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SB-1759 Pharmacy.(1993-1994)



Current Version: 09/30/94 - Chaptered

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SB1759:v92#DOCUMENT

Senate Bill No. 1759
CHAPTER 1161

An act to amend Section 4046 of the Business and Professions Code, relating to pharmacy.

[ Filed with Secretary of State  September 30, 1994. Approved by Governor  September 29, 1994. ]

LEGISLATIVE COUNSEL'S DIGEST


SB 1759, Kopp. Pharmacy.
Existing law, the Pharmacy Law, provides for the licensing and regulation of pharmacies and pharmacists. It describes some of the functions that a registered pharmacist may perform, including some functions that may only be performed in a licensed health care facility, as defined.
This bill would provide that a registered pharmacist would not be prohibited from performing certain functions , as part of the care provided by certain unlicensed facilities operated by a health care service plan, or by a licensed clinic, or a provider who contracts with a licensed health care service plan, in accordance with policies, procedures, or protocols of that facility, clinic, or health care service plan developed by health professionals, provided that the pharmacist has successfully completed clinical residency training or demonstrated clinical experience in direct patient care delivery. It would require that these policies, procedures, or protocols include requirements that the medical records of the patient be available to both the patient’s prescriber and the licensed pharmacist, that the procedures to be performed by a licensed physician relate to a condition for which the patient has already seen a physician and surgeon, and that in certain instances the pharmacist function as part of a multidisciplinary group that includes physicians and surgeons and direct care registered nurses.
This bill would incorporate additional changes in Section 4046 of the Business and Professions Code, proposed by AB 3173, to be operative only if AB 3173 and this bill are both chaptered and become effective January 1, 1995, and this bill is chaptered last.

The people of the State of California do enact as follows:


SECTION 1.

 Section 4046 of the Business and Professions Code is amended to read:

4046.
 (a)  In recognition of and consistent with the decisions of the appellate courts of this state, the Legislature hereby declares the practice of pharmacy to be a profession.
(b)  Pharmacy practice is a dynamic patient-oriented health service that applies a scientific body of knowledge to improve and promote patient health by means of appropriate drug use and drug-related therapy.
(c)  Neither this chapter nor any other provision of law shall be construed to prohibit a registered pharmacist from:
(1)  Furnishing to a prescriber a reasonable quantity of compounded medication for prescriber office use.
(2)  Transmitting to another registered pharmacist a valid prescription.
(3)  Administering, orally or topically, drugs and biologicals pursuant to a prescriber’s order.
(4)  Performing the following procedures or functions in a licensed health care facility in accordance with policies, procedures, or protocols developed by health professionals, including physicians and surgeons, pharmacists, and registered nurses, with the concurrence of the facility administrator:
(A)  Ordering or performing routine drug therapy related patient assessment procedures including temperature, pulse, and respiration.
(B)  Ordering drug therapy related laboratory tests.
(C)  Administering drugs and biologicals by injection pursuant to a prescriber’s order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a licensed health care facility).
(D)  Initiating or adjusting the drug regimen of a patient pursuant to an order or authorization made by the patient’s prescriber and in accordance with the policies, procedures, or protocols of the licensed health care facility.
As used in this paragraph, “licensed health care facility” means a facility licensed pursuant to Article 1 (commencing with Section 1250) of Chapter 2 of Division 2 of the Health and Safety Code or a facility, as defined in Section 1250 of the Health and Safety Code, operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.
(5)  (A)  Performing the following procedures or functions as part of the care provided by a health care facility, a licensed clinic in which there is physician oversight, or a provider who contracts with a licensed health care service plan with regard to the care or services provided to the enrollees of that health care service plan, in accordance with policies, procedures, or protocols of that facility, licensed clinic, or health care service plan developed by health professionals, including physicians and surgeons, pharmacists, and registered nurses, that, at a minimum shall require that the medical records of the patient be available to both the patient’s prescriber and the licensed pharmacist, and that the procedures to be performed by the licensed pharmacist relate to a condition for which the patient has first seen a physician and surgeon:
(i)  Ordering or performing routine drug therapy related patient assessment procedures including temperature, pulse, and respiration.
(ii) Ordering drug therapy related laboratory tests.
(iii)  Administering drugs and biologicals by injection pursuant to a prescriber’s order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a health care facility).
(iv)  Adjusting the drug regimen of a patient pursuant to a specific written order or authorization made by the patient’s prescriber for the individual patient, and in accordance with the policies, procedures, or protocols of the health care facility, licensed clinic, or health care service plan. Adjusting the drug regimen does not include substituting or selecting a different drug, except as authorized by Section 4047.6.
(B)  Notwithstanding this paragraph, a patient’s prescriber may prohibit by written instruction, any adjustment or change in the patient’s drug regimen by the pharmacist.
(C)  As used in this paragraph only, “health care facility” means a facility, other than a facility licensed under Division 2 (commencing with Section 1200) of the Health and Safety Code, that is owned or operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, or by an organization under common ownership or control of the health care service plan; and “licensed clinic” means a clinic licensed pursuant to Article 1 (commencing with Section 1200) of Chapter 1 of Division 2 of the Health and Safety Code.
(D)  The policies, procedures, or protocols referred to in this paragraph shall require that the pharmacist function as part of a multidisciplinary group that includes physicians and surgeons and direct care registered nurses. The multidisciplinary group shall determine the appropriate participation of the pharmacist and the direct care registered nurse.
(6)  Manufacturing, measuring, fitting to the patient, or selling and repairing, legend medical devices or furnishing instructions to the patient or the patient’s representative concerning the use of those devices.
(d)  Prior to performing any procedure authorized by paragraph (4) of subdivision (c), a registered pharmacist shall have received appropriate training as prescribed in the policies and procedures of the licensed health care facility. Prior to performing any procedure authorized by paragraph (5) of subdivision (c), a registered pharmacist shall have either (1) successfully completed clinical residency training or (2) demonstrated clinical experience in direct patient care delivery.
(e)  Nothing contained in this section shall affect the requirements of existing law relating to maintaining the confidentiality of medical records.
(f)  Nothing contained in this section shall affect the requirements of existing law relating to the licensing of a health care facility.

SEC. 2.

 Section 4046 of the Business and Professions Code is amended to read:

4046.
 (a)  In recognition of and consistent with the decisions of the appellate courts of this state, the Legislature hereby declares the practice of pharmacy to be a profession.
(b)  Pharmacy practice is a dynamic patient-oriented health service that applies a scientific body of knowledge to improve and promote patient health by means of appropriate drug use and drug-related therapy.
(c)  Neither this chapter nor any other provision of law shall be construed to prohibit a registered pharmacist from:
(1)  Furnishing to a prescriber a reasonable quantity of compounded medication for prescriber office use.
(2)  Transmitting to another registered pharmacist a valid prescription.
(3)  Administering, orally or topically, drugs and biologicals pursuant to a prescriber’s order.
(4)  Performing the following procedures or functions in a licensed health care facility in accordance with policies, procedures, or protocols developed by health professionals, including physicians and surgeons, pharmacists, and registered nurses, with the concurrence of the facility administrator:
(A)  Ordering or performing routine drug therapy related patient assessment procedures including temperature, pulse, and respiration.
(B)  Ordering drug therapy related laboratory tests.
(C)  Administering drugs and biologicals by injection pursuant to a prescriber’s order (the administration of immunizations under the supervision of a prescriber may also be performed outside of a licensed health care facility).
(D)  Initiating or adjusting the drug regimen of a patient pursuant to an order or authorization made by the patient’s prescriber and in accordance with the policies, procedures, or protocols of the licensed health care facility.
As used in this paragraph, “licensed health care facility” means a facility licensed pursuant to Article 1 (commencing with Section 1250) of Chapter 2 of Division 2 of the Health and Safety Code or a facility, as defined in Section 1250 of the Health and Safety Code, operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.
(5)  (A)  Performing the following procedures or functions as part of the care provided by a health care facility, a licensed clinic in which there is physician oversight, a home health agency, or a provider who contracts with a licensed health care service plan with regard to the care or services provided to the enrollees of that health care service plan, in accordance with policies, procedures, or protocols of that facility, licensed clinic, home health agency, or health care service plan developed by health professionals, including physicians and surgeons, pharmacists, and registered nurses, that, at a minimum shall require that the medical records of the patient be available to both the patient’s prescriber and the licensed pharmacist, and that the procedures to be performed by the licensed pharmacist relate to a condition for which the patient has first seen a physician and surgeon:
(i)  Ordering or performing routine drug therapy related patient assessment procedures including temperature, pulse, and respiration.
(ii)  Ordering drug therapy related laboratory tests.
(iii)  Administering drugs and biologicals by injection pursuant to a prescriber’s order, except as part of the care provided by a home health agency (the administration of immunizations under the supervision of a prescriber may also be performed outside of a health care facility).
(iv)  Adjusting the drug regimen of a patient pursuant to a specific written order or authorization made by the patient’s prescriber for the individual patient, and in accordance with the policies, procedures, or protocols of the health care facility, licensed clinic, home health agency, or health care service plan. Adjusting the drug regimen does not include substituting or selecting a different drug, except as authorized by Section 4047.6.
(B)  Notwithstanding this paragraph, a patient’s prescriber may prohibit by written instruction, any adjustment or change in the patient’s drug regimen by the pharmacist.
(C)  As used in this paragraph only, “health care facility” means a facility, other than a facility licensed under Division 2 (commencing with Section 1200) of the Health and Safety Code, that is owned or operated by a health care service plan licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, or by an organization under common ownership or control of the health care service plan; “licensed clinic” means a clinic licensed pursuant to Article 1 (commencing with Section 1200) of Chapter 1 of Division 2 of the Health and Safety Code; and “home health agency” means a home health agency licensed pursuant to Chapter 8 (commencing with Section 1725) of Division 2 of the Health and Safety Code.
(D)  The policies, procedures, or protocols referred to in this paragraph shall require that the pharmacist function as part of a multidisciplinary group that includes physicians and surgeons and direct care registered nurses. The multidisciplinary group shall determine the appropriate participation of the pharmacist and the direct care registered nurse.
(6)  Manufacturing, measuring, fitting to the patient, or selling and repairing, legend medical devices or furnishing instructions to the patient or the patient’s representative concerning the use of those devices.
(d)  Prior to performing any procedure authorized by paragraph (4) of subdivision (c), a registered pharmacist shall have received appropriate training as prescribed in the policies and procedures of the licensed health care facility. Prior to performing any procedure authorized by paragraph (5) of subdivision (c), a registered pharmacist shall have either (1) successfully completed clinical residency training or (2) demonstrated clinical experience in direct patient care delivery.
(e)  Nothing contained in this section shall affect the requirements of existing law relating to maintaining the confidentiality of medical records.
(f)  Nothing contained in this section shall affect the requirements of existing law relating to the licensing of a health care facility.

SEC. 3.

 Section 2 of this bill incorporates amendments to Section 4046 of the Business and Professions Code proposed by both this bill and AB 3173. It shall only become operative if (1) both bills are enacted and become effective on January 1, 1995, (2) each bill amends Section 4046 of the Business and Professions Code, and (3) this bill is enacted after AB 3173, in which case Section 1 of this bill shall not become operative.