BILL ANALYSIS Ó
SB 538
Page 1
Date of Hearing: August 10, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 538
(Hueso) - As Amended August 4, 2016
-----------------------------------------------------------------
|Policy |Business and Professions |Vote:|8 - 4 |
|Committee: | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| |Appropriations |Vote:|7 - 6 |
| | | | |
| | | | |
| | | | |
-----------------------------------------------------------------
Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
As proposed to be amended, this bill provides a minor expansion
of the scope of practice for naturopathic doctors (NDs).
Specifically, this bill:
SB 538
Page 2
1)After a 12-month period of supervision by a physician, allows
NDs to prescribe Schedule V drugs (those with some, albeit
low, potential for abuse) and drugs that are not classified on
the DEA schedule, without physician supervision.
2)Provides the period of supervision must be waived if: (a) the
naturopathic doctor has completed an approved residency
program of at least 12 months, or (b) the naturopathic doctor
has practiced for at least 12 months in another state where
independent prescribing is within the scope of naturopathic
doctors. Specifies this supervision period must be completed
once.
3)Modifies under what circumstances an ND may order diagnostic
imaging studies and dispense, administer, order, prescribe,
provide, or furnish devices and durable medical equipment.
FISCAL EFFECT:
Minor and absorbable costs to the Osteopathic Medical Board to
oversee the new requirements (Naturopathic Doctors Fund).
COMMENTS:
1)Purpose. This bill intends to remove barriers for patients
seeking medical care from licensed NDs, by allowing them to
prescribe routine and low-risk medications, such as blood
pressure medications and antibiotics, without a written
supervision agreement after a 12-month period of supervision.
It also allows independent prescribing of such drugs if a
specified residency program has been completed, or if an ND
has practiced for 12 months in another state where independent
SB 538
Page 3
prescribing is within their scope.
2)Naturopathic Doctors. NDs are licensed and regulated by the
Naturopathic Medicine Committee within the Osteopathic Medical
Board. NDs must complete four years of post-graduate training
and take a national standardized licensing examination, but
they are not required to complete a residency training
program, as are medical doctors.
An ND may be considered as a primary care provider who uses
herbs, supplements, vitamins, homeopathy, nutritional
counseling, some prescription medicines, and other treatments
to help the body.
Under current law, naturopathic doctors can furnish or
prescribe Schedule III - V drugs, in accordance with
standardized procedures established by a supervising
physician. Naturopathic doctors can order diagnostic imaging
studies such as x-rays, but must refer those studies to a
properly licensed health care professional to interpret the
results.
3)Drug Schedules. Drugs are classified into five schedules
depending on the drug's medical use and potential for abuse or
dependency. Schedule I drugs are considered the most dangerous
and Schedule V are the least dangerous. Schedule V drugs
include drugs with limited quantities of narcotic and
stimulant drugs (such as cough syrups with codeine).
4)Prior Legislation. SB 1446 (McCleod), Chapter 333, Statutes of
2012, allowed NDs to independently prescribe and administer
vitamins, minerals, amino acids, and other substances.
SB 538
Page 4
5)Recent Amendments. Amendments taken August 4th, 2016 add a
12-month period of physician supervision, with certain
exceptions, prior to allowing independent prescribing.
6)Support. This bill is sponsored by the California Naturopathic
Doctors Association and supported by numerous natural and
integrative medicine groups. They support the ability of NDs
to offer more expansive primary care services.
7)Opposition. Numerous groups representing physicians, as well
as Kaiser Permanente, opposed a previous version of this bill.
Amendments taken in the Assembly Business and Professions on
August 17, 2015 removed many of the opposition's concerns.
However, some physician groups remain opposed to the expansion
of NDs' prescribing abilities, citing the belief NDs are
inadequately prepared to prescribe the specified drugs without
supervision.
8)Author amendments. The author notes the August 4th amendments
to the bill inadvertently add independent prescribing to the
subdivision related to Schedule III and IV drugs, instead of
the subdivision related to Schedule V and legend drugs. The
author proposes amendments to correct this error, such that
the supervision requirement for prescribing Schedule III and
IV drugs will remain the same as current law. The amendments
also clarify the supervision period must be completed once.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
SB 538
Page 5