Bill Text: OH SB200 | 2009-2010 | 128th General Assembly | Introduced

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Bill Title: To authorize certified registered nurse anesthetists to issue prescriptions for the administration of drugs during certain phases of patient care.

Spectrum: Moderate Partisan Bill (Democrat 7-1)

Status: (Introduced - Dead) 2009-11-10 - To Health, Human Services, & Aging [SB200 Detail]

Download: Ohio-2009-SB200-Introduced.html

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As Introduced

128th General Assembly Regular Session 2009-2010

S. B. No. 200

Senator Morano 

Cosponsors: Senators Cafaro, Miller, D., Kearney, Sawyer, Schiavoni, Turner, Schaffer 

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A BILL

To amend sections 4723.43, 4723.44, 4729.01, and

1

4761.17 of the Revised Code to authorize

2

certified registered nurse anesthetists to issue

3

prescriptions for the administration of drugs

4

during certain phases of patient care.

5

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 4723.43, 4723.44, 4729.01, and	6
4761.17 of the Revised Code be amended to read as follows:	7

Sec. 4723.43.  A certified registered nurse anesthetist,	8
clinical nurse specialist, certified nurse-midwife, or certified	9
nurse practitioner may provide to individuals and groups nursing	10
care that requires knowledge and skill obtained from advanced	11
formal education and clinical experience. In this capacity as an	12
advanced practice nurse, a certified nurse-midwife is subject to	13
division (A) of this section, a certified registered nurse	14
anesthetist is subject to division (B) of this section, a	15
certified nurse practitioner is subject to division (C) of this	16
section, and a clinical nurse specialist is subject to division	17
(D) of this section.	18

(A) A nurse authorized to practice as a certified	19
nurse-midwife, in collaboration with one or more physicians, may	20
provide the management of preventive services and those primary	21
care services necessary to provide health care to women	22
antepartally, intrapartally, postpartally, and gynecologically,	23
consistent with the nurse's education and certification, and in	24
accordance with rules adopted by the board.	25

No certified nurse-midwife may perform version, deliver	26
breech or face presentation, use forceps, do any obstetric	27
operation, or treat any other abnormal condition, except in	28
emergencies. Division (A) of this section does not prohibit a	29
certified nurse-midwife from performing episiotomies or normal	30
vaginal deliveries, or repairing vaginal tears. A certified	31
nurse-midwife who holds a certificate to prescribe issued under	32
section 4723.48 of the Revised Code may, in collaboration with one	33
or more physicians, prescribe drugs and therapeutic devices in	34
accordance with section 4723.481 of the Revised Code.	35

(B)(1) A nurse authorized to practice as a certified	36
registered nurse anesthetist, with the supervision and in the	37
immediate presence of a physician, podiatrist, or dentist who is	38
actively engaged in practice in this state, consistent with the	39
nurse's education and certification, and in accordance with rules	40
adopted by the board, may administerdo all of the following:	41

(a) While in the immediate presence of a physician,	42
podiatrist, or dentist, administer anesthesia and perform	43
anesthesia induction, maintenance, and emergence, and may perform	44
with supervision;	45

(b) Perform preanesthetic preparation and evaluation,	46
postanesthesia care, and clinical support functions, consistent	47
with the nurse's education and certification, and in accordance	48
with rules adopted by the board. A;	49

(c) Only during the phases of patient care directly related	50
to the activities described in divisions (B)(1)(a) and (b) of this	51
section and subject to divisions (B)(3) and (4) of this section,	52
issue a written, oral, or electronic prescription under which	53
the certified registered nurse anesthetist directs any of the	54
following to administer a drug to a patient:	55

(i) An individual licensed under this chapter as a registered	56
nurse or a licensed practical nurse and is acting within the scope	57
of that individual's practice;	58

(ii) An individual licensed under Chapter 4761. of the	59
Revised Code as a respiratory therapist and is acting within the	60
scope of that individual's practice;	61

(iii) Any other individual licensed or otherwise specifically	62
authorized by the Revised Code to administer drugs and is acting	63
within the scope of that individual's practice.	64

(2) A certified registered nurse anesthetist is not required	65
to obtain a certificate to prescribe in order to provide the	66
anesthesia care or issue a prescription as described in this	67
division (B)(1) of this section.	68

The physician, podiatrist, or dentist supervising a certified	69
registered nurse anesthetist must be actively engaged in practice	70
in this state. When	71

(3) When a certified registered nurse anesthetist is	72
supervised by a podiatrist, theall of the following conditions	73
apply:	74

(a) The nurse's scope of practice is limited to the	75
anesthesia procedures that the podiatrist has the authority under	76
section 4731.51 of the Revised Code to perform. A certified	77
registered nurse anesthetist may	78

(b) The nurse shall not administer general anesthesia under	79
the podiatrist's supervision of a podiatrist in athe podiatrist's	80
office. When	81

(c) The nurse's authority to issue a prescription as	82
described in division (B)(1)(c) of this section shall not exceed	83
the podiatrist's authority to issue a prescription.	84

(4) When a certified registered nurse anesthetist is	85
supervised by a dentist, theboth of the following conditions	86
apply:	87

(a) The nurse's scope of practice is limited to the	88
anesthesia procedures that the dentist has the authority under	89
Chapter 4715. of the Revised Code to perform.	90

(b) The nurse's authority to issue a prescription as	91
described in division (B)(1)(c) of this division shall not exceed	92
the dentist's authority to issue a prescription.	93

(C) A nurse authorized to practice as a certified nurse	94
practitioner, in collaboration with one or more physicians or	95
podiatrists, may provide preventive and primary care services and	96
evaluate and promote patient wellness within the nurse's nursing	97
specialty, consistent with the nurse's education and	98
certification, and in accordance with rules adopted by the board.	99
A certified nurse practitioner who holds a certificate to	100
prescribe issued under section 4723.48 of the Revised Code may, in	101
collaboration with one or more physicians or podiatrists,	102
prescribe drugs and therapeutic devices in accordance with section	103
4723.481 of the Revised Code.	104

When a certified nurse practitioner is collaborating with a	105
podiatrist, the nurse's scope of practice is limited to the	106
procedures that the podiatrist has the authority under section	107
4731.51 of the Revised Code to perform.	108

(D) A nurse authorized to practice as a clinical nurse	109
specialist, in collaboration with one or more physicians or	110
podiatrists, may provide and manage the care of individuals and	111
groups with complex health problems and provide health care	112
services that promote, improve, and manage health care within the	113
nurse's nursing specialty, consistent with the nurse's education	114
and in accordance with rules adopted by the board. A clinical	115
nurse specialist who holds a certificate to prescribe issued under	116
section 4723.48 of the Revised Code may, in collaboration with one	117
or more physicians or podiatrists, prescribe drugs and therapeutic	118
devices in accordance with section 4723.481 of the Revised Code.	119

When a clinical nurse specialist is collaborating with a	120
podiatrist, the nurse's scope of practice is limited to the	121
procedures that the podiatrist has the authority under section	122
4731.51 of the Revised Code to perform.	123

Sec. 4723.44.  (A) No person shall do any of the following	124
unless the person holds a current, valid certificate of authority	125
to practice nursing as a certified registered nurse anesthetist,	126
clinical nurse specialist, certified nurse-midwife, or certified	127
nurse practitioner issued by the board of nursing under this	128
chapter:	129

(1) Engage in the practice of nursing as a certified	130
registered nurse anesthetist, clinical nurse specialist, certified	131
nurse-midwife, or certified nurse practitioner for a fee, salary,	132
or other consideration, or as a volunteer;	133

(2) Represent the person as being a certified registered	134
nurse anesthetist, clinical nurse specialist, certified	135
nurse-midwife, or certified nurse practitioner;	136

(3) Use any title or initials implying that the person is a	137
certified registered nurse anesthetist, clinical nurse specialist,	138
certified nurse-midwife, or certified nurse practitioner;	139

(4) Represent the person as being an advanced practice nurse;

140

(5) Use any title or initials implying that the person is an	141
advanced practice nurse.	142

(B) No person who is not certified by the national council on	143
certification of nurse anesthetists of the American association of	144
nurse anesthetists, the national council on recertification of	145
nurse anesthetists of the American association of nurse	146
anesthetists, or another national certifying organization approved	147
by the board under section 4723.46 of the Revised Code shall use	148
the title "certified registered nurse anesthetist" or the initials	149
"C.R.N.A.," or any other title or initial implying that the person	150
has been certified by the council or organization.	151

(C) No certified registered nurse anesthetist, clinical nurse	152
specialist, certified nurse-midwife, or certified nurse	153
practitioner shall do any of the following:	154

(1) Engage, for a fee, salary, or other consideration, or as	155
a volunteer, in the practice of a nursing specialty other than the	156
specialty designated on the nurse's current, valid certificate of	157
authority issued by the board under this chapter;	158

(2) Represent the person as being authorized to practice any	159
nursing specialty other than the specialty designated on the	160
current, valid certificate of authority;	161

(3) Use the title "certified registered nurse anesthetist" or	162
the initials "N.A." or "C.R.N.A.," the title "clinical nurse	163
specialist" or the initials "C.N.S.," the title "certified	164
nurse-midwife" or the initials "C.N.M.," the title "certified	165
nurse practitioner" or the initials "C.N.P.," the title "advanced	166
practice nurse" or the initials "A.P.N.," or any other title or	167
initials implying that the nurse is authorized to practice any	168
nursing specialty other than the specialty designated on the	169
nurse's current, valid certificate of authority;	170

(4) Enter into a standard care arrangement with a physician	171
or podiatrist whose practice is not the same as or similar to the	172
nurse's nursing specialty;	173

(5) Prescribe drugs or therapeutic devices unless the nurse	174
holds a current, valid certificate to prescribe issued under	175
section 4723.48 of the Revised Code or the nurse prescribes drugs	176
pursuant to division (B) of section 4723.43 of the Revised Code;	177

(6) Prescribe drugs or therapeutic devices under a	178
certificate to prescribe in a manner that does not comply with	179
section 4723.481 of the Revised Code or prescribe drugs pursuant	180
to division (B) of section 4723.43 of the Revised Code in a manner	181
that does not comply with that division;	182

(7) Prescribe any drug or device to perform or induce an	183
abortion, or otherwise Performperform or induce an abortion.	184

(D) No person shall knowingly employ a person to engage in	185
the practice of nursing as a certified registered nurse	186
anesthetist, clinical nurse specialist, certified nurse-midwife,	187
or certified nurse practitioner unless the person so employed	188
holds a current, valid certificate of authority to engage in that	189
nursing specialty issued by the board under this chapter.	190

(E) A certificate certified by the executive director of the	191
board, under the official seal of the board, to the effect that it	192
appears from the records that no certificate of authority to	193
practice nursing as a certified registered nurse anesthetist,	194
clinical nurse specialist, certified nurse-midwife, or certified	195
nurse practitioner has been issued to any person specified	196
therein, or that a certificate, if issued, has been revoked or	197
suspended, shall be received as prima-facie evidence of the record	198
in any court or before any officer of the state.	199

Sec. 4729.01. As used in this chapter:

200

(A) "Pharmacy," except when used in a context that refers to	201
the practice of pharmacy, means any area, room, rooms, place of	202
business, department, or portion of any of the foregoing where the	203
practice of pharmacy is conducted.	204

(B) "Practice of pharmacy" means providing pharmacist care	205
requiring specialized knowledge, judgment, and skill derived from	206
the principles of biological, chemical, behavioral, social,	207
pharmaceutical, and clinical sciences. As used in this division,	208
"pharmacist care" includes the following:	209

(1) Interpreting prescriptions;

210

(2) Dispensing drugs and drug therapy related devices;

211

(3) Compounding drugs;

212

(4) Counseling individuals with regard to their drug therapy,	213
recommending drug therapy related devices, and assisting in the	214
selection of drugs and appliances for treatment of common diseases	215
and injuries and providing instruction in the proper use of the	216
drugs and appliances;	217

(5) Performing drug regimen reviews with individuals by	218
discussing all of the drugs that the individual is taking and	219
explaining the interactions of the drugs;	220

(6) Performing drug utilization reviews with licensed health	221
professionals authorized to prescribe drugs when the pharmacist	222
determines that an individual with a prescription has a drug	223
regimen that warrants additional discussion with the prescriber;	224

(7) Advising an individual and the health care professionals	225
treating an individual with regard to the individual's drug	226
therapy;	227

(8) Acting pursuant to a consult agreement with a physician	228
authorized under Chapter 4731. of the Revised Code to practice	229
medicine and surgery or osteopathic medicine and surgery, if an	230
agreement has been established with the physician;	231

(9) Engaging in the administration of immunizations to the	232
extent authorized by section 4729.41 of the Revised Code.	233

(C) "Compounding" means the preparation, mixing, assembling,	234
packaging, and labeling of one or more drugs in any of the	235
following circumstances:	236

(1) Pursuant to a prescription issued by a licensed health	237
professional authorized to prescribe drugs;	238

(2) Pursuant to the modification of a prescription made in	239
accordance with a consult agreement;	240

(3) As an incident to research, teaching activities, or	241
chemical analysis;	242

(4) In anticipation of orders for drugs pursuant to	243
prescriptions, based on routine, regularly observed dispensing	244
patterns;	245

(5) Pursuant to a request made by a licensed health	246
professional authorized to prescribe drugs for a drug that is to	247
be used by the professional for the purpose of direct	248
administration to patients in the course of the professional's	249
practice, if all of the following apply:	250

(a) At the time the request is made, the drug is not	251
commercially available regardless of the reason that the drug is	252
not available, including the absence of a manufacturer for the	253
drug or the lack of a readily available supply of the drug from a	254
manufacturer.	255

(b) A limited quantity of the drug is compounded and provided	256
to the professional.	257

(c) The drug is compounded and provided to the professional	258
as an occasional exception to the normal practice of dispensing	259
drugs pursuant to patient-specific prescriptions.	260

(D) "Consult agreement" means an agreement to manage an	261
individual's drug therapy that has been entered into by a	262
pharmacist and a physician authorized under Chapter 4731. of the	263
Revised Code to practice medicine and surgery or osteopathic	264
medicine and surgery.	265

(E) "Drug" means:

266

(1) Any article recognized in the United States pharmacopoeia	267
and national formulary, or any supplement to them, intended for	268
use in the diagnosis, cure, mitigation, treatment, or prevention	269
of disease in humans or animals;	270

(2) Any other article intended for use in the diagnosis,	271
cure, mitigation, treatment, or prevention of disease in humans or	272
animals;	273

(3) Any article, other than food, intended to affect the	274
structure or any function of the body of humans or animals;	275

(4) Any article intended for use as a component of any	276
article specified in division (E)(1), (2), or (3) of this section;	277
but does not include devices or their components, parts, or	278
accessories.	279

(F) "Dangerous drug" means any of the following:

280

(1) Any drug to which either of the following applies:

281

(a) Under the "Federal Food, Drug, and Cosmetic Act," 52	282
Stat. 1040 (1938), 21 U.S.C.A. 301, as amended, the drug is	283
required to bear a label containing the legend "Caution: Federal	284
law prohibits dispensing without prescription" or "Caution:	285
Federal law restricts this drug to use by or on the order of a	286
licensed veterinarian" or any similar restrictive statement, or	287
the drug may be dispensed only upon a prescription;	288

(b) Under Chapter 3715. or 3719. of the Revised Code, the	289
drug may be dispensed only upon a prescription.	290

(2) Any drug that contains a schedule V controlled substance	291
and that is exempt from Chapter 3719. of the Revised Code or to	292
which that chapter does not apply;	293

(3) Any drug intended for administration by injection into	294
the human body other than through a natural orifice of the human	295
body.	296

(G) "Federal drug abuse control laws" has the same meaning as	297
in section 3719.01 of the Revised Code.	298

(H) "Prescription" means a written, electronic, or oral order	299
for drugs or combinations or mixtures of drugs to be used by a	300
particular individual or for treating a particular animal, issued	301
by a licensed health professional authorized to prescribe drugs.	302

(I) "Licensed health professional authorized to prescribe	303
drugs" or "prescriber" means an individual who is authorized by	304
law to prescribe drugs or dangerous drugs or drug therapy related	305
devices in the course of the individual's professional practice,	306
including only the following:	307

(1) A dentist licensed under Chapter 4715. of the Revised	308
Code;	309

(2) A clinical nurse specialist, certified nurse-midwife, or	310
certified nurse practitioner who holds a certificate to prescribe	311
issued under section 4723.48 of the Revised Code;	312

(3) A certified registered nurse anesthetist who prescribes	313
drugs pursuant to division (B) of section 4723.43 of the Revised	314
Code;	315

(4) An optometrist licensed under Chapter 4725. of the	316
Revised Code to practice optometry under a therapeutic	317
pharmaceutical agents certificate;	318

(4)(5) A physician authorized under Chapter 4731. of the	319
Revised Code to practice medicine and surgery, osteopathic	320
medicine and surgery, or podiatry;	321

(5)(6) A physician assistant who holds a certificate to	322
prescribe issued under Chapter 4730. of the Revised Code;	323

(6)(7) A veterinarian licensed under Chapter 4741. of the	324
Revised Code.	325

(J) "Sale" and "sell" include delivery, transfer, barter,	326
exchange, or gift, or offer therefor, and each such transaction	327
made by any person, whether as principal proprietor, agent, or	328
employee.	329

(K) "Wholesale sale" and "sale at wholesale" mean any sale in	330
which the purpose of the purchaser is to resell the article	331
purchased or received by the purchaser.	332

(L) "Retail sale" and "sale at retail" mean any sale other	333
than a wholesale sale or sale at wholesale.	334

(M) "Retail seller" means any person that sells any dangerous	335
drug to consumers without assuming control over and responsibility	336
for its administration. Mere advice or instructions regarding	337
administration do not constitute control or establish	338
responsibility.	339

(N) "Price information" means the price charged for a	340
prescription for a particular drug product and, in an easily	341
understandable manner, all of the following:	342

(1) The proprietary name of the drug product;

343

(2) The established (generic) name of the drug product;

344

(3) The strength of the drug product if the product contains	345
a single active ingredient or if the drug product contains more	346
than one active ingredient and a relevant strength can be	347
associated with the product without indicating each active	348
ingredient. The established name and quantity of each active	349
ingredient are required if such a relevant strength cannot be so	350
associated with a drug product containing more than one	351
ingredient.	352

(4) The dosage form;

353

(5) The price charged for a specific quantity of the drug	354
product. The stated price shall include all charges to the	355
consumer, including, but not limited to, the cost of the drug	356
product, professional fees, handling fees, if any, and a statement	357
identifying professional services routinely furnished by the	358
pharmacy. Any mailing fees and delivery fees may be stated	359
separately without repetition. The information shall not be false	360
or misleading.	361

(O) "Wholesale distributor of dangerous drugs" means a person	362
engaged in the sale of dangerous drugs at wholesale and includes	363
any agent or employee of such a person authorized by the person to	364
engage in the sale of dangerous drugs at wholesale.	365

(P) "Manufacturer of dangerous drugs" means a person, other	366
than a pharmacist, who manufactures dangerous drugs and who is	367
engaged in the sale of those dangerous drugs within this state.	368

(Q) "Terminal distributor of dangerous drugs" means a person	369
who is engaged in the sale of dangerous drugs at retail, or any	370
person, other than a wholesale distributor or a pharmacist, who	371
has possession, custody, or control of dangerous drugs for any	372
purpose other than for that person's own use and consumption, and	373
includes pharmacies, hospitals, nursing homes, and laboratories	374
and all other persons who procure dangerous drugs for sale or	375
other distribution by or under the supervision of a pharmacist or	376
licensed health professional authorized to prescribe drugs.	377

(R) "Promote to the public" means disseminating a	378
representation to the public in any manner or by any means, other	379
than by labeling, for the purpose of inducing, or that is likely	380
to induce, directly or indirectly, the purchase of a dangerous	381
drug at retail.	382

(S) "Person" includes any individual, partnership,	383
association, limited liability company, or corporation, the state,	384
any political subdivision of the state, and any district,	385
department, or agency of the state or its political subdivisions.	386

(T) "Finished dosage form" has the same meaning as in section	387
3715.01 of the Revised Code.	388

(U) "Generically equivalent drug" has the same meaning as in	389
section 3715.01 of the Revised Code.	390

(V) "Animal shelter" means a facility operated by a humane	391
society or any society organized under Chapter 1717. of the	392
Revised Code or a dog pound operated pursuant to Chapter 955. of	393
the Revised Code.	394

(W) "Food" has the same meaning as in section 3715.01 of the	395
Revised Code.	396

Sec. 4761.17.  All of the following apply to the practice of	397
respiratory care by a person who holds a license or limited permit	398
issued under this chapter:	399

(A) The person shall practice only pursuant to a	400
prescription or other order for respiratory care issued by a	401
physician or by aone or more of the following:	402

(1) A physician;

403

(2) A registered nurse who holds a certificate of authority	404
issued under Chapter 4723. of the Revised Code to practice as a	405
certified nurse practitioner or clinical nurse specialist and has	406
entered into a standard care arrangement with a physician that	407
allows the nurse to prescribe or order respiratory care services;	408

(3) A certified registered nurse anesthetist when the	409
prescription is issued in accordance with division (B) of section	410
4723.43 of the Revised Code.	411

(B) The person shall practice only under one of the following	412
conditions:	413

(1) Pursuant to the supervision of a physician or under;

414

(2) Pursuant to the supervision of a certified nurse	415
practitioner or clinical nurse specialist who is authorized to	416
prescribe or order respiratory care services as provided in	417
division (A)(2) of this section;	418

(3) Pursuant to the authority of a certified registered nurse	419
anesthetist who is supervised by a physician in accordance with	420
division (B) of section 4723.43 of the Revised Code.	421

(C)(1) When practicing under the prescription or order of a	422
certified nurse practitioner or clinical nurse specialist or under	423
pursuant to the supervision of such a nurse, the person's	424
administration of medication that requires a prescription is	425
limited to the drugs that the nurse is authorized to prescribe	426
pursuant to the nurse's certificate to prescribe issued under	427
section 4723.48 of the Revised Code.	428

(2) When practicing under the prescription or order of a	429
certified registered nurse anesthetist or pursuant to the	430
authority of such a nurse, the person's administration of	431
medication shall occur only during the phases of patient care	432
directly related to the nurse's activities described in divisions	433
(B)(1)(a) and (b) of section 4723.43 of the Revised Code and in	434
accordance with the nurse's authority to prescribe drugs during	435
those phases, as described in division (B)(1)(c) of section	436
4723.43 of the Revised Code.	437

Section 2. That existing sections 4723.43, 4723.44, 4729.01,	438
and 4761.17 of the Revised Code are hereby repealed.	439