California Senate Bill SB538 Amended / Bill

 BILL NUMBER: SB 538AMENDED 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.