June 7, 2016, Introduced by Senator KOWALL and referred to the Committee on Michigan Competitiveness.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 17210 and 17708 (MCL 333.17210 and 333.17708),
section 17708 as amended by 2016 PA 49.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 17210. (1) The board of nursing may issue a specialty
certification to a registered professional nurse who has advanced
training beyond that required for initial licensure and who has
demonstrated competency through examination or other evaluative
processes
and who practices in 1 of the following health profession
specialty
fields: field of nurse midwifery, nurse anesthetist, or
nurse practitioner.
(2) All of the following apply to a registered professional
nurse who holds a specialty certification as a nurse anesthetist:
(a) In addition to performing duties within the scope of the
practice of nursing, his or her scope of practice includes any of
the following anesthesia and analgesia services:
(i) Development of a plan of care.
(ii) Performance of all patient assessments, procedures, and
monitoring to implement the plan of care or to address patient
emergencies that arise during implementation of the plan of care.
(iii) Selection, ordering, or prescribing and the
administration of anesthesia and analgesic agents, including
pharmacological agents that are prescription drugs as defined in
section 17708 or controlled substances. For purposes of this
subparagraph, the authority of a registered professional nurse who
holds a specialty certification as a nurse anesthetist to prescribe
pharmacological agents is limited to pharmacological agents for
administration to patients as described in subdivision (b) or (c),
and his or her authority does not include any activity that would
permit a patient to obtain or receive pharmacological agents,
including prescription drugs or controlled substances, outside of
the facility in which the anesthetic or analgesic services are
performed.
(b) He or she may provide the anesthesia and analgesia
services described in subdivision (a) as the sole and independent
anesthesia provider if he or she is part of a patient-centered care
team in a hospital inpatient or outpatient facility; a freestanding
surgical outpatient facility; an office of an allopathic or
osteopathic physician or podiatrist; or any other office or
facility in which diagnostic imaging, endoscopy, or cystoscopy
services are provided to patients. As used in this subdivision:
(i) "Health care professional" means an individual who is
licensed or registered to perform a health profession under this
article.
(ii) "Patient-centered care team" means the patient and an
interdisciplinary group of health care professionals that includes
health care professionals who are directly involved in an
operative, obstetrical, or diagnostic procedure performed on the
patient. A patient-centered care team may include, but is not
required to include, physicians, registered professional nurses,
licensed practical nurses, or any other specific categories or
types of health care professionals.
(iii) "Physician" means that term as defined in section 17001
or 17501.
(iv) "Podiatrist" means that term as defined in section 18001.
(c) The anesthesia and analgesia services described in
subdivision (a) may be performed for operative, obstetrical,
interventional, or diagnostic purposes, but only during 1 or more
of the following:
(i) The preoperative, intraoperative, and postoperative
period.
(ii) The obstetrical service period.
(iii) The preoperative, intraoperative, and postoperative
surgical or interventional service period.
(iv) The preoperative, intraoperative, and postoperative
diagnostic service period.
(d) The anesthesia and analgesia services described in
subdivision (a) do not include chronic pain management services.
However, he or she may perform chronic pain management services
under delegation pursuant to section 16215.
(3) Subsection (2) does not require new or additional third
party reimbursement or mandated worker's compensation benefits for
anesthesia and analgesia services provided under that subsection by
a registered professional nurse who holds a specialty certification
as a nurse anesthetist under this part.
Sec. 17708. (1) "Preceptor" means a pharmacist who is approved
by the board to direct the training of an intern in an approved
pharmacy.
(2)
"Prescriber" means a any
of the following:
(a)
A licensed dentist. ,
a
(b)
A licensed doctor of medicine. ,
a
(c)
A licensed doctor of osteopathic
medicine and surgery. , a
(d)
A licensed doctor of podiatric medicine
and surgery. , a
(e) A licensed optometrist certified under part 174 to
administer
and prescribe therapeutic pharmaceutical agents. , a
(f)
A licensed veterinarian. ,
or another
(g) A registered professional nurse who holds a specialty
certification as a nurse anesthetist under section 17210 when he or
she is engaging in the practice of nursing and providing the
anesthesia and analgesia services described in section 17210(2).
For purposes of this subdivision, the authority of a registered
professional nurse who holds a specialty certification as a nurse
anesthetist under section 17210 to prescribe pharmacological agents
is limited to pharmacological agents for administration to patients
as described in section 17210(2)(b) or (c).
(h) Any other licensed health professional acting under the
delegation and using, recording, or otherwise indicating the name
of the delegating licensed doctor of medicine or licensed doctor of
osteopathic medicine and surgery.
(3) "Prescription" means an order by a prescriber to fill,
compound, or dispense a drug or device written and signed; written
or created in an electronic format, signed, and transmitted by
facsimile; or transmitted electronically or by other means of
communication. An order transmitted in other than written or hard-
copy form must be electronically recorded, printed, or written and
immediately dated by the pharmacist, and that record constitutes
the original prescription. In a health facility or agency licensed
under article 17 or other medical institution, an order for a drug
or device in the patient's chart constitutes for the purposes of
this definition the original prescription. Subject to section
17751(2) and (5), prescription includes, but is not limited to, an
order
for a drug, not including a controlled substance as defined
in
section 7104 except under
circumstances described in section
17763(e), written and signed; written or created in an electronic
format, signed, and transmitted by facsimile; or transmitted
electronically or by other means of communication by a physician
prescriber, dentist prescriber, or veterinarian prescriber licensed
to practice dentistry, medicine, osteopathic medicine and surgery,
or veterinary medicine in another state.
(4) "Prescription drug" means a drug to which 1 or more of the
following apply:
(a) The drug is dispensed pursuant to a prescription.
(b) The drug bears the federal legend "CAUTION: federal law
prohibits dispensing without prescription" or "Rx only".
(c) The drug is designated by the board as a drug that may
only be dispensed pursuant to a prescription.
(5) Subsection (2)(g) does not require new or additional third
party reimbursement or mandated worker's compensation benefits for
anesthesia and analgesia services provided under section 17210(2)
by a registered professional nurse who holds a specialty
certification as a nurse anesthetist under section 17210(2).
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.