Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 58 Fourth Substitute (2016GS)

Sponsor

Sen. Hinkins, D.

Final action

Governor Signed 3/21/2016

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines pain clinic for Title 58, Division of Occupational and Professional Licensing Act;
• allows an advanced practice registered nurse to prescribe a Schedule II controlled substance without a consultation and referral plan if the advanced practice registered nurse:
• meets certain experience requirements;
• consults the Controlled Substance Database; and
• when treating an injured worker, follows prescribing for chronic pain guidelines developed by the Workers' Compensation System;
• prohibits an advanced practice registered nurse from establishing an independent pain clinic without a consultation and referral plan; and
• makes technical and conforming amendments.

Every vote on this bill

Bill text

NURSE PRACTITIONER AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: David P. Hinkins
House Sponsor: 
Justin L. Fawson
LONG TITLE
General Description:
This bill allows an advanced practice registered nurse to prescribe a Schedule II
controlled substance without a consultation and referral plan under certain
circumstances.
Highlighted Provisions:
This bill:
▸ defines pain clinic for Title 58, Division of Occupational and Professional
Licensing Act;
▸ allows an advanced practice registered nurse to prescribe a Schedule II controlled
substance without a consultation and referral plan if the advanced practice
registered nurse:
• meets certain experience requirements;
• consults the Controlled Substance Database; and
• when treating an injured worker, follows prescribing for chronic pain guidelines
developed by the Workers' Compensation System;
▸ prohibits an advanced practice registered nurse from establishing an independent
pain clinic without a consultation and referral plan; and
▸ makes technical and conforming amendments.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
26-55-102
, as enacted by Laws of Utah 2014, Chapter 130
58-1-102
, as last amended by Laws of Utah 2012, Chapter 362
58-31b-102
, as last amended by Laws of Utah 2011, Chapter 366
58-31b-502
, as last amended by Laws of Utah 2014, Chapter 72
58-31d-103
, as last amended by Laws of Utah 2015, Chapter 258
ENACTS:
58-31b-803
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-55-102
 is amended to read:
26-55-102.
Definitions.
As used in this chapter:
(1) "Health care facility" means a hospital, a hospice inpatient residence, a nursing
facility, a dialysis treatment facility, an assisted living residence, an entity that provides home-
and community-based services, a hospice or home health care agency, or another facility that
provides or contracts to provide health care services, which facility is licensed under Chapter
21, Health Care Facility Licensing and Inspection Act.
(2) "Health care provider" means:
(a) a physician as defined in Section 
58-67-102
;
(b) an advanced practice registered nurse as defined in [
Subsection
] 
Section
58-31b-102
[
(13)
]; or
(c) a physician assistant as defined in Section 
58-70a-102
.
(3) "Opiate" is as defined in Section 
58-37-2
.
(4) "Opiate antagonist" means naloxone hydrochloride or any similarly acting drug that
is not a controlled substance and that is approved by the federal Food and Drug Administration
for the treatment of a drug overdose.
(5) "Opiate-related drug overdose event" means an acute condition, including a
decreased level of consciousness or respiratory depression resulting from the consumption or
use of a controlled substance, or another substance with which a controlled substance was
combined, and that a person would reasonably believe to require medical assistance.
Section 2. Section 
58-1-102
 is amended to read:
58-1-102.
Definitions.
For purposes of this title:
(1) "Ablative procedure" is as defined in Section 
58-67-102
.
(2) "Cosmetic medical procedure":
(a) is as defined in Section 
58-67-102
; and
(b) except for Chapter 67, Utah Medical Practice Act, and Chapter 68, Utah
Osteopathic Medical Practice Act, does not apply to the scope of practice of an individual
licensed under this title if the individual's scope of practice includes the authority to operate or
perform surgical procedures.
(3) "Department" means the Department of Commerce.
(4) "Director" means the director of the Division of Occupational and Professional
Licensing.
(5) "Division" means the Division of Occupational and Professional Licensing created
in Section 
58-1-103
.
(6) "Executive director" means the executive director of the Department of Commerce.
(7) "Licensee" includes any holder of a license, certificate, registration, permit, student
card, or apprentice card authorized under this title.
(8) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
alter living tissue, but not intended or expected to excise, vaporize, disintegrate, or remove
living tissue.
(ii) Notwithstanding Subsection (8)(a)(i), nonablative procedure includes hair removal.
(b) "Nonablative procedure" does not include:
(i) a superficial procedure;
(ii) the application of permanent make-up; or
(iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
performed by an individual licensed under this title who is acting within their scope of practice.
(9) 
"Pain clinic" means:
(a) a clinic that advertises its primary purpose is the treatment of chronic pain; or
(b) a clinic in which greater than 50% of the clinic's annual patient population receive
treatment primarily for non-terminal chronic pain using Schedule II-III controlled substances.
(10)
 "Superficial procedure" means a procedure that is expected or intended to
temporarily alter living skin tissue and may excise or remove stratum corneum but have no
appreciable risk of damage to any tissue below the stratum corneum.
[
(10)
] 
(11)
 "Unlawful conduct" has the meaning given in Subsection 
58-1-501
(1).
[
(11)
] 
(12)
 "Unprofessional conduct" has the meaning given in Subsection
58-1-501
(2).
Section 3. Section 
58-31b-102
 is amended to read:
58-31b-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) "Administrative penalty" means a monetary fine or citation imposed by the division
for acts or omissions determined to constitute unprofessional or unlawful conduct in
accordance with a fine schedule established by rule and as a result of an adjudicative
proceeding conducted in accordance with Title 63G, Chapter 4, Administrative Procedures Act.
(2) "Applicant" means a person who applies for licensure or certification under this
chapter by submitting a completed application for licensure or certification and the required
fees to the department.
(3) "Approved education program" means a nursing education program that meets the
minimum standards for educational programs established under this chapter and by division
rule in collaboration with the board.
(4) "Board" means the Board of Nursing created in Section 
58-31b-201
.
(5) "Consultation and referral plan" means a written plan jointly developed by an
advanced practice registered nurse and a consulting physician that permits the advanced
practice registered nurse to prescribe Schedule II[
-III
] controlled substances in consultation
with the consulting physician.
(6) "Consulting physician" means a physician and surgeon or osteopathic physician and
surgeon licensed in accordance with this title who has agreed to consult with an advanced
practice registered nurse with a controlled substance license, a DEA registration number, and
who will be prescribing Schedule II[
-III
] controlled substances.
(7) "Diagnosis" means the identification of and discrimination between physical and
psychosocial signs and symptoms essential to the effective execution and management of
health care.
(8) "Examinee" means a person who applies to take or does take any examination
required under this chapter for licensure.
(9) "Licensee" means a person who is licensed or certified under this chapter.
(10) "Long-term care facility" means any of the following facilities licensed by the
Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
Inspection Act:
(a) a nursing care facility;
(b) a small health care facility;
(c) an intermediate care facility for people with an intellectual disability;
(d) an assisted living facility Type I or II; or
(e) a designated swing bed unit in a general hospital.
(11) "Medication aide certified" means a certified nurse aide who:
(a) has a minimum of 2,000 hours experience working as a certified nurse aide;
(b) has received a minimum of 60 hours of classroom and 40 hours of practical training
that is approved by the division in collaboration with the board, in administering routine
medications to patients or residents of long-term care facilities; and
(c) is certified by the division as a medication aide certified.
(12) "Pain clinic" means the same as that term is defined in Section 
58-1-102
.
[
(12)
] 
(13)
 (a) "Practice as a medication aide certified" means the limited practice of
nursing under the supervision, as defined by the division by administrative rule, of a licensed
nurse, involving routine patient care that requires minimal or limited specialized or general
knowledge, judgment, and skill, to an individual who:
(i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
disability; and
(ii) is in a regulated long-term care facility.
(b) "Practice as a medication aide certified":
(i) includes:
(A) providing direct personal assistance or care; and
(B) administering routine medications to patients in accordance with a formulary and
protocols to be defined by the division by rule; and
(ii) does not include assisting a resident of an assisted living facility, a long term care
facility, or an intermediate care facility for people with an intellectual disability to self
administer a medication, as regulated by the Department of Health by administrative rule.
[
(13)
] 
(14)
 "Practice of advanced practice registered nursing" means the practice of
nursing within the generally recognized scope and standards of advanced practice registered
nursing as defined by rule and consistent with professionally recognized preparation and
education standards of an advanced practice registered nurse by a person licensed under this
chapter as an advanced practice registered nurse. Advanced practice registered nursing
includes:
(a) maintenance and promotion of health and prevention of disease;
(b) diagnosis, treatment, correction, consultation, and referral for common health
problems;
(c) prescription or administration of prescription drugs or devices including:
(i) local anesthesia;
(ii) Schedule [
IV
] 
III
-V controlled substances; and
(iii) Schedule II[
-III
] controlled substances in accordance with [
a consultation and
referral plan
] 
Section 
58-31b-803
; or
(d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
related services upon the request of a licensed health care professional by an advanced practice
registered nurse specializing as a certified registered nurse anesthetist, including:
(i) preanesthesia preparation and evaluation including:
(A) performing a preanesthetic assessment of the patient;
(B) ordering and evaluating appropriate lab and other studies to determine the health of
the patient; and
(C) selecting, ordering, or administering appropriate medications;
(ii) anesthesia induction, maintenance, and emergence, including:
(A) selecting and initiating the planned anesthetic technique;
(B) selecting and administering anesthetics and adjunct drugs and fluids; and
(C) administering general, regional, and local anesthesia;
(iii) postanesthesia follow-up care, including:
(A) evaluating the patient's response to anesthesia and implementing corrective
actions; and
(B) selecting, ordering, or administering the medications and studies listed in
Subsection [
(13)
] 
(14)
(d); and
(iv) other related services within the scope of practice of a certified registered nurse
anesthetist, including:
(A) emergency airway management;
(B) advanced cardiac life support; and
(C) the establishment of peripheral, central, and arterial invasive lines; and
(v) for purposes of Subsection [
(13)
] 
(14)
(d), "upon the request of a licensed health
care professional":
(A) means a health care professional practicing within the scope of the health care
professional's license, requests anesthesia services for a specific patient; and
(B) does not require an advanced practice registered nurse specializing as a certified
registered nurse anesthetist to enter into a consultation and referral plan or obtain additional
authority to select, administer, or provide preoperative, intraoperative, or postoperative
anesthesia care and services.
[
(14)
] 
(15)
 "Practice of nursing" means assisting individuals or groups to maintain or
attain optimal health, implementing a strategy of care to accomplish defined goals and
evaluating responses to care and treatment. The practice of nursing requires substantial
specialized or general knowledge, judgment, and skill based upon principles of the biological,
physical, behavioral, and social sciences, and includes:
(a) initiating and maintaining comfort measures;
(b) promoting and supporting human functions and responses;
(c) establishing an environment conducive to well-being;
(d) providing health counseling and teaching;
(e) collaborating with health care professionals on aspects of the health care regimen;
(f) performing delegated procedures only within the education, knowledge, judgment,
and skill of the licensee; and
(g) delegating nurse interventions that may be performed by others and are not in
conflict with this chapter.
[
(15)
] 
(16)
 "Practice of practical nursing" means the performance of nursing acts in the
generally recognized scope of practice of licensed practical nurses as defined by rule and as
provided in this Subsection [
(15)
] 
(16)
 by a person licensed under this chapter as a licensed
practical nurse and under the direction of a registered nurse, licensed physician, or other
specified health care professional as defined by rule. Practical nursing acts include:
(a) contributing to the assessment of the health status of individuals and groups;
(b) participating in the development and modification of the strategy of care;
(c) implementing appropriate aspects of the strategy of care;
(d) maintaining safe and effective nursing care rendered to a patient directly or
indirectly; and
(e) participating in the evaluation of responses to interventions.
[
(16)
] 
(17)
 "Practice of registered nursing" means performing acts of nursing as
provided in this Subsection [
(16)
] 
(17)
 by a person licensed under this chapter as a registered
nurse within the generally recognized scope of practice of registered nurses as defined by rule. 
Registered nursing acts include:
(a) assessing the health status of individuals and groups;
(b) identifying health care needs;
(c) establishing goals to meet identified health care needs;
(d) planning a strategy of care;
(e) prescribing nursing interventions to implement the strategy of care;
(f) implementing the strategy of care;
(g) maintaining safe and effective nursing care that is rendered to a patient directly or
indirectly;
(h) evaluating responses to interventions;
(i) teaching the theory and practice of nursing; and
(j) managing and supervising the practice of nursing.
[
(17)
] 
(18)
 "Routine medications":
(a) means established medications administered to a medically stable individual as
determined by a licensed health care practitioner or in consultation with a licensed medical
practitioner; and
(b) is limited to medications that are administered by the following routes:
(i) oral;
(ii) sublingual;
(iii) buccal;
(iv) eye;
(v) ear;
(vi) nasal;
(vii) rectal;
(viii) vaginal;
(ix) skin ointments, topical including patches and transdermal;
(x) premeasured medication delivered by aerosol/nebulizer; and
(xi) medications delivered by metered hand-held inhalers.
[
(18)
] 
(19)
 "Unlawful conduct" [
is as
] 
means the same as that term is
 defined in
Sections 
58-1-501
 and 
58-31b-501
.
[
(19)
] 
(20)
 "Unlicensed assistive personnel" means any unlicensed person, regardless
of title, to whom tasks are delegated by a licensed nurse as permitted by rule and in accordance
with the standards of the profession.
[
(20)
] 
(21)
 "Unprofessional conduct" [
is as
] 
means the same as that term is
 defined in
Sections 
58-1-501
 and 
58-31b-502
 and as may be further defined by rule.
Section 4. Section 
58-31b-502
 is amended to read:
58-31b-502.
Unprofessional conduct.
"Unprofessional conduct" includes:
(1) failure to safeguard a patient's right to privacy as to the patient's person, condition,
diagnosis, personal effects, or any other matter about which the licensee is privileged to know
because of the licensee's or person with a certification's position or practice as a nurse or
practice as a medication aide certified;
(2) failure to provide nursing service or service as a medication aide certified in a
manner that demonstrates respect for the patient's human dignity and unique personal character
and needs without regard to the patient's race, religion, ethnic background, socioeconomic
status, age, sex, or the nature of the patient's health problem;
(3) engaging in sexual relations with a patient during any:
(a) period when a generally recognized professional relationship exists between the
person licensed or certified under this chapter and patient; or
(b) extended period when a patient has reasonable cause to believe a professional
relationship exists between the person licensed or certified under the provisions of this chapter
and the patient;
(4) (a) as a result of any circumstance under Subsection (3), exploiting or using
information about a patient or exploiting the licensee's or the person with a certification's
professional relationship between the licensee or holder of a certification under this chapter and
the patient; or
(b) exploiting the patient by use of the licensee's or person with a certification's
knowledge of the patient obtained while acting as a nurse or a medication aide certified;
(5) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
(6) unauthorized taking or personal use of nursing supplies from an employer;
(7) unauthorized taking or personal use of a patient's personal property;
(8) knowingly entering into any medical record any false or misleading information or
altering a medical record in any way for the purpose of concealing an act, omission, or record
of events, medical condition, or any other circumstance related to the patient and the medical or
nursing care provided;
(9) unlawful or inappropriate delegation of nursing care;
(10) failure to exercise appropriate supervision of persons providing patient care
services under supervision of the licensed nurse;
(11) employing or aiding and abetting the employment of an unqualified or unlicensed
person to practice as a nurse;
(12) failure to file or record any medical report as required by law, impeding or
obstructing the filing or recording of such a report, or inducing another to fail to file or record
such a report;
(13) breach of a statutory, common law, regulatory, or ethical requirement of
confidentiality with respect to a person who is a patient, unless ordered by a court;
(14) failure to pay a penalty imposed by the division;
(15) prescribing a Schedule II-III controlled substance without [
a consulting physician
or outside of a consultation and referral plan
;
] 
complying with the requirements in Section
58-31b-803
;
(16) violating Section 
58-31b-801
; [
and
]
(17) violating the dispensing requirements of Section 
58-17b-309
 or Chapter 17b, Part
8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
applicable[
.
]
; and
(18) establishing or operating a pain clinic without a consultation and referral plan for
Schedule II-III controlled substances.
Section 5. Section 
58-31b-803
 is enacted to read:
 58-31b-803.
Prescriptive authority for advanced practice registered nurses --
Schedule II controlled substance or device -- Workers' compensation -- Pain clinics. 
(1) This section does not apply to an advanced practice registered nurse specializing as
a certified registered nurse anesthetist under Subsection 
58-31b-102
(14)(d).
(2) Except as provided in Subsection (3), an advanced practice registered nurse shall
prescribe or administer a Schedule II controlled substance in accordance with a consultation
and referral plan.
(3) Except as provided by Subsection 
58-31b-502
(18), an advanced practice registered
nurse may prescribe or administer a Schedule II controlled substance without a consultation
and referral plan if the advanced practice registered nurse:
(a) has the lesser of:
(i) two years of licensure as a nurse practicing advanced practice registered nursing; or
(ii) 2,000 hours of experience practicing advanced practice registered nursing;
(b) (i) prior to the first time prescribing or administering a Schedule III controlled
substance for chronic pain, or a Schedule II controlled substance to a particular patient, unless
treating the patient in a licensed general acute hospital, checks information about the patient in
the Controlled Substance Database created in Section 
58-37f-201
; and
(ii) periodically, thereafter, checks information about the patient in the Controlled
Substance Database created in Section 
58-37f-201
; and
(c) follows the health care provider prescribing guidelines for the treatment of an
injured worker, developed by the Labor Commission under Title 34A, Chapter 2, Workers'
Compensation Act, or Title 34A, Chapter 3, Utah Occupational Disease Act, if:
(i) the patient is an injured worker; and
(ii) the Schedule II or III controlled substance is prescribed for chronic pain.
Section 6. Section 
58-31d-103
 is amended to read:
58-31d-103.
Rulemaking authority -- Enabling provisions.
(1) The division may adopt rules necessary to implement Section 
58-31d-102
.
(2) As used in Article VIII (1) of the Advanced Practice Registered Nurse Compact,
"head of the licensing board" means the executive administrator of the Utah Board of Nursing.
(3) For purposes of the Advanced Practice Registered Nurse Compact, "APRN" as
defined in Article II (1) of the compact includes an individual who is:
(a) licensed to practice under Subsection 
58-31b-301
(2) as an advanced practice
registered nurse; or
(b) licensed to practice under Section 
58-44a-301
 as a certified nurse midwife.
(4) An APRN practicing in this state under a multistate licensure privilege may only be
granted prescriptive authority if that individual can document completion of graduate level
course work in the following areas:
(a) advanced health assessment;
(b) pharmacotherapeutics; and
(c) diagnosis and treatment.
(5) (a) An APRN practicing in this state under a multistate privilege who seeks to
obtain prescriptive authority must:
(i) meet all the requirements of Subsection (4) and this Subsection (5); and
(ii) be placed on a registry with the division.
(b) To be placed on a registry under Subsection (5)(a)(ii), an APRN must:
(i) submit a form prescribed by the division;
(ii) pay a fee; and
(iii) if prescribing a controlled substance:
(A) obtain a controlled substance license as required under Section 
58-37-6
; and
(B) [
if prescribing
] 
that is
 a Schedule II [
or III
] controlled substance, [
have a
consultation and referral plan with a physician licensed in Utah as required under Subsection
58-31b-102
(13)(c)(iii) or 
58-44a-102
(9)(c)(iii)(C)
] 
comply with the requirements of Section
58-31b-803
.