Amended  IN  Senate  May 19, 2022

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill
No. 1375

Introduced by Senator Atkins
(Principal coauthor: Assembly Member Wood)
(Coauthors: Senators Caballero, Eggman, Min, and Newman)
(Coauthors: Assembly Members Carrillo, Cervantes, Cristina Garcia, Jones-Sawyer, Kalra, and Luz Rivas)

February 18, 2022

An act to amend Sections 2725.4, 2837.101, and 2837.103 of the Business and Professions Code, and to amend Section 123468 of the Health and Safety Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST

SB 1375, as amended, Atkins. Nursing: nurse practitioners.
(1) Existing law, the Nursing Practice Act, provides for the licensure and regulation of registered nurses, including nurse practitioners and certified nurse-midwives, by the Board of Registered Nursing. Existing law makes a violation of this act a crime.
In order to perform an abortion by aspiration techniques under the act, a person with a license or certificate to practice as a nurse practitioner or a certified nurse-midwife is required to complete board-recognized training.
This bill would revise that provision to specify that it applies to a person with a license or certificate to practice as a nurse practitioner practicing pursuant to a standardized procedure, and or to a qualified nurse practitioner functioning pursuant to certain advanced practice provisions. By expanding the application of a crime, the bill would impose a state-mandated local program. The bill would require those persons to complete specified requisite training in performing these procedures, as provided by certain board-approved programs, courses, and trainings.
Existing law requires a person with a license or certificate to practice as a nurse practitioner or a certified nurse midwife, in order to perform an abortion by aspiration techniques, to adhere to standardized procedures that specify, among other conditions, the extent of supervision by a physician and surgeon with relevant training and expertise.
This bill would revise the above-described requirement, with respect to a nurse practitioner, to apply to practice as a nurse practitioner practicing pursuant to standardized procedures and would specify that it does not apply to a qualified nurse practitioner functioning pursuant to certain advanced practice registered nurse practitioner provisions. The bill would also delete a provision authorizing a nurse practitioner or certified nurse-midwife who has completed training and achieved clinical competency to perform abortions by aspiration techniques. revise the above-described requirements and instead would require a certified nurse-midwife to complete requisite training in performing these procedures, as provided by specified board-approved programs, courses, and trainings. The bill would authorize a nurse practitioner who has completed training required by these provisions and who is functioning pursuant to certain advanced practice provisions to perform an abortion by aspiration techniques without supervision by a physician and surgeon. By expanding the application of a crime, the bill would impose a state-mandated local program.
Existing law provides that it is unprofessional conduct for a nurse practitioner or certified nurse-midwife to perform an abortion by aspiration techniques without prior completion of training and validation of clinical competency.
This bill would instead make a violation of the above-described provisions by a nurse practitioner or certified midwife unprofessional conduct.

Existing

(2) Existing law defines specified terms for purposes of provisions governing advanced practice registered nurses. Existing law defines “transition to practice” under these provisions to mean additional clinical experience and mentorship provided to prepare a nurse practitioner to independently practice. Existing law requires the board, by regulation, to define minimum standards for transition to practice and further specifies that clinical experience may include experience obtained before January 1, 2021, if the experience meets the requirements established by the board.
This bill would delete the above-described requirement for the board to define, by regulation, minimum standards for transition to practice. The bill would require a nurse practitioner who has been practicing a minimum of 3 full-time equivalent years or 4,600 hours as of January 1, 2023, to satisfy the transition to practice requirement. The bill would authorize clinical experience to include experience obtained before January 1, 2023, and would permit that experience to be counted toward the 3 full-time equivalent years or 4,600 hours. The bill would make related, conforming changes to these provisions.

(2)Existing law, the Reproductive Privacy Act, provides that the performance of an abortion is unauthorized if either the person performing the abortion is (A) not a health care provider authorized to perform an abortion, or (B) the abortion is performed on a viable fetus and in the good faith medical judgment of the physician, the fetus was viable or the continuation of the pregnancy posed no risk to life or health of the pregnant woman.

This bill would expand the above-described provision to also provide that abortion is unauthorized if, in the good faith medical judgment of the nurse practitioner, certified nurse-midwife, or physician assistant, the fetus was viable or continuation of the pregnancy posed no risk to life or health of the pregnant woman.

(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  
Bill Text
The people of the State of California do enact as follows:
SECTION 1. Section 2725.4 of the Business and Professions Code is amended to read:
2725.4. Notwithstanding any other provision of this chapter, the following shall apply:
(a) In order to perform an abortion by aspiration techniques pursuant to Section 2253, a person with a license or certificate to practice as a nurse practitioner practicing pursuant to a standardized procedure, or a qualified nurse practitioner functioning pursuant to Section 2837.103 or 2837.104, or a certified nurse-midwife shall complete training recognized by the Board of Registered Nursing. Beginning January 1, 2014, and until January 1, 2016, the competency-based training protocols established by Health Workforce Pilot Project (HWPP) No. 171 through the Office of Statewide Health Planning and Development shall be used. shall complete requisite training in performing these procedures provided by any of the following:

(b)In order to perform an abortion by aspiration techniques pursuant to Section 2253, a person with a license or certificate to practice as a nurse practitioner practicing pursuant to standardized procedures or a certified nurse-midwife shall adhere to standardized procedures developed in compliance with subdivision (c) of Section 2725 that specify all of the following:

(1)The extent of supervision by a physician and surgeon with relevant training and expertise.

(2)Procedures for transferring patients to the care of the physician and surgeon or a hospital.

(3)Procedures for obtaining assistance and consultation from a physician and surgeon.

(4)Procedures for providing emergency care until physician assistance and consultation are available.

(5)The method of periodic review of the provisions of the standardized procedures.

(6)This subdivision does not apply to a qualified nurse practitioner functioning pursuant to Section 2837.103 or 2837.104.

(1) A board-approved nurse practitioner program or in a course offered by an accredited nurse practitioner program.
(2) A course offered by a board-approved continuing education provider that reflects evidence-based curriculum and training guidelines or a course approved for Category I continuing medical education.
(3) A course offered by a state or national health care professional or accreditation organization.
(4) Training based on the competency-based training protocols established by the Health Workforce Pilot Project (HWPP) No. 171 through the Office of Statewide Health Planning and Development.
(5) Training and verification of clinical competency, performed at a clinic or hospital, on performing abortion by aspiration techniques provided by a physician, surgeon, nurse practitioner or certified nurse midwife authorized to perform abortion by aspiration techniques pursuant to this section, or a physician assistant authorized to perform abortion by aspiration techniques pursuant to Section 3502.4.
(b) In order to perform an abortion by aspiration techniques pursuant to Section 2253, a person with a license or certificate to practice as a certified nurse-midwife shall complete requisite training in performing these procedures provided by any of the following:
(1) A board-approved nurse-midwifery program or in a course offered by an accredited nurse-midwifery program.
(2) A course offered by a Board-approved continuing education provider that reflects evidence-based curriculum and training guidelines or a course approved for Category I continuing medical education.
(3) A course offered by a state or national health care professional or accreditation organization.
(4) Training based on the competency-based training protocols established by the Health Workforce Pilot Project (HWPP) No. 171 through the Office of Statewide Health Planning and Development.
(5) Training and verification of clinical competency at a clinic or hospital on performing abortion by aspiration techniques provided by a physician, surgeon, nurse practitioner or certified nurse midwife authorized to perform abortion by aspiration techniques pursuant to this section, or a physician assistant authorized to perform abortion by aspiration techniques pursuant to Section 3502.4.
(c) It is unprofessional conduct for any nurse practitioner or certified nurse-midwife to perform an abortion by aspiration techniques pursuant to Section 2253 without prior completion of training and validation of clinical competency. A violation of this section by a nurse practitioner or certified nurse midwife constitutes unprofessional conduct.
(d) A nurse practitioner who has completed training required in this section and is functioning pursuant to Section 2837.103 or 2837.104 may perform an abortion by aspiration techniques pursuant to Section 2253 without supervision by a physician or surgeon.
SEC. 2. Section 2837.101 of the Business and Professions Code is amended to read:
2837.101. (a) For purposes of this article, the following terms apply:
(1) “Committee” means the Nurse Practitioner Advisory Committee.
(2) “Standardized procedures” has the same meaning as that term is defined in Section 2725.
(3) “Transition to practice” means additional clinical experience and mentorship provided to prepare a nurse practitioner to practice independently. “Transition to practice” includes managing a panel of patients, working in a complex health care setting, interpersonal communication, interpersonal collaboration and team-based care, professionalism, and business management of a practice.
(b) A nurse practitioner who has been practicing a minimum of three full-time equivalent years or 4,600 hours as of January 1, 2023, shall satisfy the transition to practice requirement. Clinical experience may include experience obtained before January 1, 2023, and be counted towards the three full-time equivalent years or 4,600 hours.
SEC. 3. Section 2837.103 of the Business and Professions Code is amended to read:
2837.103. (a) (1) Notwithstanding any other law, a nurse practitioner may perform the functions specified in subdivision (c) pursuant to that subdivision, in a setting or organization specified in paragraph (2) pursuant to that paragraph, if the nurse practitioner has successfully satisfied the following requirements:
(A) Passed a national nurse practitioner board certification examination and, if applicable, any supplemental examination developed pursuant to paragraph (4) of subdivision (a) of Section 2837.105.
(B) Holds a certification as a nurse practitioner from a national certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties and recognized by the board.
(C) Provides documentation that educational training was consistent with standards established by the board pursuant to Section 2836 and any applicable regulations as they specifically relate to requirements for clinical practice hours. Online educational programs that do not include mandatory clinical hours shall not meet this requirement.
(D) Has completed a transition to practice in California, as described in Section 2837.101.
(2) A nurse practitioner who meets all of the requirements of paragraph (1) may practice, including, but not limited to, performing the functions authorized pursuant to subdivision (c), in one of the following settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures:
(A) A clinic, as defined in Section 1200 of the Health and Safety Code.
(B) A health facility, as defined in Section 1250 of the Health and Safety Code, except for the following:
(i) A correctional treatment center, as defined in paragraph (1) of subdivision (j) of Section 1250 of the Health and Safety Code.
(ii) A state hospital, as defined in Section 4100 of the Welfare and Institutions Code.
(C) A facility described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code.
(D) A medical group practice, including a professional medical corporation, as defined in Section 2406, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.
(E) A home health agency, as defined in Section 1727 of the Health and Safety Code.
(F) A hospice facility licensed pursuant to Chapter 8.5 (commencing with Section 1745) of Division 2 of the Health and Safety Code.
(3) In health care agencies that have governing bodies, as defined in Division 5 of Title 22 of the California Code of Regulations, including, but not limited to, Sections 70701 and 70703 of Title 22 of the California Code of Regulations, the following apply:
(A) A nurse practitioner shall adhere to all applicable bylaws.
(B) A nurse practitioner shall be eligible to serve on medical staff and hospital committees.
(C) A nurse practitioner shall be eligible to attend meetings of the department to which the nurse practitioner is assigned. A nurse practitioner shall not vote at department, division, or other meetings unless the vote is regarding the determination of nurse practitioner privileges with the organization, peer review of nurse practitioner clinical practice, whether a licensee’s employment is in the best interest of the communities served by a hospital pursuant to Section 2401, or the vote is otherwise allowed by the applicable bylaws.
(b) An entity described in subparagraphs (A) to (F), inclusive, of paragraph (2) of subdivision (a) shall not interfere with, control, or otherwise direct the professional judgment of a nurse practitioner functioning pursuant to this section in a manner prohibited by Section 2400 or any other law.
(c) In addition to any other practices authorized by law, a nurse practitioner who meets the requirements of paragraph (1) of subdivision (a) may perform the following functions without standardized procedures in accordance with their education and training:
(1) Conduct an advanced assessment.
(2) (A) Order, perform, and interpret diagnostic procedures.
(B) For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
(3) Establish primary and differential diagnoses.
(4) Prescribe, order, administer, dispense, procure, and furnish therapeutic measures, including, but not limited to, the following:
(A) Diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources.
(B) Prescribe, administer, dispense, and furnish pharmacological agents, including over-the-counter, legend, and controlled substances.
(C) Plan and initiate a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.
(5) After performing a physical examination, certify disability pursuant to Section 2708 of the Unemployment Insurance Code.
(6) Delegate tasks to a medical assistant pursuant to Sections 1206.5, 2069, 2070, and 2071, and Article 2 (commencing with Section 1366) of Chapter 3 of Division 13 of Title 16 of the California Code of Regulations.
(d) A nurse practitioner shall verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon. For purposes of Spanish language speakers, the nurse practitioner shall use the standardized phrase “enfermera especializada.”
(e) A nurse practitioner shall post a notice in a conspicuous location accessible to public view that the nurse practitioner is regulated by the Board of Registered Nursing. The notice shall include the board’s telephone number and the internet website where the nurse practitioner’s license may be checked and complaints against the nurse practitioner may be made.
(f) A nurse practitioner shall refer a patient to a physician and surgeon or other licensed health care provider if a situation or condition of a patient is beyond the scope of the education and training of the nurse practitioner.
(g) A nurse practitioner practicing under this section shall have professional liability insurance appropriate for the practice setting.
(h) Any health care setting operated by the Department of Corrections and Rehabilitation is exempt from this section.
SEC. 4.Section 123468 of the Health and Safety Code is amended to read:123468.

The performance of an abortion is unauthorized if either of the following is true:

(a)The person performing the abortion is not a health care provider authorized to perform an abortion pursuant to Section 2253 of the Business and Professions Code.

(b)The abortion is performed on a viable fetus, and both of the following are established:

(1)In the good faith medical judgment of the physician, nurse practitioner, certified nurse-midwife, or physician assistant, the fetus was viable.

(2)In the good faith medical judgment of the physician, nurse practitioner, certified nurse-midwife, or physician assistant, continuation of the pregnancy posed no risk to life or health of the pregnant woman.

SEC. 5.SEC. 4. 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.