Amended in Senate June 2, 2014

Amended in Assembly April 21, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1841

Introduced by Assembly Member Mullin

(Coauthor: Senator Hernandez)

February 18, 2014

An act to amend Section 2069 of the Business and Professions Code, relating to medicine.

LEGISLATIVE COUNSEL’S DIGEST

AB 1841, as amended, Mullin. Medical assistants.

Existing law, the Medical Practice Act, provides for the licensure and regulation of the practice of medicine by the Medical Board of California. The act authorizes a medical assistant to administer medication only by intradermal, subcutaneous, or intramuscular injections and to perform skin tests and additional technical supportive services upon the specific authorization and supervision of a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife. Existing law defines the term “technical supportive services” to mean simple routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife. Existing law, the Pharmacy Law, prohibits a prescriber, as defined, from dispensing drugs to patients in his or her office unless specified conditions are satisfied, and authorizes a certified nurse-midwife, a nurse practitioner, a physician assistant, or a naturopathic doctor who functions pursuant to a specified protocol or procedure to hand to a patient of his or her supervising physician a properly labeled and prepackaged prescription drug. begin insert Existing law authorizes specified facilities licensed by the California State Board of Pharmacy to purchase drugs at wholesale for administration or dispensing, under the direction of a physician and surgeon, to patients registered for care at those facilities. end insert

This bill would specify that the “technical supportive services” a medical assistant may perform begin insert in those California State Board of Pharmacy licensed facilities end insert also includes handing to a patient a properly labeled and prepackaged prescription drug, other than a controlled substance, ordered by a licensed physician and surgeon, a licensed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife, as specified.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 2069 of the Business and Professions
Code is amended to read:

2069.  

(a) (1) Notwithstanding any other law, a medical
assistant may administer medication only by intradermal,
subcutaneous, or intramuscular injections and perform skin tests
and additional technical supportive services upon the specific
authorization and supervision of a licensed physician and surgeon
or a licensed podiatrist. A medical assistant may also perform all
these tasks and services upon the specific authorization of a
physician assistant, a nurse practitioner, or a certified
nurse-midwife.

(2) The supervising physician and surgeon may, at his or her
discretion, in consultation with the nurse practitioner, certified
nurse-midwife, or physician assistant, provide written instructions
to be followed by a medical assistant in the performance of tasks
or supportive services. These written instructions may provide that
the supervisory function for the medical assistant for these tasks
or supportive services may be delegated to the nurse practitioner,
certified nurse-midwife, or physician assistant within the
standardized procedures or protocol, and that tasks may be
performed when the supervising physician and surgeon is not
onsite, if either of the following apply:

(A) The nurse practitioner or certified nurse-midwife is
functioning pursuant to standardized procedures, as defined by
Section 2725, or protocol. The standardized procedures or protocol,
including instructions for specific authorizations, shall be
developed and approved by the supervising physician and surgeon
and the nurse practitioner or certified nurse-midwife.

(B) The physician assistant is functioning pursuant to regulated
services defined in Section 3502, including instructions for specific
authorizations, and is approved to do so by the supervising
physician and surgeon.

(b) As used in this section and Sections 2070 and 2071, the
following definitions apply:

(1) “Medical assistant” means a person who may be unlicensed,
who performs basic administrative, clerical, and technical
supportive services in compliance with this section and Section
2070 for a licensed physician and surgeon or a licensed podiatrist,
or group thereof, for a medical or podiatry corporation, for a
physician assistant, a nurse practitioner, or a certified
nurse-midwife as provided in subdivision (a), or for a health care
service plan, who is at least 18 years of age, and who has had at
least the minimum amount of hours of appropriate training pursuant
to standards established by the board. The medical assistant shall
be issued a certificate by the training institution or instructor
indicating satisfactory completion of the required training. A copy
of the certificate shall be retained as a record by each employer of
the medical assistant.

(2) “Specific authorization” means a specific written order
prepared by the supervising physician and surgeon or the
supervising podiatrist, or the physician assistant, the nurse
practitioner, or the certified nurse-midwife as provided in
subdivision (a), authorizing the procedures to be performed on a
patient, which shall be placed in the patient’s medical record, or
a standing order prepared by the supervising physician and surgeon
or the supervising podiatrist, or the physician assistant, the nurse
practitioner, or the certified nurse-midwife as provided in
subdivision (a), authorizing the procedures to be performed, the
duration of which shall be consistent with accepted medical
practice. A notation of the standing order shall be placed on the
patient’s medical record.

(3) “Supervision” means the supervision of procedures
authorized by this section by the following practitioners, within
the scope of their respective practices, who shall be physically
present in the treatment facility during the performance of those
procedures:

(A) A licensed physician and surgeon.

(B) A licensed podiatrist.

(C) A physician assistant, nurse practitioner, or certified
nurse-midwife as provided in subdivision (a).

(4) (A) “Technical supportive services” means simple routine
medical tasks and procedures that may be safely performed by a
medical assistant who has limited training and who functions under
the supervision of a licensed physician and surgeon or a licensed
podiatrist, or a physician assistant, a nurse practitioner, or a
certified nurse-midwife as provided in subdivision (a).

(B) Notwithstanding any other law, begin insert in a facility licensed by the
California State Board of Pharmacy under Section 4180 or 4190,
other than a facility operated by the state, end insert “technical supportive
services” begin insert also end insert includes handing to a patient a begin delete properly labeled and end delete
prepackaged prescription drug, excluding a controlled substance,
begin insert that is labeled in compliance with Section 4170 and all other
applicable state and federal laws and end insert ordered by a licensed
physician and surgeon, a licensed podiatrist, a physician assistant,
a nurse practitioner, or a certified nurse-midwife in accordance
with subdivision (a). In every instance, prior to handing the
medication to a patient begin insert pursuant to this subparagraph end insert , the properly
labeled and prepackaged prescription drug shall have the patient’s
name affixed to the package and a licensed physician and surgeon,
a licensed podiatrist, a physician assistant, a nurse practitioner, or
a certified nurse-midwife shall verify that it is the correct
medication and dosage for that specific patient begin insert and shall provide
the appropriate patient consultation regarding use of the drug end insert .

(c) Nothing in this section shall be construed as authorizing any
of the following:

(1) The licensure of medical assistants.

(2) The administration of local anesthetic agents by a medical
assistant.

(3) The board to adopt any regulations that violate the
prohibitions on diagnosis or treatment in Section 2052.

(4) A medical assistant to perform any clinical laboratory test
or examination for which he or she is not authorized by Chapter
3 (commencing with Section 1200).

(5) A nurse practitioner, certified nurse-midwife, or physician
assistant to be a laboratory director of a clinical laboratory, as those
terms are defined in paragraph (8) of subdivision (a) of Section
1206 and subdivision (a) of Section 1209.

(d) A nurse practitioner, certified nurse-midwife, or physician
assistant shall not authorize a medical assistant to perform any
clinical laboratory test or examination for which the medical
assistant is not authorized by Chapter 3 (commencing with Section
1200). A violation of this subdivision constitutes unprofessional
conduct.

(e) Notwithstanding any other law, a medical assistant shall not
be employed for inpatient care in a licensed general acute care
hospital, as defined in subdivision (a) of Section 1250 of the Health
and Safety Code.