Today's Law As Amended


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SB-993 Psychologists: scope of practice: prescribing drugs.(2007-2008)



As Amends the Law Today


SECTION 1.
 The Legislature hereby finds and declares all of the following:
(a) In September 2006 the California Department of Corrections and Rehabilitation (CDCR) reported a systemwide vacancy rate for psychiatrists of 67 percent. In February 2007, the State Department of Mental Health reported a vacancy rate for psychiatrists of 40 percent.
(b) As a result of the severe shortages, patient care has been compromised and CDCR, with over 32,000 mentally ill patients, is in federal receivership. Further, there are several outstanding lawsuits against the State of California alleging that inmates and patients at state mental hospitals are not receiving constitutionally adequate mental health care due to the severe shortage of competent psychiatrists and state-employed psychiatrists’ salaries have been raised to nearly $300,000 annually.
(c) Busy nonpsychiatrist, primary care and other physicians, with little training in mental health, prescribe 80 percent of all psychotropic medications in patient visits that average 8 to 10 minutes with typical followup of months into the future for another brief appointment. A change in law is required so that prescribing psychologists are available to those patients who need more than a few minutes and a prescription from a primary care physician.
(d) According to the National Institute for Mental Health, one in four individuals suffers from a diagnosable mental illness in a given year, and one in 17 suffers from a severe mental illness.
(e) Families with members who have a serious mental illness would benefit by being free to choose, if desired, a psychologist with the comprehensive training to prescribe not only needed medication but also provide the additional treatments that are necessary to improve the mentally ill person’s quality of life, which the National Institute of Mental Health says is beyond what antipsychotic medications are able to do.
(f) Psychologists are authorized to prescribe medication in New Mexico, Louisiana, and the United States territory of Guam, and have written over 40,000 prescriptions with no deaths and no adverse outcomes.
(g) Psychologists with appropriate training and credentials have been prescribing medications to active duty personnel and their families in military facilities since 1991. These prescribing psychologists have consulted and treated over 160,000 patients with no deaths and no adverse outcomes.
(h) Research data soundly demonstrates that there is not enough mental health care available to serve the needs of all people in California due to the severe shortages of psychiatrists. According to the American Board of Medical Specialties Directory of Board Certified Medical Specialists, there are 11 California counties with no psychiatrist and an additional 17 California counties with five or fewer psychiatrists in residence.
(i) Since 2001 and 2002, psychologists in California have been allowed to discuss and recommend psychotropic medications to both patients and physicians. California psychologists routinely collaborate with primary care physicians to provide combined therapy and psychopharmacological care for their patients. Since 1978, California psychologists have held independent hospital privileges.
(j) The American Psychological Association has a model curriculum used by training programs around the country for the education and training of prescribing psychologists. In order to meet the increasing demands for services to mentally ill and disordered persons in California, it is the intent of the Legislature to grant prescriptive authority to California licensed psychologists who choose to receive the appropriate education and training.

SEC. 2.

 Section 2902 of the Business and Professions Code is amended to read:

2902.
 As used in this chapter, unless the context clearly requires otherwise and except as in this chapter expressly otherwise provided provided,  the following definitions apply:
(a) “Licensed psychologist” means an individual to whom a license has been issued pursuant to the provisions of this chapter, which license is in force and has not been suspended or revoked.
(b) “Board” means the Board of Psychology.
(c) A person represents himself or herself to be a psychologist when the person holds himself or herself out to the public by any title or description of services incorporating the words “psychology,” “psychological,” “psychologist,” “psychology consultation,” “psychology consultant,” “psychometry,” “psychometrics” or “psychometrist,” “psychotherapy,” “psychotherapist,” “psychoanalysis,” or “psychoanalyst,” or when the person holds himself or herself out to be trained, experienced, or an expert in the field of psychology.
(d) “Accredited,” as used with reference to academic institutions, means the University of California, the California State University, an institution that is accredited under Section 94712 of the Education Code,  or an institution that is located in another state and that is  accredited by a national or an applicable regional accrediting agency recognized by the United States Department of Education.
(e) “Approved,” as used with reference to academic institutions, means an institution having “approval to operate”, as defined in Section 94718 approved under Section 94800  of the Education Code.
(f) “Prescriptive authority” means the authority to prescribe, discontinue, order, administer or dispense without charge, drugs or controlled substances, excluding narcotics, recognized for, or customarily used in, the inpatient or outpatient diagnosis, treatment, or evaluation and management of individuals with psychiatric, mental, cognitive, nervous, emotional, addictive, developmental, or behavioral disorders, and to order or utilize other procedures, consultations, devices, and tests related thereto.
(g) “Health service provider” means a licensed psychologist who is duly trained and experienced in the delivery of preventive, assessment, diagnostic, and therapeutic intervention services relative to the psychological and physical health of consumers and who has done both of the following:
(1) Completed an internship and supervised experience in health care settings.
(2) Been licensed as a psychologist at the independent practice level.
(h) “Prescribing psychologist” means a health service provider who has received from the board, pursuant to Section 2949, a valid certificate granting prescriptive authority, and whose certificate has not been revoked or suspended.
(i) “Drug” has the same meaning as provided in Section 4025, and includes controlled substances and dangerous drugs, as defined in Sections 4021 and 4022, respectively.
(j) “Device” has the same meaning as provided in Section 4023, and includes dangerous devices, as defined in Section 4022.
(k) “Prescription” has the same meaning as provided in Sections 4040 and 4070.

SEC. 3.

 Section 2904 of the Business and Professions Code is amended to read:

2904.
 The practice of psychology shall not include prescribing drugs, performing surgery or administering electroconvulsive therapy. any of the following: 
(a) Prescribing drugs or devices, except for those prescribed by prescribing psychologists, as defined in Section 2902.
(b) Performing surgery.
(c) Administering electroconvulsive therapy.

SEC. 4.

 Section 2949 is added to the Business and Professions Code, to read:

2949.
 (a) The board shall establish and administer a certification process to grant licensed psychologists prescriptive authority. The board shall also develop a procedure for prescribing-psychologists-in-training to prescribe under the supervision and license of a qualified prescriber. The board shall develop procedures for the administration of an appropriate, valid, nationally recognized examination, such as the American Psychological Association Practice Organization’s College of Professional Psychology examination, approved by the board. The board shall charge applicants reasonable fees for the issuance of, and renewal of, a certificate in order to cover the costs of administering the certification process and the examination. These fees shall be deposited in the Psychology Fund.
(b) Each applicant for certification as a prescribing psychologist, as defined in subdivision (h) of Section 2902, shall show by official transcript or other official evidence satisfactory to the board that he or she has successfully completed both of the following:
(1) An organized and planned sequence of psychopharmacological training deemed by the board to be consistent with this chapter and with the American Psychological Association’s (APA) training guidelines for prescriptive authority in effect at the time the coursework was completed. The board may certify a psychologist from a federal or other state jurisdiction to practice as a prescribing psychologist if that jurisdiction has authorized the psychologist to prescribe and if the board determines that the psychologist has practiced with competence. Also, the board may certify a psychologist to practice as a prescribing psychologist if the psychologist has lawfully prescribed under another professional license that authorizes prescribing and the training and experience under the other license is consistent with the training standards required for a prescribing psychologist. Approved programs may give credit for required didactic science courses taken at other educational institutions that would meet the educational requirements of their program. Coursework shall be consistent with the most current APA training guidelines, and shall include education in all of the following subjects:
(A) Basic science, including anatomy, physiology, and biochemistry.
(B) Neurosciences, including neuroanatomy, neurophysiology, and neurochemistry.
(C) Physical assessment and laboratory examinations, including the following:
(i) Physical assessment.
(ii) Laboratory and radiological assessment.
(iii) Medical terminology and documentation.
(iv) Integration of the subjects in clauses (i) to (iii), inclusive, through supervised clinical experience or laboratory experience in conducting physical examinations, ordering psychometric and laboratory tests, and understanding results and interpretation.
(D) Clinical medicine and pathophysiology, including the following:
(i) Pathophysiology, with particular emphasis on cardiac, renal, hepatic, neurologic, gastrointestinal, hematologic, dermatologic, and endocrine systems.
(ii) Clinical medicine, with particular emphasis on signs, symptoms, and treatment of disease states with behavioral and psychiatric manifestations or comorbidities.
(iii) Differential diagnosis.
(iv) Clinical correlations. The illustration of the content of this domain through case study.
(v) Chemical dependency and chronic pain management.
(vi) Integration of the subjects in clauses (i) to (v), inclusive, through supervised clinical experience or laboratory experience in taking medical history, assessment for differential diagnosis, and review of systems.
(E) Clinical and research pharmacology and psychopharmacology, including the following:
(i) Pharmacology.
(ii) Clinical pharmacology.
(iii) Pharmacogenetics.
(iv) Psychopharmacology.
(v) Developmental psychopharmacology.
(vi) Integration of the subjects in clauses (i) to (v), inclusive, through supervised clinical experience or laboratory experience in clinical medicine and ongoing treatment monitoring and evaluation.
(F) Clinical pharmacotherapeutics, including the following as related to pharmacotherapeutics:
(i) Professional, ethical, and legal issues.
(ii) Combined therapies, such as psychotherapy and pharmocotherapy interactions.
(iii) Computer-based aids to practice.
(iv) Pharmacoepidemiology.
(v) Integration of clauses (i) to (iv), inclusive, through supervised clinical experience or laboratory experience in integrated treatment planning and consultation and the implications of treatment.
(G) Research, including the following:
(i) Methodology and design of psychopharmacological research.
(ii) Interpretation and evaluation of research.
(iii) Federal Food and Drug Agency drug development and other regulatory processes.
(2) Relevant supervised clinical experience, in accordance with APA guidelines, to obtain competency in prescribing and the psychopharmacological treatment of a diverse patient population under the direction of qualified prescribers, as determined by the board.
(A)  The supervised clinical experience is intended to be an intensive, closely supervised experience. Approved programs shall commit to providing training courses and experiences that encourage sensitivity to the interactions between pharmacological and psychological interventions with the developmental status, gender, health status, culture, and ethnicity of patients. The supervised experience shall be an organized sequence of education and training that provides an integrative approach to learning, as well as the opportunity to assess competencies in skills and applied knowledge. The intent of the supervised clinical experience shall be both of the following:
(i) To provide ongoing integration of didactic and applied clinical knowledge throughout the learning sequence, including ample opportunities for practical learning and clinical application of skills.
(ii) To provide opportunity for programs to assess formative and summative clinical competency in skills and applied knowledge.
(B) The clinical competencies targeted by this experience shall include all of the following:
(i) Physical examination and mental status evaluation, including knowledge and execution of elements and sequence of both comprehensive and focused physical examination and mental status evaluation, proper use of instruments used in physical examination, such as stethoscopes and blood pressure measurement devices, and scope of knowledge gained from physical examination and mental status examination.
(ii) Review of systems, including knowledge and ability to systematically describe the process of integrating information learned from patient reports, signs, symptoms, and a review of each of the major body systems.
(iii) Medical history interview and documentation, including the ability to systematically conduct a patient clinical interview producing a personal and family medical history, and to communicate the findings in written and verbal form.
(iv) Assessment indications and interpretation, including the ability to order and interpret appropriate tests, such as psychometric, laboratory, and radiological tests, for the purpose of making a differential diagnosis and for monitoring therapeutic and adverse effects of treatment.
(v) Differential diagnosis, including use of appropriate processes, including established diagnostic criteria such as ICD-9 and DSM-IV, to determine primary and alternate diagnoses.
(vi) Integrated treatment planning, including the ability to identify and select, using all available data, the most appropriate treatment alternatives and to sequence treatment within the larger biopsychosocial context.
(vii) Consultation and collaboration, including understanding of the parameters of the role of the prescribing psychologist or medical psychologist and working with other professionals in an advisory or collaborative manner to effect treatment of a patient.
(viii) Treatment management, including application, monitoring, and modification, as needed, of treatment.
(C) The supervised clinical experience should also meet the following requirements:
(i) The range of diagnostic categories, settings, and developmental status, gender, health status, and ethnicity reflected in the patients seen in connection with the supervised clinical experience should be appropriate to the current and anticipated practice of the trainee. It should allow the trainee to gain exposure to acute, short-term, and maintenance medication strategies.
(ii) Prior to being granted certification as a prescribing psychologist, a trainee shall obtain supervised clinical experience with a sufficient range and number of patients in order to demonstrate threshold performance levels for each of the competency areas. In order to achieve the complex clinical competency skills required for independent prescribing, a minimal number of supervised patient contact hours shall be completed. The program shall report the total number of supervised clinical experience hours that students experience. These hours shall be specified as either face-to-face patient contacts or other clinical experiences and this shall be done for each clinical competency.
(iii) The program shall provide the board with a report for each applicant that includes a description of the method and appropriate benchmarks for assuring each clinical competency. Methods may include performing basic physical examinations, case presentations, or patient simulations based on actual patients and patients for whom the trainee assumes direct psychological responsibility. The trainee shall recommend or prescribe in consultation with or under the supervision of someone with demonstrated skills and experience in clinical psychopharmacology and in accordance with the prevailing law.
(iv) The program shall provide final approval of the supervised clinical experience of an applicant.
(D) Supervised clinical experience may be integrated into each level of a trainee’s education and training, provided in a final summative practical experience, or provided in a combination of those methods according to the design of the program.
(E) A trainee shall demonstrate competency in his or her ability to integrate didactic learning and applied clinical skill.
(c) A prescribing psychologist shall maintain competency through continuing education over the lifespan of maintaining and practicing in prescriptive authority or collaborative activities with other prescribers.

SEC. 5.

 Section 2949.2 is added to the Business and Professions Code, to read:

2949.2.
 (a) The board, shall set forth the requirements for renewal of a certificate of a prescribing psychologist for each license renewal period.
(b) Each applicant for renewal of a certificate for prescriptive authority shall present evidence of having completed approved mandatory continuing education in the area of psychopharmacology and related prescribing practice as set forth by the board.

SEC. 6.

 Section 2949.3 is added to the Business and Professions Code, to read:

2949.3.
 (a) Each prescribing psychologist shall comply with all state and federal rules and regulations relating to the prescribing, dispensing, and recordkeeping for drugs or devices, as defined in Sections 4021, 4022, 4023, 4025, and 4055, and other applicable provisions of law. If the board determines that it would facilitate administration of the provisions governing prescribing psychologists to identify a prescribing psychologist by another name that is consistent with other jurisdictions, it may do so.
(b) A written order of a prescribing psychologist shall include his or her prescribing identification number, which shall be assigned by the board to any certified prescribing psychologist.
(c) A prescribing psychologist shall not delegate the prescribing of medication to any other person except for a supervised trainee in a recognized training program for prescribing psychologists.
(d) Records of all prescriptions shall be maintained in a prescribing psychologists client records.

SEC. 7.

 Section 2949.4 is added to the Business and Professions Code, to read:

2949.4.
 (a) The board shall annually transmit to the State Board of Pharmacy a list of prescribing psychologists containing, at a minimum, all of the following information:
(1) The name of the prescribing psychologist.
(2) The unique identification number indicating certification of the prescribing psychologist to prescribe.
(3) The effective date of prescribing psychologist’s prescriptive authority.
(b) The board shall promptly forward to the State Board of Pharmacy the names and identification numbers of prescribing psychologists added to or deleted from the annual list of psychologists certified to prescribe.
(c) The board shall notify the State Board of Pharmacy in a timely manner upon termination, suspension, or reinstatement of a psychologist’s authority to prescribe.

SEC. 8.

 Section 2960 of the Business and Professions Code is amended to read:

2960.
 The board may refuse to issue any registration  registration, certification,  or license, or may issue a registration or license with terms and conditions, or may suspend or revoke the registration or license of any registrant or licensee if the applicant, registrant, or licensee has been guilty of unprofessional conduct. Unprofessional conduct shall include, but not be limited to: to, all of the following: 
(a) Conviction of a crime substantially related to the qualifications, functions or duties of a psychologist or registered  psychological associate. assistant. 
(b) Use of any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code, or dangerous drug, or any alcoholic beverage to an extent or in a manner dangerous to themselves,  himself or herself,  any other person, or the public, or to an extent that this use impairs their  his or her  ability to perform the work of a psychologist with safety to the public.
(c) Fraudulently or neglectfully misrepresenting the type or status of license or registration actually held.
(d) Impersonating another person holding a psychology license or allowing another person to use their  his or her  license or registration.
(e) Using fraud or deception in applying for a license or registration or in passing the examination provided for in this chapter.
(f) Paying, or offering to pay, accepting, or soliciting any consideration, compensation, or remuneration, whether monetary or otherwise, for the referral of clients.
(g) Violating Section 17500.
(h) Willful, unauthorized communication of information received in professional confidence.
(i) Violating any rule of professional conduct promulgated by the board and set forth in regulations duly adopted under this chapter.
(j) Being grossly negligent in the practice of their  his or her  profession.
(k) Violating any of the provisions of this chapter or regulations duly adopted thereunder.
(l) The aiding or abetting of any person to engage in the unlawful practice of psychology.
(m) The suspension, revocation or imposition of probationary conditions by another state or country of a license or certificate to practice psychology or as a psychological assistant issued by that state or country to a person also holding a license or registration issued under this chapter if the act for which the disciplinary action was taken constitutes a violation of this section.
(n) The commission of any dishonest, corrupt, or fraudulent act.
(o) (1) Any act of sexual abuse or sexual misconduct.
(2) Any act of sexual behavior or sexual contact with a client or former client within two years following termination of therapy.
(3) For purposes of this section, the following definitions apply:
(A) “Sexual abuse” means the touching of an intimate part of a person by force or coercion.
(B) “Sexual behavior” means inappropriate physical contact or communication of a sexual nature with a client or a former client for the purpose of sexual arousal, gratification, exploitation, or abuse. “Sexual behavior” does not include the provision of appropriate therapeutic interventions relating to sexual issues.
(C) “Sexual contact” means the touching of an intimate part of a client or a former client.
(D) (o)  “Sexual misconduct” means inappropriate conduct or communication of a sexual nature Any act of sexual abuse, or sexual relations with a patient or former patient within two years following termination of therapy, or sexual misconduct  that is substantially related to the qualifications, functions, functions  or duties of a psychologist or registered psychological associate. psychological assistant or registered psychologist. 
(p) Functioning outside of their  his or her  particular field or fields of competence as established by their  his or her  education, training, and experience.
(q) Willful failure to submit, on behalf of an applicant for licensure, verification of supervised experience to the board.
(r) Repeated acts of negligence.
(s) Violating Section 2949.3 relating to prescribing or dispensing drugs.

SEC. 9.

 Section 4040 of the Business and Professions Code is amended to read:

4040.
 (a) “Prescription” means an oral, written, or electronic transmission order that is both of the following:
(1) Given individually for the person or persons for whom ordered that includes all of the following:
(A) The name or names and address of the patient or patients.
(B) The name and quantity of the drug or device prescribed and the directions for use.
(C) The date of issue.
(D) Either rubber stamped, typed, or printed by hand or typeset, the name, address, and telephone number of the prescriber, the prescriber’s  his or her  license classification, and the prescriber’s  his or her  federal registry number, if a controlled substance is prescribed.
(E) A legible, clear notice of the condition or purpose  for which the drug is being prescribed, if requested by the patient or patients.
(F) If in writing, signed by the prescriber issuing the order, or the certified nurse-midwife, nurse practitioner, physician assistant, or naturopathic doctor who issues a drug order pursuant to Section 2746.51, 2836.1, 3502.1, or 3640.5, respectively, or the pharmacist who issues a drug order pursuant to Section 4052.1, 4052.2, or 4052.6. order. 
(2) Issued by a physician, dentist, optometrist, doctor of podiatric medicine, veterinarian, nurse practitioner practicing pursuant to Section 2837.103 or 2837.104, or  podiatrist, prescribing psychologist, veterinarian, or  naturopathic doctor pursuant to Section 3640.7 or, if a drug order is issued pursuant to Section 2746.51, 2836.1, 3502.1, or 3460.5, by a certified nurse-midwife, nurse practitioner, physician assistant, or naturopathic doctor licensed in this state, or pursuant to Section 4052.1, 4052.2, or 4052.6  either subparagraph (D) of paragraph (4) of, or clause (iv) of subparagraph (A) of paragraph (5) of, subdivision (a) of Section 4052  by a pharmacist licensed in this state.
(b) Notwithstanding subdivision (a), a written order of the prescriber for a dangerous drug, except for any Schedule II controlled substance, that contains at least the name and signature of the prescriber, the name or names  and address of the patient or patients  in a manner consistent with paragraph (2) (3)  of subdivision (a) (b)  of Section 11164 of the Health and Safety Code, the name and quantity of the drug prescribed, directions for use, and the date of issue may be treated as a prescription by the dispensing pharmacist as long as any additional information required by subdivision (a) is readily retrievable in the pharmacy. In the event of a conflict between this subdivision and Section 11164 of the Health and Safety Code, Section 11164 of the Health and Safety Code shall prevail.
(c) “Electronic transmission prescription” includes both image and data prescriptions. “Electronic image transmission prescription” means any prescription order for which a facsimile of the order is received by a pharmacy from a licensed prescriber. “Electronic data transmission prescription” means any prescription order, other than an electronic image transmission prescription, that is electronically transmitted from a licensed prescriber to a pharmacy.
(d) The use of commonly used abbreviations shall not invalidate an otherwise valid prescription.
(e) Nothing in the amendments made to this section (formerly Section 4036) at the 1969 Regular Session of the Legislature shall be construed as expanding or limiting the right that a chiropractor, while acting within the scope of his or her license, may have to prescribe a device.

SEC. 10.

 Section 4502 of the Business and Professions Code is amended to read:

4502.
 As used in this chapter, “psychiatric technician” means any person who, for compensation or personal profit, implements procedures and techniques that which  involve understanding of cause and effect and that which  are used in the care, treatment, and rehabilitation of mentally ill or emotionally disturbed persons, or persons with intellectual disabilities,  ill, emotionally disturbed, or mentally retarded persons  and who has one or more of the following:
(a) Direct responsibility for administering or implementing specific therapeutic procedures, techniques, treatments, or medications with the aim of enabling recipients or patients to make optimal use of their therapeutic regime, their social and personal resources, and their residential care.
(b) Direct responsibility for the application of interpersonal and technical skills in the observation and recognition of symptoms and reactions of recipients or patients, for the accurate recording of these such  symptoms and reactions, and for the carrying out of treatments and medications as prescribed by a licensed physician and surgeon or a psychiatrist. surgeon, psychiatrist, or prescribing psychologist. 
The psychiatric technician in the performance of these such  procedures and techniques is responsible to the director of the service in which those his  duties are performed. The director may be a licensed physician and surgeon, psychiatrist, psychologist, rehabilitation therapist, social worker, registered nurse, or other professional personnel.
Nothing herein shall authorize a licensed psychiatric technician to practice medicine or surgery or to undertake the prevention, treatment, treatment  or cure of disease, pain, injury, deformity, or mental or physical condition in violation of the law.

SEC. 11.

 Section 4502.1 of the Business and Professions Code is amended to read:

4502.1.
 A psychiatric technician, working in a mental health facility or developmental disability facility, when prescribed by a licensed  physician and surgeon,  surgeon or prescribing psychologist,  may administer medications by hypodermic injection.

SEC. 12.

 Section 4502.2 of the Business and Professions Code is amended to read:

4502.2.
 A psychiatric technician, when prescribed by a licensed  physician and surgeon,  surgeon or prescribing psychologist,  may withdraw blood from a patient with a mental illness or developmental disability if the psychiatric technician has received certification from the board that the psychiatric technician has completed a prescribed course of instruction approved by the board or has demonstrated competence to the satisfaction of the board.
SEC. 13.
 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.