06 LC 33
1417S
House
Bill 935 (RULES COMMITTEE SUBSTITUTE)
By:
Representatives Burmeister of the
119th,
Ehrhart of the
36th,
Hembree of the
67th,
Henson of the
87th,
Buckner of the
130th,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Code Section 16-13-21 of the Official Code of Georgia Annotated, relating
to definitions relative to regulation of controlled substances, so as to revise
the definition of "practitioner"; to amend Chapter 26 of Title 43 of the
Official Code of Georgia Annotated, relating to nurses, so as to provide for a
definition; to provide for enactment of rules and regulations affecting advanced
practice registered nurses; to provide for a change in certain prohibited
activities; to change a provision relating to a Drug Enforcement Administration
license applicability to nurses and
physiciańs
assistants; to amend Article 2 of Chapter 34 of Title 43 of the Official Code of
Georgia Annotated, relating to the physicians, so as to provide for a physician
to delegate certain medical acts to allow an advanced practice registered nurse
to issue prescription drug orders and provide professional samples, order
diagnostic studies, medical devices, and in certain life-threatening situations
to order radiographic imaging; to provide for construction and limitations
related to such delegation; to provide for definitions; to provide for the
conditions of a nurse protocol agreement; to provide for execution of
prescription drug orders; to provide for related matters; to repeal conflicting
laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Code
Section 16-13-21 of the Official Code of Georgia Annotated, relating to
definitions relative to regulation of controlled substances, is amended by
striking paragraph (23) and inserting in its place the following:
"(23)
'Practitioner' means:
(A)
A physician, dentist, pharmacist, podiatrist, veterinarian, scientific
investigator, or other person licensed, registered, or otherwise authorized
under the laws of this state to distribute, dispense, conduct research with
respect to, or to administer a controlled substance in the course of
professional practice or research in this state;
(B)
A pharmacy, hospital, or other institution licensed, registered, or otherwise
authorized by law to distribute, dispense, conduct research with respect to, or
to administer a controlled substance in the course of professional practice or
research in this state;
or
(C)
An advanced practice registered nurse acting pursuant to the authority of Code
Section 43-34-26.3. For purposes of this chapter and Code Section 43-34-26.3,
an advanced practice registered nurse is authorized to register with the federal
Drug Enforcement Administration and appropriate state authorities;
or
(C)(D)
A
physiciańs
assistant acting pursuant to the authority of subsection (e.1) of Code Section
43-34-103. For purposes of this chapter and subsection (e.1) of Code Section
43-34-103
and
notwithstanding the provisions of subsection (g) of Code Section
43-34-26.1, a
physiciańs
assistant is authorized to register with the federal Drug Enforcement
Administration and appropriate state
authorities."
SECTION
2.
Chapter
26 of Title 43 of the Official Code of Georgia Annotated, relating to nurses, is
amended by adding a new paragraph to Code Section 43-26-3, relating to
definitions, to read as follows:
"(1.1)
'Advanced practice registered nurse' means a registered professional nurse
licensed under this chapter who is recognized by the board as having met the
requirements established by the board to engage in advanced nursing practice and
who holds a
masteŕs
degree and national board certification in his or her area of speciality, or a
person who was recognized as an advanced practice registered nurse by the board
on or before January 1,
2006."
SECTION
3.
Said
chapter is further amended by striking paragraph (12) of subsection (a) of Code
Section 43-26-5, relating to general powers of the board, and inserting in lieu
thereof the following:
"(12)
Be authorized to enact rules and regulations for registered professional nurses
in their performing acts under a nurse protocol as authorized in Code Section
43-34-26.1 and
enact rules and regulations for advanced practice registered nurses in
performing acts as authorized in Code Section
43-34-26.3;"
SECTION
4.
Said
chapter is further amended by striking paragraph (4) of Code Section 43-26-10,
relating to the prohibition of practicing as a registered professional nurse
without a license, and inserting in lieu thereof the following:
"(4)
Use any words, abbreviations, figures, letters, title, sign, card, or device
implying that such person is a registered professional nurse
or advanced
practice registered nurse unless such
person is duly licensed
or recognized
by the board so to practice under the
provisions of this
article;"
SECTION
5.
Article
2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating
to physicians, is amended by striking subsection (g) of Code section 43-34-26.1,
relating to delegation of authority to a nurse or
physiciańs
assistant, and inserting in lieu thereof the following:
"(g)
Nothing in this Code section shall be construed to authorize or permit the
issuance of a Drug Enforcement Administration license to a nurse
or
physiciańs
assistant
who is not an
advanced practice registered
nurse."
SECTION
6.
Said
article is further amended by adding a new Code Section 43-34-26.3 to read as
follows:
"43-34-26.3.
(a)
As used in this Code section, the term:
(1)
'Advanced practice registered nurse' shall have the same meaning as provided in
paragraph (1.1) of Code Section 43-26-3.
(2)
'Birthing center' means a facility or building where human births occur on a
regular or ongoing basis and which is classified by the Department of Human
Resources as a birthing center.
(3)
'Controlled substance' means any controlled substance as defined in Code Section
16-13-21 but shall not include any Schedule I controlled substance included in
Code Section 16-13-25 or any Schedule II controlled substance included in Code
Section 16-13-26.
(4)
'Dangerous drug' means any dangerous drug as defined in Code Section 16-13-71.
(5)
'Delegating physician' means a physician who has entered into a nurse protocol
agreement pursuant to this Code section.
(6)
'Diagnostic study' means a laboratory test, X-ray, ultrasound, or procedure used
to identify a characteristic or distinguishing feature of a particular disease
or condition.
(7) 'Drug' means any dangerous drug or controlled substance.
(8)
'Free health clinic' shall have the same meaning as provided in Code Section
51-1-29.4.
(9)
'Life threatening' means an emergency situation in which a
patient́s
life or physical well-being will be harmed if certain testing is not performed
immediately.
(10)
'Nurse protocol agreement' means a written document mutually agreed upon and
signed by an advanced practice registered nurse and a physician, by which
document the physician delegates to that advanced practice registered nurse the
authority to perform certain medical acts pursuant to this Code section, and
which acts may include, without being limited to, the ordering of drugs, medical
devices, medical treatments, diagnostic studies, or in life-threatening
situations radiographic imaging tests. Such agreements shall conform to the
provisions set forth in subsection (c) of this Code section.
(11)
'Order' means to select pursuant to a nurse protocol agreement which drug,
medical device, medical treatment, diagnostic study, or in life-threatening
situations radiographic imaging test is appropriate for a patient and to
communicate the same in writing, orally, via facsimile, or
electronically.
(12)
'Physician' means a person licensed to practice medicine under this chapter
and:
(A)
Whose principal place of practice is within this state; or
(B)
Whose principal place of practice is outside this state but is within 50 miles
from the location where the nurse protocol agreement is being utilized within
this state.
(13)
'Prescription drug order' means a written or oral order of an advanced practice
registered nurse for a drug or medical device for a specific patient. Such term
includes an electronic visual image prescription drug order and an electronic
data prescription drug order.
(14)
'Professional sample' means a complimentary dose of a drug, medication,
medication voucher, or medical device provided by the manufacturer for use in
patient care.
(15)
'Radiographic imaging test' means a computed tomography, magnetic resonance
imaging, positron emission tomography, or nuclear medicine.
(b)
In addition to and without limiting the authority granted pursuant to Code
Section 43-34-26.1, a physician may delegate to an advanced practice registered
nurse in accordance with a nurse protocol agreement the authority to order
drugs, medical devices, medical treatments, diagnostic studies or in
life-threatening situations radiographic imaging tests.
(c)
A nurse protocol agreement between a physician and an advanced practice
registered nurse pursuant to this Code section shall:
(1)
Be between an advanced practice registered nurse who is in a comparable
specialty area or field as that of the delegating physician;
(2)
Contain a provision for immediate consultation between the advanced practice
registered nurse and the delegating physician; if the delegating physician is
not available, the delegating physician for purposes of consultation may
designate another physician who is aware of and concurs with the nurse protocol
agreement;
(3)
Identify the parameters under which delegated acts may be performed by the
advanced practice registered nurse, including without limitation the number of
refills which may be ordered, the kinds of diagnostic studies which may be
ordered, the extent to which radiographic image tests may be ordered, and the
circumstances under which a prescription drug order may be executed. In the
event the delegating physician authorizes the advanced practice registered nurse
to order an X-ray, ultrasound, or radiographic imaging test, the nurse protocol
agreement shall contain provisions whereby such X-ray, ultrasound, or
radiographic imaging test shall be read and interpreted by a physician who is
trained in the reading and interpretation of such tests; a report of such X-ray,
ultrasound, or radiographic imaging test may be reviewed by the advanced
practice registered nurse; and a copy of such report shall be forwarded to the
delegating physician, except that such provision for an ultrasound shall not be
required for an advanced practice registered nurse acting within his or her
scope of practice as authorized by Code Sections 43-26-3 and
43-26-5.
(4)
Require documentation either in writing or by electronic means or other medium
by the advanced practice registered nurse of those acts performed by the
advanced practice registered nurse which are specific to the medical acts
authorized by the delegating physician;
(5)
Include a schedule for periodic review by the delegating physician of patient
records. Such patient records review may be achieved with a sampling of such
records as determined by the delegating physician;
(6)
Provide for patient review, evaluation, or follow-up by the delegating
physician, with the frequency of such review, evaluation, or follow-up based on
the nature, extent, and scope of the delegated act or acts as determined by the
delegating physician;
(7)
Be reviewed, revised, or updated annually by the delegating physician and the
advanced practice registered nurse; and
(8)
Be available for review upon written request to the advanced practice registered
nurse by the Georgia Board of Nursing or to the physician by the
board.
(d)
A written prescription drug order issued pursuant to this Code section shall be
signed by the advanced practice registered nurse and shall be on a form which
shall include, without limitation, the names of the advanced practice registered
nurse and delegating physician who are parties to the nurse protocol agreement,
the
patient́s
name and address, the drug or device ordered, directions with regard to the
taking and dosage of the drug or use of the device, and the number of refills.
A prescription drug order which is transmitted either electronically or via
facsimile shall conform to the requirements set out in paragraphs (1) and (2) of
subsection (c) of Code Section 26-4-80, respectively.
(e)
An advanced practice registered nurse may be authorized under a nurse protocol
agreement to request, receive, and sign for professional samples and may
distribute professional samples to patients. The office or facility at which
the advanced practice registered nurse is working shall maintain a list of the
professional samples approved by the delegating physician for request, receipt,
and distribution by the advanced practice registered nurse as well as a complete
list of the specific number and dosage of each professional sample and
medication voucher received and dispensed. In addition to the requirements of
this Code section, all professional samples shall be maintained as required by
applicable state and federal laws and regulations.
(f)
A managed care system, health plan, hospital, insurance company, or other
similar entity shall not require a physician or advanced practice registered
nurse to be a party to a nurse protocol agreement as a condition for
participation in or reimbursement from such entity.
(g)
A delegating physician may not enter into a nurse protocol agreement pursuant to
this Code section with more than four advanced practice registered nurses at any
one time as calculated on a full-time equivalency basis, except this limitation
shall not apply to an advanced practice registered nurse that is
practicing:
(1)
In a hospital licensed under Title 31;
(2)
In any college or university as defined in Code Section 20-8-1;
(3)
In the Department of Human Resources;
(4)
In any county board of health;
(5)
In any free health clinic;
(6)
In a birthing center;
(7)
In any organization:
(A)
Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal
Revenue Code, as defined in Code Section 48-1-2; or
(B)
Which has been established under the authority of or is receiving funds pursuant
to 42 U.S.C. Section 254b or 254c of the United States Public Health Service
Act; or
(8)
In any local board of education which has a school nurse program.
(h)
Nothing in this Code section shall be construed to create a presumption of
liability, either civil or criminal, on the part of a pharmacist duly licensed
under Chapter 4 of Title 26 who, in good faith, fills a prescription drug order
of an advanced practice registered nurse issued pursuant to a nurse protocol
agreement.
(i)
Nothing in this Code section shall be construed to apply to the practice of a
certified registered nurse anesthetist.
(j)
Nothing in this Code section shall be construed to require an advanced practice
registered nurse to be a party to a nurse protocol agreement in order to
practice as a registered professional nurse or an advanced practice registered
nurse as otherwise permitted by Article 1 of Chapter 26 of this
title.
(k)
Nothing in this Code section shall be construed to authorize an advanced
practice registered nurse to issue a prescription drug order for a Schedule I or
II controlled substance or authorize refills of any drug for more than 12 months
from the date of the original order except in the case of oral contraceptives,
hormone replacement therapy, or prenatal vitamins which may be refilled for a
period of 24 months.
(l)
Nothing in this Code section shall be construed to authorize or permit any
practitioner to authorize an advanced practice registered nurse to perform an
abortion or administer abortion-inducing prescriptions other than as authorized
in Code Section
16-12-141."
SECTION
7.
All
laws and parts of laws in conflict with this Act are repealed.