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As Introduced
136th
General Assembly
Regular
Session
H. B. No. 537
2025-2026
Representatives McClain, Miller, M.
Cosponsors: Representatives Fowler
Arthur, Gross, Klopfenstein, Newman
To
amend sections 3701.351, 3702.30, 4723.01, 4723.02, 4723.03, 4723.06,
4723.07, 4723.08, 4723.271, 4723.28, 4723.282, 4723.33, 4723.34,
4723.341, 4723.35, 4723.41, 4723.43, 4723.431, 4723.432, 4723.481,
4723.483, 4723.487, 4723.488, 4723.4810, 4723.4811, 4723.50, 4723.91,
4723.99, 4731.22, and 4731.27 and to enact sections 5.2324
,
3722.15
,
4723.53, 4723.54, 4723.55, 4723.551, 4723.56, 4723.57, 4723.58,
4723.581, 4723.582, 4723.583, 4723.584, 4723.59, 4723.60, 4724.01,
4724.02, 4724.03, 4724.04, 4724.05, 4724.06, 4724.07, 4724.08,
4724.09, 4724.10, 4724.11, 4724.12, 4724.13, 4724.14, 4724.15,
4724.16, and 4724.99 of the Revised Code
to
regulate the practice of midwifery, to establish requirements for
freestanding birthing centers, and to designate May 5th as the "Day
of the Midwife."
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 3701.351, 3702.30, 4723.01, 4723.02, 4723.03, 4723.06,
4723.07, 4723.08, 4723.271, 4723.28, 4723.282, 4723.33, 4723.34,
4723.341, 4723.35, 4723.41, 4723.43, 4723.431, 4723.432, 4723.481,
4723.483, 4723.487, 4723.488, 4723.4810, 4723.4811, 4723.50, 4723.91,
4723.99, 4731.22, and 4731.27 be amended and sections 5.2324
,
3722.15
,
4723.53, 4723.54, 4723.55, 4723.551, 4723.56, 4723.57, 4723.58,
4723.581, 4723.582, 4723.583, 4723.584, 4723.59, 4723.60, 4724.01,
4724.02, 4724.03, 4724.04, 4724.05, 4724.06, 4724.07, 4724.08,
4724.09, 4724.10, 4724.11, 4724.12, 4724.13, 4724.14, 4724.15,
4724.16, and 4724.99 of the Revised Code be enacted to read as
follows:
Sec.
5.2324.
The
fifth day of May is designated as the "Day of the Midwife."
Sec.
3701.351.
(A)
The governing body of every hospital shall set standards and
procedures to be applied by the hospital and its medical staff in
considering and acting upon applications for staff membership or
professional privileges. These standards and procedures shall be
available for public inspection.
(B)
The governing body of any hospital, in considering and acting upon
applications for staff membership or professional privileges within
the scope of the applicants' respective licensures, shall not
discriminate against a qualified person solely on the basis of
whether that person is licensed to practice medicine, osteopathic
medicine, or podiatry, is licensed to practice dentistry or
psychology,
or
is
licensed to practice nursing as an advanced practice registered
nurse
,
or is licensed to practice as a certified midwife or licensed
midwife
.
Staff membership or professional privileges shall be considered and
acted on in accordance with standards and procedures established
under division (A) of this section. This section does not permit a
psychologist to admit a patient to a hospital in violation of section
3727.06 of the Revised Code.
(C)
The governing body of any hospital that provides maternity services,
in considering and acting upon applications for clinical privileges,
shall not discriminate against a qualified person solely on the basis
that the person is authorized to practice nurse-midwifery
or midwifery
.
An application from a certified nurse-midwife
or
certified midwife
who
is not employed by the hospital shall contain the name of a physician
member of the hospital's medical staff who holds clinical privileges
in obstetrics at that hospital and who has agreed to be the
collaborating physician for the applicant in accordance with section
4723.43
4723.431
of
the Revised Code.
(D)
Any person may apply to the court of common pleas for temporary or
permanent injunctions restraining a violation of division (A), (B),
or (C) of this section. This action is an additional remedy not
dependent on the adequacy of the remedy at law.
(E)(1)
If a hospital does not provide or permit the provision of any
diagnostic or treatment service for mental or emotional disorders or
any other service that may be legally performed by a psychologist
licensed under Chapter 4732. of the Revised Code, this section does
not require the hospital to provide or permit the provision of any
such service and the hospital shall be exempt from requirements of
this section pertaining to psychologists.
(2)
This section does not impair the right of a hospital to enter into an
employment, personal service, or any other kind of contract with a
licensed psychologist, upon any such terms as the parties may
mutually agree, for the provision of any service that may be legally
performed by a licensed psychologist.
Sec.
3702.30.
(A)
As used in this section:
(1)
"Ambulatory surgical facility" means a facility in which
surgical services are provided to patients who do not require
hospitalization for inpatient care, the duration of services for any
patient does not extend beyond twenty-four hours after the patient's
admission, and to which any of the following apply:
(a)
The surgical services are provided in a building that is separate
from another building in which inpatient care is provided, regardless
of whether the separate building is part of the same organization as
the building in which inpatient care is provided.
(b)
The surgical services are provided within a building in which
inpatient care is provided and the entity that operates the portion
of the building where the surgical services are provided is not the
entity that operates the remainder of the building.
(c)
The facility is held out to any person or government entity as an
ambulatory surgical facility or similar facility by means of signage,
advertising, or other promotional efforts.
"Ambulatory
surgical facility" does not include a hospital emergency
department, hospital provider-based department that is otherwise
licensed under Chapter 3722. of the Revised Code, or an office of a
physician, podiatrist, or dentist.
(2)
"Health care facility" means any of the following:
(a)
An ambulatory surgical facility;
(b)
A freestanding dialysis center;
(c)
A freestanding inpatient rehabilitation facility;
(d)
A freestanding birthing center;
(e)
A freestanding radiation therapy center;
(f)
A freestanding or mobile diagnostic imaging center.
(B)
By rule adopted in accordance with sections 3702.12 and 3702.13 of
the Revised Code, the director of health shall establish quality
standards for health care facilities. The standards may incorporate
accreditation standards or other quality standards established by any
entity recognized by the director.
(1)
In
the case of an ambulatory surgical facility, the standards shall
require the ambulatory surgical facility to maintain an infection
control program. The purposes of the program are to minimize
infections and communicable diseases and facilitate a functional and
sanitary environment consistent with standards of professional
practice. To achieve these purposes, ambulatory surgical facility
staff managing the program shall create and administer a plan
designed to prevent, identify, and manage infections and communicable
diseases; ensure that the program is directed by a qualified
professional trained in infection control; ensure that the program is
an integral part of the ambulatory surgical facility's quality
assessment and performance improvement program; and implement in an
expeditious manner corrective and preventive measures that result in
improvement.
(2)
In the case of a freestanding birthing center, the standards shall
require both of the following:
(a)
At least one of the following to attend each birth:
(i)
A physician licensed under Chapter 4731. of the Revised Code to
practice medicine and surgery or osteopathic medicine and surgery;
(ii)
A certified nurse-midwife licensed under Chapter 4723. of the Revised
Code;
(iii)
A certified midwife licensed under Chapter 4723. of the Revised Code;
(iv)
A licensed midwife licensed under Chapter 4724. of the Revised Code.
(b)
That each freestanding birthing center have a director of patient
services who is one of the following:
(i)
A physician licensed under Chapter 4731. of the Revised Code to
practice medicine and surgery or osteopathic medicine and surgery;
(ii)
A certified nurse-midwife licensed under Chapter 4723. of the Revised
Code who has contracted with a collaborating physician;
(iii)
A certified midwife licensed under Chapter 4723. of the Revised Code
who has contracted with a collaborating physician.
(C)
Every ambulatory surgical facility shall require that each physician
who practices at the facility comply with all relevant provisions in
the Revised Code that relate to the obtaining of informed consent
from a patient.
(D)
The director shall issue a license to each health care facility that
makes application for a license and demonstrates to the director that
it meets the quality standards established by the rules adopted under
division (B) of this section and satisfies the informed consent
compliance requirements specified in division (C) of this section.
(E)(1)
Except as provided in division (H) of this section and in section
3702.301 of the Revised Code, no health care facility shall operate
without a license issued under this section.
The
general assembly does not intend for the provisions of this section
or section 3702.301 of the Revised Code that establish health care
facility licensing requirements or exemptions to have an effect on
any third-party payments that may be available for the services
provided by either a licensed health care facility or an entity
exempt from licensure.
(2)
If the department of health finds that a physician who practices at a
health care facility is not complying with any provision of the
Revised Code related to the obtaining of informed consent from a
patient, the department shall report its finding to the state medical
board, the physician, and the health care facility.
(3)
Division (E)(2) of this section does not create, and shall not be
construed as creating, a new cause of action or substantive legal
right against a health care facility and in favor of a patient who
allegedly sustains harm as a result of the failure of the patient's
physician to obtain informed consent from the patient prior to
performing a procedure on or otherwise caring for the patient in the
health care facility.
(F)
The rules adopted under division (B) of this section shall include
all of the following:
(1)
Provisions governing application for, renewal, suspension, and
revocation of a license under this section;
(2)
Provisions governing orders issued pursuant to section 3702.32 of the
Revised Code for a health care facility to cease its operations or to
prohibit certain types of services provided by a health care
facility;
(3)
Provisions governing the imposition under section 3702.32 of the
Revised Code of civil penalties for violations of this section or the
rules adopted under this section, including a scale for determining
the amount of the penalties;
(4)
Provisions specifying the form inspectors must use when conducting
inspections of ambulatory surgical facilities.
(G)
An ambulatory surgical facility that performs or induces abortions
shall comply with section 3701.791 of the Revised Code.
(H)
The following entities are not required to obtain a license as a
freestanding diagnostic imaging center issued under this section:
(1)
A hospital registered under section 3701.07 of the Revised Code that
provides diagnostic imaging;
(2)
An entity that is reviewed as part of a hospital accreditation or
certification program and that provides diagnostic imaging;
(3)
An ambulatory surgical facility that provides diagnostic imaging in
conjunction with or during any portion of a surgical procedure.
Sec.
3722.15.
(A)
A hospital that is a medicaid provider and that operates a maternity
unit shall agree to a written transfer agreement with any
freestanding birthing center if both of the following apply:
(1)
The freestanding birthing center is located within a thirty mile
radius of the hospital.
(2)
The freestanding birthing center has requested a transfer agreement.
(B)
A transfer agreement shall specify an effective procedure for the
safe and immediate transfer of patients from the freestanding
birthing center to the hospital when medical care beyond the care
that can be provided at the freestanding birthing center is
necessary, including when emergency situations occur or medical
complications arise.
(C)
The freestanding birthing center shall file a copy of the transfer
agreement with the director of health.
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.
A certified nurse-midwife does not include a certified midwife,
licensed midwife, or traditional midwife.
(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
or certified midwife
,
that one or more physicians with whom the certified nurse-midwife
or
certified midwife
has
entered into a standard care arrangement are continuously available
to communicate with the certified nurse-midwife
or
certified midwife
either
in person or by electronic communication.
(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,
certified
midwife,
or
certified nurse practitioner and meets the requirements of section
4723.431 of the Revised Code.
(O)
"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)
"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)
"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)
"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)
"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)
"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)
"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)
"Nursing specialty" means a specialty in practice as a
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner.
(W)
"Physician assistant" means an individual who is licensed
to practice as a physician assistant under Chapter 4730. of the
Revised Code.
(X)
"Certified midwife" means an individual who is licensed
under section 4723.56 of the Revised Code and engages in one or more
of the activities described in that section. A certified midwife does
not include a certified nurse-midwife, licensed midwife, or
traditional midwife.
(Y)
"Licensed midwife" has the same meaning as in section
4724.01 of the Revised Code. A licensed midwife does not include a
certified nurse-midwife, certified midwife, or traditional midwife.
(Z)
"Traditional midwife" has the same meaning as in section
4724.01 of the Revised Code.
Sec.
4723.02.
The
board of nursing shall assume and exercise all the powers and perform
all the duties conferred and imposed on it by this chapter.
The
board shall consist of
thirteen
fifteen
members
who shall be citizens of the United States and residents of Ohio.
Eight members shall be registered nurses, each of whom shall be a
graduate of an approved program of nursing education that prepares
persons for licensure as a registered nurse, shall hold a currently
active license issued under this chapter to practice nursing as a
registered nurse, and shall have been actively engaged in the
practice of nursing as a registered nurse for the five years
immediately preceding the member's initial appointment to the board.
Of the eight members who are registered nurses, at least two shall
hold a current, valid license issued under this chapter that
authorizes the practice of nursing as an advanced practice registered
nurse. Four members shall be licensed practical nurses, each of whom
shall be a graduate of an approved program of nursing education that
prepares persons for licensure as a practical nurse, shall hold a
currently active license issued under this chapter to practice
nursing as a licensed practical nurse, and shall have been actively
engaged in the practice of nursing as a licensed practical nurse for
the five years immediately preceding the member's initial appointment
to the board.
One
member shall be a certified nurse-midwife or a certified midwife
practicing in an urban setting. One member shall be a certified
nurse-midwife or a certified midwife practicing in a rural setting.
One
member shall represent the interests of consumers of health care.
Neither this member nor any person in the member's immediate family
shall be a member of or associated with a health care provider or
profession or shall have a financial interest in the delivery or
financing of health care. Representation of nursing service and
nursing education and of the various geographical areas of the state
shall be considered in making appointments.
As
the term of any member of the board expires, a successor shall be
appointed who has the qualifications the vacancy requires. Terms of
office shall be for four years, commencing on the first day of
January and ending on the thirty-first day of December.
A
current or former board member who has served not more than one full
term or one full term and not more than thirty months of another term
may be reappointed for one additional term.
Each
member shall hold office from the date of appointment until the end
of the term for which the member was appointed. The term of a member
shall expire if the member ceases to meet any requirement of this
section for the member's position on the board. Any member appointed
to fill a vacancy occurring prior to the expiration of the term for
which the member's predecessor was appointed shall hold office for
the remainder of such term. Any member shall continue in office
subsequent to the expiration date of the member's term until the
member's successor takes office, or until a period of sixty days has
elapsed, whichever occurs first.
Nursing
organizations of this state may each submit to the governor the names
of not more than five nominees for each position to be filled on the
board. From the names so submitted or from others, at the governor's
discretion, the governor with the advice and consent of the senate
shall make such appointments.
Any
member of the board may be removed by the governor for neglect of any
duty required by law or for incompetency or unprofessional or
dishonorable conduct, after a hearing as provided in Chapter 119. of
the Revised Code.
Seven
Eight
members
of the board
,
including at least four registered nurses and at least one licensed
practical nurse
,
shall at all times constitute a quorum.
Each
member of the board shall receive an amount fixed pursuant to
division (J) of section 124.15 of the Revised Code for each day in
attendance at board meetings and in discharge of official duties, and
in addition thereto, necessary expense incurred in the performance of
such duties.
The
board shall elect one of its nurse members as president and one as
vice-president. The board shall elect one of its registered nurse
members to serve as the supervising member for disciplinary matters.
The
board may establish advisory groups to serve in consultation with the
board or the executive director. Each advisory group shall be given a
specific charge in writing and shall report to the board. Members of
advisory groups shall serve without compensation but shall receive
their actual and necessary expenses incurred in the performance of
their official duties.
Sec.
4723.03.
(A)
No person shall engage in the practice of nursing as a registered
nurse, represent the person as being a registered nurse, or use the
title "registered nurse," the initials "R.N.," or
any other title implying that the person is a registered nurse, for a
fee, salary, or other consideration, or as a volunteer, without
holding a current, valid license as a registered nurse under this
chapter.
(B)
No person shall knowingly do any of the following without holding a
current, valid license to practice nursing as an advanced practice
registered nurse issued under this chapter:
(1)
Engage in the practice of nursing as an advanced practice registered
nurse;
(2)
Represent the person as being an advanced practice registered nurse;
(3)
Use the title "advanced practice registered nurse," the
initials "A.P.R.N.," or any other title implying that the
person is an advanced practice registered nurse, for a fee, salary,
or other consideration, or as a volunteer.
(C)
No person who is not otherwise authorized to do so shall knowingly
prescribe or personally furnish drugs or therapeutic devices without
holding a current, valid license to practice nursing as an advanced
practice registered nurse issued under this chapter and being
designated as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner under section 4723.42 of the Revised
Code;
(D)
No person shall engage in the practice of nursing as a licensed
practical nurse, represent the person as being a licensed practical
nurse, or use the title "licensed practical nurse," the
initials "L.P.N.," or any other title implying that the
person is a licensed practical nurse, for a fee, salary, or other
consideration, or as a volunteer, without holding a current, valid
license as a practical nurse under this chapter.
(E)
No person shall use the titles or initials "graduate nurse,"
"G.N.," "professional nurse," "P.N.,"
"graduate practical nurse," "G.P.N.," "practical
nurse," "P.N.," "trained nurse," "T.N.,"
or any other statement, title, or initials that would imply or
represent to the public that the person is authorized to practice
nursing in this state, except as follows:
(1)
A person licensed under this chapter to practice nursing as a
registered nurse may use that title and the initials "R.N.";
(2)
A person licensed under this chapter to practice nursing as a
licensed practical nurse may use that title and the initials
"L.P.N.";
(3)
A person licensed under this chapter to practice nursing as an
advanced practice registered nurse and designated as a certified
registered nurse anesthetist may use that title or the initials
"A.P.R.N.-C.R.N.A.";
(4)
A person licensed under this chapter to practice nursing as an
advanced practice registered nurse and designated as a clinical nurse
specialist may use that title or the initials "A.P.R.N.-C.N.S.";
(5)
A person licensed under this chapter to practice nursing as an
advanced practice registered nurse and designated as a certified
nurse-midwife may use that title or the initials "A.P.R.N.-C.N.M.";
(6)
A person licensed under this chapter to practice nursing as an
advanced practice registered nurse and designated as a certified
nurse practitioner may use that title or the initials
"A.P.R.N.-C.N.P.";
(7)
A person licensed under this chapter to practice nursing as an
advanced practice registered nurse may use the title "advanced
practice registered nurse" or the initials "A.P.R.N."
(F)
No person shall employ a person not licensed as a registered nurse
under this chapter to engage in the practice of nursing as a
registered nurse.
No
person shall knowingly employ a person not licensed as an advanced
practice registered nurse under this chapter to engage in the
practice of nursing as an advanced practice registered nurse.
No
person shall employ a person not licensed as a practical nurse under
this chapter to engage in the practice of nursing as a licensed
practical nurse.
(G)
No person shall sell or fraudulently obtain or furnish any nursing
diploma, license, certificate, renewal, or record, or aid or abet
such acts.
(H)(1)
No person shall knowingly use the title "certified
nurse-midwife," the initials "C.N.M.," or any other
title implying that the person is a certified nurse-midwife without
holding a current, valid license as a certified nurse-midwife under
this chapter.
(2)
No person shall knowingly use the title "certified midwife,"
the initials "C.M.," or any other title implying that the
person is a certified midwife without holding a current, valid
license as a certified midwife under this chapter.
Sec.
4723.06.
(A)
The board of nursing shall:
(1)
Administer and enforce the provisions of this chapter, including the
taking of disciplinary action for violations of section 4723.28 of
the Revised Code, any other provisions of this chapter, or rules
adopted under this chapter;
(2)
Develop criteria that an applicant must meet to be eligible to sit
for the examination for licensure to practice as a registered nurse
or as a licensed practical nurse;
(3)
Issue and renew nursing licenses,
certified
midwife licenses,
dialysis
technician certificates,
medication
aide certificates,
and
community health worker certificates, as provided in this chapter;
(4)
Define the minimum educational standards for the schools and programs
of registered nursing and practical nursing in this state;
(5)
Survey, inspect, and grant full approval to prelicensure nursing
education programs in this state that meet the standards established
by rules adopted under section 4723.07 of the Revised Code.
Prelicensure nursing education programs include, but are not limited
to, diploma, associate degree, baccalaureate degree, master's degree,
and doctor of nursing programs leading to initial licensure to
practice nursing as a registered nurse and practical nurse programs
leading to initial licensure to practice nursing as a licensed
practical nurse.
(6)
Grant conditional approval, by a vote of a quorum of the board, to a
new prelicensure nursing education program or a program that is being
reestablished after having ceased to operate, if the program meets
and maintains the minimum standards of the board established by rules
adopted under section 4723.07 of the Revised Code. If the board does
not grant conditional approval, it shall hold an adjudication under
Chapter 119. of the Revised Code to consider conditional approval of
the program. If the board grants conditional approval, at the first
meeting following completion of the survey process required by
division (A)(5) of this section, the board shall determine whether to
grant full approval to the program. If the board does not grant full
approval or if it appears that the program has failed to meet and
maintain standards established by rules adopted under section 4723.07
of the Revised Code, the board shall hold an adjudication under
Chapter 119. of the Revised Code to consider the program. Based on
results of the adjudication, the board may continue or withdraw
conditional approval, or grant full approval.
(7)
Place on provisional approval, for a period of time specified by the
board, a prelicensure nursing education program that has ceased to
meet and maintain the minimum standards of the board established by
rules adopted under section 4723.07 of the Revised Code. Prior to or
at the end of the period, the board shall reconsider whether the
program meets the standards and shall grant full approval if it does.
If it does not, the board may withdraw approval, pursuant to an
adjudication under Chapter 119. of the Revised Code.
(8)
Approve continuing education programs and courses under standards
established in rules adopted under sections 4723.07, 4723.69,
4723.79, and 4723.88 of the Revised Code;
(9)
Establish the safe haven program in accordance with sections 4723.35
and 4723.351 of the Revised Code;
(10)
Establish the practice intervention and improvement program in
accordance with section 4723.282 of the Revised Code;
(11)
Grant approval to the course of study in advanced pharmacology and
related topics described in section 4723.482
or
4723.551
of
the Revised Code;
(12)
Make an annual edition of the exclusionary formulary established in
rules adopted under section 4723.50 of the Revised Code available to
the public by electronic means and, as soon as possible after any
revision of the formulary becomes effective, make the revision
available to the public by electronic means;
(13)
Approve under section 4723.46 of the Revised Code national certifying
organizations for examination and licensure of advanced practice
registered nurses, which may include separate organizations for each
nursing specialty;
(14)
Provide guidance and make recommendations to the general assembly,
the governor, state agencies, and the federal government with respect
to the regulation of the practice of nursing and the enforcement of
this chapter;
(15)
Make an annual report to the governor, which shall be open for public
inspection;
(16)
Maintain and have open for public inspection the following records:
(a)
A record of all its meetings and proceedings;
(b)
A record of all applicants for, and holders of, licenses and
certificates issued by the board under this chapter or in accordance
with rules adopted under this chapter. The record shall be maintained
in a format determined by the board.
(c)
A list of education and training programs approved by the board.
(17)
Deny conditional approval to a new prelicensure nursing education
program or a program that is being reestablished after having ceased
to operate if the program or a person acting on behalf of the program
submits or causes to be submitted to the board false, misleading, or
deceptive statements, information, or documentation in the process of
applying for approval of the program. If the board proposes to deny
approval of the program, it shall do so pursuant to an adjudication
conducted under Chapter 119. of the Revised Code.
(B)
The board may fulfill the requirement of division (A)(8) of this
section by authorizing persons who meet the standards established in
rules adopted under section 4723.07 of the Revised Code to approve
continuing education programs and courses. Persons so authorized
shall approve continuing education programs and courses in accordance
with standards established in rules adopted under section 4723.07 of
the Revised Code.
Persons
seeking authorization to approve continuing education programs and
courses shall apply to the board and pay the appropriate fee
established under section 4723.08 of the Revised Code. Authorizations
to approve continuing education programs and courses shall expire and
may be renewed according to the schedule established in rules adopted
under section 4723.07 of the Revised Code.
In
addition to approving continuing education programs under division
(A)(8) of this section, the board may sponsor continuing education
activities that are directly related to the statutes and rules the
board enforces.
(C)(1)
The board may deny conditional approval to a new prelicensure nursing
education program or program that is being reestablished after having
ceased to operate if the program is controlled by a person who
controls or has controlled a program that had its approval withdrawn,
revoked, suspended, or restricted by the board or a board of another
jurisdiction that is a member of the national council of state boards
of nursing. If the board proposes to deny approval, it shall do so
pursuant to an adjudication conducted under Chapter 119. of the
Revised Code.
(2)
As used in this division, "control" means any of the
following:
(a)
Holding fifty per cent or more of the outstanding voting securities
or membership interest of a prelicensure nursing education program;
(b)
In the case of an unincorporated prelicensure nursing education
program, having the right to fifty per cent or more of the program's
profits or in the event of a dissolution, fifty per cent or more of
the program's assets;
(c)
In the case of a prelicensure nursing education program that is a
for-profit or not-for-profit corporation, having the contractual
authority presently to designate fifty per cent or more of its
directors;
(d)
In the case of a prelicensure nursing education program that is a
trust, having the contractual authority presently to designate fifty
per cent or more of its trustees;
(e)
Having the authority to direct the management, policies, or
investments of a prelicensure nursing education program.
(D)(1)
When an action taken by the board under division (A)(6), (7), or (17)
or (C)(1) of this section is required to be taken pursuant to an
adjudication conducted under Chapter 119. of the Revised Code, the
board may, in lieu of an adjudication hearing, enter into a consent
agreement to resolve the matter. A consent agreement, when ratified
by a vote of a quorum of the board, constitutes the findings and
order of the board with respect to the matter addressed in the
agreement. If the board refuses to ratify a consent agreement, the
admissions and findings contained in the agreement are of no effect.
(2)
In any instance in which the board is required under Chapter 119. of
the Revised Code to give notice to a person seeking approval of a
prelicensure nursing education program of an opportunity for a
hearing and the person does not make a timely request for a hearing
in accordance with section 119.07 of the Revised Code, the board is
not required to hold a hearing, but may adopt, by a vote of a quorum,
a final order that contains the board's findings.
(3)
When the board denies or withdraws approval of a prelicensure nursing
education program, the board may specify that its action is
permanent. A program subject to a permanent action taken by the board
is forever ineligible for approval and the board shall not accept an
application for the program's reinstatement or approval.
Sec.
4723.07.
In
accordance with Chapter 119. of the Revised Code, the board of
nursing shall adopt and may amend and rescind rules that establish
all of the following:
(A)
Provisions for the board's government and control of its actions and
business affairs;
(B)
Subject to section 4723.072 of the Revised Code, minimum standards
for nursing education programs that prepare graduates to be licensed
under this chapter and procedures for granting, renewing, and
withdrawing approval of those programs;
(C)
Criteria that applicants for licensure must meet to be eligible to
take examinations for licensure;
(D)
Standards and procedures for renewal of the licenses and certificates
issued by the board;
(E)
Standards for approval of continuing nursing education programs and
courses for registered nurses, advanced practice registered nurses,
and licensed practical nurses. The standards may provide for approval
of continuing nursing education programs and courses that have been
approved by other state boards of nursing or by national
accreditation systems for nursing, including, but not limited to, the
American nurses' credentialing center and the national association
for practical nurse education and service.
(F)
Standards that persons must meet to be authorized by the board to
approve continuing education programs and courses and a schedule by
which that authorization expires and may be renewed;
(G)
Requirements, including continuing education requirements, for
reactivating inactive licenses or certificates, and for reinstating
licenses or certificates that have lapsed;
(H)
Conditions that may be imposed for reinstatement of a license or
certificate following action taken under section 3123.47, 4723.28,
4723.281, 4723.652, or 4723.86 of the Revised Code resulting in a
license or certificate suspension;
(I)
Criteria for evaluating the qualifications of an applicant for a
license to practice nursing as a registered nurse, a license to
practice nursing as an advanced practice registered nurse, or a
license to practice nursing as a licensed practical nurse for the
purpose of issuing the license by the board's endorsement of the
applicant's authority to practice issued by the licensing agency of
another state;
(J)
Universal and standard precautions that shall be used by each
licensee or certificate holder. The rules shall define and establish
requirements for universal and standard precautions that include the
following:
(1)
Appropriate use of hand washing;
(2)
Disinfection and sterilization of equipment;
(3)
Handling and disposal of needles and other sharp instruments;
(4)
Wearing and disposal of gloves and other protective garments and
devices.
(K)
Quality assurance standards for advanced practice registered nurses;
(L)
Additional criteria for the standard care arrangement required by
section 4723.431 of the Revised Code entered into by a
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner and the nurse's collaborating physician or podiatrist;
(M)
For purposes of division (B)(31) of section 4723.28 of the Revised
Code, the actions, omissions, or other circumstances that constitute
failure to establish and maintain professional boundaries with a
patient;
(N)
Standards and procedures for delegation under section 4723.48 of the
Revised Code of the authority to administer drugs.
The
board may adopt other rules necessary to carry out the provisions of
this chapter. The rules shall be adopted in accordance with Chapter
119. of the Revised Code.
Sec.
4723.08.
(A)
The board of nursing may impose fees not to exceed the following
limits:
(1)
For application for licensure by examination or endorsement to
practice nursing as a registered nurse or as a licensed practical
nurse submitted under division (A) or (B) of section 4723.09 of the
Revised Code, seventy-five dollars;
(2)
For application for licensure to practice nursing as an advanced
practice registered nurse submitted under division (A) or (B)(2) of
section 4723.41 of the Revised Code, one hundred fifty dollars;
(3)
For application for a dialysis technician certificate, the amount
specified in rules adopted under section 4723.79 of the Revised Code;
(4)
For providing, pursuant to division (B) of section 4723.271 of the
Revised Code, written verification of a nursing license, dialysis
technician certificate, medication aide certificate, or community
health worker certificate to another jurisdiction, fifteen dollars;
(5)
For providing, pursuant to division (A) of section 4723.271 of the
Revised Code, a replacement copy of a wall certificate suitable for
framing as described in that division, twenty-five dollars;
(6)
For renewal of a license to practice as a registered nurse or
licensed practical nurse, sixty-five dollars;
(7)
For renewal of a license to practice as an advanced practice
registered nurse, one hundred thirty-five dollars;
(8)
For renewal of a dialysis technician certificate, the amount
specified in rules adopted under section 4723.79 of the Revised Code;
(9)
For processing a late application for renewal of a nursing license or
dialysis technician certificate, fifty dollars;
(10)
For application for authorization to approve continuing education
programs and courses from an applicant accredited by a national
accreditation system for nursing, five hundred dollars;
(11)
For application for authorization to approve continuing education
programs and courses from an applicant not accredited by a national
accreditation system for nursing, one thousand dollars;
(12)
For each year for which authorization to approve continuing education
programs and courses is renewed, one hundred fifty dollars;
(13)
For application for approval to operate a dialysis training program,
the amount specified in rules adopted under section 4723.79 of the
Revised Code;
(14)
For reinstatement of a lapsed license or certificate issued under
this chapter, one hundred dollars except as provided in section
5903.10 of the Revised Code;
(15)
For processing a check returned to the board by a financial
institution, twenty-five dollars;
(16)
The amounts specified in rules adopted under section 4723.88 of the
Revised Code pertaining to the issuance of certificates to community
health workers, including fees for application for a certificate,
renewal of a certificate, processing a late application for renewal
of a certificate, reinstatement of a lapsed certificate, application
for approval of a community health worker training program for
community health workers, and renewal of the approval of a training
program for community health workers
;
(17)
For application for licensure to practice as a certified midwife, an
amount equal to the fee for licensure to practice as an advanced
practice registered nurse;
(18)
For renewal of a license to practice as a certified midwife, an
amount equal to the fee for renewal of a license to practice as an
advanced practice registered nurse
.
(B)
Each quarter, for purposes of transferring funds under section
4743.05 of the Revised Code to the nurse education assistance fund
created in section 3333.28 of the Revised Code, the board of nursing
shall certify to the director of budget and management the number of
licenses renewed under this chapter during the preceding quarter and
the amount equal to that number times five dollars.
(C)
The board may charge a participant in a board-sponsored continuing
education activity an amount not exceeding fifteen dollars for each
activity.
(D)
The board may contract for services pertaining to the process of
providing written verification of a license or certificate when the
verification is performed for purposes other than providing
verification to another jurisdiction. The contract may include
provisions pertaining to the collection of the fee charged for
providing the written verification. As part of these provisions, the
board may permit the contractor to retain a portion of the fees as
compensation, before any amounts are deposited into the state
treasury.
Sec.
4723.271.
(A)
Upon request of the holder of a nursing license,
certified
midwife license,
dialysis
technician certificate, medication aide certificate, or community
health worker certificate issued under this chapter, the presentment
of proper identification as prescribed in rules adopted by the board
of nursing, and payment of the fee authorized under section 4723.08
of the Revised Code, the board of nursing shall provide to the
requestor a replacement copy of a wall certificate suitable for
framing.
(B)
Upon request of the holder of a nursing license,
certified
midwife license,
volunteer's
certificate, dialysis technician certificate, medication aide
certificate, or community health worker certificate issued under this
chapter and payment of the fee authorized under section 4723.08 of
the Revised Code, the board shall verify to an agency of another
jurisdiction or foreign country the fact that the person holds such
nursing license,
certified
midwife license,
volunteer's
certificate, dialysis technician certificate, medication aide
certificate, or community health worker certificate.
Sec.
4723.28.
(A)
The board of nursing, by a vote of a quorum, may impose one or more
of the following sanctions if it finds that a person committed fraud
in passing an examination required to obtain a license or dialysis
technician certificate issued by the board or to have committed
fraud, misrepresentation, or deception in applying for or securing
any nursing license
,
certified midwife license,
or dialysis technician certificate issued by the board: deny, revoke,
suspend, or place restrictions on any nursing license
,
certified midwife license,
or dialysis technician certificate issued by the board; reprimand or
otherwise discipline a holder of a nursing license
,
certified midwife license,
or dialysis technician certificate; or impose a fine of not more than
five hundred dollars per violation.
(B)
Except as provided in section 4723.092 of the Revised Code, the board
of nursing, by a vote of a quorum, may impose one or more of the
following sanctions: deny, revoke, suspend, or place restrictions on
any nursing license
,
certified midwife license,
or dialysis technician certificate issued by the board; reprimand or
otherwise discipline a holder of a nursing license
,
certified midwife license,
or dialysis technician certificate; or impose a fine of not more than
five hundred dollars per violation. The sanctions may be imposed for
any of the following:
(1)
Denial, revocation, suspension, or restriction of authority to engage
in a licensed profession or practice a health care occupation,
including nursing or practice as a
certified
midwife or
dialysis
technician, for any reason other than a failure to renew, in Ohio or
another state or jurisdiction;
(2)
Engaging in the practice of nursing or engaging in practice as a
certified
midwife or
dialysis
technician, having failed to renew a nursing license
,
certified midwife license,
or dialysis technician certificate issued under this chapter, or
while a nursing license
,
certified midwife license,
or dialysis technician certificate is under suspension;
(3)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, a misdemeanor
committed in the course of practice;
(4)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, any felony or
of any crime involving gross immorality or moral turpitude;
(5)
Selling, giving away, or administering drugs or therapeutic devices
for other than legal and legitimate therapeutic purposes; or
conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, violating any
municipal, state, county, or federal drug law;
(6)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, an act in
another jurisdiction that would constitute a felony or a crime of
moral turpitude in Ohio;
(7)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, an act in the
course of practice in another jurisdiction that would constitute a
misdemeanor in Ohio;
(8)
Self-administering or otherwise taking into the body any dangerous
drug, as defined in section 4729.01 of the Revised Code, in any way
that is not in accordance with a legal, valid prescription issued for
that individual, or self-administering or otherwise taking into the
body any drug that is a schedule I controlled substance;
(9)
Habitual or excessive use of controlled substances, other
habit-forming drugs, or alcohol or other chemical substances to an
extent that impairs the individual's ability to provide safe nursing
care
,
safe care as a certified midwife,
or safe dialysis care;
(10)
Impairment of the ability to practice according to acceptable and
prevailing standards of safe nursing care
,
safe care as a certified midwife,
or safe dialysis care because of the use of drugs, alcohol, or other
chemical substances;
(11)
Impairment of the ability to practice according to acceptable and
prevailing standards of safe nursing care or safe dialysis care
because of a physical or mental disability;
(12)
Assaulting or causing harm to a patient or depriving a patient of the
means to summon assistance;
(13)
Misappropriation or attempted misappropriation of money or anything
of value in the course of practice;
(14)
Adjudication by a probate court of being mentally ill or mentally
incompetent. The board may reinstate the person's nursing license
,
certified midwife license,
or dialysis technician certificate upon adjudication by a probate
court of the person's restoration to competency or upon submission to
the board of other proof of competency.
(15)
The suspension or termination of employment by the United States
department of defense or department of veterans affairs for any act
that violates or would violate this chapter;
(16)
Violation of this chapter or any rules adopted under it;
(17)
Violation of any restrictions placed by the board on a nursing
license
,
certified midwife license,
or dialysis technician certificate;
(18)
Failure to use universal and standard precautions established by
rules adopted under section 4723.07 of the Revised Code;
(19)
Failure to practice in accordance with acceptable and prevailing
standards of safe nursing care
,
safe care as a certified midwife,
or safe dialysis care;
(20)
In the case of a registered nurse, engaging in activities that exceed
the practice of nursing as a registered nurse;
(21)
In the case of a licensed practical nurse, engaging in activities
that exceed the practice of nursing as a licensed practical nurse;
(22)
In the case of a dialysis technician, engaging in activities that
exceed those permitted under section 4723.72 of the Revised Code;
(23)
Aiding and abetting a person in that person's practice of nursing
or
as a certified midwife
without
a license or practice as a dialysis technician without a certificate
issued under this chapter;
(24)
In the case of an advanced practice registered nurse, except as
provided in division (M) of this section, either of the following:
(a)
Waiving the payment of all or any part of a deductible or copayment
that a patient, pursuant to a health insurance or health care policy,
contract, or plan that covers such nursing services, would otherwise
be required to pay if the waiver is used as an enticement to a
patient or group of patients to receive health care services from
that provider;
(b)
Advertising that the nurse will waive the payment of all or any part
of a deductible or copayment that a patient, pursuant to a health
insurance or health care policy, contract, or plan that covers such
nursing services, would otherwise be required to pay.
(25)
Failure to comply with the terms and conditions of participation in
the safe haven program conducted under sections 4723.35 and 4723.351
of the Revised Code;
(26)
Failure to comply with the terms and conditions required under the
practice intervention and improvement program established under
section 4723.282 of the Revised Code;
(27)
In the case of an advanced practice registered nurse:
(a)
Engaging in activities that exceed those permitted for the nurse's
nursing specialty under section 4723.43 of the Revised Code;
(b)
Failure to meet the quality assurance standards established under
section 4723.07 of the Revised Code.
(28)
In the case of an advanced practice registered nurse other than a
certified registered nurse anesthetist, failure to maintain a
standard care arrangement in accordance with section 4723.431 of the
Revised Code or to practice in accordance with the standard care
arrangement;
(29)
In the case of an advanced practice registered nurse who is
designated as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, failure to prescribe drugs and
therapeutic devices in accordance with section 4723.481 of the
Revised Code;
(30)
Prescribing any drug or device to perform or induce an abortion, or
otherwise performing or inducing an abortion;
(31)
Failure to establish and maintain professional boundaries with a
patient, as specified in rules adopted under section 4723.07 of the
Revised Code;
(32)
Regardless of whether the contact or verbal behavior is consensual,
engaging with a patient other than the spouse of the registered
nurse, licensed practical nurse,
certified
midwife,
or
dialysis technician in any of the following:
(a)
Sexual contact, as defined in section 2907.01 of the Revised Code;
(b)
Verbal behavior that is sexually demeaning to the patient or may be
reasonably interpreted by the patient as sexually demeaning.
(33)
Assisting suicide, as defined in section 3795.01 of the Revised Code;
(34)
Failure to comply with the requirements in section 3719.061 of the
Revised Code before issuing for a minor a prescription for an opioid
analgesic, as defined in section 3719.01 of the Revised Code;
(35)
Failure to comply with section 4723.487 of the Revised Code, unless
the state board of pharmacy no longer maintains a drug database
pursuant to section 4729.75 of the Revised Code;
(36)
The revocation, suspension, restriction, reduction, or termination of
clinical privileges by the United States department of defense or
department of veterans affairs or the termination or suspension of a
certificate of registration to prescribe drugs by the drug
enforcement administration of the United States department of
justice;
(37)
In the case of an advanced practice registered nurse who is
designated as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, failure to comply with the terms of
a consult agreement entered into with a pharmacist pursuant to
section 4729.39 of the Revised Code;
(38)
Violation of section 4723.93 of the Revised Code;
(39)
Failure to cooperate with an investigation conducted by the board
under this chapter, including failure to comply with a subpoena or
order issued by the board or failure to answer truthfully a question
presented by the board in an investigative interview, in an
investigative office conference, at a deposition, or in written
interrogatories, except that failure to cooperate with an
investigation does not constitute grounds for discipline if a court
of competent jurisdiction has issued an order that either quashes a
subpoena or permits the individual to withhold testimony or evidence
at issue
;
(40)
In the case of a certified midwife:
(a)
Engaging in activities that exceed those permitted under section
4723.57 of the Revised Code;
(b)
Failure to prescribe drugs and therapeutic devices in accordance with
section 4723.481 of the Revised Code;
(c)
Failure to maintain a standard care arrangement in accordance with
section 4723.431 of the Revised Code or to practice in accordance
with the standard care arrangement
.
(C)
Disciplinary actions taken by the board under divisions (A) and (B)
of this section shall be taken pursuant to an adjudication conducted
under Chapter 119. of the Revised Code, except that in lieu of a
hearing, the board may enter into a consent agreement with an
individual to resolve an allegation of a violation of this chapter or
any rule adopted under it. A consent agreement, when ratified by a
vote of a quorum, shall constitute the findings and order of the
board with respect to the matter addressed in the agreement. If the
board refuses to ratify a consent agreement, the admissions and
findings contained in the agreement shall be of no effect.
(D)
The hearings of the board shall be conducted in accordance with
Chapter 119. of the Revised Code, the board may appoint a hearing
examiner, as provided in section 119.09 of the Revised Code, to
conduct any hearing the board is authorized to hold under Chapter
119. of the Revised Code.
In
any instance in which the board is required under Chapter 119. of the
Revised Code to give notice of an opportunity for a hearing and the
applicant, licensee, or certificate holder does not make a timely
request for a hearing in accordance with section 119.07 of the
Revised Code, the board is not required to hold a hearing, but may
adopt, by a vote of a quorum, a final order that contains the board's
findings. In the final order, the board may order any of the
sanctions listed in division (A) or (B) of this section.
(E)
If a criminal action is brought against a registered nurse, licensed
practical nurse,
certified
midwife,
or
dialysis technician for an act or crime described in divisions (B)(3)
to (7) of this section and the action is dismissed by the trial court
other than on the merits, the board shall conduct an adjudication to
determine whether the registered nurse, licensed practical nurse,
certified
midwife,
or
dialysis technician committed the act on which the action was based.
If the board determines on the basis of the adjudication that the
registered nurse, licensed practical nurse,
certified midwife,
or dialysis technician committed the act, or if the registered nurse,
licensed practical nurse,
certified midwife,
or dialysis technician fails to participate in the adjudication, the
board may take action as though the registered nurse, licensed
practical nurse,
certified
midwife,
or
dialysis technician had been convicted of the act.
If
the board takes action on the basis of a conviction, plea, or a
judicial finding as described in divisions (B)(3) to (7) of this
section that is overturned on appeal, the registered nurse, licensed
practical nurse,
certified
midwife,
or
dialysis technician may, on exhaustion of the appeal process,
petition the board for reconsideration of its action. On receipt of
the petition and supporting court documents, the board shall
temporarily rescind its action. If the board determines that the
decision on appeal was a decision on the merits, it shall permanently
rescind its action. If the board determines that the decision on
appeal was not a decision on the merits, it shall conduct an
adjudication to determine whether the registered nurse, licensed
practical nurse,
certified
midwife,
or
dialysis technician committed the act on which the original
conviction, plea, or judicial finding was based. If the board
determines on the basis of the adjudication that the registered
nurse, licensed practical nurse,
certified
midwife,
or
dialysis technician committed such act, or if the registered nurse,
licensed practical nurse,
certified
midwife,
or
dialysis technician does not request an adjudication, the board shall
reinstate its action; otherwise, the board shall permanently rescind
its action.
Notwithstanding
the provision of division (D)(2) of section 2953.32 or division
(F)(1) of section 2953.39 of the Revised Code specifying that if
records pertaining to a criminal case are sealed or expunged under
that section the proceedings in the case shall be deemed not to have
occurred, sealing or expungement of the following records on which
the board has based an action under this section shall have no effect
on the board's action or any sanction imposed by the board under this
section: records of any conviction, guilty plea, judicial finding of
guilt resulting from a plea of no contest, or a judicial finding of
eligibility for a pretrial diversion program or intervention in lieu
of conviction.
The
board shall not be required to seal, destroy, redact, or otherwise
modify its records to reflect the court's sealing or expungement of
conviction records.
(F)
The board may investigate an individual's criminal background in
performing its duties under this section. As part of such
investigation, the board may order the individual to submit, at the
individual's expense, a request to the bureau of criminal
identification and investigation for a criminal records check and
check of federal bureau of investigation records in accordance with
the procedure described in section 4723.091 of the Revised Code.
(G)
During the course of an investigation conducted under this section,
the board may compel any registered nurse, licensed practical nurse,
certified
midwife,
or
dialysis technician or applicant under this chapter to submit to a
mental or physical examination, or both, as required by the board and
at the expense of the individual, if the board finds reason to
believe that the individual under investigation may have a physical
or mental impairment that may affect the individual's ability to
provide safe nursing care.
The
board shall not compel an individual who has been referred to the
safe haven program as described in sections 4723.35 and 4723.351 of
the Revised Code to submit to a mental or physical examination.
Failure
of any individual to submit to a mental or physical examination when
directed constitutes an admission of the allegations, unless the
failure is due to circumstances beyond the individual's control, and
a default and final order may be entered without the taking of
testimony or presentation of evidence.
If
the board finds that an individual is impaired, the board shall
require the individual to submit to care, counseling, or treatment
approved or designated by the board, as a condition for initial,
continued, reinstated, or renewed authority to practice. The
individual shall be afforded an opportunity to demonstrate to the
board that the individual can begin or resume the individual's
occupation in compliance with acceptable and prevailing standards of
care under the provisions of the individual's authority to practice.
For
purposes of this division, any registered nurse, licensed practical
nurse,
certified
midwife,
or
dialysis technician or applicant under this chapter shall be deemed
to have given consent to submit to a mental or physical examination
when directed to do so in writing by the board, and to have waived
all objections to the admissibility of testimony or examination
reports that constitute a privileged communication.
(H)
The board shall investigate evidence that appears to show that any
person has violated any provision of this chapter or any rule of the
board. Any person may report to the board any information the person
may have that appears to show a violation of any provision of this
chapter or rule of the board. In the absence of bad faith, any person
who reports such information or who testifies before the board in any
adjudication conducted under Chapter 119. of the Revised Code shall
not be liable for civil damages as a result of the report or
testimony.
(I)
All of the following apply under this chapter with respect to the
confidentiality of information:
(1)
Information received by the board pursuant to a complaint or an
investigation is confidential and not subject to discovery in any
civil action, except that the board may disclose information to law
enforcement officers and government entities for purposes of an
investigation of either a licensed health care professional,
including a registered nurse, licensed practical nurse,
certified
midwife,
or
dialysis technician, or a person who may have engaged in the
unauthorized practice of nursing
,
certified midwifery,
or dialysis care. No law enforcement officer or government entity
with knowledge of any information disclosed by the board pursuant to
this division shall divulge the information to any other person or
government entity except for the purpose of a government
investigation, a prosecution, or an adjudication by a court or
government entity.
(2)
If an investigation requires a review of patient records, the
investigation and proceeding shall be conducted in such a manner as
to protect patient confidentiality.
(3)
All adjudications and investigations of the board shall be considered
civil actions for the purposes of section 2305.252 of the Revised
Code.
(4)
Any board activity that involves continued monitoring of an
individual as part of or following any disciplinary action taken
under this section shall be conducted in a manner that maintains the
individual's confidentiality. Information received or maintained by
the board with respect to the board's monitoring activities is not
subject to discovery in any civil action and is confidential, except
that the board may disclose information to law enforcement officers
and government entities for purposes of an investigation of a
licensee or certificate holder.
(J)
Any action taken by the board under this section resulting in a
suspension from practice shall be accompanied by a written statement
of the conditions under which the person may be reinstated to
practice.
(K)
When the board refuses to grant a license or certificate to an
applicant, revokes a license or certificate, or refuses to reinstate
a license or certificate, the board may specify that its action is
permanent. An individual subject to permanent action taken by the
board is forever ineligible to hold a license or certificate of the
type that was refused or revoked and the board shall not accept from
the individual an application for reinstatement of the license or
certificate or for a new license or certificate.
(L)
No unilateral surrender of a nursing license
,
certified midwife license,
or dialysis technician certificate issued under this chapter shall be
effective unless accepted by majority vote of the board. No
application for a nursing license
,
certified midwife license,
or dialysis technician certificate issued under this chapter may be
withdrawn without a majority vote of the board. The board's
jurisdiction to take disciplinary action under this section is not
removed or limited when an individual has a license or certificate
classified as inactive or fails to renew a license or certificate.
(M)
Sanctions shall not be imposed under division (B)(24) of this section
against any licensee who waives deductibles and copayments as
follows:
(1)
In compliance with the health benefit plan that expressly allows such
a practice. Waiver of the deductibles or copayments shall be made
only with the full knowledge and consent of the plan purchaser,
payer, and third-party administrator. Documentation of the consent
shall be made available to the board upon request.
(2)
For professional services rendered to any other person licensed
pursuant to this chapter to the extent allowed by this chapter and
the rules of the board.
Sec.
4723.282.
(A)
As used in this section, "practice deficiency" means any
activity that does not meet acceptable and prevailing standards of
safe and effective nursing care or dialysis care
or safe and effective care as a certified midwife
.
(B)
The board of nursing may abstain from taking disciplinary action
under section 4723.28 of the Revised Code against the holder of a
license or certificate issued under this chapter who has a practice
deficiency that has been identified by the board through an
investigation conducted under section 4723.28 of the Revised Code.
The board may abstain from taking action only if the board has reason
to believe that the individual's practice deficiency can be corrected
through remediation, and if the individual enters into an agreement
with the board to seek remediation as prescribed by the board,
complies with the terms and conditions of the remediation, and
successfully completes the remediation. If an individual fails to
complete the remediation or the board determines that remediation
cannot correct the individual's practice deficiency, the board shall
proceed with disciplinary action in accordance with section 4723.28
of the Revised Code.
(C)
To implement its authority under this section to abstain from taking
disciplinary action, the board shall establish a practice
intervention and improvement program. The board shall designate an
administrator to operate the program and, in accordance with Chapter
119. of the Revised Code, adopt rules for the program that establish
the following:
(1)
Criteria for use in identifying an individual's practice deficiency;
(2)
Requirements that an individual must meet to be eligible for
remediation and the board's abstention from disciplinary action;
(3)
Standards and procedures for prescribing remediation that is
appropriate for an individual's identified practice deficiency;
(4)
Terms and conditions that an individual must meet to be successful in
completing the remediation prescribed;
(5)
Procedures for the board's monitoring of the individual's
remediation;
(6)
Procedures for maintaining confidential records regarding individuals
who participate in remediation;
(7)
Any other requirements or procedures necessary to develop and
administer the program.
(D)
All records held by the board for purposes of the program shall be
confidential, are not public records for purposes of section 149.43
of the Revised Code, and are not subject to discovery by subpoena or
admissible as evidence in any judicial proceeding. The administrator
of the program shall maintain all records in the board's office in
accordance with the board's record retention schedule.
(E)
When an individual begins the remediation prescribed by the board,
the individual shall sign a waiver permitting any entity that
provides services related to the remediation to release to the board
information regarding the individual's progress. An entity that
provides services related to remediation shall report to the board if
the individual fails to complete the remediation or does not make
satisfactory progress in remediation.
In
the absence of fraud or bad faith, an entity that reports to the
board regarding an individual's practice deficiency, or progress or
lack of progress in remediation, is not liable in damages to any
person as a result of making the report.
(F)
An individual participating in remediation prescribed under this
section is responsible for all financial obligations that may arise
from obtaining or completing the remediation.
Sec.
4723.33.
A
registered nurse, licensed practical nurse,
certified
midwife,
dialysis
technician, community health worker, or medication aide who in good
faith makes a report under this chapter or any other provision of the
Revised Code regarding a violation of this chapter or any other
provision of the Revised Code, or participates in any investigation,
administrative proceeding, or judicial proceeding resulting from the
report, has the full protection against retaliatory action provided
by sections 4113.51 to 4113.53 of the Revised Code.
Sec.
4723.34.
(A)
A person or governmental entity that employs, or contracts directly
or through another person or governmental entity for the provision of
services by, registered nurses, licensed practical nurses, nurses
holding multistate licenses to practice registered or licensed
practical nursing issued pursuant to section 4723.11 of the Revised
Code,
certified
midwives,
dialysis
technicians, medication aides, or certified community health workers
and that knows or has reason to believe that a current or former
employee or person providing services under a contract who holds a
license or certificate issued under this chapter engaged in conduct
that would be grounds for disciplinary action by the board of nursing
under this chapter or rules adopted under it shall report to the
board of nursing the name of such current or former employee or
person providing services under a contract. The report shall be made
on the person's or governmental entity's behalf by an individual
licensed by the board who the person or governmental entity has
designated to make such reports.
A
prosecutor in a case described in divisions (B)(3) to (5) of section
4723.28 of the Revised Code, or in a case where the trial court
issued an order of dismissal upon technical or procedural grounds of
a charge of a misdemeanor committed in the course of practice, a
felony charge, or a charge of gross immorality or moral turpitude,
who knows or has reason to believe that the person charged is
licensed under this chapter to practice nursing as a registered nurse
or as a licensed practical nurse
,
is licensed under this chapter to practice as a certified midwife,
or holds a certificate issued under this chapter to practice as a
dialysis technician shall notify the board of nursing of the charge.
With regard to certified community health workers and medication
aides, the prosecutor in a case involving a charge of a misdemeanor
committed in the course of employment, a felony charge, or a charge
of gross immorality or moral turpitude, including a case dismissed on
technical or procedural grounds, who knows or has reason to believe
that the person charged holds a community health worker or medication
aide certificate issued under this chapter shall notify the board of
the charge.
Each
notification from a prosecutor shall be made on forms prescribed and
provided by the board. The report shall include the name and address
of the license or certificate holder, the charge, and the certified
court documents recording the action.
(B)
If any person or governmental entity fails to provide a report
required by this section, the board may seek an order from a court of
competent jurisdiction compelling submission of the report.
Sec.
4723.341.
(A)
As used in this section, "person" has the same meaning as
in section 1.59 of the Revised Code and also includes the board of
nursing and its members and employees; health care facilities,
associations, and societies; insurers; and individuals.
(B)
In the absence of fraud or bad faith, no person reporting to the
board of nursing or testifying in an adjudication conducted under
Chapter 119. of the Revised Code with regard to alleged incidents of
negligence or malpractice or matters subject to this chapter or
sections 3123.41 to 3123.50 of the Revised Code and any applicable
rules adopted under section 3123.63 of the Revised Code shall be
subject to either of the following based on making the report or
testifying:
(1)
Liability in damages in a civil action for injury, death, or loss to
person or property;
(2)
Discipline or dismissal by an employer.
(C)
An individual who is disciplined or dismissed in violation of
division (B)(2) of this section has the same rights and duties
accorded an employee under sections 4113.52 and 4113.53 of the
Revised Code.
(D)
In the absence of fraud or bad faith, no professional association of
registered nurses, advanced practice registered nurses, licensed
practical nurses,
certified
midwives,
dialysis
technicians, community health workers, or medication aides that
sponsors a committee or program to provide peer assistance to
individuals with substance abuse problems, no representative or agent
of such a committee or program, and no member of the board of nursing
shall be liable to any person for damages in a civil action by reason
of actions taken to refer a nurse,
certified
midwife,
dialysis
technician, community health worker, or medication aide to a
treatment provider or actions or omissions of the provider in
treating a nurse,
certified
midwife,
dialysis
technician, community health worker, or medication aide.
Sec.
4723.35.
(A)
As used in this section and section 4723.351 of the Revised Code:
(1)
"Applicant" means an individual who has applied for a
license or certificate to practice issued under this chapter.
"Applicant" may include an individual who has been granted
authority by the board of nursing to practice as one type of
practitioner, but has applied for authority to practice as another
type of practitioner.
(2)
"Impaired" or "impairment" means either or both
of the following:
(a)
Impairment of the ability to practice as described in division
(B)(10) of section 4723.28 of the Revised Code;
(b)
Impairment of the ability to practice as described in division
(B)(11) of section 4723.28 of the Revised Code.
(3)
"Practitioner" means an individual authorized under this
chapter to practice as a registered nurse, including as an advanced
practice registered nurse, licensed practical nurse,
certified midwife,
dialysis technician, community health worker, or medication aide.
(B)
The board of nursing shall establish the safe haven program to
monitor applicants and practitioners who are or may be impaired, but
against whom the board has abstained from taking disciplinary action.
The program is to be conducted by the monitoring organization under
contract with the board as described in section 4723.351 of the
Revised Code.
(C)(1)
On the establishment of the program, the board may transfer to the
monitoring organization, in whole or in part, either or both of the
following responsibilities:
(a)
The monitoring and oversight of licensees as part of the substance
use disorder program as that program existed on or before
the effective date of this section
September 20, 2024
;
(b)
The monitoring and oversight of licensees under terms specified in a
board adjudication order or consent agreement.
(2)
If the board transfers the responsibilities described in division
(C)(1) of this section, both of the following apply:
(a)
The monitoring organization shall provide to the board quarterly
reports regarding the compliance of transferred licensees.
(b)
The monitoring organization shall immediately report to the board any
licensee who is not in compliance with the terms and conditions of
monitoring.
(D)
The board shall refer to the monitoring organization any applicant or
practitioner whose health and effectiveness show signs of impairment
or potential impairment, but only if the applicant or practitioner
meets the eligibility conditions of division (G) of this section.
(E)
Determinations regarding an applicant's or practitioner's eligibility
for admission to, continued participation in, and successful
completion of the safe haven program shall be made by the monitoring
organization in accordance with rules adopted under section 4723.351
of the Revised Code.
(F)
The board shall abstain from taking disciplinary action under section
4723.28, 4723.652, or 4723.86 of the Revised Code against an
individual whose health and effectiveness show signs of impairment or
potential impairment, but who is not currently under the terms of a
consent agreement with the board for impairment or an order issued by
the board for impairment if the individual is participating in the
safe haven program.
An
applicant's or practitioner's impairment neither excuses an applicant
or practitioner who has committed other violations of this chapter
nor precludes the board from investigating or taking disciplinary
action against an applicant or practitioner for other violations of
this chapter.
(G)
An applicant or practitioner is eligible to participate in the safe
haven program if both of the following conditions are met:
(1)
The applicant or practitioner needs assistance with impairment or
potential impairment.
(2)
The applicant or practitioner has an unencumbered license and is not
currently under the terms of a consent agreement with the board for
impairment or an order issued by the board for impairment.
Sec.
4723.41.
(A)
Each person who desires to practice nursing as a certified
nurse-midwife and has not been authorized to practice
midwifery
nurse-midwifery
prior
to December 1, 1967, and each person who desires to practice nursing
as a certified registered nurse anesthetist, clinical nurse
specialist, or certified nurse practitioner shall file with the board
of nursing a written application for a license to practice nursing as
an advanced practice registered nurse and designation in the desired
specialty. The application must be filed, under oath, on a form
prescribed by the board accompanied by the application fee required
by section 4723.08 of the Revised Code.
Except
as provided in division (B), (C), or (D) of this section, at the time
of making application, the applicant shall meet all of the following
requirements:
(1)
Be a registered nurse;
(2)
Submit documentation satisfactory to the board that the applicant has
earned a master's or doctoral degree with a major in a nursing
specialty or in a related field that qualifies the applicant to sit
for the certification examination of a national certifying
organization approved by the board under section 4723.46 of the
Revised Code;
(3)
Submit documentation satisfactory to the board of having passed the
certification examination of a national certifying organization
approved by the board under section 4723.46 of the Revised Code to
examine and certify, as applicable, nurse-midwives, registered nurse
anesthetists, clinical nurse specialists, or nurse practitioners;
(4)
Submit an affidavit with the application that states all of the
following:
(a)
That the applicant is the person named in the documents submitted
under this section and is the lawful possessor thereof;
(b)
The applicant's age, residence, the school at which the applicant
obtained education in the applicant's nursing specialty, and any
other facts that the board requires;
(c)
The specialty in which the applicant seeks designation.
(B)(1)
A certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner who is
practicing or has practiced as such in another jurisdiction other
than another state may apply for a license by endorsement to practice
nursing as an advanced practice registered nurse and designation as a
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner in this
state if the nurse meets the requirements set forth in division (A)
of this section or division (B)(2) of this section.
(2)
If an applicant who is practicing or has practiced in another
jurisdiction other than another state applies for designation under
division (B)(2) of this section, the application shall be submitted
to the board in the form prescribed by rules of the board and be
accompanied by the application fee required by section 4723.08 of the
Revised Code. The application shall include evidence that the
applicant meets the requirements of division (B)(2) of this section,
holds authority to practice nursing and is in good standing in
another jurisdiction other than another state granted after meeting
requirements approved by the entity of that jurisdiction that
regulates nurses, and other information required by rules of the
board of nursing.
With
respect to the educational requirements and national certification
requirements that an applicant under division (B)(2) of this section
must meet, both of the following apply:
(a)
If the applicant is a certified registered nurse anesthetist,
certified nurse-midwife, or certified nurse practitioner who, on or
before December 31, 2000, obtained certification in the applicant's
nursing specialty with a national certifying organization listed in
division (A)(3) of section 4723.41 of the Revised Code as that
division existed prior to March 20, 2013, or that was at that time
approved by the board under section 4723.46 of the Revised Code, the
applicant must have maintained the certification. The applicant is
not required to have earned a master's or doctoral degree with a
major in a nursing specialty or in a related field that qualifies the
applicant to sit for the certification examination.
(b)
If the applicant is a clinical nurse specialist, one of the following
must apply to the applicant:
(i)
On or before December 31, 2000, the applicant obtained a master's or
doctoral degree with a major in a clinical area of nursing from an
educational institution accredited by a national or regional
accrediting organization. The applicant is not required to have
passed a certification examination.
(ii)
On or before December 31, 2000, the applicant obtained a master's or
doctoral degree in nursing or a related field and was certified as a
clinical nurse specialist by the American nurses credentialing center
or another national certifying organization that was at that time
approved by the board under section 4723.46 of the Revised Code.
(3)
The board shall grant a license to practice nursing as an advanced
practice registered nurse in accordance with Chapter 4796. of the
Revised Code to an applicant if either of the following applies:
(a)
The applicant holds a license in another state.
(b)
The applicant has satisfactory work experience, a government
certification, or a private certification as described in that
chapter as an advanced practice registered nurse in a state that does
not issue that license.
(4)
The board may grant a nonrenewable temporary permit to practice
nursing as an advanced practice registered nurse to an applicant for
licensure under division (B)(2) or (3) of this section if the board
is satisfied by the evidence that the applicant holds a valid,
unrestricted license in or equivalent authorization from another
jurisdiction. Chapter 4796. of the Revised Code does not apply to a
temporary permit issued under this division. The temporary permit
shall expire at the earlier of one hundred eighty days after issuance
or upon the issuance of a license under division (B)(2) or (3) of
this section.
(C)
An applicant who desires to practice nursing as a certified
registered nurse anesthetist, certified nurse-midwife, or certified
nurse practitioner is exempt from the educational requirements in
division (A)(2) of this section if all of the following are the case:
(1)
Before January 1, 2001, the board issued to the applicant a
certificate of authority to practice as a certified registered nurse
anesthetist, certified nurse-midwife, or certified nurse
practitioner;
(2)
The applicant submits documentation satisfactory to the board that
the applicant obtained certification in the applicant's nursing
specialty with a national certifying organization listed in division
(A)(3) of section 4723.41 of the Revised Code as that division
existed prior to March 20, 2013, or that was at that time approved by
the board under section 4723.46 of the Revised Code;
(3)
The applicant submits documentation satisfactory to the board that
the applicant has maintained the certification described in division
(C)(2) of this section.
(D)
An applicant who desires to practice as a clinical nurse specialist
is exempt from the examination requirement in division (A)(3) of this
section if both of the following are the case:
(1)
Before January 1, 2001, the board issued to the applicant a
certificate of authority to practice as a clinical nurse specialist;
(2)
The applicant submits documentation satisfactory to the board that
the applicant earned either of the following:
(a)
A master's or doctoral degree with a major in a clinical area of
nursing from an educational institution accredited by a national or
regional accrediting organization;
(b)
A master's or doctoral degree in nursing or a related field and was
certified as a clinical nurse specialist by the American nurses
credentialing center or another national certifying organization that
was at that time approved by the board under section 4723.46 of the
Revised Code.
Sec.
4723.43.
A
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner 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) of this section, and a clinical nurse
specialist is subject to division (D) of this section.
(A)
A
Subject
to sections 4723.58 to 4723.584 of the Revised Code, 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
outside of the scope of practice for certified nurse-midwives
established by the American college of nurse-midwives
,
except in emergencies
.
No certified nurse-midwife may deliver breech or face presentation
except in an emergency or as provided in section 4723.581 of the
Revised Code
.
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.
A certified nurse-midwife may, in collaboration with one or more
physicians, attend births in hospitals, homes, medical offices, and
freestanding birthing centers and provide care for normal newborns
during the period consistent with the scope of practice for certified
nurse-midwives established by the American college of nurse-midwives.
(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. 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)
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. 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.
Sec.
4723.431.
(A)(1)
An
A
certified midwife or an
advanced
practice registered nurse who is designated as a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
may practice only in accordance with a standard care arrangement
entered into with each physician or podiatrist with whom the
certified
midwife or
nurse
collaborates. A copy of the standard care arrangement shall be
retained on file by the
certified
midwife's or
nurse's
employer. Prior approval of the standard care arrangement by the
board of nursing is not required, but the board may periodically
review it for compliance with this section.
A
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner may enter into a standard care arrangement with one or
more collaborating physicians or podiatrists. If a collaborating
physician or podiatrist enters into standard care arrangements with
more than five
certified
midwives or
nurses,
the physician or podiatrist shall not collaborate at the same time
with more than five
certified
midwives or
nurses
in the prescribing component of their practices.
Not
later than thirty days after first engaging in the practice of
midwifery
as a certified midwife or the practice of
nursing
as a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner, the
certified
midwife or
nurse
shall submit to the board the name and business address of each
collaborating physician or podiatrist. Thereafter, the
certified
midwife or
nurse
shall notify the board of any additions or deletions to the
midwife's
or
nurse's
collaborating physicians or podiatrists. Except as provided in
division (D) of this section, the notice must be provided not later
than thirty days after the change takes effect.
(2)
All of the following conditions apply with respect to the practice of
a collaborating physician or podiatrist with whom a
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner may enter into a standard care arrangement:
(a)
The physician or podiatrist must be authorized to practice in this
state.
(b)
Except as provided in division (A)(2)(c) of this section, the
physician or podiatrist must be practicing in a specialty that is the
same as or similar to the
certified
midwife's specialty or
nurse's
nursing specialty.
(c)
If the nurse is a clinical nurse specialist who is certified as a
psychiatric-mental health CNS or the equivalent of such title by the
American nurses credentialing center or a certified nurse
practitioner who is certified as a psychiatric-mental health NP or
the equivalent of such title by the American nurses credentialing
center or American academy of nurse practitioners certification
board, the nurse may enter into a standard care arrangement with a
physician but not a podiatrist and the collaborating physician must
be practicing in one of the following specialties:
(i)
Psychiatry;
(ii)
Pediatrics;
(iii)
Primary care or family practice.
(B)
A standard care arrangement shall be in writing and shall contain all
of the following:
(1)
Criteria for referral of a patient by the
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner to a collaborating physician or podiatrist or another
physician or podiatrist;
(2)
A process for the
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner to obtain a consultation with a collaborating physician
or podiatrist or another physician or podiatrist;
(3)
A plan for coverage in instances of emergency or planned absences of
either the
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner or a collaborating physician or podiatrist that provides
the means whereby a physician or podiatrist is available for
emergency care;
(4)
The process for resolution of disagreements regarding matters of
patient management between the
certified
midwife,
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner and a collaborating physician or podiatrist;
(5)
An agreement that the collaborating physician shall complete and sign
the medical certificate of death pursuant to section 3705.16 of the
Revised Code;
(6)
Any other criteria required by rule of the board adopted pursuant to
section 4723.07 or 4723.50 of the Revised Code.
(C)
A standard care arrangement entered into pursuant to this section may
permit a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner to do any of the following:
(1)
Supervise services provided by a home health agency as defined in
section 3740.01 of the Revised Code;
(2)
Admit a patient to a hospital in accordance with section 3727.06 of
the Revised Code;
(3)
Sign any document relating to the admission, treatment, or discharge
of an inpatient receiving psychiatric or other behavioral health care
services, but only if the conditions of section 4723.436 of the
Revised Code have been met.
(D)(1)
Except as provided in division (D)(2) of this section, if a physician
or podiatrist terminates the collaboration between the physician or
podiatrist and a
certified
midwife,
certified
nurse-midwife, certified nurse practitioner, or clinical nurse
specialist before their standard care arrangement expires, all of the
following apply:
(a)
The physician or podiatrist must give the
certified
midwife or
nurse
written or electronic notice of the termination.
(b)
Once the
certified
midwife or
nurse
receives the termination notice, the
certified
midwife or
nurse
must notify the board of nursing of the termination as soon as
practicable by submitting to the board a copy of the physician's or
podiatrist's termination notice.
(c)
Notwithstanding the
requirement
requirements
of
section
sections
4723.43
and 4723.57
of the Revised Code that the
certified
midwife or
nurse
practice in collaboration with a physician or podiatrist, the
certified
midwife or
nurse
may continue to practice under the existing standard care arrangement
without a collaborating physician or podiatrist for not more than one
hundred twenty days after submitting to the board a copy of the
termination notice.
(2)
In the event that the collaboration between a physician or podiatrist
and a
certified
midwife,
certified
nurse-midwife, certified nurse practitioner, or clinical nurse
specialist terminates because of the physician's or podiatrist's
death, the
certified
midwife or
nurse
must notify the board of the death as soon as practicable. The
certified
midwife or
nurse
may continue to practice under the existing standard care arrangement
without a collaborating physician or podiatrist for not more than one
hundred twenty days after notifying the board of the physician's or
podiatrist's death.
(E)(1)
Nothing in this section prohibits a hospital from hiring a
certified
midwife,
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.
(2)
Nothing in this section prohibits a standard care arrangement from
specifying actions that a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner is authorized to take,
or is prohibited from taking, as part of the nurse's practice in
collaboration with a physician or podiatrist. In specifying such
actions, the standard care arrangement shall not authorize the nurse
to take any action that is otherwise prohibited by the Revised Code
or rule of the board.
Sec.
4723.432.
(A)
An
A
certified midwife or 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
certified
midwife or
nurse.
The
certified
midwife
or
nurse
shall cooperate with the board in any investigation the board
conducts with respect to the unauthorized practice of medicine by the
certified
midwife or
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 with respect to a physician, podiatrist, or dentist who
permits the nurse to practice with the supervision of that physician,
podiatrist, or dentist. The nurse shall cooperate with either board
in any investigation it conducts with respect to the unauthorized
practice of medicine or dentistry by the nurse.
Sec.
4723.481.
This
section establishes standards and conditions regarding the authority
of an advanced practice registered nurse who is designated as a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner to prescribe and personally furnish drugs and
therapeutic devices under a license issued under section 4723.42 of
the Revised Code.
This
section also establishes standards and conditions regarding the
authority of a certified midwife to prescribe and personally furnish
drugs and therapeutic devices under a license issued under section
4723.56 of the Revised Code.
(A)
A clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
shall not prescribe or furnish any drug or therapeutic device that is
listed on the exclusionary formulary established in rules adopted
under section 4723.50 of the Revised Code.
(B)
The prescriptive authority of a clinical nurse specialist, certified
nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
shall not exceed the prescriptive authority of the collaborating
physician or podiatrist, including the collaborating physician's
authority to treat chronic pain with controlled substances and
products containing tramadol as described in section 4731.052 of the
Revised Code.
(C)(1)
Except as provided in division (C)(2) or (3) of this section, a
clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
may prescribe to a patient a schedule II controlled substance only if
all of the following are the case:
(a)
The patient has a terminal condition, as defined in section 2133.01
of the Revised Code.
(b)
A physician initially prescribed the substance for the patient.
(c)
The prescription is for an amount that does not exceed the amount
necessary for the patient's use in a single, seventy-two-hour period.
(2)
The restrictions on prescriptive authority in division (C)(1) of this
section do not apply if a clinical nurse specialist, certified
nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
issues the prescription to the patient from any of the following
entities:
(a)
A hospital as defined in section 3722.01 of the Revised Code;
(b)
An entity owned or controlled, in whole or in part, by a hospital or
by an entity that owns or controls, in whole or in part, one or more
hospitals;
(c)
A health care facility operated by the department of mental health
and addiction services or the department of developmental
disabilities;
(d)
A nursing home licensed under section 3721.02 of the Revised Code or
by a political subdivision certified under section 3721.09 of the
Revised Code;
(e)
A county home or district home operated under Chapter 5155. of the
Revised Code that is certified under the medicare or medicaid
program;
(f)
A hospice care program, as defined in section 3712.01 of the Revised
Code;
(g)
A community mental health services provider, as defined in section
5122.01 of the Revised Code;
(h)
An ambulatory surgical facility, as defined in section 3702.30 of the
Revised Code;
(i)
A freestanding birthing center, as defined in section 3701.503 of the
Revised Code;
(j)
A federally qualified health center, as defined in section 3701.047
of the Revised Code;
(k)
A federally qualified health center look-alike, as defined in section
3701.047 of the Revised Code;
(l)
A health care office or facility operated by the board of health of a
city or general health district or the authority having the duties of
a board of health under section 3709.05 of the Revised Code;
(m)
A site where a medical practice is operated, but only if the practice
is comprised of one or more physicians who also are owners of the
practice; the practice is organized to provide direct patient care;
and the clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
providing services at the site has a standard care arrangement and
collaborates with at least one of the physician owners who practices
primarily at that site;
(n)
A site where a behavioral health practice is operated that does not
qualify as a location otherwise described in division (C)(2) of this
section, but only if the practice is organized to provide outpatient
services for the treatment of mental health conditions, substance use
disorders, or both, and the clinical nurse specialist, certified
nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
providing services at the site of the practice has a standard care
arrangement and collaborates with at least one physician who is
employed by that practice;
(o)
A residential care facility, as defined in section 3721.01 of the
Revised Code.
(3)
A clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
shall not issue to a patient a prescription for a schedule II
controlled substance from a convenience care clinic even if the
clinic is owned or operated by an entity specified in division (C)(2)
of this section.
(D)
A pharmacist who acts in good faith reliance on a prescription issued
by a clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
under division (C)(2) of this section is not liable for or subject to
any of the following for relying on the prescription: damages in any
civil action, prosecution in any criminal proceeding, or professional
disciplinary action by the state board of pharmacy under Chapter
4729. of the Revised Code.
(E)
A clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
shall comply with section 3719.061 of the Revised Code if the nurse
prescribes for a minor, as defined in that section, an opioid
analgesic, as defined in section 3719.01 of the Revised Code.
Sec.
4723.483.
(A)(1)
Subject to division (A)(2) of this section, and notwithstanding any
provision of this chapter or rule adopted by the board of nursing, a
clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
who holds a certificate to prescribe issued under section 4723.48 of
the Revised Code
,
or certified midwife
may do either of the following without having examined an individual
to whom epinephrine may be administered:
(a)
Personally furnish a supply of epinephrine autoinjectors for use in
accordance with sections 3313.7110, 3313.7111, 3314.143, 3326.28,
3328.29, 3728.03 to 3728.05, and 5180.26 of the Revised Code;
(b)
Issue a prescription for epinephrine autoinjectors for use in
accordance with sections 3313.7110, 3313.7111, 3314.143, 3326.28,
3328.29, 3728.03 to 3728.05, and 5180.26 of the Revised Code.
(2)
An epinephrine autoinjector personally furnished or prescribed under
division (A)(1) of this section must be furnished or prescribed in
such a manner that it may be administered only in a manufactured
dosage form.
(B)
A nurse
or certified midwife
who acts in good faith in accordance with this section is not liable
for or subject to any of the following for any action or omission of
an entity to which an epinephrine autoinjector is furnished or a
prescription is issued: damages in any civil action, prosecution in
any criminal proceeding, or professional disciplinary action.
Sec.
4723.487.
(A)
As used in this section:
(1)
"Drug database" means the database established and
maintained by the state board of pharmacy pursuant to section 4729.75
of the Revised Code.
(2)
"Opioid analgesic" and "benzodiazepine" have the
same meanings as in section 3719.01 of the Revised Code.
(B)
Except as provided in divisions (C) and (E) of this section, an
advanced practice registered nurse who is designated as a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner
or
a certified midwife
shall
comply with all of the following as conditions of prescribing a drug
that is either an opioid analgesic or a benzodiazepine as part of a
patient's course of treatment for a particular condition:
(1)
Before initially prescribing the drug, the advanced practice
registered nurse or
certified
midwife or
the
advanced practice registered nurse's
or
certified midwife's
delegate
shall request from the drug database a report of information related
to the patient that covers at least the twelve months immediately
preceding the date of the request. If the advanced practice
registered nurse
or
certified midwife
practices
primarily in a county of this state that adjoins another state, the
advanced practice registered nurse
or
certified midwife
or
delegate also shall request a report of any information available in
the drug database that pertains to prescriptions issued or drugs
furnished to the patient in the state adjoining that county.
(2)
If the patient's course of treatment for the condition continues for
more than ninety days after the initial report is requested, the
advanced practice registered nurse
or
certified midwife
or
delegate shall make periodic requests for reports of information from
the drug database until the course of treatment has ended. The
requests shall be made at intervals not exceeding ninety days,
determined according to the date the initial request was made. The
request shall be made in the same manner provided in division (B)(1)
of this section for requesting the initial report of information from
the drug database.
(3)
On receipt of a report under division (B)(1) or (2) of this section,
the advanced practice registered nurse
or
certified midwife
shall
assess the information in the report. The advanced practice
registered nurse
or
certified midwife
shall
document in the patient's record that the report was received and the
information was assessed.
(C)
Division (B) of this section does not apply
if
in
any of the following circumstances:
(1)
A drug database report regarding the patient is not available, in
which case the advanced practice registered nurse
or
certified midwife
shall
document in the patient's record the reason that the report is not
available.
(2)
The drug is prescribed in an amount indicated for a period not to
exceed seven days.
(3)
The drug is prescribed for the treatment of cancer or another
condition associated with cancer.
(4)
The drug is prescribed to a hospice patient in a hospice care
program, as those terms are defined in section 3712.01 of the Revised
Code, or any other patient diagnosed as terminally ill.
(5)
The drug is prescribed for administration in a hospital, nursing
home, or residential care facility.
(D)
The board of nursing may adopt rules, in accordance with Chapter 119.
of the Revised Code, that establish standards and procedures to be
followed by an advanced practice registered nurse
or
certified midwife
regarding
the review of patient information available through the drug database
under division (A)(5) of section 4729.80 of the Revised Code. The
rules shall be adopted in accordance with Chapter 119. of the Revised
Code.
(E)
This section and any rules adopted under it do not apply if the state
board of pharmacy no longer maintains the drug database.
Sec.
4723.488.
(A)
Except as provided in division (B) of this section, in the case of a
license holder who is seeking renewal of a license to practice
nursing as an advanced practice registered nurse
or
a license to practice as a certified midwife
and
who prescribes opioid analgesics or benzodiazepines, as defined in
section 3719.01 of the Revised Code, the holder shall certify to the
board whether the holder has been granted access to the drug database
established and maintained by the state board of pharmacy pursuant to
section 4729.75 of the Revised Code.
(B)
The requirement in division (A) of this section does not apply if any
of the following is the case:
(1)
The state board of pharmacy notifies the board of nursing pursuant to
section 4729.861 of the Revised Code that the license holder has been
restricted from obtaining further information from the drug database.
(2)
The state board of pharmacy no longer maintains the drug database.
(3)
The license holder does not practice
nursing
as
an advanced practice registered nurse or certified midwife
in
this state.
(C)
If a license holder certifies to the board of nursing that the holder
has been granted access to the drug database and the board finds
through an audit or other means that the holder has not been granted
access, the board may take action under section 4723.28 of the
Revised Code.
Sec.
4723.4810.
(A)(1)
Notwithstanding any conflicting provision of this chapter or rule
adopted by the board of nursing, a clinical nurse specialist,
certified nurse-midwife,
or
certified
nurse practitioner
,
who
holds a license to practice nursing as an advanced practice
registered nurse issued under section 4723.42 of the Revised Code
or
certified midwife
may
issue a prescription for or personally furnish a complete or partial
supply of a drug to treat chlamydia, gonorrhea, or trichomoniasis,
without having examined the individual for whom the drug is intended,
if all of the following conditions are met:
(a)
The individual is a sexual partner of the nurse's
or
certified midwife's
patient.
(b)
The patient has been diagnosed with chlamydia, gonorrhea, or
trichomoniasis.
(c)
The patient reports to the nurse
or
certified midwife
that
the individual is unable or unlikely to be evaluated or treated by a
health professional.
(2)
A prescription issued under this section shall include the
individual's name and address, if known. If the nurse
or
certified midwife
is
unable to obtain the individual's name and address, the prescription
shall include the patient's name and address and the words "expedited
partner therapy" or the letters "EPT."
(3)
A nurse
or
certified midwife
may
prescribe or personally furnish a drug under this section for not
more than a total of two individuals who are sexual partners of the
nurse's
or certified midwife's
patient.
(B)
For each drug prescribed or personally furnished under this section,
the nurse
or
certified midwife
shall
do all of the following:
(1)
Provide the patient with information concerning the drug for the
purpose of sharing the information with the individual, including
directions for use of the drug and any side effects, adverse
reactions, or known contraindications associated with the drug;
(2)
Recommend to the patient that the individual seek treatment from a
health professional;
(3)
Document all of the following in the patient's record:
(a)
The name of the drug prescribed or furnished and its dosage;
(b)
That information concerning the drug was provided to the patient for
the purpose of sharing the information with the individual;
(c)
If known, any adverse reactions the individual experiences from
treatment with the drug.
(C)
A nurse
or
certified midwife
who
prescribes or personally furnishes a drug under this section may
contact the individual for whom the drug is intended.
(1)
If the nurse
or
certified midwife
contacts
the individual, the nurse
or
certified midwife
shall
do all of the following:
(a)
Inform the individual that the individual may have been exposed to
chlamydia, gonorrhea, or trichomoniasis;
(b)
Encourage the individual to seek treatment from a health
professional;
(c)
Explain the treatment options available to the individual, including
treatment with a prescription drug, directions for use of the drug,
and any side effects, adverse reactions, or known contraindications
associated with the drug;
(d)
Document in the patient's record that the nurse
or
certified midwife
contacted
the individual.
(2)
If the nurse
or
certified midwife
does
not contact the individual, the nurse
or
certified midwife
shall
document that fact in the patient's record.
(D)
A nurse
or
certified midwife
who
in good faith prescribes or personally furnishes a drug under this
section is not liable for or subject to any of the following:
(1)
Damages in any civil action;
(2)
Prosecution in any criminal proceeding;
(3)
Professional disciplinary action.
Sec.
4723.4811.
(A)(1)
Subject to division (A)(2) of this section, and notwithstanding any
provision of this chapter or rule adopted by the board of nursing, a
clinical nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
licensed as an advanced practice registered nurse under Chapter 4723.
of the Revised Code
,
or certified midwife
may do either of the following without having examined an individual
to whom glucagon may be administered:
(a)
Personally furnish a supply of injectable or nasally administered
glucagon for use in accordance with sections 3313.7115, 3313.7116,
3314.147, 3326.60, 3328.38, and 5180.262 of the Revised Code;
(b)
Issue a prescription for injectable or nasally administered glucagon
for use in accordance with sections 3313.7115, 3313.7116, 3314.147,
3326.60, 3328.38, and 5180.262 of the Revised Code.
(2)
Injectable or nasally administered glucagon personally furnished or
prescribed under division (A)(1) of this section must be furnished or
prescribed in such a manner that it may be administered only in a
manufactured dosage form.
(B)
A nurse
or certified midwife
who acts in good faith in accordance with this section is not liable
for or subject to any of the following for any action or omission of
an entity to which injectable or nasally administered glucagon is
furnished or a prescription is issued: damages in any civil action,
prosecution in any criminal proceeding, or professional disciplinary
action.
Sec.
4723.50.
(A)
As used in this section:
(1)
"Controlled substance" has the same meaning as in section
3719.01 of the Revised Code.
(2)
"Medication-assisted treatment" has the same meaning as in
section 340.01 of the Revised Code.
(B)
In accordance with Chapter 119. of the Revised Code, the board of
nursing shall adopt rules as necessary to implement the provisions of
this chapter pertaining to the authority of
advanced
practice registered nurses who are designated as
clinical
nurse specialists, certified nurse-midwives,
and
certified
nurse practitioners
,
and certified midwives
to prescribe and furnish drugs and therapeutic devices.
The
board shall adopt rules establishing an exclusionary formulary. The
exclusionary formulary shall permit, in a manner consistent with
section 4723.481 of the Revised Code, the prescribing of controlled
substances, including drugs that contain buprenorphine used in
medication-assisted treatment and both oral and long-acting opioid
antagonists. The formulary shall not permit the prescribing or
furnishing of any of the following:
(1)
A drug or device to perform or induce an abortion;
(2)
A drug or device prohibited by federal or state law.
(C)
In addition to the rules described in division (B) of this section,
the board shall adopt rules under this section that do the following:
(1)
Establish standards for board approval of the course of study in
advanced pharmacology and related topics required by
section
sections
4723.482
and
4723.551
of
the Revised Code;
(2)
Establish requirements for board approval of the two-hour course of
instruction in the laws of this state as required under division
(C)(1) of section 4723.482 of the Revised Code;
(3)
Establish criteria for the components of the standard care
arrangements described in section 4723.431 of the Revised Code that
apply to the authority to prescribe, including the components that
apply to the authority to prescribe schedule II controlled
substances. The rules shall be consistent with that section and
include all of the following:
(a)
Quality assurance standards;
(b)
Standards for periodic review by a collaborating physician or
podiatrist of the records of patients treated by the clinical nurse
specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
;
(c)
Acceptable travel time between the location at which the clinical
nurse specialist, certified nurse-midwife,
or
certified
nurse practitioner
,
or certified midwife
is engaging in the prescribing components of the nurse's practice and
the location of the nurse's
or
certified midwife's
collaborating
physician or podiatrist.
Sec.
4723.53.
As
used in sections 4723.43 and 4723.53 to 4723.60 of the Revised Code:
(A)
"Accreditation commission for midwifery education" means
the organization known by that name or its successor organization.
(B)
"American college of nurse-midwives" means the organization
known by that name or its successor organization.
(C)
"American midwifery certification board" means the
organization known by that name or its successor organization.
Sec.
4723.54.
(A)
Except as provided in division (B) of this section, no individual
shall knowingly practice as a certified midwife unless the individual
holds a current, valid license to practice as a certified midwife
issued under section 4723.56 of the Revised Code.
(B)
Division (A) of this section does not apply to any of the following:
(1)
A physician authorized under Chapter 4731. of the Revised Code to
practice medicine and surgery, osteopathic medicine and surgery, or
podiatric medicine and surgery;
(2)
A physician assistant authorized under Chapter 4730. of the Revised
Code to practice as a physician assistant;
(3)
A registered nurse, advanced practice registered nurse, or licensed
practical nurse authorized under this chapter to practice nursing as
a registered nurse, advanced practice registered nurse, or licensed
practical nurse;
(4)
A licensed midwife;
(5)
A traditional midwife;
(6)
A student who is participating in a midwifery education program
accredited by the accreditation commission for midwifery education
and who provides midwifery services under the auspices of the program
and under the supervision of a certified midwife serving for the
program as a faculty member, instructor, teaching assistant, or
preceptor.
Sec.
4723.55.
(A)
An individual seeking a license to practice as a certified midwife
shall file with the board of nursing an application in a manner
prescribed by the board. The application shall include all the
information the board considers necessary to process the application,
including evidence satisfactory to the board that the applicant meets
the requirements specified in division (B) of this section.
(B)
To be eligible to receive a license to practice as a certified
midwife, an applicant shall demonstrate to the board that the
applicant meets all of the following requirements:
(1)
Is at least eighteen years of age;
(2)
Has attained a master's degree or higher;
(3)
Has graduated from a midwifery education program accredited by the
accreditation commission for midwifery education;
(4)
Is certified by the American midwifery certification board;
(5)
Is certified in neonatal and adult cardiopulmonary resuscitation;
(6)
Has successfully completed the course of study in advanced
pharmacology required by section 4723.551 of the Revised Code.
(C)
The board shall review all applications received under this section.
After receiving an application it considers complete, the board shall
determine whether the applicant meets the requirements for a license
to practice as a certified midwife.
Sec.
4723.551.
(A)
An applicant for a license to practice as a certified midwife shall
include with the application submitted under section 4723.55 of the
Revised Code evidence of successfully completing the course of study
in advanced pharmacology and related topics in accordance with the
requirements specified in division (B) of this section.
(B)
With respect to the course of study in advanced pharmacology and
related topics, all of the following requirements apply:
(1)
The course of study shall be completed not more than five years
before the application is filed.
(2)
The course of study shall include at least forty-five contact hours.
(3)
The course of study shall meet the requirements to be approved by the
board in accordance with standards established in rules adopted under
section 4723.50 of the Revised Code.
(4)
The content of the course of study shall be specific to midwifery.
(5)
The instruction provided in the course of study shall include all of
the following:
(a)
A minimum of thirty-six contact hours of instruction in advanced
pharmacology that includes pharmacokinetic principles and clinical
application and the use of drugs and therapeutic devices in the
prevention of illness and maintenance of health;
(b)
Instruction in the fiscal and ethical implications of prescribing
drugs and therapeutic devices;
(c)
Instruction in the state and federal laws that apply to the authority
to prescribe;
(d)
Instruction that is specific to schedule II controlled substances,
including instruction in all of the following:
(i)
Indications for the use of schedule II controlled substances in drug
therapies;
(ii)
The most recent guidelines for pain management therapies, as
established by state and national organizations such as the Ohio pain
initiative and the American pain society;
(iii)
Fiscal and ethical implications of prescribing schedule II controlled
substances;
(iv)
State and federal laws that apply to the authority to prescribe
schedule II controlled substances;
(v)
Prevention of abuse and diversion of schedule II controlled
substances, including identification of the risk of abuse and
diversion, recognition of abuse and diversion, types of assistance
available for prevention of abuse and diversion, and methods of
establishing safeguards against abuse and diversion.
Sec.
4723.56.
(A)
If the board of nursing determines under section 4723.55 of the
Revised Code that an applicant meets the requirements for a license
to practice as a certified midwife, the secretary of the board shall
issue the license to the applicant.
(B)
Each license shall be valid for a two-year period unless revoked or
suspended, shall expire on the date that is two years after the date
of issuance, and may be renewed for additional two-year periods in
accordance with rules adopted under section 4723.59 of the Revised
Code.
(C)
To renew a license to practice as a certified midwife, an applicant
for renewal shall demonstrate both of the following to the board:
(1)
That the applicant has maintained certification in neonatal and adult
cardiopulmonary resuscitation;
(2)
That the applicant has satisfied the continuing education
requirements of the American midwifery certification board.
Sec.
4723.57.
(A)
An individual who holds a current, valid license to practice as a
certified midwife may, in collaboration with one or more physicians,
engage in one or more of the following activities:
(1)
Providing primary health care services for women from adolescence and
beyond menopause, including the independent provision of gynecologic
and family planning services, preconception care, and care during
pregnancy, childbirth, and the postpartum period;
(2)
Attending births in hospitals, homes, medical offices, and
freestanding birthing centers;
(3)
Providing care for normal newborns during the period consistent with
the scope of practice for certified nurse-midwives established by the
American college of nurse-midwives;
(4)
Providing initial and ongoing comprehensive assessment, diagnosis,
and treatment;
(5)
Conducting physical examinations;
(6)
Ordering and interpreting laboratory and diagnostic tests;
(7)
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;
(8)
Providing care that includes health promotion, disease prevention,
and individualized wellness education and counseling.
(B)
When engaging in any of the activities permitted under this section,
a certified midwife shall maintain appropriate medical records
regarding patient history, treatment, and outcomes.
Sec.
4723.58.
(A)
This section establishes the process by which a certified
nurse-midwife or certified midwife obtains a patient's consent to
treatment authorized by section 4723.43 or 4723.57 of the Revised
Code, but only when the certified nurse-midwife or certified midwife
seeks to provide the treatment in a setting other than a hospital or
facility.
(B)
The following information shall be exchanged in writing between a
certified nurse-midwife or certified midwife and patient when
obtaining consent to treatment as described in division (A) of this
section:
(1)
The name and license number of the certified nurse-midwife or
certified midwife;
(2)
The patient's name, address, telephone number, and primary care
provider, if the patient has one;
(3)
A description of the certified nurse-midwife's or certified midwife's
education, training, and experience in nurse-midwifery or midwifery;
(4)
The certified nurse-midwife's or certified midwife's practice
philosophy;
(5)
A promise to provide the patient, upon request, with separate
documents describing the rules governing the practice of a certified
nurse-midwife or certified midwife, including a list of conditions
indicating the need for consultation, referral, transfer, or
mandatory transfer and the certified nurse-midwife's or certified
midwife's personal written practice guidelines;
(6)
A written plan for medical consultation and transfer of care;
(7)
A description of any hospital care and procedures that may be
necessary in the event of an emergency transfer or care;
(8)
A description of the services provided to the patient by the
certified nurse-midwife or certified midwife;
(9)
That the certified nurse-midwife or certified midwife holds a
current, valid license to practice issued under this chapter;
(10)
The availability of a grievance process;
(11)
Whether the certified nurse-midwife or certified midwife is covered
by professional liability insurance;
(12)
Any other information required in rules adopted by the board.
(C)
Once the required information has been exchanged and if the patient
consents to treatment, the patient and certified nurse-midwife or
certified midwife shall sign a written document to indicate as such.
The certified nurse-midwife or certified midwife shall retain a copy
of the document for at least four years from the date on which the
document was signed.
Sec.
4723.581.
(A)
The board of nursing shall adopt rules establishing the circumstances
in which a certified nurse-midwife or certified midwife shall be
prohibited from attending a home birth, which may include a high-risk
pregnancy. In adopting the rules, the board shall allow a certified
nurse-midwife or certified midwife to attend any of the following as
a home birth only if the conditions described in division (B) of this
section are satisfied: a vaginal birth after cesarean, birth of
twins, or breech birth.
(B)
In the event of a home birth described in division (A) of this
section, a certified nurse-midwife or certified midwife may attend
the birth only if all of the following conditions are satisfied:
(1)
In addition to the informed consent required under section 4723.58 of
the Revised Code, the certified nurse-midwife or certified midwife
obtains the patient's written informed consent for the vaginal birth
after cesarean, birth of twins, or breech birth, including a
description of risks associated with the procedure.
(2)
The certified nurse-midwife or certified midwife consults with a
physician about the patient and together with the physician
determines whether referral is appropriate for the patient.
If
a referral is determined to be appropriate and the patient consents
to the referral, the certified nurse-midwife or certified midwife
shall refer the patient to the physician. If the patient refuses the
referral, the certified nurse-midwife or certified midwife shall
document the refusal and may continue to provide care to the patient,
including attending the vaginal birth after cesarean, birth of twins,
or breech birth at home.
(3)
The certified nurse-midwife or certified midwife satisfies any other
conditions required in rules adopted by the board of nursing.
(C)
In adopting rules under this section, the board of nursing shall do
both of the following:
(1)
Consider any relevant peer-reviewed medical literature;
(2)
Specify the content and format of the document to be used when
obtaining informed consent as described in this section.
Sec.
4723.582.
(A)
As used in this section and section 4723.583 of the Revised Code,
"emergency medical service," "emergency medical
service personnel," and "emergency medical service
organization" have the same meanings as in section 4765.01 of
the Revised Code.
(B)
For any pregnancy or childbirth in which a certified nurse-midwife or
certified midwife provides care and a home birth is planned, both of
the following apply:
(1)
The certified nurse-midwife or certified midwife shall create an
individualized transfer of care plan with each patient.
(2)
The certified nurse-midwife or certified midwife shall assess the
status of the patient, fetus, and newborn throughout the maternity
care cycle and shall determine when or if a transfer to a hospital is
necessary.
(C)
Each individualized transfer of care plan shall contain all of the
following:
(1)
The name and location of geographically adjacent hospitals that are
appropriately equipped to provide emergency care, obstetrical care,
and newborn care;
(2)
The approximate travel time to each hospital;
(3)
A list of the modes of transport services available, including an
emergency medical service organization available by calling 9-1-1;
(4)
The requirements for activating each mode of transportation;
(5)
The mechanism by which medical records and other information
concerning the patient may be rapidly transmitted to each hospital;
(6)
Confirmation that the certified nurse-midwife or certified midwife
has recommended that the patient pre-register with the hospital
closest to the patient's home that is appropriately equipped to
provide emergency care, obstetrical care, and newborn care;
(7)
Contact information for either a health care provider or practice
group who has agreed in advance to accept patients in transfer, or a
hospital's preferred method of accessing care by the hospital's
designated provider on call;
(8)
Any other information required in rules adopted by the board of
nursing.
(D)
When it becomes necessary to transfer a patient, a certified
nurse-midwife or certified midwife shall notify the receiving
provider or hospital of all of the following:
(1)
The incoming transfer;
(2)
The reason for the transfer;
(3)
A brief relevant clinical history;
(4)
The planned mode of transport;
(5)
The expected time of arrival;
(6)
Any other information required in rules adopted by the board.
The
certified nurse-midwife or certified midwife shall continue to
provide routine or urgent care en route in coordination with any
emergency medical services personnel or emergency medical service
organization and shall address the psychosocial needs of the patient
during the change of birth setting.
(E)
On arrival at the hospital, the certified nurse-midwife or certified
midwife shall do all of the following:
(1)
Provide a verbal report that includes details on the patient's
current health status and the need for urgent care;
(2)
Provide a legible copy of relevant prenatal and labor medical
records;
(3)
Transfer clinical responsibility to the receiving provider or
hospital;
(4)
Satisfy any other requirement established in rules adopted by the
board of nursing.
If
the patient chooses, the certified nurse-midwife or certified midwife
may remain at the hospital to provide continuous support. The
certified nurse-midwife or certified midwife also may continue to
provide midwifery services, but only if the hospital has granted the
certified nurse-midwife or certified midwife clinical privileges.
Whenever possible, the patient and her newborn shall be together
during the transfer and after admission to the hospital.
Sec.
4723.583.
Emergency
medical service personnel or an emergency medical service
organization, hospital, facility, physician, advanced practice
registered nurse, or certified midwife that provides services or care
following an adverse incident as defined in section 4723.584 of the
Revised Code or during and after a transfer of care as described in
section 4723.582 of the Revised Code are not liable in damages in a
tort or other civil action for injury or loss to person or property
arising from the services or care, unless the services or care are
provided in a manner that constitutes willful or wanton misconduct.
Sec.
4723.584.
(A)
As used in this section, "adverse incident" means an
incident over which a certified nurse-midwife or certified midwife
could exercise control, that is associated with an attempted or
completed birth in a setting or facility other than a hospital, and
that results in one or more of the following injuries or conditions:
(1)
A maternal death that occurs during delivery or within forty-two days
after delivery;
(2)
The transfer of a maternal patient to a hospital intensive care unit;
(3)
A maternal patient experiencing hemorrhagic shock or requiring a
transfusion of more than two units of blood or blood products;
(4)
A fetal or newborn death, including a stillbirth, associated with an
obstetrical delivery;
(5)
A transfer of a newborn to a neonatal intensive care unit due to a
traumatic physical or neurological birth injury, including any degree
of a brachial plexus injury;
(6)
A transfer of a newborn to a neonatal intensive care unit within the
first seventy-two hours after birth if the newborn remains in such
unit for more than seventy-two hours;
(7)
Any other condition as determined by the board of nursing in rules
adopted under section 4723.07 or 4723.59 of the Revised Code.
(B)
Beginning July 1, 2027, a certified nurse-midwife or certified
midwife who attends a birth planned for a facility or setting other
than a hospital must report any adverse incident, along with a
medical summary of events, to both of the following within fifteen
days after the adverse incident occurs:
(1)
The department of health;
(2)
The Ohio perinatal quality collaborative.
(C)
Beginning July 1, 2027, each certified nurse-midwife or certified
midwife shall report annually to the department of health the
following information regarding cases in which the midwife provided
services when the intended place of birth at the onset of care was in
a facility or setting other than a hospital:
(1)
The total number of patients provided nurse-midwifery or certified
midwifery services at the onset of care;
(2)
The number of live births attended;
(3)
The number of cases of fetal demise, newborn deaths, and maternal
deaths attended as a certified nurse-midwife or certified midwife at
the discovery of the demise or death;
(4)
The number, reason for, and outcome of each transport of a patient in
the antepartum, intrapartum period, or immediate postpartum period;
(5)
A brief description of any complications resulting in the morbidity
or mortality of a maternal patient or a newborn;
(6)
The planned delivery setting and the actual setting;
(7)
Any other information required in rules adopted by the department.
(D)
The department shall adopt rules to implement this section and shall
develop a form to be used for the reporting required under divisions
(B) and (C) of this section.
Sec.
4723.59.
(A)
In addition to the rules described in section 4723.07 of the Revised
Code, the board of nursing shall adopt rules establishing standards
and procedures for the licensure and regulation of certified
midwives, including those establishing license application and
renewal procedures. The rules shall be adopted in accordance with
Chapter 119. of the Revised Code.
(B)
The board also may adopt, in accordance with Chapter 119. of the
Revised Code, any other rules it considers necessary to implement and
administer sections 4723.53 to 4723.60 of the Revised Code. The rules
may require the completion of a criminal records check and, in the
case of a license to practice as a certified midwife issued by
another jurisdiction, may provide for licensure by endorsement.
Sec.
4723.60.
Sections
4723.53 to 4723.59 of the Revised Code do not abridge, change, or
limit in any way the right of a parent to deliver the parent's baby
where, when, how, and with whom the parent chooses, regardless of the
licensure requirements established in those sections.
Sec.
4723.91.
On
receipt of a notice pursuant to section 3123.43 of the Revised Code,
the board of nursing shall comply with sections 3123.41 to 3123.50 of
the Revised Code and any applicable rules adopted under section
3123.63 of the Revised Code with respect to a nursing license,
certified
midwife license,
medication
aide certificate, dialysis technician certificate, or community
health worker certificate issued pursuant to this chapter.
Sec.
4723.99.
(A)
Except as provided in division (B)
or
(C)
of
this section, whoever violates section 4723.03, 4723.44,
4723.54,
4723.653,
or 4723.73 of the Revised Code is guilty of a felony of the fifth
degree on a first offense and a felony of the fourth degree on each
subsequent offense.
(B)
Each of the following is guilty of a minor misdemeanor:
(1)
A registered nurse, advanced practice registered nurse, or licensed
practical nurse who violates division (A), (B), (C), or (D) of
section 4723.03 of the Revised Code by reason of a license to
practice nursing that has lapsed for failure to renew or by
practicing nursing after a license has been classified as inactive;
(2)
A medication aide who violates section 4723.653 of the Revised Code
by reason of a medication aide certificate that has lapsed for
failure to renew or by administering medication as a medication aide
after a certificate has been classified as inactive.
(C)
Whoever violates division (H) of section 4723.03 of the Revised Code
is guilty of a misdemeanor of the first degree.
Sec.
4724.01.
As
used in this chapter:
(A)
"Certified international midwife" means an individual who
is certified by the international registry of midwives but is not a
licensed midwife.
(B)
"Certified professional midwife" means an individual who is
certified by the north American registry of midwives but is not a
licensed midwife.
(C)
"International registry of midwives" means the organization
known by that name or its successor organization.
(D)
"Licensed midwife" means an individual holding a license to
practice issued under section 4724.04 of the Revised Code.
(E)
"Midwifery education accreditation council" means the
organization known by that name or its successor organization.
(F)
"North American registry of midwives" means the
organization known by that name or its successor organization.
(G)
"Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.
(H)
"Traditional midwife" means an individual who provides
traditional midwifery services pursuant to sections 4724.14 and
4724.15 of the Revised Code, does not hold a license to practice as a
licensed midwife issued under this chapter, and does not hold a
license to practice as a certified nurse-midwife or certified midwife
issued under Chapter 4723. of the Revised Code.
Sec.
4724.02.
(A)
Except as provided in division (B) of this section, no individual
shall knowingly practice as a licensed midwife unless the individual
holds a current, valid license to practice issued under section
4724.04 of the Revised Code.
(B)
Division (A) of this section does not apply to any of the following:
(1)
A physician;
(2)
A physician assistant authorized under Chapter 4730. of the Revised
Code to practice as a physician assistant;
(3)
A registered nurse, advanced practice registered nurse, or licensed
practical nurse authorized under Chapter 4723. of the Revised Code to
practice nursing as a registered nurse, advanced practice registered
nurse, or licensed practical nurse;
(4)
A certified midwife authorized under Chapter 4723. of the Revised
Code to practice as a certified midwife;
(5)
A student who is participating in a professional midwifery education
program and who provides midwifery services under the auspices of the
program and under the supervision of a licensed midwife serving for
the program as a faculty member, instructor, teaching assistant, or
preceptor;
(6)
An individual who is participating in a professional midwifery
apprenticeship and who provides midwifery services as part of the
apprenticeship program and under the supervision of a licensed
midwife serving for the program as an instructor, teaching assistant,
or preceptor;
(7)
An individual who provides midwifery services without a license while
engaging in good faith in the practice of the religious tenets of any
church or in any religious act;
(8)
An individual who is not engaged in the practice of the religious
tenets of any church or in any religious act but who provides
midwifery services without a license to others engaging in good faith
in the practice of the religious tenets of any church or in any
religious act;
(9)
An individual who is a member of a Native American community and
provides midwifery services without a license to another member of
the community;
(10)
A traditional midwife;
(11)
An individual who is participating in a midwifery apprenticeship
under the supervision of a traditional midwife and who provides
midwifery services as part of the apprenticeship program under the
supervision of a traditional midwife;
(12)
A certified professional midwife or certified international midwife,
but only if the certified professional midwife or certified
international midwife does not, as a part of the midwife's practice,
obtain or administer drugs or perform surgical suturing.
(C)
No individual shall knowingly use the title "licensed midwife"
or any other title implying that the individual is a licensed midwife
unless the individual holds a current, valid license to practice
issued under section 4724.04 of the Revised Code.
Sec.
4724.03.
(A)
An individual seeking a license to practice as a licensed midwife
shall file with the department of commerce an application in a manner
prescribed by the department. The application shall include all the
information the department considers necessary to process the
application, including evidence satisfactory to the department that
the applicant meets the requirements specified in division (B)(1) or
(2) of this section.
(B)(1)
To be eligible to receive a license to practice as a licensed
midwife, an applicant shall demonstrate to the department that the
applicant meets all of the following requirements:
(a)
Is at least eighteen years of age;
(b)
Has attained a high school degree or equivalent;
(c)
Is certified by the north American registry of midwives,
international registry of midwives, or another certifying
organization approved by the department in rules adopted under
section 4724.11 of the Revised Code;
(d)
Is certified in neonatal and adult cardiopulmonary resuscitation;
(e)
Has successfully completed a course of study in breech births
approved by the department in rules adopted under section 4724.11 of
the Revised Code;
(f)
Has successfully completed a course of study in pharmacology approved
by the department in rules adopted under section 4724.11 of the
Revised Code.
(2)
In lieu of meeting the requirements described in division (B)(1)(c)
of this section, an applicant may demonstrate either of the
following:
(a)
That the applicant holds a current, valid license to practice as a
licensed midwife issued by another state and the department has
determined that the other state's requirements for licensure are
substantially similar to those described in division (B)(1) of this
section;
(b)
That the applicant is certified by the north American registry of
midwives and holds a midwifery bridge certificate.
(C)
The department shall review all applications received under this
section. After receiving an application it considers complete, the
department shall determine whether the applicant meets the
requirements for a license to practice as a licensed midwife.
Sec.
4724.04.
(A)
If the department of commerce determines under section 4724.03 of the
Revised Code that an applicant meets the requirements for a license
to practice as a licensed midwife, the department shall issue the
license to the applicant.
(B)
Each license shall be valid for a two-year period unless revoked or
suspended, shall expire on the date that is two years after the date
of issuance, and may be renewed for additional two-year periods in
accordance with rules adopted under section 4724.11 of the Revised
Code.
(C)
To renew a license to practice as a licensed midwife, an applicant
for renewal shall demonstrate both of the following to the
department:
(1)
That the applicant has maintained certification in neonatal and adult
cardiopulmonary resuscitation;
(2)
That the applicant has maintained certification with the north
American registry of midwives, international registry of midwives, or
another certifying organization approved by the department in rules
adopted under section 4724.11 of the Revised Code.
(D)
In the event a license issued under this section is not renewed and
is therefore expired or inactive, the department shall reinstate or
restore the license if the individual seeking reinstatement or
restoration satisfies the conditions specified in rules adopted under
section 4724.11 of the Revised Code.
Sec.
4724.05.
(A)
An individual who holds a current, valid license to practice as a
licensed midwife may engage in one or more of the following
activities during the antepartum, intrapartum, postpartum, and
newborn period as part of the scope of practice for a licensed
midwife:
(1)
Offering care, education, counseling, and support to women and
newborns during pregnancy, birth, and the postpartum period;
(2)
Attending births in hospitals, homes, medical offices, and
freestanding birthing centers;
(3)
Providing ongoing and routine prenatal care throughout pregnancy and
hands on care during labor, birth, and the immediate postpartum
period;
(4)
Providing maternal and newborn assessment for the six- to eight-week
period following delivery;
(5)
Providing initial and ongoing comprehensive assessment, diagnosis,
and treatment;
(6)
Recognizing abnormal or dangerous conditions requiring consultations
with or referrals to other licensed health care professionals;
(7)
Conducting maternal and newborn physical examinations;
(8)
Ordering and interpreting laboratory and diagnostic tests without a
physician's order.
(B)
An individual who holds a current, valid license to practice as a
licensed midwife shall not engage in any of the following activities:
(1)
Administering cytotec or oxytocics, including pitocin and methergine,
except when indicated during the postpartum period;
(2)
Using forceps or vacuum extraction to assist with birth;
(3)
Performing any operative procedures or surgical repairs other than
the following: artificial rupture of membranes; episiotomies; first
or second degree perineal, vaginal, or labial repairs; clamping or
cutting the umbilical cord; or frenotomies.
(C)
For the purpose of engaging in one or more of the activities
permitted under division (A) of this section, the scope of practice
for a licensed midwife shall include the ability to purchase, obtain,
possess, and administer the following:
(1)
Subject to division (B) of this section, an antihemorraghic agent or
device, including tranexamic acid, pitocin, oxytocin, misoprostol,
and methergine;
(2)
Intravenous fluids to stabilize the laboring or postpartum patient or
as necessary to administer another drug authorized by this division;
(3)
Neonatal injectable vitamin K;
(4)
Newborn antibiotic eye prophylaxis;
(5)
Oxygen;
(6)
Intravenous antibiotics for group B streptococcal prophylaxis;
(7)
Rho (D) immune globulin;
(8)
Local anesthesia;
(9)
Epinephrine, but only to address an adverse reaction to a medication;
(10)
A drug prescribed for the patient by a prescriber.
A
licensed midwife also may obtain, without a physician's order, one or
more supplies necessary to administer any of the drugs described in
division (C) of this section.
(D)
This section does not authorize a licensed midwife to prescribe,
personally furnish, obtain, or administer either of the following:
(1)
Any controlled substance as defined in section 3719.01 of the Revised
Code;
(2)
A drug or device to perform or induce an abortion.
(E)
When engaging in any of the activities permitted under this section,
a licensed midwife shall maintain appropriate medical records
regarding patient history, treatment, and outcomes.
Sec.
4724.06.
The
department of commerce shall limit, revoke, or suspend an
individual's license to practice as a licensed midwife, refuse to
issue a license to an applicant, refuse to renew a license, refuse to
reinstate or restore a license, or reprimand or place on probation
the holder of a license for any of the reasons specified in rules
adopted under section 4724.11 of the Revised Code.
Sec.
4724.07.
(A)
This section establishes the process by which a licensed midwife
obtains a patient's consent to treatment authorized by section
4724.05 of the Revised Code, including attending a home birth or
providing care during a high-risk pregnancy.
(B)
The following information shall be exchanged in writing between a
licensed midwife and patient when obtaining consent to treatment as
described in division (A) of this section:
(1)
The name and license number of the licensed midwife;
(2)
The patient's name, address, telephone number, and primary care
provider, if the patient has one;
(3)
A description of the licensed midwife's education, training, and
experience in midwifery;
(4)
The licensed midwife's practice philosophy;
(5)
A promise to provide the patient, upon request, with separate
documents describing the rules governing the practice of midwifery,
including a list of conditions indicating the need for consultation,
referral, transfer, or mandatory transfer and the licensed midwife's
personal written practice guidelines;
(6)
A written plan for medical consultation and transfer of care;
(7)
A description of any hospital care and procedures that may be
necessary in the event of an emergency transfer or care;
(8)
A description of the services provided to the patient by the licensed
midwife;
(9)
That the licensed midwife holds a current, valid license to practice
issued under this chapter;
(10)
The availability of a grievance process;
(11)
Whether the licensed midwife is covered by professional liability
insurance;
(12)
Any other information required in rules adopted by the department.
(C)
Once the required information has been exchanged and if the patient
consents to treatment, the patient and licensed midwife shall sign a
written document to indicate as such. The licensed midwife shall
retain a copy of the document for at least four years from the date
on which the document was signed.
Sec.
4724.08.
(A)
The department of commerce shall adopt rules establishing the
circumstances in which a licensed midwife shall be prohibited from
attending a home birth, which may include a high-risk pregnancy. In
adopting the rules, the department shall allow a licensed midwife to
attend a vaginal birth after cesarean, birth of twins, or breech
birth as a home birth if the conditions described in division (B) of
this section are satisfied.
(B)
In the event of a home birth described in division (A) of this
section, a licensed midwife may attend the birth only if all of the
following conditions are satisfied:
(1)
In addition to the informed consent required under section 4724.07 of
the Revised Code, the licensed midwife obtains the patient's written
informed consent for the vaginal birth after cesarean, birth of
twins, or breech birth, including a description of risks associated
with the procedure.
(2)
The licensed midwife consults with a physician, certified
nurse-midwife, or certified midwife about the patient and together
with the physician or midwife determines whether referral is
appropriate for the patient. If a referral is determined to be
appropriate and the patient consents to the referral, the licensed
midwife shall refer the patient to the physician or provider. If the
patient refuses the referral, the licensed midwife shall document the
refusal and may continue to provide care to the patient, including
attending the vaginal birth after cesarean, birth of twins, or breech
birth.
(3)
The licensed midwife satisfies any other conditions required in rules
adopted by the department.
(C)
In adopting rules under this section, the department shall do both of
the following:
(1)
Adhere to the recommendations of the licensed midwifery advisory
council and any relevant peer-reviewed medical literature;
(2)
Specify the content and format of the document to be used when
obtaining informed consent as described in this section.
Sec.
4724.09.
(A)
As used in this section and section 4724.10 of the Revised Code,
"emergency medical service," "emergency medical
service personnel," and "emergency medical service
organization" have the same meanings as in section 4765.01 of
the Revised Code.
(B)
For any pregnancy or childbirth in which a licensed midwife provides
care and a home birth is planned, both of the following apply:
(1)
The licensed midwife shall create an individualized transfer of care
plan with each patient.
(2)
The licensed midwife shall assess the status of the patient, fetus,
and newborn throughout the maternity care cycle and shall determine
when or if a transfer to a hospital is necessary.
(C)
Each individualized transfer of care plan shall contain all of the
following:
(1)
The name and location of geographically adjacent hospitals that are
appropriately equipped to provide emergency care, obstetrical care,
and newborn care;
(2)
The approximate travel time to each hospital;
(3)
A list of the modes of transport services available, including an
emergency medical service organization available by calling 9-1-1;
(4)
The requirements for activating each mode of transportation;
(5)
The mechanism by which medical records and other information
concerning the patient may be rapidly transmitted to each hospital;
(6)
Confirmation that the licensed midwife has recommended that the
patient pre-register with the hospital closest to the patient's home
that is appropriately equipped to provide emergency care, obstetrical
care, and newborn care;
(7)
Contact information for either a health care provider or practice
group who has agreed in advance to accept patients in transfer, or a
hospital's preferred method of accessing care by the hospital's
designated provider on call;
(8)
Any other information required in rules adopted by the department of
commerce.
(D)
When it becomes necessary to transfer a patient, a licensed midwife
shall notify the receiving provider or hospital of all of the
following:
(1)
The incoming transfer;
(2)
The reason for the transfer;
(3)
A brief relevant clinical history;
(4)
The planned mode of transport;
(5)
The expected time of arrival;
(6)
Any other information required in rules adopted by the department.
The
licensed midwife may continue to provide routine or urgent care en
route in coordination with any emergency medical services personnel
or emergency medical service organization and, if continued care is
provided, the licensed midwife shall address the psychosocial needs
of the patient during the change of birth setting.
(E)
On arrival at the hospital, the licensed midwife shall do all of the
following:
(1)
Provide a verbal report that includes details on the patient's
current health status and the need for urgent care;
(2)
Provide a legible copy of relevant prenatal and labor medical
records;
(3)
Transfer clinical responsibility to the receiving provider or
hospital;
(4)
Satisfy any other requirement established in rules adopted by the
department.
If
the patient chooses, the licensed midwife may remain at the hospital
to provide continuous support. The licensed midwife also may continue
to provide midwifery services, but only if the hospital has granted
the licensed midwife clinical privileges. Whenever possible, the
patient and her newborn shall be together during the transfer and
after admission to the hospital.
Sec.
4724.10.
(A)
As used in this section, "adverse incident" means an
incident over which a licensed midwife could exercise control, that
is associated with an attempted or completed birth in a setting or
facility other than a hospital, and that results in one or more of
the following injuries or conditions:
(1)
A maternal death that occurs during delivery or within forty-two days
after delivery;
(2)
The transfer of a maternal patient to a hospital intensive care unit;
(3)
A maternal patient experiencing hemorrhagic shock or requiring a
transfusion of more than two units of blood or blood products;
(4)
A fetal or neonatal death, including a stillbirth, associated with an
obstetrical delivery;
(5)
A transfer of a newborn to a neonatal intensive care unit due to a
traumatic physical or neurological birth injury, including any degree
of a brachial plexus injury;
(6)
A transfer of a newborn to a neonatal intensive care unit within the
first seventy-two hours after birth if the newborn remains in such
unit for more than seventy-two hours;
(7)
Any other condition as determined by the department of commerce in
rules adopted under section 4724.11 of the Revised Code.
(B)
Beginning July 1, 2027, a licensed midwife who attends a birth
planned for a facility or setting other than a hospital must report
any adverse incident, along with a medical summary of events, to both
of the following within fifteen days after the adverse incident
occurs:
(1)
The licensed midwifery advisory council;
(2)
The Ohio perinatal quality collaborative.
(C)
Beginning July 1, 2027, each licensed midwife shall report annually
to the licensed midwifery advisory council the following information
regarding cases in which the licensed midwife provided services when
the intended place of birth at the onset of care was in a facility or
setting other than a hospital:
(1)
The total number of patients provided licensed midwifery services at
the onset of care;
(2)
The number of live births attended;
(3)
The number of cases of fetal demise, newborn deaths, and maternal
deaths attended as a licensed midwife at the discovery of the demise
or death;
(4)
The number, reason for, and outcome of each transport of a patient in
the antepartum, intrapartum period, or immediate postpartum period;
(5)
A brief description of any complications resulting in the morbidity
or mortality of a maternal patient or a newborn;
(6)
The planned delivery setting and the actual setting;
(7)
Any other information required in rules adopted by the department of
commerce.
(D)
The department shall adopt rules to implement this section and shall
develop a form to be used for the reporting required under divisions
(B) and (C) of this section.
Sec.
4724.11.
(A)
In accordance with Chapter 119. of the Revised Code, the department
of commerce shall adopt rules that establish all of the following:
(1)
Standards and procedures for applying for, renewing, reinstating, or
restoring a license to practice as a licensed midwife;
(2)
Application, renewal, reinstatement, and restoration fee amounts for
a license to practice as a licensed midwife, with the amount of the
application fee not to exceed forty-five dollars and the amount of
the renewal fee not to exceed twenty dollars;
(3)
Standards and procedures for approving and successfully completing a
course of study in breech births and a course of study in
pharmacology, each as described in section 4724.03 of the Revised
Code;
(4)
Subject to division (C) of this section, standards and procedures for
approving certifying organizations as described in section 4724.03 of
the Revised Code;
(5)
Reasons for which the department may refuse to issue, or renew,
suspend, or revoke a license or otherwise impose discipline on a
licensed midwife;
(6)
Conditions to be satisfied before the department reinstates or
restores an expired or inactive license;
(7)
Procedures for reporting to the department license holder misconduct;
(8)
Procedures by which the department conducts disciplinary
investigations.
(B)
In adopting rules establishing standards and procedures for the
approval of certifying organizations, the department shall approve an
organization only if its certification requirements meet or exceed
those of the north American registry of midwives or the international
registry of midwives.
(C)
The department also may adopt, in accordance with Chapter 119. of the
Revised Code, any other rules it considers necessary to implement and
administer this chapter. The rules may require the completion of a
criminal records check.
Sec.
4724.12.
This
chapter does not abridge, change, or limit in any way the right of a
parent to deliver the parent's baby where, when, how, and with whom
the parent chooses, regardless of the licensure requirements
established in this chapter.
Sec.
4724.13.
(A)
There is hereby created within the department of commerce the
licensed midwifery advisory council. The council shall consist of all
of the following members:
(1)
One certified nurse-midwife and one certified midwife or certified
nurse-midwife, preferably with experience attending a birth in a
setting or facility other than a hospital;
(2)
Four licensed midwives, including one practicing in an urban setting
and one serving a plain Amish or Mennonite community;
(3)
One physician who is board-certified in obstetrics and gynecology, as
those designations are issued by a medical specialty certifying board
recognized by the American board of medical specialties or American
osteopathic association, and with experience consulting with midwives
who provide midwifery services in locations other than hospitals;
(4)
One physician who is board-certified in neonatal medicine, as that
designation is issued by a medical specialty certifying board
recognized by the American board of medical specialties or American
osteopathic association, and with experience consulting with midwives
who provide midwifery services in locations other than hospitals;
(5)
One member of the public who has experience utilizing or receiving
midwifery services in locations other than hospitals.
Of
the members who are licensed midwives, each shall obtain licensure as
a licensed midwife under this chapter not later than January 1, 2028.
(B)
The department shall appoint the members described in division (A) of
this section. The department may solicit nominations for initial
appointments and for filling any vacancies from individuals or
organizations with an interest in midwifery services. If the
department does not receive any nominations or receives an
insufficient number of nominations, the department shall appoint
members and fill vacancies on its own advice.
Of
the physician members described in divisions (A)(3) and (4) of this
section, if the department does not receive any nominations for
physicians with experience consulting with midwives who provide
midwifery services in locations other than hospitals, the department
shall appoint physicians without such experience, but only if the
department determines that each physician satisfies the other
requirements of division (A)(3) or (4) of this section.
Initial
appointments to the council shall be made not later than ninety days
after the effective date of this section. Of the initial appointments
described in division (A) of this section, four shall be for terms of
three years and five shall be for terms of four years. Thereafter,
terms shall be for four years, with each term ending on the same day
of the same month as did the term that it succeeds. Vacancies shall
be filled in the same manner as appointments.
When
the term of any member expires, a successor shall be appointed in the
same manner as the initial appointment. Any member appointed to fill
a vacancy occurring prior to the expiration of the term for which the
member's predecessor was appointed shall hold office for the
remainder of that term. A member shall continue in office subsequent
to the expiration date of the member's term until the member's
successor takes office or until a period of sixty days has elapsed,
whichever occurs first. A member may be reappointed.
(C)
The council shall organize by selecting a chairperson from among its
members. The council may select a new chairperson at any time. Four
members constitute a quorum for the transaction of official business.
Members shall serve without compensation but shall receive payment
for their actual and necessary expenses incurred in the performance
of their official duties. The expenses shall be paid by the
department.
(D)
The council shall advise and make recommendations to the department
regarding the practice and regulation of licensed midwives. The
department shall adhere to such advice and recommendations when
adopting any rules governing the practice of licensed midwives,
including rules to address the following:
(1)
Circumstances in which attending a home birth is prohibited, as
described in section 4724.08 of the Revised Code;
(2)
Limitations on providing care during a high-risk pregnancy, including
when a home birth is planned;
(3)
Adverse incident reporting and annual reporting, both required under
section 4724.10 of the Revised Code;
(4)
Obtaining a patient's informed consent, as described in section
4724.07 of the Revised Code;
(5)
Creating an individualized transfer of care plan, as described in
section 4724.09 of the Revised Code.
(E)
The council shall review each adverse incident report submitted to
the council as described in section 4724.10 of the Revised Code. As
soon as practicable after the required review, the council shall make
a recommendation to the department regarding whether discipline
should be imposed on the licensed midwife, and if so, the type of
discipline to be imposed.
The
council shall develop a policy by which it addresses and considers
adverse incident reports.
Sec.
4724.14.
A
traditional midwife may engage in one or more of the following
activities during the antepartum, intrapartum, postpartum, and
newborn period as part of the scope of practice for a traditional
midwife:
(A)
Offering care, education, counseling, and support during pregnancy,
birth, and the postpartum period;
(B)
Attending births in locations other than hospitals;
(C)
Providing ongoing and routine prenatal care throughout pregnancy and
hands on care during labor, birth, and the immediate postpartum
period;
(D)
Providing maternal and newborn assessment for the six- to eight-week
period following delivery;
(E)
Recognizing abnormal or dangerous conditions requiring consultations
with or referrals to licensed health care professionals.
Sec.
4724.15.
(A)
This section establishes the process by which a traditional midwife
obtains a patient's consent to treatment authorized by section
4724.14 of the Revised Code.
(B)
The following information shall be exchanged in writing between a
traditional midwife and patient when obtaining consent to treatment
as described in division (A) of this section:
(1)
The name of the traditional midwife;
(2)
The patient's name, address, telephone number, and primary care
provider, if the patient has one;
(3)
A description of the traditional midwife's education, training, and
experience in midwifery;
(4)
The traditional midwife's practice philosophy;
(5)
A promise to provide the patient, upon request, with separate
documents describing a traditional midwife's scope of practice;
(6)
A written plan for medical consultation and transfer of care;
(7)
A description of any hospital care and procedures that may be
necessary in the event of an emergency transfer of care;
(8)
A description of the services provided to the patient by the
traditional midwife;
(9)
Whether the traditional midwife is covered by professional liability
insurance;
(10)
Any other information required in rules adopted by the department.
(C)
Once the required information has been exchanged and if the patient
consents to treatment, the patient and traditional midwife shall sign
a written document to indicate as such. The traditional midwife shall
retain a copy of the document for at least four years from the date
on which the document was signed.
(D)
The rights and liabilities arising from the provision of traditional
midwifery services shall be governed exclusively by the agreement
between the traditional midwife and the patient entered pursuant to
division (C) of this section.
Sec.
4724.16.
Emergency
medical service personnel or an emergency medical service
organization, hospital, facility, physician, advanced practice
registered nurse, licensed midwife, or traditional midwife that
provides services or care following an adverse incident as defined in
section 4724.10 of the Revised Code, or during and after a transfer
of care as described in section 4724.09 of the Revised Code, are not
liable in damages in a tort or other civil action for injury or loss
to person or property arising from the services or care, unless the
services or care are provided in a manner that constitutes willful or
wanton misconduct.
Sec.
4724.99.
(A)
Whoever violates division (A) of section 4724.02 of the Revised Code
is guilty of a felony of the fifth degree on a first offense and a
felony of the fourth degree on each subsequent offense.
(B)
Whoever violates division (C) of section 4724.02 of the Revised Code
is guilty of a misdemeanor of the first degree and is subject to a
fine in the amount of one thousand dollars and a jail term of not
more than one hundred eighty days.
Sec.
4731.22.
(A)
The state medical board, by an affirmative vote of not fewer than six
of its members, may limit, revoke, or suspend a license or
certificate to practice or certificate to recommend, refuse to grant
a license or certificate, refuse to renew a license or certificate,
refuse to reinstate a license or certificate, or reprimand or place
on probation the holder of a license or certificate if the individual
applying for or holding the license or certificate is found by the
board to have committed fraud during the administration of the
examination for a license or certificate to practice or to have
committed fraud, misrepresentation, or deception in applying for,
renewing, or securing any license or certificate to practice or
certificate to recommend issued by the board.
(B)
Except as provided in division (P) of this section, the board, by an
affirmative vote of not fewer than six members, shall, to the extent
permitted by law, limit, revoke, or suspend a license or certificate
to practice or certificate to recommend, refuse to issue a license or
certificate, refuse to renew a license or certificate, refuse to
reinstate a license or certificate, or reprimand or place on
probation the holder of a license or certificate for one or more of
the following reasons:
(1)
Permitting one's name or one's license or certificate to practice to
be used by a person, group, or corporation when the individual
concerned is not actually directing the treatment given;
(2)
Failure to maintain minimal standards applicable to the selection or
administration of drugs, or failure to employ acceptable scientific
methods in the selection of drugs or other modalities for treatment
of disease;
(3)
Except as provided in section 4731.97 of the Revised Code, selling,
giving away, personally furnishing, prescribing, or administering
drugs for other than legal and legitimate therapeutic purposes or a
plea of guilty to, a judicial finding of guilt of, or a judicial
finding of eligibility for intervention in lieu of conviction of, a
violation of any federal or state law regulating the possession,
distribution, or use of any drug;
(4)
Willfully betraying a professional confidence.
For
purposes of this division, "willfully betraying a professional
confidence" does not include providing any information,
documents, or reports under sections 307.621 to 307.629 of the
Revised Code to a child fatality review board; does not include
providing any information, documents, or reports under sections
307.631 to 307.6410 of the Revised Code to a drug overdose fatality
review committee, a suicide fatality review committee, or hybrid drug
overdose fatality and suicide fatality review committee; does not
include providing any information, documents, or reports under
sections 307.651 to 307.659 of the Revised Code to a domestic
violence fatality review board; does not include providing any
information, documents, or reports to the director of health pursuant
to guidelines established under section 3701.70 of the Revised Code;
does not include written notice to a mental health professional under
section 4731.62 of the Revised Code; does not include making a report
as described in division (F) of section 2921.22 and section 4731.224
of the Revised Code; and does not include the making of a report of
an employee's use of a drug of abuse, or a report of a condition of
an employee other than one involving the use of a drug of abuse, to
the employer of the employee as described in division (B) of section
2305.33 of the Revised Code. Nothing in this division affects the
immunity from civil liability conferred by section 2305.33 or 4731.62
of the Revised Code upon a physician who makes a report in accordance
with section 2305.33 or notifies a mental health professional in
accordance with section 4731.62 of the Revised Code. As used in this
division, "employee," "employer," and "physician"
have the same meanings as in section 2305.33 of the Revised Code.
(5)
Making a false, fraudulent, deceptive, or misleading statement in the
solicitation of or advertising for patients; in relation to the
practice of medicine and surgery, osteopathic medicine and surgery,
podiatric medicine and surgery, or a limited branch of medicine; or
in securing or attempting to secure any license or certificate to
practice issued by the board.
As
used in this division, "false, fraudulent, deceptive, or
misleading statement" means a statement that includes a
misrepresentation of fact, is likely to mislead or deceive because of
a failure to disclose material facts, is intended or is likely to
create false or unjustified expectations of favorable results, or
includes representations or implications that in reasonable
probability will cause an ordinarily prudent person to misunderstand
or be deceived.
(6)
A departure from, or the failure to conform to, minimal standards of
care of similar practitioners under the same or similar
circumstances, whether or not actual injury to a patient is
established;
(7)
Representing, with the purpose of obtaining compensation or other
advantage as personal gain or for any other person, that an incurable
disease or injury, or other incurable condition, can be permanently
cured;
(8)
The obtaining of, or attempting to obtain, money or anything of value
by fraudulent misrepresentations in the course of practice;
(9)
A plea of guilty to, a judicial finding of guilt of, or a judicial
finding of eligibility for intervention in lieu of conviction for, a
felony;
(10)
Commission of an act that constitutes a felony in this state,
regardless of the jurisdiction in which the act was committed;
(11)
A plea of guilty to, a judicial finding of guilt of, or a judicial
finding of eligibility for intervention in lieu of conviction for, a
misdemeanor committed in the course of practice;
(12)
Commission of an act in the course of practice that constitutes a
misdemeanor in this state, regardless of the jurisdiction in which
the act was committed;
(13)
A plea of guilty to, a judicial finding of guilt of, or a judicial
finding of eligibility for intervention in lieu of conviction for, a
misdemeanor involving moral turpitude;
(14)
Commission of an act involving moral turpitude that constitutes a
misdemeanor in this state, regardless of the jurisdiction in which
the act was committed;
(15)
Violation of the conditions of limitation placed by the board upon a
license or certificate to practice;
(16)
Failure to pay license renewal fees specified in this chapter;
(17)
Except as authorized in section 4731.31 of the Revised Code, engaging
in the division of fees for referral of patients, or the receiving of
a thing of value in return for a specific referral of a patient to
utilize a particular service or business;
(18)
Subject to section 4731.226 of the Revised Code, violation of any
provision of a code of ethics of the American medical association,
the American osteopathic association, the American podiatric medical
association, or any other national professional organizations that
the board specifies by rule. The state medical board shall obtain and
keep on file current copies of the codes of ethics of the various
national professional organizations. The individual whose license or
certificate is being suspended or revoked shall not be found to have
violated any provision of a code of ethics of an organization not
appropriate to the individual's profession.
For
purposes of this division, a "provision of a code of ethics of a
national professional organization" does not include any
provision that would preclude the making of a report by a physician
of an employee's use of a drug of abuse, or of a condition of an
employee other than one involving the use of a drug of abuse, to the
employer of the employee as described in division (B) of section
2305.33 of the Revised Code. Nothing in this division affects the
immunity from civil liability conferred by that section upon a
physician who makes either type of report in accordance with division
(B) of that section. As used in this division, "employee,"
"employer," and "physician" have the same
meanings as in section 2305.33 of the Revised Code.
(19)
Inability to practice according to acceptable and prevailing
standards of care by reason of mental illness or physical illness,
including, but not limited to, physical deterioration that adversely
affects cognitive, motor, or perceptive skills.
In
enforcing this division, the board, upon a showing of a possible
violation, shall refer any individual who is authorized to practice
by this chapter or who has submitted an application pursuant to this
chapter to the monitoring organization that conducts the confidential
monitoring program established under section 4731.25 of the Revised
Code. The board also may compel the individual to submit to a mental
examination, physical examination, including an HIV test, or both a
mental and a physical examination. The expense of the examination is
the responsibility of the individual compelled to be examined.
Failure to submit to a mental or physical examination or consent to
an HIV test ordered by the board constitutes an admission of the
allegations against the individual unless the failure is due to
circumstances beyond the individual's control, and a default and
final order may be entered without the taking of testimony or
presentation of evidence. If the board finds an individual unable to
practice because of the reasons set forth in this division, the board
shall require the individual to submit to care, counseling, or
treatment by physicians approved or designated by the board, as a
condition for initial, continued, reinstated, or renewed authority to
practice. An individual affected under this division shall be
afforded an opportunity to demonstrate to the board the ability to
resume practice in compliance with acceptable and prevailing
standards under the provisions of the individual's license or
certificate. For the purpose of this division, any individual who
applies for or receives a license or certificate to practice under
this chapter accepts the privilege of practicing in this state and,
by so doing, shall be deemed to have given consent to submit to a
mental or physical examination when directed to do so in writing by
the board, and to have waived all objections to the admissibility of
testimony or examination reports that constitute a privileged
communication.
(20)
Except as provided in division (F)(1)(b) of section 4731.282 of the
Revised Code or when civil penalties are imposed under section
4731.225 of the Revised Code, and subject to section 4731.226 of the
Revised Code, violating or attempting to violate, directly or
indirectly, or assisting in or abetting the violation of, or
conspiring to violate, any provisions of this chapter or any rule
promulgated by the board.
This
division does not apply to a violation or attempted violation of,
assisting in or abetting the violation of, or a conspiracy to
violate, any provision of this chapter or any rule adopted by the
board that would preclude the making of a report by a physician of an
employee's use of a drug of abuse, or of a condition of an employee
other than one involving the use of a drug of abuse, to the employer
of the employee as described in division (B) of section 2305.33 of
the Revised Code. Nothing in this division affects the immunity from
civil liability conferred by that section upon a physician who makes
either type of report in accordance with division (B) of that
section. As used in this division, "employee," "employer,"
and "physician" have the same meanings as in section
2305.33 of the Revised Code.
(21)
The violation of section 3701.79 of the Revised Code or of any
abortion rule adopted by the director of health pursuant to section
3701.341 of the Revised Code;
(22)
Any of the following actions taken by an agency responsible for
authorizing, certifying, or regulating an individual to practice a
health care occupation or provide health care services in this state
or another jurisdiction, for any reason other than the nonpayment of
fees: the limitation, revocation, or suspension of an individual's
license to practice; acceptance of an individual's license surrender;
denial of a license; refusal to renew or reinstate a license;
imposition of probation; or issuance of an order of censure or other
reprimand;
(23)
The violation of section 2919.12 of the Revised Code or the
performance or inducement of an abortion upon a pregnant woman with
actual knowledge that the conditions specified in division (B) of
section 2317.56 of the Revised Code have not been satisfied or with a
heedless indifference as to whether those conditions have been
satisfied, unless an affirmative defense as specified in division
(H)(2) of that section would apply in a civil action authorized by
division (H)(1) of that section;
(24)
The revocation, suspension, restriction, reduction, or termination of
clinical privileges by the United States department of defense or
department of veterans affairs or the termination or suspension of a
certificate of registration to prescribe drugs by the drug
enforcement administration of the United States department of
justice;
(25)
Termination or suspension from participation in the medicare or
medicaid programs by the department of health and human services or
other responsible agency;
(26)
Impairment of ability to practice according to acceptable and
prevailing standards of care because of substance use disorder or
excessive use or abuse of drugs, alcohol, or other substances that
may impair ability to practice.
For
the purposes of this division, any individual authorized to practice
by this chapter accepts the privilege of practicing in this state
subject to supervision by the board. By filing an application for or
holding a license or certificate to practice under this chapter, an
individual shall be deemed to have given consent to submit to a
mental or physical examination when ordered to do so by the board in
writing, and to have waived all objections to the admissibility of
testimony or examination reports that constitute privileged
communications.
If
it has reason to believe that any individual authorized to practice
by this chapter or any applicant for licensure or certification to
practice suffers such impairment, the board shall refer the
individual to the monitoring organization that conducts the
confidential monitoring program established under section 4731.25 of
the Revised Code. The board also may compel the individual to submit
to a mental or physical examination, or both. The expense of the
examination is the responsibility of the individual compelled to be
examined. Any mental or physical examination required under this
division shall be undertaken by a treatment provider or physician who
is qualified to conduct the examination and who is approved under
section 4731.251 of the Revised Code.
Failure
to submit to a mental or physical examination ordered by the board
constitutes an admission of the allegations against the individual
unless the failure is due to circumstances beyond the individual's
control, and a default and final order may be entered without the
taking of testimony or presentation of evidence. If the board
determines that the individual's ability to practice is impaired, the
board shall suspend the individual's license or certificate or deny
the individual's application and shall require the individual, as a
condition for initial, continued, reinstated, or renewed licensure or
certification to practice, to submit to treatment.
Before
being eligible to apply for reinstatement of a license or certificate
suspended under this division, the impaired practitioner shall
demonstrate to the board the ability to resume practice in compliance
with acceptable and prevailing standards of care under the provisions
of the practitioner's license or certificate. The demonstration shall
include, but shall not be limited to, the following:
(a)
Certification from a treatment provider approved under section
4731.251 of the Revised Code that the individual has successfully
completed any required inpatient treatment;
(b)
Evidence of continuing full compliance with an aftercare contract or
consent agreement;
(c)
Two written reports indicating that the individual's ability to
practice has been assessed and that the individual has been found
capable of practicing according to acceptable and prevailing
standards of care. The reports shall be made by individuals or
providers approved by the board for making the assessments and shall
describe the basis for their determination.
The
board may reinstate a license or certificate suspended under this
division after that demonstration and after the individual has
entered into a written consent agreement.
When
the impaired practitioner resumes practice, the board shall require
continued monitoring of the individual. The monitoring shall include,
but not be limited to, compliance with the written consent agreement
entered into before reinstatement or with conditions imposed by board
order after a hearing, and, upon termination of the consent
agreement, submission to the board for at least two years of annual
written progress reports made under penalty of perjury stating
whether the individual has maintained sobriety.
(27)
A second or subsequent violation of section 4731.66 or 4731.69 of the
Revised Code;
(28)
Except as provided in division (N) of this section:
(a)
Waiving the payment of all or any part of a deductible or copayment
that a patient, pursuant to a health insurance or health care policy,
contract, or plan that covers the individual's services, otherwise
would be required to pay if the waiver is used as an enticement to a
patient or group of patients to receive health care services from
that individual;
(b)
Advertising that the individual will waive the payment of all or any
part of a deductible or copayment that a patient, pursuant to a
health insurance or health care policy, contract, or plan that covers
the individual's services, otherwise would be required to pay.
(29)
Failure to use universal blood and body fluid precautions established
by rules adopted under section 4731.051 of the Revised Code;
(30)
Failure to provide notice to, and receive acknowledgment of the
notice from, a patient when required by section 4731.143 of the
Revised Code prior to providing nonemergency professional services,
or failure to maintain that notice in the patient's medical record;
(31)
Failure of a physician supervising a physician assistant to maintain
supervision in accordance with the requirements of Chapter 4730. of
the Revised Code and the rules adopted under that chapter;
(32)
Failure of a physician or podiatrist to enter into a standard care
arrangement with a
certified midwife,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner with whom the physician or podiatrist is in
collaboration pursuant to section 4731.27 of the Revised Code or
failure to fulfill the responsibilities of collaboration after
entering into a standard care arrangement;
(33)
Failure to comply with the terms of a consult agreement entered into
with a pharmacist pursuant to section 4729.39 of the Revised Code;
(34)
Failure to cooperate in an investigation conducted by the board under
division (F) of this section, including failure to comply with a
subpoena or order issued by the board or failure to answer truthfully
a question presented by the board in an investigative interview, an
investigative office conference, at a deposition, or in written
interrogatories, except that failure to cooperate with an
investigation shall not constitute grounds for discipline under this
section if a court of competent jurisdiction has issued an order that
either quashes a subpoena or permits the individual to withhold the
testimony or evidence in issue;
(35)
Failure to supervise an anesthesiologist assistant in accordance with
Chapter 4760. of the Revised Code and the board's rules for
supervision of an anesthesiologist assistant;
(36)
Assisting suicide, as defined in section 3795.01 of the Revised Code;
(37)
Failure to comply with the requirements of section 2317.561 of the
Revised Code;
(38)
Failure to supervise a radiologist assistant in accordance with
Chapter 4774. of the Revised Code and the board's rules for
supervision of radiologist assistants;
(39)
Performing or inducing an abortion at an office or facility with
knowledge that the office or facility fails to post the notice
required under section 3701.791 of the Revised Code;
(40)
Failure to comply with the standards and procedures established in
rules under section 4731.054 of the Revised Code for the operation of
or the provision of care at a pain management clinic;
(41)
Failure to comply with the standards and procedures established in
rules under section 4731.054 of the Revised Code for providing
supervision, direction, and control of individuals at a pain
management clinic;
(42)
Failure to comply with the requirements of section 4729.79 or
4731.055 of the Revised Code, unless the state board of pharmacy no
longer maintains a drug database pursuant to section 4729.75 of the
Revised Code;
(43)
Failure to comply with the requirements of section 2919.171,
2919.202, or 2919.203 of the Revised Code or failure to submit to the
department of health in accordance with a court order a complete
report as described in section 2919.171 or 2919.202 of the Revised
Code;
(44)
Practicing at a facility that is subject to licensure as a category
III terminal distributor of dangerous drugs with a pain management
clinic classification unless the person operating the facility has
obtained and maintains the license with the classification;
(45)
Owning a facility that is subject to licensure as a category III
terminal distributor of dangerous drugs with a pain management clinic
classification unless the facility is licensed with the
classification;
(46)
Failure to comply with any of the requirements regarding making or
maintaining medical records or documents described in division (A) of
section 2919.192, division (C) of section 2919.193, division (B) of
section 2919.195, or division (A) of section 2919.196 of the Revised
Code;
(47)
Failure to comply with the requirements in section 3719.061 of the
Revised Code before issuing for a minor a prescription for an opioid
analgesic, as defined in section 3719.01 of the Revised Code;
(48)
Failure to comply with the requirements of section 4731.30 of the
Revised Code or rules adopted under section 4731.301 of the Revised
Code when recommending treatment with medical marijuana;
(49)
A pattern of continuous or repeated violations of division (E)(2) or
(3) of section 3963.02 of the Revised Code;
(50)
Failure to fulfill the responsibilities of a collaboration agreement
entered into with an athletic trainer as described in section
4755.621 of the Revised Code;
(51)
Failure to take the steps specified in section 4731.911 of the
Revised Code following an abortion or attempted abortion in an
ambulatory surgical facility or other location that is not a hospital
when a child is born alive;
(52)
Violation of section 4731.77 of the Revised Code;
(53)
Failure of a physician supervising a certified mental health
assistant to maintain supervision in accordance with the requirements
of Chapter 4772. of the Revised Code and the rules adopted under that
chapter;
(54)
Failure to comply with the requirements of section 3705.16 of the
Revised Code when certifying a decedent's cause of death and
completing and signing the medical certificate of death.
(C)
Disciplinary actions taken by the board under divisions (A) and (B)
of this section shall be taken pursuant to an adjudication under
Chapter 119. of the Revised Code, except that in lieu of an
adjudication, the board may enter into a consent agreement with an
individual to resolve an allegation of a violation of this chapter or
any rule adopted under it. A consent agreement, when ratified by an
affirmative vote of not fewer than six members of the board, shall
constitute the findings and order of the board with respect to the
matter addressed in the agreement. If the board refuses to ratify a
consent agreement, the admissions and findings contained in the
consent agreement shall be of no force or effect.
A
telephone conference call may be utilized for ratification of a
consent agreement that revokes or suspends an individual's license or
certificate to practice or certificate to recommend. The telephone
conference call shall be considered a special meeting under division
(F) of section 121.22 of the Revised Code.
If
the board takes disciplinary action against an individual under
division (B) of this section for a second or subsequent plea of
guilty to, or judicial finding of guilt of, a violation of section
2919.123 or 2919.124 of the Revised Code, the disciplinary action
shall consist of a suspension of the individual's license or
certificate to practice for a period of at least one year or, if
determined appropriate by the board, a more serious sanction
involving the individual's license or certificate to practice. Any
consent agreement entered into under this division with an individual
that pertains to a second or subsequent plea of guilty to, or
judicial finding of guilt of, a violation of that section shall
provide for a suspension of the individual's license or certificate
to practice for a period of at least one year or, if determined
appropriate by the board, a more serious sanction involving the
individual's license or certificate to practice.
(D)
For purposes of divisions (B)(10), (12), and (14) of this section,
the commission of the act may be established by a finding by the
board, pursuant to an adjudication under Chapter 119. of the Revised
Code, that the individual committed the act. The board does not have
jurisdiction under those divisions if the trial court renders a final
judgment in the individual's favor and that judgment is based upon an
adjudication on the merits. The board has jurisdiction under those
divisions if the trial court issues an order of dismissal upon
technical or procedural grounds.
(E)
The sealing or expungement of conviction records by any court shall
have no effect upon a prior board order entered under this section or
upon the board's jurisdiction to take action under this section if,
based upon a plea of guilty, a judicial finding of guilt, or a
judicial finding of eligibility for intervention in lieu of
conviction, the board issued a notice of opportunity for a hearing
prior to the court's order to seal or expunge the records. The board
shall not be required to seal, expunge, destroy, redact, or otherwise
modify its records to reflect the court's sealing of conviction
records.
(F)(1)
The board shall investigate evidence that appears to show that a
person has violated any provision of this chapter or any rule adopted
under it. Any person may report to the board in a signed writing any
information that the person may have that appears to show a violation
of any provision of this chapter or any rule adopted under it. In the
absence of bad faith, any person who reports information of that
nature or who testifies before the board in any adjudication
conducted under Chapter 119. of the Revised Code shall not be liable
in damages in a civil action as a result of the report or testimony.
Each complaint or allegation of a violation received by the board
shall be assigned a case number and shall be recorded by the board.
(2)
Investigations of alleged violations of this chapter or any rule
adopted under it shall be supervised by the supervising member
elected by the board in accordance with section 4731.02 of the
Revised Code and by the secretary as provided in section 4731.39 of
the Revised Code. The president may designate another member of the
board to supervise the investigation in place of the supervising
member. Upon a vote of the majority of the board to authorize the
addition of a consumer member in the supervision of any part of any
investigation, the president shall designate a consumer member for
supervision of investigations as determined by the president. The
authorization of consumer member participation in investigation
supervision may be rescinded by a majority vote of the board. No
member of the board who supervises the investigation of a case shall
participate in further adjudication of the case.
(3)
In investigating a possible violation of this chapter or any rule
adopted under this chapter, or in conducting an inspection under
division (E) of section 4731.054 of the Revised Code, the board may
question witnesses, conduct interviews, administer oaths, order the
taking of depositions, inspect and copy any books, accounts, papers,
records, or documents, issue subpoenas, and compel the attendance of
witnesses and production of books, accounts, papers, records,
documents, and testimony, except that a subpoena for patient record
information shall not be issued without consultation with the
attorney general's office and approval of the secretary of the board.
(a)
Before issuance of a subpoena for patient record information, the
secretary shall determine whether there is probable cause to believe
that the complaint filed alleges a violation of this chapter or any
rule adopted under it and that the records sought are relevant to the
alleged violation and material to the investigation. The subpoena may
apply only to records that cover a reasonable period of time
surrounding the alleged violation.
(b)
On failure to comply with any subpoena issued by the board and after
reasonable notice to the person being subpoenaed, the board may move
for an order compelling the production of persons or records pursuant
to the Rules of Civil Procedure.
(c)
A subpoena issued by the board may be served by a sheriff, the
sheriff's deputy, or a board employee or agent designated by the
board. Service of a subpoena issued by the board may be made by
delivering a copy of the subpoena to the person named therein,
reading it to the person, or leaving it at the person's usual place
of residence, usual place of business, or address on file with the
board. When serving a subpoena to an applicant for or the holder of a
license or certificate issued under this chapter, service of the
subpoena may be made by certified mail, return receipt requested, and
the subpoena shall be deemed served on the date delivery is made or
the date the person refuses to accept delivery. If the person being
served refuses to accept the subpoena or is not located, service may
be made to an attorney who notifies the board that the attorney is
representing the person.
(d)
A sheriff's deputy who serves a subpoena shall receive the same fees
as a sheriff. Each witness who appears before the board in obedience
to a subpoena shall receive the fees and mileage provided for under
section 119.094 of the Revised Code.
(4)
All hearings, investigations, and inspections of the board shall be
considered civil actions for the purposes of section 2305.252 of the
Revised Code.
(5)
A report required to be submitted to the board under this chapter, a
complaint, or information received by the board pursuant to an
investigation or pursuant to an inspection under division (E) of
section 4731.054 of the Revised Code is confidential and not subject
to discovery in any civil action.
The
board shall conduct all investigations or inspections and proceedings
in a manner that protects the confidentiality of patients and persons
who file complaints with the board. The board shall not make public
the names or any other identifying information about patients or
complainants unless proper consent is given or, in the case of a
patient, a waiver of the patient privilege exists under division (B)
of section 2317.02 of the Revised Code, except that consent or a
waiver of that nature is not required if the board possesses reliable
and substantial evidence that no bona fide physician-patient
relationship exists.
The
board may share any information it receives pursuant to an
investigation or inspection, including patient records and patient
record information, with law enforcement agencies, other licensing
boards, and other governmental agencies that are prosecuting,
adjudicating, or investigating alleged violations of statutes or
administrative rules. An agency or board that receives the
information shall comply with the same requirements regarding
confidentiality as those with which the state medical board must
comply, notwithstanding any conflicting provision of the Revised Code
or procedure of the agency or board that applies when it is dealing
with other information in its possession. In a judicial proceeding,
the information may be admitted into evidence only in accordance with
the Rules of Evidence, but the court shall require that appropriate
measures are taken to ensure that confidentiality is maintained with
respect to any part of the information that contains names or other
identifying information about patients or complainants whose
confidentiality was protected by the state medical board when the
information was in the board's possession. Measures to ensure
confidentiality that may be taken by the court include sealing its
records or deleting specific information from its records.
No
person shall knowingly access, use, or disclose confidential
investigatory information in a manner prohibited by law.
(6)
On a quarterly basis, the board shall prepare a report that documents
the disposition of all cases during the preceding three months. The
report shall contain the following information for each case with
which the board has completed its activities:
(a)
The case number assigned to the complaint or alleged violation;
(b)
The type of license or certificate to practice, if any, held by the
individual against whom the complaint is directed;
(c)
A description of the allegations contained in the complaint;
(d)
Whether witnesses were interviewed;
(e)
Whether the individual against whom the complaint is directed is the
subject of any pending complaints;
(f)
The disposition of the case.
The
report shall state how many cases are still pending and shall be
prepared in a manner that protects the identity of each person
involved in each case. The report shall be a public record under
section 149.43 of the Revised Code.
(7)
The board may provide a status update regarding an investigation to a
complainant on request if the board verifies the complainant's
identity.
(G)(1)
If either of the following circumstances occur, the secretary and
supervising member may recommend that the board suspend an
individual's license or certificate to practice or certificate to
recommend without a prior hearing:
(a)
The secretary and supervising member determine both of the following:
(i)
That there is clear and convincing evidence that an individual has
violated division (B) of this section;
(ii)
That the individual's continued practice presents a danger of
immediate and serious harm to the public.
(b)
The board receives verifiable information that a licensee has been
charged in any state or federal court with a crime classified as a
felony under the charging court's law and the conduct constitutes a
violation of division (B) of this section.
(2)
If a recommendation is made to suspend without a prior hearing
pursuant to division (G)(1) of this section, written allegations
shall be prepared for consideration by the board. The board, upon
review of those allegations and by an affirmative vote of not fewer
than six of its members, excluding the secretary and supervising
member, may suspend a license or certificate without a prior hearing.
A telephone conference call may be utilized for reviewing the
allegations and taking the vote on the summary suspension.
The
board shall serve a written order of suspension in accordance with
sections 119.05 and 119.07 of the Revised Code. If the individual
subject to the summary suspension requests an adjudicatory hearing by
the board, the date set for the hearing shall be within fifteen days,
but not earlier than seven days, after the individual requests the
hearing, unless otherwise agreed to by both the board and the
individual.
(3)
Any summary suspension imposed under division (G)(2) of this section
is not a final appealable order and is not an adjudication that may
be appealed under section 119.12 of the Revised Code. The summary
suspension shall remain in effect until a final adjudicative order
issued by the board pursuant to this section and Chapter 119. of the
Revised Code becomes effective. Once a final adjudicative order has
been issued by the board, any party adversely affected by it may file
an appeal in accordance with the requirements of Chapter 119. of the
Revised Code.
The
board shall issue its final adjudicative order within seventy-five
days after completion of its hearing. A failure to issue the order
within seventy-five days shall result in dissolution of the summary
suspension order but shall not invalidate any subsequent, final
adjudicative order.
(H)
If the board takes action under division (B)(9), (11), or (13) of
this section and the judicial finding of guilt, guilty plea, or
judicial finding of eligibility for intervention in lieu of
conviction is overturned on appeal, upon exhaustion of the criminal
appeal, a petition for reconsideration of the order may be filed with
the board along with appropriate court documents. Upon receipt of a
petition of that nature and supporting court documents, the board
shall reinstate the individual's license or certificate to practice.
The board may then hold an adjudication under Chapter 119. of the
Revised Code to determine whether the individual committed the act in
question. Notice of an opportunity for a hearing shall be given in
accordance with Chapter 119. of the Revised Code. If the board finds,
pursuant to an adjudication held under this division, that the
individual committed the act or if no hearing is requested, the board
may order any of the sanctions identified under division (B) of this
section.
(I)
The license or certificate to practice issued to an individual under
this chapter and the individual's practice in this state are
automatically suspended as of the date of the individual's second or
subsequent plea of guilty to, or judicial finding of guilt of, a
violation of section 2919.123 or 2919.124 of the Revised Code. In
addition, the license or certificate to practice or certificate to
recommend issued to an individual under this chapter and the
individual's practice in this state are automatically suspended as of
the date the individual pleads guilty to, is found by a judge or jury
to be guilty of, or is subject to a judicial finding of eligibility
for intervention in lieu of conviction in this state or treatment or
intervention in lieu of conviction in another jurisdiction for any of
the following criminal offenses in this state or a substantially
equivalent criminal offense in another jurisdiction: aggravated
murder, murder, voluntary manslaughter, felonious assault,
trafficking in persons, kidnapping, rape, sexual battery, gross
sexual imposition, aggravated arson, aggravated robbery, or
aggravated burglary. Continued practice after suspension shall be
considered practicing without a license or certificate.
The
board shall notify the individual subject to the suspension in
accordance with sections 119.05 and 119.07 of the Revised Code. If an
individual whose license or certificate is automatically suspended
under this division fails to make a timely request for an
adjudication under Chapter 119. of the Revised Code, the board shall
do whichever of the following is applicable:
(1)
If the automatic suspension under this division is for a second or
subsequent plea of guilty to, or judicial finding of guilt of, a
violation of section 2919.123 or 2919.124 of the Revised Code, the
board shall enter an order suspending the individual's license or
certificate to practice for a period of at least one year or, if
determined appropriate by the board, imposing a more serious sanction
involving the individual's license or certificate to practice.
(2)
In all circumstances in which division (I)(1) of this section does
not apply, enter a final order permanently revoking the individual's
license or certificate to practice.
(J)
If the board is required by Chapter 119. of the Revised Code to give
notice of an opportunity for a hearing and if the individual subject
to the notice does not timely request a hearing in accordance with
section 119.07 of the Revised Code, the board is not required to hold
a hearing, but may adopt, by an affirmative vote of not fewer than
six of its members, a final order that contains the board's findings.
In that final order, the board may order any of the sanctions
identified under division (A) or (B) of this section.
(K)
Any action taken by the board under division (B) of this section
resulting in a suspension from practice shall be accompanied by a
written statement of the conditions under which the individual's
license or certificate to practice may be reinstated. The board shall
adopt rules governing conditions to be imposed for reinstatement.
Reinstatement of a license or certificate suspended pursuant to
division (B) of this section requires an affirmative vote of not
fewer than six members of the board.
(L)
When the board refuses to grant or issue a license or certificate to
practice to an applicant, revokes an individual's license or
certificate to practice, refuses to renew an individual's license or
certificate to practice, or refuses to reinstate an individual's
license or certificate to practice, the board may specify that its
action is permanent. An individual subject to a permanent action
taken by the board is forever thereafter ineligible to hold a license
or certificate to practice and the board shall not accept an
application for reinstatement of the license or certificate or for
issuance of a new license or certificate.
(M)
Notwithstanding any other provision of the Revised Code, all of the
following apply:
(1)
The surrender of a license or certificate issued under this chapter
shall not be effective unless or until accepted by the board. A
telephone conference call may be utilized for acceptance of the
surrender of an individual's license or certificate to practice. The
telephone conference call shall be considered a special meeting under
division (F) of section 121.22 of the Revised Code. Reinstatement of
a license or certificate surrendered to the board requires an
affirmative vote of not fewer than six members of the board.
(2)
An application for a license or certificate made under the provisions
of this chapter may not be withdrawn without approval of the board.
(3)
Failure by an individual to renew a license or certificate to
practice in accordance with this chapter or a certificate to
recommend in accordance with rules adopted under section 4731.301 of
the Revised Code does not remove or limit the board's jurisdiction to
take any disciplinary action under this section against the
individual.
(4)
The placement of an individual's license on retired status, as
described in section 4731.283 of the Revised Code, does not remove or
limit the board's jurisdiction to take any disciplinary action
against the individual with regard to the license as it existed
before being placed on retired status.
(5)
At the request of the board, a license or certificate holder shall
immediately surrender to the board a license or certificate that the
board has suspended, revoked, or permanently revoked.
(N)
Sanctions shall not be imposed under division (B)(28) of this section
against any person who waives deductibles and copayments as follows:
(1)
In compliance with the health benefit plan that expressly allows such
a practice. Waiver of the deductibles or copayments shall be made
only with the full knowledge and consent of the plan purchaser,
payer, and third-party administrator. Documentation of the consent
shall be made available to the board upon request.
(2)
For professional services rendered to any other person authorized to
practice pursuant to this chapter, to the extent allowed by this
chapter and rules adopted by the board.
(O)
Under the board's investigative duties described in this section and
subject to division (F) of this section, the board shall develop and
implement a quality intervention program designed to improve through
remedial education the clinical and communication skills of
individuals authorized under this chapter to practice medicine and
surgery, osteopathic medicine and surgery, and podiatric medicine and
surgery. In developing and implementing the quality intervention
program, the board may do all of the following:
(1)
Offer in appropriate cases as determined by the board an educational
and assessment program pursuant to an investigation the board
conducts under this section;
(2)
Select providers of educational and assessment services, including a
quality intervention program panel of case reviewers;
(3)
Make referrals to educational and assessment service providers and
approve individual educational programs recommended by those
providers. The board shall monitor the progress of each individual
undertaking a recommended individual educational program.
(4)
Determine what constitutes successful completion of an individual
educational program and require further monitoring of the individual
who completed the program or other action that the board determines
to be appropriate;
(5)
Adopt rules in accordance with Chapter 119. of the Revised Code to
further implement the quality intervention program.
An
individual who participates in an individual educational program
pursuant to this division shall pay the financial obligations arising
from that educational program.
(P)
The board shall not refuse to issue a license to an applicant because
of a conviction, plea of guilty, judicial finding of guilt, judicial
finding of eligibility for intervention in lieu of conviction, or the
commission of an act that constitutes a criminal offense, unless the
refusal is in accordance with section 9.79 of the Revised Code.
(Q)
A license or certificate to practice or certificate to recommend
issued to an individual under this chapter and an individual's
practice under this chapter in this state are automatically suspended
if the individual's license or certificate to practice a health care
occupation or provide health care services is suspended, revoked, or
surrendered or relinquished in lieu of discipline by an agency
responsible for authorizing, certifying, or regulating an individual
to practice a health care occupation or provide health care services
in this state or another jurisdiction. The automatic suspension
begins immediately upon entry of the order by the agency and lasts
for ninety days to permit the board to investigate the basis for the
action under this chapter. Continued practice during the automatic
suspension shall be considered practicing without a license or
certificate.
The
board shall notify the individual subject to the automatic suspension
by certified mail or in person in accordance with section 119.07 of
the Revised Code. If an individual subject to an automatic suspension
under this division fails to make a timely request for an
adjudication under Chapter 119. of the Revised Code, the board is not
required to hold a hearing, but may adopt, by an affirmative vote of
not fewer than six of its members, a final order that contains the
board's findings. In that final order, the board may order any of the
sanctions identified under division (A) or (B) of this section.
Sec.
4731.27.
(A)
As used in this section, "collaboration," "physician,"
"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
certified
midwife,
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
certified
midwife's or
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
midwife,
certified
nurse-midwife, certified nurse practitioner, or clinical nurse
specialist before their standard care arrangement expires shall give
the
certified
midwife or
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
certified
midwife,
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
certified
midwife,
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 with the supervision of the physician or podiatrist.
Section
2.
That
existing sections 3701.351, 3702.30, 4723.01, 4723.02, 4723.03,
4723.06, 4723.07, 4723.08, 4723.271, 4723.28, 4723.282, 4723.33,
4723.34, 4723.341, 4723.35, 4723.41, 4723.43, 4723.431, 4723.432,
4723.481, 4723.483, 4723.487, 4723.488, 4723.4810, 4723.4811,
4723.50, 4723.91, 4723.99, 4731.22, and 4731.27 of the Revised Code
are hereby repealed.
Section
3.
Sections
4723.54 and 4724.02 of the Revised Code, as enacted by this act, take
effect January 1, 2028.
Section
4.
The
General Assembly, applying the principle stated in division (B) of
section 1.52 of the Revised Code that amendments are to be harmonized
if reasonably capable of simultaneous operation, finds that the
following sections, presented in this act as composites of the
sections as amended by the acts indicated, are the resulting versions
of the sections in effect prior to the effective date of the sections
as presented in this act:
Section
4723.08 of the Revised Code as amended by both H.B. 509 and S.B. 131
of the 134th General Assembly.
Section
4723.431 of the Revised Code as amended by both H.B. 497 and S.B. 196
of the 135th General Assembly.
Section
4723.481 of the Revised Code as amended by H.B. 33 of the 135th
General Assembly and by H.B. 110 and H.B. 509 of the 134th General
Assembly.