Bill Text: CA AB1306 | 2015-2016 | Regular Session | Introduced

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

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Bill Title: Healing arts: certified nurse-midwives: scope of practice.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed - Dead) 2016-08-31 - Assembly refused to concur in Senate amendments. (Ayes 31. Noes 21. Page 6600.) [AB1306 Detail]

Download: California-2015-AB1306-Introduced.html

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BILL NUMBER: AB 1306	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Burke

                        FEBRUARY 27, 2015

   An act to amend Sections 2725.1, 2746.2, 2746.5, 2746.51, 2746.52,
4061, 4076, and 4170 of, and to add Section 2746.6 to, the Business
and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1306, as introduced, Burke. Healing arts: certified
nurse-midwives: scope of practice.
   (1) Existing law, the Nursing Practice Act, provides for the
licensure and regulation of the practice of nursing by the Board of
Registered Nursing and authorizes the board to issue a certificate to
practice nurse-midwifery to a person who meets educational standards
established by the board or the equivalent of those educational
standards. The act makes the violation of any of its provisions a
misdemeanor punishable upon conviction by imprisonment in the county
jail for not less than 10 days nor more than one year, or by a fine
of not less than $20 nor more than $1,000, or by both that fine and
imprisonment.
   This bill would additionally require an applicant for a
certificate to practice nurse-midwifery to provide evidence of
current advanced level national certification by a certifying body
that meets standards established and approved by the board. This bill
would also require the board to create and appoint a Nurse-Midwifery
Advisory Council consisting of certified nurse-midwives in good
standing with experience in hospital and nonhospital practice
settings, a nurse-midwife educator, as specified, and a consumer of
midwifery care. This bill would require the council to make
recommendations to the board on all matters related to
nurse-midwifery practice, education, and other matters specified by
the board, and would require the council to meet regularly, but at
least twice a year.
   (2) The act authorizes a certified nurse-midwife, under the
supervision of a licensed physician and surgeon, to attend cases of
normal childbirth and to provide prenatal, intrapartum, and
postpartum care, including family-planning care, for the mother, and
immediate care for the newborn, and provides that the practice of
nurse-midwifery constitutes the furthering or undertaking by a
certified person, under the supervision of a licensed physician and
surgeon who has current practice or training in obstetrics, to assist
a woman in childbirth so long as progress meets criteria accepted as
normal.
   This bill would delete those provisions and would instead
authorize a certified nurse-midwife to manage a full range of primary
health care services for women from adolescence beyond menopause,
including, but not limited to, gynecologic and family planning
services. The bill would authorize a certified nurse-midwife to
practice in all settings, including, but not limited to, a home. This
bill would declare that the practice of nurse-midwifery within a
health care system provides for consultation, collaboration, or
referral as indicated by the health status of the client and the
resources of the medical personnel available in the setting of care,
and would provide that the practice of nurse-midwifery emphasizes
informed consent, preventive care and early detection and referral of
complications to a physician and surgeon. This bill would authorize
a certified nurse-midwife to provide peripartum care in an
out-of-hospital setting to low-risk women with uncomplicated
singleton-term pregnancies who are expected to have uncomplicated
birth.
   (3) The act authorizes a certified nurse-midwife to furnish and
order drugs or devices incidentally to the provision of family
planning services, routine health care or perinatal care, and care
rendered consistently with the certified nurse-midwife's educational
preparation in specified facilities and clinics, and only in
accordance with standardized procedures and protocols, as specified.
   This bill would delete the requirement that drugs or devices are
furnished or ordered in accordance with standardized procedures and
protocols. The bill would authorize a certified nurse-midwife to
furnish and order drugs or devices in connection with care rendered
in a home, and would authorize a certified nurse-midwife to directly
procure supplies and devices, to order, obtain, and administer drugs
and diagnostic tests, to order laboratory and diagnostic testing, and
to receive reports that are necessary to his or her practice as a
certified nurse-midwife and that are consistent with nurse-midwifery
education preparation.
   (4) The act also authorizes a certified nurse-midwife to perform
and repair episiotomies and to repair first-degree and 2nd-degree
lacerations of the perineum in a licensed acute care hospital and a
licensed alternate birth center, if certain requirements are met,
including, but not limited to, that episiotomies are performed
pursuant to protocols developed and approved by the supervising
physician and surgeon.
   This bill would also authorize a certified nurse-midwife to
perform and repair episiotomies and to repair first-degree and
2nd-degree lacerations of the perineum in a patient's home, and would
delete all requirements that those procedures be performed pursuant
to protocols developed and approved by the supervising physician and
surgeon. The bill would require a certified nurse-midwife to provide
emergency care to a patient during times when a physician and surgeon
is unavailable.
    This bill would provide that a consultative relationship between
a certified nurse-midwife and a physician and surgeon by it self is
not a basis for finding the physician and surgeon liable for any acts
or omissions on the part of the certified nurse-midwife. The bill
would also update cross-references as needed.
   (5) Because the act makes a violation of any of its provisions a
misdemeanor, this bill would expand the scope of an existing crime
and therefore this bill would impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 2725.1 of the Business and Professions Code is
amended to read:
   2725.1.  (a) Notwithstanding any other  provision of
 law, a registered nurse may dispense drugs or devices upon
an order by a licensed physician and surgeon or an order by a
certified nurse-midwife, nurse practitioner, or physician assistant
issued pursuant to Section 2746.51, 2836.1, or 3502.1, respectively,
if the registered nurse is functioning within a licensed primary care
clinic as defined in subdivision (a) of Section 1204 of, or within a
clinic as defined in subdivision (b), (c), (h), or (j) of Section
1206 of, the Health and Safety Code.
   (b) No clinic shall employ a registered nurse to perform
dispensing duties exclusively. No registered nurse shall dispense
drugs in a pharmacy, keep a pharmacy, open shop, or drugstore for the
retailing of drugs or poisons. No registered nurse shall compound
drugs. Dispensing of drugs by a registered nurse, except a certified
nurse-midwife who functions pursuant to  a standardized
procedure or protocol described in  Section 2746.51 or a
nurse practitioner who functions pursuant to a standardized procedure
described in Section 2836.1, or protocol, shall not include
substances included in the California Uniform Controlled Substances
Act (Division 10 (commencing with Section 11000) of the Health and
Safety Code). Nothing in this section shall exempt a clinic from the
provisions of Article 13 (commencing with Section 4180) of Chapter 9.

   (c)  Nothing in this   This   
section shall  not  be construed to limit any other
authority granted to a certified nurse-midwife pursuant to Article
2.5 (commencing with Section 2746), to a nurse practitioner pursuant
to Article 8 (commencing with Section 2834), or to a physician
assistant pursuant to Chapter 7.7 (commencing with Section 3500).
   (d)  Nothing in this   This  section
shall  not  be construed to affect the sites or types of
health care facilities at which drugs or devices are authorized to be
dispensed pursuant to Chapter 9 (commencing with Section 4000).
  SEC. 2.  Section 2746.2 of the Business and Professions Code is
amended to read:
   2746.2.   (a)    Each applicant shall show by
evidence satisfactory to the board that he  or she  has met
the educational standards established by the board or has at least
the equivalent  thereof. The board is authorized to appoint a
committee of qualified physicians and nurses, including, but not
limited to, obstetricians and nurse-midwives, to develop the
necessary standards relating to educational requirements, ratios of
nurse-midwives to supervising physicians, and associated matters.
  thereof, including evidence of current advanced level
national certification by a certifying body that meets standards
established and approved by the board.  
   (b) The board shall create and appoint a Nurse-Midwifery Advisory
Council consisting of certified nurse-midwives in good standing with
experience in hospital and nonhospital practice settings, a
nurse-midwife educator who has demonstrated familiarity with consumer
needs, collegial practice and accompanied liability, and related
educational standards in the delivery of maternal-child health care,
and a consumer of midwifery care. The council shall make
recommendations to the board on all matters related to
nurse-midwifery practice, education, and other matters as specified
by the board. The council shall meet regularly, but at least twice a
year. 
  SEC. 3.  Section 2746.5 of the Business and Professions Code is
amended to read:
   2746.5.  (a) The certificate to practice nurse-midwifery
authorizes the  holder, under the supervision of a licensed
physician and surgeon, to attend cases of normal childbirth and to
provide prenatal, intrapartum, and postpartum care, including
family-planning care, for the mother, and immediate care for the
newborn.   holder to manage a full range of primary
health care services for women from adolescence to beyond menopause.
These services include, but are not limited to, primary health care,
gynecologic and family planning services, preconception care, care
during pregnancy, childbirth, and the postpartum period, immediate
care of   the newborn, and treatment of male partners for
sexually transmitted infections. A certified nurse-midwife is
authorized to practice in all settings, including, but not limited
to, private practice, clinics, hospitals, birth centers, and homes.

   (b) As used in this chapter, the practice of nurse-midwifery
 constitutes the furthering or undertaking by any certified
person, under the supervision of a licensed physician and surgeon who
has current practice or training in obstetrics, to assist a woman in
childbirth so long as progress meets criteria accepted as normal.
All complications shall be referred to a physician immediately. The
practice of nurse-midwifery does not include the assisting of
childbirth by any artificial, forcible, or mechanical means, nor the
performance of any version.   within a health care
system provides for consultation, collaboration, or referral as
indicated by the health status of the patient and the resources and
medical personnel available in the setting of care. When providing
peripartum care in out-of-hospital settings, the certified
nurse-midwife shall only provide care to low-risk women with
uncomplicated singleton-term pregnancies who are expected to ha 
 ve an uncomplicated birth. The practice of nurse-midwifery care
emphasizes informed consent, preventive care, and early detection
and referral of complications to physicians and surgeons. While
practicing in a hospital setting, the certified nurse-midwife shall
collaboratively care for women with more complex health needs. 

   (c) As used in this article, "supervision" shall not be construed
to require the physical presence of the supervising physician.
 
   (d) 
    (c)  A certified nurse-midwife is not authorized to
practice medicine and surgery by the provisions of this chapter.

   (e) 
    (d)  Any regulations promulgated by a state department
that affect the scope of practice of a certified nurse-midwife shall
be developed in consultation with the board.
  SEC. 4.  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 
 the  drugs or devices are furnished or ordered 
incidentally   related  to the provision of any of
the following: 
   (A) 
    (1)  Family planning services, as defined in Section
14503 of the Welfare and Institutions Code. 
   (B) 
    (2)  Routine health care or perinatal care, as defined
in subdivision (d) of Section 123485 of the Health and Safety Code.

   (C) 
    (3)  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 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. 
   (4) Care rendered in a home pursuant to subdivision (a) of Section
2746.5.  
   (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 physician and surgeon shall supervise
more than four 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) 
    (3)  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 
 when 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:   patient.  
   (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   a 
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. 
   (f) A certified nurse-midwife is authorized to directly procure
supplies and devices, to order, obtain, and administer drugs and
diagnostic tests, to order laboratory and diagnostic testing, and to
receive reports that are necessary to his or her practice as a
certified nurse-midwife and consistent with nurse-midwifery education
preparation. 
  SEC. 5.  Section 2746.52 of the Business and Professions Code is
amended to read:
   2746.52.   (a)    Notwithstanding Section
2746.5, the certificate to practice nurse-midwifery authorizes the
holder to perform and repair episiotomies, and to repair first-degree
and second-degree lacerations of the perineum, in a licensed acute
care hospital, as defined in subdivision (a) of Section 1250 of the
Health and Safety Code,  and   in  a
licensed alternate birth center, as defined in paragraph (4) of
subdivision (b) of Section 1204 of the Health and Safety Code,
 but only if all of the following conditions are met:
  and in a home pursuant to subdivision (a) of Section
2746.5.  
   (a) The supervising physician and surgeon and any backup physician
and surgeon is credentialed to perform obstetrical care in the
facility.  
   (b) The episiotomies are performed pursuant to protocols developed
and approved by all of the following:  
   (1) The supervising physician and surgeon.  
   (2) The certified nurse-midwife.  
   (3) The director of the obstetrics department or the director of
the family practice department, or both, if a physician and surgeon
in the obstetrics department or the family practice department is a
supervising physician and surgeon, or an equivalent person if there
is no specifically identified obstetrics department or family
practice department.  
   (4) The interdisciplinary practices committee, if applicable.
 
   (5) The facility administrator or his or her designee. 

   (c) 
    (b)  The  protocols, and the procedures which
shall be developed pursuant to the protocols, shall relate to the
performance and repair of episiotomies and the repair of 
 certified nurse-midwife performing and repairing 
first-degree and second-degree lacerations of the  perineum,
and   perineum  shall do  all 
 both  of the following:
   (1) Ensure that all complications are referred to a physician and
surgeon immediately.
   (2) Ensure immediate care of patients who are in need of care
beyond the scope of practice of the certified nurse midwife, or 
provide  emergency care for times when  the supervising
  a  physician and surgeon is not  on the
premises.   available.  
   (3) Establish the number of certified nurse-midwives that a
supervising physician and surgeon may supervise. 
  SEC. 6.  Section 2746.6 is added to the Business and Professions
Code, to read:
   2746.6.  A consultative relationship between a certified
nurse-midwife and a physician and surgeon shall not, by it self,
provide the basis for finding a physician and surgeon liable for any
act or omission of the certified nurse-midwife.
  SEC. 7.  Section 4061 of the Business and Professions Code is
amended to read:
   4061.  (a)  No   A  manufacturer's sales
representative shall  not  distribute any dangerous drug or
dangerous device as a complimentary sample without the written
request of a physician, dentist, podiatrist, optometrist,
veterinarian, or naturopathic doctor pursuant to Section 3640.7.
However, a certified nurse-midwife who functions pursuant to 
a standardized procedure or protocol described in  Section
2746.51, a nurse practitioner who functions pursuant to a
standardized procedure described in Section 2836.1, or protocol, a
physician assistant who functions pursuant to a protocol described in
Section 3502.1, or a naturopathic doctor who functions pursuant to a
standardized procedure or protocol described in Section 3640.5, may
sign for the request and receipt of complimentary samples of a
dangerous drug or dangerous device that has been identified in the
standardized procedure, protocol, or practice agreement. Standardized
procedures, protocols, and practice agreements shall include
specific approval by a physician. A review process, consistent with
the requirements of Section 2725, 3502.1, or 3640.5, of the
complimentary samples requested and received by a nurse practitioner,
certified nurse-midwife, physician assistant, or naturopathic
doctor, shall be defined within the standardized procedure, protocol,
or practice agreement.
   (b) Each written request shall contain the names and addresses of
the supplier and the requester, the name and quantity of the specific
dangerous drug desired, the name of the certified nurse-midwife,
nurse practitioner, physician assistant, or naturopathic doctor, if
applicable, receiving the samples pursuant to this section, the date
of receipt, and the name and quantity of the dangerous drugs or
dangerous devices provided. These records shall be preserved by the
supplier with the records required by Section 4059.
   (c) Nothing in this section is intended to expand the scope of
practice of a certified nurse-midwife, nurse practitioner, physician
assistant, or naturopathic doctor.
  SEC. 8.  Section 4076 of the Business and Professions Code is
amended to read:
   4076.  (a) A pharmacist shall not dispense any prescription except
in a container that meets the requirements of state and federal law
and is correctly labeled with all of the following:
   (1) Except when the prescriber or the certified nurse-midwife who
functions pursuant to  a standardized procedure or protocol
described in  Section 2746.51, the nurse practitioner who
functions pursuant to a standardized procedure described in Section
2836.1 or protocol, the physician assistant who functions pursuant to
Section 3502.1, the naturopathic doctor who functions pursuant to a
standardized procedure or protocol described in Section 3640.5, or
the pharmacist who functions pursuant to a policy, procedure, or
protocol pursuant to Section 4052.1, 4052.2, or 4052.6 orders
otherwise, either the manufacturer's trade name of the drug or the
generic name and the name of the manufacturer. Commonly used
abbreviations may be used. Preparations containing two or more active
ingredients may be identified by the manufacturer's trade name or
the commonly used name or the principal active ingredients.
   (2) The directions for the use of the drug.
   (3) The name of the patient or patients.
   (4) The name of the prescriber or, if applicable, the name of the
certified nurse-midwife who functions pursuant to  a
standardized procedure or protocol described in  Section
2746.51, the nurse practitioner who functions pursuant to a
standardized procedure described in Section 2836.1 or protocol, the
physician assistant who functions pursuant to Section 3502.1, the
naturopathic doctor who functions pursuant to a standardized
procedure or protocol described in Section 3640.5, or the pharmacist
who functions pursuant to a policy, procedure, or protocol pursuant
to Section 4052.1, 4052.2, or 4052.6.
   (5) The date of issue.
   (6) The name and address of the pharmacy, and prescription number
or other means of identifying the prescription.
   (7) The strength of the drug or drugs dispensed.
   (8) The quantity of the drug or drugs dispensed.
   (9) The expiration date of the effectiveness of the drug
dispensed.
   (10) The condition or purpose for which the drug was prescribed if
the condition or purpose is indicated on the prescription.
   (11) (A) Commencing January 1, 2006, the physical description of
the dispensed medication, including its color, shape, and any
identification code that appears on the tablets or capsules, except
as follows:
   (i) Prescriptions dispensed by a veterinarian.
   (ii) An exemption from the requirements of this paragraph shall be
granted to a new drug for the first 120 days that the drug is on the
market and for the 90 days during which the national reference file
has no description on file.
   (iii) Dispensed medications for which no physical description
exists in any commercially available database.
   (B) This paragraph applies to outpatient pharmacies only.
   (C) The information required by this paragraph may be printed on
an auxiliary label that is affixed to the prescription container.
   (D) This paragraph shall not become operative if the board, prior
to January 1, 2006, adopts regulations that mandate the same labeling
requirements set forth in this paragraph.
   (b) If a pharmacist dispenses a prescribed drug by means of a unit
dose medication system, as defined by administrative regulation, for
a patient in a skilled nursing, intermediate care, or other health
care facility, the requirements of this section will be satisfied if
the unit dose medication system contains the aforementioned
information or the information is otherwise readily available at the
time of drug administration.
   (c) If a pharmacist dispenses a dangerous drug or device in a
facility licensed pursuant to Section 1250 of the Health and Safety
Code, it is not necessary to include on individual unit dose
containers for a specific patient, the name of the certified
nurse-midwife who functions pursuant to  a standardized
procedure or protocol described in  Section 2746.51, the
nurse practitioner who functions pursuant to a standardized procedure
described in Section 2836.1 or protocol, the physician assistant who
functions pursuant to Section 3502.1, the naturopathic doctor who
functions pursuant to a standardized procedure or protocol described
in Section 3640.5, or the pharmacist who functions pursuant to a
policy, procedure, or protocol pursuant to Section 4052.1, 4052.2, or
4052.6.
   (d) If a pharmacist dispenses a prescription drug for use in a
facility licensed pursuant to Section 1250 of the Health and Safety
Code, it is not necessary to include the information required in
paragraph (11) of subdivision (a) when the prescription drug is
administered to a patient by a person licensed under the Medical
Practice Act (Chapter 5 (commencing with Section 2000)), the Nursing
Practice Act (Chapter 6 (commencing with Section 2700)), or the
Vocational Nursing Practice Act (Chapter 6.5 (commencing with Section
2840)), who is acting within his or her scope of practice.
  SEC. 9.  Section 4170 of the Business and Professions Code is
amended to read:
   4170.  (a)  No   A  prescriber shall
 not  dispense drugs or dangerous devices to patients in his
or her office or place of practice unless all of the following
conditions are met:
   (1) The dangerous drugs or dangerous devices are dispensed to the
prescriber's own patient, and the drugs or dangerous devices are not
furnished by a nurse or physician attendant.
   (2) The dangerous drugs or dangerous devices are necessary in the
treatment of the condition for which the prescriber is attending the
patient.
   (3) The prescriber does not keep a pharmacy, open shop, or
drugstore, advertised or otherwise, for the retailing of dangerous
drugs, dangerous devices, or poisons.
   (4) The prescriber fulfills all of the labeling requirements
imposed upon pharmacists by Section 4076, all of the recordkeeping
requirements of this chapter, and all of the packaging requirements
of good pharmaceutical practice, including the use of childproof
containers.
                                                      (5) The
prescriber does not use a dispensing device unless he or she
personally owns the device and the contents of the device, and
personally dispenses the dangerous drugs or dangerous devices to the
patient packaged, labeled, and recorded in accordance with paragraph
(4).
   (6) The prescriber, prior to dispensing, offers to give a written
prescription to the patient that the patient may elect to have filled
by the prescriber or by any pharmacy.
   (7) The prescriber provides the patient with written disclosure
that the patient has a choice between obtaining the prescription from
the dispensing prescriber or obtaining the prescription at a
pharmacy of the patient's choice.
   (8) A certified nurse-midwife who functions pursuant to  a
standardized procedure or protocol described in  Section
2746.51, a nurse practitioner who functions pursuant to a
standardized procedure described in Section 2836.1, or protocol, a
physician assistant who functions pursuant to Section 3502.1, or a
naturopathic doctor who functions pursuant to Section 3640.5, may
hand to a patient of the supervising physician and surgeon a properly
labeled prescription drug prepackaged by a physician and surgeon, a
manufacturer as defined in this chapter, or a pharmacist.
   (b) The Medical Board of California, the State Board of Optometry,
the Bureau of Naturopathic Medicine, the Dental Board of California,
the Osteopathic Medical Board of California, the Board of Registered
Nursing, the Veterinary Medical Board, and the Physician Assistant
Committee shall have authority with the California State Board of
Pharmacy to ensure compliance with this section, and those boards are
specifically charged with the enforcement of this chapter with
respect to their respective licensees.
   (c) "Prescriber," as used in this section, means a person, who
holds a physician's and surgeon's certificate, a license to practice
optometry, a license to practice naturopathic medicine, a license to
practice dentistry, a license to practice veterinary medicine, or a
certificate to practice podiatry, and who is duly registered by the
Medical Board of California, the State Board of Optometry, the Bureau
of Naturopathic Medicine, the Dental Board of California, the
Veterinary Medical Board, or the Board of Osteopathic Examiners of
this state.
  SEC. 10.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.