06 LC 33
1434S
The
Senate Health and Human Services Committee offered the following substitute to
SB 603:
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 require that applicants for licensure as
registered professional nurses undergo a criminal background check; 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 patients receiving
certain care to be examined by a physician on a determinative basis; to provide
for execution of prescription drug orders; to prohibit certain activities in
certain business establishments; to require that applicants for licensure as a
physician undergo a criminal backround check; 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. Only a person recognized by the board as an
advanced practice registered nurse shall be authorized to hold himself or
herself out as an advanced practice registered nurse or to use the initials
A.P.R.N."
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 Code Section 43-26-7, relating to
requirements for licensure as a registered professional nurse, and inserting in
lieu thereof the
following: "43-26-7.
(a)
Any applicant who meets the requirements of this Code section shall be eligible
for licensure as a registered professional nurse.
(b)
An applicant for licensure by examination shall:
(1)
Submit a completed written application and fee;
(2)
Have graduated from a nursing education program, approved by this board, or
which meets criteria similar to, and not less stringent than, those established
by this board;
(3)
Pass a board recognized licensing examination; provided, however, such
examination may not be taken prior to graduation from the nursing education
program;
and
(4)
Provide the
board with any and all information necessary, including but not limited to
classifiable sets of fingerprints, to perform a criminal background check and
expressly consent and authorize the board or its representative to perform such
a check. The
applicant́s
fingerprints shall be forwarded to the Georgia Crime Information Center which
shall run a criminal background check on the applicant and provide the results
of the background check to the board. Additionally, the
applicant́s
fingerprints will be forwarded to the Federal Bureau of Investigation for a
national criminal history record check. The applicant shall be responsible for
all fees associated with the performance of a background check; and
(5)
Meet such other criteria as established by the board.
(c)
An applicant for licensure by endorsement shall:
(1)
Submit a completed written application and fee;
(2)
Have passed a board recognized licensing examination following graduation from
the nursing education program;
(3)
Submit verification of initial and current licensure in any other licensing
jurisdiction administering a board recognized licensing
examination;
(4)
Have practiced nursing as a registered professional nurse for a period of time
as determined by the board or have graduated from a nursing education program
within the four years immediately preceding the date of the application;
and
(5)
Meet such other criteria as established by the board.
(d)
An applicant for reinstatement who has previously held a valid license in
Georgia shall:
(1)
Submit a completed written application and fee;
(2)
Have practiced nursing as a registered professional nurse for a period of time
as determined by the board or have graduated from a nursing education program
within the four years immediately preceding the date of the application;
and
(3)
Provide the
board with any and all information necessary, including but not limited to
classifiable sets of fingerprints, to perform a criminal background check and
expressly consent and authorize the board or its representative to perform such
a check. The
applicant́s
fingerprints shall be forwarded to the Georgia Crime Information Center which
shall run a criminal background check on the applicant and provide the results
of the background check to the board. Additionally, the
applicant́s
fingerprints will be forwarded to the Federal Bureau of Investigation for a
national criminal history record check. The applicant shall be responsible for
all fees associated with the performance of a background check; and
(4)
Meet such other criteria as established by the
board."
SECTION
5.
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 so to practice under the provisions of this
article;"
SECTION
6.
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
7.
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)
'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.
(3)
'Dangerous drug' means any dangerous drug as defined in Code Section 16-13-71.
(4)
'Delegating physician' means a physician who has entered into a nurse protocol
agreement pursuant to this Code section.
(5)
'Designated teaching hospital' shall have the same meaning as provided in Code
Section 31-7-95.
(6)
'Diagnostic study' means a laboratory test, X-ray, or ultrasound.
(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, or 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, or 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 and is within 100 miles
of the location where the nurse protocol agreement is being utilized;
or
(B)
Whose principal place of practice is outside this state but is within 50 miles
of 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.
(16)
'Routine preventive health maintenance' means evaluation and maintenance of an
individuaĺs
health including those medical acts appropriate to age and gender, medical
history, and risk factors such as examination, counseling, anticipatory
guidance, risk factor reduction intervention, and ordering of appropriate
immunizations and laboratory and diagnostic procedures.
(b)(1)
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, or diagnostic studies or in
life-threatening situations radiographic imaging tests.
(2)
Unless patients are receiving services in facilities identified in paragraphs
(1) through (7) of subsection (g) of this Code section, a delegating physician
entering into a nurse protocol agreement pursuant to this Code section shall be
physically present at the location at which the delegated acts are being carried
out for at least 25 percent of the time while such acts are being carried out.
(3)
A delegating physician entering into a nurse protocol agreement pursuant to this
Code section shall adequately supervise acts delegated in accordance with a
nurse protocol agreement. Except for patients receiving services in the
facilities identified in paragraphs (1) through (7) of subsection (g) of this
Code section, patients receiving services pursuant to a nurse protocol agreement
shall be examined by a physician:
(A)
Biennially for patients receiving oral contraceptives, hormone replacement
therapy, prenatal vitamins, or routine preventive health maintenance;
and
(B)
Annually for patients receiving ongoing medical treatments, drugs other than
controlled substances, or medical devices.
(4)
Patients receiving services pursuant to a nurse protocol agreement shall be
examined by a physician quarterly if the patient is receiving controlled
substances.
(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 in agreement 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, if authorized, to which radiographic images may be ordered
in life-threatening situations, and the circumstances, if any, under which the
advanced practice registered nurse may execute a prescription drug order. The
nurse protocol agreement may allow an advanced practice registered nurse to
review a report of diagnostic studies or radiographic images but shall not
authorize the advanced practice registered nurse to interpret such images and
shall require the advanced practice registered nurse to forward a copy of such
report to the delegating physician;
(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 medical acts required to be
authorized by the delegating physician in the nurse protocol
agreement;
(5)
Include a schedule for periodic review by the delegating physician of patient
records;
(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 and in accordance with paragraphs (3) and (4) of subsection
(b) of this Code section;
(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;
(9)
Be approved by the board and filed with the board by the delegating
physician;
(10)
Not allow an advanced practice registered nurse to perform an abortion;
and
(11)
Not allow an advanced practice registered nurse to issue a prescription drug
order that is intended to cause an abortion to occur
pharmacologically.
(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;
provided, however, that no physician may supervise more than two 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 the emergency department of a hospital licensed under Title 31;
(2)
In a designated teaching hospital;
(3)
In the Division of Public Health of the Department of Human
Resources;
(4)
In any county board of health;
(5)
In any free health clinic;
(6)
In any organization 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
(7)
In a health maintenance organization that has an exclusive contract with a
medical group practice to provide or arrange for the provision of substantially
all physician service to enrollees in health benefit plans 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)
Except for advanced practice registered nurses who work in the facilities
identified in paragraphs (1) through (7) of subsection (g) of this Code section,
it shall be unlawful for an advanced practice registered nurse, alone or in
combination with others, to employ a physician who is required to supervise the
medical acts of the employing advanced practice registered nurse. Such unlawful
practice shall be sanctioned by the Georgia Board of Nursing and the board
governing the respective
professions."
SECTION
8.
Said
article is further amended by adding a new Code section to read as
follows:
"43-34-26.4.
No
advanced practice registered nurse or
physiciańs
assistant shall exercise authority delegated pursuant to Code Section 43-34-26.1
or 43-34-26.3 while located within a general merchandising establishment or
business establishment, a portion of which is licensed as a pharmacy pursuant to
Article 6 of Chapter 4 of Title 26. This Code section shall not apply to the
office of a physician licensed pursuant to this chapter, a hospital licensed
pursuant to Title 31, or in a health maintenance organization that has an
exclusive contract with a medical group practice to provide or arrange for the
provision of substantially all physician service to enrollees in health benefit
plans of the health maintenance
organization."
SECTION
9.
Said
article is further amended by striking subparagraph (a)(1)(A) of Code Section
43-34-27, relating to license requirement for persons engaged in the practice of
medicine, and inserting in lieu thereof the following:
"(a)(1)(A)
Any person who wishes to obtain the right to practice medicine in this state and
who was not, prior to March 16, 1970, registered or licensed to practice
medicine, either by the State Board of Medical Examiners or the State Board of
Examiners in Osteopathy, shall, before it shall be lawful for him to practice
medicine in this state, make application to the board through the executive
director, upon such forms and in such manner as shall be adopted and prescribed
by the board, and shall obtain from the board a license to practice medicine.
All applicants
shall provide the board with any and all information necessary, including but
not limited to classifiable sets of fingerprints, to perform a criminal
background check and expressly consent and authorize the board or its
representative to perform such a check. The
applicant́s
fingerprints shall be forwarded to the Georgia Crime Information Center which
shall run a criminal background check on the applicant and provide the results
of the background check to the board. Additionally, the
applicant́s
fingerprints will be forwarded to the Federal Bureau of Investigation for a
national criminal history record check. The applicant shall be responsible for
all fees associated with the performance of a background
check. Any person who practices medicine
without first having obtained a license shall be deemed to have violated this
chapter. All applicants for a license to practice medicine or for a renewal of
any such license which has been revoked shall furnish the board with evidence of
good moral character. Applications from candidates to practice medicine or
surgery in any of its branches shall be accompanied by proof that the applicant
is a graduate of one of the two colleges of medicine now existing in this state,
or from some other legally incorporated medical college or osteopathic
college."
SECTION
10.
All
laws and parts of laws in conflict with this Act are repealed.