As Introduced

130th General Assembly Regular Session 2013-2014

H. B. No. 314

Representatives Baker, Kunze 

Cosponsors: Representatives Hagan, C., Landis, Antonio, Sprague, Boose, Smith, Stebelton, Hood, Green, Sears, Driehaus, Patterson, O'Brien, Becker 

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A BILL

To amend sections 4715.30, 4723.481, and 4730.41 and

1

to enact sections 3719.061, 4723.283, 4725.191,

2

4730.252, and 4731.229 of the Revised Code to

3

require a prescriber to obtain written informed

4

consent from a minor's parent, guardian, or other

5

person responsible for the minor before issuing a

6

controlled substance prescription to the minor and

7

to establish sanctions for a prescriber's failure

8

to comply with this requirement.

9

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

Section 1. That sections 4715.30, 4723.481, and 4730.41 be	10
amended and sections 3719.061, 4723.283, 4725.191, 4730.252, and	11
4731.229 of the Revised Code be enacted to read as follows:	12

Sec. 3719.061.  (A)(1) As used in this section:

13

(a) "Medical emergency" means a situation that in a	14
prescriber's good faith medical judgment creates an immediate	15
threat of serious risk to the life or physical health of a minor.	16

(b) "Minor" means a person under eighteen years of age who is	17
not emancipated.	18

(2) For the purposes of this section, a person under eighteen	19
years of age shall be considered emancipated only if the person	20
has married, entered the armed services of the United States,	21
became employed and self-sustaining, or has otherwise become	22
independent from the care and control of the person's parent,	23
guardian, or custodian.	24

(B) Except in a medical emergency, before issuing a	25
prescription for a controlled substance to a minor, a prescriber	26
shall obtain the informed consent of the minor's parent, guardian,	27
or other person responsible for the minor. The informed consent	28
must be recorded on a form separate from any other document the	29
prescriber uses to obtain informed consent for other treatment	30
provided to the minor and contain all of the following:	31

(1) The name and quantity of the controlled substance being	32
prescribed and the amount of each dose;	33

(2) A statement indicating that a controlled substance is a	34
drug or other substance that the United States drug enforcement	35
agency has identified as having a potential for abuse;	36

(3) The number of refills authorized by the prescription;

37

(4) The signature of the minor's parent, guardian, or other	38
person responsible for the minor and the date of signing.	39

(C) The signed consent form shall be maintained in the	40
minor's medical record.	41

Sec. 4715.30.  (A) An applicant for or holder of a	42
certificate or license issued under this chapter is subject to	43
disciplinary action by the state dental board for any of the	44
following reasons:	45

(1) Employing or cooperating in fraud or material deception	46
in applying for or obtaining a license or certificate;	47

(2) Obtaining or attempting to obtain money or anything of	48
value by intentional misrepresentation or material deception in	49
the course of practice;	50

(3) Advertising services in a false or misleading manner or	51
violating the board's rules governing time, place, and manner of	52
advertising;	53

(4) Commission of an act that constitutes a felony in this	54
state, regardless of the jurisdiction in which the act was	55
committed;	56

(5) Commission of an act in the course of practice that	57
constitutes a misdemeanor in this state, regardless of the	58
jurisdiction in which the act was committed;	59

(6) Conviction of, a plea of guilty to, a judicial finding of	60
guilt of, a judicial finding of guilt resulting from a plea of no	61
contest to, or a judicial finding of eligibility for intervention	62
in lieu of conviction for, any felony or of a misdemeanor	63
committed in the course of practice;	64

(7) Engaging in lewd or immoral conduct in connection with	65
the provision of dental services;	66

(8) Selling, prescribing, giving away, or administering drugs	67
for other than legal and legitimate therapeutic purposes, or	68
conviction of, a plea of guilty to, a judicial finding of guilt	69
of, a judicial finding of guilt resulting from a plea of no	70
contest to, or a judicial finding of eligibility for intervention	71
in lieu of conviction for, a violation of any federal or state law	72
regulating the possession, distribution, or use of any drug;	73

(9) Providing or allowing dental hygienists, expanded	74
function dental auxiliaries, or other practitioners of auxiliary	75
dental occupations working under the certificate or license	76
holder's supervision, or a dentist holding a temporary limited	77
continuing education license under division (C) of section 4715.16	78
of the Revised Code working under the certificate or license	79
holder's direct supervision, to provide dental care that departs	80
from or fails to conform to accepted standards for the profession,	81
whether or not injury to a patient results;	82

(10) Inability to practice under accepted standards of the	83
profession because of physical or mental disability, dependence on	84
alcohol or other drugs, or excessive use of alcohol or other	85
drugs;	86

(11) Violation of any provision of this chapter or any rule	87
adopted thereunder;	88

(12) Failure to use universal blood and body fluid	89
precautions established by rules adopted under section 4715.03 of	90
the Revised Code;	91

(13) Except as provided in division (H) of this section,	92
either of the following:	93

(a) Waiving the payment of all or any part of a deductible or	94
copayment that a patient, pursuant to a health insurance or health	95
care policy, contract, or plan that covers dental services, would	96
otherwise be required to pay if the waiver is used as an	97
enticement to a patient or group of patients to receive health	98
care services from that certificate or license holder;	99

(b) Advertising that the certificate or license holder will	100
waive the payment of all or any part of a deductible or copayment	101
that a patient, pursuant to a health insurance or health care	102
policy, contract, or plan that covers dental services, would	103
otherwise be required to pay.	104

(14) Failure to comply with section 4729.79 of the Revised	105
Code, unless the state board of pharmacy no longer maintains a	106
drug database pursuant to section 4729.75 of the Revised Code;	107

(15) Any of the following actions taken by an agency	108
responsible for authorizing, certifying, or regulating an	109
individual to practice a health care occupation or provide health	110
care services in this state or another jurisdiction, for any	111
reason other than the nonpayment of fees: the limitation,	112
revocation, or suspension of an individual's license to practice;	113
acceptance of an individual's license surrender; denial of a	114
license; refusal to renew or reinstate a license; imposition of	115
probation; or issuance of an order of censure or other reprimand;	116

(16) Failure to cooperate in an investigation conducted by	117
the board under division (D) of section 4715.03 of the Revised	118
Code, including failure to comply with a subpoena or order issued	119
by the board or failure to answer truthfully a question presented	120
by the board at a deposition or in written interrogatories, except	121
that failure to cooperate with an investigation shall not	122
constitute grounds for discipline under this section if a court of	123
competent jurisdiction has issued an order that either quashes a	124
subpoena or permits the individual to withhold the testimony or	125
evidence in issue;	126

(17) Failure to comply with section 3719.061 of the Revised	127
Code.	128

(B) A manager, proprietor, operator, or conductor of a dental	129
facility shall be subject to disciplinary action if any dentist,	130
dental hygienist, expanded function dental auxiliary, or qualified	131
personnel providing services in the facility is found to have	132
committed a violation listed in division (A) of this section and	133
the manager, proprietor, operator, or conductor knew of the	134
violation and permitted it to occur on a recurring basis.	135

(C)(1) Subject to Chapter 119. of the Revised Code, the board	136
may take one or more of the following disciplinary actions if one	137
or more of the grounds for discipline listed in divisions (A)(1)	138
to (16) and (B) of this section exist:	139

(1)(a) Censure the license or certificate holder;

140

(2)(b) Place the license or certificate on probationary	141
status for such period of time the board determines necessary and	142
require the holder to:	143

(a)(i) Report regularly to the board upon the matters which	144
are the basis of probation;	145

(b)(ii) Limit practice to those areas specified by the board;

146

(c)(iii) Continue or renew professional education until a	147
satisfactory degree of knowledge or clinical competency has been	148
attained in specified areas.	149

(3)(c) Suspend the certificate or license;

150

(4)(d) Revoke the certificate or license.

151

(2) Subject to Chapter 119. of the Revised Code, the board	152
shall suspend for not less than six months the license of a	153
dentist who fails to comply with section 3719.061 of the Revised	154
Code.	155

Where the board places a holder of a license or certificate	156
on probationary status pursuant to division (C)(2)(1)(b) of this	157
section, the board may subsequently suspend or revoke the license	158
or certificate if it determines that the holder has not met the	159
requirements of the probation or continues to engage in activities	160
that constitute grounds for discipline pursuant to division (A) or	161
(B) of this section.	162

Any order suspending a license or certificate for a grounds	163
for discipline listed in divisions (A)(1) to (16) of this section	164
shall state the conditions under which the license or certificate	165
will be restored, which may include a conditional restoration	166
during which time the holder is in a probationary status pursuant	167
to division (C)(2)(1)(b) of this section. The board shall restore	168
the license or certificate unconditionally when such conditions	169
are met.	170

(D) If the physical or mental condition of an applicant or a	171
license or certificate holder is at issue in a disciplinary	172
proceeding, the board may order the license or certificate holder	173
to submit to reasonable examinations by an individual designated	174
or approved by the board and at the board's expense. The physical	175
examination may be conducted by any individual authorized by the	176
Revised Code to do so, including a physician assistant, a clinical	177
nurse specialist, a certified nurse practitioner, or a certified	178
nurse-midwife. Any written documentation of the physical	179
examination shall be completed by the individual who conducted the	180
examination.	181

Failure to comply with an order for an examination shall be	182
grounds for refusal of a license or certificate or summary	183
suspension of a license or certificate under division (E) of this	184
section.	185

(E) If a license or certificate holder has failed to comply	186
with an order under division (D) of this section, the board may	187
apply to the court of common pleas of the county in which the	188
holder resides for an order temporarily suspending the holder's	189
license or certificate, without a prior hearing being afforded by	190
the board, until the board conducts an adjudication hearing	191
pursuant to Chapter 119. of the Revised Code. If the court	192
temporarily suspends a holder's license or certificate, the board	193
shall give written notice of the suspension personally or by	194
certified mail to the license or certificate holder. Such notice	195
shall inform the license or certificate holder of the right to a	196
hearing pursuant to Chapter 119. of the Revised Code.	197

(F) Any holder of a certificate or license issued under this	198
chapter who has pleaded guilty to, has been convicted of, or has	199
had a judicial finding of eligibility for intervention in lieu of	200
conviction entered against the holder in this state for aggravated	201
murder, murder, voluntary manslaughter, felonious assault,	202
kidnapping, rape, sexual battery, gross sexual imposition,	203
aggravated arson, aggravated robbery, or aggravated burglary, or	204
who has pleaded guilty to, has been convicted of, or has had a	205
judicial finding of eligibility for treatment or intervention in	206
lieu of conviction entered against the holder in another	207
jurisdiction for any substantially equivalent criminal offense, is	208
automatically suspended from practice under this chapter in this	209
state and any certificate or license issued to the holder under	210
this chapter is automatically suspended, as of the date of the	211
guilty plea, conviction, or judicial finding, whether the	212
proceedings are brought in this state or another jurisdiction.	213
Continued practice by an individual after the suspension of the	214
individual's certificate or license under this division shall be	215
considered practicing without a certificate or license. The board	216
shall notify the suspended individual of the suspension of the	217
individual's certificate or license under this division by	218
certified mail or in person in accordance with section 119.07 of	219
the Revised Code. If an individual whose certificate or license is	220
suspended under this division fails to make a timely request for	221
an adjudicatory hearing, the board shall enter a final order	222
revoking the individual's certificate or license.	223

(G) If the supervisory investigative panel determines both of	224
the following, the panel may recommend that the board suspend an	225
individual's certificate or license without a prior hearing:	226

(1) That there is clear and convincing evidence that an	227
individual has violated divisiondivisions (A)(1) to (16) of this	228
section;	229

(2) That the individual's continued practice presents a	230
danger of immediate and serious harm to the public.	231

Written allegations shall be prepared for consideration by	232
the board. The board, upon review of those allegations and by an	233
affirmative vote of not fewer than four dentist members of the	234
board and seven of its members in total, excluding any member on	235
the supervisory investigative panel, may suspend a certificate or	236
license without a prior hearing. A telephone conference call may	237
be utilized for reviewing the allegations and taking the vote on	238
the summary suspension.	239

The board shall issue a written order of suspension by	240
certified mail or in person in accordance with section 119.07 of	241
the Revised Code. The order shall not be subject to suspension by	242
the court during pendency or any appeal filed under section 119.12	243
of the Revised Code. If the individual subject to the summary	244
suspension requests an adjudicatory hearing by the board, the date	245
set for the hearing shall be within fifteen days, but not earlier	246
than seven days, after the individual requests the hearing, unless	247
otherwise agreed to by both the board and the individual.	248

Any summary suspension imposed under this division shall	249
remain in effect, unless reversed on appeal, until a final	250
adjudicative order issued by the board pursuant to this section	251
and Chapter 119. of the Revised Code becomes effective. The board	252
shall issue its final adjudicative order within seventy-five days	253
after completion of its hearing. A failure to issue the order	254
within seventy-five days shall result in dissolution of the	255
summary suspension order but shall not invalidate any subsequent,	256
final adjudicative order.	257

(H) Sanctions shall not be imposed under division (A)(13) of	258
this section against any certificate or license holder who waives	259
deductibles and copayments as follows:	260

(1) In compliance with the health benefit plan that expressly	261
allows such a practice. Waiver of the deductibles or copayments	262
shall be made only with the full knowledge and consent of the plan	263
purchaser, payer, and third-party administrator. Documentation of	264
the consent shall be made available to the board upon request.	265

(2) For professional services rendered to any other person	266
who holds a certificate or license issued pursuant to this chapter	267
to the extent allowed by this chapter and the rules of the board.	268

(I) In no event shall the board consider or raise during a	269
hearing required by Chapter 119. of the Revised Code the	270
circumstances of, or the fact that the board has received, one or	271
more complaints about a person unless the one or more complaints	272
are the subject of the hearing or resulted in the board taking an	273
action authorized by this section against the person on a prior	274
occasion.	275

(J) The board may share any information it receives pursuant	276
to an investigation under division (D) of section 4715.03 of the	277
Revised Code, including patient records and patient record	278
information, with law enforcement agencies, other licensing	279
boards, and other governmental agencies that are prosecuting,	280
adjudicating, or investigating alleged violations of statutes or	281
administrative rules. An agency or board that receives the	282
information shall comply with the same requirements regarding	283
confidentiality as those with which the state dental board must	284
comply, notwithstanding any conflicting provision of the Revised	285
Code or procedure of the agency or board that applies when it is	286
dealing with other information in its possession. In a judicial	287
proceeding, the information may be admitted into evidence only in	288
accordance with the Rules of Evidence, but the court shall require	289
that appropriate measures are taken to ensure that confidentiality	290
is maintained with respect to any part of the information that	291
contains names or other identifying information about patients or	292
complainants whose confidentiality was protected by the state	293
dental board when the information was in the board's possession.	294
Measures to ensure confidentiality that may be taken by the court	295
include sealing its records or deleting specific information from	296
its records.	297

Sec. 4723.283.  The board of nursing, by a vote of a quorum,	298
shall suspend for not less than six months the certificate of	299
authority of a clinical nurse specialist, certified nurse-midwife,	300
or certified nurse practitioner who fails to comply with section	301
3719.061 of the Revised Code. Disciplinary action under this	302
section shall be taken pursuant to an adjudication conducted under	303
Chapter 119. of the Revised Code.	304

When investigating or conducting a hearing on an alleged	305
violation of section 3719.061 of the Revised Code, the board may	306
take any action it is authorized to take under division (D), (F),	307
or (G) of section 4723.28 of the Revised Code.	308

Sec. 4723.481.  This section establishes standards and	309
conditions regarding the authority of a clinical nurse specialist,	310
certified nurse-midwife, or certified nurse practitioner to	311
prescribe drugs and therapeutic devices under a certificate to	312
prescribe issued under section 4723.48 of the Revised Code.	313

(A) A clinical nurse specialist, certified nurse-midwife, or	314
certified nurse practitioner shall not prescribe any drug or	315
therapeutic device that is not included in the types of drugs and	316
devices listed on the formulary established in rules adopted under	317
section 4723.50 of the Revised Code.	318

(B) The prescriptive authority of a clinical nurse	319
specialist, certified nurse-midwife, or certified nurse	320
practitioner shall not exceed the prescriptive authority of the	321
collaborating physician or podiatrist, including the collaborating	322
physician's authority to treat chronic pain with controlled	323
substances and products containing tramadol as described in	324
section 4731.052 of the Revised Code.	325

(C)(1) Except as provided in division (C)(2) or (3) of this	326
section, a clinical nurse specialist, certified nurse-midwife, or	327
certified nurse practitioner may prescribe to a patient a schedule	328
II controlled substance only if all of the following are the case:	329

(a) The patient has a terminal condition, as defined in	330
section 2133.01 of the Revised Code.	331

(b) The collaborating physician of the clinical nurse	332
specialist, certified nurse-midwife, or certified nurse	333
practitioner initially prescribed the substance for the patient.	334

(c) The prescription is for an amount that does not exceed	335
the amount necessary for the patient's use in a single,	336
twenty-four-hour period.	337

(2) The restrictions on prescriptive authority in division	338
(C)(1) of this section do not apply if a clinical nurse	339
specialist, certified nurse-midwife, or certified nurse	340
practitioner issues the prescription to the patient from any of	341
the following locations:	342

(a) A hospital registered under section 3701.07 of the	343
Revised Code;	344

(b) An entity owned or controlled, in whole or in part, by a	345
hospital or by an entity that owns or controls, in whole or in	346
part, one or more hospitals;	347

(c) A health care facility operated by the department of	348
mental health and addiction services or the department of	349
developmental disabilities;	350

(d) A nursing home licensed under section 3721.02 of the	351
Revised Code or by a political subdivision certified under section	352
3721.09 of the Revised Code;	353

(e) A county home or district home operated under Chapter	354
5155. of the Revised Code that is certified under the medicare or	355
medicaid program;	356

(f) A hospice care program, as defined in section 3712.01 of	357
the Revised Code;	358

(g) A community mental health services provider, as defined	359
in section 5122.01 of the Revised Code;	360

(h) An ambulatory surgical facility, as defined in section	361
3702.30 of the Revised Code;	362

(i) A freestanding birthing center, as defined in section	363
3702.141 of the Revised Code;	364

(j) A federally qualified health center, as defined in	365
section 3701.047 of the Revised Code;	366

(k) A federally qualified health center look-alike, as	367
defined in section 3701.047 of the Revised Code;	368

(l) A health care office or facility operated by the board of	369
health of a city or general health district or the authority	370
having the duties of a board of health under section 3709.05 of	371
the Revised Code;	372

(m) A site where a medical practice is operated, but only if	373
the practice is comprised of one or more physicians who also are	374
owners of the practice; the practice is organized to provide	375
direct patient care; and the clinical nurse specialist, certified	376
nurse-midwife, or certified nurse practitioner providing services	377
at the site has a standard care arrangement and collaborates with	378
at least one of the physician owners who practices primarily at	379
that site.	380

(3) A clinical nurse specialist, certified nurse-midwife, or	381
certified nurse practitioner shall not issue to a patient a	382
prescription for a schedule II controlled substance from a	383
convenience care clinic even if the clinic is owned or operated by	384
an entity specified in division (C)(2) of this section.	385

(D) A pharmacist who acts in good faith reliance on a	386
prescription issued by a clinical nurse specialist, certified	387
nurse-midwife, or certified nurse practitioner under division	388
(C)(2) of this section is not liable for or subject to any of the	389
following for relying on the prescription: damages in any civil	390
action, prosecution in any criminal proceeding, or professional	391
disciplinary action by the state board of pharmacy under Chapter	392
4729. of the Revised Code.	393

(E) A clinical nurse specialist, certified nurse-midwife, or	394
certified nurse practitioner may personally furnish to a patient a	395
sample of any drug or therapeutic device included in the types of	396
drugs and devices listed on the formulary, except that all of the	397
following conditions apply:	398

(1) The amount of the sample furnished shall not exceed a	399
seventy-two-hour supply, except when the minimum available	400
quantity of the sample is packaged in an amount that is greater	401
than a seventy-two-hour supply, in which case the packaged amount	402
may be furnished.	403

(2) No charge may be imposed for the sample or for furnishing	404
it.	405

(3) Samples of controlled substances may not be personally	406
furnished.	407

(F) A clinical nurse specialist, certified nurse-midwife, or	408
certified nurse practitioner may personally furnish to a patient a	409
complete or partial supply of a drug or therapeutic device	410
included in the types of drugs and devices listed on the	411
formulary, except that all of the following conditions apply:	412

(1) The clinical nurse specialist, certified nurse-midwife,	413
or certified nurse practitioner shall personally furnish only	414
antibiotics, antifungals, scabicides, contraceptives, prenatal	415
vitamins, antihypertensives, drugs and devices used in the	416
treatment of diabetes, drugs and devices used in the treatment of	417
asthma, and drugs used in the treatment of dyslipidemia.	418

(2) The clinical nurse specialist, certified nurse-midwife,	419
or certified nurse practitioner shall not furnish the drugs and	420
devices in locations other than a health department operated by	421
the board of health of a city or general health district or the	422
authority having the duties of a board of health under section	423
3709.05 of the Revised Code, a federally funded comprehensive	424
primary care clinic, or a nonprofit health care clinic or program.	425

(3) The clinical nurse specialist, certified nurse-midwife,	426
or certified nurse practitioner shall comply with all safety	427
standards for personally furnishing supplies of drugs and devices,	428
as established in rules adopted under section 4723.50 of the	429
Revised Code.	430

(G) A clinical nurse specialist, certified nurse-midwife, or	431
certified nurse practitioner shall comply with section 3719.061 of	432
the Revised Code if the nurse prescribes a controlled substance to	433
a minor, as defined in that section.	434

Sec. 4725.191.  By an affirmative vote of a majority of its	435
members, the state board of optometry shall suspend for not less	436
than six months the operation of an optometrist's certificate of	437
licensure if the optometrist fails to comply with section 3719.061	438
of the Revised Code. Disciplinary action under this section shall	439
be taken pursuant to an adjudication conducted under Chapter 119.	440
of the Revised Code.	441

Sec. 4730.252.  By an affirmative vote of not fewer than six	442
members, the state medical board shall suspend for not less than	443
six months the certificate to practice of a physician assistant	444
who fails to comply with section 3719.061 of the Revised Code.	445
Except as specified in division (J) of section 4730.25 of the	446
Revised Code, disciplinary action under this section shall be	447
taken pursuant to an adjudication conducted under Chapter 119. of	448
the Revised Code.	449

Sec. 4730.41.  (A) A certificate to prescribe issued under	450
this chapter authorizes a physician assistant to prescribe and	451
personally furnish drugs and therapeutic devices in the exercise	452
of physician-delegated prescriptive authority.	453

(B) In exercising physician-delegated prescriptive authority,	454
a physician assistant is subject to all of the following:	455

(1) The physician assistant shall exercise	456
physician-delegated prescriptive authority only to the extent that	457
the physician supervising the physician assistant has granted that	458
authority.	459

(2) The physician assistant shall comply with all conditions	460
placed on the physician-delegated prescriptive authority, as	461
specified by the supervising physician who is supervising the	462
physician assistant in the exercise of physician-delegated	463
prescriptive authority.	464

(3) If the physician assistant possesses physician-delegated	465
prescriptive authority for controlled substances, the physician	466
assistant shall register with the federal drug enforcement	467
administration.	468

(4) If the physician assistant possesses physician-delegated	469
prescriptive authority for schedule II controlled substances, the	470
physician assistant shall comply with section 4730.411 of the	471
Revised Code.	472

(5) If the physician assistant prescribes controlled	473
substances to a minor, the physician assistant shall comply with	474
section 3719.061 of the Revised Code. As used in this division,	475
"minor" has the same meaning as in section 3719.061 of the Revised	476
Code.	477

Sec. 4731.229.  By an affirmative vote of not fewer than six	478
of its members, the state medical board shall suspend for not less	479
than six months the certificate to practice medicine and surgery,	480
osteopathic medicine and surgery, or podiatric medicine and	481
surgery of a physician who fails to comply with section 3719.061	482
of the Revised Code.	483

When investigating or conducting a hearing on an alleged	484
violation of section 3719.061 of the Revised Code, the board may	485
take any action it is authorized to take under division (F) of	486
section 4731.22 of the Revised Code.	487

Except as specified in division (J) of section 4731.22 of the	488
Revised Code, disciplinary action under this section shall be	489
taken pursuant to an adjudication conducted under Chapter 119. of	490
the Revised Code.	491

Section 2.  That existing sections 4715.30, 4723.481, and	492
4730.41 of the Revised Code are hereby repealed.	493