour 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 stewardshipbegin delete policy. The bill would also require each skilled nursing facility, within 3 months of the establishment of antimicrobial stewardship guidelines byend deletebegin insert policy that is consistent with the antimicrobial stewardship guidelines developed byend insert the federal Centers for Disease Control and Prevention, the federal Centers for Medicare and Medicaid Services, or specified professionalbegin delete organizations, to amend its policy to be consistent with those antimicrobial stewardship guidelines.end deletebegin insert organizations.end insert

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:

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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
P3    1a minimum of 36 hours of continuing education in the preceding
2two years.

3(b) (1) Notwithstanding any other law, continuing education
4hours shall be earned by attending courses relevant to veterinary
5medicine and sponsored or cosponsored by any of the following:

6(A) American Veterinary Medical Association (AVMA)
7accredited veterinary medical colleges.

8(B) Accredited colleges or universities offering programs
9relevant to veterinary medicine.

10(C) The American Veterinary Medical Association.

11(D) American Veterinary Medical Association recognized
12specialty or affiliated allied groups.

13(E) American Veterinary Medical Association’s affiliated state
14veterinary medical associations.

15(F) Nonprofit annual conferences established in conjunction
16with state veterinary medical associations.

17(G) Educational organizations affiliated with the American
18Veterinary Medical Association or its state affiliated veterinary
19medical associations.

20(H) Local veterinary medical associations affiliated with the
21California Veterinary Medical Association.

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

23(J) Providers accredited by the Accreditation Council for
24Continuing Medical Education (ACCME) or approved by the
25American Medical Association (AMA), providers recognized by
26the American Dental Association Continuing Education
27Recognition Program (ADA CERP), and AMA or ADA affiliated
28state, local, and specialty organizations.

29(2) Continuing education credits shall be granted to those
30veterinarians taking self-study courses, which may include, but
31are not limited to, reading journals, viewing video recordings, or
32listening to audio recordings. The taking of these courses shall be
33limited to no more than six hours biennially.

34(3) The board may approve other continuing veterinary medical
35 education providers not specified in paragraph (1).

36(A) The board has the authority to recognize national continuing
37education approval bodies for the purpose of approving continuing
38education providers not specified in paragraph (1).

P4    1(B) Applicants seeking continuing education provider approval
2shall have the option of applying to the board or to a
3board-recognized national approval body.

4(4) For good cause, the board may adopt an order specifying,
5on a prospective basis, that a provider of continuing veterinary
6medical education authorized pursuant to paragraph (1) or (3) is
7no longer an acceptable provider.

8(5) Continuing education hours earned by attending courses
9sponsored or cosponsored by those entities listed in paragraph (1)
10between January 1, 2000, and January 1, 2001, shall be credited
11toward a veterinarian’s continuing education requirement under
12this section.

13(c) Every person renewing his or her license issued pursuant to
14Section 4846.4, or any person applying for relicensure or for
15reinstatement of his or her license to active status, shall submit
16proof of compliance with this section to the board certifying that
17he or she is in compliance with this section. Any false statement
18submitted pursuant to this section shall be a violation subject to
19Section 4831.

20(d) This section shall not apply to a veterinarian’s first license
21renewal. This section shall apply only to second and subsequent
22license renewals granted on or after January 1, 2002.

23(e) The board shall have the right to audit the records of all
24applicants to verify the completion of the continuing education
25requirement. Applicants shall maintain records of completion of
26required continuing education coursework for a period of four
27years and shall make these records available to the board for
28auditing purposes upon request. If the board, during this audit,
29questions whether any course reported by the veterinarian satisfies
30the continuing education requirement, the veterinarian shall provide
31information to the board concerning the content of the course; the
32name of its sponsor and cosponsor, if any; and specify the specific
33curricula that was of benefit to the veterinarian.

34(f) A veterinarian desiring an inactive license or to restore an
35inactive license under Section 701 shall submit an application on
36a form provided by the board. In order to restore an inactive license
37to active status, the veterinarian shall have completed a minimum
38of 36 hours of continuing education within the last two years
39preceding application. The inactive license status of a veterinarian
P5    1shall not deprive the board of its authority to institute or continue
2a disciplinary action against a licensee.

3(g) Knowing misrepresentation of compliance with this article
4by a veterinarian constitutes unprofessional conduct and grounds
5for disciplinary action or for the issuance of a citation and the
6imposition of a civil penalty pursuant to Section 4883.

7(h) The board, in its discretion, may exempt from the continuing
8education requirement any veterinarian who for reasons of health,
9military service, or undue hardship cannot meet those requirements.
10Applications for waivers shall be submitted on a form provided
11by the board.

12(i) The administration of this section may be funded through
13professional license and continuing education provider fees. The
14fees related to the administration of this section shall not exceed
15the costs of administering the corresponding provisions of this

17(j) For those continuing education providers not listed in
18paragraph (1) of subdivision (b), the board or its recognized
19national approval agent shall establish criteria by which a provider
20of continuing education shall be approved. The board shall initially
21review and approve these criteria and may review the criteria as
22 needed. The board or its recognized agent shall monitor, maintain,
23and manage related records and data. The board may impose an
24application fee, not to exceed two hundred dollars ($200)
25biennially, for continuing education providers not listed in
26paragraph (1) of subdivision (b).

27(k) (1) On or after January 1, 2018, a licensed veterinarian who
28renews his or her license shall complete a minimum of one credit
29hour of continuing education on the judicious use of medically
30important antimicrobial drugs every four years as part of his or
31her continuing education requirements.

32(2) For purposes of this subdivision, “medically important
33antimicrobial drug” means an antimicrobial drug listed in Appendix
34A of the federal Food and Drug Administration’s Guidance for
35Industry #152, including critically important, highly important,
36and important antimicrobial drugs, as that appendix may be


SEC. 2.  

Section 1275.4 is added to the Health and Safety Code,
39to read:

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(a) begin delete(1)end deletebegin deleteend deleteOn or before January 1, 2017, each skilled
2nursing facility, as defined in subdivision (c) of Section 1250, shall
3adopt and implement an antimicrobial stewardshipbegin delete policy.end deletebegin insert policy
4that is consistent with antimicrobial stewardship guidelines
5developed by the federal Centers for Disease Control and
6Prevention, the federal Centers for Medicare and Medicaid
7Services, the Society for Healthcare Epidemiology of America, or
8similar recognized professional organizations.end insert

begin delete

9(2) Within three months of the establishment of antimicrobial
10stewardship guidelines specific to skilled nursing facilities by the
11federal Centers for Disease Control and Prevention, the federal
12Centers for Medicare and Medicaid Services, the Society for
13Healthcare Epidemiology of America, or similar recognized
14professional organizations, each skilled nursing facility shall amend
15its antimicrobial stewardship policy to be consistent with those
16newly established antimicrobial stewardship guidelines.

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17(b) All skilled nursing facilities, as defined in subdivision (c)
18of Section 1250, shall comply with this section. Failure to comply
19with the requirements of this section may subject the facility to
20the enforcement actions set forth in Section 1423.


SEC. 3.  

No reimbursement is required by this act pursuant to
22Section 6 of Article XIII B of the California Constitution because
23the only costs that may be incurred by a local agency or school
24district will be incurred because this act creates a new crime or
25infraction, eliminates a crime or infraction, or changes the penalty
26for a crime or infraction, within the meaning of Section 17556 of
27the Government Code, or changes the definition of a crime within
28the meaning of Section 6 of Article XIII B of the California


SEC. 4.  

This act is an urgency statute necessary for the
31immediate preservation of the public peace, health, or safety within
32the meaning of Article IV of the Constitution and shall go into
33immediate effect. The facts constituting the necessity are:

34In order to protect Californians from the burden and threats posed
35by the national security priority of antimicrobial-resistant
36infections, it is necessary that this act take effect immediately.