Bill Text: OR SB952 | 2011 | Regular Session | Engrossed
Bill Title: Relating to dispensing of drugs; declaring an emergency.
Spectrum: Committee Bill
Status: (Failed) 2011-06-30 - In committee upon adjournment. [SB952 Detail]
Download: Oregon-2011-SB952-Engrossed.html
76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 3992
A-Engrossed
Senate Bill 952
Ordered by the Senate April 20
Including Senate Amendments dated April 20
Sponsored by COMMITTEE ON HEALTH CARE, HUMAN SERVICES AND RURAL
HEALTH POLICY
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure.
Permits supervising physician or supervising physician
organization to apply to Oregon Medical Board for dispensing
authority for physician assistant.
Removes limitation providing that Oregon State Board of Nursing
may grant dispensing authority only to nurse practitioner in area
that lacks readily available access to pharmacy services.
Declares emergency, effective on passage.
A BILL FOR AN ACT
Relating to dispensing of drugs; creating new provisions;
amending ORS 677.510, 677.515, 677.545 and 678.390; and
declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2011 Act is added to and made
a part of ORS 677.495 to 677.545. + }
SECTION 2. { + (1)(a) A supervising physician or supervising
physician organization may apply to the Oregon Medical Board for
authority for a physician assistant to dispense drugs specified
by the supervising physician or supervising physician
organization.
(b) Notwithstanding paragraph (a) of this subsection, a
physician assistant may not dispense controlled substances
classified in schedules I through IV under the federal Controlled
Substances Act, 21 U.S.C. 811 and 812, as modified under ORS
475.035.
(2) The board shall adopt rules establishing standards and
qualifications for physician assistants with dispensing
authority. The rules must require:
(a) A physician assistant seeking dispensing authority to
complete a drug dispensing training program; and
(b) The supervising physician or supervising physician
organization that applies for dispensing authority for a
physician assistant to:
(A) Provide the board with a plan for drug delivery and
control;
(B) Submit an annual report to the board on the physician
assistant's use of dispensing authority; and
(C) Submit a list of the drugs or classes of drugs that the
supervising physician or supervising physician organization
proposes to authorize the physician assistant to dispense.
(3) The Oregon Medical Board, in collaboration with the State
Board of Pharmacy, shall develop a drug dispensing training
program for physician assistants.
(4) Drugs dispensed by a physician assistant with dispensing
authority under this section must be personally dispensed by the
physician assistant. + }
SECTION 3. ORS 677.510, as amended by section 3, chapter 43,
Oregon Laws 2010, is amended to read:
677.510. (1) A person licensed to practice medicine under this
chapter { - shall - } { + may + } not use the services of a
physician assistant without the prior approval of the Oregon
Medical Board.
(2) A supervising physician or a supervising physician
organization may apply to the board to use the services of a
physician assistant. The application { - shall - } { +
must + }:
(a) State the name of the physician assistant;
(b) If the applicant is a supervising physician organization:
(A) State the names of all supervising physicians; and
(B) State the name of the primary supervising physician
required by subsection (5) of this section;
(c) Describe the manner and extent to which the physician
assistant's services would be used and supervised;
(d) Include a practice description that provides for the
maintenance of direct, verbal communication between the physician
assistant and one or more supervising physicians either in person
or by means described in ORS 677.515 (4);
(e) State the education, training and experience of the
physician assistant; and
(f) Provide such other information in such a form as the board
may require.
(3) The board may approve or reject an application, or it may
modify the proposed use of the services of the physician
assistant and approve the application as modified. The board may
not require that a supervising physician be physically present at
all times.
(4) A supervising physician organization shall provide the
board with a list of the supervising physicians in the
supervising physician organization. The supervising physician
organization shall continually update the list and notify the
board of any changes.
(5) A supervising physician organization shall designate a
primary supervising physician and notify the board in the manner
prescribed by the board.
(6) When it appears to the board that the services of a
physician assistant are being used in a manner inconsistent with
the approval granted, the board may withdraw its approval. If a
hearing is requested by the supervising physician, the
supervising physician organization or the physician assistant
upon the rejection of an application or upon the withdrawal of an
approval, a hearing shall be conducted in accordance with ORS
677.200.
(7) A supervising physician may have a different specialty from
the physician assistant.
(8)(a) A supervising physician organization may supervise any
number of physician assistants. The board may not adopt rules
limiting the number of physician assistants that a supervising
physician organization may supervise.
(b) A physician assistant who is supervised by a supervising
physician organization may be supervised by any of the
supervising physicians in the supervising physician organization.
(9) If a physician assistant is not supervised by a supervising
physician organization, the physician assistant may be supervised
by no more than four supervising physicians. A supervising
physician who is not acting as part of a supervising physician
organization may supervise four physician assistants. A
supervising physician who is not acting as part of a supervising
physician organization may designate a physician to serve as the
agent of the supervising physician for a predetermined period of
time.
(10) The board may review and approve applications from
physicians serving federally designated underserved populations,
or physicians in federally designated health professional
shortage areas, federally designated medically underserved areas
or areas designated as medically disadvantaged and in need of
primary health care providers by the Director of the Oregon
Health Authority or the Office of Rural Health to supervise more
than four physician assistants, and applications from physician
assistants to be supervised by more than four physicians.
{ + (11) + } A physician assistant may render services in an
emergency room and other hospital settings, a nursing home, a
corrections institution and any site included in the practice
description.
{ - (11) A licensed physician assistant may make application
to the board for emergency drug dispensing authority. The board
shall consider the criteria adopted by the Physician Assistant
Committee under ORS 677.545 (4) in reviewing the application.
Such emergency dispensing shall be of drugs prepared or
prepackaged by a licensed pharmacist, manufacturing drug outlet
or wholesale drug outlet authorized to do so under ORS chapter
689. - }
(12) A physician assistant for whom an application under this
section has been approved by the board on or after January 2,
2006, shall submit to the board, within 24 months after the
approval, documentation of completion of:
(a) A pain management education program approved by the board
and developed in conjunction with the Pain Management Commission
established under ORS 409.500; or
(b) An equivalent pain management education program, as
determined by the board.
SECTION 4. ORS 677.515, as amended by section 4, chapter 43,
Oregon Laws 2010, is amended to read:
677.515. (1) This chapter does not prohibit a person from
rendering medical services:
(a) If the person has satisfactorily completed an educational
program for physician assistants approved by the Oregon Medical
Board;
(b) If the services are rendered under the supervision and
control of a supervising physician or supervising physician
organization and the use of the physician assistant's services
has been approved by the board as provided by ORS 677.510; and
(c) If the person is licensed as a physician assistant as
provided by ORS 677.495 and 677.505 to 677.525.
(2) This chapter does not prohibit a student enrolled in an
approved program for educating physician assistants from
rendering medical services if the services are rendered in the
course of the program.
(3) Notwithstanding subsections (1) and (2) of this section,
the degree of independent judgment that a physician assistant may
exercise shall be determined by the supervising physician, or
supervising physician organization, and the physician assistant
in accordance with a practice description approved by the board.
(4) A physician assistant may provide medical services to
patients in a setting where a supervising physician does not
regularly practice if the following conditions exist:
(a) Direct communication between the physician assistant and
one or more supervising physicians either in person or by
telephone, radio, radiotelephone, television or similar means is
maintained; and
(b) The medical services provided by the physician assistant
are reviewed by a supervising physician or supervising physician
organization on a regularly scheduled basis as determined by the
board.
(5) A supervising physician, upon the approval of the board and
in accordance with the rules established by the board, may
delegate to the physician assistant the authority { - to
administer and dispense limited emergency medications and - } to
prescribe medications pursuant to this section and ORS 677.535 to
677.545.
{ - Neither - } The board { - nor - } { + and + } the
Physician Assistant Committee
{ - shall - } { + may not + } limit the privilege of
administering, dispensing and prescribing to population groups
federally designated as underserved, or to geographic areas of
the state that are federally designated health professional
shortage areas, federally designated medically underserved areas
or areas designated as medically disadvantaged and in need of
primary health care providers by the Director of the Oregon
Health Authority or the Office of Rural Health. All prescriptions
written pursuant to this subsection { - shall - }
{ + must + } bear the name, office address and telephone number
of the supervising physician.
(6) Nothing in this chapter is intended to require or prohibit
a physician assistant from practicing in a hospital licensed
pursuant to ORS 441.015 to 441.089.
(7) Prescriptions for medications prescribed by a physician
assistant in accordance with this section and ORS 475.005,
677.010, 677.500, 677.510 and 677.535 to 677.545 and dispensed by
a licensed pharmacist may be filled by the pharmacist according
to the terms of the prescription, and the filling of such a
prescription shall not constitute evidence of negligence on the
part of the pharmacist if the prescription was dispensed within
the reasonable and prudent practice of pharmacy.
SECTION 5. ORS 677.545, as amended by section 7, chapter 43,
Oregon Laws 2010, is amended to read:
677.545. The Physician Assistant Committee shall:
(1) Review all applications for physician assistants' licensure
and for renewal thereof.
{ - (2) Review applications of physician assistants for
dispensing privileges. - }
{ - (3) - } { + (2) + } Recommend approval or disapproval
of applications submitted under subsection (1) { - or (2) - }
of this section to the Oregon Medical Board.
{ - (4) Recommend criteria to be used in granting dispensing
privileges under ORS 677.515. - }
{ - (5) - } { + (3) + } Recommend the formulary for
prescriptive privileges that may include all or parts of
Schedules II, III, IV and V controlled substances and the
procedures for physician assistants, supervising physicians and
supervising physician organizations to follow in exercising the
prescriptive privileges.
{ - (6) - } { + (4) + } Recommend the approval, disapproval
or modification of the application for prescriptive privileges
for any physician assistant. An application for Schedule II
controlled substances prescriptive privileges must be submitted
to the Oregon Medical Board by the physician assistant's
supervising physician or supervising physician organization and
must be accompanied by the practice description of the physician
assistant. The Schedule II controlled substances prescriptive
privileges of a physician assistant { - shall be - }
{ + are + } limited by the practice description approved by the
board and may be restricted further by the supervising physician
or supervising physician organization at any time. The
supervising physician or supervising physician organization shall
notify the physician assistant and the board of any additional
restrictions imposed by the supervising physician or supervising
physician organization, and the practice description on file with
the board shall be amended to reflect the additional restrictions
imposed. To be eligible for Schedule II controlled substances
prescriptive privileges, a physician assistant must be certified
by the National Commission on Certification of Physician
Assistants and must complete all required continuing medical
education coursework.
SECTION 6. ORS 678.390 is amended to read:
678.390. (1) The Oregon State Board of Nursing may grant to a
certified nurse practitioner or certified clinical nurse
specialist the privilege of writing prescriptions, including
prescriptions for controlled substances listed in schedules II,
III, III N, IV and V.
(2) A certified nurse practitioner or certified clinical nurse
specialist may submit an application to the Oregon State Board of
Nursing to dispense prescription drugs. The Oregon State Board of
Nursing shall provide immediate notice to the State Board of
Pharmacy upon receipt and upon approval of an application from a
certified nurse practitioner or certified clinical nurse
specialist for authority to dispense prescription drugs to the
patients of the applicant.
(3) An application for the authority to dispense prescription
drugs as authorized under subsection (1) of this section must
include:
(a) Evidence of completion of a prescription drug dispensing
training program jointly developed and adopted by rule by the
Oregon State Board of Nursing and the State Board of Pharmacy.
{ - (b) Except when a certified nurse practitioner is seeking
authority to dispense prescription drugs at a qualified
institution of higher education as defined in ORS 399.245,
demonstration of a lack of readily available access to pharmacy
services in the practice area of the applicant and that the lack
of access would be corrected by granting authority to dispense
prescription drugs by the applicant. Lack of readily available
access to pharmacy services for patients may be established by
evidence: - }
{ - (A) That the patients of the applicant are located: - }
{ - (i) Outside the boundaries of a metropolitan statistical
area; - }
{ - (ii) Thirty or more highway miles from the closest
hospital within the major population center in a metropolitan
statistical area; or - }
{ - (iii) In a county with a population of less than 75,000;
or - }
{ - (B) Of financial barrier to access, including but not
limited to receiving services from a health care safety net
clinic or eligibility for participation in a patient assistance
program of a pharmaceutical company. - }
{ - (c) - } { + (b) + } Any other information required by
the Oregon State Board of Nursing.
(4) Prescription drugs dispensed by a certified nurse
practitioner or certified clinical nurse specialist
{ - shall - } { + must + } be personally dispensed by the
certified nurse practitioner or certified clinical nurse
specialist, except that nonjudgmental dispensing functions may be
delegated to staff assistants when:
(a) The accuracy and completeness of the prescription is
verified by the certified nurse practitioner or certified
clinical nurse specialist; and
(b) The prescription drug is labeled with the name of the
patient to whom it is being dispensed.
(5) The Oregon State Board of Nursing shall adopt rules
requiring:
(a) Drugs dispensed by certified nurse practitioners and
certified clinical nurse specialists to be either prepackaged by
a manufacturer registered with the State Board of Pharmacy or
repackaged by a pharmacist licensed by the State Board of
Pharmacy under ORS chapter 689;
(b) Labeling requirements for drugs dispensed by certified
nurse practitioners and certified clinical nurse specialists that
are the same as labeling requirements required of pharmacies
licensed under ORS chapter 689;
(c) Record keeping requirements for prescriptions and drug
dispensing by a certified nurse practitioner and a certified
clinical nurse specialist that are the same as the record keeping
requirements required of pharmacies licensed under ORS chapter
689;
(d) A dispensing certified nurse practitioner and a dispensing
certified clinical nurse specialist to have available at the
dispensing site a hard copy or electronic version of prescription
drug reference works commonly used by professionals authorized to
dispense prescription medications; and
(e) A dispensing certified nurse practitioner and a dispensing
certified clinical nurse specialist to allow representatives of
the State Board of Pharmacy, upon receipt of a complaint, to
inspect a dispensing site after prior notice to the Oregon State
Board of Nursing.
(6) The Oregon State Board of Nursing has sole disciplinary
authority regarding certified nurse practitioners and certified
clinical nurse specialists who have drug dispensing authority.
(7) The privilege of writing prescriptions and dispensing drugs
may be denied, suspended or revoked by the Oregon State Board of
Nursing upon proof that the privilege has been abused. The
procedure shall be a contested case under ORS chapter 183.
Disciplinary action under this subsection is grounds for
discipline of the certified nurse practitioner or certified
clinical nurse specialist in the same manner as a licensee may be
disciplined under ORS 678.111.
SECTION 7. { + (1) Section 2 of this 2011 Act and the
amendments to ORS 677.510, 677.515, 677.545 and 678.390 by
sections 3 to 6 of this 2011 Act become operative on September 1,
2011.
(2) The Oregon Medical Board, the State Board of Pharmacy and
the Oregon State Board of Nursing may take any action on or
before the operative date specified in subsection (1) of this
section that is necessary to enable the boards to exercise, on
and after the operative date specified in subsection (1) of this
section, all of the duties, functions and powers conferred on the
boards by section 2 of this 2011 Act and the amendments to ORS
677.510, 677.515, 677.545 and 678.390 by sections 3 to 6 of this
2011 Act. + }
SECTION 8. { + This 2011 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2011 Act takes effect on its
passage. + }
----------
