Bill Text: CA AB2346 | 2013-2014 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Physician and surgeon assistance program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2014-05-23 - In committee: Set, second hearing. Held under submission. [AB2346 Detail]

Download: California-2013-AB2346-Introduced.html

---

BILL NUMBER: AB 2346	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Gonzalez

                        FEBRUARY 21, 2014

   An act to amend Sections 2746.51, 2836.1, and 3516 of the Business
and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2346, as introduced, Gonzalez. Nurse practitioners, certified
nurse-midwives, and physician assistants: supervision.
   Existing law, the Nursing Practice Act, provides for the licensure
and regulation of the practice of nursing by the Board of Registered
Nursing. Existing law authorizes a nurse practitioner and a
certified nurse-midwife to furnish or order drugs or devices under
specified circumstances subject to physician and surgeon supervision.
Existing law prohibits a physician and surgeon from supervising more
than 4 nurse practitioners and certified nurse-midwives at one time
for purposes of furnishing drugs or devices. A violation of the
Nursing Practice Act is a crime.
   This bill would prohibit a physician and surgeon from supervising
more than 6 nurse practitioners and certified nurse-midwives at one
time for purposes of furnishing drugs or devices.
   The Physician Assistant Practice Act provides for the licensure
and regulation of physician assistants by the Physician Assistant
Board within the jurisdiction of the Medical Board of California.
Existing law authorizes a physician assistant to perform certain
health care activities subject to physician and surgeon supervision.
Existing law prohibits a physician and surgeon from supervising more
than 4 physician assistants at one time, except as specified.
   This bill would prohibit a physician and surgeon from supervising
more than 6 physician assistants at one time, except 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 2746.51 of the Business and Professions Code is
amended to read:
   2746.51.  (a) Neither this chapter nor any other provision of law
shall be construed to prohibit a certified nurse-midwife from
furnishing or ordering drugs or devices, including controlled
substances classified in Schedule II, III, IV, or V under the
California Uniform Controlled Substances Act (Division 10 (commencing
with Section 11000) of the Health and Safety Code), when all of the
following apply:
   (1) The drugs or devices are furnished or ordered incidentally to
the provision of any of the following:
   (A) Family planning services, as defined in Section 14503 of the
Welfare and Institutions Code.
   (B) Routine health care or perinatal care, as defined in
subdivision (d) of Section 123485 of the Health and Safety Code.
   (C) Care rendered, consistent with the certified nurse-midwife's
educational preparation or for which clinical competency has been
established and maintained, to persons within a facility specified in
subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the
Health and Safety Code, a clinic as specified in Section 1204 of the
Health and Safety Code, a general acute care hospital as defined in
subdivision (a) of Section 1250 of the Health and Safety Code, a
licensed  alternative  birth center as defined in Section
1204.3 of the Health and Safety Code, or a special hospital specified
as a maternity hospital in subdivision (f) of Section 1250 of the
Health and Safety Code.
   (2) The drugs or devices are furnished or ordered by a certified
nurse-midwife in accordance with standardized procedures or
protocols. For purposes of this section, standardized procedure means
a document, including protocols, developed and approved by the
supervising physician and surgeon, the certified nurse-midwife, and
the facility administrator or his or her designee. The standardized
procedure covering the furnishing or ordering of drugs or devices
shall specify all of the following:
   (A) Which certified nurse-midwife may furnish or order drugs or
devices.
   (B) Which drugs or devices may be furnished or ordered and under
what circumstances.
   (C) The extent of physician and surgeon supervision.
   (D) The method of periodic review of the certified nurse-midwife's
competence, including peer review, and review of the provisions of
the standardized procedure.
   (3) If Schedule II or III controlled substances, as defined in
Sections 11055 and 11056 of the Health and Safety Code, are furnished
or ordered by a certified nurse-midwife, the controlled substances
shall be furnished or ordered in accordance with a patient-specific
protocol approved by the treating or supervising physician and
surgeon. For Schedule II controlled substance protocols, the
provision for furnishing the Schedule II controlled substance shall
address the diagnosis of the illness, injury, or condition for which
the Schedule II controlled substance is to be furnished.
   (4) The furnishing or ordering of drugs or devices by a certified
nurse-midwife occurs under physician and surgeon supervision. For
purposes of this section,  no   a 
physician and surgeon shall  not  supervise more than
 four   six  certified nurse-midwives at
one time. Physician and surgeon supervision shall not be construed to
require the physical presence of the physician, but does include all
of the following:
   (A) Collaboration on the development of the standardized procedure
or protocol.
   (B) Approval of the standardized procedure or protocol.
   (C) Availability by telephonic contact at the time of patient
examination by the certified nurse-midwife.
   (b) (1) The furnishing or ordering of drugs or devices by a
certified nurse-midwife is conditional on the issuance by the board
of a number to the applicant who has successfully completed the
requirements of paragraph (2). The number shall be included on all
transmittals of orders for drugs or devices by the certified
nurse-midwife. The board shall maintain a list of the certified
nurse-midwives that it has certified pursuant to this paragraph and
the number it has issued to each one. The board shall make the list
available to the California State Board of Pharmacy upon its request.
Every certified nurse-midwife who is authorized pursuant to this
section to furnish or issue a drug order for a controlled substance
shall register with the United States Drug Enforcement
Administration.
   (2) The board has certified in accordance with paragraph (1) that
the certified nurse-midwife has satisfactorily completed a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section. The board shall establish the requirements for
satisfactory completion of this paragraph.
   (3) A physician and surgeon may determine the extent of
supervision necessary pursuant to this section in the furnishing or
ordering of drugs and devices.
   (4) A copy of the standardized procedure or protocol relating to
the furnishing or ordering of controlled substances by a certified
nurse-midwife shall be provided upon request to any licensed
pharmacist who is uncertain of the authority of the certified
nurse-midwife to perform these functions.
   (5) Certified nurse-midwives who are certified by the board and
hold an active furnishing number, who are currently authorized
through standardized procedures or protocols to furnish Schedule II
controlled substances, and who are registered with the United States
Drug Enforcement Administration shall provide documentation of
continuing education specific to the use of Schedule II controlled
substances in settings other than a hospital based on standards
developed by the board.
   (c) Drugs or devices furnished or ordered by a certified
nurse-midwife may include Schedule II controlled substances under the
California Uniform Controlled Substances Act (Division 10
(commencing with Section 11000) of the Health and Safety Code) under
the following conditions:
   (1) The drugs and devices are furnished or ordered in accordance
with requirements referenced in paragraphs (2) to (4), inclusive, of
subdivision (a) and in paragraphs (1) to (3), inclusive, of
subdivision (b).
   (2) When Schedule II controlled substances, as defined in Section
11055 of the Health and Safety Code, are furnished or ordered by a
certified nurse-midwife, the controlled substances shall be furnished
or ordered in accordance with a patient-specific protocol approved
by the treating or supervising physician and surgeon.
   (d) Furnishing of drugs or devices by a certified nurse-midwife
means the act of making a pharmaceutical agent or agents available to
the patient in strict accordance with a standardized procedure or
protocol. Use of the term "furnishing" in this section shall include
the following:
   (1) The ordering of a drug or device in accordance with the
standardized procedure or protocol.
   (2) Transmitting an order of a supervising physician and surgeon.
   (e) "Drug order" or "order" for purposes of this section means an
order for medication or for a drug or device that is dispensed to or
for an ultimate user, issued by a certified nurse-midwife as an
individual practitioner, within the meaning of Section 1306.03 of
Title 21 of the Code of Federal Regulations. Notwithstanding any
other provision of law, (1) a 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 certified nurse-midwives; and (3) the signature of a certified
nurse-midwife 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.
  SEC. 2.  Section 2836.1 of the Business and Professions Code is
amended to read:
   2836.1.  Neither this chapter nor any other provision of law shall
be construed to prohibit a nurse practitioner from furnishing or
ordering drugs or devices when all of the following apply:
   (a) The drugs or devices are furnished or ordered by a nurse
practitioner in accordance with standardized procedures or protocols
developed by the nurse practitioner and the supervising physician and
surgeon when the drugs or devices furnished or ordered are
consistent with the practitioner's educational preparation or for
which clinical competency has been established and maintained.
   (b) The nurse practitioner is functioning pursuant to standardized
procedure, as defined by Section 2725, or protocol. The standardized
procedure or protocol shall be developed and approved by the
supervising physician and surgeon, the nurse practitioner, and the
facility administrator or the designee.
   (c) (1) The standardized procedure or protocol covering the
furnishing of drugs or devices shall specify which nurse
practitioners may furnish or order drugs or devices, which drugs or
devices may be furnished or ordered, under what circumstances, the
extent of physician and surgeon supervision, the method of periodic
review of the nurse practitioner's competence, including peer review,
and review of the provisions of the standardized procedure.
   (2) In addition to the requirements in paragraph (1), for Schedule
II controlled substance protocols, the provision for furnishing
Schedule II controlled substances shall address the diagnosis of the
illness, injury, or condition for which the Schedule II controlled
substance is to be furnished.
   (d) The furnishing or ordering of drugs or devices by a nurse
practitioner occurs under physician and surgeon supervision.
Physician and surgeon supervision shall not be construed to require
the physical presence of the physician, but does include (1)
collaboration on the development of the standardized procedure, (2)
approval of the standardized procedure, and (3) availability by
telephonic contact at the time of patient examination by the nurse
practitioner.
   (e) For purposes of this section,  no   a
 physician and surgeon shall  not  supervise more than
 four   six  nurse practitioners at one
time.
   (f) (1) Drugs or devices furnished or ordered by a nurse
practitioner may include Schedule II 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 shall be further limited to those drugs agreed upon by the
nurse practitioner and physician and surgeon and specified in the
standardized procedure.
   (2) When Schedule II or III controlled substances, as defined in
Sections 11055 and 11056, respectively, of the Health and Safety
Code, are furnished or ordered by a nurse practitioner, the
controlled substances shall be furnished or ordered in accordance
with a patient-specific protocol approved by the treating or
supervising physician. A copy of the section of the nurse
practitioner's standardized procedure relating to controlled
substances shall be provided, upon request, to any licensed
pharmacist who dispenses drugs or devices, when there is uncertainty
about the nurse practitioner furnishing the order.
   (g) (1) The board has certified in accordance with Section 2836.3
that the nurse practitioner has satisfactorily completed a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section.
   (2) A physician and surgeon may determine the extent of
supervision necessary pursuant to this section in the furnishing or
ordering of drugs and devices.
   (3) Nurse practitioners who are certified by the board and hold an
active furnishing number, who are authorized through standardized
procedures or protocols to furnish Schedule II controlled substances,
and who are registered with the United States Drug Enforcement
Administration, shall complete, as part of their continuing education
requirements, a course including Schedule II controlled substances
based on the standards developed by the board. The board shall
establish the requirements for satisfactory completion of this
subdivision.
   (h) Use of the term "furnishing" in this section, in health
facilities defined in Section 1250 of the Health and Safety Code,
shall include (1) the ordering of a drug or device in accordance with
the standardized procedure and (2) transmitting an order of a
supervising physician and surgeon.
   (i) "Drug order" or "order" for purposes of this section means an
order for medication which is dispensed to or for an ultimate user,
issued by a nurse practitioner as an individual practitioner, within
the meaning of Section  1306.02   1306.03 
of Title 21 of the Code of Federal Regulations. Notwithstanding any
other provision of law, (1) a 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 nurse practitioners; and (3) the signature of a nurse practitioner
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.
  SEC. 3.  Section 3516 of the Business and Professions Code is
amended to read:
   3516.  (a) Notwithstanding any other provision of law, a physician
assistant licensed by the board shall be eligible for employment or
supervision by any physician and surgeon who is not subject to a
disciplinary condition imposed by the Medical Board of California
prohibiting that employment or supervision.
   (b)  No   A  physician and surgeon shall
 not  supervise more than  four   six
 physician assistants at  any  one time, except
as provided in Section 3502.5.
   (c) The Medical Board of California may restrict a physician and
surgeon to supervising specific types of physician assistants
including, but not limited to, restricting a physician and surgeon
from supervising physician assistants outside of the field of
specialty of the physician and surgeon.