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H.B. 336

This document includes House Committee Amendments incorporated into the bill on Tue, Feb 22, 2011 at 11:29 AM by lerror. --> This document includes House Floor Amendments incorporated into the bill on Fri, Feb 25, 2011 at 2:26 PM by lerror. -->              1     

MEDICAL PROFESSIONAL LICENSING DURING A

             2     
DECLARED EMERGENCY

             3     
2011 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Evan J. Vickers

             6     
Senate Sponsor: Allen M. Christensen

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill modifies the Division of Occupational and Professional Licensing Act and the
             11      Pharmacy Practice Act by enacting language regarding health department protocols.
             12      Highlighted Provisions:
             13          This bill:
             14          .    authorizes the Department of Health to establish a protocol for the distribution of
             15      medicine in a national, state, or local emergency to:
             16              .    a local health department;
             17              .    a pharmacy;
             18              .    a prescribing practitioner;
             19              .    a licensed health care facility;
             20              .    a federally qualified community health clinic;
             21              .    a patient's contact; or
             22              .    emergency service personnel;
             23          .    authorizes the Department of Health to establish a protocol to allow a physician to
             24      write a prescription for a patient's contact when necessary to treat a reportable
             25      disease or non-emergency condition; and
             26          .    makes technical changes.
             27      Money Appropriated in this Bill:


             28          None
             29      Other Special Clauses:
             30          None
             31      Utah Code Sections Affected:
             32      AMENDS:
             33          58-1-307, as last amended by Laws of Utah 2008, Chapter 242
             34          58-17b-620, as enacted by Laws of Utah 2004, Chapter 280
             35     
             36      Be it enacted by the Legislature of the state of Utah:
             37          Section 1. Section 58-1-307 is amended to read:
             38           58-1-307. Exemptions from licensure.
             39          (1) Except as otherwise provided by statute or rule, the following individuals may
             40      engage in the practice of their occupation or profession, subject to the stated circumstances and
             41      limitations, without being licensed under this title:
             42          (a) an individual serving in the armed forces of the United States, the United States
             43      Public Health Service, the United States Department of Veterans Affairs, or other federal
             44      agencies while engaged in activities regulated under this chapter as a part of employment with
             45      that federal agency if the individual holds a valid license to practice a regulated occupation or
             46      profession issued by any other state or jurisdiction recognized by the division;
             47          (b) a student engaged in activities constituting the practice of a regulated occupation or
             48      profession while in training in a recognized school approved by the division to the extent the
             49      activities are supervised by qualified faculty, staff, or designee and the activities are a defined
             50      part of the training program;
             51          (c) an individual engaged in an internship, residency, preceptorship, postceptorship,
             52      fellowship, apprenticeship, or on-the-job training program approved by the division while
             53      under the supervision of qualified individuals;
             54          (d) an individual residing in another state and licensed to practice a regulated
             55      occupation or profession in that state, who is called in for a consultation by an individual
             56      licensed in this state, and the services provided are limited to that consultation;
             57          (e) an individual who is invited by a recognized school, association, society, or other
             58      body approved by the division to conduct a lecture, clinic, or demonstration of the practice of a


             59      regulated occupation or profession if the individual does not establish a place of business or
             60      regularly engage in the practice of the regulated occupation or profession in this state;
             61          (f) an individual licensed under the laws of this state, other than under this title, to
             62      practice or engage in an occupation or profession, while engaged in the lawful, professional,
             63      and competent practice of that occupation or profession;
             64          (g) an individual licensed in a health care profession in another state who performs that
             65      profession while attending to the immediate needs of a patient for a reasonable period during
             66      which the patient is being transported from outside of this state, into this state, or through this
             67      state;
             68          (h) an individual licensed in another state or country who is in this state temporarily to
             69      attend to the needs of an athletic team or group, except that the practitioner may only attend to
             70      the needs of the athletic team or group, including all individuals who travel with the team or
             71      group in any capacity except as a spectator;
             72          (i) an individual licensed and in good standing in another state, who is in this state:
             73          (i) temporarily, under the invitation and control of a sponsoring entity;
             74          (ii) for a reason associated with a special purpose event, based upon needs that may
             75      exceed the ability of this state to address through its licensees, as determined by the division;
             76      and
             77          (iii) for a limited period of time not to exceed the duration of that event, together with
             78      any necessary preparatory and conclusionary periods; and
             79          (j) a law enforcement officer, as defined under Section 53-13-103 , who:
             80          (i) is operating a voice stress analyzer in the course of the officer's full-time
             81      employment with a federal, state, or local law enforcement agency;
             82          (ii) has completed the manufacturer's training course and is certified by the
             83      manufacturer to operate that voice stress analyzer; and
             84          (iii) is operating the voice stress analyzer in accordance with Section 58-64-601 ,
             85      regarding deception detection instruments.
             86          (2) (a) A practitioner temporarily in this state who is exempted from licensure under
             87      Subsection (1) shall comply with each requirement of the licensing jurisdiction from which the
             88      practitioner derives authority to practice.
             89          (b) Violation of a limitation imposed by this section constitutes grounds for removal of


             90      exempt status, denial of license, or other disciplinary proceedings.
             91          (3) An individual who is licensed under a specific chapter of this title to practice or
             92      engage in an occupation or profession may engage in the lawful, professional, and competent
             93      practice of that occupation or profession without additional licensure under other chapters of
             94      this title, except as otherwise provided by this title.
             95          (4) Upon the declaration of a national, state, or local emergency, a public health
             96      emergency as defined in Section 26-23b-102 , or a declaration by the President of the United
             97      States or other federal official requesting public health-related activities, the division in
             98      collaboration with the board may:
             99          (a) suspend the requirements for permanent or temporary licensure of individuals who
             100      are licensed in another state. Individuals exempt under this Subsection (4)(a) are exempt from
             101      licensure for the duration of the emergency while engaged in the scope of practice for which
             102      they are licensed in the other state;
             103          (b) modify, under the circumstances described in this Subsection (4) and Subsection
             104      (5), the scope of practice restrictions under this title for individuals who are licensed under this
             105      title as:
             106          (i) a physician under Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah
             107      Osteopathic Medical Practice Act;
             108          (ii) a nurse under Chapter 31b, Nurse Practice Act, or Chapter 31c, Nurse Licensure
             109      Compact;
             110          (iii) a certified nurse midwife under Chapter 44a, Nurse Midwife Practice Act;
             111          (iv) a pharmacist, pharmacy technician, or pharmacy intern under Chapter 17b,
             112      Pharmacy Practice Act;
             113          (v) a respiratory therapist under Chapter 57, Respiratory Care Practices Act;
             114          (vi) a dentist and dental hygienist under Chapter 69, Dentist and Dental Hygienist
             115      Practice Act; and
             116          (vii) a physician assistant under Chapter 70a, Physician Assistant Act;
             117          (c) suspend the requirements for licensure under this title and modify the scope of
             118      practice in the circumstances described in this Subsection (4) and Subsection (5) for medical
             119      services personnel or paramedics required to be certified under Section 26-8a-302 ;
             120          (d) suspend requirements in Subsections 58-17b-620 (3) through (6) which require


             121      certain prescriptive procedures;
             122          (e) exempt or modify the requirement for licensure of an individual who is activated as
             123      a member of a medical reserve corps during a time of emergency as provided in Section
             124      26A-1-126 ; and
             125          (f) exempt or modify the requirement for licensure of an individual who is registered as
             126      a volunteer health practitioner as provided in Title 26, Chapter 49, Uniform Emergency
             127      Volunteer Health Practitioners Act.
             128          (5) Individuals exempt under Subsection (4)(c) and individuals operating under
             129      modified scope of practice provisions under Subsection (4)(b):
             130          (a) are exempt from licensure or subject to modified scope of practice for the duration
             131      of the emergency;
             132          (b) must be engaged in the distribution of medicines or medical devices in response to
             133      the emergency or declaration; and
             134          (c) must be employed by or volunteering for:
             135          (i) a local or state department of health; or
             136          (ii) a host entity as defined in Section 26-49-102 .
             137          (6) In accordance with the protocols established under Subsection (8), upon the
             138      declaration of a national, state, or local emergency, the Department of Health or a local health
             139      department H. shall coordinate with public safety authorities as defined in
             139a      Section 26-23b-110(1) and .H may:
             140          (a) use a H. [ stockpile ] .H vaccine, antiviral, antibiotic, or other
             140a      prescription medication that is
             141      not a controlled substance to prevent or treat a disease or condition that gave rise to, or was a
             142      consequence of, the emergency; or
             143          (b) distribute a H. [ stockpile ] .H vaccine, antiviral, antibiotic, or other
             143a      prescription medication
             144      that is not a controlled substance:
             145          (i) if necessary, to replenish a commercial pharmacy in the event that the commercial
             146      pharmacy's normal source of the vaccine, antiviral, antibiotic, or other prescription medication
             147      is exhausted; or
             148          (ii) for dispensing or direct administration to treat the disease or condition that gave
             149      rise to, or was a consequence of, the emergency by:
             150          (A) a pharmacy;
             151          (B) a prescribing practitioner;



             152          (C) a licensed health care facility;
             153          (D) a federally qualified community health clinic; or
             154          (E) a governmental entity for use by a community more than 50 miles from a person
             155      described in Subsections (6)(b)(ii)(A) through (D).
             156          (7) In accordance with protocols established under Subsection (8), upon the declaration
             157      of a national, state, or local emergency, the Department of Health shall coordinate the
             158      distribution of medications:
             159          (a) received from the strategic national stockpile to local health departments; and
             160          (b) from local health departments to emergency personnel within the local health
             161      departments' geographic region.
             162          (8) The Department of Health shall establish by rule, made in accordance with Title
             163      63G, Chapter 3, Utah Administrative Rulemaking Act, protocols for administering, dispensing,
             164      and distributing a vaccine, an antiviral, an antibiotic, or other prescription medication that is
             165      not a controlled substance in the event of a declaration of a national, state, or local emergency.
             166      The protocol shall establish procedures for the Department of Health
             166a      H. or a local health department .H to:
             167          (a) coordinate the distribution of:
             168          (i) a vaccine, an antiviral, an antibiotic, or other prescription medication that is not a
             169      controlled substance received by the Department of Health from the strategic national stockpile
             170      to local health departments; and
             171          (ii) a vaccine, an antiviral, an antibiotic, or other non-controlled prescription
             172      medication received by a local health department to emergency personnel within the local
             173      health department's geographic region;
             174          (b) authorize the H. dispensing, .H administration H. , .H or distribution
             174a      of a vaccine, an antiviral, an antibiotic,
             175      or other prescription medication that is not a controlled substance to the contact of a patient, as
             176      defined in Subsection 26-6-2 (4), without a patient-practitioner relationship, H. [ so long as ] if [ the
             177      prescription is the same substance prescribed for
] the contact's condition is the same as that of .H
             177a      the physician's patient; and
             178          (c) authorize the administration, distribution, or dispensing of a vaccine, an antiviral,
             179      an antibiotic, or other non-controlled prescription medication to an individual who:
             180          (i) is working in a triage situation;
             181          (ii) is receiving H. preventative or .H medical treatment in a triage situation;
             182          (iii) does not have coverage for the prescription in the individual's health insurance


             183      plan;
             184          (iv) is involved in the delivery of medical or other emergency services in response to
             185      the declared national, state, or local emergency; or
             186          (v) otherwise has a direct impact on public health.
             187          (9) The Department of Health shall give notice to the division upon implementation of
             188      the protocol established under Subsection (8).
             189          Section 2. Section 58-17b-620 is amended to read:
             190           58-17b-620. Prescriptions issued within the public health system.
             191          (1) As used in this section:
             192          (a) "Department of Health" means the state Department of Health created in Section
             193      26-1-4 .
             194          (b) "Health department" means either the Department of Health or a local health
             195      department.
             196          (c) "Local health departments" mean the local health departments created in Title 26A,
             197      Chapter 1, Local Health Departments.
             198          [(2) A health department may implement the prescription procedure under Subsection
             199      (3) for prescription drugs, other than controlled substances, for use in clinics providing:]
             200          (2) When it is necessary to treat a reportable disease or non-emergency condition that
             201      has a direct impact on public health, a health department may implement the prescription
             202      procedure described in Subsection (3) for a prescription drug that is not a controlled substance
             203      for use in:
             204          (a) a clinic; or
             205          (b) a remote or temporary off-site location, including a triage facility established in the
             206      community, that provides:
             207          [(a)] (i) treatment for sexually transmitted [disease treatment] infections;
             208          [(b)] (ii) fluoride treatment; [or]
             209          [(c)] (iii) travel immunization[.];
             210          (iv) preventative treatment for an individual with latent tuberculosis infection;
             211          (v) preventative treatment for an individual H. [ exposed to a communicable disease ] at risk
             211a      for an infectious disease that has a direct impact on public health .H when
             212      the treatment is indicated to prevent the spread of disease or to mitigate the seriousness of
             213      infection in the exposed individual; or


             214          (vi) other treatment as defined by the Department of Health rule.
             215          (3) In a circumstance described in Subsection (2), H. [ a physician ] an individual with
             215a      prescriptive authority .H may write a prescription
             216      for each contact, as defined in Subsection 26-6-2 (4), of H. [ the physician's ] a patient of the
             216a      individual with prescriptive authority [ patient ] .H without a
             217      face-to-face exam, if:
             218          (a) the H. [ physician ] individual with prescriptive authority .H is
             218a      treating the H. [ physician's ] .H patient for a reportable disease or
             219      non-emergency condition having a direct impact on public health; and
             220          (b) H. [ the prescription is for the same substance as prescribed to ] the contact's
             220a      condition is the same as .H the H. [ physician's ] patient of the individual with
             220b      prescriptive authority [ patient ] .H .
             221          [(3)] (4) The following prescription procedure shall be carried out in accordance with
             222      the requirements of Subsection [(4)] (5) and may be used only in the [clinics listed]
             223      circumstances described under [Subsection] Subsections (2) and (3):
             224          (a) a physician writes and signs a prescription for a prescription [drugs] drug, other
             225      than a controlled [substances] substance, without the name and address of the patient and
             226      without the date the prescription is provided to the patient; and
             227          (b) the physician authorizes a registered nurse employed by the health department to
             228      complete the prescription written under this Subsection (3) by inserting the patient's name and
             229      address, and the date the prescription is provided to the patient, in accordance with the
             230      physician's standing written orders and a written health department protocol approved by the
             231      physician and the medical director of the state Department of Health.
             232          [(4) When allowing prescriptions to be written under Subsection (3), the health
             233      department shall employ a physician who:]
             234          [(a) assumes specific responsibility for all prescriptions issued in his name under the
             235      procedure in Subsection (3) by the health department; and]
             236          [(b) enters into a written, signed agreement with the health department, which
             237      agreement is approved by the division and state:]
             238          [(i) the terms and conditions under which the physician will prepare and sign
             239      prescriptions that do not include the name and address of the patient and the date the
             240      prescription is provided to the patient;]
             241          [(ii) the methods which will be used to ensure the signed prescriptions are secure and
             242      not available for unauthorized use;]


             243          [(iii) the minimum qualifications and training of a registered nurse authorized by the
             244      physician and department to complete and provide prescriptions to a patient;]


             245          [(iv) under what conditions prescriptions completed by an authorized registered nurse
             246      will be provided to a patient in accordance with standing orders and written protocols, and the
             247      specific prescription drugs for which prescriptions may be written;]
             248          [(v) the manner in which the physician will audit and review the records of patients
             249      receiving prescriptions; and]
             250          [(vi) the manner in which records of prescriptions issued will be maintained for audit
             251      by the physician and division.]
             252          [(5) The health department shall file and maintain with the division a current copy of
             253      all agreements signed by physicians under Subsection (4).]
             254          (5) A physician assumes responsibility for all prescriptions issued under this section in
             255      the physician's name.
             256          (6) (a) All prescription forms to be used by a physician and health department in
             257      accordance with this section shall be serially numbered according to a numbering system
             258      assigned to that health department.
             259          (b) All prescriptions issued shall contain all information required under this chapter
             260      and rules adopted under this chapter.




Legislative Review Note
    as of 2-2-11 2:57 PM


Office of Legislative Research and General Counsel


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