Florida Senate - 2012                                    SB 1014
       
       
       
       By Senator Bennett
       
       
       
       
       21-00759A-12                                          20121014__
    1                        A bill to be entitled                      
    2         An act relating to the health care; amending s.
    3         456.013, F.S.; requiring that a licensed health care
    4         practitioner wear a name tag indicating licensure
    5         credentials when rendering health care services;
    6         amending s. 463.002, F.S.; conforming provisions to
    7         changes made by the act; amending s. 463.005, F.S.;
    8         authorizing the Board of Optometry to adopt rules for
    9         the administration and prescription of ocular
   10         pharmaceutical agents rather than topical ocular
   11         pharmaceutical agents; amending s. 463.0055, F.S.;
   12         authorizing certified optometrists to administer and
   13         prescribe ocular pharmaceutical agents under certain
   14         circumstances; revising qualifications of certain
   15         members of the formulary committee; amending ss.
   16         463.0057 and 463.006, F.S.; conforming provisions to
   17         changes made by the act; amending s. 464.012, F.S.;
   18         expanding the scope of practice to authorize an
   19         advanced registered nurse practitioner to order,
   20         administer, monitor, and alter any drug or drug
   21         therapies that are necessary for the proper medical
   22         care and treatment of a patient under specified
   23         circumstances; requiring that the Board of Nursing
   24         adopt rules; authorizing a certified registered nurse
   25         anesthetist, while participating in the management of
   26         a patient in the postanesthesia recovery area, to
   27         order the administration of drugs that are commonly
   28         used to alleviate pain; amending s. 483.035, F.S.,
   29         relating to licensure and regulation of clinical
   30         laboratories operated by practitioners for exclusive
   31         use; providing applicability to clinical laboratories
   32         operated by practitioners licensed to practice
   33         optometry; amending s. 483.041, F.S.; revising the
   34         definition of the term “licensed practitioner” for
   35         purposes of the Florida Clinical Laboratory Law to
   36         include a practitioner licensed under ch. 463, F.S.,
   37         relating to the practice of optometry; amending s.
   38         483.181, F.S.; requiring clinical laboratories to
   39         accept human specimens submitted by practitioners
   40         licensed to practice under ch. 463, F.S.; amending s.
   41         766.102, F.S.; revising the burden of proof that a
   42         claimant must demonstrate in order to prove medical
   43         negligence by a health care provider or an emergency
   44         health care provider; providing for applicability;
   45         amending s. 893.02, F.S.; revising the definition of
   46         the term “practitioner” for purposes of the Florida
   47         Comprehensive Drug Abuse Prevention and Control Act to
   48         include certified optometrists; amending s. 893.05,
   49         F.S.; prohibiting certified optometrists from
   50         administering and prescribing certain controlled
   51         substances; providing effective dates.
   52  
   53  Be It Enacted by the Legislature of the State of Florida:
   54  
   55         Section 1. Subsection (13) is added to section 456.013,
   56  Florida Statutes, to read:
   57         456.013 Department; general licensing provisions.—
   58         (13) When rendering professional health care services, a
   59  health care practitioner shall wear at all times a name badge
   60  that indicates his or her appropriate licensure credentials.
   61         Section 2. Subsections (3), (4), and (5) of section
   62  463.002, Florida Statutes, are amended to read:
   63         463.002 Definitions.—As used in this chapter, the term:
   64         (3)(a) “Licensed practitioner” means a person who is a
   65  primary health care provider licensed to engage in the practice
   66  of optometry under the authority of this chapter.
   67         (b) A licensed practitioner who is not a certified
   68  optometrist shall be required to display at her or his place of
   69  practice a sign which states, “I am a Licensed Practitioner, not
   70  a Certified Optometrist, and I am not able to prescribe topical
   71  ocular pharmaceutical agents.”
   72         (c) All practitioners initially licensed after July 1,
   73  1993, must be certified optometrists.
   74         (4) “Certified optometrist” means a licensed practitioner
   75  authorized by the board to administer and prescribe topical
   76  ocular pharmaceutical agents.
   77         (5) “Optometry” means the diagnosis of conditions of the
   78  human eye and its appendages; the employment of any objective or
   79  subjective means or methods, including the administration of
   80  topical ocular pharmaceutical agents, for the purpose of
   81  determining the refractive powers of the human eyes, or any
   82  visual, muscular, neurological, or anatomic anomalies of the
   83  human eyes and their appendages; and the prescribing and
   84  employment of lenses, prisms, frames, mountings, contact lenses,
   85  orthoptic exercises, light frequencies, and any other means or
   86  methods, including topical ocular pharmaceutical agents, for the
   87  correction, remedy, or relief of any insufficiencies or abnormal
   88  conditions of the human eyes and their appendages.
   89         Section 3. Paragraph (g) of subsection (1) of section
   90  463.005, Florida Statutes, is amended to read:
   91         463.005 Authority of the board.—
   92         (1) The Board of Optometry has authority to adopt rules
   93  pursuant to ss. 120.536(1) and 120.54 to implement the
   94  provisions of this chapter conferring duties upon it. Such rules
   95  shall include, but not be limited to, rules relating to:
   96         (g) Administration and prescription of topical ocular
   97  pharmaceutical agents.
   98         Section 4. Section 463.0055, Florida Statutes, is amended
   99  to read:
  100         463.0055 Administration and prescription of topical ocular
  101  pharmaceutical agents; committee.—
  102         (1) Certified optometrists may administer and prescribe
  103  topical ocular pharmaceutical agents as provided in this section
  104  for the diagnosis and treatment of ocular conditions of the
  105  human eye and its appendages without the use of surgery or other
  106  invasive techniques. However, a licensed practitioner who is not
  107  certified may use topically applied anesthetics solely for the
  108  purpose of glaucoma examinations, but is otherwise prohibited
  109  from administering or prescribing topical ocular pharmaceutical
  110  agents.
  111         (2)(a) There is hereby created a committee composed of two
  112  certified optometrists licensed pursuant to this chapter,
  113  appointed by the Board of Optometry, two board-certified
  114  ophthalmologists licensed pursuant to chapter 458 or chapter
  115  459, appointed by the Board of Medicine, and one additional
  116  person with a doctorate degree in pharmacology who is not
  117  licensed pursuant to chapter 458, chapter 459, or this chapter,
  118  appointed by the State Surgeon General. The committee shall
  119  review requests for additions to, deletions from, or
  120  modifications of a formulary of topical ocular pharmaceutical
  121  agents for administration and prescription by certified
  122  optometrists and shall provide to the board advisory opinions
  123  and recommendations on such requests. The formulary shall
  124  consist of those topical ocular pharmaceutical agents which the
  125  certified optometrist is qualified to use in the practice of
  126  optometry. The board shall establish, add to, delete from, or
  127  modify the formulary by rule. Notwithstanding any provision of
  128  chapter 120 to the contrary, the formulary rule shall become
  129  effective 60 days following from the date it is filed with the
  130  Secretary of State.
  131         (b) The formulary may be added to, deleted from, or
  132  modified according to the procedure described in paragraph (a).
  133  Any person who requests an addition, deletion, or modification
  134  of an authorized topical ocular pharmaceutical agent shall have
  135  the burden of proof to show cause why such addition, deletion,
  136  or modification should be made.
  137         (c) The State Surgeon General shall have standing to
  138  challenge any rule or proposed rule of the board pursuant to s.
  139  120.56. In addition to challenges for any invalid exercise of
  140  delegated legislative authority, the administrative law judge,
  141  upon such a challenge by the State Surgeon General, may declare
  142  all or part of a rule or proposed rule invalid if it:
  143         1. Does not protect the public from any significant and
  144  discernible harm or damages;
  145         2. Unreasonably restricts competition or the availability
  146  of professional services in the state or in a significant part
  147  of the state; or
  148         3. Unnecessarily increases the cost of professional
  149  services without a corresponding or equivalent public benefit.
  150  
  151  However, there shall not be created a presumption of the
  152  existence of any of the conditions cited in this subsection if
  153  in the event that the rule or proposed rule is challenged.
  154         (d) Upon adoption of the formulary required by this
  155  section, and upon each addition, deletion, or modification to
  156  the formulary, the board shall mail a copy of the amended
  157  formulary to each certified optometrist and to each pharmacy
  158  licensed by the state.
  159         (3) A certified optometrist shall be issued a prescriber
  160  number by the board. Any prescription written by a certified
  161  optometrist for a topical ocular pharmaceutical agent pursuant
  162  to this section shall have the prescriber number printed
  163  thereon.
  164         Section 5. Subsection (3) of section 463.0057, Florida
  165  Statutes, is amended to read:
  166         463.0057 Optometric faculty certificate.—
  167         (3) The holder of a faculty certificate may engage in the
  168  practice of optometry as permitted by this section, but may not
  169  administer or prescribe topical ocular pharmaceutical agents
  170  unless the certificateholder has satisfied the requirements of
  171  s. 463.006(1)(b)4. and 5.
  172         Section 6. Subsections (2) and (3) of section 463.006,
  173  Florida Statutes, are amended to read:
  174         463.006 Licensure and certification by examination.—
  175         (2) The examination shall consist of the appropriate
  176  subjects, including applicable state laws and rules and general
  177  and ocular pharmacology with emphasis on the use topical
  178  application and side effects of ocular pharmaceutical agents.
  179  The board may by rule substitute a national examination as part
  180  or all of the examination and may by rule offer a practical
  181  examination in addition to the written examination.
  182         (3) Each applicant who successfully passes the examination
  183  and otherwise meets the requirements of this chapter is entitled
  184  to be licensed as a practitioner and to be certified to
  185  administer and prescribe topical ocular pharmaceutical agents in
  186  the diagnosis and treatment of ocular conditions.
  187         Section 7. Subsection (3) and paragraph (a) of subsection
  188  (4) of section 464.012, Florida Statutes, are amended to read:
  189         464.012 Certification of advanced registered nurse
  190  practitioners; fees.—
  191         (3) An advanced registered nurse practitioner shall perform
  192  those functions authorized in this section within the framework
  193  of an established protocol that is filed with the board upon
  194  biennial license renewal and within 30 days after entering into
  195  a supervisory relationship with a physician or changes to the
  196  protocol. The board shall review the protocol to ensure
  197  compliance with applicable regulatory standards for protocols.
  198  The board shall refer to the department licensees submitting
  199  protocols that are not compliant with the regulatory standards
  200  for protocols. A practitioner currently licensed under chapter
  201  458, chapter 459, or chapter 466 shall maintain supervision for
  202  directing the specific course of medical treatment. Within the
  203  established framework, an advanced registered nurse practitioner
  204  may:
  205         (a) Order, administer, monitor, and alter any drug or drug
  206  therapies that are necessary for the proper medical care and
  207  treatment of a patient, including Schedule II through Schedule V
  208  controlled substances under chapter 893 and those drugs agreed
  209  upon by the advanced registered nurse practitioner and the
  210  supervising practitioner and specified in the protocol. An
  211  advanced registered nurse practitioner may order or administer
  212  such drugs under the following conditions:
  213         1.The drugs are ordered or administered by an advanced
  214  registered nurse practitioner in accordance with a protocol
  215  developed by the advanced registered nurse practitioner and the
  216  supervising practitioner, and the drugs ordered are consistent
  217  with the advanced registered nurse practitioner’s educational
  218  preparation or for which clinical competency has been
  219  established and maintained.
  220         2. The protocol covering the order or administration of
  221  drugs specifies the name of the advanced registered nurse
  222  practitioner who may administer or order drugs, the drugs that
  223  may be ordered and the circumstances under which they may be
  224  ordered, the extent of the practitioner’s supervision of the
  225  advanced registered nurse practitioner, and the method of
  226  periodic review of the advanced registered nurse practitioner’s
  227  competence, including peer review. The protocol for
  228  administering Schedule II controlled substances must address the
  229  illness, injury, or condition for which a Schedule II controlled
  230  substance is administered.
  231         3. The administering or ordering of drugs by an advanced
  232  registered nurse practitioner occurs under practitioner
  233  supervision. As used in this paragraph, the term “practitioner
  234  supervision” means a collaboration between the advanced
  235  registered nurse practitioner and the supervising practitioner
  236  on the development of the protocol and the availability of the
  237  supervising practitioner via telephonic contact at the time the
  238  patient is examined by the advanced registered nurse
  239  practitioner. The term does not mean that the physical presence
  240  of the supervising practitioner is required. A practitioner may
  241  not supervise more than four advanced registered nurse
  242  practitioners at any one time.
  243         4. The controlled substances are administered or ordered in
  244  accordance with a patient-specific protocol approved by the
  245  treating or supervising practitioner if Schedule II or Schedule
  246  III controlled substances are administered or ordered by the
  247  advanced registered nurse practitioner. A copy of the section of
  248  the advanced registered nurse practitioner’s protocol relating
  249  to controlled substances must be provided upon request to the
  250  licensed pharmacist who dispenses the drugs.
  251         5. The board has certified that the advanced registered
  252  nurse practitioner has satisfactorily completed:
  253         a.At least 6 months of direct supervision in the
  254  administering and ordering of drugs; and
  255         b. A course in pharmacology covering the order, use,
  256  administration, and dispensing of controlled substances.
  257  
  258  The board shall adopt rules to administer this paragraph.
  259         (b) Initiate appropriate therapies for certain conditions.
  260         (c) Perform additional functions as may be determined by
  261  rule in accordance with s. 464.003(2).
  262         (d) Order diagnostic tests and physical and occupational
  263  therapy.
  264         (4) In addition to the general functions specified in
  265  subsection (3), an advanced registered nurse practitioner may
  266  perform the following acts within his or her specialty:
  267         (a) The certified registered nurse anesthetist may, to the
  268  extent authorized by established protocol approved by the
  269  medical staff of the facility in which the anesthetic service is
  270  performed, perform any or all of the following:
  271         1. Determine the health status of the patient as it relates
  272  to the risk factors and to the anesthetic management of the
  273  patient through the performance of the general functions.
  274         2. Based on history, physical assessment, and supplemental
  275  laboratory results, determine, with the consent of the
  276  responsible physician, the appropriate type of anesthesia within
  277  the framework of the protocol.
  278         3. Order under the protocol preanesthetic medication.
  279         4. Perform under the protocol procedures commonly used to
  280  render the patient insensible to pain during the performance of
  281  surgical, obstetrical, therapeutic, or diagnostic clinical
  282  procedures. These procedures include ordering and administering
  283  regional, spinal, and general anesthesia; inhalation agents and
  284  techniques; intravenous agents and techniques; and techniques of
  285  hypnosis.
  286         5. Order or perform monitoring procedures indicated as
  287  pertinent to the anesthetic health care management of the
  288  patient.
  289         6. Support life functions during anesthesia health care,
  290  including induction and intubation procedures, the use of
  291  appropriate mechanical supportive devices, and the management of
  292  fluid, electrolyte, and blood component balances.
  293         7. Recognize and take appropriate corrective action for
  294  abnormal patient responses to anesthesia, adjunctive medication,
  295  or other forms of therapy.
  296         8. Recognize and treat a cardiac arrhythmia while the
  297  patient is under anesthetic care.
  298         9. Participate in management of the patient while in the
  299  postanesthesia recovery area, including ordering the
  300  administration of fluids and drugs, which include those drugs
  301  that are commonly used to alleviate pain.
  302         10. Place special peripheral and central venous and
  303  arterial lines for blood sampling and monitoring as appropriate.
  304         Section 8. Subsection (1) of section 483.035, Florida
  305  Statutes, is amended to read:
  306         483.035 Clinical laboratories operated by practitioners for
  307  exclusive use; licensure and regulation.—
  308         (1) A clinical laboratory operated by one or more
  309  practitioners licensed under chapter 458, chapter 459, chapter
  310  460, chapter 461, chapter 462, chapter 463, or chapter 466,
  311  exclusively in connection with the diagnosis and treatment of
  312  their own patients, must be licensed under this part and must
  313  comply with the provisions of this part, except that the agency
  314  shall adopt rules for staffing, for personnel, including
  315  education and training of personnel, for proficiency testing,
  316  and for construction standards relating to the licensure and
  317  operation of the laboratory based upon and not exceeding the
  318  same standards contained in the federal Clinical Laboratory
  319  Improvement Amendments of 1988 and the federal regulations
  320  adopted thereunder.
  321         Section 9. Subsection (7) of section 483.041, Florida
  322  Statutes, is amended to read:
  323         483.041 Definitions.—As used in this part, the term:
  324         (7) “Licensed practitioner” means a physician licensed
  325  under chapter 458, chapter 459, chapter 460, or chapter 461, or
  326  chapter 463; a dentist licensed under chapter 466; a person
  327  licensed under chapter 462; or an advanced registered nurse
  328  practitioner licensed under part I of chapter 464; or a duly
  329  licensed practitioner from another state licensed under similar
  330  statutes who orders examinations on materials or specimens for
  331  nonresidents of the State of Florida, but who reside in the same
  332  state as the requesting licensed practitioner.
  333         Section 10. Subsection (5) of section 483.181, Florida
  334  Statutes, is amended to read:
  335         483.181 Acceptance, collection, identification, and
  336  examination of specimens.—
  337         (5) A clinical laboratory licensed under this part must
  338  accept a human specimen submitted for examination by a
  339  practitioner licensed under chapter 458, chapter 459, chapter
  340  460, chapter 461, chapter 462, chapter 463, s. 464.012, or
  341  chapter 466, if the specimen and test are the type performed by
  342  the clinical laboratory. A clinical laboratory may only refuse a
  343  specimen based upon a history of nonpayment for services by the
  344  practitioner. A clinical laboratory shall not charge different
  345  prices for tests based upon the chapter under which a
  346  practitioner submitting a specimen for testing is licensed.
  347         Section 11. Effective October 1, 2012, and applicable to
  348  causes of action accruing on or after that date, subsection (1)
  349  of section 766.102, Florida Statutes, is amended to read:
  350         766.102 Medical negligence; standards of recovery; expert
  351  witness.—
  352         (1) In any action for recovery of damages based on the
  353  death or personal injury of any person in which it is alleged
  354  that such death or injury resulted from the negligence of the
  355  following persons:
  356         (a) A health care provider as defined in s. 766.202(4); or
  357         (b) An emergency health care provider, which includes a
  358  person or an entity that provides services according to
  359  obligations imposed by s. 395.1041 or s. 401.45, but does not
  360  include a person or entity that is otherwise covered under this
  361  section,
  362  
  363  the claimant has shall have the burden of proving by clear and
  364  convincing the greater weight of evidence that the alleged
  365  actions of the health care provider or emergency health care
  366  provider represented a breach of the prevailing professional
  367  standard of care for that health care provider or emergency
  368  health care provider. The prevailing professional standard of
  369  care for a given health care provider or emergency health care
  370  provider is the shall be that level of care, skill, and
  371  treatment which, in light of all relevant surrounding
  372  circumstances, is recognized as acceptable and appropriate by
  373  reasonably prudent similar health care providers or emergency
  374  health care providers.
  375         Section 12. Subsection (21) of section 893.02, Florida
  376  Statutes, is amended to read:
  377         893.02 Definitions.—The following words and phrases as used
  378  in this chapter shall have the following meanings, unless the
  379  context otherwise requires:
  380         (21) “Practitioner” means a physician licensed pursuant to
  381  chapter 458, a dentist licensed pursuant to chapter 466, a
  382  veterinarian licensed pursuant to chapter 474, an osteopathic
  383  physician licensed pursuant to chapter 459, a naturopath
  384  licensed pursuant to chapter 462, a certified optometrist
  385  licensed pursuant to chapter 463 to administer and prescribe
  386  ocular pharmaceutical agents, or a podiatric physician licensed
  387  pursuant to chapter 461, provided such practitioner holds a
  388  valid federal controlled substance registry number.
  389         Section 13. Subsection (1) of section 893.05, Florida
  390  Statutes, is amended to read:
  391         893.05 Practitioners and persons administering controlled
  392  substances in their absence.—
  393         (1) A practitioner, in good faith and in the course of his
  394  or her professional practice only, may prescribe, administer,
  395  dispense, mix, or otherwise prepare a controlled substance, or
  396  the practitioner may cause the same to be administered by a
  397  licensed nurse or an intern practitioner under his or her
  398  direction and supervision only, except that an optometrist
  399  certified pursuant to chapter 463 to administer and prescribe
  400  ocular pharmaceutical agents may not administer or prescribe any
  401  controlled substance listed in Schedule I or Schedule II of s.
  402  893.03. A veterinarian may so prescribe, administer, dispense,
  403  mix, or prepare a controlled substance for use on animals only,
  404  and may cause it to be administered by an assistant or orderly
  405  under the veterinarian’s direction and supervision only.
  406         Section 14. Except as otherwise expressly provided in this
  407  act, this act shall take effect July 1, 2012.