BILL NUMBER: SB 538 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 7, 2015
AMENDED IN SENATE APRIL 16, 2015
AMENDED IN SENATE APRIL 6, 2015
INTRODUCED BY Senator Block
(Coauthor: Senator Hueso)
FEBRUARY 26, 2015
An act to amend Sections 3640 and 3640.5 of the Business and
Professions Code, relating to naturopathic doctors.
LEGISLATIVE COUNSEL'S DIGEST
SB 538, as amended, Block. Naturopathic doctors.
(1) Existing law, the Naturopathic Doctors Act, provides for the
licensure and regulation of naturopathic doctors by the Naturopathic
Medicine Committee in the Osteopathic Medical Board of California.
Existing law authorizes a naturopathic doctor to perform certain
tasks, including physical and laboratory examinations for diagnostic
purposes, purposes and to order
diagnostic imaging studies, as specified.
consistent with naturopathic training as determined by the committee.
Under the act, a naturopathic doctor is authorized to
dispense, administer, order, prescribe, furnish, or perform certain
things, including health education and health counseling.
The act also authorizes a naturopathic doctor to utilize routes of
administration that include, among others, intramuscular.
This bill would revise and recast those provisions and
would expressly , instead, authorize a naturopathic
doctor to perform certain tasks, consistent with the practice of
naturopathic medicine, and would additionally authorize a
naturopathic doctor to dispense, administer, order, prescribe,
provide, or furnish, or perform parenteral
therapy and minor procedures. The bill would define terms for those
purposes. The bill would authorize a naturopathic doctor to use a
cervical route of administration only for the purpose of
administering barrier contraception. devices and
durable medical equipment consistent with the naturopathic training
as determined by the committee.
(2) Existing law, the California Uniform Controlled Substances
Act, classifies controlled substances into 5 designated schedules,
with the most restrictive limitations generally placed on controlled
substances classified in Schedule I, and the least restrictive
limitation generally placed on controlled substances classified in
Schedule V.
Existing law states that nothing in the Naturopathic Doctors Act
or any other law shall be construed to prohibit a naturopathic doctor
from furnishing or ordering drugs when, among other requirements,
the naturopathic doctor is functioning pursuant to standardized
procedure, as defined, or protocol developed and approved, as
specified, and the Naturopathic Medicine Committee has certified that
the naturopathic doctor has satisfactorily completed adequate
coursework in pharmacology covering the drugs to be furnished or
ordered. Existing law requires that the furnishing or ordering of
drugs by a naturopathic doctor occur under the supervision of a
physician and surgeon. Existing law also authorizes a naturopathic
doctor to furnish or order controlled substances classified in
Schedule III, IV, or V of the California Uniform Controlled
Substances Act, but limits this authorization to those drugs agreed
upon by the naturopathic doctor and physician and surgeon as
specified in the standardized procedure. Existing law further
requires that drugs classified in Schedule III be furnished or
ordered in accordance with a patient-specific protocol approved by
the treating or supervising physician.
This bill would instead provide that, except as specified, nothing
in the provisions governing naturopathic doctors or any other law
shall be construed to prohibit a naturopathic doctor from
administering, furnishing, ordering, or prescribing drugs and would
make a conforming change to the scope of the certification duties of
the Naturopathic Medicine Committee. The bill would delete certain
provisions described above restricting the authority of naturopathic
doctors to furnish or order drugs, including the requirements that
the naturopathic doctor function pursuant to a standardized
procedure, or furnish or order drugs under the supervision of a
physician and surgeon for Schedule IV through
Schedule V controlled substances and for any drug approved by the
federal Food and Drug Administration and labeled "for prescription
only," except chemotherapeutics, that is not classified.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 3640 of the Business and Professions Code is
amended to read:
3640. (a) A naturopathic doctor may order and perform physical
and laboratory examinations for diagnostic purposes, including, but
not limited to, phlebotomy, clinical laboratory tests, speculum
examinations, orificial examinations, and physiological function
tests.
(b) A naturopathic doctor may order diagnostic imaging studies,
including X-ray, ultrasound, mammogram, bone densitometry, and
others, consistent with the practice of naturopathic medicine, but
shall refer the studies to an appropriately licensed health care
professional to conduct the study and interpret the results.
(c) A naturopathic doctor may dispense, administer, order,
prescribe, provide, furnish, or perform the following:
(1) Food, extracts of food, nutraceuticals, vitamins, amino acids,
minerals, enzymes, botanicals and their extracts, botanical
medicines, homeopathic medicines, all dietary supplements and
nonprescription drugs as defined by the Federal Food, Drug, and
Cosmetic Act, consistent with the routes of administration identified
in subdivision (d).
(2) Hot or cold hydrotherapy; naturopathic physical medicine
inclusive of the manual use of massage, stretching, resistance, or
joint play examination but exclusive of small amplitude movement at
or beyond the end range of normal joint motion; electromagnetic
energy; colon hydrotherapy; and therapeutic exercise.
(3) Devices, including, but not limited to, therapeutic devices,
barrier contraception, and durable medical equipment consistent with
the naturopathic training as determined by the committee.
(4) Health education and health counseling.
(5) Parenteral therapy.
(6) Minor procedures.
(5) Repair and care incidental to superficial lacerations and
abrasions, except suturing.
(6) Removal of foreign bodies located in the superficial tissues.
(d) A naturopathic doctor may utilize routes of administration
that include oral, nasal, auricular, ocular, rectal, vaginal,
transdermal, intradermal, subcutaneous, intravenous, and
intramuscular. A naturopathic doctor may utilize a cervical
route of administration only for the purpose of administering barrier
contraception.
(e) The committee may establish regulations regarding ocular or
intravenous routes of administration that are consistent with the
education and training of a naturopathic doctor.
(f) Nothing in this section shall exempt a naturopathic doctor
from meeting applicable licensure requirements for the performance of
clinical laboratory tests, including the requirements imposed under
Chapter 3 (commencing with Section 1200).
(g) For purposes of this section, the following terms have the
following meanings:
(1) "Minor procedures" means care and operative procedures
relative to superficial lacerations, superficial clinically benign
lesions less than one centimeter and not located on the face, and
superficial abrasions, and the removal of foreign bodies located in
superficial structures and the topical and parenteral use of
substances consistent with the practice of naturopathic medicine, in
accordance with rules established by the Naturopathic Medicine
Committee. A naturopathic doctor may obtain samples of superficial
human tissue by means of shave, punch, or excisional biopsy
consistent with the practice of naturopathic medicine. "Minor
procedures" does not include general or spinal anesthesia,
sclerotherapy, or procedures involving the eye.
(2) "Parenteral therapy" means the administration of substances by
means other than through the gastrointestinal tract, including
intravenous, subcutaneous, intramuscular, and other areas of the
body, excluding the ventral and dorsal body cavities.
SEC. 2. Section 3640.5 of the Business and Professions Code is
amended to read:
3640.5. (a) Except as set forth in this section, nothing in this
chapter or any other provision of law shall be construed to prohibit
a naturopathic doctor from administering, furnishing, ordering, or
prescribing drugs when functioning pursuant to this section.
(b) Schedule III and Schedule IV controlled substances
under the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) shall
be administered, furnished, ordered, and prescribed by a naturopathic
doctor in accordance with standardized procedures or protocols
developed by the naturopathic doctor and his or her supervising
physician and surgeon.
(c) The naturopathic doctor shall function pursuant to a
standardized procedure, as defined by paragraphs (1) and (2) of
subdivision (c) of Section 2725, or protocol. The standardized
procedure or protocol shall be developed and approved by the
supervising physician and surgeon, the naturopathic doctor, and,
where applicable, the facility administrator or his or her designee.
(d) The standardized procedure or protocol covering the
administering, furnishing, ordering, or prescribing of Schedule III
and Schedule IV drugs shall specify which naturopathic
doctors may administer, furnish, order, or prescribe Schedule III
and Schedule IV drugs, which Schedule III through
Schedule IV drugs may be administered, furnished, ordered, or
prescribed and under what circumstances, the extent of physician and
surgeon supervision, the method of periodic review of the
naturopathic doctor's competence, including peer review, which shall
be subject to the reporting requirement in Section 805, and review of
the provisions of the standardized procedure.
(e) The administering, furnishing, ordering, or prescribing of
Schedule III and Schedule IV drugs by a naturopathic
doctor shall occur under physician and surgeon supervision. Physician
and surgeon supervision shall not be construed to require the
physical presence of the physician, but does include all of the
following:
(1) Collaboration on the development of the standardized
procedure.
(2) Approval of the standardized procedure.
(3) Availability by telephonic contact at the time of patient
examination by the naturopathic doctor.
(f) When Schedule III controlled substances, as defined in Section
11056 of the Health and Safety Code, are administered, furnished,
ordered, or prescribed by a naturopathic doctor, the controlled
substances shall be administered, furnished, ordered, or prescribed
in accordance with a patient-specific protocol approved by the
treating or supervising physician. A copy of the section of the
naturopathic doctor's standardized procedure or protocol relating to
controlled substances shall be provided, upon request, to a licensed
pharmacist who dispenses drugs when there is uncertainty about the
naturopathic doctor furnishing the order.
(g) For purposes of this section, a physician and surgeon shall
not supervise more than four naturopathic doctors at one time.
(h) Notwithstanding subdivision (c), drugs administered,
furnished, ordered, or prescribed by a naturopathic doctor without
the supervision of a physician and surgeon shall include
Schedule IV through Schedule V controlled substances under
the California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) and
any drug approved by the federal Food and Drug Administration and
labeled "for prescription only" or words of similar import, except
chemotherapeutics, that is not classified.
(i) The committee shall certify that the naturopathic doctor has
satisfactorily completed adequate coursework in pharmacology covering
the drugs to be administered, furnished, ordered, or prescribed
under this section. The committee shall establish the requirements
for satisfactory completion of this subdivision.
(j) Use of the term "furnishing" in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of
Section 1250 of the Health and Safety Code, shall include both of the
following for Schedule III through Schedule IV controlled
substances.
(1) Ordering a drug in accordance with the standardized procedure.
(2) Transmitting an order of a supervising physician and surgeon.
(k) For purposes of this section, "drug order" or "order" means an
order for medication which is dispensed to or for an ultimate user,
issued by a naturopathic doctor as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations.
(l) Notwithstanding any other law, all of the following shall
apply:
(1) A Schedule III through Schedule IV drug order
issued pursuant to this section shall be treated in the same manner
as a prescription of the supervising physician.
(2) All references to prescription in this code and the Health and
Safety Code shall include drug orders issued by naturopathic
doctors.
(3) The signature of a naturopathic doctor on a drug order issued
in accordance with this section shall be deemed to be the signature
of a prescriber for purposes of this code and the Health and Safety
Code.