06 SB480/AP
Senate
Bill 480
By:
Senators Unterman of the 45th, Thomas of the 54th and Goggans of the 7th
AS PASSED
AS PASSED
AN
ACT
To
amend Chapter 26 of Title 43 of the Official Code of Georgia Annotated, relating
to nurses, so as to provide for the certification of qualified medication aides;
to provide for a short title; to provide legislative findings; to provide for
definitions; to provide for the delegation of certain nursing tasks; to provide
for powers and responsibilities of the Georgia Board of Examiners of Licensed
Practical Nurses; to provide for certification standards and requirements; to
provide for the issuance and renewal of certificates; to provide for permitted
and prohibited activities; to provide for requirements of community living
arrangements which utilize qualified medication aides; to provide for sanctions;
to provide for construction; to provide for automatic repeal; 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 change certain provisions relating to the use of
a title by a licensed registered nurse or applicant; to provide for a change in
certain prohibited activities; to provide for certain information given to the
board by licensees; 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.
Chapter
26 of Title 43 of the Official Code of Georgia Annotated, relating to nurses, is
amended by adding a new article to read as follows:
"ARTICLE
3
43-26-50.
This
article shall be known and may be cited as the 'Georgia Qualified Medication
Aide Act.'
43-26-51.
The
purpose of this article is to protect, promote, and preserve the public health,
safety, and welfare through the delegation of certain activities performed by
registered professional nurses and licensed practical nurses to persons who are
certified as qualified medication aides and who are employed by and working in
community living arrangements established by the Department of Human Resources
pursuant to paragraphs (15) and (16) of subsection (b) of Code Section
37-1-20.
43-26-52.
As
used in this article, the term:
(1)
'Applicant' means any person seeking certification under this
article.
(2)
'Board' means the Georgia Board of Examiners of Licensed Practical Nurses
established pursuant to Article 2 of this chapter.
(3)
'Community living arrangement' means any residence, whether operated for profit
or not for profit, which undertakes through its ownership or management to
provide or arrange for the provision of daily personal services, support, care,
or treatment exclusively for two or more adults who are not related to the owner
or administrator by blood or marriage which is established by the Department of
Human Resources pursuant to paragraph (16) of subsection (b) of Code Section
37-1-20 and whose services are financially supported, in whole or part, by funds
authorized through the Division of Mental Health, Developmental Disabilities,
and Addictive Diseases of the Department of Human Resources. A community living
arrangement is also referred to as a 'residence.'
(4)
'Licensed practical nurse' means an individual who is licensed to practice
nursing under Article 2 of this chapter.
(5)
'Medication administration record' means a written record of medication ordered
for and received by a resident of a community living arrangement.
(6)
'Qualified medication aide' means a person who meets the qualifications
specified in this article and who is currently certified by the
board.
(7)
'Physician' means an individual who is licensed to practice medicine under
Article 2 of Chapter 34 of this title.
(8)
'Registered professional nurse' means an individual who is licensed to practice
nursing under Article 1 of this chapter.
(9)
'Resident' means an individual in a community living arrangement.
(10)
'Supervising nurse' means the registered professional nurse who is responsible
for the supervision of a qualified medication aide in a community living
arrangement.
(11)
'Supervision' means initial and ongoing direction, procedural guidance, and
observation and evaluation of the qualified medication aide by a registered
professional nurse.
43-26-53.
(a)
A registered professional nurse or a licensed practical nurse may delegate
certain nursing tasks, as set out in Code Section 43-26-56, to no more than 15
qualified medication aides who are working at and employed by community living
arrangements.
(b)
Certification as a qualified medication aide by the board shall constitute a
presumption that the qualified medication aide has acquired the necessary
knowledge, skills, and experience to perform the delegated nursing task with
reasonable skill and safety upon the residents of community living arrangements.
The presumption may be overcome or rebutted by evidence to the contrary,
including, but not limited to, the determination that deceptive or fraudulent
information was used to obtain certification as a qualified medication
aide.
43-26-54.
The
board shall have the power and responsibility to:
(1)
Determine the qualifications and fitness of applicants for certification as a
qualified medication aide and renewal of the certificate;
(2)
Adopt rules and regulations consistent with this article necessary to enable it
to carry into effect the provisions of this article, including disciplinary
rules;
(3)
Examine for, approve, issue, deny, revoke, suspend, and renew the certification
of qualified medication aide certificate holders and applicants under this
article;
(4)
Conduct hearings in accordance with the Georgia Administrative Procedure Act
regarding the regulation and enforcement of this article;
(5)
Regulate the acts and practices that are allowed or prohibited for qualified
medication aides, in accordance with the provisions of this
article;
(6)
Establish application, examination, and certification fees;
(7)
Establish requirements for the education and training of qualified medication
aides; and
(8)
Establish continuing education requirements.
43-26-55.
(a)
The board shall receive applications for certification to be qualified
medication aides in Georgia. Each applicant shall meet the following
qualifications:
(1)
Be at least 18 years of age;
(2)
Be able to read, write, speak, and understand the English language;
(3)
Have attained a high school diploma or a general educational development (GED)
diploma or the equivalent thereof;
(4)
Have satisfactory results from a fingerprint record check report conducted by
the Georgia Crime Information Center, as determined by the board. Application
for a certificate under this Code section shall constitute consent for
performance of a criminal background check. Each applicant who submits an
application to the board for certification agrees to provide the board with any
and all information necessary to run a criminal background check, including, but
not limited to, classifiable sets of fingerprints. The applicant shall be
responsible for all fees associated with the performance of a background
check;
(5)
Have completed a prescribed course of study in a qualified medication aide
program conducted by the Department of Technical and Adult Education;
(6)
Have successfully passed a board approved or administered competency exam for
qualified medication aides; and
(7)
Have met such other requirements as may be prescribed by the board.
(b)
Each qualified medication aide shall, in order to maintain certification, work
under the supervision of a registered professional nurse.
(c)
Certificates issued under this article shall be renewed biennially according to
schedules and fees approved by the board.
43-26-56.
(a)
The following tasks are permitted activities that may be delegated to a
qualified medication aide under supervision and are subject to the rules and
regulations promulgated by the board:
(1)
Administer physician ordered oral, ophthalmic, topical, otic, nasal, vaginal,
and rectal medications and medications by gastric ('G' or 'J')
tube;
(2)
Administer insulin under physician direction and protocol;
(3)
Administer medication via metered dose inhaler;
(4)
Conduct finger stick blood glucose testing following established
protocol;
(5)
Administer commercially prepared disposable enema as ordered by a
physician;
(6)
Administer treatment for skin conditions, including stage I and II decubitus
ulcers, following a designated protocol;
(7)
Assist residents in supervised self-administration of medication;
(8)
Record in the medication administration record all medications that the
qualified medication aide has personally administered, including a
resident́s
refusal to take medication; and
(9)
Observe and report to the supervising nurse any changes in the
resident́s
condition.
(b)
The board shall promulgate rules and regulations regarding the activities
permitted by this Code section and any other permitted activities, as
determined by the board, and those activities that the supervising nurse is
prohibited from delegating to a qualified medication aide and that the qualified
medication aide is prohibited from performing.
43-26-57.
A
community living arrangement which utilizes the services of a qualified
medication aide shall employ or contract with a registered professional nurse
who has responsibility for the supervision of the qualified medication aide. A
registered professional nurse under discipline, sanction, or restriction by the
Georgia Board of Nursing shall not provide supervision for a qualified
medication aide.
43-26-58.
(a)
The board shall have the authority to refuse to grant or to renew a certificate
to an applicant, to revoke the certificate of a certificate holder, or to
discipline a certificate holder upon a finding by the board that the applicant
or certificate holder has:
(1)
Been convicted of a felony, a crime involving moral turpitude, or any crime
violating a federal or state law relating to controlled substances or dangerous
drugs or marijuana in the courts of this state, any other state, territory, or
country, or in the courts of the United States, including, but not limited to, a
plea of nolo contendere entered to the charge, the granting of first offender
treatment without adjudication of guilt, or the withholding of adjudication of
guilt on the charges or crime;
(2)
Had a certificate to practice as a qualified medication aide revoked, suspended,
or annulled by any lawful certificating authority of any state or county, had
other disciplinary action taken by any lawful certificating authority for any
certification or licensure to practice a business or profession, including
refusal of certification or licensure, or was denied a certificate by any lawful
certificating authority;
(3)
Engaged in any unprofessional, unethical, deceptive, or deleterious conduct or
practice harmful to the public, which conduct or practice need not have resulted
in actual injury to any person. As used in this paragraph, the term
'unprofessional conduct' includes any departure from, or the failure to conform
to, the minimum standards of acceptable and prevailing practice as a qualified
medication aide;
(4)
Violated or attempted to violate a law or any lawfully promulgated rule or
regulation of the board, this state, any other state, the United States, or any
other lawful authority, without regard to whether the violation is criminally
punishable, which statute, law, or rule or regulation relates to or in part
regulates the practice of a qualified medication aide, when the qualified
medication aide or applicant knows or should have known that such action
violates such law or rule or regulation;
(5)
Violated a lawful order of the board previously entered by the board or the
order of any certifying or licensing authority; or
(6)
Displayed an inability to practice as a qualified medication aide with
reasonable skill and safety due to illness; use of alcohol, drugs, narcotics,
chemicals, or any other types of material; or as a result of any mental or
physical condition.
(A)
In enforcement of this paragraph, the board may, upon reasonable grounds,
require a certificate holder or applicant to submit to a mental or physical
examination by a board approved health care professional. The expense of such
mental or physical examination shall be borne by the certificate holder or
applicant. The results of such examination shall be admissible in any hearing
before the board, notwithstanding any claim of privilege under contrary law or
rule. Every certificate holder and applicant shall be deemed to have given such
persońs
consent to submit to such mental or physical examination and to have waived all
objections to the admissibility of the results in any hearing before the board
upon the grounds that the same constitutes a privileged communication. If a
certificate holder or applicant fails to submit to such an examination when
properly directed to do so by the board, unless such failure was due to
circumstances beyond that
persońs
control, the board may enter a final order upon proper notice, hearing, and
proof of such refusal. Any certificate holder or applicant who is prohibited
from practicing under this paragraph shall at reasonable intervals be afforded
an opportunity to demonstrate to the board that such person can resume or begin
to practice as a qualified medication aide with reasonable skill and
safety.
(B)
In enforcement of this paragraph, the board may, upon reasonable grounds, obtain
any and all records relating to the mental or physical condition of a
certificate holder or applicant, including psychiatric records; such records
shall be admissible in any hearing before the board, notwithstanding any
privilege under a contrary law or rule. Every person who is certificated in
this state or who shall file an application for said certificate shall be deemed
to have given such
persońs
consent to the
board́s
obtaining such records and to have waived all objections to the admissibility of
such records in any hearing before the board upon the grounds that the same
constitute a privileged communication.
(b)
Neither denial of an initial certificate, the issuance of a private reprimand,
nor the denial of a request for reinstatement of a certificate on the grounds
that the certificate holder or applicant has failed to meet the minimum
requirements shall be considered a contested case within the meaning of Chapter
13 of Title 50, the 'Georgia Administrative Procedure Act'; and notice and
hearing within the meaning of Chapter 13 of Title 50 shall not be required, but
the certificate holder or applicant shall be allowed to appear before the board
if he or she so requests.
43-26-59.
(a)
Nothing in this article shall be construed to limit or repeal Articles 1 and 2
of this chapter, relating to registered professional nurses and licensed
practical nurses, respectively.
(b)
Nothing in this article shall be construed to limit or repeal any existing
authority of a physician to delegate to a qualified person any acts, duties, or
functions which are otherwise permitted by law or established by
custom.
43-26-60.
This
article shall be repealed in its entirety on July 1,
2011."
SECTION
2.
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;
(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
(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, a
physiciańs
assistant is authorized to register with the federal Drug Enforcement
Administration and appropriate state
authorities."
SECTION
3.
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 or other graduate degree approved by the board 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 June 30,
2006."
SECTION
4.
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
5.
Said
chapter is further amended by striking subsections (a) and (d) of Code Section
43-26-6, relating to use of title by licensed registered nurses or applicant,
and inserting in lieu thereof the following:
"(a)
Any person who is licensed as a registered professional nurse shall have the
right to use the title 'registered professional nurse' and the abbreviation
'R.N.' Any person recognized by the board as an advanced practice registered
nurse shall have the right to use the title 'advanced practice registered nurse'
and the abbreviation 'A.P.R.N.' No other person shall assume such titles or use
such abbreviations or any other words, letters, signs, or symbols to indicate
that such person is a registered professional nurse or an advanced practice
registered nurse in Georgia. Nothing in this subsection shall be construed to
repeal the right of any person who is licensed as a registered professional
nurse or recognized by the board as an advanced practice registered nurse on
June 30, 2006, to be licensed and to use the title 'registered professional
nurse' or to use the title 'advanced practice registered nurse,'
respectively."
"(d)
Any person who is licensed as a registered professional nurse shall identify
that he or she is so licensed by displaying either the title 'registered
professional nurse' or 'registered nurse,' the abbreviation 'R.N.,' the title
'advanced practice registered nurse,' or the abbreviation 'A.P.R.N.' on a name
tag or other similar form of identification during times when such person is
providing direct patient
care."
SECTION
6.
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
7.
Said
chapter is further amended by adding a new Code Section 43-26-13 to read as
follows:
"43-26-13.
A
licensee may, in lieu of providing his or her home address, provide the board a
legitimate business address for purposes of the public information made
available by the board with regard to licensed registered professional
nurses."
SECTION
8.
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 who is not an
advanced practice registered
nurse."
SECTION
9.
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 prescribe 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 concurs with the terms of 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 evaluation or follow-up examination by the delegating
physician or other physician designated by the delegating physician pursuant to
paragraph (2) of this subsection, with the frequency of such evaluation or
follow-up examination based on the nature, extent, and scope of the delegated
act or acts as determined by the delegating physician in accordance with
paragraph (3) of this subsection and accepted standards of medical practice as
determined by the board;
(7)
Be reviewed, revised, or updated annually by the delegating physician and the
advanced practice registered nurse;
(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;
and
(9)
Provide that a patient who receives a prescription drug order for any controlled
substance pursuant to a nurse protocol agreement shall be evaluated or examined
by the delegating physician or other physician designated by the delegating
physician pursuant to paragraph (2) of this subsection on at least a quarterly
basis or at a more frequent interval as determined 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, 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 entity:
(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, and primarily serves uninsured
or indigent Medicaid and medicare patients; 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;
(8)
In any local board of education which has a school nurse program;
or
(9)
In a health maintenance organization that has an exclusive contract with a
medical group practice and arranges for the provision of substantially all
physician services to enrollees in health benefits of the health maintenance
organization.
(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 allow an advanced practice
registered nurse to perform an abortion or to administer, prescribe, or issue a
drug order that is intended to cause an abortion to occur
pharmacologically.
(m)
The board shall have the authority to promulgate rules and regulations governing
a delegating physician in order to carry out the intents and purposes of this
Code section. Further, the board shall be authorized to:
(1)
Require that a nurse protocol agreement shall be filed by the delegating
physician with the board within a reasonable time from the date of
execution;
(2)
Determine, after review of a filed nurse protocol agreement, if such nurse
protocol agreement fails to meet accepted standards of medical practice as
established by the board; and
(3)
Require the delegating physician to amend any such noncompliant nurse protocol
agreement in order to meet such accepted standards.
(n)
Except for practice settings identified in paragraph (7) of subsection (g) of
this Code section, it shall be unlawful for a physician to be an employee of an
advanced practice registered nurse, alone or in combination with others, if the
physician is required to supervise the employing advanced practice registered
nurse. Such conduct shall be subject to sanctions by the Georgia Board of
Nursing as to the advanced practice registered nurse and the board as to the
physician."
SECTION
10.
All
laws and parts of laws in conflict with this Act are repealed.