Senate Bill sb1820

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    Florida Senate - 2003                                  SB 1820

    By Senator Margolis





    35-354A-03

  1                      A bill to be entitled

  2         An act relating to the practice of psychology;

  3         amending s. 490.003, F.S.; redefining the term

  4         "practice of psychology" to include the

  5         prescription and administration of drugs,

  6         including, but not limited to, controlled

  7         substances, under certain circumstances;

  8         creating s. 490.0146, F.S.; providing

  9         requirements for and conditions to the

10         prescription and administration of drugs,

11         including controlled substances, by

12         psychologists; defining terms; requiring

13         certification; providing requirements for

14         application for and renewal of prescriptive

15         authority; providing prescribing practices;

16         requiring the transmission of certain

17         information to the Board of Pharmacy; providing

18         rulemaking authority to establish grounds for

19         discipline and for the suspension or revocation

20         of prescriptive authority; amending s. 458.348,

21         F.S.; revising references, to conform; amending

22         s. 464.003, F.S.; redefining the term "practice

23         of practical nursing" to include acts performed

24         under the direction or supervision of a

25         licensed psychologist certified to prescribe

26         drugs; amending s. 464.012, F.S.; including

27         psychological treatment under supervision of a

28         licensed psychologist certified to prescribe

29         drugs among those functions an advanced

30         registered nurse practitioner may perform

31         within the framework of an established

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    Florida Senate - 2003                                  SB 1820
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  1         protocol; amending s. 893.02, F.S.; redefining

  2         the term "practitioner" as used in the Florida

  3         Comprehensive Drug Abuse Prevention and Control

  4         Act to include licensed psychologists certified

  5         to prescribe drugs; reenacting s. 775.051,

  6         F.S., relating to voluntary intoxication as a

  7         defense, to incorporate the amendment to s.

  8         893.02, F.S., in a reference thereto; providing

  9         an effective date.

10

11  Be It Enacted by the Legislature of the State of Florida:

12

13         Section 1.  Subsection (4) of section 490.003, Florida

14  Statutes, is amended to read:

15         490.003  Definitions.--As used in this chapter:

16         (4)  "Practice of psychology" means the observations,

17  description, evaluation, interpretation, and modification of

18  human behavior, by the use of scientific and applied

19  psychological principles, methods, and procedures, for the

20  purpose of describing, preventing, alleviating, or eliminating

21  symptomatic, maladaptive, or undesired behavior and of

22  enhancing interpersonal behavioral health and mental or

23  psychological health. The practice of psychology includes the

24  prescription and administration of drugs, including, but not

25  limited to, controlled substances, if the licensee is

26  certified to prescribe drugs under s. 490.0146. The ethical

27  practice of psychology includes, but is not limited to,

28  psychological testing and the evaluation or assessment of

29  personal characteristics such as intelligence, personality,

30  abilities, interests, aptitudes, and neuropsychological

31  functioning, including evaluation of mental competency to

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    Florida Senate - 2003                                  SB 1820
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  1  manage one's affairs and to participate in legal proceedings;

  2  counseling, psychoanalysis, all forms of psychotherapy, sex

  3  therapy, hypnosis, biofeedback, and behavioral analysis and

  4  therapy; psychoeducational evaluation, therapy, remediation,

  5  and consultation; and use of psychological methods to diagnose

  6  and treat mental, nervous, psychological, marital, or

  7  emotional disorders, illness, or disability, alcoholism and

  8  substance abuse, and disorders of habit or conduct, as well as

  9  the psychological aspects of physical illness, accident,

10  injury, or disability, including neuropsychological

11  evaluation, diagnosis, prognosis, etiology, and treatment.

12         (a)  Psychological services may be rendered to

13  individuals, couples, families, groups, and the public without

14  regard to place of service.

15         (b)  The use of specific modalities within the practice

16  of psychology is restricted to psychologists appropriately

17  trained in the use of such modalities.

18         (c)  The practice of psychology shall be construed

19  within the meaning of this definition without regard to

20  whether payment is requested or received for services

21  rendered.

22         Section 2.  Section 490.0146, Florida Statutes, is

23  created to read:

24         490.0146  Prescription of drugs.--

25         (1)  DEFINITIONS.--As used in this section, the term:

26         (a)  "Prescription" means an order for a drug,

27  laboratory test, or any medicine, device, or treatment,

28  including, but not limited to, a controlled substance.

29         (b)  "Prescriptive authority" means the authority to

30  prescribe, administer, and dispense drugs, including, but not

31  limited to, controlled substances, and other treatment

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  1  procedures within the scope of the practice of psychology, in

  2  accordance with rules adopted by the board.

  3         (c)  "Psychologist certified to prescribe" means a

  4  licensed, doctoral-level psychologist who has undergone

  5  specialized training, has passed an examination approved by

  6  the board, and has received from the board a certificate

  7  granting prescriptive authority, which certificate is current

  8  and has not been revoked or suspended.

  9         (2)  CERTIFICATION OF PRESCRIPTIVE AUTHORITY.--

10         (a)  The board shall certify licensed, doctoral-level

11  psychologists to prescribe, administer, and dispense drugs,

12  including, but not limited to, controlled substances, in

13  accordance with applicable state and federal laws.

14         (b)  The board shall adopt rules for reviewing

15  educational and training credentials for the certification

16  process in accordance with current standards of professional

17  practice.

18         (c)  The board may seek the advice of other state

19  agencies that have relevant expertise in devising

20  certification procedures and criteria.

21         (3)  APPLICATION FOR INITIAL PRESCRIPTIVE

22  AUTHORITY.--In applying to the board for prescriptive

23  authority, a psychologist shall demonstrate, by official

24  transcript or other official evidence satisfactory to the

25  board, that he or she:

26         (a)  Has completed a doctoral degree in psychology in

27  accordance with s. 490.003(3);

28         (b)  Holds a current license to practice psychology in

29  this state;

30         (c)  Has completed an organized educational program of

31  intensive didactic instruction, as defined by the board, which

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  1  consists of the following core areas of instruction:

  2  neuroscience, pharmacology, psychopharmacology, physiology,

  3  pathophysiology, appropriate and relevant physical and

  4  laboratory assessment, and clinical pharmacotherapeutics;

  5         (d)  Has had supervised and relevant clinical

  6  experience sufficient to assure competency to treat patients

  7  under the direction of qualified practitioners, as determined

  8  by the board; and

  9         (e)  Has passed a certification examination

10  administered by the board and developed by a nationally

11  recognized body approved by the board.

12         (4)  RENEWAL OF PRESCRIPTIVE AUTHORITY.--

13         (a)  The board shall establish, by rule, a procedure

14  for renewing prescriptive authority at the time of or in

15  conjunction with license renewal.

16         (b)  Each applicant for renewal of prescriptive

17  authority must present evidence satisfactory to the board

18  which demonstrates that the applicant has completed 10 hours

19  of continuing education relevant to prescriptive authority

20  during the biennium immediately preceding the date of

21  application for licensure renewal.

22         (5)  PRESCRIBING PRACTICES.--

23         (a)  Each prescription issued by a psychologist

24  certified to prescribe must comply with all applicable state

25  and federal laws.

26         (b)  Records of all prescriptions issued by a

27  psychologist certified to prescribe must be maintained in

28  patient records.

29         (6)  CONTROLLED SUBSTANCES PRESCRIPTIVE AUTHORITY.--

30         (a)  Each psychologist certified to prescribe

31  controlled substances shall timely file with the board all

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    Florida Senate - 2003                                  SB 1820
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  1  individual registrations and numbers issued by the federal

  2  Drug Enforcement Administration.

  3         (b)  The board shall maintain current records of each

  4  psychologist certified to prescribe, including, but not

  5  limited to, each registration and number issued by the federal

  6  Drug Enforcement Administration.

  7         (7)  INTERACTION WITH THE BOARD OF PHARMACY.--

  8         (a)  The board shall transmit annually to the Board of

  9  Pharmacy a list of psychologists certified to prescribe which

10  contains the following information:

11         1.  The name of each psychologist.

12         2.  Each psychologist's identification number assigned

13  by the board.

14         3.  The effective date of the psychologist's

15  prescriptive authority.

16         (b)  The board shall promptly forward to the Board of

17  Pharmacy the names and titles of psychologists who are added

18  to or deleted from the annual list of psychologists certified

19  to prescribe.

20         (c)  The board shall timely notify the Board of

21  Pharmacy upon the termination, suspension, or reinstatement of

22  a psychologist's prescriptive authority.

23         (8)  DISCIPLINE; SUSPENSION OR REVOCATION OF

24  PRESCRIPTIVE AUTHORITY.--The board shall establish, by rule,

25  criteria for disciplining, suspending, or revoking the

26  prescriptive authority of a psychologist certified to

27  prescribe. The board may prescribe standards for education,

28  training, rehabilitation, fines, reprimand, or restriction of

29  practice of such psychologists and for the suspension or

30  revocation of a psychologist's prescriptive authority.

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  1         Section 3.  Paragraph (a) of subsection (1) and

  2  subsection (2) of section 458.348, Florida Statutes, are

  3  amended to read:

  4         458.348  Formal supervisory relationships, standing

  5  orders, and established protocols; notice; standards.--

  6         (1)  NOTICE.--

  7         (a)  When a physician enters into a formal supervisory

  8  relationship or standing orders with an emergency medical

  9  technician or paramedic licensed pursuant to s. 401.27, which

10  relationship or orders contemplate the performance of medical

11  acts, or when a physician enters into an established protocol

12  with an advanced registered nurse practitioner, which protocol

13  contemplates the performance of medical acts or acts of

14  psychological practice identified and approved by the joint

15  committee pursuant to s. 464.003(3)(c) or acts set forth in s.

16  464.012(3) and (4), the physician shall submit notice to the

17  board. The notice shall contain a statement in substantially

18  the following form:

19

20         I, ...(name and professional license number of

21  physician)..., of ...(address of physician)... have hereby

22  entered into a formal supervisory relationship, standing

23  orders, or an established protocol with ...(number of

24  persons)... emergency medical technician(s), ...(number of

25  persons)... paramedic(s), or ...(number of persons)...

26  advanced registered nurse practitioner(s).

27

28         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

29  COMMITTEE.--The joint committee created by s. 464.003(3)(c)

30  shall determine minimum standards for the content of

31  established protocols pursuant to which an advanced registered

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  1  nurse practitioner may perform medical acts or acts of

  2  psychological practice identified and approved by the joint

  3  committee pursuant to s. 464.003(3)(c) or acts set forth in s.

  4  464.012(3) and (4) and shall determine minimum standards for

  5  supervision of such acts by the physician, unless the joint

  6  committee determines that any act set forth in s. 464.012(3)

  7  or (4) is not a medical act or an act of psychological

  8  practice.  Such standards shall be based on risk to the

  9  patient and acceptable standards of medical or psychological

10  practice care and shall take into account the special problems

11  of medically underserved areas. The standards developed by the

12  joint committee shall be adopted as rules by the Board of

13  Nursing and the Board of Medicine for purposes of carrying out

14  their responsibilities pursuant to part I of chapter 464 and

15  this chapter, respectively, but neither board shall have

16  disciplinary powers over the licensees of the other board.

17         Section 4.  Paragraphs (b) and (c) of subsection (3) of

18  section 464.003, Florida Statutes, are amended to read:

19         464.003  Definitions.--As used in this part:

20         (3)

21         (b)  "Practice of practical nursing" means the

22  performance of selected acts, including the administration of

23  treatments and medications, in the care of the ill, injured,

24  or infirm and the promotion of wellness, maintenance of

25  health, and prevention of illness of others under the

26  direction of a registered nurse, a licensed physician, a

27  licensed osteopathic physician, a licensed podiatric

28  physician, or a licensed dentist, or a licensed psychologist

29  certified to prescribe drugs under s. 490.0146.

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  1  The professional nurse and the practical nurse shall be

  2  responsible and accountable for making decisions that are

  3  based upon the individual's educational preparation and

  4  experience in nursing.

  5         (c)  "Advanced or specialized nursing practice" means,

  6  in addition to the practice of professional nursing, the

  7  performance of advanced-level nursing acts approved by the

  8  board which, by virtue of postbasic specialized education,

  9  training, and experience, are proper to be performed by an

10  advanced registered nurse practitioner.  Within the context of

11  advanced or specialized nursing practice, the advanced

12  registered nurse practitioner may perform acts of nursing

13  diagnosis and nursing treatment of alterations of the health

14  status.  The advanced registered nurse practitioner may also

15  perform acts of medical diagnosis and treatment, prescription,

16  and operation which are identified and approved by a joint

17  committee composed of three members appointed by the Board of

18  Nursing, two of whom shall be advanced registered nurse

19  practitioners; three members appointed by the Board of

20  Medicine, two of whom shall have had work experience with

21  advanced registered nurse practitioners; and the secretary of

22  the department or the secretary's designee. Each committee

23  member appointed by a board shall be appointed to a term of 4

24  years unless a shorter term is required to establish or

25  maintain staggered terms. The Board of Nursing shall adopt

26  rules authorizing the performance of any such acts approved by

27  the joint committee. Unless otherwise specified by the joint

28  committee, such acts shall be performed under the general

29  supervision of a practitioner licensed under chapter 458,

30  chapter 459, or chapter 466, or a practitioner licensed under

31  chapter 490 who is certified to prescribe drugs under s.

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  1  490.0146, within the framework of standing protocols that

  2  which identify the medical acts to be performed and the

  3  conditions for their performance.  The department may, by

  4  rule, require that a copy of the protocol be filed with the

  5  department along with the notice required by s. 458.348.

  6         Section 5.  Subsection (3) of section 464.012, Florida

  7  Statutes, is amended to read:

  8         464.012  Certification of advanced registered nurse

  9  practitioners; fees.--

10         (3)  An advanced registered nurse practitioner shall

11  perform those functions authorized in this section within the

12  framework of an established protocol.  A practitioner

13  currently licensed under chapter 458, chapter 459, or chapter

14  466, or a practitioner currently licensed under chapter 490

15  who is certified to prescribe drugs under s. 490.0146, shall

16  maintain supervision for directing the specific course of

17  medical treatment.  Within the established framework, an

18  advanced registered nurse practitioner may:

19         (a)  Monitor and alter drug therapies.

20         (b)  Initiate appropriate therapies for certain

21  conditions.

22         (c)  Perform additional functions as may be determined

23  by rule in accordance with s. 464.003(3)(c).

24         (d)  Order diagnostic tests and physical and

25  occupational therapy.

26         Section 6.  Subsection (19) of section 893.02, Florida

27  Statutes, is amended to read:

28         893.02  Definitions.--The following words and phrases

29  as used in this chapter shall have the following meanings,

30  unless the context otherwise requires:

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  1         (19)  "Practitioner" means a physician licensed

  2  pursuant to chapter 458, a dentist licensed pursuant to

  3  chapter 466, a veterinarian licensed pursuant to chapter 474,

  4  an osteopathic physician licensed pursuant to chapter 459, a

  5  naturopath licensed pursuant to chapter 462, or a podiatric

  6  physician licensed pursuant to chapter 461, or a psychologist

  7  licensed under chapter 490 and certified to prescribe drugs

  8  under s. 490.0146, if the provided such practitioner holds a

  9  valid federal controlled substance registry number.

10         Section 7.  For the purpose of incorporating the

11  amendment to section 893.02, Florida Statutes, in references

12  thereto, section 775.051, Florida Statutes, is reenacted to

13  read:

14         775.051  Voluntary intoxication; not a defense;

15  evidence not admissible for certain purposes;

16  exception.--Voluntary intoxication resulting from the

17  consumption, injection, or other use of alcohol or other

18  controlled substance as described in chapter 893 is not a

19  defense to any offense proscribed by law. Evidence of a

20  defendant's voluntary intoxication is not admissible to show

21  that the defendant lacked the specific intent to commit an

22  offense and is not admissible to show that the defendant was

23  insane at the time of the offense, except when the

24  consumption, injection, or use of a controlled substance under

25  chapter 893 was pursuant to a lawful prescription issued to

26  the defendant by a practitioner as defined in s. 893.02.

27         Section 8.  This act shall take effect July 1, 2003.

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  2                          SENATE SUMMARY

  3    Allows psychologists licensed under ch. 490, F.S., to
      prescribe drugs, including, but not limited to,
  4    controlled substances. Provides procedures for becoming a
      psychologist certified to prescribe drugs. Provides for
  5    discipline and for suspension or revocation of the
      licensure of a psychologist who violates rules adopted by
  6    the Board of Psychology. Amends other statutes, including
      provisions relating to advanced registered nurse
  7    practitioners, to conform.

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