BILL ANALYSIS �
SB 993
Page 1
SENATE THIRD READING
SB 993 (Mitchell)
As Amended July 2, 2014
Majority vote
SENATE VOTE :32-0
BUSINESS & PROFESSIONS 14-0
APPROPRIATIONS 17-0
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|Ayes:|Bonilla, Jones, |Ayes:|Gatto, Bigelow, |
| |Bocanegra, Campos, | |Bocanegra, Bradford, Ian |
| |Dickinson, Eggman, | |Calderon, Campos, |
| |Gordon, Hagman, Holden, | |Donnelly, Eggman, Gomez, |
| |Maienschein, Mullin, | |Holden, Jones, Linder, |
| |Skinner, Ting, Wilk | |Pan, Quirk, |
| | | |Ridley-Thomas, Wagner, |
| | | |Weber |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Modifies educational and training requirements for a
dietetic technician, registered (DTR), authorizes a registered
dietitian (RD) to perform additional duties, and makes
additional changes to the practice authorizations for a DTR and
RD, as specified. Specifically, this bill :
1)Revises the existing requirement and creates a second
educational option for an individual to represent himself or
herself as a DTR, as follows:
a) 450 hours of supervised practice experience in addition
to existing requirements mandating appropriate academic
requirements for dietetic technicians, registered, and
receipt of an associate's degree or higher from a college
or university accredited by the Western Association of
Schools and Colleges (WASC) or other regional accreditation
agency; or,
b) Appropriate academic requirements for the field of
dietetics and related disciplines and receipt of a
baccalaureate or higher degree from a college or university
accredited by WASC or other regional accreditation agency.
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2)States that it is a misdemeanor for any person not meeting the
qualifications of an RD or DTR to use, in connection with his
or her name or place of business, the words "registered
dietitian nutritionist" or the letters "RDN," or any other
words, letters, abbreviations, or insignia indicating or
implying that the person is a registered dietitian
nutritionist or to represent, in any way, orally, in writing,
in print or by sign, directly or by implication, that he or
she is a registered dietitian nutritionist.
3)Replaces the phrasing that a referral for medical nutrition
therapy may include a "written protocol governing the
patient's treatment" with the term "diet order."
4)Authorizes the following responsibilities for an RD or other
nutritional professional, as specified, within the term
"medical nutrition therapy":
a) Recommend nutritional and dietary treatments; and,
b) Perform nutritional assessments and initiate nutritional
interventions within the parameters of the prescribed diet
order pursuant to a licensed health care facility's
approved nutrition screening policy and procedure.
5)Requires an RD, or other nutritional professional, as
specified, to collaborate with a multidisciplinary team, which
shall include the treating physician and the registered nurse,
in developing the patient's nutrition care plan.
6)Authorizes an RD or other nutritional professional, as
specified, to individualize the patient's nutritional or
dietary treatment when necessary by modifying the
distribution, type, or quantity of food and nutrients within
the parameters of the prescribed diet order, unless otherwise
stated in the diet order by a patient's provider.
7)Requires any modification, and the rationale for the
modification, to be documented in the patient's record for
review by the physician responsible for the care of the
patient.
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8)States that nothing in this bill shall be construed to
authorize an RD, or other nutritional professional, as
specified, to order or administer a central vein or peripheral
vein nutrition.
9)Authorizes an RD or other nutritional professional, as
specified, to accept or transmit verbal orders or
electronically transmitted orders for medical nutrition
therapy from the physician responsible for the care of the
patient in a licensed health care facility.
10)Authorizes an RD or other nutritional professional, as
specified, to order medical laboratory tests related to
medical nutrition therapy services when approved by the
physician responsible for the care of the patient and when, in
the absence the physician responsible for the care of the
patient at a patient visit, in a clinic where there is a
registered nurse on duty, a registered nurse is notified that
a medical laboratory test is being ordered and is afforded an
opportunity to assess the patient.
11)Clarifies that nothing in this bill prohibits a DTR from
providing nutritional advice, as specified.
12)Requires a person to have completed, not just be enrolled in,
a course of study for a DTR to assist in the implementation or
monitoring of specified services under the direct supervision
of an RD.
13)Authorizes a person to assist in the implementation or
monitoring of specified services, as specified, after
completing the academic requirements for DTRs and providing
written verification thereof, rather than after completing a
supervised practice program.
14)States that no reimbursement is required by this bill because
the only costs that may be incurred by a local agency will be
incurred because this bill creates a new crime or infraction,
eliminates a crime or infraction, changes the penalty for a
crime or infraction, or changes the definition of a crime.
15)Makes clarifying and technical amendments.
FISCAL EFFECT : According to the Assembly Appropriations
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Committee, potential minor and absorbable fiscal impact to the
Licensing and Certification Division within the Department of
Public Health (DPH) to revise policies governing the activities
of RDs and DTRs in health facilities regulated by DPH.
COMMENTS :
1)Purpose of this bill. This bill updates educational, title
protection, and practice provisions for DTRs and RDs to align
more closely with the practice environment. This bill is
sponsored by the California Dietetic Association.
2)Author's statement. According to the author's office,
"Neither RDs nor DTRs are licensed by the state, but RDs are
considered 'registered' ?. However, the institutions in which
they are employed and practice are licensed and regulated by
the Department of Public Health (DPH). As a result of the
narrow and confusing language in the code sections that set
forth the authority of RDs, DPH has imposed citations alleging
violations of law by these institutions employing RDs. The
violations involve very simple and logical actions by RDs
which are entirely consistent with the training RDs receive
and the services for which they are responsible.
"The most significant example is the following. Currently,
DPH asserts that, based on a plain reading of the statute, RDs
must receive physician approval before making minor
modifications to a patient's diet plan (such changing the
texture of the diet when a patient has poor-fitting dentures,
or adding calories at lunch when the patient was not able to
have breakfast). [Asking] the treating physician to approve
such changes is not the best use of the physician's time, does
not require any medical judgment, and ultimately, the delay in
addressing the patient's needs is not in the best interest of
the patient. RDs have the training and expertise to make
those minor changes within the existing nutrition/diet orders
without waiting for the patient's physician to modify the diet
as long as the changes are within the parameters of the
physician-prescribed diet order."
3)RDs and DTRs. RDs are trained health care professionals who
provide dietetic and nutrition services. The majority of RDs
work in the treatment and prevention of disease through the
practice of evidence-based medical nutrition therapy, often in
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hospitals, health maintenance organizations, private practice,
and other healthcare facilities. RDs must have a bachelor's
degree, complete dietetics coursework specified by the
Accreditation Council for Education in Nutrition and
Dietetics, complete an internship, pass a national
registration examination, and complete continuing education
requirements.
Some RDs hold additional certifications in specialty areas
(e.g. pediatrics, renal, oncology, and diabetes) awarded by
the Commission on Dietetic Registration or other medical or
health care organizations or certifying boards.
DTRs are authorized to assist RDs while under direct
supervision of an RD, but may not develop nutritional or
dietary therapy or treatments or accept or transmit verbal
orders. To be a DTR, an individual must be 18 years of age or
older, complete an approved dietetic technician program
including at least 450 hours of supervised practice, have an
associate's degree or higher, pass an examination, and
complete continuing education requirements. This bill
modifies existing educational requirements for DTRs by
requiring either an associate's degree and practice experience
or a bachelor's degree. This bill also updates provisions of
law regarding the role of DTRs and RDs in licensed
institutional settings and addresses specific issues regarding
the modification of medically prescribed diets.
California law provides title-protection and a
non-exclusionary scope of practice for RDs and DTRs. Current
law also recognizes the ability of other nutritional
professionals with a master's or higher degree in a field
covering clinical nutrition sciences, from a college or
university accredited by a regional accreditation agency, to
provide nutritional advice, nutritional assessments,
counseling, and treatments.
There are 9,120 RDs and 532 DTRs in California.
Analysis Prepared by : Sarah Huchel / B., P. & C.P. / (916)
319-3301
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