BILL ANALYSIS �
AB 1841
Page 1
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
AB 1841 (Mullin) - As Amended: April 21, 2014
SUBJECT : Medical assistants.
SUMMARY : Clarifies that medical assistants (MAs) may hand out
properly labeled and prepackaged prescription drugs to patients
as part of their existing authorization to provide "technical
supportive services." Specifically, this bill :
1)States that, notwithstanding any other law, "technical
supportive services" includes the ability for an MA to hand a
patient a properly labeled and prepackaged prescription drug,
excluding 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.
2)Requires a licensed physician and surgeon, a licensed
podiatrist, a physician assistant, a nurse practitioner, or a
certified nurse-midwife to verify that the medication and
dosage for that specific patient is correct, and that the
patient's name is affixed to the package prior to an MA
handing the medication to a patient.
EXISTING LAW :
1)Establishes the Medical Board of California (MBC) to
administer and enforce the Medical Practice Act, which
includes the regulation of MAs. (Business and Professions
Code (BPC) Section 2000 et seq.)
2)Defines an MA as a person who may be unlicensed, who performs
basic administrative, clerical, and technical supportive
services, as specified, 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, or for a health
care service plan. (BPC 2069 (b)(1))
3)Requires an MA to be at least 18 years of age and have at
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least the minimum amount of hours of appropriate training
pursuant to standards established MBC, and further requires an
MA to have a certificate by the training institution or
instructor indicating satisfactory completion of the required
training, and for each employer to retain a copy of this
certificate. (BPC 2069 (b)(1))
4)Permits a supervising physician and surgeon to provide written
instructions to be followed by an MA 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
protocols. (BPC 2069 (a)(2)
5)Permits an MA to 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. (BPC 2069 (a)(1))
6)Defines "technical supportive services" as simple routine
medical tasks and procedures that may be safely performed by
an MA 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 specified. (BPC 2069(b)(4))
7)Permits an MA to perform venipuncture or skin puncture for the
purposes of withdrawing blood upon specific authorization and
under the supervision of a licensed physician and surgeon or a
licensed podiatrist, or a physician assistant, a nurse
practitioner, or a nurse-midwife with at least the minimum
amount of hours of appropriate training pursuant to standards
established by MBC. (BPC 2070)
8)Authorizes a pharmacy to employ a non-licensed person to type
a prescription label or otherwise enter prescription
information into a computer record system, but the
responsibility for the accuracy of the prescription
information and the prescription as dispensed lies with the
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registered pharmacist who initials the prescription or
prescription record. At the direction of the registered
pharmacist, a non-licensed person may also request and receive
refill authorization. (California Code of Regulations, Title
16, Division 17, Article 11, Section 1793.3(a))
FISCAL EFFECT : None. This bill is keyed non-fiscal by the
Legislative Counsel.
COMMENTS :
1)Purpose of this bill . This bill clarifies that MAs may hand
out properly labeled and prepackaged prescription drugs to
patients as part of their existing scope of practice under
"technical supportive services." This bill is sponsored by
Planned Parenthood.
2)Author's statement . According to the author's office, "AB
1841 will help increase and improve patient access to care by
clarifying that [a] medical assistant's ability to provide
'technical supportive services' includes handing over
pre-labeled, pre-packaged medications, excluding controlled
substances.
"Current practice in community health centers relies on the
use of [MAs] to support clinicians (Nurse Practitioners,
Certified Nurse-Midwives, and Physician Assistants). The minor
increase in MAs ability to hand over medication will increase
health center efficiency and allow clinicians to focus on
patient care, improving patient satisfaction. This change will
streamline and improve health center operations, increasing
and expanding patient access to care.
"Providing MAs this authority will help reduce waiting times,
expand access, and improve patient care and satisfaction in
community clinics, including Planned Parenthoods. Allowing an
MA to hand over medication and provide follow up instruction
will ensure that a patient has received counseling on their
medication twice and will provide them an additional
opportunity to ask questions. This will also free up the
clinician, allowing them to spend more time with the patient
answering questions because they are not rushing to perform
additional duties.
"With millions of patients who are newly eligible for health
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care coverage, including the 1.2 million who have enrolled in
Medi-Cal, expanding access to care is especially important
health care providers like community clinics. Planned
Parenthood, along with all other health care facilities, [is]
striving to ensure the highest level of health care efficiency
and quality in order to serve new populations and continue
providing needed coverage for the remaining uninsured."
3)Medical Assistants . MAs are unlicensed, but certificated,
individuals. An MA must have a high school diploma or GED
equivalent and take a certificate course at an approved
school. The exact duration of these programs vary, but San
Francisco State University, for example, requires 140
classroom hours and a clinical externship. MAs also must
complete a minimum of 60 hours of continuing education over 5
years.
An MA may perform the following specific functions as part of
"technical supportive" services in addition to administrative
functions:
a) Administer medication orally, sublingually, topically,
vaginally or rectally, or by providing a single dose to a
patient for immediate self-administration;
b) Administer medication by inhalation if the medications
are patient-specific and have been or will be routinely and
repetitively administered to that patient. In every
instance, prior to administration of medication by the
medical assistant, a licensed physician or podiatrist, or
another person authorized by law to do so shall verify the
correct medication and dosage. Nothing in this section
shall be construed as authorizing the administration of any
anesthetic agent by a medical assistant;
c) Perform electrocardiogram, electroencephalogram, or
plethysmography tests (used to measure changes in volume in
different parts of the body), except full body
plethysmography;
d) Apply and remove bandages and dressings; apply
orthopedic appliances such as knee immobilizers, envelope
slings, orthotics, and similar devices; remove casts,
splints and other external devices; obtain impressions for
orthotics, padding and custom molded shoes; select and
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adjust crutches to patient; and instruct patient in proper
use of crutches;
e) Remove sutures or staples from superficial incisions or
lacerations;
f) Perform ear lavage to remove impacted cerumen (remove
excess earwax);
g) Collect by non-invasive techniques and preserve
specimens for testing, including urine, sputum, semen and
stool;
h) Assist patients in ambulation (moving) and transfers;
i) Prepare patients for and assist the physician,
podiatrist, physician assistant or registered nurse in
examinations or procedures including positioning, draping,
shaving and disinfecting treatment sites; and prepare a
patient for gait analysis testing;
j) As authorized by the physician or podiatrist, provide
patient information and instructions;
aa) Collect and record patient data including height,
weight, temperature, pulse, respiration rate and blood
pressure, and basic information about presenting and
previous conditions; and,
bb) Perform simple laboratory and screening tests
customarily performed in a medical office.
This bill simply clarifies that MAs may hand out properly
labeled and prepackaged prescription drugs to patients as part
of "technical supportive services." Based on their current
abilities, this appears to be well within their scope of
practice.
This clarification is consistent with the work of similarly
unlicensed "pharmacy clerks" or "pharmacy assistants." This
is a traditional title used in the pharmacy industry and is
included under regulations for "ancillary personnel" in
pharmacy regulations. A pharmacy clerk may also perform
various "non-discretionary" tasks that do not require the
abilities and authorities of either a pharmacist or a Licensed
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Pharmacy Technician.
These unlicensed individuals work in the pharmacy under the
supervision of a pharmacist and cannot "dispense"
prescriptions as that term is understood in current law, but
they can "hand" the patient filled prescriptions that have
been approved by a pharmacist for dispensing.
4)Arguments in support . Planned Parenthood writes, "AB 1841
will allow MAs to hand to a patient their medication
(excluding controlled substances) that has already been
packaged and labeled by a physician, nurse practitioner,
certified nurse midwife or physician assistant - those who
have prescribing, furnishing and dispensing authority. The MA
would hand over this pre-packaged/pre-labeled medication only
after that patient has been seen by their physician or
clinician, who has diagnosed them, discussed treatment
options, educated them about their medication, and finally,
selected and packaged that medication. The MA would also be
authorized to hand over pre-packaged/pre-labeled medication to
an existing patient who is picking up a re-fill.
"Authorizing MA to hand over pre-packaged/pre-labeled
medication is consistent with (if not less complicated than)
the level and complexity and range of medical and technical
support services they are already authorized to perform,
including administering narcotics and giving injections.
"Providing MAs the ability to hand over medication will
increase access to care in Planned Parenthood health centers
by reducing waiting times caused, in part, by clinicians who
must package the medications and then themselves hand it to
the patient. Freeing up the clinician from this ministerial
duty will allow them to see more patients and spend more time
with each patient answering questions."
5)Arguments in opposition . Service Employees International
Union (SEIU) Local 1000 writes, "We believe AB 1841 has
several unintended consequences. First, it changes the scope
of practice for [unlicensed MAs], not just at community health
clinics, but also those in state agencies that [utilize]
medical professionals. Our members include [licensed
vocational nurses, registered nurses] and pharmacy
technicians, all of whom are trained and [licensed]. This is
an industry mandate in the State of California. Second, the
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intent of this bill is to allow MAs to dispense medication in
a health clinic like a pharmacy tech does in a pharmacy. MAs
have restrictions on handling medications. Currently, MAs can
administer a single dose under the supervision of a licensed
provider who must physically be present.
"Our members have expressed additional concerns including that
AB 1841 will give MAs authority to make decisions based on a
physician's orders which they are not trained to do and has
the potential to cause liability issues for supervising
staff."
REGISTERED SUPPORT / OPPOSITION :
Support
Planned Parenthood Affiliates of California (sponsor)
Association of California Healthcare Districts
California Academy of Physician Assistants
California Association for Nurse Practitioners
California Family Health Council
California Nurse-Midwives Association
California Primary Care Association
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino Counties
Planned Parenthood of Santa Barbara, Ventura, and San Luis
Obispo Counties, Inc.
Planned Parenthood of the Pacific Southwest
Planned Parenthood Pasadena and San Gabriel Valley
Planned Parenthood Shasta Pacific Action Fund
Six Rivers Planned Parenthood
Opposition
SEIU Local 1000
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301