BILL NO. 2584 By: Hilbert of the House
and
Paxton
of the Senate
An Act relating to physician assistants;
amending 59
O.S. 2021, Sections 353.1, as amended by Section 6, Chapter 288, O.S.L. 2022
and 353.1a (59 O.S. Supp. 2024, Section 353.1), which relate to the
Oklahoma Pharmacy Act; updating and clarifying certain defined terms;
specifying who pharmacists may dispense certain prescriptions to; amending 59
O.S. 2021, Sections 519.2, 519.3, 519.6 and 519.11, as amended by Section 1,
Chapter 164, O.S.L. 2022 (59 O.S. Supp. 2024, Section 591.11), which relate to
the Physician Assistant Act; updating, deleting, and clarifying certain defined
terms; increasing number of Physician Assistant Committee members; exempting
physician assistants from being supervised by delegating physicians under
certain circumstances; establishing procedures to report completion of
postgraduate clinical practice experience hours to the State Board of Medical
Licensure and Supervision; directing the Board to maintain and update a list of
certain physician assistants on its website; requiring the Board to prescribe
certain reporting form; prohibiting the assessment of fees related to the
filing of reporting forms; authorizing physician assistants to maintain
practice agreements; providing an exception; requiring supervision of physician
assistants under certain circumstances; clarifying manner by which physician
assistants may practice under the supervision of delegating physicians;
providing specific limitations on physician assistants and their ability to
prescribe drugs; deleting certain prescription writing requirements; requiring
certain physician assistants to carry malpractice insurance or demonstrate
proof of financial responsibility; providing exceptions; deleting certain
construing provision; amending 63 O.S. 2021, Section 1-317, as last amended by
Section 133, Chapter 452, O.S.L. 2024 (63 O.S. Supp. 2024, Section 1-317),
which relates to the filing of death certificates; providing statutory
reference; amending 63 O.S. 2021, Sections 2-101, as last amended by Section 1,
Chapter 308, O.S.L. 2024 and 2-312, as amended by Section 2, Chapter 184,
O.S.L. 2022 (63 O.S. Supp. 2024, Sections 2-101 and 2-312), which relate to the
Uniform Controlled Dangerous Substances Act; clarifying certain defined term;
authorizing physician assistants to prescribe and administer controlled
dangerous substances subject to certain restrictions; and repealing 59 O.S.
2021, Section 521.4, which relates to physician supervision and practice
agreements of physician assistants.
SUBJECT:
Physician assistants
BE
IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION
1. AMENDATORY 59 O.S. 2021, Section 353.1, as amended by
Section 6, Chapter 288, O.S.L. 2022 (59 O.S. Supp. 2024, Section 353.1), is
amended to read as follows:
Section
353.1. For the purposes of the Oklahoma
Pharmacy Act:
1. “Accredited
program” means those seminars, classes, meetings, work projects, and
other educational courses approved by the Board State Board of
Pharmacy for purposes of continuing professional education;
2. “Act” means the Oklahoma Pharmacy Act;
3. “Administer”
means the direct application of a drug, whether by injection, inhalation,
ingestion, or any other means, to the body of a patient;
4. “Assistant
pharmacist” means any person presently licensed as an assistant
pharmacist in the State of Oklahoma this state by the Board
pursuant to Section 353.10 of this title and for the purposes of the Oklahoma
Pharmacy Act shall be considered the same as a pharmacist, except where
otherwise specified;
5. “Board”
or “State Board” means the State
Board of Pharmacy;
6. “Certify” or “certification of a
prescription” means the review of a filled prescription by a licensed
pharmacist or a licensed practitioner with dispensing authority to confirm that
the medication, labeling, and packaging of the filled prescription are
accurate and meet all requirements prescribed by state and federal law. For the purposes of this paragraph, “licensed
practitioner” shall not include optometrists with dispensing authority;
7. “Chemical”
means any medicinal substance, whether simple or compound or obtained through
the process of the science and art of chemistry, whether of organic or
inorganic origin;
8. “Compounding”
means the combining, admixing, mixing, diluting, pooling, reconstituting,
or otherwise altering of a drug or bulk drug substance to create a drug. Compounding
includes the preparation of drugs or devices in anticipation of prescription
drug orders based on routine, regularly observed prescribing patterns;
9. “Continuing
professional education” means professional, pharmaceutical education in
the general areas of the socioeconomic and legal aspects of health care; the
properties and actions of drugs and dosage forms; and the etiology,
characteristics, and therapeutics of the diseased state;
10. “Dangerous
drug”, “legend drug”, “prescription drug”, or “Rx Only” means a drug:
a. for
human use subject to 21 U.S.C., Section 353(b)(1), or
b. is
labeled “Prescription Only”, or labeled with the following statement: “Caution:
Federal law restricts this drug except for to use by or on
the order of a licensed veterinarian.”;
11. “Director” means the Executive Director of
the State Board of Pharmacy unless context clearly indicates otherwise;
12. “Dispense” or “dispensing” means the
interpretation, evaluation, and implementation of a prescription drug order
including the preparation and delivery of a drug or device to a patient or a
patient’s agent in a suitable container appropriately labeled for subsequent
administration to, or use by, a patient.
Dispense includes sell, distribute, leave with, give away, dispose of,
deliver, or supply;
13. “Dispenser” means a retail pharmacy, hospital
pharmacy, a group of chain pharmacies under common ownership and control that
do not act as a wholesale distributor, or any other person authorized by law to
dispense or administer prescription drugs, and the affiliated warehouses or
distributions of such entities under common ownership and control that do not
act as a wholesale distributor. For the
purposes of this paragraph, “dispenser” dispenser does not mean a
person who dispenses only products to be used in animals in accordance with 21
U.S.C., Section 360b(a)(5);
14. “Distribute” or “distribution” means the
sale, purchase, trade, delivery, handling, storage, or receipt of a product,
and does not include the dispensing of a product pursuant to a prescription
executed in accordance with 21 U.S.C., Section 353(b)(1) or the
dispensing of a product approved under 21 U.S.C., Section 360b(b);
provided, taking actual physical possession of a product or title shall not be
required;
15. “Doctor
of Pharmacy” means a person licensed by the Board to engage in the
practice of pharmacy. The terms
“pharmacist”, “D.Ph.”, and “Doctor of Pharmacy” shall be interchangeable and
shall have the same meaning wherever they appear in the Oklahoma Statutes and
the rules promulgated by the Board;
16. “Drug
outlet” means all manufacturers, repackagers, outsourcing facilities,
wholesale distributors, third-party logistics providers, pharmacies, and all
other facilities which are engaged in dispensing, delivery, distribution,
or storage of dangerous drugs;
17. “Drugs”
means all medicinal substances and preparations recognized by the United States
Pharmacopoeia Pharmacopeia and National Formulary, or any
revision thereof, and all substances and preparations intended for external
and/or internal use in the cure, diagnosis, mitigation, treatment, or
prevention of disease in humans or animals and all substances and preparations,
other than food, intended to affect the structure or any function of the body
of a human or animals;
18. “Drug sample” means a unit of a prescription
drug packaged under the authority and responsibility of the manufacturer that
is not intended to be sold and is intended to promote the sale of the drug;
19. “Durable medical equipment” has the same
meaning as provided by Section 2 of this act Section 375.2 of this
title;
20. “Filled
prescription” means a packaged prescription medication to which a label
has been affixed which contains such information as is required by the Oklahoma
Pharmacy Act;
21. “Hospital”
means any institution licensed as a hospital by this state for the care and
treatment of patients, or a pharmacy operated by the Oklahoma Department of
Veterans Affairs;
22. “Licensed
practitioner” means:
a. an
allopathic physician,
b. an
osteopathic physician,
c. a
podiatric physician,
d. a
dentist,
e. a
veterinarian or,
f. an
optometrist, or
g. a
physician assistant,
licensed
to practice and authorized to prescribe dangerous drugs within the scope of
practice of such practitioner;
23. “Manufacturer”
or “virtual manufacturer” means with respect to a product:
a. a
person that holds an application approved under 21 U.S.C., Section 355
or a license issued under 42 U.S.C., Section 262 for such product, or if
such product is not the subject of an approved application or license, the
person who manufactured the product,
b. a
co-licensed partner of the person described in subparagraph a of this
paragraph that obtains the product directly from a person described in this
subparagraph or subparagraph a of this paragraph,
c. an
affiliate of a person described in subparagraph a or b of this paragraph
who receives the product directly from a person described in this subparagraph
or in subparagraph a or b of this paragraph, or
d. a
person who contracts with another to manufacture a product;
24. “Manufacturing”
means the production, preparation, propagation, compounding, conversion,
or processing of a device or a drug, either directly or indirectly by
extraction from substances of natural origin or independently by means of
chemical or biological synthesis and includes any packaging or repackaging of
the substances or labeling or relabeling of its container, and the promotion
and marketing of such drugs or devices.
The term “manufacturing”
manufacturing also includes the preparation and promotion of
commercially available products from bulk compounds for resale by licensed
pharmacies, licensed practitioners, or other persons;
25. “Medical
gas” means those gases including those in liquid state upon which the
manufacturer or distributor has placed one of several cautions, such as “Rx
Only”, in compliance with federal law;
26. “Medical
gas order” means an order for medical gas issued by a licensed prescriber;
27. “Medical
gas distributor” means a person licensed to distribute, transfer, wholesale,
deliver, or sell medical gases on drug orders to suppliers or other
entities licensed to use, administer, or distribute medical gas and may
also include a patient or ultimate user;
28. “Medical
gas supplier” means a person who dispenses medical gases on drug orders only to
a patient or ultimate user;
29. “Medicine”
means any drug or combination of drugs which has the property of curing,
preventing, treating, diagnosing, or mitigating diseases, or which is
used for that purpose;
30. “Nonprescription
drugs” means medicines or drugs which are sold without a prescription
and which are prepackaged for use by the consumer and labeled in accordance
with the requirements of the statutes and regulations of this state and the
federal government. Such items shall
also include medical and dental supplies and bottled or nonbulk chemicals which
are sold or offered for sale to the general public if such articles or
preparations meet the requirements of the Federal Food, Drug, and
Cosmetic Act, 21 U.S.C.A., Section 321 et seq.;
31. “Outsourcing facility” including “virtual
outsourcing facility” means a facility at one geographic location or address
that:
a. is
engaged in the compounding of sterile drugs,
b. has
elected to register as an outsourcing facility, and
c. complies
with all requirements of 21 U.S.C., Section 353b;
32. “Package” means the smallest individual
saleable unit of product for distribution by a manufacturer or repackager that
is intended by the manufacturer for ultimate sale to the dispenser of such
product. For the purposes of this
paragraph, “individual saleable unit” means the smallest container of a product
introduced into commerce by the manufacturer or repackager that is intended by
the manufacturer or repackager for individual sale to a dispenser;
33. “Person”
means an individual, partnership, limited liability company, corporation,
or association, unless the context otherwise requires;
34. “Pharmacist-in-charge” or “PIC” means the
pharmacist licensed in this state responsible for the management control of a
pharmacy and all other aspects of the practice of pharmacy in a licensed
pharmacy as defined provided by Section 353.18 of this title;
35. “Pharmacy” means a place regularly licensed
by the State Board of Pharmacy in which prescriptions, drugs, medicines,
chemicals, and poisons are compounded or dispensed or such place where
pharmacists practice the profession of pharmacy, or a pharmacy operated by the
Oklahoma Department of Veterans Affairs;
36. “Pharmacy technician”, “technician”, “Rx
tech”, or “tech” means a person issued a Technician technician
permit by the State Board of Pharmacy to assist the pharmacist and perform
nonjudgmental, technical, manipulative, non-discretionary functions in the
prescription department under the immediate and direct supervision of a
pharmacist;
37. “Poison” means any substance which when
introduced into the body, either directly or by absorption, produces violent,
morbid, or fatal changes, or which destroys living tissue with which
such substance comes into contact;
38. “Practice
of pharmacy” means:
a. the
interpretation and evaluation of prescription orders,
b. the
compounding, dispensing, administering, and labeling of drugs and
devices, except labeling by a manufacturer, repackager, or distributor
of nonprescription drugs and commercially packaged legend drugs and devices,
c. the
participation in drug selection and drug utilization reviews,
d. the
proper and safe storage of drugs and devices and the maintenance of proper
records thereof,
e. the
responsibility for advising by counseling and providing information, where
professionally necessary or where regulated, of therapeutic values, content,
hazards, and use of drugs and devices,
f. the
offering or performing of those acts, services, operations, or
transactions necessary in the conduct, operation, management, and
control of a pharmacy, or
g. the
provision of those acts or services that are necessary to provide
pharmaceutical care;
39. “Preparation” means an article which may or
may not contain sterile products compounded in a licensed pharmacy pursuant to
the order of a licensed prescriber;
40. “Prescriber” means a person licensed in this
state who is authorized to prescribe dangerous drugs within the scope of
practice of the person’s profession;
41. “Prescription” means and includes any order
for drug or medical supplies written or signed, or transmitted by word of
mouth, telephone, or other means of communication:
a. by
a licensed prescriber,
b. (1) under the supervision of an Oklahoma
licensed practitioner a supervising physician, by an Oklahoma
licensed advanced practice registered nurse, or
(2) by
an Oklahoma licensed physician assistant pursuant to a practice agreement,
or
c. by
an Oklahoma licensed wholesaler or distributor as authorized in Section
353.29.1 of this title;
42. “Product” means a prescription drug in a
finished dosage form for administration to a patient without substantial
further manufacturing, such as capsules, tablets, and lyophilized products
before reconstitution. “Product” Product
does not include blood components intended for transfusion, radioactive drugs
or biologics and medical gas;
43. “Repackager”, including “virtual repackager”,
means a person who owns or operates an establishment that repacks and relabels
a product or package for further sale or distribution without further
transaction;
44. “Sterile drug” means a drug that is intended
for parenteral administration, an ophthalmic or oral inhalation drug in aqueous
format, or a drug that is required to be sterile under state and federal law;
45. “Supervising physician” means an individual
holding a current license to practice as a physician from the State Board of
Medical Licensure and Supervision, pursuant to the provisions of the Oklahoma
Allopathic Medical and Surgical Licensure and Supervision Act, or the State
Board of Osteopathic Examiners, pursuant to the provisions of the Oklahoma
Osteopathic Medicine Act, who supervises an advanced practice registered nurse
as defined in Section 567.3a of this title,
and
who is not in training as an intern, resident, or fellow. To be eligible to supervise an advanced
practice registered nurse, such physician shall remain in compliance with the
rules promulgated by the State Board of Medical Licensure and Supervision or
the State Board of Osteopathic Examiners;
46. “Supportive personnel” means technicians and
auxiliary supportive persons who are regularly paid employees of a pharmacy who
work and perform tasks in the pharmacy as authorized by Section 353.18A of this
title;
47. “Third-party logistics provider” including
“virtual third-party logistics provider” means an entity that provides or
coordinates warehousing, or other logistics services of a product in interstate
commerce on behalf of a manufacturer, wholesale distributor, or dispenser of a
product but does not take ownership of the product, nor have responsibility to
direct the sale or disposition of the product.
For the purposes of this paragraph, “third-party logistics provider”
third-party logistics provider does not include shippers and the United
States Postal Service;
48. “Wholesale distributor” including “virtual
wholesale distributor” means a person other than a manufacturer, a
manufacturer’s co-licensed partner, a third-party logistics provider, or
repackager engaged in wholesale distribution as defined by 21 U.S.C.,
Section 353(e)(4) as amended by the Drug Supply Chain Security Act;
49. “County jail” means a facility operated by a
county for the physical detention and correction of persons charged with, or
convicted of, criminal offenses or ordinance violations or persons found guilty
of civil or criminal contempt;
50. “State correctional facility” means a
facility or institution that houses a prisoner population under the
jurisdiction of the Department of Corrections;
51. “Unit dose package” means a package that
contains a single dose drug with the name, strength, control number, and
expiration date of that drug on the label; and
52. “Unit of issue package” means a package that
provides multiple doses of the same drug, but each drug is individually
separated and includes the name, lot number, and expiration date.
SECTION
2. AMENDATORY 59 O.S. 2021, Section 353.1a, is amended
to read as follows:
Section
353.1a A. Prescribing authority shall be allowed, under
the medical direction of a supervising physician, for an advanced practice
nurse recognized by the Oklahoma Board of Nursing in one of the following
categories: advanced registered nurse
practitioners, clinical nurse specialists, or certified nurse-midwives. The advanced practice nurse may write or
sign, or transmit by word of mouth, telephone or other means of communication
an order for drugs or medical supplies that is intended to be filled,
compounded, or dispensed by a pharmacist.
The supervising physician and the advanced practice nurse shall be
identified at the time of origination of the prescription and the name of the
advanced practice nurse shall be printed on the prescription label.
B.
Pharmacists may dispense prescriptions for non-controlled prescription
drugs authorized by an advanced practice nurse or physician assistant, not
located in Oklahoma, provided that they are licensed in the state in which they
are actively prescribing.
C.
Pharmacists may only dispense prescriptions for controlled dangerous
substances prescribed by an:
1.
An
advanced practice nurse or physician assistant licensed in the State
of Oklahoma and supervised by an Oklahoma-licensed practitioner; or
2.
A physician assistant licensed in the State of Oklahoma and supervised by an
Oklahoma-licensed practitioner.
SECTION
3. AMENDATORY 59 O.S. 2021, Section 519.2, is amended to
read as follows:
Section
519.2 As used in the Physician Assistant
Act:
1. "Board" means the State Board of
Medical Licensure and Supervision;
2. "Committee" means the Physician
Assistant Committee;
3.
"Practice of medicine" means services which require training
in the diagnosis, treatment and prevention of disease, including the use and
administration of drugs, and which are performed by physician assistants so
long as such services are within the physician assistants' skill,. For a physician assistant required to
practice under supervision of a delegating physician, services form a
component of the physician's scope of practice, and are provided with physician
supervision, including authenticating by signature any form that may be
authenticated by the delegating physician's signature with prior delegation by
the physician;
4.
"Patient care setting" means and includes, but is not
limited to, a physician's office, clinic, hospital, nursing home, extended care
facility, patient's home, ambulatory surgical center, hospice facility or any
other setting authorized by the delegating physician;
5.
"Physician assistant" means a health care professional,
qualified by academic and clinical education and licensed by the State Board of
Medical Licensure and Supervision, to practice medicine with physician
supervision as a physician assistant;
6. 5. "Delegating physician" means an
individual holding a license in good standing as a physician from the State
Board of Medical Licensure and Supervision or the State Board of Osteopathic
Examiners, who supervises one or more physician assistants and delegates
decision making pursuant to the practice agreement;
7. 6. "Supervision" means overseeing or
delegating the activities of the medical services rendered by a physician
assistant through a practice agreement between a medical
doctor or osteopathic delegating physician performing procedures
or directly or indirectly involved with the treatment of a patient, and the
physician assistant working jointly toward a common goal of providing
services. Delegation shall be defined by
the practice agreement. The physical presence of the delegating
physician is not required as long as the delegating physician and physician
assistant are or can be easily in contact with each other by
telecommunication. At all times a
physician assistant required to practice under supervision shall be
considered an agent of the delegating physician;
8. 7. "Telecommunication" means the use
of electronic technologies to transmit words, sounds or images for
interpersonal communication, clinical care (telemedicine) and review of
electronic health records; and
9. 8. "Practice agreement" means a
written agreement between a physician assistant and the a
delegating physician concerning the scope of practice of the physician
assistant to only be determined by the delegating physician and the physician
assistant based on the education, training, skills and experience of the
physician assistant. The
agreement shall involve the joint formulation, discussion and agreement on the
methods of supervision and collaboration for diagnosis, consultation and
treatment of medical conditions and shall include the scope of and any
limitations on prescribing. A practice
agreement is required for a physician assistant as described in subsection C of
Section 519.6 of this title.
SECTION
4. AMENDATORY 59 O.S. 2021, Section 519.3, is amended to
read as follows:
Section
519.3 A.
There is hereby created the Physician Assistant Committee, which shall
be composed of seven (7) nine (9) members. Three Five members of the
Committee shall be physician assistants appointed by the State Board of Medical
Licensure and Supervision from a list of qualified individuals submitted by the
Oklahoma Academy of Physician Assistants.
One member shall be a physician appointed by the Board from its
membership. One member shall be a
physician appointed by the Board from a list of qualified individuals submitted
by the Oklahoma State Medical Association and who is not a member of the
Board. One member shall be a physician
appointed by the State Board of Osteopathic Examiners from its membership. One member shall be a physician appointed by
the State Board of Osteopathic Examiners from a list of qualified individuals
submitted by the Oklahoma Osteopathic Association and who is not a member of
said board.
B.
The term of office for each member of the Committee shall be five (5)
years.
C.
The Committee shall meet at least quarterly. At the initial meeting of each calendar year,
the Committee members shall elect a chair from the physician assistant
members. The chair or his or her
designee shall represent the Committee at all meetings of the Board. Four Five members shall
constitute a quorum for the purpose of conducting official business of the
Committee.
D.
The State Board of Medical Licensure and Supervision is hereby granted
the power and authority to promulgate rules, which are in accordance with the
provisions of Section 519.1 et seq. of this title, governing the requirements
for licensure as a physician assistant, as well as to establish standards for
training, approve institutions for training, and regulate the standards of
practice of a physician assistant after licensure, including the power of
revocation of a license.
E.
The State Board of Medical Licensure and Supervision is hereby granted
the power and authority to investigate all complaints, hold hearings, subpoena
witnesses and initiate prosecution concerning violations of Section 519.1 et
seq. of this title. When such complaints
involve physicians licensed by the State Board of Osteopathic Examiners, the
State Board of Osteopathic Examiners shall be officially notified of such
complaints.
F.
1. The Committee shall advise the
Board on all matters pertaining to the practice of physician assistants.
2.
The Committee shall review and make recommendations to the Board on all
applications for licensure as a physician assistant and all applications to
practice which shall be approved by the Board.
When considering applicants for licensure, to establish standards of
training or approve institutions for training, the Committee shall include the
Director, or designee, of all Physician Assistant educational programs
conducted by institutions of higher education in the state as members.
3.
The Committee shall assist and advise the Board in all hearings
involving physician assistants who are deemed to be in violation of Section
519.1 et seq. of this title or the rules of the Board.
SECTION
5. AMENDATORY 59 O.S. 2021, Section 519.6, is amended to
read as follows:
Section
519.6 A.
No health care services may be performed by a physician assistant unless
a current license is on file with and approved by the State Board of Medical
Licensure and Supervision.
B. A physician assistant with six thousand two
hundred forty (6,240) or more hours of postgraduate clinical practice
experience who has reported those hours to the Board shall not be required to
practice under the supervision of a delegating physician.
1. A physician assistant may report the
completion of postgraduate clinical practice experience to the Board at any
time after completion of at least six thousand two hundred forty (6,240) such
hours.
2. Hours earned prior to the effective date of
this act shall be counted towards the six thousand two hundred forty (6,240)
hours.
3. The Board shall maintain, make available, and
keep updated, on the Internet website of the Board, a list of physician
assistants who have reported completion of six thousand two hundred forty
(6,240) or more postgraduate clinical practice experience hours.
4. The Board shall prescribe a form for
reporting postgraduate clinical practice experience by a physician
assistant. The Board shall make
available and keep updated on the Internet website of the Board the prescribed
form. This reporting form may be filed
electronically. The Board shall not
charge a fee for reporting hours or filing of the prescribed form.
5. Nothing in this subsection shall prohibit a
physician assistant from maintaining a practice agreement; however, such an
agreement is not required for a physician assistant with the reported six
thousand two hundred forty (6,240) hours of postgraduate clinical practice
experience, provided any practice agreements are subject to the requirements of
paragraphs 1, 2, 3, and 4 of subsection C of this section.
6. Nothing in this subsection shall restrict the
ability of the Board to require supervision as a part of disciplinary action
against the license of a physician assistant.
C. A physician assistant with less than six
thousand two hundred forty (6,240) hours of postgraduate clinical practice
experience or who has completed six thousand two hundred forty (6,240) hours
but has not reported those hours to the Board shall practice under the
supervision of a delegating physician with the following requirements:
1.
All practice agreements and any amendments shall be filed with the State
Board of Medical Licensure and Supervision within ten (10) business days of
being executed. Practice agreements may
be filed electronically. The State Board
of Medical Licensure and Supervision shall not charge a fee for filing practice
agreements or amendments of to practice agreements.;
B. 2. A physician assistant may have practice
agreements with multiple allopathic or osteopathic physicians. Each physician shall be in good standing with
the State Board of Medical Licensure and Supervision or the State Board of
Osteopathic Examiners.;
C. 3. The delegating physician need not be
physically present nor be specifically consulted before each delegated patient
care service is performed by a physician assistant, so long as the delegating
physician and physician assistant are or can be easily in contact with one
another by means of telecommunication. In
all patient care settings, the The delegating physician shall
provide appropriate methods of participating in health care services provided
by the physician assistant including:
a. being
responsible for the formulation or approval of all orders and protocols,
whether standing orders, direct orders or any other orders or protocols, which
direct the delivery of health care services provided by a physician assistant,
and periodically reviewing such orders and protocols,
b. regularly
reviewing the health care services provided by the physician assistant and any
problems or complications encountered,
c. being
available physically or through telemedicine or direct telecommunications for
consultation, assistance with medical emergencies or patient referral,
d. reviewing
a sample of outpatient medical records.
Such reviews shall take place at a site agreed upon between the
delegating physician and physician assistant in the practice agreement which
may also occur using electronic or virtual conferencing, and
e. that
it remains clear that the physician assistant is an agent of the delegating
physician; but, in no event shall the delegating physician be an employee of
the physician assistant.;
D. 4. In patients with newly diagnosed complex
illnesses, the physician assistant shall contact the delegating physician
within forty-eight (48) hours of the physician assistant's initial examination
or treatment and schedule the patient for appropriate evaluation by the
delegating physician as directed by the physician. The delegating physician shall determine
which conditions qualify as complex illnesses based on the clinical setting and
the skill and experience of the physician assistant.
E.
1.
D. A physician assistant under
the direction of a delegating physician not practicing under a practice
agreement may prescribe written and oral prescriptions and orders. The physician assistant not practicing
under a practice agreement may prescribe medical supplies, services, and
drugs, including controlled medications in Schedules II III
through V pursuant to Section 2-312 of Title 63 of the Oklahoma Statutes,
and medical supplies and services as delegated by the delegating physician and
as approved by the State Board of Medical Licensure and Supervision after
consultation with the State Board of Pharmacy on the Physician Assistant Drug
Formulary. Physician assistants
not practicing under a practice agreement may not dispense drugs, but may
request, receive, and sign for professional samples and may distribute
professional samples to patients.
2.
A physician assistant may write an order for a Schedule II drug for
immediate or ongoing administration on site.
Prescriptions and orders for Schedule II drugs written by a physician
assistant must be included on a written protocol determined by the delegating
physician and approved by the medical staff committee of the facility or by
direct verbal order of the delegating physician. Physician assistants may not dispense drugs,
but may request, receive, and sign for professional samples and may distribute
professional samples to patients.
F. E. A physician assistant may perform health
care services in patient care settings as authorized by the delegating
physician practicing under a practice agreement may prescribe written
and oral prescriptions and orders. The
physician assistant practicing under a practice agreement may prescribe medical
supplies, services, and drugs, including controlled medications in Schedules II
through V pursuant to Section 2-312 of Title 63 of the Oklahoma Statutes,
written and oral prescriptions and orders only as delegated by the delegating physician,
and prescriptions and orders for Schedule II drugs written by such physician
assistant shall be included on a written protocol determined by the delegating
physician. Physician assistants
practicing under a practice agreement may not dispense drugs, but may request,
receive, and sign for professional samples and may distribute professional
samples to patients. Provided that a
physician assistant practicing under a practice agreement may not prescribe any
controlled medications in a Schedule that the delegating physician is not
registered to prescribe.
G. F. Each physician assistant licensed under the
Physician Assistant Act shall keep his or her license available for inspection
at the primary place of business and shall, when engaged in professional
activities, identify himself or herself as a physician assistant.
H. G. A physician assistant shall be bound by the
provisions contained in Sections 725.1 through 725.5 of Title 59 of the
Oklahoma Statutes this title.
H.
1. A physician assistant not
practicing under a practice agreement, or the employer of such physician
assistant on his or her behalf, shall carry malpractice insurance or demonstrate
proof of financial responsibility in a minimum amount of One Million Dollars
($1,000,000.00) per occurrence and Three Million Dollars ($3,000,000.00) in the
aggregate per year. This requirement
shall not apply to a physician assistant practicing under a practice agreement.
2. A physician assistant who is
employed by or under contract with a federal agency that carries malpractice
insurance in any amount on behalf of the physician assistant shall be deemed in
compliance with paragraph 1 of this subsection when practicing under such
federal employment or contract. However,
to the extent the physician assistant practices outside of such federal
employment or contract, the physician assistant, or his or her employer, shall
comply with paragraph 1 of this subsection.
SECTION
6. AMENDATORY 59 O.S. 2021, Section 519.11, as amended
by Section 1, Chapter 164, O.S.L. 2022 (59 O.S. Supp. 2024, Section 519.11), is
amended to read as follows:
Section
519.11 A. Nothing in the Physician Assistant Act shall
be construed to prevent or restrict the practice, services or activities of any
persons of other licensed professions or personnel supervised by licensed
professions in this state from performing work incidental to the practice of
their profession or occupation, if that person does not represent himself or
herself as a physician assistant.
B.
Nothing stated in the Physician Assistant Act shall prevent any hospital
from requiring the physician assistant or the delegating physician to meet and
maintain certain staff appointment and credentialing qualifications for the
privilege of practicing as, or utilizing, a physician assistant in the
hospital.
C.
Nothing in the Physician Assistant Act shall be construed to permit a
physician assistant to practice medicine or prescribe drugs and medical
supplies in this state except when such actions are performed under the
supervision and at the direction of a physician or physicians approved by the
State Board of Medical Licensure and Supervision.
D.
Nothing herein shall be construed to require licensure under the
Physician Assistant Act of a physician assistant student enrolled in a
physician assistant educational program accredited by the Accreditation Review
Commission on Education for the Physician Assistant.
E. D. Notwithstanding any other provision of law,
no one who is not a physician licensed to practice medicine in this state may
perform acts restricted to such physicians pursuant to the provisions of
Section 1-731 of Title 63 of the Oklahoma Statutes. This paragraph subsection is
inseverable.
F. E. Nothing in the Physician Assistant Act shall
limit the activities of a physician assistant in the performance of their
duties if the physician assistant is employed by or under contract with the
United States Department of Veterans Affairs or if the physician assistant is
employed by, under contract with, or commissioned by one of the uniformed
services; provided, the physician assistant must be currently licensed in this
state or any other state or currently credentialed as a physician assistant by the
United States Department of Veterans Affairs or the applicable uniformed
service. Any physician assistant who is
employed by or under contract with the United States Department of Veterans
Affairs or is employed by, under contract with, or commissioned by one of the
uniformed services and practices outside of such employment, contract, or
commission shall be subject to the Physician Assistant Act while practicing
outside of such employment, contract, or commission. As used in this subsection, "uniformed
services" shall have the same meaning as provided by Title 10 of the U.S.
United States Code.
SECTION
7. AMENDATORY 63 O.S. 2021, Section 1-317, as last
amended by Section 133, Chapter 452, O.S.L. 2024 (63 O.S. Supp. 2024, Section
1-317), is amended to read as follows:
Section
1-317. A. A death certificate for each death which
occurs in this state shall be filed with the State Department of Health, within
three (3) days after such death.
B. The funeral director shall personally sign
the death certificate and shall be responsible for filing the death
certificate. If the funeral director is
not available, the person acting as such who first assumes custody of a dead
body in accordance with Section 1158 of Title 21 of the Oklahoma Statutes shall
personally sign and file the death certificate.
The personal data shall be obtained from the next of kin or the best
qualified person or source available.
The funeral director or person acting as such shall notify the person
providing the personal data that it is a felony to knowingly provide false data
or misrepresent any person’s relationship to the decedent. The certificate shall be completed as to
personal data and delivered to the attending physician or the medical examiner
responsible for completing the medical certification portion of the certificate
of death within twenty-four (24) hours after the death. No later than July 1, 2012, the personal
data, and no later than July 1, 2017, the medical certificate portion, shall be
entered into the prescribed electronic system provided by the State Registrar
of Vital Statistics and the information submitted to the State Registrar of
Vital Statistics. The resultant
certificate produced by the electronic system shall be provided to the
physician or medical examiner for medical certification within twenty-four (24)
hours after the death.
C. The medical certification shall be completed
and signed within forty-eight (48) hours after death by the physician,
physician assistant, or advanced practice registered nurse in charge of the
patient’s care for the illness or condition which resulted in death, except
when inquiry as to the cause of death is required by Section 938 of this
title. No later than July 1, 2017, the
medical certification portion of certificate data shall be entered into the
prescribed electronic system provided by the State Registrar of Vital
Statistics and the information submitted to the State Registrar of Vital
Statistics.
D. In the event that the physician, physician
assistant, or advanced practice registered nurse in charge of the patient’s
care for the illness or condition which resulted in death is not in attendance
at the time of death, the medical certification shall be completed and signed
within forty-eight (48) hours after death by the physician, physician
assistant, or advanced practice registered nurse in attendance at the time of
death, except:
1. When the patient is under hospice care at the
time of death, the medical certification may be signed by the hospice’s medical
director; and
2. When inquiry as to the cause of death is
required by Section 938 of this title.
Provided,
that such certification, if signed by other than the attending physician,
physician assistant, or advanced practice registered nurse, shall note on the
face the name of the attending physician, physician assistant, or advanced
practice registered nurse and that the information shown is only as reported.
E. A certifier completing cause of death on a
certificate of death who knows that a lethal drug, overdose or other means of
assisting suicide within the meaning of Sections 3141.2 through 3141.4 of this
title caused or contributed to the death shall list that means among the chain
of events under cause of death or list it in the box that describes how the
injury occurred. If such means is in the
chain of events under cause of death or in the box that describes how the
injury occurred, the certifier shall indicate “suicide” as the manner of death.
F. The authority of a physician assistant subject
to subsection C of Section 519.6 of Title 59 of the Oklahoma Statutes to
carry out the functions described in this section shall be governed by the
practice agreement as provided by Section 519.6 of Title 59 of the Oklahoma
Statutes.
SECTION
8. AMENDATORY 63 O.S. 2021, Section 2-101, as last
amended by Section 1, Chapter 308, O.S.L. 2024 (63 O.S. Supp. 2024, Section
2-101), is amended to read as follows:
Section
2-101. As used in the Uniform Controlled
Dangerous Substances Act:
1.
“Acute pain” means pain, whether resulting from disease, accidental
trauma, intentional trauma, or other cause that the practitioner reasonably
expects to last only a short period of time.
Acute pain does not include chronic pain, pain being treated as part of
cancer care, hospice or other end-of-life care, or pain being treated as part
of palliative care;
2.
“Administer” means the direct application of a controlled dangerous substance,
whether by injection, inhalation, ingestion or any other means, to the body of
a patient, animal or research subject by:
a. a
practitioner (or, in the presence of the practitioner, by the authorized agent
of the practitioner), or
b. the
patient or research subject at the direction and in the presence of the
practitioner;
3.
“Agent” means a peace officer appointed by and who acts on behalf of the
Director of the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control
or an authorized person who acts on behalf of or at the direction of a person
who manufactures, distributes, dispenses, prescribes, administers or uses for
scientific purposes controlled dangerous substances but does not include a
common or contract carrier, public warehouser or employee thereof, or a person
required to register under the Uniform Controlled Dangerous Substances Act;
4.
“Anhydrous ammonia” means any substance that exhibits cryogenic
evaporative behavior and tests positive for ammonia;
5.
“Board” means the Advisory Board to the Director of the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control;
6.
“Bureau” means the Oklahoma State Bureau of Narcotics and Dangerous
Drugs Control;
7.
“Chronic pain” means pain that persists beyond the usual course of an
acute disease or healing of an injury.
Chronic pain may or may not be associated with an acute or chronic
pathologic process that causes continuous or intermittent pain over months or
years;
8.
“Coca leaves” includes cocaine and any compound, manufacture, salt,
derivative, mixture or preparation of coca leaves, except derivatives of coca
leaves which do not contain cocaine or ecgonine;
9.
“Commissioner” or “Director” means the Director of the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control;
10.
“Control” means to add, remove or change the placement of a drug,
substance or immediate precursor under the Uniform Controlled Dangerous
Substances Act;
11.
“Controlled dangerous substance” means a drug, substance or immediate
precursor in Schedules I through V of the Uniform Controlled Dangerous
Substances Act or any drug, substance or immediate precursor listed either
temporarily or permanently as a federally controlled substance. Any conflict between state and federal law
with regard to the particular schedule in which a substance is listed shall be
resolved in favor of state law;
12.
“Counterfeit substance” means a controlled substance which, or the
container or labeling of which without authorization, bears the trademark,
trade name or other identifying marks, imprint, number or device or any
likeness thereof of a manufacturer, distributor or dispenser other than the
person who in fact manufactured, distributed or dispensed the substance;
13.
“Deliver” or “delivery” means the actual, constructive or attempted
transfer from one person to another of a controlled dangerous substance or drug
paraphernalia, whether or not there is an agency relationship;
14.
“Dispense” means to deliver a controlled dangerous substance to an
ultimate user or human research subject by or pursuant to the lawful order of a
practitioner, including the prescribing, administering, packaging, labeling or
compounding necessary to prepare the substance for such distribution. “Dispenser” is a practitioner who delivers a
controlled dangerous substance to an ultimate user or human research subject;
15.
“Distribute” means to deliver other than by administering or dispensing
a controlled dangerous substance;
16.
“Distributor” means a commercial entity engaged in the distribution or
reverse distribution of narcotics and dangerous drugs and who complies with all
regulations promulgated by the federal Drug Enforcement Administration and the
Oklahoma State Bureau of Narcotics and Dangerous Drugs Control;
17.
“Drug” means articles:
a. recognized
in the official United States Pharmacopeia, official Homeopathic Pharmacopoeia
of the United States, or official National Formulary, or any supplement to any
of them,
b. intended
for use in the diagnosis, cure, mitigation, treatment or prevention of disease
in man or other animals,
c. other
than food, intended to affect the structure or any function of the body of man
or other animals, and
d. intended
for use as a component of any article specified in this paragraph;
provided,
however, the term drug does not include devices or their components, parts or
accessories;
18. “Drug paraphernalia” means all equipment,
products, and materials of any kind which are used, intended for use, or
fashioned specifically for use in planting, propagating, cultivating, growing,
harvesting, manufacturing, compounding, converting, producing, processing,
preparing, testing, analyzing, packaging, repackaging, storing, containing,
concealing, injecting, ingesting, inhaling, or otherwise introducing into the
human body, a controlled dangerous substance in violation of the Uniform
Controlled Dangerous Substances Act including, but not limited to:
a. kits
used, intended for use, or fashioned specifically for use in planting,
propagating, cultivating, growing, or harvesting of any species of plant which
is a controlled dangerous substance or from which a controlled dangerous
substance can be derived,
b. kits
used, intended for use, or fashioned specifically for use in manufacturing,
compounding, converting, producing, processing, or preparing controlled
dangerous substances,
c. isomerization
devices used, intended for use, or fashioned specifically for use in increasing
the potency of any species of plant which is a controlled dangerous substance,
d. testing
equipment used, intended for use, or fashioned specifically for use in
identifying or in analyzing the strength, effectiveness, or purity of
controlled dangerous substances,
e. scales
and balances used, intended for use, or fashioned specifically for use in
weighing or measuring controlled dangerous substances,
f. diluents
and adulterants, such as quinine hydrochloride, mannitol, mannite, dextrose,
and lactose used, intended for use, or fashioned specifically for use in
cutting controlled dangerous substances,
g. separation
gins and sifters used, intended for use, or fashioned specifically for use in
removing twigs and seeds from, or in otherwise cleaning or refining, marijuana,
h. blenders,
bowls, containers, spoons, and mixing devices used, intended for use, or
fashioned specifically for use in compounding controlled dangerous substances,
i. capsules,
balloons, envelopes, and other containers used, intended for use, or fashioned
specifically for use in packaging small quantities of controlled dangerous
substances,
j. containers
and other objects used, intended for use, or fashioned specifically for use in
parenterally injecting controlled dangerous substances into the human body,
k. hypodermic
syringes, needles, and other objects used, intended for use, or fashioned
specifically for use in parenterally injecting controlled dangerous substances
into the human body, except as authorized by Section 2-1101 of this title,
l. objects
used, intended for use, or fashioned specifically for use in ingesting,
inhaling, or otherwise introducing marijuana, cocaine, hashish, or hashish oil
into the human body, such as:
(1) metal,
wooden, acrylic, glass, stone, plastic, or ceramic pipes with or without
screens, permanent screens, hashish heads, or punctured metal bowls,
(2) water
pipes,
(3) carburetion
tubes and devices,
(4) smoking
and carburetion masks,
(5) roach
clips, meaning objects used to hold burning material, such as a marijuana
cigarette, that has become too small or too short to be held in the hand,
(6) miniature
cocaine spoons and cocaine vials,
(7) chamber
pipes,
(8) carburetor
pipes,
(9) electric
pipes,
(10) air-driven
pipes,
(11) chillums,
(12) bongs,
or
(13) ice
pipes or chillers,
m. all
hidden or novelty pipes, and
n. any
pipe that has a tobacco bowl or chamber of less than one-half (1/2) inch in
diameter in which there is any detectable residue of any controlled dangerous
substance as defined in this section or any other substances not legal for
possession or use;
provided,
however, the term drug paraphernalia shall not include separation gins intended
for use in preparing tea or spice, clamps used for constructing electrical
equipment, water pipes designed for ornamentation in which no detectable amount
of an illegal substance is found or pipes designed and used solely for smoking
tobacco, traditional pipes of an American Indian tribal religious ceremony,
antique pipes that are thirty (30) years of age or older, or drug testing
strips possessed by a person for purposes of determining the presence of
fentanyl or a fentanyl-related compound;
19. “Drug-dependent person” means a person who is
using a controlled dangerous substance and who is in a state of psychic or
physical dependence, or both, arising from administration of that controlled
dangerous substance on a continuous basis.
Drug dependence is characterized by behavioral and other responses which
include a strong compulsion to take the substance on a continuous basis in
order to experience its psychic effects, or to avoid the discomfort of its
absence;
20. “Harm-reduction services” means programs
established to:
a. reduce
the spread of infectious diseases related to injection drug use,
b. reduce
drug dependency, overdose deaths, and associated complications, and
c. increase
safe recovery and disposal of used syringes and sharp waste;
21. “Hazardous materials” means materials,
whether solid, liquid, or gas, which are toxic to human, animal, aquatic, or
plant life, and the disposal of such materials is controlled by state or
federal guidelines;
22. “Home care agency” means any sole
proprietorship, partnership, association, corporation, or other organization
which administers, offers, or provides home care services, for a fee or
pursuant to a contract for such services, to clients in their place of
residence;
23.
“Home care services” means skilled or personal care services provided to
clients in their place of residence for a fee;
24.
“Hospice” means a centrally administered, nonprofit or for-profit,
medically directed, nurse-coordinated program which provides a continuum of
home and inpatient care for the terminally ill patient and the patient’s
family. Such term shall also include a
centrally administered, nonprofit or for-profit, medically directed,
nurse-coordinated program if such program is licensed pursuant to the
provisions of the Uniform Controlled Dangerous Substances Act. A hospice program offers palliative and
supportive care to meet the special needs arising out of the physical,
emotional and spiritual stresses which are experienced during the final stages
of illness and during dying and bereavement.
This care is available twenty-four (24) hours a day, seven (7) days a
week, and is provided on the basis of need, regardless of ability to pay. “Class A” Hospice refers to
Medicare-certified hospices. “Class B”
refers to all other providers of hospice services;
25.
“Imitation controlled substance” means a substance that is not a
controlled dangerous substance, which by dosage unit appearance, color, shape,
size, markings or by representations made, would lead a reasonable person to
believe that the substance is a controlled dangerous substance, or is a drug
intended solely for veterinary purposes that is not a controlled dangerous
substance and is being used outside of the scope of practice or normal course
of business, as defined by the State Board of Veterinary Medical Examiners, or
is a federal Food and Drug Administration-approved drug that is not a
controlled dangerous substance and is being used outside the scope of approval
for illicit purposes such as adulterating or lacing other controlled dangerous
substances. In the event the appearance
of the dosage unit or use is not reasonably sufficient to establish that the
substance is an imitation controlled substance, the court or authority
concerned should consider, in addition to all other factors, the following
factors:
a. statements
made by an owner or by any other person in control of the substance concerning
the nature of the substance, or its use or effect,
b. statements
made to the recipient that the substance may be resold for inordinate profit,
c. whether
the substance is packaged in a manner normally used for illicit controlled
substances,
d. evasive
tactics or actions utilized by the owner or person in control of the substance
to avoid detection by law enforcement authorities,
e. prior
convictions, if any, of an owner, or any other person in control of the object,
under state or federal law related to controlled substances or fraud, and
f. the
proximity of the substances to controlled dangerous substances;
26.
“Immediate precursor” means a substance which the Director has found to
be and by regulation designates as being the principal compound commonly used
or produced primarily for use, and which is an immediate chemical intermediary
used, or likely to be used, in the manufacture of a controlled dangerous
substance, the control of which is necessary to prevent, curtail or limit such
manufacture;
27.
“Initial prescription” means a prescription issued to a patient who:
a. has
never previously been issued a prescription for the drug or its pharmaceutical
equivalent in the past year, or
b. requires
a prescription for the drug or its pharmaceutical equivalent due to a surgical
procedure or new acute event and has previously had a prescription for the drug
or its pharmaceutical equivalent within the past year.
When determining whether a patient
was previously issued a prescription for a drug or its pharmaceutical
equivalent, the practitioner shall consult with the patient and review the
medical record and prescription monitoring information of the patient;
28.
“Isomer” means the optical isomer, except as used in subsections C and F
of Section 2-204 of this title and paragraph 4 of subsection A of Section 2-206
of this title. As used in subsections C
and F of Section 2-204 of this title, isomer means the optical, positional, or
geometric isomer. As used in paragraph 4
of subsection A of Section 2-206 of this title, the term isomer means the optical
or geometric isomer;
29.
“Laboratory” means a laboratory approved by the Director as proper to be
entrusted with the custody of controlled dangerous substances and the use of
controlled dangerous substances for scientific and medical purposes and for
purposes of instruction;
30.
“Manufacture” means the production, preparation, propagation,
compounding or processing of a controlled dangerous substance, either directly
or indirectly by extraction from substances of natural or synthetic origin, or
independently by means of chemical synthesis or by a combination of extraction
and chemical synthesis. “Manufacturer”
includes any person who packages, repackages or labels any container of any
controlled dangerous substance, except practitioners who dispense or compound
prescription orders for delivery to the ultimate consumer;
31.
“Marijuana” means all parts of the plant Cannabis sativa L., whether
growing or not; the seeds thereof; the resin extracted from any part of such
plant; and every compound, manufacture, salt, derivative, mixture or
preparation of such plant, its seeds or resin, but shall not include:
a. the
mature stalks of such plant or fiber produced from such stalks,
b. oil
or cake made from the seeds of such plant, including cannabidiol derived from
the seeds of the marijuana plant,
c. any
other compound, manufacture, salt, derivative, mixture or preparation of such
mature stalks (except the resin extracted therefrom), including cannabidiol
derived from mature stalks, fiber, oil or cake,
d. the
sterilized seed of such plant which is incapable of germination,
e. for
any person participating in a clinical trial to administer cannabidiol for the
treatment of severe forms of epilepsy pursuant to Section 2-802 of this title,
a drug or substance approved by the federal Food and Drug Administration for
use by those participants,
f. for
any person or the parents, legal guardians or caretakers of the person who have
received a written certification from a physician licensed in this state that
the person has been diagnosed by a physician as having Lennox-Gastaut syndrome,
Dravet syndrome, also known as severe myoclonic epilepsy of infancy, or any
other severe form of epilepsy that is not adequately treated by traditional
medical therapies, spasticity due to multiple sclerosis or due to paraplegia,
intractable nausea and vomiting, appetite stimulation with chronic wasting
diseases, the substance cannabidiol, a nonpsychoactive cannabinoid, found in
the plant Cannabis sativa L. or any other preparation thereof, that has a
tetrahydrocannabinol concentration not more than three-tenths of one percent
(0.3%) and that is delivered to the patient in the form of a liquid,
g. any
federal Food and Drug Administration-approved drug or substance, or
h. industrial
hemp, from the plant Cannabis sativa L. and any part of such plant, whether
growing or not, with a delta-9 tetrahydrocannabinol concentration not more than
three-tenths of one percent (0.3%) on a dry-weight basis which shall only be
grown pursuant to the Oklahoma Industrial Hemp Program and may be shipped
intrastate and interstate;
32.
“Medical purpose” means an intention to utilize a controlled dangerous
substance for physical or mental treatment, for diagnosis, or for the
prevention of a disease condition not in violation of any state or federal law
and not for the purpose of satisfying physiological or psychological dependence
or other abuse;
33.
“Mid-level practitioner” means an Advanced Practice Registered Nurse as
defined and within parameters specified in Section 567.3a of Title 59 of the
Oklahoma Statutes, or a certified animal euthanasia technician as defined in
Section 698.2 of Title 59 of the Oklahoma Statutes, or an animal control
officer registered by the Oklahoma State Bureau of Narcotics and Dangerous
Drugs Control under subsection B of Section 2-301 of this title within the
parameters of such officer’s duties under Sections 501 through 508 of Title 4
of the Oklahoma Statutes;
34.
“Narcotic drug” means any of the following, whether produced directly or
indirectly by extraction from substances of vegetable origin, or independently
by means of chemical synthesis, or by a combination of extraction and chemical
synthesis:
a. opium,
coca leaves and opiates,
b. a
compound, manufacture, salt, derivative or preparation of opium, coca leaves or
opiates,
c. cocaine,
its salts, optical and geometric isomers, and salts of isomers,
d. ecgonine,
its derivatives, their salts, isomers and salts of isomers, and
e. a
substance, and any compound, manufacture, salt, derivative or preparation
thereof, which is chemically identical with any of the substances referred to
in subparagraphs a through d of this paragraph, except that the words narcotic
drug as used in Section 2-101 et seq. of this title shall not include
decocainized coca leaves or extracts of coca leaves, which extracts do not
contain cocaine or ecgonine;
35.
“Opiate” or “opioid” means any Schedule II, III, IV or V substance
having an addiction-forming or addiction-sustaining liability similar to
morphine or being capable of conversion into a drug having such addiction-forming
or addiction-sustaining liability. The
terms do not include, unless specifically designated as controlled under the
Uniform Controlled Dangerous Substances Act, the dextrorotatory isomer of
3-methoxy-n-methyl-morphinan and its salts (dextromethorphan). The terms do include the racemic and
levorotatory forms;
36.
“Opium poppy” means the plant of the species Papaver somniferum L.,
except the seeds thereof;
37.
“Palliative care” means a specialized medical service for people of any
age and at any stage of a serious illness or life-altering medical event that
focuses on navigating complex medical decisions while providing patient
autonomy and access to information.
Utilizing a holistic and interdisciplinary team approach, palliative
care addresses physical, intellectual, emotional, social, and spiritual needs. Palliative care may be provided in the
inpatient, outpatient, or home care setting and strives to improve quality of
life for both the patient and the family;
38.
“Patient-provider agreement” means a written contract or agreement that
is executed between a practitioner and a patient prior to the commencement of
treatment for chronic pain using an opioid drug as a means to:
a. explain
the possible risk of development of physical or psychological dependence in the
patient and prevent the possible development of addiction,
b. document
the understanding of both the practitioner and the patient regarding the
patient-provider agreement of the patient,
c. establish
the rights of the patient in association with treatment and the obligations of
the patient in relation to the responsible use, discontinuation of use, and
storage of opioid drugs, including any restrictions on the refill of
prescriptions or the acceptance of opioid prescriptions from practitioners,
d. identify
the specific medications and other modes of treatment, including physical
therapy or exercise, relaxation, or psychological counseling, that are included
as a part of the patient-provider agreement,
e. specify
the measures the practitioner may employ to monitor the compliance of the
patient including, but not limited to, random specimen screens and pill counts,
and
f. delineate
the process for terminating the agreement, including the consequences if the
practitioner has reason to believe that the patient is not complying with the
terms of the agreement. Compliance with
the consent items described in this paragraph shall constitute a valid,
informed consent for opioid therapy. The
practitioner shall be held harmless from civil litigation for failure to treat
pain if the event occurs because of nonadherence by the patient with any of the
provisions of the patient-provider agreement;
39.
“Peace officer” means a police officer, sheriff, deputy sheriff,
district attorney’s investigator, investigator from the Office of the Attorney
General, or any other person elected or appointed by law to enforce any of the
criminal laws of this state or of the United States;
40.
“Person” means an individual, corporation, government or governmental
subdivision or agency, business trust, estate, trust, partnership or
association, or any other legal entity;
41.
“Poppy straw” means all parts, except the seeds, of the opium poppy,
after mowing;
42.
“Practitioner” means:
a. (1) a medical doctor or osteopathic physician,
(2) a
dentist,
(3) a
podiatrist,
(4) an
optometrist,
(5) a
veterinarian,
(6) a
physician assistant or an Advanced Practice Registered Nurse under
the supervision of a licensed medical doctor or osteopathic physician, or a
physician assistant,
(7) a
scientific investigator, or
(8) any
other person,
licensed, registered or otherwise
permitted to prescribe, distribute, dispense, conduct research with respect to,
use for scientific purposes or administer a controlled dangerous substance in
the course of professional practice or research in this state, or
b. a
pharmacy, hospital, laboratory or other institution licensed, registered or
otherwise permitted to distribute, dispense, conduct research with respect to,
use for scientific purposes or administer a controlled dangerous substance in
the course of professional practice or research in this state;
43.
“Production” includes the manufacture, planting, cultivation, growing or
harvesting of a controlled dangerous substance;
44. “Serious illness” means a medical illness or
physical injury or condition that substantially affects quality of life for
more than a short period of time.
Serious illness includes, but is not limited to, Alzheimer’s disease or
related dementias, lung disease, cancer, heart failure, renal failure, liver
failure, or chronic, unremitting, or intractable pain such as neuropathic pain;
45.
“State” means the State of Oklahoma or any other state of the United
States;
46.
“Straw person” or “straw party”, also known as a “front”, means a third
party who:
a. is
put up in name only to take part in a transaction or otherwise is a nominal
party to a transaction with no actual control,
b. acts
on behalf of another person to obtain title to property and executes documents
and instruments the principal may direct respecting property, or
c. purchases
property for another for the purpose of concealing the identity of the real
purchaser or to accomplish some purpose otherwise in violation of the Oklahoma
Statutes;
47. “Surgical procedure” means a procedure that
is performed for the purpose of structurally altering the human body by
incision or destruction of tissues as part of the practice of medicine. This term includes the diagnostic or
therapeutic treatment of conditions or disease processes by use of instruments
such as lasers, ultrasound, ionizing, radiation, scalpels, probes, or needles
that cause localized alteration or transportation of live human tissue by
cutting, burning, vaporizing, freezing, suturing, probing, or manipulating by
closed reduction for major dislocations or fractures, or otherwise altering by
any mechanical, thermal, light-based, electromagnetic, or chemical means;
48. a. “Synthetic controlled substance” means a
substance:
(1) the
chemical structure of which is substantially similar to the chemical structure
of a controlled dangerous substance in Schedule I or II,
(2) which
has a stimulant, depressant, or hallucinogenic effect on the central nervous
system that is substantially similar to or greater than the stimulant,
depressant, or hallucinogenic effect on the central nervous system of a
controlled dangerous substance in Schedule I or II, or
(3) with
respect to a particular person, which such person represents or intends to have
a stimulant, depressant, or hallucinogenic effect on the central nervous system
that is substantially similar to or greater than the stimulant, depressant, or
hallucinogenic effect on the central nervous system of a controlled dangerous
substance in Schedule I or II.
b. The
designation of gamma-butyrolactone or any other chemical as a precursor,
pursuant to Section 2-322 of this title, does not preclude a finding pursuant
to subparagraph a of this paragraph that the chemical is a synthetic controlled
substance.
c. Synthetic
controlled substance does not include:
(1) a
controlled dangerous substance,
(2) any
substance for which there is an approved new drug application,
(3) with
respect to a particular person any substance, if an exemption is in effect for
investigational use, for that person under the provisions of Section 505 of the
Federal Food, Drug, and Cosmetic Act, 21 U.S.C., Section 355, to the extent
conduct with respect to such substance is pursuant to such exemption, or
(4) any
substance to the extent not intended for human consumption before such an
exemption takes effect with respect to that substance.
d. Prima
facie evidence that a substance containing salvia divinorum has been enhanced,
concentrated, or chemically or physically altered shall give rise to a
rebuttable presumption that the substance is a synthetic controlled substance;
49. “Tetrahydrocannabinols” means all substances
that have been chemically synthesized to emulate the tetrahydrocannabinols of
marijuana, specifically including any tetrahydrocannabinols derived from
industrial hemp; and
50.
“Ultimate user” means a person who lawfully possesses a controlled
dangerous substance for the person’s own use or for the use of a member of the
person’s household or for administration to an animal owned by the person or by
a member of the person’s household.
SECTION
9. AMENDATORY 63 O.S. 2021, Section 2-312, as amended by
Section 2, Chapter 184, O.S.L. 2022 (63 O.S. Supp. 2024, Section 2-312), is
amended to read as follows:
Section
2-312. A. A physician, podiatrist, optometrist or a
dentist who has complied with the registration requirements of the Uniform
Controlled Dangerous Substances Act, in good faith and in the course of such
person's professional practice only, may prescribe and administer controlled
dangerous substances, or may cause the same to be administered by medical or
paramedical personnel acting under the direction and supervision of the
physician, podiatrist, optometrist or dentist, and only may dispense controlled
dangerous substances pursuant to the provisions of Sections 355.1 and 355.2 of
Title 59 of the Oklahoma Statutes.
B.
A veterinarian who has complied with the registration requirements of
the Uniform Controlled Dangerous Substances Act, in good faith and in the
course of the professional practice of the veterinarian only, and not for use
by a human being, may prescribe, administer, and dispense controlled dangerous
substances and may cause them to be administered by an assistant or orderly
under the direction and supervision of the veterinarian.
C.
An advanced practice nurse who is recognized to prescribe by the
Oklahoma Board of Nursing as an advanced registered nurse practitioner,
clinical nurse specialist or certified nurse-midwife, who is subject to medical
direction by a supervising physician, pursuant to Section 567.3a of Title 59 of
the Oklahoma Statutes, and who has complied with the registration requirements
of the Uniform Controlled Dangerous Substances Act, in good faith and in the
course of professional practice only, may prescribe and administer Schedule
III, IV and V controlled dangerous substances.
D.
An advanced practice nurse who is recognized to order, select, obtain
and administer drugs by the Oklahoma Board of Nursing as a certified registered
nurse anesthetist pursuant to Section 353.1b of Title 59 of the Oklahoma
Statutes and who has complied with the registration requirements of the Uniform
Controlled Dangerous Substances Act, in good faith and in the course of such
practitioner's professional practice only, may order, select, obtain and
administer Schedules II through V controlled dangerous substances in a
preanesthetic preparation or evaluation; anesthesia induction, maintenance or
emergence; or postanesthesia care setting only.
A certified registered nurse anesthetist may order, select, obtain and
administer such drugs only during the perioperative or periobstetrical period.
E.
A physician assistant who is recognized to prescribe by the State Board
of Medical Licensure and Supervision under the medical direction of a
supervising physician, pursuant to Section 519.6 of Title 59 of the
Oklahoma Statutes, and who has complied with the registration requirements of
the Uniform Controlled Dangerous Substances Act, in good faith and in the
course of professional practice only, may prescribe and administer Schedule II
through V controlled dangerous substances subject to the restrictions in
Section 519.6 of Title 59 of the Oklahoma Statutes.
SECTION
10. REPEALER 59 O.S. 2021, Section 521.4, is hereby
repealed.
Passed the House of
Representatives the 21st day of May, 2025.
Presiding
Officer of the House
of
Representatives
Passed the Senate the 8th day of May, 2025.
Presiding
Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By:
_________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor
of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By:
_________________________________