Bill Text: CA SB538 | 2015-2016 | Regular Session | Amended

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

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Bill Title: Naturopathic doctors.

Spectrum: Slight Partisan Bill (Democrat 3-1)

Status: (Failed) 2016-09-01 - From Assembly without further action. [SB538 Detail]

Download: California-2015-SB538-Amended.html

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BILL NUMBER: SB 538	AMENDED
	BILL TEXT

	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, and to order diagnostic imaging studies, as specified. 
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 authorize a naturopathic doctor  to order, perform,
review, and interpret the results of diagnostic procedures commonly
used by physicians and surgeons in general practice and  to
dispense, administer, order, prescribe, provide, furnish, or perform
parenteral therapy and minor  procedures, among other duties.
  procedures.   The bill would include
cervical routes of administration among the authorized routes of
administration.  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. 
   (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 
furnishing, prescribing, administering, or ordering  
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.  
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
 training as determined by the committee,  
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,  and furnish   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.
  equipment consistent with the naturopathic training as
determined by the committee. 
   (4) Health education and health counseling. 
   (5) Repair and care incidental to superficial lacerations and
abrasions, except suturing.  
   (6) Removal of foreign bodies located in the superficial tissues.
 
   (5) Parenteral therapy.  
   (6) Minor procedures. 
   (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.   Nothing   (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  furnishing or ordering 
 administering, furnishing, ordering, or prescribing  drugs
when  all of the following apply:   functioning
pursuant to this section.  
   (a) The drugs are furnihsed or ordered
    (b)     Schedule III 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. 
   (b) 
    (c)  The naturopathic doctor  is functioning
  shall function  pursuant to  a 
standardized procedure, as defined by  subdivisions (a), (b),
(d), (e), (h), and (i) of Section 2836.1 and paragraph (1) of
subdivision (c) of Section 2836.1,   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.

   (c) 
    (d)  The standardized procedure or protocol covering the
 furnishing   administering, furnishing,
ordering, or prescribing  of  Schedule III  drugs shall
specify which naturopathic doctors may  furnish or order
  administer, furnish, order, or prescribe Schedule III
 drugs, which  Schedule III  drugs may be
furnished or ordered   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.

   (d) 
    (e)  The  furnishing or ordering  
administering, furnishing, ordering, or prescribing  of 
Schedule III  drugs by a naturopathic doctor  occurs
  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.  
   (e) 
    (g)  For purposes of this section, a physician and
surgeon shall not supervise more than four naturopathic doctors at
one time. 
   (f) Drugs furnished or ordered 
    (h)     Notwithstanding subdivision (c),
drugs administered, furnished, ordered, or prescribed  by a
naturopathic doctor  may   without the
supervision of a physician and surgeon shall  include Schedule
 III   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  shall be further limited to those drugs agreed
upon by the naturopathic doctor and physician and surgeon as
specified in the standardized procedure. When Schedule III controlled
substances, as defined in Section 11056 of the Health and Safety
Code, are furnished or ordered by a naturopathic doctor, 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 naturopathic
doctor's standardized procedure 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.   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.  
   (g) 
    (i)  The committee  has certified  
shall certify  that the naturopathic doctor has satisfactorily
completed adequate coursework in pharmacology covering the drugs to
be  furnished or ordered   administered,
furnished, ordered, or prescribed  under this section. The
committee shall establish the requirements for satisfactory
completion of this subdivision. 
   (h) 
    (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:   following for Schedule III
controlled substances. 
   (1) Ordering a drug in accordance with the standardized procedure.

   (2) Transmitting an order of a supervising physician and surgeon.

   (i) 
    (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. 
   (j) 
    (l)  Notwithstanding any other  provision of
 law,  all of  the following  shall 
apply:
   (1) A  Schedule III  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. 
  SECTION 1.   Section 3640 of the Business and
Professions Code is amended to read:
   3640.  (a) A naturopathic doctor may order, perform, review, and
interpret the results of diagnostic procedures commonly used by
physicians and surgeons in general practice, including:
   (1) Venipuncture.
   (2) Physical and orificial examinations.
   (3) Electrocardiograms.
   (4) Diagnostic imaging technique consistent with the practice of
naturopathic medicine.
   (5) Phlebotomy.
   (6) Clinical laboratory test and examinations, as described in
subdivision (e).
   (7) Obtaining samples of human tissue, consistent with the
practice of naturopathic medicine.
   (b) 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
naturopathic training as determined by the committee.
   (4) Health education and health counseling.
   (5) Parenteral therapy.
   (6) Minor procedures.
   (c) A naturopathic doctor may utilize routes of administration
that include oral, nasal, auricular, ocular, cervical, rectal,
vaginal, transdermal, intradermal, subcutaneous, intravenous, and
intramuscular.
   (d) The committee may establish regulations regarding ocular or
intravenous routes of administration that are consistent with the
education and training of a naturopathic doctor.
   (e) 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).
   (f) For purposes of this section:
   (1) "Minor procedures" means care and operative procedures
relative to superficial laceration, lesions, and abrasions, and the
removal of foreign bodies located in superficial structures and
aspiration of joints, 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.
   (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 law shall be construed to prohibit a
naturopathic doctor from furnishing, prescribing, administering, or
ordering drugs.
   (b) Drugs furnished or ordered by a naturopathic doctor may
include Schedule III 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 that is
not classified and labeled "for prescription only" or words of
similar import.
   (c) The committee shall certify that the naturopathic doctor has
satisfactorily completed adequate coursework in pharmacology covering
the drugs to be furnished, prescribed, administered, or ordered
under this section. The committee shall establish the requirements
for satisfactory completion of this subdivision.
   (d) 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 ordering
and furnishing a drug.
   (e) 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.
   (f) Notwithstanding any other provision of law, both of the
following shall apply:
   (1) All references to prescription in this code and the Health and
Safety Code shall include drug orders issued by naturopathic
doctors.
   (2) 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.