As Reported by the House Health and Aging Committee

130th General Assembly Regular Session 2013-2014

Sub. H. B. No. 170

Representatives Johnson, Stinziano 

Cosponsors: Representatives Amstutz, Antonio, Gonzales, Grossman, Letson, Lynch, Maag, Milkovich, Phillips, Reece, Rogers, Sprague, Stebelton, Ramos, Barnes, Bishoff, Brown, Schuring, Sears, Smith 

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A BILL

To amend sections 4762.03, 4765.35, and 4765.37 and

1

to enact sections 2925.61, 4723.488, 4730.431, and

2

4731.94 of the Revised Code to provide for

3

increased access to naloxone, to ensure English

4

proficiency in licensed practitioners of Oriental

5

medicine and acupuncture, and to declare an

6

emergency.

7

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

Section 1. That sections 4762.03, 4765.35, and 4765.37 be	8
amended and sections 2925.61, 4723.488, 4730.431, and 4731.94 of	9
the Revised Code be enacted to read as follows:	10

Sec. 2925.61. (A) As used in this section:

11

(1) "Administer naloxone" means to give naloxone to a person	12
by either of the following routes:	13

(a) Using a device manufactured for the intranasal	14
administration of liquid drugs;	15

(b) Using an autoinjector in a manufactured dosage form.

16

(2) "Law enforcement agency" means a government entity that	17
employs peace officers to perform law enforcement duties.	18

(3) "Licensed health professional" means all of the	19
following:	20

(a) A physician who is authorized under Chapter 4731. of the	21
Revised Code to practice medicine and surgery, osteopathic	22
medicine and surgery, or podiatric medicine and surgery;	23

(b) A physician assistant who holds a certificate to	24
prescribe issued under Chapter 4730. of the Revised Code;	25

(c) A clinical nurse specialist, certified nurse-midwife, or	26
certified nurse practitioner who holds a certificate to prescribe	27
issued under section 4723.48 of the Revised Code.	28

(4) "Peace officer" has the same meaning as in section	29
2921.51 of the Revised Code.	30

(B) A family member, friend, or other individual who is in a	31
position to assist an individual who is apparently experiencing or	32
at risk of experiencing an opioid-related overdose, is not subject	33
to criminal prosecution for a violation of section 4731.41 of the	34
Revised Code or criminal prosecution under this chapter if the	35
individual, acting in good faith, does all of the following:	36

(1) Obtains naloxone from a licensed health professional or a	37
prescription for naloxone from a licensed health professional;	38

(2) Administers that naloxone to an individual who is	39
apparently experiencing an opioid-related overdose;	40

(3) Attempts to summon emergency services either immediately	41
before or immediately after administering the naloxone.	42

(C) Division (B) of this section does not apply to a peace	43
officer or to an emergency medical technician-basic, emergency	44
medical technician-intermediate, or emergency medical	45
technician-paramedic, as defined in section 4765.01 of the Revised	46
Code.	47

(D) A peace officer employed by a law enforcement agency	48
licensed under Chapter 4729. of the Revised Code as a terminal	49
distributor of dangerous drugs is not subject to administrative	50
action, criminal prosecution for a violation of section 4731.41 of	51
the Revised Code, or criminal prosecution under this chapter if	52
the peace officer, acting in good faith, obtains naloxone from the	53
peace officer's law enforcement agency and administers the	54
naloxone to an individual who is apparently experiencing an	55
opioid-related overdose.	56

Sec. 4723.488.  (A) Notwithstanding any provision of this	57
chapter or rule adopted by the board of nursing, a clinical nurse	58
specialist, certified nurse-midwife, or certified nurse	59
practitioner who holds a certificate to prescribe issued under	60
section 4723.48 of the Revised Code may personally furnish a	61
supply of naloxone, or issue a prescription for naloxone, without	62
having examined the individual to whom it may be administered if	63
all of the following conditions are met:	64

(1) The naloxone supply is furnished to, or the prescription	65
is issued to and in the name of, a family member, friend, or other	66
individual in a position to assist an individual who there is	67
reason to believe is at risk of experiencing an opioid-related	68
overdose;	69

(2) The nurse instructs the individual receiving the naloxone	70
supply or prescription to summon emergency services either	71
immediately before or immediately after administering naloxone to	72
an individual apparently experiencing an opioid-related overdose;	73

(3) The naloxone is personally furnished or prescribed in	74
such a manner that it may be administered by only either of the	75
following routes:	76

(a) Using a device manufactured for the intranasal	77
administration of liquid drugs;	78

(b) Using an autoinjector in a manufactured dosage form.

79

(B) A nurse who under division (A) of this section in good	80
faith furnishes a supply of naloxone or issues a prescription for	81
naloxone is not liable for or subject to any of the following for	82
any action or omission of the individual to whom the naloxone is	83
furnished or the prescription is issued: damages in any civil	84
action, prosecution in any criminal proceeding, or professional	85
disciplinary action.	86

Sec. 4730.431.  (A) Notwithstanding any provision of this	87
chapter or rule adopted by the state medical board, a physician	88
assistant who holds a certificate to prescribe issued under this	89
chapter may personally furnish a supply of naloxone, or issue a	90
prescription for naloxone, without having examined the individual	91
to whom it may be administered if all of the following conditions	92
are met:	93

(1) The naloxone supply is furnished to, or the prescription	94
is issued to and in the name of, a family member, friend, or other	95
individual in a position to assist an individual who there is	96
reason to believe is at risk of experiencing an opioid-related	97
overdose;	98

(2) The physician assistant instructs the individual	99
receiving the naloxone supply or prescription to summon emergency	100
services either immediately before or immediately after	101
administering naloxone to an individual apparently experiencing an	102
opioid-related overdose;	103

(3) The naloxone is personally furnished or prescribed in	104
such a manner that it may be administered by only either of the	105
following routes:	106

(a) Using a device manufactured for the intranasal	107
administration of liquid drugs;	108

(b) Using an autoinjector in a manufactured dosage form.

109

(B) A physician assistant who under division (A) of this	110
section in good faith furnishes a supply of naloxone or issues a	111
prescription for naloxone is not liable for or subject to any of	112
the following for any action or omission of the individual to whom	113
the naloxone is furnished or the prescription is issued: damages	114
in any civil action, prosecution in any criminal proceeding, or	115
professional disciplinary action.	116

Sec. 4731.94.  (A) As used in this section, "physician" means	117
an individual authorized under this chapter to practice medicine	118
and surgery, osteopathic medicine and surgery, or podiatric	119
medicine and surgery.	120

(B) Notwithstanding any provision of this chapter or rule	121
adopted by the state medical board, a physician may personally	122
furnish a supply of naloxone, or issue a prescription for	123
naloxone, without having examined the individual to whom it may be	124
administered if all of the following conditions are met:	125

(1) The naloxone supply is furnished to, or the prescription	126
is issued to and in the name of, a family member, friend, or other	127
individual in a position to assist an individual who there is	128
reason to believe is at risk of experiencing an opioid-related	129
overdose;	130

(2) The physician instructs the individual receiving the	131
naloxone supply or prescription to summon emergency services	132
either immediately before or immediately after administering the	133
naloxone to an individual apparently experiencing an	134
opioid-related overdose;	135

(3) The naloxone is personally furnished or prescribed in	136
such a manner that it may be administered by only either of the	137
following routes:	138

(a) Using a device manufactured for the intranasal	139
administration of liquid drugs;	140

(b) Using an autoinjector in a manufactured dosage form.

141

(C) A physician who under division (B) of this section in	142
good faith furnishes a supply of naloxone or issues a prescription	143
for naloxone is not liable for or subject to any of the following	144
for any action or omission of the individual to whom the naloxone	145
is furnished or the prescription is issued: damages in any civil	146
action, prosecution in any criminal proceeding, or professional	147
disciplinary action.	148

Sec. 4762.03.  (A) An individual seeking a certificate to	149
practice as an oriental medicine practitioner or certificate to	150
practice as an acupuncturist shall file with the state medical	151
board a written application on a form prescribed and supplied by	152
the board.	153

(B) To be eligible for the certificate to practice, an	154
applicant shall meet all of the following conditions, as	155
applicable:	156

(1) The applicant shall submit evidence satisfactory to the	157
board that the applicant is at least eighteen years of age and of	158
good moral character.	159

(2) In the case of an applicant seeking a certificate to	160
practice as an oriental medicine practitioner, the applicant shall	161
submit evidence satisfactory to the board of both of the	162
following:	163

(a) That the applicant holds a current and active designation	164
from the national certification commission for acupuncture and	165
oriental medicine as either a diplomate in oriental medicine or	166
diplomate of acupuncture and Chinese herbology;	167

(b) That the applicant has successfully completed, in the	168
two-year period immediately preceding application for the	169
certificate to practice, one course approved by the commission on	170
federal food and drug administration dispensary and compounding	171
guidelines and procedures.	172

(3) In the case of an applicant seeking a certificate to	173
practice as an acupuncturist, the applicant shall submit evidence	174
satisfactory to the board that the applicant holds a current and	175
active designation from the national certification commission for	176
acupuncture and oriental medicine as a diplomate in acupuncture.	177

(4) The applicant shall demonstrate to the board proficiency	178
in spoken English by either passingsatisfying one of the	179
following requirements:	180

(a) Passing the examination described in section 4731.142 of	181
the Revised Code or submitting;	182

(b) Submitting evidence satisfactory to the board that the	183
applicant was required to demonstrate proficiency in spoken	184
English as a condition of obtaining designation from the national	185
certification commission for acupuncture and oriental medicine as	186
a diplomate in oriental medicine, diplomate of acupuncture and	187
Chinese herbology, or diplomate in acupuncture;	188

(c) Submitting evidence satisfactory to the board that the	189
applicant, in seeking a designation from the national	190
certification commission for acupuncture and oriental medicine as	191
a diplomate of oriental medicine, diplomate of acupuncture and	192
Chinese herbology, or diplomate of acupuncture, has successfully	193
completed in English the examination required for such a	194
designation by the national certification commission for	195
acupuncture and oriental medicine;	196

(d) In the case of an applicant seeking a certificate to	197
practice as an oriental medicine practitioner, submitting evidence	198
satisfactory to the board that the applicant has previously held a	199
certificate to practice as an acupuncturist issued under section	200
4762.04 of the Revised Code.	201

(5) The applicant shall submit to the board any other	202
information the board requires.	203

(6) The applicant shall pay to the board a fee of one hundred	204
dollars, no part of which may be returned to the applicant.	205

(C) The board shall review all applications received under	206
this section. The board shall determine whether an applicant meets	207
the requirements to receive a certificate to practice not later	208
than sixty days after receiving a complete application. The	209
affirmative vote of not fewer than six members of the board is	210
required to determine that an applicant meets the requirements for	211
a certificate.	212

Sec. 4765.35.  (A) A first responder shall perform the	213
emergency medical services described in this section in accordance	214
with this chapter and any rules adopted under it.	215

(B) A first responder may provide limited emergency medical	216
services to patients until the arrival of an emergency medical	217
technician-basic, emergency medical technician-intermediate, or	218
emergency medical technician-paramedic. In an emergency, a first	219
responder may render emergency medical services such as opening	220
and maintaining an airway, giving mouth to barrier ventilation,	221
chest compressions, electrical interventions with automated	222
defibrillators to support or correct the cardiac function and	223
other methods determined by the board, controlling of hemorrhage,	224
manual stabilization of fractures, bandaging, assisting in	225
childbirth, and determining triage of trauma victims.	226

(C)(1) Subject to division (C)(2) of this section, a first	227
responder may administer naloxone by either of the following	228
routes to a person who is apparently experiencing an	229
opioid-related overdose:	230

(a) Using a device manufactured for the intranasal	231
administration of liquid drugs;	232

(b) Using an autoinjector in a manufactured dosage form.

233

(2) Except as provided in division (E) of this section, a	234
first responder shall administer naloxone only pursuant to the	235
written or verbal authorization of a physician or of the	236
cooperating physician advisory board or pursuant to an	237
authorization transmitted through a direct communication device by	238
a physician, physician assistant designated by a physician, or	239
registered nurse designated by a physician.	240

(D)(1) A first responder may perform any other emergency	241
medical services approved pursuant to rules adopted under section	242
4765.11 of the Revised Code. The board shall determine whether the	243
nature of any such service requires that a first responder receive	244
authorization prior to performing the service.	245

(D)(1)(2) Except as provided in division (D)(2)(E) of this	246
section, if the board determines under division (C)(D)(1) of this	247
section that a service requires prior authorization, the service	248
shall be performed only pursuant to the written or verbal	249
authorization of a physician or of the cooperating physician	250
advisory board, or pursuant to an authorization transmitted	251
through a direct communication device by a physician, physician	252
assistant designated by a physician, or registered nurse	253
designated by a physician.	254

(2)(E) If communications fail during an emergency situation	255
or the required response time prohibits communication, a first	256
responder may perform services subject to this division (C)(2) or	257
(D)(2) of this section, if, in the judgment of the first	258
responder, the life of the patient is in immediate danger.	259
Services performed under these circumstances shall be performed in	260
accordance with the written protocols for triage of adult and	261
pediatric trauma victims established in rules adopted under	262
sections 4765.11 and 4765.40 of the Revised Code and any	263
applicable protocols adopted by the emergency medical service	264
organization with which the first responder is affiliated.	265

Sec. 4765.37.  (A) An emergency medical technician-basic	266
shall perform the emergency medical services described in this	267
section in accordance with this chapter and any rules adopted	268
under it by the state board of emergency medical, fire, and	269
transportation services.	270

(B) An emergency medical technician-basic may operate, or be	271
responsible for operation of, an ambulance and may provide	272
emergency medical services to patients. In an emergency, an	273
EMT-basic may determine the nature and extent of illness or injury	274
and establish priority for required emergency medical services. An	275
EMT-basic may render emergency medical services such as opening	276
and maintaining an airway, giving positive pressure ventilation,	277
cardiac resuscitation, electrical interventions with automated	278
defibrillators to support or correct the cardiac function and	279
other methods determined by the board, controlling of hemorrhage,	280
treatment of shock, immobilization of fractures, bandaging,	281
assisting in childbirth, management of mentally disturbed	282
patients, initial care of poison and burn patients, and	283
determining triage of adult and pediatric trauma victims. Where	284
patients must in an emergency be extricated from entrapment, an	285
EMT-basic may assess the extent of injury and render all possible	286
emergency medical services and protection to the entrapped	287
patient; provide light rescue services if an ambulance has not	288
been accompanied by a specialized unit; and after extrication,	289
provide additional care in sorting of the injured in accordance	290
with standard emergency procedures.	291

(C)(1) Subject to division (C)(2) of this section, an	292
EMT-basic may administer naloxone by either of the following	293
routes to a person who is apparently experiencing an	294
opioid-related overdose:	295

(a) Using a device manufactured for the intranasal	296
administration of liquid drugs;	297

(b) Using an autoinjector in a manufactured dosage form.

298

(2) Except as provided in division (E) of this section, an	299
EMT-basic shall administer naloxone only pursuant to the written	300
or verbal authorization of a physician or of the cooperating	301
physician advisory board or pursuant to an authorization	302
transmitted through a direct communication device by a physician,	303
physician assistant designated by a physician, or registered nurse	304
designated by a physician.	305

(D)(1) An EMT-basic may perform any other emergency medical	306
services approved pursuant to rules adopted under section 4765.11	307
of the Revised Code. The board shall determine whether the nature	308
of any such service requires that an EMT-basic receive	309
authorization prior to performing the service.	310

(D)(1)(2) Except as provided in division (D)(2)(E) of this	311
section, if the board determines under division (C)(D)(1) of this	312
section that a service requires prior authorization, the service	313
shall be performed only pursuant to the written or verbal	314
authorization of a physician or of the cooperating physician	315
advisory board, or pursuant to an authorization transmitted	316
through a direct communication device by a physician, physician	317
assistant designated by a physician, or registered nurse	318
designated by a physician.	319

(2)(E) If communications fail during an emergency situation	320
or the required response time prohibits communication, an	321
EMT-basic may perform services subject to this division (C)(2) or	322
(D)(2) of this section, if, in the judgment of the EMT-basic, the	323
life of the patient is in immediate danger. Services performed	324
under these circumstances shall be performed in accordance with	325
the protocols for triage of adult and pediatric trauma victims	326
established in rules adopted under sections 4765.11 and 4765.40 of	327
the Revised Code and any applicable protocols adopted by the	328
emergency medical service organization with which the EMT-basic is	329
affiliated.	330

Section 2. That existing sections 4762.03, 4765.35, and	331
4765.37 of the Revised Code are hereby repealed.	332

Section 3.  This act is hereby declared to be an emergency	333
measure necessary for the immediate preservation of the public	334
peace, health, and safety. The reason for such necessity is to	335
enhance the delivery of health services in this state by promptly	336
increasing access to certain forms of care, including Oriental	337
medicine, acupuncture, and emergency treatments for drug	338
overdoses. Therefore, this act shall go into immediate effect.	339