HB1309: HB1309 Practitioners; clarify that all who dispense drugs are engaged in the practice of pharmacy and shall comply with all record keeping and other requirements

26 LC 46 1496S 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 Cod e of Georgia Annotated,1 relating to practitioners of the healing arts, so as to clarify that all practitioners who dispense2 drugs are engaged in the practice of pharmacy and shall comply with all record keeping and3 other requirements; to provide for the Georgia State Board of Pharmacy to enforce rules and4 regulations; to amend Article 2 of Chapter 34 of Title 43 of th e Official Code of Georgia5 Annotated, relating to medical practice, so as to expand the au thority of physicians to6 delegate the authority to dispense certain drugs; to provide fo r statutory construction; to7 provide for definitions; to provide for related matters; to rep eal conflicting laws; and for8 other purposes.9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10 SECTION 1.11 Article 7 of Chapter 4 of Title 26 of the Official Code of Geor gia Annotated, relating to12 practitioners of the healing arts, is amended by revising paragraph (2) of subsection (a) and13 subsections (c) and (f) of Code Section 26-4-130, relating to dispensing drugs, compliance14 with labeling and packaging requirements, records available for inspection by board, and15 renewal of licenses, as follows:16 H. B. 1309 (SUB) - 1 - 26 LC 46 1496S "(2) 'Practitioner' or 'practitioner of the healing arts' means , notwithstanding Code17 Section 26-4-5, a person licensed as a dentist, optometrist, ph ysician, podiatrist, or18 veterinarian under Chapter 11, 30, 34, 35, or 50, respectively, of Title 43 shall have the19 same meaning as set forth in Code Section 26-4-5."20 "(c) All practitioners who dispense drugs shall be considered to be engaged in the practice21 of pharmacy and shall comply with all record-keeping, labeling, packaging, and storage22 requirements imposed upon pharmacists and pharmacies with regard to such drugs pursuant23 to this chapter and Chapter 13 of Title 16."24 "(f) The board shall have the authority to promulgate and enfor ce rules and regulations25 governing the dispensing of drugs pursuant to this Code section."26 SECTION 2.27 Article 2 of Chapter 34 of Title 43 of the Official Code of Geo rgia Annotated, relating to28 medical practice, is amended by revising Code Section 43-34-23, relating to delegation of29 authority to nurse or physician assistant, as follows:30 "43-34-23.31 (a) As used in this Code section, the term:32 (1) 'Administer' means to give a unit dose of any drug or to p erform any medical33 treatment or diagnostic study.34 (2) 'Controlled substance' means any controlled substance, as defined in Code Section35 16-13-21, except any Schedule I controlled substance listed in Code Section 16-13-25.36 (3) 'Dangerous drug' means any dangerous drug, as defined in Code Section 16-13-71,37 but does not include any controlled substance or Schedule I controlled substance.38 (3.1)(4) 'Dispense' means to issue one or more doses of any drug in a suitable container39 with appropriate labeling for subsequent administration to, or use by, a patient.40 H. B. 1309 (SUB) - 2 - 26 LC 46 1496S (4)(5) 'Dispensing procedure' means a written document signed by a licensed pharmacist41 and a licensed physician which document establishes the appropriate manner under which42 drugs may be dispensed pursuant to this Code section.43 (5)(6) 'Drug' means any dangerous drug or controlled substance.44 (5.1)(7) 'Job description' shall have the same meaning as set forth in Code45 Section 43-34-102.46 (6)(8) 'Nurse' means a person who is a registered professional nurse and licensed as such47 under Article 1 of Chapter 26 of this title. , the 'Georgia Registered Professional Nurse48 Practice Act.'49 (7)(9) 'Nurse protocol' means a written document mutually agreed upon and signed by50 a nurse and a licensed physician, by which document the physician delegates to that such51 nurse the authority to perform certain medical acts pursuant to subsection (b) of this Code52 section, and which acts shall in clude, without being limited to , the administering and53 ordering of any drug.54 (8)(10) 'Order' means to select a drug, medical treatment, or diagnos tic study through55 physician delegation in accordance with a nurse protocol or a p hysician assistant's job56 description. Ordering under such delegation shall not be construed to be prescribing nor57 shall ordering of a drug be construed to authorize the issuance of a written prescription.58 (9)(11) 'Physician assistant' means a person licensed as a physician assistant pursuant to59 Article 4 of this chapter, the 'Physician Assistant Act.'60 (b)(1)(A) A physician may delegate the authority contained provided i n61 subparagraph (B) of this paragraph to:62 (i) A physician assistant in accordance with a job description; or63 (ii) A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife,64 certified registered nurse anesthetist, certified nurse practit ioner, or clinical nurse65 specialist in psychiatric/mental health in accordance with a nurse protocol.66 H. B. 1309 (SUB) - 3 - 26 LC 46 1496S (B) A physician may delegate to those healthcare professionals identified in67 subparagraph (A) of this paragraph:68 (i) The authority to order controlled substances selected from a formulary of such69 drugs established by the board and the authority to order dange rous drugs, medical70 treatments, and diagnostic studies;71 (ii) The authority to request, receive, and sign for professio nal samples and to72 distribute professional samples to patients. The office or fac ility at which the73 healthcare professional identified in subparagraph (A) of this paragraph is working74 shall maintain a general list of the professional samples approved by the delegating75 physician for request, receipt, and distribution by the healthc are professional76 identified in subparagraph (A) of this paragraph as well as a c omplete list of the77 specific number and dosage of each professional sample and medi cation voucher78 received. Professional samples that are distributed by a healt hcare professional79 identified in subparagraph (A) of this paragraph shall be so no ted in the patient's80 medical record. In addition to the requirements of this Code section, all professional81 samples shall be maintained as required by applicable state and federal laws and82 regulations; and83 (iii) The authority to sign, certify, and endorse all documents relating to healthcare84 provided to a patient within his or her scope of authorized practice, including, but not85 limited to, documents relating to physical examination forms of all state agencies and86 verification and evaluation forms of the Department of Human Se rvices, the State87 Board of Education, local boards of education, the Department of Community Health,88 and the Department of Corrections; provided, however, that a healthcare professional89 identified in subparagraph (A) of this paragraph shall not have the authority to assign90 a percentage of a disability rating.91 Healthcare professionals identified in subparagraph (A) of this paragraph must shall92 complete biennial continuing education regarding the recognition and documentation93 H. B. 1309 (SUB) - 4 - 26 LC 46 1496S of the causes of death and appropriate execution of death certificates, as approved by94 the board.95 (C) A physician may delegate the authority provided in subpara graph (D) of this96 paragraph to:97 (i) A physician assistant in accordance with a job description; or98 (ii) A nurse recognized by the Georgia Board of Nursing as an advance practice99 registered nurse.100 (D) The authority to dispense dangerous drugs, in accordance w ith a dispensing101 procedure and the authority of an order issued in conformity with a nurse protocol or102 job description, if such advance practice registered nurse or p hysician assistant103 dispenses such dangerous drugs in conformity with subsection (b ) of Code Section104 26-4-130. Nothing in this paragraph shall be construed to allow a physician to dispense105 Schedule II drugs.106 (2) A physician may delegate to a nurse or physician assistant the authority to order107 dangerous drugs, medical treatments, or diagnostic studies and a nurse or physician108 assistant is authorized to dispense dangerous drugs, in accorda nce with a dispensing109 procedure and under the authority of an order issued in conformity with a nurse protocol110 or job description, if that nurse or physician assistant orders or dispenses those dangerous111 drugs, medical treatments, or diagnostic studies:112 (A) As an agent or employee of:113 (i) The Department of Public Health;114 (ii) Any county board of health; or115 (iii) Any organization:116 (I) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal117 Revenue Code, as defined in Code Section 48-1-2, other than an organization which118 is a hospital, preferred provider organization, health maintenance organization, or119 similar organization; or120 H. B. 1309 (SUB) - 5 - 26 LC 46 1496S (II) Established under the authority of or receiving funds pur suant to 42 U.S.C.121 Section 254b or 254c of the United States Public Health Service Act,122 which organization provides that those medical services and dangerous drugs which123 are ordered or dispensed by its physician assistants and nurses will be provided at no124 cost to the patient or at a cost based solely upon the patient's ability to pay; and125 (B) In conformity with subsection (b) of Code Section 26-4-130 and the rules and126 regulations established pursuant thereto by the State Board of Pharmacy.127 (3) In addition, a physician may delegate to a nurse or physician assistant the authority128 to order dangerous drugs, medical treatments, or diagnostic stu dies and a nurse or129 physician assistant is authorized to dispense dangerous drugs, in accordance with a130 dispensing procedure and under the authority of an order issued in conformity with a131 nurse protocol or job description, if that nurse or physician assistant orders or dispenses132 such drugs, treatments, or studies to a patient of an outpatient clinic:133 (A) Which is owned or operated by a licensed hospital;134 (B) Which provides such drugs, treatments, or studies free or at a charge to the patient135 based solely upon the patient's ability to pay; provided, however, such charge shall not136 exceed the actual cost to the outpatient clinic; and137 (C) Whose services are primarily provided to the medically disadvantaged138 and that nurse or physician assistant orders or dispenses such drugs in conformity with139 subsection (b) of Code Section 26-4-130 and the rules and regul ations established140 pursuant thereto by the State Board of Pharmacy.141 (4) Delegation of authority to a physician assistant pursuant to this subsection shall be142 authorized only if that such delegation is contained in the job description approved for143 that such physician assistant by the board.144 (5) Delegation of authority to a nurse pursuant to this subsection shall be authorized only145 if that such delegation is contained in a nurse protocol for that such nurse.146 H. B. 1309 (SUB) - 6 - 26 LC 46 1496S (c) The board shall be empowered to promulgate rules and regul ations governing147 physicians and physician assistants to carry out the intents an d purposes of this Code148 section, including establishing criteria and standards governin g physicians, physician149 assistants, job descriptions, and nurse protocols. The board shall be authorized to require150 that protocols not falling within such established criteria and standards be submitted to the151 board for review and approval or rejection.152 (d) Notwithstanding any other provision of law to the contrary , a physician assistant or153 nurse may perform any act authorized to be performed by that such person pursuant to and154 in conformity with this Code section without such act constituting the practice of medicine.155 (e) Nothing in this Code section shall be construed to limit o r repeal this article and156 Articles 4 and 6 of this chapter, relating to physicians, osteopathic physicians, physician157 assistants, and respiratory therapists care, respectively, or Article 1 of Chapter 26 of this158 title, relating to registered nurses. the 'Georgia Registered Professional Nurse Practice Act.'159 (f) Nothing in this Code section shall be construed to limit or repeal any existing authority160 of a licensed physician to delegate to a qualified person any acts, duties, or functions which161 are otherwise permitted by law or established by custom.162 (g) Nothing in this Code section shall be construed to authorize or permit the issuance of163 a United States Drug Enforcement Administration license to a nurse who is not an164 advanced practice registered nurse.165 (h) Nothing in this Code section shall be construed to limit or repeal the authority of any166 organization described in division (i) or (ii) of subparagraph (b)(2)(A) of this Code section167 or any organization established under the authority of or recei ving funds pursuant to168 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act to supervise169 its agents or employees or interfere with the employer and empl oyee relationship of any170 such agents or employees.171 (i) Notwithstanding any other provision of law to the contrary , a physician assistant or172 nurse may perform any act deemed necessary to provide treatment to a hospital or nursing173 H. B. 1309 (SUB) - 7 - 26 LC 46 1496S home patient in a life-threatening situation when such act is a uthorized by standing174 procedures established by the medical staff of the hospital or nursing home."175 SECTION 3.176 All laws and parts of laws in conflict with this Act are repealed.177 H. B. 1309 (SUB) - 8 -