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(123rd General Assembly)(Amended Substitute Senate Bill Number 178)
AN ACT
To amend sections 3721.01, 3721.02, 3721.021, 3721.03, 3721.07,
3721.08, 3721.09, 3721.99, 4723.02, and 4723.48 and to enact sections 3721.051
and 4723.481 of the
Revised Code to provide that a county home or district home may be
licensed as a residential care facility and, if licensed, the laws
and rules governing residential care facilities apply to the home, to permit a
licensed practical nurse to perform certain activities relating to
intravenous therapy, to make other changes in the law
governing intravenous therapy procedures performed by licensed practical
nurses, and to maintain the
provisions of this act on and after July 1, 2000, by amending the version of
section 3721.08 of the Revised Code that takes effect on that date.
Be it enacted by the General Assembly of the State of Ohio:
SECTION 1 . That sections 3721.01, 3721.02, 3721.021, 3721.03,
3721.07, 3721.08, 3721.09, 3721.99, 4723.02, and 4723.48 be amended and
sections 3721.051 and 4723.481 of the Revised Code be enacted to read as
follows:
Sec. 3721.01. (A) As used in sections 3721.01 to 3721.09
and 3721.99 of the Revised Code: (1)(a) "Home" means an institution, residence, or facility that provides, for
a period of more than twenty-four hours, whether for a
consideration or not, accommodations to three or more unrelated
individuals who are dependent upon the services of others, including a nursing
home, residential care facility, home for the aging, and the Ohio veterans'
home. (b) "Home" also means any both of the following: (i) Any facility that a person, as defined in section
3702.51 of the Revised Code, proposes for certification as a skilled nursing
facility or nursing facility under Title XVIII or XIX of the
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as
amended, and for which a certificate of need, other than a
certificate to recategorize hospital beds as described in section 3702.522 of
the Revised Code or division (R)(7)(d) of the version of section 3702.51 of
the Revised Code in effect immediately prior to April 20, 1995, has been
granted to the person under sections 3702.51 to 3702.62 of the
Revised Code after August 5, 1989; (ii) A county home or district home that is or has been licensed
as a residential care facility. (c) "Home" does not mean any of the following: (i) Except as provided in division (A)(1)(b) of this
section, a public hospital or hospital as defined in section
3701.01 or 5122.01 of the Revised Code; (ii) A residential facility for mentally ill persons as
defined under section 5119.22 of the Revised Code; (iii) A residential facility as defined in section 5123.19
of the Revised Code; (iv) A habilitation center as defined in section 5123.041
of the Revised Code; (v) A community alternative home as defined in section
3724.01 of the Revised Code; (vi) An adult care facility as defined in section 3722.01
of the Revised Code; (vii) An alcohol or drug addiction program as defined in
section 3793.01 of the Revised Code; (viii) A facility licensed to provide methadone treatment
under section 3793.11 of the Revised Code; (ix) A facility providing services under contract with the
department of mental retardation and developmental disabilities
under section 5123.18 of the Revised Code; (x) A facility operated by a hospice care program licensed
under section 3712.04 of the Revised Code that is used
exclusively for care of hospice patients; (xi) A facility, infirmary, or
other entity that is operated by a religious order, provides care
exclusively to members of religious orders who take vows of
celibacy and live by virtue of their vows within the orders as if
related, and does not participate in the medicare program
established under Title XVIII of the "Social Security Act" or the
medical assistance program established under Chapter 5111. of the
Revised Code and Title XIX of the "Social Security Act," if on
January 1, 1994, the facility, infirmary, or entity was providing
care exclusively to members of the religious order; (xii) A county home or district home that has never been licensed
as a residential care facility. (2) "Unrelated individual" means one who is not related to
the owner or operator of a home or to the spouse of the
owner or operator as a parent, grandparent, child, grandchild, brother,
sister, niece, nephew, aunt, uncle, or as the child of an aunt or uncle. (3) "Mental impairment" does not mean mental illness as
defined in section 5122.01 of the Revised Code or mental
retardation as defined in section 5123.01 of the Revised Code. (4) "Skilled nursing care" means procedures that require
technical skills and knowledge beyond those the untrained person
possesses and that are commonly employed in providing for the
physical, mental, and emotional needs of the ill or otherwise
incapacitated. "Skilled nursing care" includes, but is not
limited to, the following: (a) Irrigations, catheterizations, application of
dressings, and supervision of special diets; (b) Objective observation of changes in the patient's
condition as a means of analyzing and determining the nursing
care required and the need for further medical diagnosis and
treatment; (c) Special procedures contributing to rehabilitation; (d) Administration of medication by any method ordered by
a physician, such as hypodermically, rectally, or orally,
including observation of the patient after receipt of the
medication; (e) Carrying out other treatments prescribed by the
physician that involve a similar level of complexity and skill in
administration. (5)(a) "Personal care services" means services including,
but not limited to, the following: (i) Assisting residents with activities of daily living; (ii) Assisting residents with self-administration of
medication, in accordance with rules adopted under section
3721.04 of the Revised Code; (iii) Preparing special diets, other than complex
therapeutic diets, for residents pursuant to the instructions of
a physician or a licensed dietitian, in accordance with rules
adopted under section 3721.04 of the Revised Code. (b) "Personal care services" does not include "skilled
nursing care" as defined in division (A)(4) of this section. A
facility need not provide more than one of the services listed in
division (A)(5)(a) of this section to be considered to be
providing personal care services. (6) "Nursing home" means a home used for the reception and
care of individuals who by reason of illness or physical or
mental impairment require skilled nursing care and of individuals
who require personal care services but not skilled nursing care.
A nursing home is licensed to provide personal care services and
skilled nursing care. (7) "Residential care facility" means a home that provides either of the
following: (a) Accommodations for seventeen or more unrelated
individuals and supervision and personal care services for three
or more of those individuals who are dependent on the services of
others by reason of age or physical or mental impairment; (b) Accommodations for three or more unrelated
individuals, supervision and personal care services for at least
three of those individuals who are dependent on the services of
others by reason of age or physical or mental impairment, and, to at least one
of those individuals, any of the skilled nursing care authorized by section
3721.011 of the Revised Code. (8) "Home for the aging" means a home that provides services as a
residential care facility and a nursing home, except that the home provides
its services only to individuals who are dependent on the services of others
by reason of both age and physical or mental impairment. The part or unit of a home for the aging that provides
services only as a residential care facility is licensed as a residential care
facility. The part or unit that may provide skilled nursing care beyond the
extent authorized by section 3721.011 of the Revised Code is licensed as a
nursing home. (9) "County home" and "district home" mean a county home or
district home operated under Chapter 5155. of the Revised
Code. (B) The public health council may further classify homes.
For the purposes of this chapter, any residence, institution,
hotel, congregate housing project, or similar facility that meets
the definition of a home under this section is such a home regardless of how
the facility holds itself out to the public. (C) For purposes of this chapter, personal care services
or skilled nursing care shall be considered to be provided by a
facility if they are provided by a person employed by or
associated with the facility or by another person pursuant to an
agreement to which neither the resident who receives the services
nor his the resident's sponsor is a party. (D) Nothing in division (A)(4) of this section shall be
construed to permit skilled nursing care to be imposed on an
individual who does not require skilled nursing care. Nothing in division (A)(5) of this section shall be
construed to permit personal care services to be imposed on an
individual who is capable of performing the activity in question
without assistance. (E) Division (A)(1)(c)(xi) of this section does not
prohibit a facility, infirmary, or other entity described in that
division from seeking licensure under
sections 3721.01 to 3721.09 of the Revised Code or certification
under Title XVIII or XIX of the "Social Security Act." However,
such a facility, infirmary, or entity that applies for licensure
or certification must meet the requirements of those sections or
titles and the rules adopted under them and
obtain a certificate of need from the director of health under
section 3702.52 of the Revised Code. (F) Nothing in this chapter, or rules adopted pursuant to
it, shall be construed as authorizing the supervision,
regulation, or control of the spiritual care or treatment of
residents or patients in any home who rely upon treatment by
prayer or spiritual means in accordance with the creed or tenets
of any recognized church or religious denomination. Sec. 3721.02. The director of health shall license homes
and establish procedures to be followed in inspecting and
licensing homes. The director may inspect a home at any time.
Each home shall be inspected by the director at least once prior
to the issuance of a license and at least once every fifteen
months thereafter. The state fire marshal or a township,
municipal, or other legally constituted fire department approved
by the marshal shall also inspect a home prior to issuance of a
license, at least once every fifteen months thereafter, and at
any other time requested by the director. A home does not have
to be inspected prior to issuance of a license by the director,
state fire marshal, or a fire department if ownership of the home
is assigned or transferred to a different person and the home was
licensed under this chapter immediately prior to the assignment
or transfer. The director may enter at any time, for the
purposes of investigation, any institution, residence, facility,
or other structure which has been reported to the director or
that the director has reasonable cause to believe is operating as
a, nursing home, residential care facility, or
home for the aging without a valid
license required by section 3721.05 of the Revised Code
or, in the case of a county home or district home, is operating despite the
revocation of its residential care facility license. The director may
delegate his the director's
authority
and duties
under this chapter to any division, bureau, agency, or official
of the department of health. A single facility may be licensed both as a nursing home
pursuant to this chapter and as an adult care facility pursuant
to Chapter 3722. of the Revised Code if the director determines
that the part or unit to be licensed as a nursing home can be
maintained separate and discrete from the part or unit to be
licensed as an adult care facility. In determining the number of residents in a home for the
purpose of licensing, the director shall consider all the
individuals for whom the home provides accommodations as one
group unless one of the following is the case: (A) The home is a home for the aging, in which case all
the individuals in the part or unit licensed as a nursing home
shall be considered as one group and all the individuals in the
part or unit licensed as a rest home shall be considered as
another group; (B) The home is both a nursing home and an adult care
facility. In that case, all the individuals in the part or unit
licensed as a nursing home shall be considered as one group and
all the individuals in the part or unit licensed as an adult care
facility shall be considered as another group. (C) The home maintains, in addition to a nursing home or
residential care facility, a separate and discrete part
or unit that provides accommodations to individuals who do not require or
receive skilled nursing care and do not receive personal care services
from the home, in which case the individuals in the separate and
discrete part or unit shall not be considered in determining the
number of residents in the home if the separate and discrete part
or unit is in compliance with the Ohio basic building code
established by the board of building standards under Chapters
3781. and 3791. of the Revised Code and the home permits the
director, on request, to inspect the separate and discrete part
or unit and speak with the individuals residing there, if they
consent, to determine whether the separate and discrete part or
unit meets the requirements of this division. The director of health shall charge an application fee and
an annual renewal licensing and inspection fee of one hundred
dollars for each fifty persons or part thereof of a home's
licensed capacity. All fees collected by the director for the
issuance or renewal of licenses shall be deposited into the state
treasury to the credit of the general operations fund created in
section 3701.83 of the Revised Code for use only in administering
and enforcing this chapter and rules adopted under it. Sec. 3721.021. Every person who operates a home, as defined in section
3721.01
of the Revised Code, and each county home and district home licensed as a
residential care facility shall have available in the home for review by
prospective patients and residents, their guardians, or other persons
assisting in their placement, each inspection report completed pursuant to
section 3721.02 of the Revised Code and each statement of deficiencies and
plan of correction completed and made available to the public under Titles
XVIII and XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.
301, as amended, and any rules promulgated under Titles XVIII and XIX,
including such reports that result from life safety code and health
inspections during the preceding three years, and shall post prominently
within the home a notice of this requirement. Sec. 3721.03. The director of health shall enforce the
provisions of sections 3721.01 to 3721.09 and 3721.99 of the
Revised Code and may issue orders to secure compliance with the
provisions of these sections and the rules adopted under them.
He The director may hold hearings, issue subpoenas, compel
testimony, and make
adjudications. In the event the director finds, upon hearing or
opportunity afforded therefor, that any person, firm,
partnership, association, or corporation, county home, or
district home licensed under section
3721.07 of the Revised Code is in violation of any of the
provisions of Chapter 3721. of the Revised Code or rules adopted
by the public health council under it; is in violation of any
order issued by the director; is not, or any of its principals
are not suitable, morally or financially to operate such an
institution; or is not furnishing humane, kind, and adequate
treatment and care, the director may issue an order revoking the
license previously issued by him the director. Upon the
issuance of any order
of revocation, the person whose license is revoked, or the county
home or district home that has its license revoked, may appeal in
accordance with Chapter 119. of the Revised Code. The state fire marshal shall enforce all statutes and rules
pertaining to fire safety in homes and shall adopt rules
pertaining to fire safety in homes as he the marshal determines
necessary.
The rules adopted by the marshal shall be in addition to those
fire safety rules that the board of building standards and the
public health council are empowered to adopt and shall be adopted
prior to December 31, 1972. In the event of a dispute between
the marshal and another officer having responsibilities under
sections 3721.01 to 3721.09 of the Revised Code with respect to
the interpretation or application of a specific fire safety
statute or rule, the interpretation of the marshal shall prevail. If the ownership of a home is assigned or tranferred TRANSFERRED to a
different person, the new owner is responsible and liable for
compliance with any notice of proposed action or order issued
under this section in accordance with Chapter 119. of the Revised
Code prior to the effective date of the assignment or transfer. Sec. 3721.051. No county home or district home licensed under
section 3721.07 of the Revised Code shall do any of the
following: (A) Violate any of the conditions or requirements necessary for
licensing after the license has been issued; (B) Continue operation after its license has been revoked by the
director of health; (C) Fail to be open for an inspection, or interfere with an
inspection, by a state or local official performing inspection duties
under Chapter 3721. of the Revised Code; (D) Violate any of the provisions of this chapter
or any rules adopted thereunder. Sec. 3721.07. Every person desiring to operate a home
and the superintendent or administrator of each county home or district
home for which a license as a residential care facility is sought shall
apply for a license to the director of health. The
director shall issue a license for the home, if after
investigation of the applicant and, if required by section
3721.02 of the Revised Code, inspection of the home, the
following requirements or conditions are satisfied or complied
with: (A) The applicant has not been convicted of a felony or a
crime involving moral turpitude; (B) The applicant is not violating any of the rules made
by the public health council or any order issued by the director
of health; (C) The buildings in which the home is housed have been
approved by the state fire marshal or a township, municipal, or
other legally constituted fire department approved by the
marshal. In the approval of a home such agencies shall apply
standards prescribed by the board of building standards, and by
the state fire marshal, and by section 3721.071 of the Revised
Code. (D) The applicant, if it is an individual, or the
principal participants, if it is an association or a corporation,
is or are suitable financially and morally to operate a home; (E) The applicant is equipped to furnish humane, kind, and
adequate treatment and care; (F) The home does not maintain or contain: (1) Facilities for the performance of major surgical
procedures; (2) Facilities for providing therapeutic radiation; (3) An emergency ward; (4) A clinical laboratory unless it is under the
supervision of a clinical pathologist who is a licensed physician
in this state; (5) Facilities for radiological examinations unless such
examinations are performed only by a person licensed to practice
medicine, surgery, or dentistry in this state. (G) The home does not accept or treat outpatients, except
upon the written orders of a physician licensed in this state,
maternity cases, boarding children, and does not house transient
guests, other than participants in an adult day-care program, for
twenty-four hours or less; (H) The home is in compliance with sections 3721.28 and
3721.29 of the Revised Code. When the director issues a license, the license shall
remain in effect until revoked by the director or voided at the
request of the applicant; provided, there shall be an annual
renewal fee payable during the month of January of each calendar
year. Any licensed home that does not pay its renewal fee in
January shall pay, beginning the first day of February, a
late fee of one hundred dollars for each week or part thereof that the renewal
fee is not paid. If either the renewal fee or the late fee is not paid by the
fifteenth day of February, the
director may, in accordance with Chapter 119. of the Revised Code, revoke the
home's license. A person whose license is revoked, and a county home or district
home that has its license as a residential care facility revoked,
for any reason other than nonpayment of
the license renewal fee or late fees may not apply for a new license under
this
chapter until a period of one year following the date of revocation has
elapsed. Any applicant who is denied a license may appeal in
accordance with Chapter 119. of the Revised Code. Sec. 3721.08. (A) As used in this section, "real and
present danger" means imminent danger of serious physical or
life-threatening harm to one or more occupants of a home. (B) The director of health may petition the court of
common pleas of the county in which the home is located for an
order enjoining any person from operating a home without a
license or enjoining a county home or district home that has had its
license revoked from continuing to operate. The court shall have
jurisdiction to grant such
injunctive relief upon a showing that the respondent named in the
petition is operating a home without a license or that the county home or
district home named in the petition is operating despite the revocation of its
license. The court shall
have jurisdiction to grant such injunctive relief against the
operation of a home without a valid license regardless of whether the
home meets essential licensing requirements. (C) Unless the department of human services or contracting
agency has taken action under section 5111.51 of the Revised Code
to appoint a temporary manager or seek injunctive relief, if, in
the judgment of the director of health, real and present danger
exists at any home, the director may petition the court of common
pleas of the county in which the home is located for such
injunctive relief as is necessary to close the home, transfer one
or more occupants to other homes or other appropriate care
settings, or otherwise eliminate the real and present danger.
The court shall have the jurisdiction to grant such injunctive
relief upon a showing that there is real and present danger. (D)(1) If the director determines that real and present
danger exists at a home and elects not to immediately seek
injunctive relief under division (C) of this section, he the
director may give
written notice of proposed action to the home. The notice shall
specify all of the following: (a) The nature of the conditions giving rise to the real
and present danger; (b) The measures that the director determines the home
must take to respond to the conditions; (c) The date on which the director intends to seek
injunctive relief under division (C) of this section if he the
director
determines that real and present danger exists at the home. (2) If the home notifies the director, within the time
specified pursuant to division (D)(1)(c) of this section, that it
believes the conditions giving rise to the real and present
danger have been substantially corrected, the director shall
conduct an inspection to determine whether real and present
danger exists. If the director determines on the basis of the
inspection that real and present danger exists, he the director
may petition
under division (C) of this section for injunctive relief. (E)(1) If in the judgment of the director of health
conditions exist at a home that will give rise to real and
present danger if not corrected, the director shall give written
notice of proposed action to the home. The notice shall specify
all of the following: (a) The nature of the conditions giving rise to the
director's judgment; (b) The measures that the director determines the home
must take to respond to the conditions; (c) The date, which shall be no less than ten days after
the notice is delivered, on which the director intends to seek
injunctive relief under division (C) of this section if the
conditions are not substantially corrected and he the director
determines that
a real and present danger exists. (2) If the home notifies the director, within the period
of time specified pursuant to division (E)(1)(c) of this section,
that the conditions giving rise to the director's determination
have been substantially corrected, the director shall conduct an
inspection. If the director determines on the basis of the
inspection that the conditions have not been corrected and a real
and present danger exists, he the director may petition under
division (C) of
this section for injunctive relief. (F)(1) A court that grants injunctive relief under
division (C) of this section may also appoint a special master
who, subject to division (F)(2) of this section, shall have such
powers and authority over the home and length of appointment as
the court considers necessary. Subject to division (F)(2) of
this section, the salary of a special master and any costs
incurred by a special master shall be the obligation of the home. (2) No special master shall enter into any employment
contract on behalf of a home, or purchase with the home's funds
any capital goods totaling more than ten thousand dollars, unless
the special master has obtained approval for the contract or
purchase from the home's operator or the court. (G) If the director takes action under division (C), (D),
or (E) of this section, he the director may also appoint
employees of the
department of health to conduct on-site monitoring of the home.
Appointment of monitors is not subject to appeal under Chapter
119. or any other section of the Revised Code. No employee of a
home for which monitors are appointed, no person employed by the
home within the previous two years, and no person who currently
has a consulting contract with the department or a home, shall be
appointed under this division. Every monitor shall have the
professional qualifications necessary to monitor correction of
the conditions that give rise to or, in the director's judgment,
will give rise to real and present danger. The number of
monitors present at a home at any given time shall not exceed one
for every fifty residents, or fraction thereof. (H) On finding that the real and present danger for which
injunctive relief was granted under division (C) of this section
has been eliminated and that the home's operator has demonstrated
the capacity to prevent the real and present danger from
recurring, the court shall terminate its jurisdiction over the
home and return control and management of the home to the
operator. If the real and present danger cannot be eliminated
practicably within a reasonable time following appointment of a
special master, the court may order the special master to close
the home and transfer all residents to other homes or other
appropriate care settings. (I) The director of health shall give notice of proposed
action under divisions (D) and (E) of this section to both of the
following: (1) The home's administrator; (2) If the home is operated by an organization described
in subsection 501(c)(3) and tax exempt under subsection 501(a) of
the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A.
1, as amended, the board of trustees of the organization; or, if
the home is not operated by such an organization, the owner of
the home. Notices shall be delivered by certified mail or hand
delivery. If notices are mailed, they shall be addressed to the
persons specified in divisions (I)(1) and (2) of this section, as
indicated in the department of health's records. If they are
hand delivered, they shall be delivered to persons who would
reasonably appear to the average prudent person to have authority
to accept them. (J) If ownership of a home is assigned or transferred to a
different person, the new owner is responsible and liable for
compliance with any notice of proposed action or order issued
under this section prior to the effective date of the assignment
or transfer. This is an interim section effective until July 1, 2000. Sec. 3721.09. Sections 3721.02, 3721.03, 3721.04, 3721.05, 3721.051,
3721.07, and
3721.08 of the Revised Code and the regulations adopted pursuant thereto are
not applicable in political subdivisions which the the director of
health, by
annual certification, determines have adopted and are enforcing their own
standards which are equal to or greater in their requirements than those of
sections 3721.02, 3721.03, 3721.04, 3721.05, 3721.051, 3721.07, and
3721.08 of the
Revised Code and the regulations adopted pursuant thereto. Officials of
political subdivisions shall cooperate fully with the director and provide
him the director
with information which he the director finds necessary in order
to make a determination. Sec. 3721.99. (A) Whoever violates section 3721.021,
division (B), (D), or (E) of section 3721.05, division (A),
(C), or (D) of section 3721.051, section
3721.06, division (A) of section 3721.22, division (A) or (B) of section
3721.24, or division (E) or (F) of section 3721.30 of the Revised
Code shall be fined one hundred dollars for a first offense. For
each subsequent offense, the violator shall be fined five hundred
dollars. (B) Whoever violates division (A) or (C) of section
3721.05 or division (B) of section 3721.051 of the
Revised Code shall be fined five thousand dollars
for a first offense. For each subsequent offense, the violator
shall be fined ten thousand dollars. (C) Whoever violates division (D) of section 3721.031 or
division (E) of section 3721.22 of the Revised Code is guilty of
registering a false complaint, a misdemeanor of the first degree. Sec. 4723.02. As used in this chapter: (A) "Registered nurse" means an individual who holds a
current, valid license issued under this chapter that authorizes
the practice of nursing as a registered nurse. (B) "Practice of nursing as a registered nurse" means
providing to individuals and groups nursing care requiring
specialized knowledge, judgment, and skill derived from the
principles of biological, physical, behavioral, social, and
nursing sciences. Such nursing care includes: (1) Identifying patterns of human responses to actual or
potential health problems amenable to a nursing regimen; (2) Executing a nursing regimen through the selection,
performance, management, and evaluation of nursing actions; (3) Assessing health status for the purpose of providing
nursing care; (4) Providing health counseling and health teaching; (5) Administering medications, treatments, and executing
regimens prescribed by licensed physicians;
dentists; optometrists;
podiatrists; or, until January 1,
2010, advanced practice nurses authorized to prescribe under
section 4723.56 of the Revised Code; (6) Teaching, administering, supervising, delegating, and
evaluating nursing practice. (C) "Nursing regimen" may include preventative,
restorative, and health promotion activities. (D) "Assessing health status" means the collection of data
through nursing assessment techniques, which may include
interviews, observation, and physical evaluations for the purpose
of providing nursing care. (E) "Licensed practical nurse" means an individual who
holds a current, valid license issued under this chapter that
authorizes the practice of nursing as a licensed practical nurse. (F) "The practice of nursing as a licensed practical
nurse" means providing to individuals and groups nursing care
requiring the application of basic knowledge of the biological,
physical, behavioral, social, and nursing sciences at the
direction of a licensed physician, dentist, podiatrist,
optometrist, or registered nurse. Such nursing care includes: (1) Observation, patient teaching, and care in a diversity
of health care settings; (2) Contributions to the planning, implementation, and
evaluation of nursing; (3) Administration of medications and treatments
prescribed by a licensed physician;
dentist; optometrist;
podiatrist; or, until January 1, 2010,
an advanced practice nurse authorized to prescribe under section
4723.56 of the Revised Code, except that administration of
intravenous therapy shall be performed only in accordance with section 4723.48
or 4723.481 of the Revised Code. Medications may be
administered by a licensed
practical nurse upon proof of completion of a course in
medication administration approved by the board of nursing. (4) Administration to an adult of intravenous therapy
prescribed by a licensed physician; dentist; optometrist; podiatrist; or,
until January 1, 2010, an advanced practice nurse
authorized to prescribe under section 4723.56 of the Revised
Code,
on the condition that the licensed practical nurse is authorized by the
board of nursing pursuant to under section 4723.48 or
4723.481 of the Revised Code
to perform intravenous therapy
and performs intravenous
therapy only in accordance with section 4723.48 of the Revised
Code those sections. (G) "Certified registered
nurse anesthetist" means a registered nurse who holds a valid
certificate of authority issued under this chapter that
authorizes the practice of nursing as a certified registered
nurse anesthetist in accordance with section 4723.43 of the
Revised Code and rules adopted by the board of
nursing. (H) "Clinical nurse specialist" means a registered
nurse who holds a valid certificate of authority issued under
this chapter that authorizes the practice of nursing as a
clinical nurse specialist in accordance with section 4723.43 of
the Revised Code and rules adopted by the board
of nursing. (I) "Certified nurse-midwife" means a registered nurse who
holds a valid certificate of authority issued under this chapter
that authorizes the practice of nursing as a certified nurse-midwife in
accordance with section 4723.43 of the Revised
Code and rules adopted by the board of nursing. (J) "Certified nurse practitioner" means a registered nurse
who holds a valid certificate of authority issued under this
chapter that authorizes the practice of nursing as a certified nurse
practitioner in accordance with section 4723.43 of the
Revised Code and rules adopted by the board of
nursing. (K) "Physician" means an individual
who holds a certificate issued under Chapter 4731. of
the
Revised Code authorizing the practice
of medicine
and surgery or osteopathic medicine and surgery and is practicing
in this state. (L) "Dentist" means an individual who
is licensed under Chapter 4715. of the Revised
Code to practice dentistry and is practicing in this
state. (M) "Podiatrist" means an individual
who holds a certificate issued under Chapter 4731. of the
Revised Code authorizing the practice of podiatry
and is practicing in this state. (N) "Collaboration" or "collaborating" means the
following: (1) In the case of a clinical nurse specialist, except
as provided in division (N)(3) of this section, or a certified nurse
practitioner, that a podiatrist acting within the podiatrist's scope of
practice in accordance with section 4731.51 of the
Revised Code and with whom the nurse has entered into a
standard care arrangement or physician with whom the nurse has entered into a
standard care arrangement is continuously
available to communicate with the clinical nurse specialist or
certified nurse practitioner either in person or by radio, telephone, or
other form of telecommunication; (2) In the case of a certified nurse-midwife, that a physician with whom
the certified nurse-midwife has entered into a standard care arrangement is
continuously available to communicate with the certified nurse-midwife
either in person or by radio, telephone, or other form of
telecommunication; (3) In the case of a clinical nurse specialist whose nursing specialty
is mental health or psychiatric mental health, that a physician is
continuously
available to communicate with the nurse either in person or by radio,
telephone, or other form of telecommunication. (O) "Supervision" means that a certified
registered nurse anesthetist is under the direction of a podiatrist acting
within the podiatrist's scope of practice in accordance with section 4731.51
of the Revised
Code, a dentist acting within the dentist's
scope of practice in accordance with Chapter
4715. of the Revised
Code, or a physician, and, when administering
anesthesia, the certified registered nurse anesthetist is in the immediate
presence of the podiatrist, dentist, or physician. (P) "Standard care arrangement" means a
written, formal guide for planning and evaluating a patient's health care that
is developed by a collaborating physician or podiatrist and a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner and meets
the requirements of section 4723.431 of the
Revised Code. Sec. 4723.48. (A) The board of nursing may
authorize a licensed practical nurse to
administer to an adult intravenous therapy prescribed by a
licensed physician;
dentist; optometrist; podiatrist; or, until January 1, 2010, an
advanced practice nurse authorized to prescribe under section 4723.56 of
the Revised Code, if all of the following are true of the licensed practical
nurse: (1) The nurse has a current, valid license issued under this
chapter that includes authorization to administer medications. (2) The nurse has successfully completed a course in intravenous
administration approved by the board of nursing that includes both of
the following: (a) A minimum of forty hours of training that includes all of the
following: (i) The curriculum established by rules adopted by the board of
nursing and in effect
on January 1, 1999; (ii) Training in the anatomy and physiology of the cardiovascular
system, signs and symptoms of local and systemic complications in the
administration of fluids and
antibiotic additives, and guidelines for management of these
complications; (iii) Any other training or instruction the board considers
appropriate. (b) A testing component that includes the successful performance of
three venipunctures
supervised by a physician or registered nurse in a health care
setting. (B) A Except as provided in section 4723.481 of the Revised Code, a licensed
practical nurse may perform intravenous
therapy
only if authorized by the board of nursing
pursuant to division (A) of this section and only if it is
performed
in accordance with this section. A licensed practical nurse authorized by the board to perform
intravenous therapy may perform an intravenous therapy procedure only at the
direction of one of the following: (1) A licensed physician, dentist, optometrist, or podiatrist who,
except as provided in division (C)(2) of this section, is
present
and readily available at the facility where the intravenous therapy procedure
is performed; (2) A registered nurse in accordance with
division (C) of this section. (C)(1) Except as provided in division
(C)(2) of this
section and section 4723.481 of the Revised Code, when a licensed practical nurse
authorized by the board to
perform intravenous
therapy performs an intravenous therapy procedure at the direction of a
registered
nurse, the registered nurse or another registered nurse shall be readily
available at the site
where the intravenous therapy is performed, and before the
licensed practical nurse initiates the intravenous therapy, the
registered nurse shall personally perform an on-site assessment of
the individual who is to receive the intravenous therapy. (2) When a licensed practical nurse authorized by the board to perform
intravenous therapy performs an intravenous therapy procedure in a home
as defined in section 3721.10 of the Revised Code, or in an
intermediate care facility for the mentally retarded as defined in
section 5111.20 of the Revised Code,
at the direction of a registered
nurse or licensed physician, dentist, optometrist, or
podiatrist, a registered nurse shall be on the premises of the
home or facility or accessible by some form of telecommunication. (D) No licensed practical nurse shall perform any of the
following intravenous therapy procedures: (1) Initiating or maintaining any of the following: (a) Blood or blood components; (b) Solutions for total parenteral nutrition; (c) Any cancer therapeutic medication including, but not limited
to, cancer chemotherapy or an anti-neoplastic agent; (d) Solutions administered through any central venous line or
arterial line or any other line that
does not terminate in a peripheral vein, except that a licensed
practical nurse authorized by the board to perform intravenous therapy
may maintain the solutions specified in division
(D)(6)(a) of this
section that are being administered
through a central venous line or peripherally inserted central
catheter; (e) Any investigational or experimental medication. (2) Initiating intravenous therapy in any vein other than,
except that a licensed practical nurse authorized by the board
to perform intravenous therapy may initiate intravenous therapy in
accordance with this section in
a vein
of the hand, forearm, or antecubital fossa; (3) Discontinuing a central venous, arterial, or any other line
that does not terminate in a peripheral vein; (4) Initiating or discontinuing a peripherally inserted central
catheter; (5) Mixing, preparing, or reconstructing reconstituting any
medication for
intravenous therapy, except that a licensed practical nurse authorized
by the board to perform intravenous therapy may prepare or reconstitute
an antibiotic
additive; (6) Administering medication via the intravenous route, including
all of the following activities: (a) Adding medication to an intravenous solution or to an
existing infusion, except that a licensed practical
nurse authorized by the board to administer perform
intravenous therapy
may initiate do either of the following: (i) Initiate an intravenous infusion containing one or more
of the
following elements: (i) Dextrose dextrose 5%;
(ii) Normal normal saline;
(iii) Lactated lactated ringers;
(iv) Sodium sodium chloride .45%;
(v) Sodium sodium chloride 0.2%;
(vi) Water
sterile water.
(ii) Hang subsequent containers of the intravenous
solutions
specified in division (D)(6)(a) of this
section that contain
vitamins or electrolytes, if a registered nurse initiated the infusion of
that same intravenous solution. (b) Initiating or maintaining an intravenous piggyback infusion,
except that a licensed practical nurse authorized by the board to
administer perform intravenous therapy may initiate or maintain
an intravenous
piggyback infusion containing an antibiotic additive; (c) Injecting medication via a direct intravenous route, except
that a licensed practical nurse authorized by the board to
administer perform intravenous therapy
may inject heparin or
normal saline to flush an intermittent infusion device or heparin
lock including, but not limited to, bolus or push. (7) Aspirating any intravenous line to maintain patency; (8) Changing tubing on any line other than one that terminates in
a peripheral vein including, but not limited to, an arterial line or a
central venous line, except that a licensed practical nurse
authorized by the board to perform intravenous therapy may change tubing on an
intravenous line that terminates in a peripheral vein; (9) Programming or setting any function of a patient controlled
infusion pump. (E) Notwithstanding division (D) of
this section, at the
direction of a licensed physician or a registered nurse, a licensed practical
nurse authorized by the board to perform intravenous therapy may
perform the following
activities for the purpose of performing dialysis;: (1) The routine administration and regulation of saline solution for the
purpose of maintaining an established fluid plan; (2) The administration of a heparin dose intravenously; (3) The administration of a heparin dose peripherally via a fistula
needle; (4) The loading and activation of a constant infusion pump or the
intermittent injection of a dose of medication prescribed by a licensed
physician for dialysis. (F) No person shall employ or direct a licensed practical
nurse
to perform an intravenous therapy procedure without first verifying that the
licensed practical nurse has been approved is authorized by the
board of nursing to perform intravenous therapy. (G) The board of nursing shall maintain a registry
of the
names of licensed practical nurses authorized pursuant to
division (A) of this section to perform intravenous therapy. Sec. 4723.481. (A) A licensed practical nurse may perform on
any
person any of
the intravenous
therapy procedures specified in division (B) of this section
without receiving authorization to perform intravenous therapy
from the board of nursing under section 4723.48 of the Revised
Code, if both of the following apply: (1) The licensed practical
nurse acts at the direction of a registered nurse or a licensed
physician, dentist, optometrist, or podiatrist and the registered
nurse, physician, dentist, optometrist, or podiatrist is on the premises where
the procedure is to be performed or accessible by some form of
telecommunication. (2) The
licensed practical nurse can demonstrate the knowledge, skills, and
ability to perform the procedure safely. (B) The intravenous therapy procedures that a licensed practical
nurse may perform pursuant to division (A) of this section are
limited to the following: (1) Verification of the type of peripheral intravenous solution
being administered; (2) Examination of a peripheral infusion site and the extremity
for possible infiltration; (3) Regulation of a peripheral intravenous infusion according to
the prescribed flow rate; (4) Discontinuation of a peripheral intravenous device at the
appropriate time; (5) Performance of routine dressing changes at the insertion site
of a peripheral venous or arterial infusion, peripherally inserted central
catheter infusion, or central venous pressure
subclavian infusion. SECTION 2 . That existing sections 3721.01, 3721.02, 3721.021,
3721.03, 3721.07, 3721.08, 3721.09, 3721.99, 4723.02, and 4723.48 of the
Revised Code are hereby repealed.
SECTION 3 . That the version of section 3721.08 of the Revised Code that is
scheduled to take effect on July 1, 2000, be amended to read as follows:
Sec. 3721.08. (A) As used in this section, "real and
present danger" means imminent danger of serious physical or
life-threatening harm to one or more occupants of a home. (B) The director of health may petition the court of
common pleas of the county in which the home is located for an
order enjoining any person from operating a home without a
license or enjoining a county home or district home that has had its
license revoked from continuing to operate. The court shall have
jurisdiction to grant such
injunctive relief upon a showing that the respondent named in the
petition is operating a home without a license or that the county home or
district home named in the petition is operating despite the revocation of its
license. The court shall
have jurisdiction to grant such injunctive relief against the
operation of a home without a valid license regardless of whether the
home meets essential licensing requirements. (C) Unless the department of job and family services or contracting
agency has taken action under section 5111.51 of the Revised Code
to appoint a temporary manager or seek injunctive relief, if, in
the judgment of the director of health, real and present danger
exists at any home, the director may petition the court of common
pleas of the county in which the home is located for such
injunctive relief as is necessary to close the home, transfer one
or more occupants to other homes or other appropriate care
settings, or otherwise eliminate the real and present danger.
The court shall have the jurisdiction to grant such injunctive
relief upon a showing that there is real and present danger. (D)(1) If the director determines that real and present
danger exists at a home and elects not to immediately seek
injunctive relief under division (C) of this section, the
director may give
written notice of proposed action to the home. The notice shall
specify all of the following: (a) The nature of the conditions giving rise to the real
and present danger; (b) The measures that the director determines the home
must take to respond to the conditions; (c) The date on which the director intends to seek
injunctive relief under division (C) of this section if the
director
determines that real and present danger exists at the home. (2) If the home notifies the director, within the time
specified pursuant to division (D)(1)(c) of this section, that it
believes the conditions giving rise to the real and present
danger have been substantially corrected, the director shall
conduct an inspection to determine whether real and present
danger exists. If the director determines on the basis of the
inspection that real and present danger exists, the director
may petition
under division (C) of this section for injunctive relief. (E)(1) If in the judgment of the director of health
conditions exist at a home that will give rise to real and
present danger if not corrected, the director shall give written
notice of proposed action to the home. The notice shall specify
all of the following: (a) The nature of the conditions giving rise to the
director's judgment; (b) The measures that the director determines the home
must take to respond to the conditions; (c) The date, which shall be no less than ten days after
the notice is delivered, on which the director intends to seek
injunctive relief under division (C) of this section if the
conditions are not substantially corrected and the director
determines that
a real and present danger exists. (2) If the home notifies the director, within the period
of time specified pursuant to division (E)(1)(c) of this section,
that the conditions giving rise to the director's determination
have been substantially corrected, the director shall conduct an
inspection. If the director determines on the basis of the
inspection that the conditions have not been corrected and a real
and present danger exists, the director may petition under
division (C) of
this section for injunctive relief. (F)(1) A court that grants injunctive relief under
division (C) of this section may also appoint a special master
who, subject to division (F)(2) of this section, shall have such
powers and authority over the home and length of appointment as
the court considers necessary. Subject to division (F)(2) of
this section, the salary of a special master and any costs
incurred by a special master shall be the obligation of the home. (2) No special master shall enter into any employment
contract on behalf of a home, or purchase with the home's funds
any capital goods totaling more than ten thousand dollars, unless
the special master has obtained approval for the contract or
purchase from the home's operator or the court. (G) If the director takes action under division (C), (D),
or (E) of this section, the director may also appoint
employees of the
department of health to conduct on-site monitoring of the home.
Appointment of monitors is not subject to appeal under Chapter
119. or any other section of the Revised Code. No employee of a
home for which monitors are appointed, no person employed by the
home within the previous two years, and no person who currently
has a consulting contract with the department or a home, shall be
appointed under this division. Every monitor shall have the
professional qualifications necessary to monitor correction of
the conditions that give rise to or, in the director's judgment,
will give rise to real and present danger. The number of
monitors present at a home at any given time shall not exceed one
for every fifty residents, or fraction thereof. (H) On finding that the real and present danger for which
injunctive relief was granted under division (C) of this section
has been eliminated and that the home's operator has demonstrated
the capacity to prevent the real and present danger from
recurring, the court shall terminate its jurisdiction over the
home and return control and management of the home to the
operator. If the real and present danger cannot be eliminated
practicably within a reasonable time following appointment of a
special master, the court may order the special master to close
the home and transfer all residents to other homes or other
appropriate care settings. (I) The director of health shall give notice of proposed
action under divisions (D) and (E) of this section to both of the
following: (1) The home's administrator; (2) If the home is operated by an organization described
in subsection 501(c)(3) and tax exempt under subsection 501(a) of
the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A.
1, as amended, the board of trustees of the organization; or, if
the home is not operated by such an organization, the owner of
the home. Notices shall be delivered by certified mail or hand
delivery. If notices are mailed, they shall be addressed to the
persons specified in divisions (I)(1) and (2) of this section, as
indicated in the department of health's records. If they are
hand delivered, they shall be delivered to persons who would
reasonably appear to the average prudent person to have authority
to accept them. (J) If ownership of a home is assigned or transferred to a
different person, the new owner is responsible and liable for
compliance with any notice of proposed action or order issued
under this section prior to the effective date of the assignment
or transfer. SECTION 4 . That all existing versions of section 3721.08 of the Revised Code
are hereby repealed.
SECTION 5 . Sections 3 and 4 of this act shall take effect on July 1, 2000.
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