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Bill Title: To modify the authority of certain advanced practice nurses to prescribe schedule II controlled substances and to authorize the Board of Nursing to take disciplinary actions for self-administration of schedule I controlled substances.
Spectrum: Slight Partisan Bill (Democrat 34-22)
Status: (Passed) 2012-06-08 - Effective Date
[SB83 Detail]Download: Ohio-2011-SB83-Introduced.html
As Introduced
129th General Assembly | Regular Session | 2011-2012 |
| |
Cosponsors:
Senators Tavares, Cafaro
A BILL
| To amend sections 3719.06, 4723.481, 4723.482, | 1 |
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4723.492, and 4723.50 of the Revised Code to | 2 |
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modify the authority of certain advanced practice | 3 |
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nurses to prescribe schedule II controlled | 4 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3719.06, 4723.481, 4723.482, | 6 |
4723.492, and 4723.50 of the Revised Code be amended to read as | 7 |
follows:
| 8 |
Sec. 3719.06. (A)(1) A licensed health professional | 9 |
authorized to prescribe drugs, if acting in the course of | 10 |
professional practice, in accordance with the laws regulating the | 11 |
professional's practice, and in accordance with rules adopted by | 12 |
the state board of pharmacy, may, except as provided in division | 13 |
(A)(2) or (3) of this section, do the following:
| 14 |
(a) Prescribe schedule II, III, IV, and V controlled | 15 |
substances;
| 16 |
(b) Administer or personally furnish to patients schedule II, | 17 |
III, IV, and V controlled substances;
| 18 |
(c) Cause schedule II, III, IV, and V controlled substances | 19 |
to be administered under the prescriber's direction and | 20 |
supervision.
| 21 |
(2) AAs provided in section 4723.481 of the Revised Code, a | 22 |
licensed health professional authorized to prescribe drugs who is | 23 |
a clinical nurse specialist, certified nurse-midwife, or | 24 |
certified nurse practitioner
is subject to bothshall not do | 25 |
either of the following:
| 26 |
(a) APrescribe to a patient in a convenience care clinic any | 27 |
schedule II controlled substance may be prescribed only for a | 28 |
patient with a terminal condition, as defined in section 2133.01 | 29 |
of the Revised Code, only if the nurse's collaborating physician | 30 |
initially prescribed the substance for the patient, and only in | 31 |
an amount that does not exceed the amount necessary for the | 32 |
patient's use in a single, twenty-four-hour period.; | 33 |
(b) NoPersonally furnish to a patient any schedule II | 34 |
controlled substance shall be personally furnished to any patient.
| 35 |
(3) A licensed health professional authorized to prescribe | 36 |
drugs who is a physician assistant shall not prescribe or | 37 |
personally furnish to patients any controlled substance that is | 38 |
not included in the physician-delegated prescriptive authority | 39 |
granted to the physician assistant in accordance with Chapter | 40 |
4730. of the Revised Code.
| 41 |
(B) No licensed health professional authorized to prescribe | 42 |
drugs shall prescribe, administer, or personally furnish a | 43 |
schedule III anabolic steroid for the purpose of human muscle | 44 |
building or enhancing human athletic performance and no pharmacist | 45 |
shall dispense a schedule III anabolic steroid for either purpose, | 46 |
unless it has been approved for that purpose under the "Federal | 47 |
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A. | 48 |
301, as amended.
| 49 |
(C) Each written prescription shall be properly executed, | 50 |
dated, and signed by the prescriber on the day when issued and | 51 |
shall bear the full name and address of the person for whom, or | 52 |
the owner of the animal for which, the controlled substance is | 53 |
prescribed and the full name, address, and registry number under | 54 |
the federal drug abuse control laws of the prescriber. If the | 55 |
prescription is for an animal, it shall state the species of the | 56 |
animal for which the controlled substance is prescribed.
| 57 |
Sec. 4723.481. Under a certificate to prescribe issued under | 58 |
section 4723.48 of the Revised Code, a clinical nurse specialist, | 59 |
certified nurse-midwife, or certified nurse practitioner is | 60 |
subject to all of the following:
| 61 |
(A) The clinical nurse specialist, certified nurse-midwife, | 62 |
or certified nurse practitioner shall not prescribe any drug or | 63 |
therapeutic device that is not included in the types of drugs and | 64 |
devices listed on the formulary established in rules adopted under | 65 |
section 4723.50 of the Revised Code.
| 66 |
(B) The nurse's prescriptive authority of the clinical nurse | 67 |
specialist, certified nurse-midwife, or certified nurse | 68 |
practitioner shall not exceed the prescriptive authority of the | 69 |
collaborating physician or podiatrist.
| 70 |
(C) The nurse may prescribe a schedule II controlled | 71 |
substance as specified in division (A)(2) of section 3719.06 of | 72 |
the Revised Code, but shall not prescribe a schedule II controlled | 73 |
substance in collaboration with a podiatristclinical nurse | 74 |
specialist, certified nurse-midwife, or certified nurse | 75 |
practitioner may prescribe to a patient a schedule II controlled | 76 |
substance included in the types of drugs and devices listed on the | 77 |
formulary, except that a schedule II controlled substance may not | 78 |
be prescribed to a patient in a convenience care clinic.
| 79 |
(D) The clinical nurse specialist, certified nurse-midwife, | 80 |
or certified nurse practitioner may personally furnish to a | 81 |
patient a sample of any drug or therapeutic device included in the | 82 |
types of drugs and devices listed on the formulary,
subject to | 83 |
except that all of the following conditions apply:
| 84 |
(1) The amount of the sample furnished shall not exceed a | 85 |
seventy-two-hour supply, except when the minimum available | 86 |
quantity of the sample is packaged in an amount that is greater | 87 |
than a seventy-two-hour supply, in which case
the nurse may | 88 |
furnish the sample in the packaged amount may be furnished.
| 89 |
(2) No charge may be imposed for the sample or for furnishing | 90 |
it.
| 91 |
(3) Samples of controlled substances may not be personally | 92 |
furnished.
| 93 |
(E) The clinical nurse specialist, certified nurse-midwife, | 94 |
or certified nurse practitioner may personally furnish to a | 95 |
patient a complete or partial supply of a drug or therapeutic | 96 |
device included in the types of drugs and devices listed on the | 97 |
formulary, subject toexcept that all of the following conditions | 98 |
apply:
| 99 |
(1) The clinical nurse specialist, certified nurse-midwife, | 100 |
or certified nurse practitioner shall personally furnish only | 101 |
antibiotics, antifungals, scabicides, contraceptives, prenatal | 102 |
vitamins, antihypertensives, drugs and devices used in the | 103 |
treatment of diabetes, drugs and devices used in the treatment of | 104 |
asthma, and drugs used in the treatment of dyslipidemia.
| 105 |
(2) The clinical nurse specialist, certified nurse-midwife, | 106 |
or certified nurse practitioner shall not furnish the drugs and | 107 |
devices in locations other than a health department operated by | 108 |
the board of health of a city or general health district or the | 109 |
authority having the duties of a board of health under section | 110 |
3709.05 of the Revised Code, a federally funded comprehensive | 111 |
primary care clinic, or a nonprofit health care clinic or program.
| 112 |
(3) The clinical nurse specialist, certified nurse-midwife, | 113 |
or certified nurse practitioner shall comply with all safety | 114 |
standards for personally furnishing supplies of drugs and devices, | 115 |
as established in rules adopted under section 4723.50 of the | 116 |
Revised Code.
| 117 |
Sec. 4723.482. (A) Except as provided in divisions (C) and | 118 |
(D) of this section, an applicant shall include with the | 119 |
application submitted under section 4723.48 of the Revised Code | 120 |
all of the following: | 121 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 122 |
of holding a current, valid certificate of authority issued under | 123 |
this chapter to practice as a clinical nurse specialist, certified | 124 |
nurse-midwife, or certified nurse practitioner; | 125 |
(2) Except for a person who on May 17, 2000, was approved to | 126 |
prescribe drugs and therapeutic devices under section 4723.56 of | 127 |
the Revised Code, as that section existed on that date, evidence | 128 |
Evidence of successfully completing the instructioncourse of | 129 |
study in advanced pharmacology and related topics in accordance | 130 |
with the requirements specified in division (B) of this section; | 131 |
(3) The fee required by section 4723.08 of the Revised Code | 132 |
for a certificate to prescribe; | 133 |
(4) Any additional information the board of nursing requires | 134 |
pursuant to rules adopted under section 4723.50 of the Revised | 135 |
Code. | 136 |
(B) AllWith respect to the course of study in advanced | 137 |
pharmacology and related topics that must be successfully | 138 |
completed to obtain a certificate to prescribe, all of the | 139 |
following requirements apply to the instruction required under | 140 |
division (A)(2) of this section: | 141 |
(1) The instruction mustcourse of study shall be obtained | 142 |
completed not longer than three years before the application for | 143 |
the certificate to prescribe is filed. | 144 |
(2) The instruction must be obtained through a course of | 145 |
study consistingshall consist of planned classroom and clinical | 146 |
study that isinstruction for a total of not less than forty-five | 147 |
contact hours. | 148 |
(3) The course of study shall meet the requirements to be | 149 |
approved by the board of nursing in accordance with standards | 150 |
established in rules adopted under section 4723.50 of the Revised | 151 |
Code. | 152 |
(3)(4) The content of the instruction mustcourse of study | 153 |
shall be specific to the applicant's nursing specialty and. | 154 |
(5) The instruction provided in the course of study shall | 155 |
include all of the following: | 156 |
(a) A minimum of thirtythirty-six contact hours of training | 157 |
instruction in advanced pharmacology that includes pharmacokinetic | 158 |
principles and clinical application and the use of drugs and | 159 |
therapeutic devices in the prevention of illness and maintenance | 160 |
of health; | 161 |
(b) TrainingInstruction in the fiscal and ethical | 162 |
implications of prescribing drugs and therapeutic devices; | 163 |
(c) TrainingInstruction in the state and federal laws that | 164 |
apply to the authority to prescribe; | 165 |
(d) Instruction that is specific to schedule II controlled | 166 |
substances, including instruction in all of the following: | 167 |
(i) Indications for the use of schedule II controlled | 168 |
substances in drug therapies; | 169 |
(ii) The most recent guidelines for pain management | 170 |
therapies, as established by state and national organizations | 171 |
such as the Ohio pain initiative and the American pain society; | 172 |
(iii) Fiscal and ethical implications of prescribing schedule | 173 |
II controlled substances; | 174 |
(iv) State and federal laws that apply to the authority to | 175 |
prescribe schedule II controlled substances; | 176 |
(v) Prevention of abuse and diversion of schedule II | 177 |
controlled substances, including identification of the risk of | 178 |
abuse and diversion, recognition of abuse and diversion, types of | 179 |
assistance available for prevention of abuse and diversion, and | 180 |
methods of establishing safeguards against abuse and diversion. | 181 |
(e) Any additional traininginstruction required pursuant to | 182 |
rules adopted under section 4723.50 of the Revised Code. | 183 |
(C) An applicant who practiced or is practicing as a clinical | 184 |
nurse specialist, certified nurse-midwife, or certified nurse | 185 |
practitioner in another jurisdiction or as an employee of the | 186 |
United States government, and is not seeking authority to | 187 |
prescribe drugs and therapeutic devices by meeting the | 188 |
requirements of division (A) or (D) of this section, shall include | 189 |
with the application submitted under section 4723.48 of the | 190 |
Revised Code all of the following: | 191 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 192 |
of holding a current, valid certificate of authority issued under | 193 |
this chapter to practice as a clinical nurse specialist, certified | 194 |
nurse-midwife, or certified nurse practitioner; | 195 |
(2) The fee required by section 4723.08 of the Revised Code | 196 |
for a certificate to prescribe; | 197 |
(3) Either of the following: | 198 |
(a) Evidence of having held, for a continuous period of at | 199 |
least one year during the three years immediately preceding the | 200 |
date of application, valid authority issued by another | 201 |
jurisdiction to prescribe therapeutic devices and drugs, including | 202 |
at least some controlled substances; | 203 |
(b) Evidence of having been employed by the United States | 204 |
government and authorized, for a continuous period of at least one | 205 |
year during the three years immediately preceding the date of | 206 |
application, to prescribe therapeutic devices and drugs, including | 207 |
at least some controlled substances, in conjunction with that | 208 |
employment. | 209 |
(4) If the applicant includes the evidence described in | 210 |
division (C)(3)(a) of this section, documentation from a licensed | 211 |
physician in a form acceptable to the board that the prescribing | 212 |
component of the nurse's practice was overseen or supervised by a | 213 |
licensed physician in the other jurisdiction; | 214 |
(5) If the applicant includes the evidence described in | 215 |
division (C)(3)(b) of this section, documentation from a licensed | 216 |
physician employed by the United States government in a form | 217 |
acceptable to the board that the prescribing component of the | 218 |
nurse's practice was overseen or supervised by a licensed | 219 |
physician employed by the United States government; | 220 |
(6) Evidence of having completed a two-hour course of | 221 |
instruction approved by the board in the laws of this state that | 222 |
govern drugs and prescriptive authority; | 223 |
(7) Any additional information the board requires pursuant to | 224 |
rules adopted under section 4723.50 of the Revised Code. | 225 |
(D) An applicant who practiced or is practicing as a clinical | 226 |
nurse specialist, certified nurse-midwife, or certified nurse | 227 |
practitioner in another jurisdiction or as an employee of the | 228 |
United States government, and is not seeking authority to | 229 |
prescribe drugs and therapeutic devices by meeting the | 230 |
requirements of division (A) or (C) of this section, shall include | 231 |
with the application submitted under section 4723.48 of the | 232 |
Revised Code all of the following: | 233 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 234 |
of holding a current, valid certificate of authority issued under | 235 |
this chapter to practice as a clinical nurse specialist, certified | 236 |
nurse-midwife, or certified nurse practitioner; | 237 |
(2) The fee required by section 4723.08 of the Revised Code | 238 |
for a certificate to prescribe; | 239 |
(3) Either of the following: | 240 |
(a) Evidence of having held, for a continuous period of at | 241 |
least one year during the three years immediately preceding the | 242 |
date of application, valid authority issued by another | 243 |
jurisdiction to prescribe therapeutic devices and drugs, excluding | 244 |
controlled substances; | 245 |
(b) Evidence of having been employed by the United States | 246 |
government and authorized, for a continuous period of at least one | 247 |
year during the three years immediately preceding the date of | 248 |
application, to prescribe therapeutic devices and drugs, excluding | 249 |
controlled substances, in conjunction with that employment. | 250 |
(4) If the applicant includes the evidence described in | 251 |
division (D)(3)(a) of this section, documentation from a licensed | 252 |
physician in a form acceptable to the board that the prescribing | 253 |
component of the nurse's practice was overseen or supervised by a | 254 |
licensed physician in the other jurisdiction; | 255 |
(5) If the applicant includes the evidence described in | 256 |
division (D)(3)(b) of this section, documentation from a licensed | 257 |
physician employed by the United States government in a form | 258 |
acceptable to the board that the prescribing component of the | 259 |
nurse's practice was overseen or supervised by a licensed | 260 |
physician employed by the United States government; | 261 |
(6) Any additional information the board requires pursuant to | 262 |
rules adopted under section 4723.50 of the Revised Code. | 263 |
Sec. 4723.492. The committee on prescriptive governance | 264 |
shall develop recommendations regarding the authority to prescribe | 265 |
drugs and therapeutic devices pursuant to a certificate to | 266 |
prescribe issued under section 4723.48 of the Revised Code. Not | 267 |
later than fourteen months after the effective date of this | 268 |
section, theThe recommendations shall include provisions that | 269 |
apply specifically to the authority to prescribe schedule II | 270 |
controlled substances. | 271 |
The committee shall submit recommendations to the board of | 272 |
nursing as necessary for the board to fulfill its duty to adopt | 273 |
rules under section 4723.50 of the Revised Code. At the board's | 274 |
request, the committee shall reconsider a recommendation it has | 275 |
submitted and resubmit the recommendation to the board | 276 |
accordingly.
| 277 |
Sec. 4723.50. (A) In accordance with Chapter 119. of the | 278 |
Revised Code, the board of nursing shall adopt rules as necessary | 279 |
to implement the provisions of this chapter pertaining to the | 280 |
authority of clinical nurse specialists, certified nurse-midwives, | 281 |
and certified nurse practitioners to prescribe drugs and | 282 |
therapeutic devices and the issuance and renewal of certificates | 283 |
to prescribe. Initial rules shall be adopted not later than twenty | 284 |
months after May 17, 2000. | 285 |
The board shall adopt rules that are consistent with the | 286 |
recommendations the board receives from the committee on | 287 |
prescriptive governance pursuant to section 4723.492 of the | 288 |
Revised Code. After reviewing a recommendation submitted by the | 289 |
committee, the board may either adopt the recommendation as a rule | 290 |
or ask the committee to reconsider and resubmit the | 291 |
recommendation. The board shall not adopt any rule that does not | 292 |
conform to a recommendation made by the committee. | 293 |
(B) The board shall adopt rules under this section that do | 294 |
all of the following: | 295 |
(1) Establish a formulary listing the types of drugs and | 296 |
therapeutic devices that may be prescribed by a clinical nurse | 297 |
specialist, certified nurse-midwife, or certified nurse | 298 |
practitioner. The formulary may include controlled substances, as | 299 |
defined in section 3719.01 of the Revised Code. The formulary | 300 |
shall not permit the prescribing of any drug or device to perform | 301 |
or induce an abortion. | 302 |
(2) Establish safety standards to be followed by a clinical | 303 |
nurse specialist, certified nurse-midwife, or certified nurse | 304 |
practitioner when personally furnishing to patients complete or | 305 |
partial supplies of antibiotics, antifungals, scabicides, | 306 |
contraceptives, prenatal vitamins, antihypertensives, drugs and | 307 |
devices used in the treatment of diabetes, drugs and devices used | 308 |
in the treatment of asthma, and drugs used in the treatment of | 309 |
dyslipidemia.; | 310 |
(3) Establish criteria for the components of the standard | 311 |
care arrangements described in section 4723.431 of the Revised | 312 |
Code that apply to a nurse'sthe authority to prescribe, including | 313 |
the components that apply to the authority to prescribe schedule | 314 |
II controlled substances. The rules shall be consistent with that | 315 |
section and include all of the following: | 316 |
(a) Quality assurance standards; | 317 |
(b) Standards for periodic review by a collaborating | 318 |
physician or podiatrist of the records of patients treated by the | 319 |
clinical nurse specialist, certified nurse-midwife, or certified | 320 |
nurse practitioner; | 321 |
(c) Acceptable travel time between the location at which the | 322 |
clinical nurse specialist, certified nurse-midwife, or certified | 323 |
nurse practitioner is engaging in the prescribing components of | 324 |
the nurse's practice and the location of the nurse's collaborating | 325 |
physician or podiatrist; | 326 |
(d) Any other criteria recommended by the committee on | 327 |
prescriptive governance. | 328 |
(4) Establish standards and procedures for issuance and | 329 |
renewal of a certificate to prescribe, including specification of | 330 |
any additional information the board may require under division | 331 |
(A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3) | 332 |
of section 4723.485 of the Revised Code; | 333 |
(5) Establish requirementsstandards for board approval of | 334 |
the
instructioncourse of study in advanced pharmacology and | 335 |
related topics required by section 4723.482 of the Revised Code; | 336 |
(6) Establish requirements for board approval of the two-hour | 337 |
course of instruction in the laws of this state as required under | 338 |
division (C)(6) of section 4723.482 of the Revised Code and | 339 |
division (B)(2) of section 4723.484 of the Revised Code; | 340 |
(7) Establish standards and procedures for the appropriate | 341 |
conduct of an externship as described in section 4723.484 of the | 342 |
Revised Code, including the following: | 343 |
(a) Standards and procedures to be used in evaluating a | 344 |
nurse'san individual's participation in an externship; | 345 |
(b) Standards and procedures for the supervision that a | 346 |
physician must provide during an externship, including supervision | 347 |
provided by working with the nurseparticipant and supervision | 348 |
provided by making timely reviews of the records of patients | 349 |
treated by the
nurseparticipant. The manner in which supervision | 350 |
must be provided may vary according to the location where the | 351 |
nurseparticipant is practicing and with the nurse'sparticipant's | 352 |
level of experience. | 353 |
Section 2. That existing sections 3719.06, 4723.481, | 354 |
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby | 355 |
repealed.
| 356 |
Section 3. (A) Notwithstanding the provisions of section | 357 |
4723.486 of the Revised Code specifying the requirements for | 358 |
renewal of a certificate to prescribe, or the provisions of | 359 |
division (B) of section 4723.485 of the Revised Code specifying | 360 |
the conditions of eligibility for a certificate to prescribe | 361 |
issued after practicing under an externship certificate, a | 362 |
clinical nurse specialist, certified nurse-midwife, or certified | 363 |
nurse practitioner holding a certificate to prescribe that was | 364 |
issued prior to the effective date of this act shall successfully | 365 |
complete, as a condition of renewing the certificate or receiving | 366 |
a new certificate, a minimum of six contact hours of instruction | 367 |
regarding schedule II controlled substances as described in | 368 |
section 4723.482 of the Revised Code, as amended by this act. In | 369 |
the case of a certificate that is being renewed, the certificate | 370 |
holder shall complete the instruction in addition to all other | 371 |
continuing nursing education that must be completed by the | 372 |
certificate holder not later than August 31, 2013.
| 373 |
(B) Notwithstanding the amendments made by this act to | 374 |
sections 3719.06 and 4723.481 of the Revised Code, until the | 375 |
applicable requirements of division (A) of this section have been | 376 |
complied with, a certificate holder shall not prescribe a schedule | 377 |
II controlled substance to a patient unless all of the following | 378 |
conditions are met:
| 379 |
(1) The patient is in a terminal condition, as defined in | 380 |
section 2133.01 of the Revised Code.
| 381 |
(2) The certificate holder's collaborating physician | 382 |
initially prescribed the substance for the patient.
| 383 |
(3) The amount prescribed does not exceed the amount | 384 |
necessary for the patient's use in a single, twenty-four-hour | 385 |
period.
| 386 |
Section 4. Not later than 90 days after the effective date of | 387 |
this section, the Committee on Prescriptive Governance shall | 388 |
develop recommendations under section 4723.492 of the Revised | 389 |
Code regarding the authority to prescribe schedule II controlled | 390 |
substances pursuant to a certificate to prescribe. The Committee | 391 |
shall submit the recommendations to the Board of Nursing in | 392 |
accordance with the procedures specified in section 4723.492 of | 393 |
the Revised Code.
| 394 |
Section 5. The Board of Nursing shall adopt rules under | 395 |
section 4723.50 of the Revised Code as necessary to implement the | 396 |
provisions of this act pertaining to the authority to prescribe | 397 |
schedule II controlled substances pursuant to a certificate to | 398 |
prescribe. The rules shall conform to the recommendations | 399 |
submitted by the Committee on Prescriptive Governance.
| 400 |