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To amend sections 3719.06, 4723.28, 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 and to authorize the Board | 5 |
of Nursing to take disciplinary actions for | 6 |
self-administration of schedule I controlled | 7 |
substances. | 8 |
Section 1. That sections 3719.06, 4723.28, 4723.481, | 9 |
4723.482, 4723.492, and 4723.50 of the Revised Code be amended to | 10 |
read as follows: | 11 |
Sec. 3719.06. (A)(1) A licensed health professional | 12 |
authorized to prescribe drugs, if acting in the course of | 13 |
professional practice, in accordance with the laws regulating the | 14 |
professional's practice, and in accordance with rules adopted by | 15 |
the state board of pharmacy, may, except as provided in division | 16 |
(A)(2) or (3) of this section, do the following: | 17 |
(a) Prescribe schedule II, III, IV, and V controlled | 18 |
substances; | 19 |
(b) Administer or personally furnish to patients schedule II, | 20 |
III, IV, and V controlled substances; | 21 |
(c) Cause schedule II, III, IV, and V controlled substances | 22 |
to be administered under the prescriber's direction and | 23 |
supervision. | 24 |
(2) A licensed health professional authorized to prescribe | 25 |
drugs who is a clinical nurse specialist, certified nurse-midwife, | 26 |
or certified nurse practitioner is subject to both of the | 27 |
following: | 28 |
(a) A schedule II controlled substance may be prescribed only | 29 |
30 | |
31 | |
32 | |
33 | |
34 | |
accordance with division (C) of section 4723.481 of the Revised | 35 |
Code. | 36 |
(b) No schedule II controlled substance shall be personally | 37 |
furnished to any patient. | 38 |
(3) A licensed health professional authorized to prescribe | 39 |
drugs who is a physician assistant shall not prescribe or | 40 |
personally furnish to patients any controlled substance that is | 41 |
not included in the physician-delegated prescriptive authority | 42 |
granted to the physician assistant in accordance with Chapter | 43 |
4730. of the Revised Code. | 44 |
(B) No licensed health professional authorized to prescribe | 45 |
drugs shall prescribe, administer, or personally furnish a | 46 |
schedule III anabolic steroid for the purpose of human muscle | 47 |
building or enhancing human athletic performance and no pharmacist | 48 |
shall dispense a schedule III anabolic steroid for either purpose, | 49 |
unless it has been approved for that purpose under the "Federal | 50 |
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A. | 51 |
301, as amended. | 52 |
(C) Each written prescription shall be properly executed, | 53 |
dated, and signed by the prescriber on the day when issued and | 54 |
shall bear the full name and address of the person for whom, or | 55 |
the owner of the animal for which, the controlled substance is | 56 |
prescribed and the full name, address, and registry number under | 57 |
the federal drug abuse control laws of the prescriber. If the | 58 |
prescription is for an animal, it shall state the species of the | 59 |
animal for which the controlled substance is prescribed. | 60 |
Sec. 4723.28. (A) The board of nursing, by a vote of a | 61 |
quorum, may revoke or may refuse to grant a nursing license, | 62 |
certificate of authority, or dialysis technician certificate to a | 63 |
person found by the board to have committed fraud in passing an | 64 |
examination required to obtain the license, certificate of | 65 |
authority, or dialysis technician certificate or to have committed | 66 |
fraud, misrepresentation, or deception in applying for or securing | 67 |
any nursing license, certificate of authority, or dialysis | 68 |
technician certificate issued by the board. | 69 |
(B) Subject to division (N) of this section, the board of | 70 |
nursing, by a vote of a quorum, may impose one or more of the | 71 |
following sanctions: deny, revoke, suspend, or place restrictions | 72 |
on any nursing license, certificate of authority, or dialysis | 73 |
technician certificate issued by the board; reprimand or otherwise | 74 |
discipline a holder of a nursing license, certificate of | 75 |
authority, or dialysis technician certificate; or impose a fine of | 76 |
not more than five hundred dollars per violation. The sanctions | 77 |
may be imposed for any of the following: | 78 |
(1) Denial, revocation, suspension, or restriction of | 79 |
authority to practice a health care occupation, including nursing | 80 |
or practice as a dialysis technician, for any reason other than a | 81 |
failure to renew, in Ohio or another state or jurisdiction; | 82 |
(2) Engaging in the practice of nursing or engaging in | 83 |
practice as a dialysis technician, having failed to renew a | 84 |
nursing license or dialysis technician certificate issued under | 85 |
this chapter, or while a nursing license or dialysis technician | 86 |
certificate is under suspension; | 87 |
(3) Conviction of, a plea of guilty to, a judicial finding of | 88 |
guilt of, a judicial finding of guilt resulting from a plea of no | 89 |
contest to, or a judicial finding of eligibility for intervention | 90 |
in lieu of conviction for, a misdemeanor committed in the course | 91 |
of practice; | 92 |
(4) Conviction of, a plea of guilty to, a judicial finding of | 93 |
guilt of, a judicial finding of guilt resulting from a plea of no | 94 |
contest to, or a judicial finding of eligibility for intervention | 95 |
in lieu of conviction for, any felony or of any crime involving | 96 |
gross immorality or moral turpitude; | 97 |
(5) Selling, giving away, or administering drugs or | 98 |
therapeutic devices for other than legal and legitimate | 99 |
therapeutic purposes; or conviction of, a plea of guilty to, a | 100 |
judicial finding of guilt of, a judicial finding of guilt | 101 |
resulting from a plea of no contest to, or a judicial finding of | 102 |
eligibility for intervention in lieu of conviction for, violating | 103 |
any municipal, state, county, or federal drug law; | 104 |
(6) Conviction of, a plea of guilty to, a judicial finding of | 105 |
guilt of, a judicial finding of guilt resulting from a plea of no | 106 |
contest to, or a judicial finding of eligibility for intervention | 107 |
in lieu of conviction for, an act in another jurisdiction that | 108 |
would constitute a felony or a crime of moral turpitude in Ohio; | 109 |
(7) Conviction of, a plea of guilty to, a judicial finding of | 110 |
guilt of, a judicial finding of guilt resulting from a plea of no | 111 |
contest to, or a judicial finding of eligibility for intervention | 112 |
in lieu of conviction for, an act in the course of practice in | 113 |
another jurisdiction that would constitute a misdemeanor in Ohio; | 114 |
(8) Self-administering or otherwise taking into the body any | 115 |
dangerous drug, as defined in section 4729.01 of the Revised Code, | 116 |
in any way not in accordance with a legal, valid prescription | 117 |
issued for that individual, or self-administering or otherwise | 118 |
taking into the body any drug that is a schedule I controlled | 119 |
substance; | 120 |
(9) Habitual indulgence in the use of controlled substances, | 121 |
other habit-forming drugs, or alcohol or other chemical substances | 122 |
to an extent that impairs ability to practice; | 123 |
(10) Impairment of the ability to practice according to | 124 |
acceptable and prevailing standards of safe nursing care because | 125 |
of habitual or excessive use of drugs, alcohol, or other chemical | 126 |
substances that impair the ability to practice; | 127 |
(11) Impairment of the ability to practice according to | 128 |
acceptable and prevailing standards of safe nursing care because | 129 |
of a physical or mental disability; | 130 |
(12) Assaulting or causing harm to a patient or depriving a | 131 |
patient of the means to summon assistance; | 132 |
(13) Obtaining or attempting to obtain money or anything of | 133 |
value by intentional misrepresentation or material deception in | 134 |
the course of practice; | 135 |
(14) Adjudication by a probate court of being mentally ill or | 136 |
mentally incompetent. The board may restore the person's nursing | 137 |
license or dialysis technician certificate upon adjudication by a | 138 |
probate court of the person's restoration to competency or upon | 139 |
submission to the board of other proof of competency. | 140 |
(15) The suspension or termination of employment by the | 141 |
department of defense or the veterans administration of the United | 142 |
States for any act that violates or would violate this chapter; | 143 |
(16) Violation of this chapter or any rules adopted under it; | 144 |
(17) Violation of any restrictions placed on a nursing | 145 |
license or dialysis technician certificate by the board; | 146 |
(18) Failure to use universal blood and body fluid | 147 |
precautions established by rules adopted under section 4723.07 of | 148 |
the Revised Code; | 149 |
(19) Failure to practice in accordance with acceptable and | 150 |
prevailing standards of safe nursing care or safe dialysis care; | 151 |
(20) In the case of a registered nurse, engaging in | 152 |
activities that exceed the practice of nursing as a registered | 153 |
nurse; | 154 |
(21) In the case of a licensed practical nurse, engaging in | 155 |
activities that exceed the practice of nursing as a licensed | 156 |
practical nurse; | 157 |
(22) In the case of a dialysis technician, engaging in | 158 |
activities that exceed those permitted under section 4723.72 of | 159 |
the Revised Code; | 160 |
(23) Aiding and abetting a person in that person's practice | 161 |
of nursing without a license or practice as a dialysis technician | 162 |
without a certificate issued under this chapter; | 163 |
(24) In the case of a certified registered nurse anesthetist, | 164 |
clinical nurse specialist, certified nurse-midwife, or certified | 165 |
nurse practitioner, except as provided in division (M) of this | 166 |
section, either of the following: | 167 |
(a) Waiving the payment of all or any part of a deductible or | 168 |
copayment that a patient, pursuant to a health insurance or health | 169 |
care policy, contract, or plan that covers such nursing services, | 170 |
would otherwise be required to pay if the waiver is used as an | 171 |
enticement to a patient or group of patients to receive health | 172 |
care services from that provider; | 173 |
(b) Advertising that the nurse will waive the payment of all | 174 |
or any part of a deductible or copayment that a patient, pursuant | 175 |
to a health insurance or health care policy, contract, or plan | 176 |
that covers such nursing services, would otherwise be required to | 177 |
pay. | 178 |
(25) Failure to comply with the terms and conditions of | 179 |
participation in the chemical dependency monitoring program | 180 |
established under section 4723.35 of the Revised Code; | 181 |
(26) Failure to comply with the terms and conditions required | 182 |
under the practice intervention and improvement program | 183 |
established under section 4723.282 of the Revised Code; | 184 |
(27) In the case of a certified registered nurse anesthetist, | 185 |
clinical nurse specialist, certified nurse-midwife, or certified | 186 |
nurse practitioner: | 187 |
(a) Engaging in activities that exceed those permitted for | 188 |
the nurse's nursing specialty under section 4723.43 of the Revised | 189 |
Code; | 190 |
(b) Failure to meet the quality assurance standards | 191 |
established under section 4723.07 of the Revised Code. | 192 |
(28) In the case of a clinical nurse specialist, certified | 193 |
nurse-midwife, or certified nurse practitioner, failure to | 194 |
maintain a standard care arrangement in accordance with section | 195 |
4723.431 of the Revised Code or to practice in accordance with the | 196 |
standard care arrangement; | 197 |
(29) In the case of a clinical nurse specialist, certified | 198 |
nurse-midwife, or certified nurse practitioner who holds a | 199 |
certificate to prescribe issued under section 4723.48 of the | 200 |
Revised Code, failure to prescribe drugs and therapeutic devices | 201 |
in accordance with section 4723.481 of the Revised Code; | 202 |
(30) Prescribing any drug or device to perform or induce an | 203 |
abortion, or otherwise performing or inducing an abortion; | 204 |
(31) Failure to establish and maintain professional | 205 |
boundaries with a patient, as specified in rules adopted under | 206 |
section 4723.07 of the Revised Code; | 207 |
(32) Regardless of whether the contact or verbal behavior is | 208 |
consensual, engaging with a patient other than the spouse of the | 209 |
registered nurse, licensed practical nurse, or dialysis technician | 210 |
in any of the following: | 211 |
(a) Sexual contact, as defined in section 2907.01 of the | 212 |
Revised Code; | 213 |
(b) Verbal behavior that is sexually demeaning to the patient | 214 |
or may be reasonably interpreted by the patient as sexually | 215 |
demeaning. | 216 |
(33) Assisting suicide as defined in section 3795.01 of the | 217 |
Revised Code. | 218 |
(C) Disciplinary actions taken by the board under divisions | 219 |
(A) and (B) of this section shall be taken pursuant to an | 220 |
adjudication conducted under Chapter 119. of the Revised Code, | 221 |
except that in lieu of a hearing, the board may enter into a | 222 |
consent agreement with an individual to resolve an allegation of a | 223 |
violation of this chapter or any rule adopted under it. A consent | 224 |
agreement, when ratified by a vote of a quorum, shall constitute | 225 |
the findings and order of the board with respect to the matter | 226 |
addressed in the agreement. If the board refuses to ratify a | 227 |
consent agreement, the admissions and findings contained in the | 228 |
agreement shall be of no effect. | 229 |
(D) The hearings of the board shall be conducted in | 230 |
accordance with Chapter 119. of the Revised Code, the board may | 231 |
appoint a hearing examiner, as provided in section 119.09 of the | 232 |
Revised Code, to conduct any hearing the board is authorized to | 233 |
hold under Chapter 119. of the Revised Code. | 234 |
In any instance in which the board is required under Chapter | 235 |
119. of the Revised Code to give notice of an opportunity for a | 236 |
hearing and the applicant or license holder does not make a timely | 237 |
request for a hearing in accordance with section 119.07 of the | 238 |
Revised Code, the board is not required to hold a hearing, but may | 239 |
adopt, by a vote of a quorum, a final order that contains the | 240 |
board's findings. In the final order, the board may order any of | 241 |
the sanctions listed in division (A) or (B) of this section. | 242 |
(E) If a criminal action is brought against a registered | 243 |
nurse, licensed practical nurse, or dialysis technician for an act | 244 |
or crime described in divisions (B)(3) to (7) of this section and | 245 |
the action is dismissed by the trial court other than on the | 246 |
merits, the board shall conduct an adjudication to determine | 247 |
whether the registered nurse, licensed practical nurse, or | 248 |
dialysis technician committed the act on which the action was | 249 |
based. If the board determines on the basis of the adjudication | 250 |
that the registered nurse, licensed practical nurse, or dialysis | 251 |
technician committed the act, or if the registered nurse, licensed | 252 |
practical nurse, or dialysis technician fails to participate in | 253 |
the adjudication, the board may take action as though the | 254 |
registered nurse, licensed practical nurse, or dialysis technician | 255 |
had been convicted of the act. | 256 |
If the board takes action on the basis of a conviction, plea, | 257 |
or a judicial finding as described in divisions (B)(3) to (7) of | 258 |
this section that is overturned on appeal, the registered nurse, | 259 |
licensed practical nurse, or dialysis technician may, on | 260 |
exhaustion of the appeal process, petition the board for | 261 |
reconsideration of its action. On receipt of the petition and | 262 |
supporting court documents, the board shall temporarily rescind | 263 |
its action. If the board determines that the decision on appeal | 264 |
was a decision on the merits, it shall permanently rescind its | 265 |
action. If the board determines that the decision on appeal was | 266 |
not a decision on the merits, it shall conduct an adjudication to | 267 |
determine whether the registered nurse, licensed practical nurse, | 268 |
or dialysis technician committed the act on which the original | 269 |
conviction, plea, or judicial finding was based. If the board | 270 |
determines on the basis of the adjudication that the registered | 271 |
nurse, licensed practical nurse, or dialysis technician committed | 272 |
such act, or if the registered nurse, licensed practical nurse, or | 273 |
dialysis technician does not request an adjudication, the board | 274 |
shall reinstate its action; otherwise, the board shall permanently | 275 |
rescind its action. | 276 |
Notwithstanding the provision of division (C)(2) of section | 277 |
2953.32 of the Revised Code specifying that if records pertaining | 278 |
to a criminal case are sealed under that section the proceedings | 279 |
in the case shall be deemed not to have occurred, sealing of the | 280 |
records of a conviction on which the board has based an action | 281 |
under this section shall have no effect on the board's action or | 282 |
any sanction imposed by the board under this section. | 283 |
The board shall not be required to seal, destroy, redact, or | 284 |
otherwise modify its records to reflect the court's sealing of | 285 |
conviction records. | 286 |
(F) The board may investigate an individual's criminal | 287 |
background in performing its duties under this section. | 288 |
(G) During the course of an investigation conducted under | 289 |
this section, the board may compel any registered nurse, licensed | 290 |
practical nurse, or dialysis technician or applicant under this | 291 |
chapter to submit to a mental or physical examination, or both, as | 292 |
required by the board and at the expense of the individual, if the | 293 |
board finds reason to believe that the individual under | 294 |
investigation may have a physical or mental impairment that may | 295 |
affect the individual's ability to provide safe nursing care. | 296 |
Failure of any individual to submit to a mental or physical | 297 |
examination when directed constitutes an admission of the | 298 |
allegations, unless the failure is due to circumstances beyond the | 299 |
individual's control, and a default and final order may be entered | 300 |
without the taking of testimony or presentation of evidence. | 301 |
If the board finds that an individual is impaired, the board | 302 |
shall require the individual to submit to care, counseling, or | 303 |
treatment approved or designated by the board, as a condition for | 304 |
initial, continued, reinstated, or renewed authority to practice. | 305 |
The individual shall be afforded an opportunity to demonstrate to | 306 |
the board that the individual can begin or resume the individual's | 307 |
occupation in compliance with acceptable and prevailing standards | 308 |
of care under the provisions of the individual's authority to | 309 |
practice. | 310 |
For purposes of this division, any registered nurse, licensed | 311 |
practical nurse, or dialysis technician or applicant under this | 312 |
chapter shall be deemed to have given consent to submit to a | 313 |
mental or physical examination when directed to do so in writing | 314 |
by the board, and to have waived all objections to the | 315 |
admissibility of testimony or examination reports that constitute | 316 |
a privileged communication. | 317 |
(H) The board shall investigate evidence that appears to show | 318 |
that any person has violated any provision of this chapter or any | 319 |
rule of the board. Any person may report to the board any | 320 |
information the person may have that appears to show a violation | 321 |
of any provision of this chapter or rule of the board. In the | 322 |
absence of bad faith, any person who reports such information or | 323 |
who testifies before the board in any adjudication conducted under | 324 |
Chapter 119. of the Revised Code shall not be liable for civil | 325 |
damages as a result of the report or testimony. | 326 |
(I) All of the following apply under this chapter with | 327 |
respect to the confidentiality of information: | 328 |
(1) Information received by the board pursuant to an | 329 |
investigation is confidential and not subject to discovery in any | 330 |
civil action, except that the board may disclose information to | 331 |
law enforcement officers and government entities investigating | 332 |
either a licensed health care professional, including a registered | 333 |
nurse, licensed practical nurse, or dialysis technician, or a | 334 |
person who may have engaged in the unauthorized practice of | 335 |
nursing. No law enforcement officer or government entity with | 336 |
knowledge of any information disclosed by the board pursuant to | 337 |
this division shall divulge the information to any other person or | 338 |
government entity except for the purpose of a government | 339 |
investigation, a prosecution, or an adjudication by a court or | 340 |
government entity. | 341 |
(2) If an investigation requires a review of patient records, | 342 |
the investigation and proceeding shall be conducted in such a | 343 |
manner as to protect patient confidentiality. | 344 |
(3) All adjudications and investigations of the board shall | 345 |
be considered civil actions for the purposes of section 2305.252 | 346 |
of the Revised Code. | 347 |
(4) Any board activity that involves continued monitoring of | 348 |
an individual as part of or following any disciplinary action | 349 |
taken under this section shall be conducted in a manner that | 350 |
maintains the individual's confidentiality. Information received | 351 |
or maintained by the board with respect to the board's monitoring | 352 |
activities is confidential and not subject to discovery in any | 353 |
civil action. | 354 |
(J) Any action taken by the board under this section | 355 |
resulting in a suspension from practice shall be accompanied by a | 356 |
written statement of the conditions under which the person may be | 357 |
reinstated to practice. | 358 |
(K) When the board refuses to grant a license or certificate | 359 |
to an applicant, revokes a license or certificate, or refuses to | 360 |
reinstate a license or certificate, the board may specify that its | 361 |
action is permanent. An individual subject to permanent action | 362 |
taken by the board is forever ineligible to hold a license or | 363 |
certificate of the type that was refused or revoked and the board | 364 |
shall not accept from the individual an application for | 365 |
reinstatement of the license or certificate or for a new license | 366 |
or certificate. | 367 |
(L) No unilateral surrender of a nursing license, certificate | 368 |
of authority, or dialysis technician certificate issued under this | 369 |
chapter shall be effective unless accepted by majority vote of the | 370 |
board. No application for a nursing license, certificate of | 371 |
authority, or dialysis technician certificate issued under this | 372 |
chapter may be withdrawn without a majority vote of the board. The | 373 |
board's jurisdiction to take disciplinary action under this | 374 |
section is not removed or limited when an individual has a license | 375 |
or certificate classified as inactive or fails to renew a license | 376 |
or certificate. | 377 |
(M) Sanctions shall not be imposed under division (B)(24) of | 378 |
this section against any licensee who waives deductibles and | 379 |
copayments as follows: | 380 |
(1) In compliance with the health benefit plan that expressly | 381 |
allows such a practice. Waiver of the deductibles or copayments | 382 |
shall be made only with the full knowledge and consent of the plan | 383 |
purchaser, payer, and third-party administrator. Documentation of | 384 |
the consent shall be made available to the board upon request. | 385 |
(2) For professional services rendered to any other person | 386 |
licensed pursuant to this chapter to the extent allowed by this | 387 |
chapter and the rules of the board. | 388 |
(N)(1) Any person who enters a prelicensure nursing education | 389 |
program on or after June 1, 2003, and who subsequently applies | 390 |
under division (A) of section 4723.09 of the Revised Code for | 391 |
licensure to practice as a registered nurse or as a licensed | 392 |
practical nurse and any person who applies under division (B) of | 393 |
that section for license by endorsement to practice nursing as a | 394 |
registered nurse or as a licensed practical nurse shall submit a | 395 |
request to the bureau of criminal identification and investigation | 396 |
for the bureau to conduct a criminal records check of the | 397 |
applicant and to send the results to the board, in accordance with | 398 |
section 4723.09 of the Revised Code. | 399 |
The board shall refuse to grant a license to practice nursing | 400 |
as a registered nurse or as a licensed practical nurse under | 401 |
section 4723.09 of the Revised Code to a person who entered a | 402 |
prelicensure nursing education program on or after June 1, 2003, | 403 |
and applied under division (A) of section 4723.09 of the Revised | 404 |
Code for the license or a person who applied under division (B) of | 405 |
that section for the license, if the criminal records check | 406 |
performed in accordance with division (C) of that section | 407 |
indicates that the person has pleaded guilty to, been convicted | 408 |
of, or has had a judicial finding of guilt for violating section | 409 |
2903.01, 2903.02, 2903.03, 2903.11, 2905.01, 2907.02, 2907.03, | 410 |
2907.05, 2909.02, 2911.01, or 2911.11 of the Revised Code or a | 411 |
substantially similar law of another state, the United States, or | 412 |
another country. | 413 |
(2) Any person who enters a dialysis training program on or | 414 |
after June 1, 2003, and who subsequently applies for a certificate | 415 |
to practice as a dialysis technician shall submit a request to the | 416 |
bureau of criminal identification and investigation for the bureau | 417 |
to conduct a criminal records check of the applicant and to send | 418 |
the results to the board, in accordance with section 4723.75 of | 419 |
the Revised Code. | 420 |
The board shall refuse to issue a certificate to practice as | 421 |
a dialysis technician under section 4723.75 of the Revised Code to | 422 |
a person who entered a dialysis training program on or after June | 423 |
1, 2003, and whose criminal records check performed in accordance | 424 |
with division (C) of that section indicates that the person has | 425 |
pleaded guilty to, been convicted of, or has had a judicial | 426 |
finding of guilt for violating section 2903.01, 2903.02, 2903.03, | 427 |
2903.11, 2905.01, 2907.02, 2907.03, 2907.05, 2909.02, 2911.01, or | 428 |
2911.11 of the Revised Code or a substantially similar law of | 429 |
another state, the United States, or another country. | 430 |
Sec. 4723.481. | 431 |
432 | |
standards and conditions regarding the authority of a clinical | 433 |
nurse specialist, certified nurse-midwife, or certified nurse | 434 |
practitioner | 435 |
drugs and therapeutic devices under a certificate to prescribe | 436 |
issued under section 4723.481 of the Revised Code. | 437 |
(A) | 438 |
or certified nurse practitioner shall not prescribe any drug or | 439 |
therapeutic device that is not included in the types of drugs and | 440 |
devices listed on the formulary established in rules adopted under | 441 |
section 4723.50 of the Revised Code. | 442 |
(B) The | 443 |
specialist, certified nurse-midwife, or certified nurse | 444 |
practitioner shall not exceed the prescriptive authority of the | 445 |
collaborating physician or podiatrist. | 446 |
(C) | 447 |
448 | |
449 | |
450 | |
provided in division (C)(2) or (3) of this section, a clinical | 451 |
nurse specialist, certified nurse-midwife, or certified nurse | 452 |
practitioner may prescribe to a patient a schedule II controlled | 453 |
substance only if all of the following are the case: | 454 |
(a) The patient has a terminal condition, as defined in | 455 |
section 2133.01 of the Revised Code. | 456 |
(b) The collaborating physician of the clinical nurse | 457 |
specialist, certified nurse-midwife, or certified nurse | 458 |
practitioner initially prescribed the substance for the patient. | 459 |
(c) The prescription is for an amount that does not exceed | 460 |
the amount necessary for the patient's use in a single, | 461 |
twenty-four hour period. | 462 |
(2) The restrictions on prescriptive authority in division | 463 |
(C)(1) of this section do not apply if a clinical nurse | 464 |
specialist, certified nurse-midwife, or certified nurse | 465 |
practitioner issues the prescription to the patient from any of | 466 |
the following locations: | 467 |
(a) A hospital registered under section 3701.07 of the | 468 |
Revised Code; | 469 |
(b) An entity owned or controlled, in whole or in part, by a | 470 |
hospital or by an entity that owns or controls, in whole or in | 471 |
part, one or more hospitals; | 472 |
(c) A health care facility operated by the department of | 473 |
mental health or the department of developmental disabilities; | 474 |
(d) A nursing home licensed under section 3721.02 of the | 475 |
Revised Code or by a political subdivision certified under section | 476 |
3721.09 of the Revised Code; | 477 |
(e) A county home or district home operated under Chapter | 478 |
5155. of the Revised Code that is certified under the medicare or | 479 |
medicaid program; | 480 |
(f) A hospice care program, as defined in section 3712.01 of | 481 |
the Revised Code; | 482 |
(g) A community mental health agency, as defined in section | 483 |
5122.01 of the Revised Code; | 484 |
(h) An ambulatory surgical facility, as defined in section | 485 |
3702.30 of the Revised Code; | 486 |
(i) A freestanding birthing center, as defined in section | 487 |
3702.51 of the Revised Code; | 488 |
(j) A federally qualified health center, as defined in | 489 |
section 3701.047 of the Revised Code; | 490 |
(k) A federally qualified health center look-alike, as | 491 |
defined in section 3701.047 of the Revised Code; | 492 |
(l) A health care office or facility operated by the board of | 493 |
health of a city or general health district or the authority | 494 |
having the duties of a board of health under section 3709.05 of | 495 |
the Revised Code; | 496 |
(m) A site where a medical practice is operated, but only if | 497 |
the practice is comprised of one or more physicians who also are | 498 |
owners of the practice; the practice is organized to provide | 499 |
direct patient care; and the clinical nurse specialist, certified | 500 |
nurse-midwife, or certified nurse practitioner providing services | 501 |
at the site has a standard care arrangement and collaborates with | 502 |
at least one of the physician owners who practices primarily at | 503 |
that site. | 504 |
(3) A clinical nurse specialist, certified nurse-midwife, or | 505 |
certified nurse practitioner shall not issue to a patient a | 506 |
prescription for a schedule II controlled substance from a | 507 |
convenience care clinic even if the clinic is owned or operated by | 508 |
an entity specified in division (C)(2) of this section. | 509 |
(D) | 510 |
prescription issued by a clinical nurse specialist, certified | 511 |
nurse-midwife, or certified nurse practitioner under division | 512 |
(C)(2) of this section is not liable for or subject to any of the | 513 |
following for relying on the prescription: damages in any civil | 514 |
action, prosecution in any criminal proceeding, or professional | 515 |
disciplinary action by the state board of pharmacy under Chapter | 516 |
4729. of the Revised Code. | 517 |
(E) A clinical nurse specialist, certified nurse-midwife, or | 518 |
certified nurse practitioner may personally furnish to a patient a | 519 |
sample of any drug or therapeutic device included in the types of | 520 |
drugs and devices listed on the formulary,
| 521 |
all of the following conditions apply: | 522 |
(1) The amount of the sample furnished shall not exceed a | 523 |
seventy-two-hour supply, except when the minimum available | 524 |
quantity of the sample is packaged in an amount that is greater | 525 |
than a seventy-two-hour supply, in which case
| 526 |
527 |
(2) No charge may be imposed for the sample or for furnishing | 528 |
it. | 529 |
(3) Samples of controlled substances may not be personally | 530 |
furnished. | 531 |
| 532 |
nurse-midwife, or certified nurse practitioner may personally | 533 |
furnish to a patient a complete or partial supply of a drug or | 534 |
therapeutic device included in the types of drugs and devices | 535 |
listed on the formulary, | 536 |
following conditions apply: | 537 |
(1) The clinical nurse specialist, certified nurse-midwife, | 538 |
or certified nurse practitioner shall personally furnish only | 539 |
antibiotics, antifungals, scabicides, contraceptives, prenatal | 540 |
vitamins, antihypertensives, drugs and devices used in the | 541 |
treatment of diabetes, drugs and devices used in the treatment of | 542 |
asthma, and drugs used in the treatment of dyslipidemia. | 543 |
(2) The clinical nurse specialist, certified nurse-midwife, | 544 |
or certified nurse practitioner shall not furnish the drugs and | 545 |
devices in locations other than a health department operated by | 546 |
the board of health of a city or general health district or the | 547 |
authority having the duties of a board of health under section | 548 |
3709.05 of the Revised Code, a federally funded comprehensive | 549 |
primary care clinic, or a nonprofit health care clinic or program. | 550 |
(3) The clinical nurse specialist, certified nurse-midwife, | 551 |
or certified nurse practitioner shall comply with all safety | 552 |
standards for personally furnishing supplies of drugs and devices, | 553 |
as established in rules adopted under section 4723.50 of the | 554 |
Revised Code. | 555 |
Sec. 4723.482. (A) Except as provided in divisions (C) and | 556 |
(D) of this section, an applicant shall include with the | 557 |
application submitted under section 4723.48 of the Revised Code | 558 |
all of the following: | 559 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 560 |
of holding a current, valid certificate of authority issued under | 561 |
this chapter to practice as a clinical nurse specialist, certified | 562 |
nurse-midwife, or certified nurse practitioner; | 563 |
(2) | 564 |
565 | |
566 | |
Evidence of successfully completing the | 567 |
study in advanced pharmacology and related topics in accordance | 568 |
with the requirements specified in division (B) of this section; | 569 |
(3) The fee required by section 4723.08 of the Revised Code | 570 |
for a certificate to prescribe; | 571 |
(4) Any additional information the board of nursing requires | 572 |
pursuant to rules adopted under section 4723.50 of the Revised | 573 |
Code. | 574 |
(B) | 575 |
pharmacology and related topics that must be successfully | 576 |
completed to obtain a certificate to prescribe, all of the | 577 |
following requirements apply | 578 |
579 |
(1) The | 580 |
completed not longer than three years before the application for | 581 |
the certificate to prescribe is filed. | 582 |
(2) The | 583 |
study | 584 |
585 | |
contact hours. | 586 |
(3) The course of study shall meet the requirements to be | 587 |
approved by the board | 588 |
established in rules adopted under section 4723.50 of the Revised | 589 |
Code. | 590 |
| 591 |
shall be specific to the applicant's nursing specialty | 592 |
(5) The instruction provided in the course of study shall | 593 |
include all of the following: | 594 |
(a) A minimum of | 595 |
instruction in advanced pharmacology that includes pharmacokinetic | 596 |
principles and clinical application and the use of drugs and | 597 |
therapeutic devices in the prevention of illness and maintenance | 598 |
of health; | 599 |
(b) | 600 |
implications of prescribing drugs and therapeutic devices; | 601 |
(c) | 602 |
apply to the authority to prescribe; | 603 |
(d) Instruction that is specific to schedule II controlled | 604 |
substances, including instruction in all of the following: | 605 |
(i) Indications for the use of schedule II controlled | 606 |
substances in drug therapies; | 607 |
(ii) The most recent guidelines for pain management | 608 |
therapies, as established by state and national organizations such | 609 |
as the Ohio pain initiative and the American pain society; | 610 |
(iii) Fiscal and ethical implications of prescribing schedule | 611 |
II controlled substances; | 612 |
(iv) State and federal laws that apply to the authority to | 613 |
prescribe schedule II controlled substances; | 614 |
(v) Prevention of abuse and diversion of schedule II | 615 |
controlled substances, including identification of the risk of | 616 |
abuse and diversion, recognition of abuse and diversion, types of | 617 |
assistance available for prevention of abuse and diversion, and | 618 |
methods of establishing safeguards against abuse and diversion. | 619 |
(e) Any additional | 620 |
rules adopted under section 4723.50 of the Revised Code. | 621 |
(C) An applicant who practiced or is practicing as a clinical | 622 |
nurse specialist, certified nurse-midwife, or certified nurse | 623 |
practitioner in another jurisdiction or as an employee of the | 624 |
United States government, and is not seeking authority to | 625 |
prescribe drugs and therapeutic devices by meeting the | 626 |
requirements of division (A) or (D) of this section, shall include | 627 |
with the application submitted under section 4723.48 of the | 628 |
Revised Code all of the following: | 629 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 630 |
of holding a current, valid certificate of authority issued under | 631 |
this chapter to practice as a clinical nurse specialist, certified | 632 |
nurse-midwife, or certified nurse practitioner; | 633 |
(2) The fee required by section 4723.08 of the Revised Code | 634 |
for a certificate to prescribe; | 635 |
(3) Either of the following: | 636 |
(a) Evidence of having held, for a continuous period of at | 637 |
least one year during the three years immediately preceding the | 638 |
date of application, valid authority issued by another | 639 |
jurisdiction to prescribe therapeutic devices and drugs, including | 640 |
at least some controlled substances; | 641 |
(b) Evidence of having been employed by the United States | 642 |
government and authorized, for a continuous period of at least one | 643 |
year during the three years immediately preceding the date of | 644 |
application, to prescribe therapeutic devices and drugs, including | 645 |
at least some controlled substances, in conjunction with that | 646 |
employment. | 647 |
(4) If the applicant includes the evidence described in | 648 |
division (C)(3)(a) of this section, documentation from a licensed | 649 |
physician in a form acceptable to the board that the prescribing | 650 |
component of the nurse's practice was overseen or supervised by a | 651 |
licensed physician in the other jurisdiction; | 652 |
(5) If the applicant includes the evidence described in | 653 |
division (C)(3)(b) of this section, documentation from a licensed | 654 |
physician employed by the United States government in a form | 655 |
acceptable to the board that the prescribing component of the | 656 |
nurse's practice was overseen or supervised by a licensed | 657 |
physician employed by the United States government; | 658 |
(6) Evidence of having completed a two-hour course of | 659 |
instruction approved by the board in the laws of this state that | 660 |
govern drugs and prescriptive authority; | 661 |
(7) Any additional information the board requires pursuant to | 662 |
rules adopted under section 4723.50 of the Revised Code. | 663 |
(D) An applicant who practiced or is practicing as a clinical | 664 |
nurse specialist, certified nurse-midwife, or certified nurse | 665 |
practitioner in another jurisdiction or as an employee of the | 666 |
United States government, and is not seeking authority to | 667 |
prescribe drugs and therapeutic devices by meeting the | 668 |
requirements of division (A) or (C) of this section, shall include | 669 |
with the application submitted under section 4723.48 of the | 670 |
Revised Code all of the following: | 671 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 672 |
of holding a current, valid certificate of authority issued under | 673 |
this chapter to practice as a clinical nurse specialist, certified | 674 |
nurse-midwife, or certified nurse practitioner; | 675 |
(2) The fee required by section 4723.08 of the Revised Code | 676 |
for a certificate to prescribe; | 677 |
(3) Either of the following: | 678 |
(a) Evidence of having held, for a continuous period of at | 679 |
least one year during the three years immediately preceding the | 680 |
date of application, valid authority issued by another | 681 |
jurisdiction to prescribe therapeutic devices and drugs, excluding | 682 |
controlled substances; | 683 |
(b) Evidence of having been employed by the United States | 684 |
government and authorized, for a continuous period of at least one | 685 |
year during the three years immediately preceding the date of | 686 |
application, to prescribe therapeutic devices and drugs, excluding | 687 |
controlled substances, in conjunction with that employment. | 688 |
(4) If the applicant includes the evidence described in | 689 |
division (D)(3)(a) of this section, documentation from a licensed | 690 |
physician in a form acceptable to the board that the prescribing | 691 |
component of the nurse's practice was overseen or supervised by a | 692 |
licensed physician in the other jurisdiction; | 693 |
(5) If the applicant includes the evidence described in | 694 |
division (D)(3)(b) of this section, documentation from a licensed | 695 |
physician employed by the United States government in a form | 696 |
acceptable to the board that the prescribing component of the | 697 |
nurse's practice was overseen or supervised by a licensed | 698 |
physician employed by the United States government; | 699 |
(6) Any additional information the board requires pursuant to | 700 |
rules adopted under section 4723.50 of the Revised Code. | 701 |
Sec. 4723.492. The committee on prescriptive governance | 702 |
shall develop recommendations regarding the authority to prescribe | 703 |
drugs and therapeutic devices pursuant to a certificate to | 704 |
prescribe issued under section 4723.48 of the Revised Code. | 705 |
706 | |
707 | |
apply specifically to the authority to prescribe schedule II | 708 |
controlled substances. | 709 |
The committee shall submit recommendations to the board of | 710 |
nursing as necessary for the board to fulfill its duty to adopt | 711 |
rules under section 4723.50 of the Revised Code. At the board's | 712 |
request, the committee shall reconsider a recommendation it has | 713 |
submitted and resubmit the recommendation to the board | 714 |
accordingly. | 715 |
Sec. 4723.50. (A) In accordance with Chapter 119. of the | 716 |
Revised Code, the board of nursing shall adopt rules as necessary | 717 |
to implement the provisions of this chapter pertaining to the | 718 |
authority of clinical nurse specialists, certified nurse-midwives, | 719 |
and certified nurse practitioners to prescribe drugs and | 720 |
therapeutic devices and the issuance and renewal of certificates | 721 |
to prescribe. | 722 |
723 |
The board shall adopt rules that are consistent with the | 724 |
recommendations the board receives from the committee on | 725 |
prescriptive governance pursuant to section 4723.492 of the | 726 |
Revised Code. After reviewing a recommendation submitted by the | 727 |
committee, the board may either adopt the recommendation as a rule | 728 |
or ask the committee to reconsider and resubmit the | 729 |
recommendation. The board shall not adopt any rule that does not | 730 |
conform to a recommendation made by the committee. | 731 |
(B) The board shall adopt rules under this section that do | 732 |
all of the following: | 733 |
(1) Establish a formulary listing the types of drugs and | 734 |
therapeutic devices that may be prescribed by a clinical nurse | 735 |
specialist, certified nurse-midwife, or certified nurse | 736 |
practitioner. The formulary may include controlled substances, as | 737 |
defined in section 3719.01 of the Revised Code. The formulary | 738 |
shall not permit the prescribing of any drug or device to perform | 739 |
or induce an abortion. | 740 |
(2) Establish safety standards to be followed by a clinical | 741 |
nurse specialist, certified nurse-midwife, or certified nurse | 742 |
practitioner when personally furnishing to patients complete or | 743 |
partial supplies of antibiotics, antifungals, scabicides, | 744 |
contraceptives, prenatal vitamins, antihypertensives, drugs and | 745 |
devices used in the treatment of diabetes, drugs and devices used | 746 |
in the treatment of asthma, and drugs used in the treatment of | 747 |
dyslipidemia | 748 |
(3) Establish criteria for the components of the standard | 749 |
care arrangements described in section 4723.431 of the Revised | 750 |
Code that apply to | 751 |
the components that apply to the authority to prescribe schedule | 752 |
II controlled substances. The rules shall be consistent with that | 753 |
section and include all of the following: | 754 |
(a) Quality assurance standards; | 755 |
(b) Standards for periodic review by a collaborating | 756 |
physician or podiatrist of the records of patients treated by the | 757 |
clinical nurse specialist, certified nurse-midwife, or certified | 758 |
nurse practitioner; | 759 |
(c) Acceptable travel time between the location at which the | 760 |
clinical nurse specialist, certified nurse-midwife, or certified | 761 |
nurse practitioner is engaging in the prescribing components of | 762 |
the nurse's practice and the location of the nurse's collaborating | 763 |
physician or podiatrist; | 764 |
(d) Any other criteria recommended by the committee on | 765 |
prescriptive governance. | 766 |
(4) Establish standards and procedures for issuance and | 767 |
renewal of a certificate to prescribe, including specification of | 768 |
any additional information the board may require under division | 769 |
(A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3) | 770 |
of section 4723.485 of the Revised Code; | 771 |
(5) Establish | 772 |
the
| 773 |
related topics required by section 4723.482 of the Revised Code; | 774 |
(6) Establish requirements for board approval of the two-hour | 775 |
course of instruction in the laws of this state as required under | 776 |
division (C)(6) of section 4723.482 of the Revised Code and | 777 |
division (B)(2) of section 4723.484 of the Revised Code; | 778 |
(7) Establish standards and procedures for the appropriate | 779 |
conduct of an externship as described in section 4723.484 of the | 780 |
Revised Code, including the following: | 781 |
(a) Standards and procedures to be used in evaluating | 782 |
783 |
(b) Standards and procedures for the supervision that a | 784 |
physician must provide during an externship, including supervision | 785 |
provided by working with the | 786 |
provided by making timely reviews of the records of patients | 787 |
treated by the
| 788 |
must be provided may vary according to the location where the | 789 |
790 | |
level of experience. | 791 |
Section 2. That existing sections 3719.06, 4723.28, 4723.481, | 792 |
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby | 793 |
repealed. | 794 |
Section 3. Beginning on the effective date of this act, the | 795 |
authority of a clinical nurse specialist, certified nurse-midwife, | 796 |
or certified nurse practitioner who holds a certificate to | 797 |
prescribe, including an externship certificate, includes the | 798 |
authority to prescribe schedule II controlled substances as | 799 |
authorized by sections 3719.06 and 4723.481 of the Revised Code, | 800 |
as amended by this act. | 801 |
In the case of a clinical nurse specialist, certified | 802 |
nurse-midwife, or certified nurse practitioner who received a | 803 |
certificate to prescribe before the effective date of this act or | 804 |
before the Board of Nursing has implemented the requirements of | 805 |
this act pertaining to instruction specific to schedule II | 806 |
controlled substances, the certificate holder shall submit | 807 |
evidence satisfactory to the Board that the certificate holder has | 808 |
completed a minimum of six contact hours of instruction specific | 809 |
to schedule II controlled substances. The evidence of completing | 810 |
the instruction shall be submitted by the certificate holder as a | 811 |
condition of eligibility for renewal of the certificate to | 812 |
prescribe or, in the case of an externship certificate holder, as | 813 |
a condition of eligibility for receipt of a new certificate to | 814 |
prescribe. | 815 |
Section 4. The Board of Nursing shall adopt rules under | 816 |
section 4723.50 of the Revised Code as necessary to implement the | 817 |
provisions of this act pertaining to the authority to prescribe | 818 |
schedule II controlled substances pursuant to a certificate to | 819 |
prescribe. The rules shall conform to the recommendations | 820 |
submitted by the Committee on Prescriptive Governance. | 821 |