The House Committee on Health offers the following substitute to HB 1309:
A BILL TO BE ENTITLED
AN ACT
To amend Article 7 of Chapter 4 of Title 26 of the Official Code of Georgia Annotated,
relating to practitioners of the healing arts, so as to clarify that all practitioners who dispense
drugs are engaged in the practice of pharmacy and shall comply with all record keeping and
other requirements; to provide for the Georgia State Board of Pharmacy to enforce rules and
regulations; to amend Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia
Annotated, relating to medical practice, so as to expand the authority of physicians to
delegate the authority to dispense certain drugs; to provide for statutory construction; to
provide for definitions; to provide for related matters; to repeal conflicting laws; and for
other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 7 of Chapter 4 of Title 26 of the Official Code of Georgia Annotated, relating to
practitioners of the healing arts, is amended by revising paragraph (2) of subsection (a) and
subsections (c) and (f) of Code Section 26-4-130, relating to dispensing drugs, compliance
with labeling and packaging requirements, records available for inspection by board, and
renewal of licenses, as follows:
"(2) 'Practitioner' or 'practitioner of the healing arts' <del>means, notwithstanding Code
Section 26-4-5, a person licensed as a dentist, optometrist, physician, podiatrist, or
veterinarian under Chapter 11, 30, 34, 35, or 50, respectively, of Title 43</del> <ins>shall have the
same meaning as set forth in Code Section 26-4-5."
</ins> "(c) All practitioners who dispense drugs <ins>shall be considered to be engaged in the practice
of pharmacy and</ins> shall comply with all record-keeping, labeling, packaging, and storage
requirements imposed upon pharmacists and pharmacies with regard to such drugs pursuant
to this chapter and Chapter 13 of Title 16."
"(f) The board shall have the authority to promulgate <ins>and enforce</ins> rules and regulations
governing the dispensing of drugs pursuant to this Code section."
SECTION 2.
Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to
medical practice, is amended by revising Code Section 43-34-23, relating to delegation of
authority to nurse or physician assistant, as follows:
"43-34-23.
(a) As used in this Code section, the term:
(1) 'Administer' means to give a unit dose of any drug or to perform any medical
treatment or diagnostic study.
(2) 'Controlled substance' means any controlled substance, as defined in Code Section
16-13-21, except any Schedule I controlled substance listed in Code Section 16-13-25.
(3) 'Dangerous drug' means any dangerous drug, as defined in Code Section 16-13-71,
but does not include any controlled substance or Schedule I controlled substance.
<del>(3.1)(4)</del> 'Dispense' means to issue one or more doses of any drug in a suitable container
with appropriate labeling for subsequent administration to, or use by, a patient.
<del>(4)(5)</del> 'Dispensing procedure' means a written document signed by a licensed pharmacist
and a licensed physician which <del>document</del> establishes the appropriate manner under which
drugs may be dispensed pursuant to this Code section.
<del>(5)(6)</del> 'Drug' means any dangerous drug or controlled substance.
<del>(5.1)(7)</del> 'Job description' shall have the same meaning as <ins>set forth</ins> in Code
Section 43-34-102.
<del>(6)(8)</del> 'Nurse' means a person who is a registered professional nurse and licensed as such
under Article 1 of Chapter 26 of this title., <ins>the 'Georgia Registered Professional Nurse
Practice Act.'
</ins> <del>(7)(9)</del> 'Nurse protocol' means a written document mutually agreed upon and signed by
a nurse and a licensed physician, by which document the physician delegates to <del>that</del> <ins>such
</ins> nurse the authority to perform certain medical acts pursuant to subsection (b) of this Code
section, and which acts shall include, without being limited to, the administering and
ordering of any drug.
<ins>(8)(10)</ins> 'Order' means to select a drug, medical treatment, or diagnostic study through
physician delegation in accordance with a nurse protocol or a physician assistant's job
description. Ordering under such delegation shall not be construed to be prescribing nor
shall ordering of a drug be construed to authorize the issuance of a written prescription.
<ins>(9)(11)</ins> 'Physician assistant' means a person licensed as a physician assistant pursuant to
Article 4 of this chapter, the 'Physician Assistant Act.'
(b)(1)(A) A physician may delegate the authority <del>contained</del> <ins>provided</ins> in
subparagraph (B) of this paragraph to:
(i) A physician assistant in accordance with a job description; or
(ii) A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife,
certified registered nurse anesthetist, certified nurse practitioner, or clinical nurse
specialist in psychiatric/mental health in accordance with a nurse protocol.
(B) A physician may delegate to those healthcare professionals identified in
subparagraph (A) of this paragraph:
(i) The authority to order controlled substances selected from a formulary of such
drugs established by the board and the authority to order dangerous drugs, medical
treatments, and diagnostic studies;
(ii) The authority to request, receive, and sign for professional samples and to
distribute professional samples to patients. The office or facility at which the
healthcare professional identified in subparagraph (A) of this paragraph is working
shall maintain a general list of the professional samples approved by the delegating
physician for request, receipt, and distribution by the healthcare professional
identified in subparagraph (A) of this paragraph as well as a complete list of the
specific number and dosage of each professional sample and medication voucher
received. Professional samples that are distributed by a healthcare professional
identified in subparagraph (A) of this paragraph shall be so noted in the patient's
medical record. 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; and
(iii) The authority to sign, certify, and endorse all documents relating to healthcare
provided to a patient within his or her scope of authorized practice, including, but not
limited to, documents relating to physical examination forms of all state agencies and
verification and evaluation forms of the Department of Human Services, the State
Board of Education, local boards of education, the Department of Community Health,
and the Department of Corrections; provided, however, that a healthcare professional
identified in subparagraph (A) of this paragraph shall not have the authority to assign
a percentage of a disability rating.
Healthcare professionals identified in subparagraph (A) of this paragraph <del>must</del> <ins>shall
</ins> complete biennial continuing education regarding the recognition and documentation
of the causes of death and appropriate execution of death certificates, as approved by
the board.
<ins>(C) A physician may delegate the authority provided in subparagraph (D) of this
paragraph to:
(i) A physician assistant in accordance with a job description; or
(ii) A nurse recognized by the Georgia Board of Nursing as an advance practice
registered nurse.
(D) The authority to dispense dangerous drugs, in accordance with a dispensing
procedure and the authority of an order issued in conformity with a nurse protocol or
job description, if such advance practice registered nurse or physician assistant
dispenses such dangerous drugs in conformity with subsection (b) of Code Section
26-4-130. Nothing in this paragraph shall be construed to allow a physician to dispense
Schedule II drugs.
</ins> (2) A physician may delegate to a nurse or physician assistant the authority to order
dangerous drugs, medical treatments, or diagnostic studies and a nurse or physician
assistant is authorized to dispense dangerous drugs, in accordance with a dispensing
procedure and under the authority of an order issued in conformity with a nurse protocol
or job description, if that nurse or physician assistant orders or dispenses those dangerous
drugs, medical treatments, or diagnostic studies:
(A) As an agent or employee of:
(i) The Department of Public Health;
(ii) Any county board of health; or
(iii) Any organization:
(I) 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, other than an organization which
is a hospital, preferred provider organization, health maintenance organization, or
similar organization; or
(II) Established under the authority of or receiving funds pursuant to 42 U.S.C.
Section 254b or 254c of the United States Public Health Service Act,
which organization provides that those medical services and dangerous drugs which
are ordered or dispensed by its physician assistants and nurses will be provided at no
cost to the patient or at a cost based solely upon the patient's ability to pay; and
(B) In conformity with subsection (b) of Code Section 26-4-130 and the rules and
regulations established pursuant thereto by the State Board of Pharmacy.
(3) In addition, a physician may delegate to a nurse or physician assistant the authority
to order dangerous drugs, medical treatments, or diagnostic studies and a nurse or
physician assistant is authorized to dispense dangerous drugs, in accordance with a
dispensing procedure and under the authority of an order issued in conformity with a
nurse protocol or job description, if that nurse or physician assistant orders or dispenses
such drugs, treatments, or studies to a patient of an outpatient clinic:
(A) Which is owned or operated by a licensed hospital;
(B) Which provides such drugs, treatments, or studies free or at a charge to the patient
based solely upon the patient's ability to pay; provided, however, such charge shall not
exceed the actual cost to the outpatient clinic; and
(C) Whose services are primarily provided to the medically disadvantaged
and that nurse or physician assistant orders or dispenses such drugs in conformity with
subsection (b) of Code Section 26-4-130 and the rules and regulations established
pursuant thereto by the State Board of Pharmacy.
(4) Delegation of authority to a physician assistant pursuant to this subsection shall be
authorized only if <del>that</del> <ins>such</ins> delegation is contained in the job description approved for
<del>that</del> <ins>such</ins> physician assistant by the board.
(5) Delegation of authority to a nurse pursuant to this subsection shall be authorized only
if <del>that</del> <ins>such</ins> delegation is contained in a nurse protocol for <del>that</del> <ins>such</ins> nurse.
(c) The board shall be empowered to promulgate rules and regulations governing
physicians and physician assistants to carry out the intents and purposes of this Code
section, including establishing criteria and standards governing physicians, physician
assistants, job descriptions, and nurse protocols. The board shall be authorized to require
that protocols not falling within such established criteria and standards be submitted to the
board for review and approval or rejection.
(d) Notwithstanding any other provision of law to the contrary, a physician assistant or
nurse may perform any act authorized to be performed by <del>that</del> <ins>such</ins> person pursuant to and
in conformity with this Code section without such act constituting the practice of medicine.
(e) Nothing in this Code section shall be construed to limit or repeal this article and
Articles 4 and 6 of this chapter, relating to <del>physicians, osteopathic physicians,</del> physician
assistants, and respiratory <del>therapists</del> <ins>care, respectively,</ins> or Article 1 of Chapter 26 of this
title, <del>relating to registered nurses.</del> <ins>the 'Georgia Registered Professional Nurse Practice Act.'
</ins> (f) Nothing in this Code section shall be construed to limit or repeal any existing authority
of a licensed physician to delegate to a qualified person any acts, duties, or functions which
are otherwise permitted by law or established by custom.
(g) Nothing in this Code section shall be construed to authorize or permit the issuance of
a <ins>United States</ins> Drug Enforcement Administration license to a nurse who is not an
advanced practice registered nurse.
(h) Nothing in this Code section shall be construed to limit or repeal the authority of any
organization described in division (i) or (ii) of subparagraph (b)(2)(A) of this Code section
or any organization established under the authority of or receiving funds pursuant to
42 U.S.C. Section 254b or 254c of the United States Public Health Service Act to supervise
its agents or employees or interfere with the employer and employee relationship of any
such agents or employees.
(i) Notwithstanding any other provision of law to the contrary, a physician assistant or
nurse may perform any act deemed necessary to provide treatment to a hospital or nursing
home patient in a life-threatening situation when such act is authorized by standing
procedures established by the medical staff of the hospital or nursing home."
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.