As Introduced

129th General Assembly
Regular Session
2011-2012
S. B. No. 83


Senator Oelslager 

Cosponsors: Senators Tavares, Cafaro 

A BILL
To amend sections 3719.06, 4723.481, 4723.482, 1
4723.492, and 4723.50 of the Revised Code to 2
modify the authority of certain advanced practice 3
nurses to prescribe schedule II controlled 4
substances. 5


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, a22
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 any27
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 to83
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, evidence128
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 obtained142
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 be149
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 shall155
include all of the following: 156

       (a) A minimum of thirtythirty-six contact hours of training157
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 certified320
nurse practitioner; 321

       (c) Acceptable travel time between the location at which the 322
clinical nurse specialist, certified nurse-midwife, or certified323
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's352
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