BILL ANALYSIS Ó
SB 482
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Date of Hearing: August 3, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 482
(Lara) - As Amended August 1, 2016
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|Policy |Business and Professions |Vote:|16 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires a health care practitioner, as specified,
authorized to prescribe, order, administer, or furnish a
controlled substance to consult the Controlled Substance
Utilization Review and Evaluation System (CURES) database before
prescribing specified controlled substances. It also:
1)Requires health care practitioners to check CURES upon initial
prescriptions, and regularly as long as the controlled
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substances continue to be prescribed, as well as no earlier
than 24 hours before the prescribing or furnishing.
2)Specifies liability provisions, including provisions that: (a)
protect health care practitioners from liability related to
false, incomplete, or inaccurate information contained in the
CURES database; (b) specify it does not limit liability for
negligent failure to diagnose and treat a patient; and (c)
specify it does not create a private cause of action.
3)Contains a number of exemptions from the bill's requirements,
including based on specified circumstances, quantities of
drugs, and type of practitioner (for instance, it excludes
medication dispensed during emergency transport, medication
dispensed by veterinarians, and medication administered to
patients in hospice care, as defined).
4)Specifies a practitioner who knowingly fails to consult the
CURES database must be referred to the appropriate state
professional licensing board solely for administrative
sanctions, as deemed appropriate by that board.
5)Allow health care practitioners to provide a copy of the
patient's CURES patient activity report, as long as
reasonable care is used to comply with medical confidentiality
laws.
FISCAL EFFECT:
1)Boards within the Department of Consumer Affairs that license
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health professionals will incur likely minor and absorbable
costs to notify licensees and enforce the bill's requirements,
as well as make any necessary information technology changes
(various fee-supported special funds). The 2016-17 budget
provides $500,000 from the CURES Fund for additional user
outreach and staffing support.
2)No anticipated costs to the Department of Justice, who
administers CURES. An upgrade to the CURES system was
completed last year to address shortcomings in usability and
reliability. The DOJ indicates the upgraded system is designed
to accommodate high usage by prescribers and will be able to
accommodate the projected demand if this bill is enacted.
COMMENTS:
1)Purpose. This bill is co-sponsored by the Consumer Attorneys
of California and the California Narcotics Officers'
Association, who indicate the current voluntary approach has
not been able to attract sufficient participation to make use
of CURES truly effective for preventing prescription drug
abuse. This bill, by requiring providers to consult the CURES
system, is intended to enable prescribers to make informed
decisions about their patient's care and to limit the number
of people who doctor-shop and overuse prescription drugs.
2)Background. Under current law, the DOJ manages CURES, a system
used to track prescriptions of Schedule II, III, and IV
drugs-generally, drugs accepted for medical use with moderate
to significant potential for addiction or abuse. Pharmacies
are required to submit information on those prescriptions when
they are dispensed. Prescribers, law enforcement personnel,
and regulatory agencies are authorized to access CURES. For
example, a physician can access CURES to review whether a
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patient has already been prescribed controlled substances
before issuing a new prescription.
3)Prior Legislation. SB 809 (DeSaulnier, Statutes of 2013)
raised licensing fees on health care providers by $6 to fund
CURES and required health care providers who can prescribe or
furnish controlled substances to apply for access to CURES by
January 1, 2016.
4)Support. In addition to the co-sponsors, this bill is
supported by the American Insurance Association, California
Chamber of Commerce, California Teamsters Public Affairs
Council, Center for Public Interest Law, Consumer Watchdog,
National Alliance on Mental Illness, and ShatterProof - a
national organization committed to preventing and ending
stigma related to prescription drug and alcohol addiction.
5)Opposition. The California Medical Association (CMA) is
opposed to this bill unless amended. CMA cites a number of
issues related to the bill, and to implementation and
administration of CURES more generally. Requested amendments
include, among others, allowing a third party to make a
determination of readiness before the bill is implemented and
the creation of additional parameters around access to CURES
among other entities, such as governmental entities.
CMA also noted the prior version of the bill created a
conflict around information privacy, whereby the bill would
have potentially lead providers to use CURES information to
make treatment decisions that must be recorded in a medical
record that is accessible to the patient, which conflicts with
an interpretation of current law that prohibits a clinician
from sharing with a patient such information. The author has
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recently amended this bill (see provision 5 in the summary) to
address this issue.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081