Today's Law As Amended

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SB-538 Naturopathic doctors.(2015-2016)



SECTION 1.

 Section 3640 of the Business and Professions Code is amended to read:

3640.
 (a) A naturopathic doctor may order and perform physical and laboratory examinations for diagnostic purposes, including, but not limited to, phlebotomy, clinical laboratory tests, speculum examinations, orificial examinations, and physiological function tests.
(b) A naturopathic doctor may order diagnostic imaging studies, including X-ray, ultrasound, mammogram, bone densitometry, and others, consistent with naturopathic training as determined by the committee,  the practice of naturopathic medicine,  but shall refer the studies to an appropriately licensed health care professional to conduct the study and interpret the results.
(c) A naturopathic doctor may dispense, administer, order, prescribe, and furnish provide, furnish,  or perform the following:
(1) Food, extracts of food, nutraceuticals, vitamins, amino acids, minerals, enzymes, botanicals and their extracts, botanical medicines, homeopathic medicines, all dietary supplements and nonprescription drugs as defined by the federal Federal  Food, Drug, and Cosmetic Act, consistent with the routes of administration identified in subdivision (d).
(2) Hot or cold hydrotherapy; naturopathic physical medicine inclusive of the manual use of massage, stretching, resistance, or joint play examination but exclusive of small amplitude movement at or beyond the end range of normal joint motion; electromagnetic energy; colon hydrotherapy; and therapeutic exercise.
(3) Devices, including, but not limited to, therapeutic devices, barrier contraception, and durable medical equipment. equipment consistent with the naturopathic training as determined by the committee. 
(4) Health education and health counseling.
(5) Repair and care incidental to superficial lacerations and abrasions, except suturing.  
(6) Removal of foreign bodies located in the superficial tissues.  
(d) A naturopathic doctor may utilize routes of administration that include oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, intravenous, and intramuscular.
(e) The committee may establish regulations regarding ocular or intravenous routes of administration that are consistent with the education and training of a naturopathic doctor.
(f) Nothing in this  This  section shall not  exempt a naturopathic doctor from meeting applicable licensure requirements for the performance of clinical laboratory tests, including the requirements imposed under Chapter 3 (commencing with Section 1200).

SEC. 2.

 Section 3640.5 of the Business and Professions Code is amended to read:

3640.5.
 Nothing (a)   in this  Except as set forth in this section, nothing in this  chapter or any other provision of  law shall be construed to prohibit a naturopathic doctor from furnishing or ordering drugs when all of the following apply: administering, furnishing, ordering, or prescribing drugs when functioning pursuant to this section. 
(a)  (b)  The drugs are furnished or ordered  Schedule III and Schedule IV controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) shall be administered, furnished, ordered, and prescribed  by a naturopathic doctor in accordance with standardized procedures or protocols developed by the naturopathic doctor and his or her supervising physician and surgeon.
(b) (c)  The naturopathic doctor is functioning shall function  pursuant to a  standardized procedure, as defined by subdivisions (a), (b), (d), (e), (h), and (i) of Section 2836.1 and paragraph (1) of  paragraphs (1) and (2) of  subdivision (c) of Section 2836.1, 2725,  or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the naturopathic doctor, and, where applicable, the facility administrator or his or her designee.
(c) (d)  The standardized procedure or protocol covering the furnishing of  administering, furnishing, ordering, or prescribing of Schedule III and Schedule IV  drugs shall specify which naturopathic doctors may furnish or order drugs, which  administer, furnish, order, or prescribe Schedule III and Schedule IV drugs, which Schedule III through Schedule IV  drugs may be furnished or ordered  administered, furnished, ordered, or prescribed and  under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the naturopathic doctor’s competence, including peer review, which shall be subject to the reporting requirement in Section 805,  and review of the provisions of the standardized procedure.
(d) (e)  The furnishing or ordering of  administering, furnishing, ordering, or prescribing of Schedule III and Schedule IV  drugs by a naturopathic doctor occurs  shall occur  under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(1) Collaboration on the development of the standardized procedure.
(2) Approval of the standardized procedure.
(3) Availability by telephonic contact at the time of patient examination by the naturopathic doctor.
(e) For purposes of this section, a physician and surgeon shall not supervise more than four naturopathic doctors at one time.
(f) Drugs furnished or ordered by a naturopathic doctor may include Schedule III through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the naturopathic doctor and physician and surgeon as specified in the standardized procedure.  When Schedule III controlled substances, as defined in Section 11056 of the Health and Safety Code, are furnished or ordered administered, furnished, ordered, or prescribed  by a naturopathic doctor, the controlled substances shall be furnished or ordered administered, furnished, ordered, or prescribed  in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the naturopathic doctor’s standardized procedure or protocol  relating to controlled substances shall be provided provided,  upon request, to a licensed pharmacist who dispenses drugs, drugs  when there is uncertainty about the naturopathic doctor furnishing the order.
(g) For purposes of this section, a physician and surgeon shall not supervise more than four naturopathic doctors at one time.
(g) (h)  The committee has certified shall certify  that the naturopathic doctor has satisfactorily completed adequate coursework in pharmacology covering the drugs to be furnished or ordered administered, furnished, ordered, or prescribed  under this section. The committee shall establish the requirements for satisfactory completion of this subdivision.
(h) (i)  Use of the term “furnishing” in this section, in health facilities defined in subdivisions (b), (c), (d), (e), and (i) of Section 1250 of the Health and Safety Code, shall include both of the following: following for Schedule III through Schedule IV controlled substances. 
(1) Ordering a drug in accordance with the standardized procedure.
(2) Transmitting an order of a supervising physician and surgeon.
(i) (j)  For purposes of this section, “drug order” or “order” means an order for medication which is dispensed to or for an ultimate user, issued by a naturopathic doctor as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations.
(j) (k)  Notwithstanding any other provision of law, law, all of  the following shall  apply:
(1) A Schedule III through Schedule IV  drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician.
(2) All references to prescription in this code and the Health and Safety Code shall include drug orders issued by naturopathic doctors.
(3) The signature of a naturopathic doctor on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.

SEC. 3.

 Section 3640.7 of the Business and Professions Code is amended to read:

3640.7.
 (a)  Notwithstanding the requirements of Section 3640.5 or any other provision of this chapter, a naturopathic doctor may independently prescribe and administer the following:
(a) (1)  Epinephrine to treat anaphylaxis.
(b) (2)  Natural and synthetic hormones.
(c) (3)  Vitamins, minerals, amino acids, glutathione, botanicals and their extracts, homeopathic medicines, electrolytes, sugars, and diluents that may be administered utilizing routes of administration, pursuant to subdivision (d) of Section 3640, only when such substances are chemically identical to those for sale without a prescription.
(b) (1) A naturopathic doctor may independently administer, furnish, order, or prescribe Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and any drug approved by the federal Food and Drug Administration and labeled “for prescription only” or words of similar import, except chemotherapeutics, that is not classified, after the completion of 12 consecutive months of supervision by a physician and surgeon for the substances and drugs specified in this subdivision. The supervision required by this subdivision shall follow the same procedures or protocols as those described in Section 3640.5 for other prescription medications.
(2) The supervision requirement under this subdivision shall be waived if either:
(A) The naturopathic doctor has completed a residency program of at least 12 months that is approved by the Council on Naturopathic Medical Education or any other agency approved by the committee.
(B) The naturopathic doctor has a license in good standing and has practiced for at least 12 months in another state where independent prescribing of the substances and drugs described in this chapter is permitted for a licensed naturopathic doctor in that other state.