Bill Text: CA SB538 | 2015-2016 | Regular Session | Amended
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
BILL NUMBER: SB 538 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 15, 2016
AMENDED IN ASSEMBLY AUGUST 4, 2016
AMENDED IN ASSEMBLY JUNE 29, 2016
AMENDED IN ASSEMBLY AUGUST 17, 2015
AMENDED IN ASSEMBLY JULY 7, 2015
AMENDED IN SENATE APRIL 16, 2015
AMENDED IN SENATE APRIL 6, 2015
INTRODUCED BY Senator Hueso
(Principal coauthor: Senator Block)
(Coauthor: Senator Stone)
(Coauthor: Assembly Member Nazarian)
FEBRUARY 26, 2015
An act to amend Sections 3640, 3640.5, and 3640.7 of the Business
and Professions Code, relating to naturopathic doctors.
LEGISLATIVE COUNSEL'S DIGEST
SB 538, as amended, Hueso. 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, 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.
This bill would, 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 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 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. The bill would require the
period of supervision of a naturopathic doctor for the
administering, furnishing, ordering, or prescribing of Schedule III
and Schedule IV drugs to be 12 months, after which the naturopathic
doctor would be authorized to prescribe independently. The bill would
waive from that supervision requirement a naturopathic doctor who
has completed a residency program, as specified, or who has practiced
for at least 12 months in another state where independent
prescribing is within a naturopathic doctor's scope of practice.
drugs. The bill would authorize a naturopathic doctor
to administer, furnish, order, or prescribe Schedule III and Schedule
IV controlled substances pursuant to a standardized procedure or
protocol and under the supervision of a physician and surgeon, as
specified.
(3) Existing law, notwithstanding any provision of the
Naturopathic Doctors Act, authorizes a naturopathic doctor to
independently prescribe and administer certain things, including,
among others, epinephrine to treat anaphylaxis.
This bill would additionally authorize a
naturopathic doctor to independently prescribe and
administer all legend drugs and administer, furnish,
order, or prescribe Schedule V controlled substances
after 12 months of supervision, residency, or practice in a state
that allows a naturopathic doctor to prescribe medications
independently. and any drug approved by the federal
Food and Drug Administration and labeled "for prescription only,"
except chemotherapeutics, that is not classified, after the
completion of 12 months of physician and surgeon supervision, as
specified, and would waive that supervision requirement for a
naturopathic doctor who has completed a residency program, as
specified, or who has a license in good standing and practiced for at
least 12 months in another state where independent prescribing is
within a naturopathic doctor's scope of practice in that other state.
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) 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.
(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) This section shall not 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).
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 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) (1) 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:
(A)
(1) Collaboration on the development of the
standardized procedure.
(B)
(2) Approval of the standardized procedure.
(C)
(3) Availability by telephonic contact at the time of
patient examination by the naturopathic doctor.
(2) The period of supervision under this subdivision shall last 12
months, after which the naturopathic doctor may prescribe
independently.
(3) The supervision requirement under this subdivision shall be
waived if either:
(A) The naturopathic doctor has completed a residency program of
at least 12 months that is approved by the National Council on
Naturopathic Medical Education or any other agency approved by the
committee.
(B) The naturopathic doctor has practiced for at least 12 months
in another state where independent prescribing is within the scope of
practice of a 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 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)
(h) 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)
(i) 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)
(j) 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)
(k) 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.
SEC. 3. Section 3640.7 of the Business and Professions Code is
amended to read:
3640.7. (a) Notwithstanding the
requirements of Section 3640.5 or any other provision of this
chapter, a naturopathic doctor may independently prescribe and
administer the following:
(a)
(1) Epinephrine to treat anaphylaxis.
(b)
(2) Natural and synthetic hormones.
(c)
(3) Vitamins, minerals, amino acids, glutathione,
botanicals and their extracts, homeopathic medicines, electrolytes,
sugars, and diluents that may be administered utilizing routes of
administration, pursuant to subdivision (d) of Section 3640, only
when such substances are chemically identical to those for sale
without a prescription.
(d) All legend drugs and Schedule V controlled substances after 12
months of supervision, residency, or practice in another state that
allows a naturopathic doctor to prescribe medications independently.
(b) (1) A naturopathic doctor may independently administer,
furnish, order, or prescribe 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, after the completion of 12
consecutive months of supervision by a physician and surgeon for the
substances and drugs specified in this subdivision. The supervision
required by this subdivision shall follow the same procedures or
protocols as those described in Section 3640.5 for other prescription
medications.
(2) The supervision requirement under this subdivision shall be
waived if either:
(A) The naturopathic doctor has completed a residency program of
at least 12 months that is approved by the Council on Naturopathic
Medical Education or any other agency approved by the committee.
(B) The naturopathic doctor has a license in good standing and has
practiced for at least 12 months in another state where independent
prescribing of the substances and drugs described in this chapter is
permitted for a licensed naturopathic doctor in that other state.
