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S. B. No. 83 As IntroducedAs Introduced
129th General Assembly | Regular Session | 2011-2012 |
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Cosponsors:
Senators Tavares, Cafaro
A BILL
To amend sections 3719.06, 4723.481, 4723.482,
4723.492, and 4723.50 of the Revised Code to
modify the authority of certain advanced practice
nurses to prescribe schedule II controlled
substances.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3719.06, 4723.481, 4723.482,
4723.492, and 4723.50 of the Revised Code be amended to read as
follows:
Sec. 3719.06. (A)(1) A licensed health professional
authorized to prescribe drugs, if acting in the course of
professional practice, in accordance with the laws regulating the
professional's practice, and in accordance with rules adopted by
the state board of pharmacy, may, except as provided in division
(A)(2) or (3) of this section, do the following:
(a) Prescribe schedule II, III, IV, and V controlled
substances;
(b) Administer or personally furnish to patients schedule II,
III, IV, and V controlled substances;
(c) Cause schedule II, III, IV, and V controlled substances
to be administered under the prescriber's direction and
supervision.
(2) A As provided in section 4723.481 of the Revised Code, a
licensed health professional authorized to prescribe drugs who is
a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner
is subject to both shall not do
either of the following:
(a) A Prescribe to a patient in a convenience care clinic any
schedule II controlled substance may be prescribed only for a
patient with a terminal condition, as defined in section 2133.01
of the Revised Code, only if the nurse's collaborating physician
initially prescribed the substance for the patient, and only in
an amount that does not exceed the amount necessary for the
patient's use in a single, twenty-four-hour period.;
(b) No Personally furnish to a patient any schedule II
controlled substance shall be personally furnished to any patient.
(3) A licensed health professional authorized to prescribe
drugs who is a physician assistant shall not prescribe or
personally furnish to patients any controlled substance that is
not included in the physician-delegated prescriptive authority
granted to the physician assistant in accordance with Chapter
4730. of the Revised Code.
(B) No licensed health professional authorized to prescribe
drugs shall prescribe, administer, or personally furnish a
schedule III anabolic steroid for the purpose of human muscle
building or enhancing human athletic performance and no pharmacist
shall dispense a schedule III anabolic steroid for either purpose,
unless it has been approved for that purpose under the "Federal
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.
301, as amended.
(C) Each written prescription shall be properly executed,
dated, and signed by the prescriber on the day when issued and
shall bear the full name and address of the person for whom, or
the owner of the animal for which, the controlled substance is
prescribed and the full name, address, and registry number under
the federal drug abuse control laws of the prescriber. If the
prescription is for an animal, it shall state the species of the
animal for which the controlled substance is prescribed.
Sec. 4723.481. Under a certificate to prescribe issued under
section 4723.48 of the Revised Code, a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner is
subject to all of the following:
(A) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall not prescribe any drug or
therapeutic device that is not included in the types of drugs and
devices listed on the formulary established in rules adopted under
section 4723.50 of the Revised Code.
(B) The nurse's prescriptive authority of the clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner shall not exceed the prescriptive authority of the
collaborating physician or podiatrist.
(C) The nurse may prescribe a schedule II controlled
substance as specified in division (A)(2) of section 3719.06 of
the Revised Code, but shall not prescribe a schedule II controlled
substance in collaboration with a podiatrist clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner may prescribe to a patient a schedule II controlled
substance included in the types of drugs and devices listed on the
formulary, except that a schedule II controlled substance may not
be prescribed to a patient in a convenience care clinic.
(D) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner may personally furnish to a
patient a sample of any drug or therapeutic device included in the
types of drugs and devices listed on the formulary,
subject to
except that all of the following conditions apply:
(1) The amount of the sample furnished shall not exceed a
seventy-two-hour supply, except when the minimum available
quantity of the sample is packaged in an amount that is greater
than a seventy-two-hour supply, in which case
the nurse may
furnish the sample in the packaged amount may be furnished.
(2) No charge may be imposed for the sample or for furnishing
it.
(3) Samples of controlled substances may not be personally
furnished.
(E) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner may personally furnish to a
patient a complete or partial supply of a drug or therapeutic
device included in the types of drugs and devices listed on the
formulary, subject to except that all of the following conditions
apply:
(1) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall personally furnish only
antibiotics, antifungals, scabicides, contraceptives, prenatal
vitamins, antihypertensives, drugs and devices used in the
treatment of diabetes, drugs and devices used in the treatment of
asthma, and drugs used in the treatment of dyslipidemia.
(2) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall not furnish the drugs and
devices in locations other than a health department operated by
the board of health of a city or general health district or the
authority having the duties of a board of health under section
3709.05 of the Revised Code, a federally funded comprehensive
primary care clinic, or a nonprofit health care clinic or program.
(3) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall comply with all safety
standards for personally furnishing supplies of drugs and devices,
as established in rules adopted under section 4723.50 of the
Revised Code.
Sec. 4723.482. (A) Except as provided in divisions (C) and
(D) of this section, an applicant shall include with the
application submitted under section 4723.48 of the Revised Code
all of the following:
(1) Subject to section 4723.483 of the Revised Code, evidence
of holding a current, valid certificate of authority issued under
this chapter to practice as a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner;
(2) Except for a person who on May 17, 2000, was approved to
prescribe drugs and therapeutic devices under section 4723.56 of
the Revised Code, as that section existed on that date, evidence
Evidence of successfully completing the instruction course of
study in advanced pharmacology and related topics in accordance
with the requirements specified in division (B) of this section;
(3) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(4) Any additional information the board of nursing requires
pursuant to rules adopted under section 4723.50 of the Revised
Code.
(B) All With respect to the course of study in advanced
pharmacology and related topics that must be successfully
completed to obtain a certificate to prescribe, all of the
following requirements apply to the instruction required under
division (A)(2) of this section:
(1) The instruction must course of study shall be obtained
completed not longer than three years before the application for
the certificate to prescribe is filed.
(2) The instruction must be obtained through a course of
study consisting shall consist of planned classroom and clinical
study that is
instruction for a total of not less than forty-five
contact hours.
(3) The course of study shall meet the requirements to be
approved by the board of nursing in accordance with standards
established in rules adopted under section 4723.50 of the Revised
Code.
(3)(4) The content of the instruction must course of study
shall be specific to the applicant's nursing specialty and.
(5) The instruction provided in the course of study shall
include all of the following:
(a) A minimum of thirty thirty-six contact hours of training
instruction in advanced pharmacology that includes pharmacokinetic
principles and clinical application and the use of drugs and
therapeutic devices in the prevention of illness and maintenance
of health;
(b) Training Instruction in the fiscal and ethical
implications of prescribing drugs and therapeutic devices;
(c) Training Instruction in the state and federal laws that
apply to the authority to prescribe;
(d) Instruction that is specific to schedule II controlled
substances, including instruction in all of the following:
(i) Indications for the use of schedule II controlled
substances in drug therapies;
(ii) The most recent guidelines for pain management
therapies, as established by state and national organizations
such as the Ohio pain initiative and the American pain society;
(iii) Fiscal and ethical implications of prescribing schedule
II controlled substances;
(iv) State and federal laws that apply to the authority to
prescribe schedule II controlled substances;
(v) Prevention of abuse and diversion of schedule II
controlled substances, including identification of the risk of
abuse and diversion, recognition of abuse and diversion, types of
assistance available for prevention of abuse and diversion, and
methods of establishing safeguards against abuse and diversion.
(e) Any additional training instruction required pursuant to
rules adopted under section 4723.50 of the Revised Code.
(C) An applicant who practiced or is practicing as a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner in another jurisdiction or as an employee of the
United States government, and is not seeking authority to
prescribe drugs and therapeutic devices by meeting the
requirements of division (A) or (D) of this section, shall include
with the application submitted under section 4723.48 of the
Revised Code all of the following:
(1) Subject to section 4723.483 of the Revised Code, evidence
of holding a current, valid certificate of authority issued under
this chapter to practice as a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner;
(2) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(3) Either of the following:
(a) Evidence of having held, for a continuous period of at
least one year during the three years immediately preceding the
date of application, valid authority issued by another
jurisdiction to prescribe therapeutic devices and drugs, including
at least some controlled substances;
(b) Evidence of having been employed by the United States
government and authorized, for a continuous period of at least one
year during the three years immediately preceding the date of
application, to prescribe therapeutic devices and drugs, including
at least some controlled substances, in conjunction with that
employment.
(4) If the applicant includes the evidence described in
division (C)(3)(a) of this section, documentation from a licensed
physician in a form acceptable to the board that the prescribing
component of the nurse's practice was overseen or supervised by a
licensed physician in the other jurisdiction;
(5) If the applicant includes the evidence described in
division (C)(3)(b) of this section, documentation from a licensed
physician employed by the United States government in a form
acceptable to the board that the prescribing component of the
nurse's practice was overseen or supervised by a licensed
physician employed by the United States government;
(6) Evidence of having completed a two-hour course of
instruction approved by the board in the laws of this state that
govern drugs and prescriptive authority;
(7) Any additional information the board requires pursuant to
rules adopted under section 4723.50 of the Revised Code.
(D) An applicant who practiced or is practicing as a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner in another jurisdiction or as an employee of the
United States government, and is not seeking authority to
prescribe drugs and therapeutic devices by meeting the
requirements of division (A) or (C) of this section, shall include
with the application submitted under section 4723.48 of the
Revised Code all of the following:
(1) Subject to section 4723.483 of the Revised Code, evidence
of holding a current, valid certificate of authority issued under
this chapter to practice as a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner;
(2) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(3) Either of the following:
(a) Evidence of having held, for a continuous period of at
least one year during the three years immediately preceding the
date of application, valid authority issued by another
jurisdiction to prescribe therapeutic devices and drugs, excluding
controlled substances;
(b) Evidence of having been employed by the United States
government and authorized, for a continuous period of at least one
year during the three years immediately preceding the date of
application, to prescribe therapeutic devices and drugs, excluding
controlled substances, in conjunction with that employment.
(4) If the applicant includes the evidence described in
division (D)(3)(a) of this section, documentation from a licensed
physician in a form acceptable to the board that the prescribing
component of the nurse's practice was overseen or supervised by a
licensed physician in the other jurisdiction;
(5) If the applicant includes the evidence described in
division (D)(3)(b) of this section, documentation from a licensed
physician employed by the United States government in a form
acceptable to the board that the prescribing component of the
nurse's practice was overseen or supervised by a licensed
physician employed by the United States government;
(6) Any additional information the board requires pursuant to
rules adopted under section 4723.50 of the Revised Code.
Sec. 4723.492. The committee on prescriptive governance
shall develop recommendations regarding the authority to prescribe
drugs and therapeutic devices pursuant to a certificate to
prescribe issued under section 4723.48 of the Revised Code. Not
later than fourteen months after the effective date of this
section, the The recommendations shall include provisions that
apply specifically to the authority to prescribe schedule II
controlled substances.
The committee shall submit recommendations to the board of
nursing as necessary for the board to fulfill its duty to adopt
rules under section 4723.50 of the Revised Code. At the board's
request, the committee shall reconsider a recommendation it has
submitted and resubmit the recommendation to the board
accordingly.
Sec. 4723.50. (A) In accordance with Chapter 119. of the
Revised Code, the board of nursing shall adopt rules as necessary
to implement the provisions of this chapter pertaining to the
authority of clinical nurse specialists, certified nurse-midwives,
and certified nurse practitioners to prescribe drugs and
therapeutic devices and the issuance and renewal of certificates
to prescribe. Initial rules shall be adopted not later than twenty
months after May 17, 2000.
The board shall adopt rules that are consistent with the
recommendations the board receives from the committee on
prescriptive governance pursuant to section 4723.492 of the
Revised Code. After reviewing a recommendation submitted by the
committee, the board may either adopt the recommendation as a rule
or ask the committee to reconsider and resubmit the
recommendation. The board shall not adopt any rule that does not
conform to a recommendation made by the committee.
(B) The board shall adopt rules under this section that do
all of the following:
(1) Establish a formulary listing the types of drugs and
therapeutic devices that may be prescribed by a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner. The formulary may include controlled substances, as
defined in section 3719.01 of the Revised Code. The formulary
shall not permit the prescribing of any drug or device to perform
or induce an abortion.
(2) Establish safety standards to be followed by a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner when personally furnishing to patients complete or
partial supplies of antibiotics, antifungals, scabicides,
contraceptives, prenatal vitamins, antihypertensives, drugs and
devices used in the treatment of diabetes, drugs and devices used
in the treatment of asthma, and drugs used in the treatment of
dyslipidemia.;
(3) Establish criteria for the components of the standard
care arrangements described in section 4723.431 of the Revised
Code that apply to a nurse's the authority to prescribe, including
the components that apply to the authority to prescribe schedule
II controlled substances. The rules shall be consistent with that
section and include all of the following:
(a) Quality assurance standards;
(b) Standards for periodic review by a collaborating
physician or podiatrist of the records of patients treated by the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner;
(c) Acceptable travel time between the location at which the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner is engaging in the prescribing components of
the nurse's practice and the location of the nurse's collaborating
physician or podiatrist;
(d) Any other criteria recommended by the committee on
prescriptive governance.
(4) Establish standards and procedures for issuance and
renewal of a certificate to prescribe, including specification of
any additional information the board may require under division
(A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3)
of section 4723.485 of the Revised Code;
(5) Establish requirements standards for board approval of
the
instruction course of study in advanced pharmacology and
related topics required by section 4723.482 of the Revised Code;
(6) Establish requirements for board approval of the two-hour
course of instruction in the laws of this state as required under
division (C)(6) of section 4723.482 of the Revised Code and
division (B)(2) of section 4723.484 of the Revised Code;
(7) Establish standards and procedures for the appropriate
conduct of an externship as described in section 4723.484 of the
Revised Code, including the following:
(a) Standards and procedures to be used in evaluating a
nurse's an individual's participation in an externship;
(b) Standards and procedures for the supervision that a
physician must provide during an externship, including supervision
provided by working with the nurse participant and supervision
provided by making timely reviews of the records of patients
treated by the
nurse participant. The manner in which supervision
must be provided may vary according to the location where the
nurse participant is practicing and with the nurse's participant's
level of experience.
Section 2. That existing sections 3719.06, 4723.481,
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby
repealed.
Section 3. (A) Notwithstanding the provisions of section
4723.486 of the Revised Code specifying the requirements for
renewal of a certificate to prescribe, or the provisions of
division (B) of section 4723.485 of the Revised Code specifying
the conditions of eligibility for a certificate to prescribe
issued after practicing under an externship certificate, a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner holding a certificate to prescribe that was
issued prior to the effective date of this act shall successfully
complete, as a condition of renewing the certificate or receiving
a new certificate, a minimum of six contact hours of instruction
regarding schedule II controlled substances as described in
section 4723.482 of the Revised Code, as amended by this act. In
the case of a certificate that is being renewed, the certificate
holder shall complete the instruction in addition to all other
continuing nursing education that must be completed by the
certificate holder not later than August 31, 2013.
(B) Notwithstanding the amendments made by this act to
sections 3719.06 and 4723.481 of the Revised Code, until the
applicable requirements of division (A) of this section have been
complied with, a certificate holder shall not prescribe a schedule
II controlled substance to a patient unless all of the following
conditions are met:
(1) The patient is in a terminal condition, as defined in
section 2133.01 of the Revised Code.
(2) The certificate holder's collaborating physician
initially prescribed the substance for the patient.
(3) The amount prescribed does not exceed the amount
necessary for the patient's use in a single, twenty-four-hour
period.
Section 4. Not later than 90 days after the effective date of
this section, the Committee on Prescriptive Governance shall
develop recommendations under section 4723.492 of the Revised
Code regarding the authority to prescribe schedule II controlled
substances pursuant to a certificate to prescribe. The Committee
shall submit the recommendations to the Board of Nursing in
accordance with the procedures specified in section 4723.492 of
the Revised Code.
Section 5. The Board of Nursing shall adopt rules under
section 4723.50 of the Revised Code as necessary to implement the
provisions of this act pertaining to the authority to prescribe
schedule II controlled substances pursuant to a certificate to
prescribe. The rules shall conform to the recommendations
submitted by the Committee on Prescriptive Governance.
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