Revise the practice of certified registered nurse anesthetists

(136th General Assembly)

(Substitute
House Bill Number 52)

AN
ACT

To amend sections 4723.01,
4723.43, 4723.432, 4729.01, 4731.27, 4731.35, and 4761.17; to enact
new sections 4723.433 and 4723.434 and section 4731.513; and to
repeal sections 4723.433, 4723.434, and 4723.435 of the Revised Code
to revise the law governing the practice of certified registered
nurse anesthetists.

Be
it enacted by the General Assembly of the State of Ohio:

Section
1.
That
sections 4723.01, 4723.43, 4723.432, 4729.01, 4731.27, 4731.35, and
4761.17 be amended and new
sections

4723.433

and 4723.434

and section 4731.513 of the Revised Code be enacted to read as
follows:

Sec.
4723.01.
As
used in this chapter:

(A)
"Registered nurse" means an individual who holds a current,
valid license issued under this chapter that authorizes the practice
of nursing as a registered nurse.

(B)
"Practice of nursing as a registered nurse" means providing
to individuals and groups nursing care requiring specialized
knowledge, judgment, and skill derived from the principles of
biological, physical, behavioral, social, and nursing sciences. Such
nursing care includes:

(1)
Identifying patterns of human responses to actual or potential health
problems amenable to a nursing regimen;

(2)
Executing a nursing regimen through the selection, performance,
management, and evaluation of nursing actions;

(3)
Assessing health status for the purpose of providing nursing care;

(4)
Providing health counseling and health teaching;

(5)
Administering medications, treatments, and executing regimens
authorized by an individual who is authorized to practice in this
state and is acting within the course of the individual's
professional practice;

(6)
Teaching, administering, supervising, delegating, and evaluating
nursing practice.

(C)
"Nursing regimen" may include preventative, restorative,
and health-promotion activities.

(D)
"Assessing health status" means the collection of data
through nursing assessment techniques, which may include interviews,
observation, and physical evaluations for the purpose of providing
nursing care.

(E)
"Licensed practical nurse" means an individual who holds a
current, valid license issued under this chapter that authorizes the
practice of nursing as a licensed practical nurse.

(F)
"The practice of nursing as a licensed practical nurse"
means providing to individuals and groups nursing care requiring the
application of basic knowledge of the biological, physical,
behavioral, social, and nursing sciences at the direction of a
registered nurse or any of the following who is authorized to
practice in this state: a physician, physician assistant, dentist,
podiatrist, optometrist, or chiropractor. Such nursing care includes:

(1)
Observation, patient teaching, and care in a diversity of health care
settings;

(2)
Contributions to the planning, implementation, and evaluation of
nursing;

(3)
Administration of medications and treatments authorized by an
individual who is authorized to practice in this state and is acting
within the course of the individual's professional practice;

(4)
Administration to an adult of intravenous therapy authorized by an
individual who is authorized to practice in this state and is acting
within the course of the individual's professional practice, on the
condition that the licensed practical nurse is authorized under
section 4723.18 or 4723.181 of the Revised Code to perform
intravenous therapy and performs intravenous therapy only in
accordance with those sections;

(5)
Delegation of nursing tasks as directed by a registered nurse;

(6)
Teaching nursing tasks to licensed practical nurses and individuals
to whom the licensed practical nurse is authorized to delegate
nursing tasks as directed by a registered nurse.

(G)
"Certified registered nurse anesthetist" means an advanced
practice registered nurse who holds a current, valid license issued
under this chapter and is designated as a certified registered nurse
anesthetist in accordance with section 4723.42 of the Revised Code
and rules adopted by the board of nursing.

(H)
"Clinical nurse specialist" means an advanced practice
registered nurse who holds a current, valid license issued under this
chapter and is designated as a clinical nurse specialist in
accordance with section 4723.42 of the Revised Code and rules adopted
by the board of nursing.

(I)
"Certified nurse-midwife" means an advanced practice
registered nurse who holds a current, valid license issued under this
chapter and is designated as a certified nurse-midwife in accordance
with section 4723.42 of the Revised Code and rules adopted by the
board of nursing.

(J)
"Certified nurse practitioner" means an advanced practice
registered nurse who holds a current, valid license issued under this
chapter and is designated as a certified nurse practitioner in
accordance with section 4723.42 of the Revised Code and rules adopted
by the board of nursing.

(K)
"Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.

(L)
"Collaboration" or "collaborating" means the
following:

(1)
In the case of a clinical nurse specialist or a certified nurse
practitioner, that one or more podiatrists acting within the scope of
practice of podiatry in accordance with section 4731.51 of the
Revised Code and with whom the nurse has entered into a standard care
arrangement or one or more physicians with whom the nurse has entered
into a standard care arrangement are continuously available to
communicate with the clinical nurse specialist or certified nurse
practitioner either in person or by electronic communication;

(2)
In the case of a certified nurse-midwife, that one or more physicians
with whom the certified nurse-midwife has entered into a standard
care arrangement are continuously available to communicate with the
certified nurse-midwife either in person or by electronic
communication
;

(3)
In the case of a certified registered nurse anesthetist, that a
dentist who holds a conscious sedation or general anesthesia permit
issued under Chapter 4715. of the Revised Code, physician, or
podiatrist requests, either verbally or in writing, the nurse to
perform patient care activities authorized by division (D) of section
4723.43 of the Revised Code and the request is made in accordance
with policies established by the health care facility where the nurse
and the dentist, physician, or podiatrist practice
.

For
purposes of this division, division (D) of section 4723.43 of the
Revised Code, and sections 4723.433 and 4723.434 of the Revised Code,
"health care facility" means an ambulatory surgical
facility, cardiovascular or vascular center, freestanding birthing
center, hospital, or office of a dentist, physician, or podiatrist.

(M)

"Supervision,"
as it pertains to a certified registered nurse anesthetist, means
that the certified registered nurse anesthetist is under the
direction of a podiatrist acting within the podiatrist's scope of
practice in accordance with section 4731.51 of the Revised Code, a
dentist acting within the dentist's scope of practice in accordance
with Chapter 4715. of the Revised Code, or a physician, and, when
administering anesthesia, the certified registered nurse anesthetist
is in the immediate presence of the podiatrist, dentist, or
physician.

(N)

"Standard
care arrangement" means a written, formal guide for planning and
evaluating a patient's health care that is developed by one or more
collaborating physicians or podiatrists and a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
and meets the requirements of section 4723.431 of the Revised Code.

(O)
(N)

"Advanced practice registered nurse" means an individual
who holds a current, valid license issued under this chapter that
authorizes the practice of nursing as an advanced practice registered
nurse and is designated as any of the following:

(1)
A certified registered nurse anesthetist;

(2)
A clinical nurse specialist;

(3)
A certified nurse-midwife;

(4)
A certified nurse practitioner.

(P)
(O)

"Practice of nursing as an advanced practice registered nurse"
means providing to individuals and groups nursing care that requires
knowledge and skill obtained from advanced formal education,
training, and clinical experience. Such nursing care includes the
care described in section 4723.43 of the Revised Code.

(Q)
(P)

"Dialysis care" means the care and procedures that a
dialysis technician or dialysis technician intern is authorized to
provide and perform, as specified in section 4723.72 of the Revised
Code.

(R)
(Q)

"Dialysis technician" means an individual who holds a
current, valid certificate to practice as a dialysis technician
issued under section 4723.75 of the Revised Code.

(S)
(R)

"Dialysis technician intern" means an individual who has
not passed the dialysis technician certification examination required
by section 4723.751 of the Revised Code, but who has successfully
completed a dialysis training program approved by the board of
nursing under section 4723.74 of the Revised Code within the previous
eighteen months.

(T)
(S)

"Certified community health worker" means an individual who
holds a current, valid certificate as a community health worker
issued under section 4723.85 of the Revised Code.

(U)
(T)

"Medication aide" means an individual who holds a current,
valid certificate issued under this chapter that authorizes the
individual to administer medication in accordance with section
4723.67 of the Revised Code
;
.

(V)
(U)

"Nursing specialty" means a specialty in practice as a
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner.

(W)
(V)

"Physician assistant" means an individual who is licensed
to practice as a physician assistant under Chapter 4730. of the
Revised Code.

(W)
"Podiatrist" means an individual authorized under Chapter
4731. of the Revised Code to practice podiatric medicine and surgery.

(X)
"Dentist" means an individual who is licensed to practice
dentistry under Chapter 4715. of the Revised Code.

Sec.
4723.43.
A

certified
registered nurse anesthetist, clinical nurse specialist,
certified
nurse-midwife,
or

certified
nurse practitioner
,
clinical nurse specialist, or certified registered nurse anesthetist

may provide to individuals and groups nursing care that requires
knowledge and skill obtained from advanced formal education and
clinical experience. In this capacity as an advanced practice
registered nurse, a certified nurse-midwife is subject to division
(A) of this section,
a
certified registered nurse anesthetist is subject to division (B) of
this section,
a
certified nurse practitioner is subject to division
(C)

(B)

of
this section,
and

a
clinical nurse specialist is subject to division
(D)

(C)

of
this section
,
and a certified registered nurse anesthetist is subject to division
(D) of this section and section 4723.433 of the Revised Code
.

(A)
A
nurse
authorized to practice as a
certified
nurse-midwife, in collaboration with one or more physicians, may
provide the management of preventive services and those primary care
services necessary to provide health care to women antepartally,
intrapartally, postpartally, and gynecologically, consistent with the
nurse's education and certification, and in accordance with rules
adopted by the board of nursing.

No
certified nurse-midwife may perform version, deliver breech or face
presentation, use forceps, do any obstetric operation, or treat any
other abnormal condition, except in emergencies. Division (A) of this
section does not prohibit a certified nurse-midwife from performing
episiotomies or normal vaginal deliveries, or repairing vaginal
tears. A certified nurse-midwife may, in collaboration with one or
more physicians, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.

(B)

A
nurse authorized to practice as a certified registered nurse
anesthetist, consistent with the nurse's education and certification
and in accordance with rules adopted by the board, may do the
following:

(1)
With supervision and in the immediate presence of a physician,
podiatrist, or dentist, administer anesthesia and perform anesthesia
induction, maintenance, and emergence;

(2)
With supervision, obtain informed consent for anesthesia care and
perform preanesthetic preparation and evaluation, postanesthetic
preparation and evaluation, postanesthesia care, and, subject to
section 4723.433 of the Revised Code, clinical support functions;

(3)
With supervision and in accordance with section 4723.434 of the
Revised Code, engage in the activities described in division (A) of
that section.

The
physician, podiatrist, or dentist supervising a certified registered
nurse anesthetist must be actively engaged in practice in this state.
When a certified registered nurse anesthetist is supervised by a
podiatrist, the nurse's scope of practice is limited to the
anesthesia procedures that the podiatrist has the authority under
section 4731.51 of the Revised Code to perform. A certified
registered nurse anesthetist may not administer general anesthesia
under the supervision of a podiatrist in a podiatrist's office. When
a certified registered nurse anesthetist is supervised by a dentist,
the nurse's scope of practice is limited to the anesthesia procedures
that the dentist has the authority under Chapter 4715. of the Revised
Code to perform.

(C)

A

nurse
authorized to practice as a
certified
nurse practitioner, in collaboration with one or more physicians or
podiatrists, may provide preventive and primary care services,
provide services for acute illnesses, and evaluate and promote
patient wellness within the nurse's nursing specialty, consistent
with the nurse's education and certification, and in accordance with
rules adopted by the board

of nursing
.
A certified nurse practitioner may, in collaboration with one or more
physicians or podiatrists, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.

When
a certified nurse practitioner is collaborating with a podiatrist,
the nurse's scope of practice is limited to the procedures that the
podiatrist has the authority under section 4731.51 of the Revised
Code to perform.

(D)

(C)

A

nurse
authorized to practice as a
clinical
nurse specialist, in collaboration with one or more physicians or
podiatrists, may provide and manage the care of individuals and
groups with complex health problems and provide health care services
that promote, improve, and manage health care within the nurse's
nursing specialty, consistent with the nurse's education and in
accordance with rules adopted by the board

of nursing
.
A clinical nurse specialist may, in collaboration with one or more
physicians or podiatrists, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.

When
a clinical nurse specialist is collaborating with a podiatrist, the
nurse's scope of practice is limited to the procedures that the
podiatrist has the authority under section 4731.51 of the Revised
Code to perform.

(D)
A certified registered nurse anesthetist, in collaboration with a
physician, podiatrist, or dentist actively engaged in practice in
this state, and with a verbal or written request consistent with
division (L) of section 4723.01 of the Revised Code, may perform the
following patient care activities, in accordance with the nurse's
education and certification, rules adopted by the board of nursing,
and policies established and privileges delineated by the health care
facility where the nurse and collaborating physician, podiatrist, or
dentist practice:

(1)
Obtaining informed consent for anesthesia care and performing
preanesthetic preparation and evaluation;

(2)
Administering anesthesia, by performing anesthesia induction,
maintenance, and emergence;

(3)
Performing epidural or spinal anesthetic procedures;

(4)
Performing postanesthetic preparation and evaluation and providing
postanesthesia care;

(5)
Performing clinical support functions;

(6)
As necessary for patient management and care, selecting, ordering,
and administering treatments, drugs, and intravenous fluids for
conditions related to either the administration of anesthesia or the
performance of clinical support functions;

(7)
Performing and documenting evaluations and assessments, which may
include ordering and evaluating one or more diagnostic tests for
conditions related to the administration of anesthesia or the
performance of clinical support functions;

(8)
Directing a registered nurse, licensed practical nurse, or
respiratory therapist to do the following, but only if the nurse or
therapist is authorized by law to do so:

(a)
Provide supportive care, with such care to include monitoring vital
signs, conducting electrocardiograms, and administering intravenous
fluids;

(b)
Administer treatments, drugs, and intravenous fluids for conditions
related to either the administration of anesthesia or the performance
of clinical support functions.

When
a certified registered nurse anesthetist collaborates with a dentist,
the nurse's scope of practice is limited to the anesthesia procedures
that the dentist has the authority to perform under the dentist's
conscious sedation or general anesthesia permit issued under Chapter
4715. of the Revised Code.

A
certified registered nurse anesthetist may perform the induction,
maintenance, and emergence of general anesthesia only if the
collaborating physician, podiatrist, or dentist is present at the
health care facility during such induction, maintenance, and
emergence.

A
certified registered nurse anesthetist shall not prescribe a drug for
use outside of the health care facility where the nurse practices.

Sec.
4723.432.
(A)
An advanced practice registered nurse who is designated as a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner shall cooperate with the state medical board in any
investigation the board conducts with respect to a physician or
podiatrist who collaborates with the nurse. The nurse shall cooperate
with the board in any investigation the board conducts with respect
to the unauthorized practice of medicine by the nurse.

(B)
An advanced practice registered nurse who is designated as a
certified registered nurse anesthetist shall cooperate with the state
medical board or state dental board in any investigation
either
board conducts
conducted
by such board
with
respect to a
collaborating

physician,
podiatrist, or dentist who
permits

requests
that
the
nurse
to
practice with the supervision of that physician, podiatrist, or
dentist
perform
patient care activities as described in division (D) of section
4723.43 of the Revised Code
.

The

The

nurse

also

shall
cooperate with either
the
state medical board or state dental
board
in any investigation it conducts with respect to the unauthorized
practice of medicine or dentistry by the nurse.

Sec.
4723.433.
(A)
A certified registered nurse anesthetist shall not engage in one or
more of the patient care activities described in division (D) of
section 4723.43 of the Revised Code if either of the following
determines that it is not in the patient's best interest for the
nurse to perform such an activity or activities:

(1)
The nurse's collaborating physician, podiatrist, or dentist;

(2)
The health care facility where the nurse and physician, podiatrist,
or dentist practice.

If
a collaborating physician, podiatrist, or dentist or health care
facility makes such a determination, the patient's medical or
electronic health record shall indicate that the nurse is prohibited
from performing the activity or activities.

(B)
If a certified registered nurse anesthetist performs one or more of
the activities described in division (D) of section 4723.43 of the
Revised Code, the nurse shall so indicate in the patient's medical or
electronic health record.

(C)
This section does not prohibit a certified registered nurse
anesthetist from implementing a verbal order issued by a
collaborating physician, podiatrist, or dentist.

Sec.
4723.434.
(A)
Prior to administering anesthesia to a patient or performing an
epidural or spinal anesthetic procedure for a patient in a health
care facility, the health care facility shall notify the patient or
patient's representative, both verbally and in writing, that a
certified registered nurse anesthetist, physician, podiatrist, or
dentist will administer the patient's anesthesia or perform the
patient's epidural or spinal anesthetic procedure.

(B)
Division (A) of this section does not authorize either of the
following:

(1)
A dentist to administer anesthesia in a manner that exceeds the
dentist's authority under a conscious sedation or general anesthesia
permit issued under Chapter 4715. of the Revised Code;

(2)
A podiatrist to administer anesthesia in a manner that exceeds the
podiatrist's scope of practice as described in section 4731.51 of the
Revised Code.

Sec.
4729.01.
As
used in this chapter:

(A)
"Pharmacy," except when used in a context that refers to
the practice of pharmacy, means any area, room, rooms, place of
business, department, or portion of any of the foregoing where the
practice of pharmacy is conducted.

(B)
"Practice of pharmacy" means providing pharmacist care
requiring specialized knowledge, judgment, and skill derived from the
principles of biological, chemical, behavioral, social,
pharmaceutical, and clinical sciences. As used in this division,
"pharmacist care" includes the following:

(1)
Interpreting prescriptions;

(2)
Dispensing drugs and drug therapy related devices;

(3)
Compounding drugs;

(4)
Counseling individuals with regard to their drug therapy,
recommending drug therapy related devices, and assisting in the
selection of drugs and appliances for treatment of common diseases
and injuries and providing instruction in the proper use of the drugs
and appliances;

(5)
Performing drug regimen reviews with individuals by discussing all of
the drugs that the individual is taking and explaining the
interactions of the drugs;

(6)
Performing drug utilization reviews with licensed health
professionals authorized to prescribe drugs when the pharmacist
determines that an individual with a prescription has a drug regimen
that warrants additional discussion with the prescriber;

(7)
Advising an individual and the health care professionals treating an
individual with regard to the individual's drug therapy;

(8)
Acting pursuant to a consult agreement, if an agreement has been
established;

(9)
Engaging in the administration of immunizations to the extent
authorized by section 4729.41 of the Revised Code;

(10)
Engaging in the administration of drugs to the extent authorized by
section 4729.45 of the Revised Code.

(C)
"Compounding" means the preparation, mixing, assembling,
packaging, and labeling of one or more drugs in any of the following
circumstances:

(1)
Pursuant to a prescription issued by a licensed health professional
authorized to prescribe drugs;

(2)
Pursuant to the modification of a prescription made in accordance
with a consult agreement;

(3)
As an incident to research, teaching activities, or chemical
analysis;

(4)
In anticipation of orders for drugs pursuant to prescriptions, based
on routine, regularly observed dispensing patterns;

(5)
Pursuant to a request made by a licensed health professional
authorized to prescribe drugs for a drug that is to be used by the
professional for the purpose of direct administration to patients in
the course of the professional's practice, if all of the following
apply:

(a)
At the time the request is made, the drug is not commercially
available regardless of the reason that the drug is not available,
including the absence of a manufacturer for the drug or the lack of a
readily available supply of the drug from a manufacturer.

(b)
A limited quantity of the drug is compounded and provided to the
professional.

(c)
The drug is compounded and provided to the professional as an
occasional exception to the normal practice of dispensing drugs
pursuant to patient-specific prescriptions.

(D)
"Consult agreement" means an agreement that has been
entered into under section 4729.39 of the Revised Code.

(E)
"Drug" means:

(1)
Any article recognized in the United States pharmacopoeia and
national formulary, or any supplement to them, intended for use in
the diagnosis, cure, mitigation, treatment, or prevention of disease
in humans or animals;

(2)
Any other article intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease in humans or animals;

(3)
Any article, other than food, intended to affect the structure or any
function of the body of humans or animals;

(4)
Any article intended for use as a component of any article specified
in division (E)(1), (2), or (3) of this section; but does not include
devices or their components, parts, or accessories.

"Drug"
does not include "hemp" or a "hemp product" as
those terms are defined in section 928.01 of the Revised Code.

(F)
"Dangerous drug" means any of the following:

(1)
Any drug to which either of the following applies:

(a)
Under the "Federal Food, Drug, and Cosmetic Act," 52 Stat.
1040 (1938), 21 U.S.C.A. 301, as amended, the drug is required to
bear a label containing the legend "Caution: Federal law
prohibits dispensing without prescription" or "Caution:
Federal law restricts this drug to use by or on the order of a
licensed veterinarian" or any similar restrictive statement, or
the drug may be dispensed only upon a prescription;

(b)
Under Chapter 3715. or 3719. of the Revised Code, the drug may be
dispensed only upon a prescription.

(2)
Any drug that contains a schedule V controlled substance and that is
exempt from Chapter 3719. of the Revised Code or to which that
chapter does not apply;

(3)
Any drug intended for administration by injection into the human body
other than through a natural orifice of the human body;

(4)
Any drug that is a biological product, as defined in section 3715.01
of the Revised Code.

(G)
"Federal drug abuse control laws" has the same meaning as
in section 3719.01 of the Revised Code.

(H)
"Prescription" means all of the following:

(1)
A written, electronic, or oral order for drugs or combinations or
mixtures of drugs to be used by a particular individual or for
treating a particular animal, issued by a licensed health
professional authorized to prescribe drugs;

(2)
For purposes of sections 4723.4810, 4729.282, 4730.432, and 4731.93
of the Revised Code, a written, electronic, or oral order for a drug
to treat chlamydia, gonorrhea, or trichomoniasis issued to and in the
name of a patient who is not the intended user of the drug but is the
sexual partner of the intended user;

(3)
For purposes of sections 3313.7110, 3313.7111, 3314.143, 3326.28,
3328.29, 4723.483, 4729.88, 4730.433, 4731.96, and 5101.76 of the
Revised Code, a written, electronic, or oral order for an epinephrine
autoinjector issued to and in the name of a school, school district,
or camp;

(4)
For purposes of Chapter 3728. and sections 4723.483, 4729.88,
4730.433, and 4731.96 of the Revised Code, a written, electronic, or
oral order for an epinephrine autoinjector issued to and in the name
of a qualified entity, as defined in section 3728.01 of the Revised
Code;

(5)
For purposes of sections 3313.7115, 3313.7116, 3314.147, 3326.60,
3328.38, 4723.4811, 4730.437, 4731.92, and 5101.78 of the Revised
Code, a written, electronic, or oral order for injectable or nasally
administered glucagon in the name of a school, school district, or
camp.

(I)
"Licensed health professional authorized to prescribe drugs"
or "prescriber" means an individual who is authorized by
law to prescribe drugs or dangerous drugs or drug therapy related
devices in the course of the individual's professional practice,
including only the following:

(1)
A dentist licensed under Chapter 4715. of the Revised Code;

(2)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who holds a current, valid license issued under
Chapter 4723. of the Revised Code to practice nursing as an advanced
practice registered nurse;

(3)
A certified registered nurse anesthetist who holds a current, valid
license issued under Chapter 4723. of the Revised Code to practice
nursing as an advanced practice registered nurse, but only to the
extent of the nurse's authority under
sections

section

4723.43

and
4723.434
of
the Revised Code;

(4)
An optometrist licensed under Chapter 4725. of the Revised Code to
practice optometry;

(5)
A physician authorized under Chapter 4731. of the Revised Code to
practice medicine and surgery, osteopathic medicine and surgery, or
podiatric medicine and surgery;

(6)
A physician assistant who holds a license to practice as a physician
assistant issued under Chapter 4730. of the Revised Code, holds a
valid prescriber number issued by the state medical board, and has
been granted physician-delegated prescriptive authority;

(7)
A veterinarian licensed under Chapter 4741. of the Revised Code;

(8)
A certified mental health assistant licensed under Chapter 4772. of
the Revised Code who has been granted physician-delegated
prescriptive authority by the physician supervising the certified
mental health assistant.

(J)
"Sale" or "sell" includes any transaction made by
any person, whether as principal proprietor, agent, or employee, to
do or offer to do any of the following: deliver, distribute, broker,
exchange, gift or otherwise give away, or transfer, whether the
transfer is by passage of title, physical movement, or both.

(K)
"Wholesale sale" and "sale at wholesale" mean any
sale in which the purpose of the purchaser is to resell the article
purchased or received by the purchaser.

(L)
"Retail sale" and "sale at retail" mean any sale
other than a wholesale sale or sale at wholesale.

(M)
"Retail seller" means any person that sells any dangerous
drug to consumers without assuming control over and responsibility
for its administration. Mere advice or instructions regarding
administration do not constitute control or establish responsibility.

(N)
"Price information" means the price charged for a
prescription for a particular drug product and, in an easily
understandable manner, all of the following:

(1)
The proprietary name of the drug product;

(2)
The established (generic) name of the drug product;

(3)
The strength of the drug product if the product contains a single
active ingredient or if the drug product contains more than one
active ingredient and a relevant strength can be associated with the
product without indicating each active ingredient. The established
name and quantity of each active ingredient are required if such a
relevant strength cannot be so associated with a drug product
containing more than one ingredient.

(4)
The dosage form;

(5)
The price charged for a specific quantity of the drug product. The
stated price shall include all charges to the consumer, including,
but not limited to, the cost of the drug product, professional fees,
handling fees, if any, and a statement identifying professional
services routinely furnished by the pharmacy. Any mailing fees and
delivery fees may be stated separately without repetition. The
information shall not be false or misleading.

(O)
"Wholesale distributor of dangerous drugs" or "wholesale
distributor" means a person engaged in the sale of dangerous
drugs at wholesale and includes any agent or employee of such a
person authorized by the person to engage in the sale of dangerous
drugs at wholesale.

(P)
"Manufacturer of dangerous drugs" or "manufacturer"
means a person, other than a pharmacist or prescriber, who
manufactures dangerous drugs and who is engaged in the sale of those
dangerous drugs.

(Q)
"Terminal distributor of dangerous drugs" or "terminal
distributor" means a person who is engaged in the sale of
dangerous drugs at retail, or any person, other than a manufacturer,
repackager, outsourcing facility, third-party logistics provider,
wholesale distributor, or pharmacist, who has possession, custody, or
control of dangerous drugs for any purpose other than for that
person's own use and consumption. "Terminal distributor"
includes pharmacies, hospitals, nursing homes, and laboratories and
all other persons who procure dangerous drugs for sale or other
distribution by or under the supervision of a pharmacist, licensed
health professional authorized to prescribe drugs, or other person
authorized by the state board of pharmacy.

(R)
"Promote to the public" means disseminating a
representation to the public in any manner or by any means, other
than by labeling, for the purpose of inducing, or that is likely to
induce, directly or indirectly, the purchase of a dangerous drug at
retail.

(S)
"Person" includes any individual, partnership, association,
limited liability company, or corporation, the state, any political
subdivision of the state, and any district, department, or agency of
the state or its political subdivisions.

(T)(1)
"Animal shelter" means a facility operated by a humane
society or any society organized under Chapter 1717. of the Revised
Code or a dog pound operated pursuant to Chapter 955. of the Revised
Code.

(2)
"County dog warden" means a dog warden or deputy dog warden
appointed or employed under section 955.12 of the Revised Code.

(U)
"Food" has the same meaning as in section 3715.01 of the
Revised Code.

(V)
"Pain management clinic" has the same meaning as in section
4731.054 of the Revised Code.

(W)
"Investigational drug or product" means a drug or product
that has successfully completed phase one of the United States food
and drug administration clinical trials and remains under clinical
trial, but has not been approved for general use by the United States
food and drug administration. "Investigational drug or product"
does not include controlled substances in schedule I, as defined in
section 3719.01 of the Revised Code.

(X)
"Product," when used in reference to an investigational
drug or product, means a biological product, other than a drug, that
is made from a natural human, animal, or microorganism source and is
intended to treat a disease or medical condition.

(Y)
"Third-party logistics provider" means a person that
provides or coordinates warehousing or other logistics services
pertaining to dangerous drugs including distribution, on behalf of a
manufacturer, wholesale distributor, or terminal distributor of
dangerous drugs, but does not take ownership of the drugs or have
responsibility to direct the sale or disposition of the drugs.

(Z)
"Repackager of dangerous drugs" or "repackager"
means a person that repacks and relabels dangerous drugs for sale or
distribution.

(AA)
"Outsourcing facility" means a facility that is engaged in
the compounding and sale of sterile drugs and is registered as an
outsourcing facility with the United States food and drug
administration.

(BB)
"Laboratory" means a laboratory licensed under this chapter
as a terminal distributor of dangerous drugs and entrusted to have
custody of any of the following drugs and to use the drugs for
scientific and clinical purposes and for purposes of instruction:
dangerous drugs that are not controlled substances, as defined in
section 3719.01 of the Revised Code; dangerous drugs that are
controlled substances, as defined in that section; and controlled
substances in schedule I, as defined in that section.

(CC)
"Overdose reversal drug" means both of the following:

(1)
Naloxone;

(2)
Any other drug that the state board of pharmacy, through rules
adopted in accordance with Chapter 119. of the Revised Code,
designates as a drug that is approved by the federal food and drug
administration for the reversal of a known or suspected
opioid-related overdose.

Sec.
4731.27.
(A)
As used in this section, "collaboration," "physician,"

and

"standard
care arrangement
,
"

and
"supervision"
have
the same meanings as in section 4723.01 of the Revised Code.

(B)
A physician or podiatrist shall enter into a standard care
arrangement with each clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner with whom the
physician or podiatrist is in collaboration.

The
collaborating physician or podiatrist shall fulfill the
responsibilities of collaboration, as specified in the arrangement
and in accordance with division (A) of section 4723.431 of the
Revised Code. A copy of the standard care arrangement shall be
retained on file by the nurse's employer. Prior approval of the
standard care arrangement by the state medical board is not required,
but the board may periodically review it.

A
physician or podiatrist who terminates collaboration with a certified
nurse-midwife, certified nurse practitioner, or clinical nurse
specialist before their standard care arrangement expires shall give
the nurse the written or electronic notice of termination required by
division (D)(1) of section 4723.431 of the Revised Code.

Nothing
in this division prohibits a hospital from hiring a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
as an employee and negotiating standard care arrangements on behalf
of the employee as necessary to meet the requirements of this
section. A standard care arrangement between the hospital's employee
and the employee's collaborating physician is subject to approval by
the medical staff and governing body of the hospital prior to
implementation of the arrangement at the hospital.

(C)
A physician or podiatrist shall cooperate with the board of nursing
in any investigation the board conducts with respect to a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner who collaborates with the physician or podiatrist or
with respect to a certified registered nurse anesthetist who
practices
in
collaboration
with
the
supervision
of the
physician
or podiatrist.

Sec.
4731.35.
(A)
This chapter does not apply to or prohibit in any way
the
administration of anesthesia by a certified registered nurse
anesthetist under the direction of and in the immediate presence of
an individual authorized by this chapter to practice medicine and
surgery, osteopathic medicine and surgery, or podiatric medicine and
surgery
an
individual from practicing as a certified registered nurse
anesthetist in accordance with Chapter 4723. of the Revised Code
.

(B)
This chapter does not prohibit an individual from practicing as an
anesthesiologist assistant in accordance with Chapter 4760. of the
Revised Code.

Sec.
4731.513.
In
administering and enforcing sections 4731.51 to 4731.61 of the
Revised Code and in adopting rules under section 4731.05 of the
Revised Code, the state medical board shall not prohibit a podiatrist
who practices other than in a hospital or college of podiatric
medicine and surgery as described in section 4731.51 of the Revised
Code from collaborating with a certified registered nurse
anesthetist.

For
purposes of this section, "certified registered nurse
anesthetist" and "collaborating" have the same
meanings as in section 4723.01 of the Revised Code.

Sec.
4761.17.
All
of the following apply to the practice of respiratory care by a
person who holds a license or limited permit issued under this
chapter:

(A)
The person shall practice only pursuant to a prescription or other
order for respiratory care issued by any of the following:

(1)
A physician;

(2)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who holds a current, valid license issued under
Chapter 4723. of the Revised Code to practice nursing as an advanced
practice registered nurse and has entered into a standard care
arrangement with a physician;

(3)
A certified registered nurse anesthetist who holds a current, valid
license issued under Chapter 4723. of the Revised Code to practice
nursing as an advanced practice registered nurse and acts in
compliance with
sections

section

4723.43
,
4723.433, and 4723.434

of the Revised Code;

(4)
A physician assistant who holds a valid prescriber number issued by
the state medical board, has been granted physician-delegated
prescriptive authority, and has entered into a supervision agreement
that allows the physician assistant to prescribe or order respiratory
care services.

(B)
The person shall practice only under the supervision of any of the
following:

(1)
A physician;

(2)
A certified nurse practitioner, certified nurse-midwife, or clinical
nurse specialist;

(3)
A physician assistant who is authorized to prescribe or order
respiratory care services as provided in division (A)(4) of this
section.

(C)(1)
When practicing under the prescription or order of a certified nurse
practitioner, certified nurse midwife, or clinical nurse specialist
or under the supervision of such a nurse, the person's administration
of medication that requires a prescription is limited to the drugs
that the nurse is authorized to prescribe pursuant to section
4723.481 of the Revised Code.

(2)
When practicing under the order of a certified registered nurse
anesthetist, the person's administration of medication is limited to
the drugs that the nurse is authorized to order or direct the person
to administer, as provided in
sections

section

4723.43
,
4723.433, and 4723.434

of the Revised Code.

(3)
When practicing under the prescription or order of a physician
assistant or under the supervision of a physician assistant, the
person's administration of medication that requires a prescription is
limited to the drugs that the physician assistant is authorized to
prescribe pursuant to the physician assistant's physician-delegated
prescriptive authority.

Section
2.
That
existing sections 4723.01, 4723.43, 4723.432, 4729.01, 4731.27,
4731.35, and 4761.17 of the Revised Code are hereby repealed.

Section
3.
That
sections 4723.433, 4723.434, and 4723.435 of the Revised Code are
hereby repealed.

Speaker
___________________ of the House of Representatives.

President
___________________ of the Senate.

Passed
________________________, 20____

Approved
________________________, 20____

Governor.

The section numbering of law
of a general and permanent nature is complete and in conformity with
the Revised Code.

Director, Legislative
Service Commission.

Filed
in the office of the Secretary of State at Columbus, Ohio, on the
____ day of ___________, A. D. 20____.

Secretary of State.

File
No. _________ Effective Date ___________________