House Bill 981
By: Representatives Powell of the 33rd, Ehrhart of the 36th, O’Steen of the 169th, Jackson of
the 128th, and Jones of the 47th
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to
physicians, assistants, and others, so as to expand certain advanced practice registered nurse
and physician assistant prescriptive authorizations; to provide for a definition; to increase
certain prescriptive authorizations from five-day to 30 day supplies; to remove certain
prohibitions on writing prescriptions for minors; to provide for certain prescriptive
authorization to order stimulants; 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 34 of Title 43 of the Official Code of Georgia Annotated, relating to physicians,
assistants, and others, is amended by adding a new paragraph to subsection (a) of and by
revising subsection (d.1), paragraph (10) of subsection (g), and paragraph (2) of subsection
(m) of Code Section 43-34-25, relating to delegation of certain medical acts to advanced
practice registered nurse, construction and limitations of such delegation, definitions,
conditions of nurse protocol, and issuance of prescription drug orders, to read as follows:
<ins>"(16) 'Stimulant' means any material, compound, mixture, or preparation that increases
heart rate, breathing, or brain function as provided in paragraph (3) of Code Section
16-13-26."
</ins> "(d.1) An advanced practice registered nurse who has at least one year of post-licensure
clinical experience and is in good standing with the board may be authorized under a nurse
protocol agreement to issue prescription drug orders for <ins>stimulants,</ins> hydrocodone,
oxycodone, or compounds thereof in emergency situations pursuant to the following
requirements:
(1) The authorization is specifically included in the nurse protocol agreement;
(2) The advanced practice registered nurse has directly evaluated the patient;
(3) The prescription drug order is limited to an initial prescription, not to exceed a
<del>five-day</del> <ins>30 day</ins> supply; <ins>and
</ins> <del>(4) The prescription drug order is for an individual 18 years of age or older; and
(5)(4)</del> The advanced practice registered nurse completes one hour of continuing
education biennially in the appropriate ordering and use of <ins>stimulants,</ins> hydrocodone,
oxycodone, and compounds thereof."
"(10) Notwithstanding the provisions of subsection (d.1) of this Code section, in any
emergency medical services system operated by, or on behalf of, any county,
municipality, or hospital authority with a full-time physician medical director who does
not order drugs, except that he or she may order up to a 14 day supply of drugs as
necessary in an emergency situation, <del>excluding benzodiazepines and all Schedule II
controlled substances except hydrocodone, oxycodone, or compounds thereof;</del> provided,
however, that an advanced practice registered nurse shall not order radiographic imaging,
diagnostic studies, or medical devices pursuant to this paragraph; and provided, further,
that a patient shall be referred to a physician, a dentist, or a federally qualified health
center."
"(2)(A) Further, the board shall be authorized to:
(i) 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;
(ii) 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
(iii) Require the delegating physician to amend any such noncompliant nurse protocol
agreement in order to meet such accepted standards.
(B) If a medical practice has an existing approved nurse protocol agreement and an
alternate delegating physician or a change in the delegating physician within the same
or similar specialty, such new nurse protocol agreement for the new alternate delegating
physician or a change in the delegating physician, upon submission, shall be
automatically deemed <del>approved</del> <ins>authorized</ins> by the board.
(C) If a delegating physician submits a nurse protocol agreement for a new advanced
practice registered nurse and such nurse protocol agreement has substantially the same
terms and provisions as a nurse protocol agreement previously submitted by such
delegating physician for another advanced practice registered nurse and approved by
the board, the nurse protocol agreement for the new advanced practice registered nurse,
upon submission, shall be automatically deemed approved <ins>authorized</ins> by the board."
SECTION 2.
Said chapter is further amended by revising paragraphs (1) and (10) of subsection (e.1) of
Code Section 43-34-103, relating to delegation of authority to physician assistants, as
follows:
"(e.1)(1)(A) In addition to and without limiting the authority granted by Code Section
43-34-23, a physician may delegate to a physician assistant, in accordance with a job
description, the authority to issue a prescription drug order or orders for any device as
defined in Code Section 26-4-5 or to issue any dangerous drug as defined in Code
Section 16-13-71, <ins>stimulants,</ins> hydrocodone, oxycodone, or compounds thereof in
accordance with subparagraph (B) of this paragraph, or any Schedule III, IV, or V
controlled substance as defined in Code Section 16-13-21 on a prescription drug order
or prescription device order form as specified in paragraph (3) of this subsection.
Delegation of such authority shall be contained in the job description required by this
Code section. The delegating physician shall remain responsible for the medical acts
of the physician assistant performing such delegated acts and shall adequately supervise
the physician assistant. If an existing job description for a physician assistant does not
contain such authority to order a prescription drug or device order as provided by this
subsection, that physician assistant may not issue any such prescription drug or device
order until a new job description delegating such authority is submitted to and approved
by the board. Nothing in this Code section shall be construed to authorize the written
prescription drug order of a Schedule I or II controlled substance, except as authorized
pursuant to subparagraph (B) of this paragraph.
(B) A physician may delegate to a physician assistant who has at least one year of
post-licensure clinical experience and is in good standing with the board the authority
to issue prescription drug orders for stimulants, hydrocodone, oxycodone, or
compounds thereof in emergency situations pursuant to the following requirements:
(i) The authorization is specifically included in the job description;
(ii) The physician assistant has directly evaluated the patient; <ins>and
</ins> (iii) The drug order is limited to an initial prescription not to exceed a <del>five-day</del> <ins>30
day</ins> supply; <del>and
(iv) The prescription drug order is for an individual 18 years of age or older."
</del> "(10)(A) A physician assistant delegated the authority by the primary supervising
physician to issue a prescription drug or device order shall be required to complete a
minimum of three hours of continuing education biennially in practice specific
pharmaceuticals in which the physician assistant has prescriptive order privileges.
(B) A physician assistant delegated the authority by the primary supervising physician
to issue a prescription drug or device order for <ins>stimulants,</ins> hydrocodone, oxycodone,
or compounds thereof shall be required to complete one additional hour of continuing
education biennially in the appropriate ordering and use of <ins>stimulants,</ins> hydrocodone,
oxycodone, or compounds thereof."
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.