As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 206

Representatives Boyd, Oelslager 

Cosponsors: Representatives Combs, Domenick, Wachtmann, Ujvagi, Letson, Yuko, Okey, Chandler 

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A BILL

To amend sections 3719.06, 4723.06, 4723.481,

1

4723.482, 4723.492, and 4723.50 of the Revised

2

Code to modify the authority of certain advanced

3

practice nurses to prescribe schedule II

4

controlled substances.

5

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

Section 1. That sections 3719.06, 4723.06, 4723.481,	6
4723.482, 4723.492, and 4723.50 of the Revised Code be amended to	7
read as 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) A licensed health professional authorized to prescribe	22
drugs who is a clinical nurse specialist, certified nurse-midwife,	23
or certified nurse practitioner is subject to both of the	24
following:	25

(a) A schedule II controlled substance may be prescribed only	26
for a patient with a terminal condition, as defined in section	27
2133.01 of the Revised Code, only if the nurse's collaborating	28
physician initially prescribed the substance for the patient, and	29
only in an amount that does not exceed the amount necessary for	30
the patient's use in a single, twenty-four-hour period.	31

(b) Noshall not personally furnish to patients any schedule	32
II controlled substance shall be personally furnished to any	33
patient.	34

(3) A licensed health professional authorized to prescribe	35
drugs who is a physician assistant shall not prescribe or	36
personally furnish to patients any controlled substance that is	37
not included in the physician-delegated prescriptive authority	38
granted to the physician assistant in accordance with Chapter	39
4730. of the Revised Code.	40

(B) No licensed health professional authorized to prescribe	41
drugs shall prescribe, administer, or personally furnish a	42
schedule III anabolic steroid for the purpose of human muscle	43
building or enhancing human athletic performance and no pharmacist	44
shall dispense a schedule III anabolic steroid for either purpose,	45
unless it has been approved for that purpose under the "Federal	46
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.	47
301, as amended.	48

(C) Each written prescription shall be properly executed,	49
dated, and signed by the prescriber on the day when issued and	50
shall bear the full name and address of the person for whom, or	51
the owner of the animal for which, the controlled substance is	52
prescribed and the full name, address, and registry number under	53
the federal drug abuse control laws of the prescriber. If the	54
prescription is for an animal, it shall state the species of the	55
animal for which the controlled substance is prescribed.	56

Sec. 4723.06.  (A) The board of nursing shall:

57

(1) Administer and enforce the provisions of this chapter,	58
including the taking of disciplinary action for violations of	59
section 4723.28 of the Revised Code, any other provisions of this	60
chapter, or rules adopted under this chapter;	61

(2) Develop criteria that an applicant must meet to be	62
eligible to sit for the examination for licensure to practice as a	63
registered nurse or as a licensed practical nurse;	64

(3) Issue and renew nursing licenses, dialysis technician	65
certificates, and community health worker certificates, as	66
provided in this chapter;	67

(4) Define the minimum curricula and standards for	68
educational programs of the schools of professional nursing and	69
schools of practical nursing in this state;	70

(5) Survey, inspect, and grant full approval to prelicensure	71
nursing education programs that meet the standards established by	72
rules adopted under section 4723.07 of the Revised Code.	73
Prelicensure nursing education programs include, but are not	74
limited to, associate degree, baccalaureate degree, diploma, and	75
doctor of nursing programs leading to initial licensure to	76
practice nursing as a registered nurse and practical nurse	77
programs leading to initial licensure to practice nursing as a	78
licensed practical nurse.	79

(6) Grant conditional approval, by a vote of a quorum of the	80
board, to a new prelicensure nursing education program or a	81
program that is being reestablished after having ceased to	82
operate, if the program meets and maintains the minimum standards	83
of the board established by rules adopted under section 4723.07 of	84
the Revised Code. If the board does not grant conditional	85
approval, it shall hold an adjudication under Chapter 119. of the	86
Revised Code to consider conditional approval of the program. If	87
the board grants conditional approval, at its first meeting after	88
the first class has completed the program, the board shall	89
determine whether to grant full approval to the program. If the	90
board does not grant full approval or if it appears that the	91
program has failed to meet and maintain standards established by	92
rules adopted under section 4723.07 of the Revised Code, the board	93
shall hold an adjudication under Chapter 119. of the Revised Code	94
to consider the program. Based on results of the adjudication, the	95
board may continue or withdraw conditional approval, or grant full	96
approval.	97

(7) Place on provisional approval, for a period of time	98
specified by the board, a program that has ceased to meet and	99
maintain the minimum standards of the board established by rules	100
adopted under section 4723.07 of the Revised Code. At the end of	101
the period, the board shall reconsider whether the program meets	102
the standards and shall grant full approval if it does. If it does	103
not, the board may withdraw approval, pursuant to an adjudication	104
under Chapter 119. of the Revised Code.	105

(8) Approve continuing nursing education programs and courses	106
under standards established in rules adopted under section 4723.07	107
of the Revised Code;	108

(9) Approve peer support programs, under rules adopted under	109
section 4723.07 of the Revised Code, for nurses, for dialysis	110
technicians, and for certified community health workers;	111

(10) Establish a program for monitoring chemical dependency	112
in accordance with section 4723.35 of the Revised Code;	113

(11) Establish the practice intervention and improvement	114
program in accordance with section 4723.282 of the Revised Code;	115

(12) Issue and renew certificates of authority to practice	116
nursing as a certified registered nurse anesthetist, clinical	117
nurse specialist, certified nurse-midwife, or certified nurse	118
practitioner;	119

(13) Approve under section 4723.46 of the Revised Code	120
national certifying organizations for examination and	121
certification of certified registered nurse anesthetists, clinical	122
nurse specialists, certified nurse-midwives, or certified nurse	123
practitioners;	124

(14) Issue and renew certificates to prescribe in accordance	125
with sections 4723.48 and 4723.485 of the Revised Code;	126

(15) Grant approval to the planned classroom and clinical	127
study required by section 4723.4834723.482 of the Revised Code to	128
be eligible for a certificate to prescribe;	129

(16) Make an annual edition of the formulary established in	130
rules adopted under section 4723.50 of the Revised Code available	131
to the public either in printed form or by electronic means and,	132
as soon as possible after any revision of the formulary becomes	133
effective, make the revision available to the public in printed	134
form or by electronic means;	135

(17) Provide guidance and make recommendations to the general	136
assembly, the governor, state agencies, and the federal government	137
with respect to the regulation of the practice of nursing and the	138
enforcement of this chapter;	139

(18) Make an annual report to the governor, which shall be	140
open for public inspection;	141

(19) Maintain and have open for public inspection the	142
following records:	143

(a) A record of all its meetings and proceedings;

144

(b) A file of holders of nursing licenses, registrations, and	145
certificates granted under this chapter; dialysis technician	146
certificates granted under this chapter; and community health	147
worker certificates granted under this chapter. The file shall be	148
maintained in the form prescribed by rule of the board.	149

(c) A list of prelicensure nursing education programs	150
approved by the board;	151

(d) A list of approved peer support programs for nurses,	152
dialysis technicians, and certified community health workers.	153

(B) The board may fulfill the requirement of division (A)(8)	154
of this section by authorizing persons who meet the standards	155
established in rules adopted under section 4723.07 of the Revised	156
Code to approve continuing nursing education programs and courses.	157
Persons so authorized shall approve continuing nursing education	158
programs and courses in accordance with standards established in	159
rules adopted under section 4723.07 of the Revised Code.	160

Persons seeking authorization to approve continuing nursing	161
education programs and courses shall apply to the board and pay	162
the appropriate fee established under section 4723.08 of the	163
Revised Code. Authorizations to approve continuing nursing	164
education programs and courses shall expire, and may be renewed	165
according to the schedule established in rules adopted under	166
section 4723.07 of the Revised Code.	167

In addition to approving continuing nursing education	168
programs under division (A)(8) of this section, the board may	169
sponsor continuing education activities that are directly related	170
to the statutes and rules pertaining to the practice of nursing in	171
this state.	172

Sec. 4723.481.  Under a certificate to prescribe issued under	173
section 4723.48 of the Revised Code, a clinical nurse specialist,	174
certified nurse-midwife, or certified nurse practitioner is	175
subject to all of the following:	176

(A) The clinical nurse specialist, certified nurse-midwife,	177
or certified nurse practitioner shall not prescribe any drug or	178
therapeutic device that is not included in the types of drugs and	179
devices listed on the formulary established in rules adopted under	180
section 4723.50 of the Revised Code.	181

(B) The nurse's prescriptive authority of the clinical nurse	182
specialist, certified nurse-midwife, or certified nurse	183
practitioner shall not exceed the prescriptive authority of the	184
collaborating physician or podiatrist.	185

(C) The nurse may prescribe a schedule II controlled	186
substance as specified in division (A)(2) of section 3719.06 of	187
the Revised Code, but shall not prescribe a schedule II controlled	188
substance in collaboration with a podiatrist.	189

(D) The clinical nurse specialist, certified nurse-midwife,	190
or certified nurse practitioner may personally furnish to a	191
patient a sample of any drug or therapeutic device included in the	192
types of drugs and devices listed on the formulary, subject to all	193
of the following:	194

(1) The amount of the sample furnished shall not exceed a	195
seventy-two-hour supply, except when the minimum available	196
quantity of the sample is packaged in an amount that is greater	197
than a seventy-two-hour supply, in which case the nurse may	198
furnish the sample in the packaged amount may be furnished.	199

(2) No charge may be imposed for the sample or for furnishing	200
it.	201

(3) Samples of controlled substances may not be personally	202
furnished.	203

(E)(D) The clinical nurse specialist, certified	204
nurse-midwife, or certified nurse practitioner may personally	205
furnish to a patient a complete or partial supply of a drug or	206
therapeutic device included in the types of drugs and devices	207
listed on the formulary, subject to all of the following:	208

(1) The clinical nurse specialist, certified nurse-midwife,	209
or certified nurse practitioner shall personally furnish only	210
antibiotics, antifungals, scabicides, contraceptives, prenatal	211
vitamins, antihypertensives, drugs and devices used in the	212
treatment of diabetes, drugs and devices used in the treatment of	213
asthma, and drugs used in the treatment of dyslipidemia.	214

(2) The clinical nurse specialist, certified nurse-midwife,	215
or certified nurse practitioner shall not furnish the drugs and	216
devices in locations other than a health department operated by	217
the board of health of a city or general health district or the	218
authority having the duties of a board of health under section	219
3709.05 of the Revised Code, a federally funded comprehensive	220
primary care clinic, or a nonprofit health care clinic or program.	221

(3) The clinical nurse specialist, certified nurse-midwife,	222
or certified nurse practitioner shall comply with all safety	223
standards for personally furnishing supplies of drugs and devices,	224
as established in rules adopted under section 4723.50 of the	225
Revised Code.	226

Sec. 4723.482.  (A) An applicant shall include with the	227
application submitted under section 4723.48 of the Revised Code	228
all of the following:	229

(1) Subject to section 4723.483 of the Revised Code, evidence	230
of holding a current, valid certificate of authority issued under	231
this chapter to practice as a clinical nurse specialist, certified	232
nurse-midwife, or certified nurse practitioner;	233

(2) Except for a person who on May 17, 2000, was approved to	234
prescribe drugs and therapeutic devices under section 4723.56 of	235
the Revised Code, as that section existed on that date, evidence	236
Evidence of successfully completing the instructioncourse of	237
study in advanced pharmacology and related topics in accordance	238
with the requirements specified in division (B) of this section;	239

(3) The fee required by section 4723.08 of the Revised Code	240
for a certificate to prescribe;	241

(4) Any additional information the board of nursing requires	242
pursuant to rules adopted under section 4723.50 of the Revised	243
Code.	244

(B) AllWith respect to the course of study in advanced	245
pharmacology and related topics that must be successfully	246
completed to obtain a certificate to prescribe, all of the	247
following requirements apply to the instruction required under	248
division (A)(2) of this section:	249

(1) The instruction mustcourse of study shall be obtained	250
completed not longer than three years before the application for	251
the certificate to prescribe is filed.	252

(2) The instruction must be obtained through a course of	253
study consistingshall consist of planned classroom and clinical	254
study that isinstruction for a total of not less than forty-five	255
contact hours.	256

(3) The course of study shall meet the requirements to be	257
approved by the board of nursing in accordance with standards	258
established in rules adopted under section 4723.50 of the Revised	259
Code.	260

(3)(4) The content of the instruction mustcourse of study	261
shall be specific to the applicant's nursing specialty and.	262

(5) The instruction provided in the course of study shall	263
include all of the following:	264

(a) A minimum of thirtythirty-six contact hours of training	265
instruction in advanced pharmacology that includes pharmacokinetic	266
principles and clinical application and the use of drugs and	267
therapeutic devices in the prevention of illness and maintenance	268
of health;	269

(b) TrainingInstruction in the fiscal and ethical	270
implications of prescribing drugs and therapeutic devices;	271

(c) TrainingInstruction in the state and federal laws that	272
apply to the authority to prescribe;	273

(d) Instruction that is specific to schedule II controlled	274
substances, including instruction in all of the following:	275

(i) Indications for the use of schedule II controlled	276
substances in drug therapies, including pain management therapies;	277

(ii) The most recent guidelines for pain management	278
therapies, as established by state and national organizations	279
such as the Ohio pain initiative and the American pain society;	280

(iii) Ethical and fiscal implications of prescribing schedule	281
II controlled substances;	282

(iv) State and federal laws that apply to the authority to	283
prescribe schedule II controlled substances;	284

(v) Prevention of abuse and diversion of schedule II	285
controlled substances, including identification of the risk of	286
abuse and diversion, recognition of abuse and diversion, types of	287
assistance available for prevention of abuse and diversion, and	288
methods of establishing safeguards against abuse and diversion.	289

(e) Any additional traininginstruction required pursuant to	290
rules adopted under section 4723.50 of the Revised Code.	291

Sec. 4723.492.  The committee on prescriptive governance	292
shall develop recommendations regarding the authority to prescribe	293
drugs and therapeutic devices pursuant to a certificate to	294
prescribe issued under section 4723.48 of the Revised Code. Not	295
later than fourteen months after the effective date of this	296
section, theThe recommendations shall include provisions that	297
apply specifically to the authority to prescribe schedule II	298
controlled substances.	299

The committee shall submit recommendations to the board of	300
nursing as necessary for the board to fulfill its duty to adopt	301
rules under section 4723.50 of the Revised Code. At the board's	302
request, the committee shall reconsider a recommendation it has	303
submitted and resubmit the recommendation to the board	304
accordingly.	305

Sec. 4723.50.  (A) In accordance with Chapter 119. of the	306
Revised Code, the board of nursing shall adopt rules as necessary	307
to implement the provisions of this chapter pertaining to the	308
authority of clinical nurse specialists, certified nurse-midwives,	309
and certified nurse practitioners to prescribe drugs and	310
therapeutic devices and the issuance and renewal of certificates	311
to prescribe. Initial rules shall be adopted not later than twenty	312
months after the effective date of this section.	313

The board shall adopt rules that are consistent with the	314
recommendations the board receives from the committee on	315
prescriptive governance pursuant to section 4723.492 of the	316
Revised Code. After reviewing a recommendation submitted by the	317
committee, the board may either adopt the recommendation as a rule	318
or ask the committee to reconsider and resubmit the	319
recommendation. The board shall not adopt any rule that does not	320
conform to a recommendation made by the committee.	321

(B) The board shall adopt rules under this section that do	322
all of the following:	323

(1) Establish a formulary listing the types of drugs and	324
therapeutic devices that may be prescribed by a clinical nurse	325
specialist, certified nurse-midwife, or certified nurse	326
practitioner. The formulary may include controlled substances, as	327
defined in section 3719.01 of the Revised Code. The formulary	328
shall not permit the prescribing of any drug or device to perform	329
or induce an abortion.	330

(2) Establish safety standards to be followed by a clinical	331
nurse specialist, certified nurse-midwife, or certified nurse	332
practitioner when personally furnishing to patients complete or	333
partial supplies of antibiotics, antifungals, scabicides,	334
contraceptives, prenatal vitamins, antihypertensives, drugs and	335
devices used in the treatment of diabetes, drugs and devices used	336
in the treatment of asthma, and drugs used in the treatment of	337
dyslipidemia.	338

(3) Establish criteria for the components of the standard	339
care arrangements described in section 4723.431 of the Revised	340
Code that apply to a nurse'sthe authority to prescribe, including	341
the components that apply to the authority to prescribe schedule	342
II controlled substances. The rules shall be consistent with that	343
section and include all of the following:	344

(a) Quality assurance standards;

345

(b) Standards for periodic review by a collaborating	346
physician or podiatrist of the records of patients treated by the	347
clinical nurse specialist, certified nurse-midwife, or certified	348
nurse practitioner;	349

(c) Acceptable travel time between the location at which the	350
clinical nurse specialist, certified nurse-midwife, or certified	351
nurse practitioner is engaging in the prescribing components of	352
the nurse's practice and the location of the nurse's collaborating	353
physician or podiatrist;	354

(d) Any other criteria recommended by the committee on	355
prescriptive governance.	356

(4) Establish standards and procedures for issuance and	357
renewal of a certificate to prescribe, including specification of	358
any additional information the board may require under division	359
(A)(4) of section 4723.482 or division (B)(3) of section 4723.484	360
of the Revised Code;	361

(5) Establish requirementsstandards for board approval of	362
the instructioncourse of study in advanced pharmacology and	363
related topics required by section 4723.482 of the Revised Code;	364

(6) Establish standards and procedures for the appropriate	365
conduct of an externship required bythat must be completed to be	366
eligible for a subsequent certificate to prescribe, as provided in	367
division (B)(1) of section 4723.484 of the Revised Code,	368
including the following:	369

(a) Standards and procedures to be used in evaluating a	370
nurse'san individual's participation in an externship. Regardless	371
of the method of evaluation used, athe clinical nurse specialist,	372
certified nurse-midwife, or certified nurse practitioner shall not	373
be required to participate in an externship longer than one	374
thousand eight hundred hours.	375

(b) Standards and procedures for the supervision that a	376
physician must provide during an externship, including supervision	377
provided by working with the nurseparticipant and supervision	378
provided by making timely reviews of the records of patients	379
treated by the nurseparticipant. The manner in which supervision	380
must be provided may vary according to the location where the	381
nurseparticipant is practicing and with the nurse'sparticipant's	382
level of experience.	383

Section 2. That existing sections 3719.06, 4723.06, 4723.481,	384
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby	385
repealed.	386

Section 3. (A) Notwithstanding the provisions of section	387
4723.485 of the Revised Code specifying the requirements for	388
renewal of a certificate to prescribe, or the provisions of	389
division (B) of section 4723.484 specifying the conditions of	390
eligibility for a certificate to prescribe issued after practicing	391
under an externship certificate, a clinical nurse specialist,	392
certified nurse-midwife, or certified nurse practitioner holding	393
a certificate to prescribe that was issued prior to the	394
effective date of this act shall successfully complete, as a	395
condition of renewing the certificate or receiving a new	396
certificate, a minimum of six contact hours of instruction	397
regarding schedule II controlled substances as described in	398
section 4723.482 of the Revised Code, as amended by this act. In	399
the case of a certificate that is being renewed, the certificate	400
holder shall complete the instruction in addition to all other	401
continuing nursing education that must be completed by the	402
certificate holder not later than August 31, 2011.	403

(B) Notwithstanding the amendments made by this act to	404
section 3719.06 of the Revised Code, until the applicable	405
requirements of division (A) of this section have been met, a	406
certificate holder shall not prescribe a schedule II controlled	407
substance to a patient unless all of the following conditions are	408
met:	409

(1) The patient is in a terminal condition, as defined in	410
section 2133.01 of the Revised Code.	411

(2) The certificate holder's collaborating physician	412
initially prescribed the substance for the patient.	413

(3) The amount prescribed does not exceed the amount	414
necessary for the patient's use in a single, twenty-four-hour	415
period.	416

Section 4. Not later than 90 days after the effective date of	417
this section, the Committee on Prescriptive Governance shall	418
develop recommendations under section 4723.492 of the Revised	419
Code regarding the authority to prescribe schedule II controlled	420
substances pursuant to a certificate to prescribe. The Committee	421
shall submit the recommendations to the Board of Nursing in	422
accordance with the procedures specified in section 4723.492 of	423
the Revised Code.	424

Section 5. The Board of Nursing shall adopt rules under	425
section 4723.50 of the Revised Code as necessary to implement the	426
provisions of this act pertaining to the authority to prescribe	427
schedule II controlled substances pursuant to a certificate to	428
prescribe. The rules shall conform to the recommendations	429
submitted by the Committee on Prescriptive Governance.	430