BILL ANALYSIS
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|Hearing Date:June 28, 1999 | Bill No:AB 141|
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SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
Senator Liz Figueroa, Chair
Bill No: AB 141Author:Knox
As Amended: June 22, 1999 Fiscal:Yes
SUBJECT: Pharmacies: study of medication errors in pharmacies.
SUMMARY: Requires the Board of Pharmacy (Board) to conduct
a study of the incidence of medication errors in pharmacies
and to issue a report of its findings to the Legislature by
December 1, 2004.
Existing law establishes the Board of Pharmacy within the
Department of Consumer Affairs (DCA), and charges the Board
with the administration and enforcement of laws regarding
the practice of pharmacy.
This bill:
1)Requires the Board to conduct a study of the incidence of
medication errors in pharmacies in California, employing
a methodology that uses "test" prescriptions, as defined,
distributed to a statistically significant cross section
of pharmacies in the state. Requires the Board to ensure
that the study is based on sound scientific and analytic
principles.
2)Defines "test" prescription as a prescription that is
prepared solely for the purposes of this study and not
for the actual medical needs of a patient, and requires
all "test" prescription drugs and containers, after
examination for purposes of the study, to be forwarded to
the Board to remain in the Board's custody until
destroyed.
3)States that the purpose of the study is to measure the
frequency and describe the type of medication errors
occurring in California, to improve patient safety, and
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to identify broader issues that may become the basis for
instituting profession-wide standards and changes.
4)Permits the Board to contract with outside entities to
design the study, collect and analyze data results and
disseminate findings.
5)Provides that information collected and produced in the
course of the study be used only for research purposes
and disclosed solely for determining the validity and
propriety of the study. Also requires the identity of
pharmacists and pharmacies to remain confidential, and
prohibits any information, records or reports received or
generated in the study from being used for disciplinary
purposes or being subject to discovery in any proceeding.
6)Authorizes an expenditure of up to $600,000 from the
Pharmacy Board Contingent Fund (special fund) by the
Board for the purposes of conducting the study, and
requires the Board to reimburse that fund in an amount
equal to any private funding it obtains for the study.
7)Requires the Board to issue a report of its findings from
the study to the Legislature by December 1, 2004, and
sunsets the provisions of the bill on January 1, 2005.
FISCAL EFFECT: According to the Assembly Appropriations
Committee analysis (May 26), the cost of the study would
depend on its scope, but would likely be in the range of
$500,000 to $1 million on a one time basis from the
Pharmacy Board Contingent Fund. The bill currently
authorizes up to $600,000.
The Pharmacy Board has requested that the maximum allowable
appropriation be increased to $1.24 million because it
believes the complexity of the study will require
additional funds. (See comment 5, below.)
COMMENTS:
1.Purpose. The author introduced this bill at the request
of the Engineers and Scientists of California (ESC), the
Region 8 States Council of the United Food and Commercial
Workers (UFCW), and the California Pharmacists
Association (CPhA). The bill is intended to require the
Board to conduct a study on prescription errors in
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California since California-specific information about
such errors does not currently exist.
2.Background. According to ESC and UFCW, there is strong
evidence that prescription error rates have increased
dramatically, and point to a study published in the
February 1998 issue of the journal Lancet. This study
found that deaths due to medication errors in the United
States more than doubled between 1983 and 1993, only
about one half of which could be explained by the
increase in filled prescriptions.
CPhA argues in support that this bill would focus the
concern of the Board on the issue of prescription errors
in California. CPhA states that while studies exist
reinforcing evidence that prescription error rates are
increasing, it is important to specifically examine the
degree of this problem in California, the types of errors
that are occurring and potentially why they are
occurring.
3.Arguments in Support. The Consumer Federation of
California states in support that this bill will require
the Board to be more cognizant of the existence and
causes of increasing prescription error rates in
California, and that consumers will ultimately benefit
from increased awareness of the causes of prescription
errors in California.
The California Nurses Association (CNA) also supports this
bill, arguing that reducing medication errors to a
minimum should be one of the prime regulatory objectives
of the Board. The CNA states that in addition to the
Lancet study noted above, a similar study of hospital
error rates published last year in the Archives of
Internal Medicine of the American Medical Association
found that between 1987 and 1995 there was a fourfold
increase in prescription errors rated as having the
potential for adverse effects on patients. Further the
CNA notes that the Guild for Professional Pharmacists
published a study in 1997 that found that in California
there was one error for every 285 prescriptions filled -
an average of over 300 prescription errors annually per
pharmacy.
4.Prior Legislation. Last year's AB 1889 by the same
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author would have similarly required the Board to conduct
a medication error study in California. The Board and
the DCA opposed last year's bill and it was vetoed by
then-Governor Pete Wilson. This year the Board is
supportive.
5.Requested amendment to increase maximum appropriation to
$1.24 million. The Board has requested that the bill be
amended to increase the maximum allowable expenditure for
the study from $600,000 to $1.24 million to assure that
the necessary funding is available for the study to be
properly performed in a sound scientific manner. The
Board states that the proposed study will be quite
complex, that it does not have the necessary expertise
in-house, and will have to contract with an outside
source that has Ph.D. level researchers who are
clinically trained in pharmaceutical care. Further, the
Board notes that the study's "test" prescriptions will
necessitate prescription drug purchases and payments to
the test "patients".
The Board estimates approximately $200,000 will be needed
to develop the contract proposal, evaluate the submitted
proposals and bids, and award the contract. Another
$240,000 would fund a Board staff position for four years
to monitor and provide staff support to the project,
gather data on Board prescription error complaints to be
included in the study, and seek private grants to
supplement the funding of the study. Finally, $800,000
would fund the conduct the actual study and report to the
Legislature.
The Board states that its contingent fund has sufficient
reserves to sustain that higher level of appropriation,
even with the upcoming fee decrease this July.
SUPPORT AND OPPOSITION:
Support:Engineers and Scientists of California
Region 8 States Council of the United Food and
Commercial Workers
California Nurses Association
California Pharmacists Association
California State Board of Pharmacy
Consumer Federation of California
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Opposition:None received.
Consultant:Jay J. DeFuria