Bill Text: CA SB1246 | 2009-2010 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Naturopathic medicine.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2010-09-29 - Chaptered by Secretary of State. Chapter 523, Statutes of 2010. [SB1246 Detail]
Download: California-2009-SB1246-Amended.html
Bill Title: Naturopathic medicine.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2010-09-29 - Chaptered by Secretary of State. Chapter 523, Statutes of 2010. [SB1246 Detail]
Download: California-2009-SB1246-Amended.html
BILL NUMBER: SB 1246 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 5, 2010
INTRODUCED BY Senator Negrete McLeod
FEBRUARY 19, 2010
An act to amend Sections 1206.5, 1209, and 3613 of, and to add
Sections 3640.2 and 3640.3 to, the Business and Professions Code,
relating to naturopathic medicine.
LEGISLATIVE COUNSEL'S DIGEST
SB 1246, as amended, Negrete McLeod. Naturopathic medicine.
Existing law provides for the regulation and licensure of clinical
laboratories and clinical laboratory personnel by the State
Department of Health Care Services. Existing law prohibits the
performance of a clinical laboratory test or examination classified
as waived under the federal Clinical Laboratory Improvement
Amendments of 1988 unless the test or examination is performed under
the overall operation and administration of a laboratory director, as
defined, and is performed by specified persons, including certain
health care personnel. Existing law, the Naturopathic Doctors Act,
provides for the regulation and licensure of naturopathic doctors by
the Naturopathic Medicine Committee.
This bill would expand the category of persons who may perform
clinical laboratory tests or examinations that are classified as
waived to include licensed naturopathic doctors if the results of the
tests can be lawfully utilized within their practice, and would
provide that a laboratory director includes a naturopathic doctor, as
specified for purposes of waived examinations. The bill would define
a naturopathic medical assistant for purposes of
the Naturopathic Doctors Act, would authorize those assistants to
perform certain medical procedures under the supervision of a
naturopathic doctor, and would also authorize those assistants to
perform specified naturopathic technical support services
, and additional technical support services under
regulations and standards established by the Naturopathic Medicine
Committee. The bill would prohibit a naturopathic
assistant from being employed for inpatient care in a licensed
general acute care hospital.
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 1206.5 of the Business and Professions Code is
amended to read:
1206.5. (a) Notwithstanding subdivision (b) of Section 1206 and
except as otherwise provided in Section 1241, no person shall perform
a clinical laboratory test or examination classified as waived under
CLIA unless the clinical laboratory test or examination is performed
under the overall operation and administration of the laboratory
director, as described in Section 1209, including, but not limited
to, documentation by the laboratory director of the adequacy of the
qualifications and competency of the personnel, and the test is
performed by any of the following persons:
(1) A licensed physician and surgeon holding a M.D. or D.O.
degree.
(2) A licensed podiatrist, a licensed dentist, or a licensed
naturopathic doctor, if the results of the tests can be lawfully
utilized within his or her practice.
(3) A person licensed under this chapter to engage in clinical
laboratory practice or to direct a clinical laboratory.
(4) A person authorized to perform tests pursuant to a certificate
issued under Article 5 (commencing with Section 101150) of Chapter 2
of Part 3 of Division 101 of the Health and Safety Code.
(5) A licensed physician assistant if authorized by a supervising
physician and surgeon in accordance with Section 3502 or
Section 3535.
(6) A person licensed under Chapter 6 (commencing with Section
2700).
(7) A person licensed under Chapter 6.5 (commencing with Section
2840).
(8) A perfusionist if authorized by and performed in compliance
with Section 2590.
(9) A respiratory care practitioner if authorized by and performed
in compliance with Chapter 8.3 (commencing with Section 3700).
(10) A medical assistant, as defined in Section 2069, if the
waived test is performed pursuant to a specific authorization meeting
the requirements of Section 2069.
(11) A pharmacist, as defined in Section 4036, if ordering drug
therapy-related laboratory tests in compliance with clause (ii) of
subparagraph (A) of paragraph (5) of, or subparagraph (B) of
paragraph (4) of, subdivision (a) of Section 4052, or if performing
skin puncture in the course of performing routine patient assessment
procedures in compliance with Section 4052.1.
(12) Other health care personnel providing direct patient care.
(13) Any other person performing nondiagnostic testing pursuant to
Section 1244.
(b) Notwithstanding subdivision (b) of Section 1206, no person
shall perform clinical laboratory tests or examinations classified as
of moderate complexity under CLIA unless the clinical laboratory
test or examination is performed under the overall operation and
administration of the laboratory director, as described in Section
1209, including, but not limited to, documentation by the laboratory
director of the adequacy of the qualifications and competency of the
personnel, and the test is performed by any of the following persons:
(1) A licensed physician and surgeon holding a M.D. or D.O.
degree.
(2) A licensed podiatrist or a licensed dentist if the results of
the tests can be lawfully utilized within his or her practice.
(3) A person licensed under this chapter to engage in clinical
laboratory practice or to direct a clinical laboratory.
(4) A person authorized to perform tests pursuant to a certificate
issued under Article 5 (commencing with Section 101150) of Chapter 2
of Part 3 of Division 101 of the Health and Safety Code.
(5) A licensed physician assistant if authorized by a supervising
physician and surgeon in accordance with Section 3502 or
Section 3535.
(6) A person licensed under Chapter 6 (commencing with Section
2700).
(7) A perfusionist if authorized by and performed in compliance
with Section 2590.
(8) A respiratory care practitioner if authorized by and performed
in compliance with Chapter 8.3 (commencing with Section 3700).
(9) A person performing nuclear medicine technology if authorized
by and performed in compliance with Article 6 (commencing with
Section 107150) of Chapter 4 of Part 1 of Division 104 of the Health
and Safety Code.
(10) Any person if performing blood gas analysis in compliance
with Section 1245.
(11) A naturopathic assistant, as defined in Sections 3613 and
3640.2, if the waived test is performed pursuant to a specific
authorization meeting the requirements of Sections 3613 and 3640.2.
(11)
(12) (A) A person certified or licensed as an
"Emergency Medical Technician II" or paramedic pursuant to Division
2.5 (commencing with Section 1797) of the Health and Safety Code
while providing prehospital medical care, a person licensed as a
psychiatric technician under Chapter 10 (commencing with Section
4500) of Division 2, as a vocational nurse pursuant to Chapter 6.5
(commencing with Section 2840), or as a midwife licensed pursuant to
Article 24 (commencing with Section 2505) of Chapter 5, or certified
by the department pursuant to Division 5 (commencing with Section
70001) of Title 22 of the California Code of Regulations as a nurse
assistant or a home health aide, who provides direct patient care, if
the person is performing the test as an adjunct to the provision of
direct patient care by the person, is utilizing a point-of-care
laboratory testing device at a site for which a laboratory license or
registration has been issued, meets the minimum clinical laboratory
education, training, and experience requirements set forth in
regulations adopted by the department, and has demonstrated to the
satisfaction of the laboratory director that he or she is competent
in the operation of the point-of-care laboratory testing device for
each analyte to be reported.
(B) Prior to being authorized by the laboratory director to
perform laboratory tests or examinations, testing personnel
identified in subparagraph (A) shall participate in a preceptor
program until they are able to perform the clinical laboratory tests
or examinations authorized in this section with results that are
deemed accurate and skills that are deemed competent by the
preceptor. For the purposes of this section, a "preceptor program"
means an organized system that meets regulatory requirements in which
a preceptor provides and documents personal observation and critical
evaluation, including review of accuracy, reliability, and validity,
of laboratory testing performed.
(12)
(13) Any other person within a physician office
laboratory if the test is performed under the supervision of the
patient's physician and surgeon or podiatrist who shall be accessible
to the laboratory to provide onsite, telephone, or electronic
consultation as needed, and shall: (A) ensure that the person is
performing test methods as required for accurate and reliable tests;
and (B) have personal knowledge of the results of the clinical
laboratory testing or examination performed by that person before the
test results are reported from the laboratory.
(13)
(14) A pharmacist, if ordering drug therapy-related
laboratory tests in compliance with clause (ii) of subparagraph (A)
of paragraph (5) of, or subparagraph (B) of paragraph (4) of,
subdivision (a) of Section 4052.
(c) Notwithstanding subdivision (b) of Section 1206, no person
shall perform clinical laboratory tests or examinations classified as
of high complexity under CLIA unless the clinical laboratory test or
examination is performed under the overall operation and
administration of the laboratory director, as described in Section
1209, including, but not limited to, documentation by the laboratory
director of the adequacy of the qualifications and competency of the
personnel, and the test is performed by any of the following persons:
(1) A licensed physician and surgeon holding a M.D. or D.O.
degree.
(2) A licensed podiatrist or a licensed dentist if the results of
the tests can be lawfully utilized within his or her practice.
(3) A person licensed under this chapter to engage in clinical
laboratory practice or to direct a clinical laboratory if the test or
examination is within a specialty or subspecialty authorized by the
person's licensure.
(4) A person authorized to perform tests pursuant to a certificate
issued under Article 5 (commencing with Section 101150) of Chapter 2
of Part 3 of Division 101 of the Health and Safety Code if the test
or examination is within a specialty or subspecialty authorized by
the person's certification.
(5) A licensed physician assistant if authorized by a supervising
physician and surgeon in accordance with Section 3502 or
Section 3535.
(6) A perfusionist if authorized by and performed in compliance
with Section 2590.
(7) A respiratory care practitioner if authorized by and performed
in compliance with Chapter 8.3 (commencing with Section 3700).
(8) A person performing nuclear medicine technology if authorized
by and performed in compliance with Article 6 (commencing with
Section 107150) of Chapter 4 of Part 1 of Division 104 of the Health
and Safety Code.
(9) Any person if performing blood gas analysis in compliance with
Section 1245.
(10) Any other person within a physician office laboratory if the
test is performed under the onsite supervision of the patient's
physician and surgeon or podiatrist who shall: (A) ensure that the
person is performing test methods as required for accurate and
reliable tests; and (B) have personal knowledge of the results of
clinical laboratory testing or examination performed by that person
before the test results are reported from the laboratory.
(d) Clinical laboratory examinations classified as
provider-performed microscopy under CLIA may be personally performed
using a brightfield or phase/contrast microscope by one of the
following practitioners:
(1) A licensed physician and surgeon using the microscope during
the patient's visit on a specimen obtained from his or her own
patient or from a patient of a group medical practice of which the
physician is a member or employee.
(2) A nurse midwife holding a certificate as specified by Section
2746.5, a licensed nurse practitioner as specified in Section 2835.5,
or a licensed physician assistant acting under the supervision of a
physician pursuant to Section 3502 using the microscope during the
patient's visit on a specimen obtained from his or her own patient or
from the patient of a clinic, group medical practice, or other
health care provider of which the certified nurse midwife, licensed
nurse practitioner, or licensed physician assistant is an employee.
(3) A licensed dentist using the microscope during the patient's
visit on a specimen obtained from his or her own patient or from a
patient of a group dental practice of which the dentist is a member
or an employee.
SEC. 2. Section 1209 of the Business and
Professions Code is amended to read:
1209. (a) As used in this chapter, "laboratory director" means
any person who is a duly licensed physician and surgeon, or only for
purposes of a clinical licensing test or examination classified as
waived, is a duly licensed naturopathic doctor, or is licensed to
direct a clinical laboratory under this chapter and who substantially
meets the laboratory director qualifications under CLIA for the type
and complexity of tests being offered by the laboratory. The
laboratory director, if qualified under CLIA, may perform the duties
of the technical consultant, technical supervisor, clinical
consultant, general supervisor, and testing personnel, or delegate
these responsibilities to persons qualified under CLIA. If the
laboratory director reapportions performance of those
responsibilities or duties, he or she shall remain responsible for
ensuring that all those duties and responsibilities are properly
performed.
(b) (1) The laboratory director is responsible for the overall
operation and administration of the clinical laboratory, including
administering the technical and scientific operation of a clinical
laboratory, the selection and supervision of procedures, the
reporting of results, and active participation in its operations to
the extent necessary to assure compliance with this act and CLIA. He
or she shall be responsible for the proper performance of all
laboratory work of all subordinates and shall employ a sufficient
number of laboratory personnel with the appropriate education and
either experience or training to provide appropriate consultation,
properly supervise and accurately perform tests, and report test
results in accordance with the personnel qualifications, duties, and
responsibilities described in CLIA and this chapter.
(2) Where a point-of-care laboratory testing device is utilized
and provides results for more than one analyte, the testing personnel
may perform and report the results of all tests ordered for each
analyte for which he or she has been found by the laboratory director
to be competent to perform and report.
(c) As part of the overall operation and administration, the
laboratory director of a registered laboratory shall document the
adequacy of the qualifications (educational background, training, and
experience) of the personnel directing and supervising the
laboratory and performing the laboratory test procedures and
examinations. In determining the adequacy of qualifications, the
laboratory director shall comply with any regulations adopted by the
department that specify the minimum qualifications for personnel, in
addition to any CLIA requirements relative to the education or
training of personnel.
(d) As part of the overall operation and administration, the
laboratory director of a licensed laboratory shall do all of the
following:
(1) Ensure that all personnel, prior to testing biological
specimens, have the appropriate education and experience, receive the
appropriate training for the type and complexity of the services
offered, and have demonstrated that they can perform all testing
operations reliably to provide and report accurate results. In
determining the adequacy of qualifications, the laboratory director
shall comply with any regulations adopted by the department that
specify the minimum qualifications for, and the type of procedures
that may be performed by, personnel in addition to any CLIA
requirements relative to the education or training of personnel. Any
regulations adopted pursuant to this section that specify the type of
procedure that may be performed by testing personnel shall be based
on the skills, knowledge, and tasks required to perform the type of
procedure in question.
(2) Ensure that policies and procedures are established for
monitoring individuals who conduct preanalytical, analytical, and
postanalytical phases of testing to assure that they are competent
and maintain their competency to process biological specimens,
perform test procedures, and report test results promptly and
proficiently, and, whenever necessary, identify needs for remedial
training or continuing education to improve skills.
(3) Specify in writing the responsibilities and duties of each
individual engaged in the performance of the preanalytic, analytic,
and postanalytic phases of clinical laboratory tests or examinations,
including which clinical laboratory tests or examinations the
individual is authorized to perform, whether supervision is required
for the individual to perform specimen processing, test performance,
or results reporting, and whether consultant, supervisor, or director
review is required prior to the individual reporting patient test
results.
(e) The competency and performance of staff of a licensed
laboratory shall be evaluated and documented by the laboratory
director, or by a person who qualifies as a technical consultant or a
technical supervisor under CLIA depending on the type and complexity
of tests being offered by the laboratory.
(1) The procedures for evaluating the competency of the staff
shall include, but are not limited to, all of the following:
(A) Direct observations of routine patient test performance,
including patient preparation, if applicable, and specimen handling,
processing, and testing.
(B) Monitoring the recording and reporting of test results.
(C) Review of intermediate test results or worksheets, quality
control records, proficiency testing results, and preventive
maintenance records.
(D) Direct observation of performance of instrument maintenance
and function checks.
(E) Assessment of test performance through testing previously
analyzed specimens, internal blind testing samples, or external
proficiency testing samples.
(F) Assessment of problem solving skills.
(2) Evaluation and documentation of staff competency and
performance shall occur at least semiannually during the first year
an individual tests biological specimens. Thereafter, evaluations
shall be performed at least annually unless test methodology or
instrumentation changes, in which case, prior to reporting patient
test results, the individual's performance shall be reevaluated to
include the use of the new test methodology or instrumentation.
(f) The laboratory director of each clinical laboratory of an
acute care hospital shall be a physician and surgeon who is a
qualified pathologist, except as follows:
(1) If a qualified pathologist is not available, a physician and
surgeon or a clinical laboratory bioanalyst qualified as a laboratory
director under subdivision (a) may direct the laboratory. However, a
qualified pathologist shall be available for consultation at
suitable intervals to ensure high quality service.
(2) If there are two or more clinical laboratories of an acute
care hospital, those additional clinical laboratories that are
limited to the performance of blood gas analysis, blood electrolyte
analysis, or both may be directed by a physician and surgeon
qualified as a laboratory director under subdivision (a),
irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a
physician and surgeon certified or eligible for certification in
clinical or anatomical pathology by the American Board of Pathology
or the American Osteopathic Board of Pathology.
(g) Subdivision (f) does not apply to any director of a clinical
laboratory of an acute care hospital acting in that capacity on or
before January 1, 1988.
SEC. 2. Section 1209 of the Business
and Professions Code is amended to read:
1209. (a) As used in this chapter, "laboratory director" means
any person who is a duly licensed physician and surgeon, or,
only for purposes of a clinical licensing test or examination
classified as waived, is a duly licensed naturopathic doctor,
or is licensed to direct a clinical laboratory under this chapter and
who substantially meets the laboratory director qualifications under
CLIA for the type and complexity of tests being offered by the
laboratory. The laboratory director, if qualified under CLIA, may
perform the duties of the technical consultant, technical supervisor,
clinical consultant, general supervisor, and testing personnel, or
delegate these responsibilities to persons qualified under CLIA. If
the laboratory director reapportions performance of those
responsibilities or duties, he or she shall remain responsible for
ensuring that all those duties and responsibilities are properly
performed.
(b) (1) The laboratory director is responsible for the overall
operation and administration of the clinical laboratory, including
administering the technical and scientific operation of a clinical
laboratory, the selection and supervision of procedures, the
reporting of results, and active participation in its operations to
the extent necessary to ensure compliance with this act and CLIA. He
or she shall be responsible for the proper performance of all
laboratory work of all subordinates and shall employ a sufficient
number of laboratory personnel with the appropriate education and
either experience or training to provide appropriate consultation,
properly supervise and accurately perform tests, and report test
results in accordance with the personnel qualifications, duties, and
responsibilities described in CLIA and this chapter.
(2) Where a point-of-care laboratory testing device is utilized
and provides results for more than one analyte, the testing personnel
may perform and report the results of all tests ordered for each
analyte for which he or she has been found by the laboratory director
to be competent to perform and report.
(c) As part of the overall operation and administration, the
laboratory director of a registered laboratory shall document the
adequacy of the qualifications (educational background, training, and
experience) of the personnel directing and supervising the
laboratory and performing the laboratory test procedures and
examinations. In determining the adequacy of qualifications, the
laboratory director shall comply with any regulations adopted by the
department that specify the minimum qualifications for personnel, in
addition to any CLIA requirements relative to the education or
training of personnel.
(d) As part of the overall operation and administration, the
laboratory director of a licensed laboratory shall do all of the
following:
(1) Ensure that all personnel, prior to testing biological
specimens, have the appropriate education and experience, receive the
appropriate training for the type and complexity of the services
offered, and have demonstrated that they can perform all testing
operations reliably to provide and report accurate results. In
determining the adequacy of qualifications, the laboratory director
shall comply with any regulations adopted by the department that
specify the minimum qualifications for, and the type of procedures
that may be performed by, personnel in addition to any CLIA
requirements relative to the education or training of personnel. Any
regulations adopted pursuant to this section that specify the type of
procedure that may be performed by testing personnel shall be based
on the skills, knowledge, and tasks required to perform the type of
procedure in question.
(2) Ensure that policies and procedures are established for
monitoring individuals who conduct preanalytical, analytical, and
postanalytical phases of testing to ensure that they are competent
and maintain their competency to process biological specimens,
perform test procedures, and report test results promptly and
proficiently, and, whenever necessary, identify needs for remedial
training or continuing education to improve skills.
(3) Specify in writing the responsibilities and duties of each
individual engaged in the performance of the preanalytic, analytic,
and postanalytic phases of clinical laboratory tests or examinations,
including which clinical laboratory tests or examinations the
individual is authorized to perform, whether supervision is required
for the individual to perform specimen processing, test performance,
or results reporting, and whether consultant, supervisor, or director
review is required prior to the individual reporting patient test
results.
(e) The competency and performance of staff of a licensed
laboratory shall be evaluated and documented by the laboratory
director, or by a person who qualifies as a technical consultant or a
technical supervisor under CLIA depending on the type and complexity
of tests being offered by the laboratory.
(1) The procedures for evaluating the competency of the staff
shall include, but are not limited to, all of the following:
(A) Direct observations of routine patient test performance,
including patient preparation, if applicable, and specimen handling,
processing, and testing.
(B) Monitoring the recording and reporting of test results.
(C) Review of intermediate test results or worksheets, quality
control records, proficiency testing results, and preventive
maintenance records.
(D) Direct observation of performance of instrument maintenance
and function checks.
(E) Assessment of test performance through testing previously
analyzed specimens, internal blind testing samples, or external
proficiency testing samples.
(F) Assessment of problem solving skills.
(2) Evaluation and documentation of staff competency and
performance shall occur at least semiannually during the first year
an individual tests biological specimens. Thereafter, evaluations
shall be performed at least annually unless test methodology or
instrumentation changes, in which case, prior to reporting patient
test results, the individual's performance shall be reevaluated to
include the use of the new test methodology or instrumentation.
(f) The laboratory director of each clinical laboratory of an
acute care hospital shall be a physician and surgeon who is a
qualified pathologist, except as follows:
(1) If a qualified pathologist is not available, a physician and
surgeon or a clinical laboratory bioanalyst qualified as a laboratory
director under subdivision (a) may direct the laboratory. However, a
qualified pathologist shall be available for consultation at
suitable intervals to ensure high quality service.
(2) If there are two or more clinical laboratories of an acute
care hospital, those additional clinical laboratories that are
limited to the performance of blood gas analysis, blood electrolyte
analysis, or both , may be directed by a physician and
surgeon qualified as a laboratory director under subdivision (a),
irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a
physician and surgeon certified or eligible for certification in
clinical or anatomical
pathology by the American Board of Pathology or the American
Osteopathic Board of Pathology.
(g) Subdivision (f) does not apply to any director of a clinical
laboratory of an acute care hospital acting in that capacity on or
before January 1, 1988.
(h) A laboratory director may serve as the director of up to the
maximum number of laboratories stipulated by CLIA, as defined under
Section 1202.5.
SEC. 3. Section 3613 of the Business and Professions Code is
amended to read:
3613. The following definitions apply for the purposes of this
chapter:
(a) "Committee" means the Naturopathic Medicine Committee within
the Osteopathic Medical Board of California. Any reference in any law
or regulation to the Bureau of Naturopathic Medicine shall be deemed
to refer to the Naturopathic Medicine Committee within the
Osteopathic Medical Board of California.
(b) "Naturopathic childbirth attendance" means the specialty
practice of natural childbirth by a naturopathic doctor that includes
the management of normal pregnancy, normal labor and delivery, and
the normal postpartum period, including normal newborn care.
(c) "Naturopathic medicine" means a distinct and comprehensive
system of primary health care practiced by a naturopathic doctor for
the diagnosis, treatment, and prevention of human health conditions,
injuries, and disease.
(d) "Naturopathic doctor" means a person who holds an active
license issued pursuant to this chapter.
(e) "Naturopathy" means a noninvasive system of health practice
that employs natural health modalities, substances, and education to
promote health.
(f) "Drug" means any substance defined as a drug by Section 11014
of the Health and Safety Code.
(g) "Naturopathic medical assistant" means a
person who may be unlicensed, who performs basic administrative,
clerical, and naturopathic technical supportive
services in compliance with this chapter for a licensed
naturopathic doctor or naturopathic corporation and who is
in compliance with the age, educational, and licensing requirements
of a medical assistant set forth in Sections 2069 and 2070.
at least 18 years of age, and who has had at least the minimum
amount of hours of appropriate training pursuant to standards
established by the Medical Board of California for a medical
assistant pursuant to Section 2069. The naturopathic assistant shall
be issued a certificate by the training institution or instructor
indicating satisfactory completion of the required
training. A copy of the certificate shall be retained as a record by
each employer or the naturopathic assistant.
(h) "Naturopathic technical supportive services" means simple
routine medical tasks and procedures that may be safely performed by
a naturopathic medical assistant who has limited
training and who functions under the supervision of a licensed
naturopathic doctor.
(i) "Specific authorization" means a specific written order
prepared by the supervising naturopathic doctor authorizing the
procedures to be performed on a patient, which shall be placed in the
patient's medical record, or a standing order prepared by the
supervising naturopathic doctor authorizing the procedures to be
performed. A notation of the standing order shall be placed on the
patient's medical record.
(j) "Supervision" means the supervision of procedures ,
performed by naturopathic medical assistants practicing within their
scope of practice, that are authorized by a naturopathic doctor
authorized under this section or Section 3640.2 by a
naturopathic doctor, within his or her scope of practice , who
is physically present in the treatment facility during the
performance of those procedures.
SEC. 4. Section 3640.2 is added to the Business and Professions
Code, to read:
3640.2. Notwithstanding any other provision of law, a
naturopathic medical assistant may do all of the
following:
(a) Administer medication only by intradermal, subcutaneous, or
intramuscular injections and perform skin tests and additional
technical support services upon the specific authorization and
supervision of a licensed naturopathic doctor. A naturopathic
medical assistant may also perform all these tasks
and services in a clinic licensed pursuant to subdivision (a) of
Section 1204 of the Health and Safety Code upon the specific
authorization of a naturopathic doctor.
(b) Perform venipuncture or skin puncture for the purposes of
withdrawing blood upon specific authorization and under the
supervision of a licensed naturopathic doctor if prior thereto the
naturopathic medical assistant has met the
educational and training requirements for medical assistants as
established in Section 2070. A copy of any related certificates shall
be retained as a record by each employer of the medical
assistant.
(c) Perform the following naturopathic technical support services:
(1) Administer medications orally, sublingually, topically,
vaginally, or rectally, or by providing a single dose to a patient
for immediate self-administration. Administer medication by
inhalation if the medications are patient-specific and have been or
will be repetitively administered to the patient. In every instance,
prior to administration of medication by the naturopathic assistant,
the naturopathic doctor shall verify the correct medication and
dosage.
(2) Apply and remove bandages and dressings.
(3) Collect by noninvasive techniques and preserve specimens for
testing, including urine, sputum, semen, and stool.
(4) Assist patients in ambulation and transfers.
(5) As authorized by the naturopathic doctor, provide patient
information and instructions.
(6) Collect and record patient data, including height, weight,
temperature, pulse, respiration rate, and blood pressure, and basic
information about the presenting and previous conditions.
(7) Perform simple laboratory and screening tests customarily
performed in a medical office.
(c)
(d) Perform additional naturopathic technical support
services under the regulations and standards established by the
committee in consultation with the naturopathic formulary
advisory subcommittee. The scope of naturopathic technical support
services a naturopathic medical assistant shall be allowed to perform
under regulations established by the committee shall be no more
expansive than the scope of technical support services a medical
assistant is authorized to perform pursuant to the regulations and
standards established by the Division of Licensing except those
provisions related to limiting authorization and supervision to
licensed medical providers other than naturopathic doctors. All
regulations adopted by the committee shall clearly identify the
conditions and restrictions on authorization and supervision for
naturopathic medical assistants. committee. The
committee shall, prior to the adoption of any regulations, request
recommendations regarding these standards from appropriate public
agencies, including, but not limited to, the Medical Board of
California, the Board of Registered Nursing, the Board of Vocational
Nursing and Psychiatric Technicians of the State of California, the
Laboratory Field Services division of the State Department of Public
Health, and the Physical Therapy Examining Committee. The
Naturopathic Medicine Committee shall also request recommendations
regarding these standards from associations of medical assistants,
physicians, and others, as appropriate, including, but not limited
to, the California Medical Association, the California
Society of Medical Assistants, and the California Medical Assistants'
Association. Nothing in this subdivision shall be construed to
supersede or modify that portion of the Administrative Procedure Act
that relates to the procedure for the adoption of regulations set
forth in Article 5 (commencing with Section 11346) of Chapter 3.5 of
Part 1 of Division 3 of Title 2 of the Government Code.
SEC. 5. Section 3640.3 is added to the Business and Professions
Code, to read:
3640.3. (a) Nothing in this chapter shall be construed as
authorizing the licensure of naturopathic medical
assistants. Nothing in this chapter shall be construed as authorizing
the administration of local anesthetic agents by a naturopathic
medical assistant. Nothing in this chapter shall
be construed as authorizing naturopathic medical assistants
to diagnose. the Naturopathic Medicine Committee to
adopt any regulations that violate the prohibitions on
diagnosis or treatment in Section 2052.
(b) Nothing in this chapter shall be construed as authorizing a
naturopathic medical assistant to perform any
clinical laboratory test or examination for which he or she is not
authorized under Chapter 3 (commencing with Section 1200).
(c) Notwithstanding any other provision of law, a naturopathic
assistant may not be employed for inpatient care in a licensed
general acute care hospital as defined in subdivision (a) of Section
1250 of the Health and Safety Code.
