HB 537

As Introduced
136th General Assembly
   Regular Session  H. B. No. 537
       2025-2026
  Representatives McClain, Miller, M.
  Cosponsors: Representatives Fowler Arthur, Gross, Klopfenstein, Newman
  To amend sections 3701.351, 3702.30, 4723.01,  1
  4723.02, 4723.03, 4723.06, 4723.07, 4723.08,  2
  4723.271, 4723.28, 4723.282, 4723.33, 4723.34,  3
  4723.341, 4723.35, 4723.41, 4723.43, 4723.431,  4
  4723.432, 4723.481, 4723.483, 4723.487,  5
  4723.488, 4723.4810, 4723.4811, 4723.50,  6
  4723.91, 4723.99, 4731.22, and 4731.27 and to  7
  enact sections 5.2324, 3722.15, 4723.53,  8
  4723.54, 4723.55, 4723.551, 4723.56, 4723.57,  9
  4723.58, 4723.581, 4723.582, 4723.583, 4723.584,  10
  4723.59, 4723.60, 4724.01, 4724.02, 4724.03,  11
  4724.04, 4724.05, 4724.06, 4724.07, 4724.08,  12
  4724.09, 4724.10, 4724.11, 4724.12, 4724.13,  13
  4724.14, 4724.15, 4724.16, and 4724.99 of the  14
  Revised Code to regulate the practice of  15
  midwifery, to establish requirements for  16
  freestanding birthing centers, and to designate  17
  May 5th as the "Day of the Midwife."  18
 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
     Section 1. That sections 3701.351, 3702.30, 4723.01,  19
4723.02, 4723.03, 4723.06, 4723.07, 4723.08, 4723.271, 4723.28,  20
H. B. No. 537  Page 2
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4723.282, 4723.33, 4723.34, 4723.341, 4723.35, 4723.41, 4723.43,  21
4723.431, 4723.432, 4723.481, 4723.483, 4723.487, 4723.488,  22
4723.4810, 4723.4811, 4723.50, 4723.91, 4723.99, 4731.22, and  23
4731.27 be amended and sections 5.2324, 3722.15, 4723.53,  24
4723.54, 4723.55, 4723.551, 4723.56, 4723.57, 4723.58, 4723.581,  25
4723.582, 4723.583, 4723.584, 4723.59, 4723.60, 4724.01,  26
4724.02, 4724.03, 4724.04, 4724.05, 4724.06, 4724.07, 4724.08,  27
4724.09, 4724.10, 4724.11, 4724.12, 4724.13, 4724.14, 4724.15,  28
4724.16, and 4724.99 of the Revised Code be enacted to read as  29
follows:  30
       Sec. 5.2324. The fifth day of May is designated as the  31
"Day of the Midwife."  32
       Sec. 3701.351. (A) The governing body of every hospital  33
shall set standards and procedures to be applied by the hospital  34
and its medical staff in considering and acting upon  35
applications for staff membership or professional privileges.  36
These standards and procedures shall be available for public  37
inspection.  38
       (B) The governing body of any hospital, in considering and  39
acting upon applications for staff membership or professional  40
privileges within the scope of the applicants' respective  41
licensures, shall not discriminate against a qualified person  42
solely on the basis of whether that person is licensed to  43
practice medicine, osteopathic medicine, or podiatry, is  44
licensed to practice dentistry or psychology, or is licensed to  45
practice nursing as an advanced practice registered nurse, or is  46
licensed to practice as a certified midwife or licensed midwife.  47
Staff membership or professional privileges shall be considered  48
and acted on in accordance with standards and procedures  49
established under division (A) of this section. This section  50
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As Introduced
does not permit a psychologist to admit a patient to a hospital  51
in violation of section 3727.06 of the Revised Code.  52
       (C) The governing body of any hospital that provides  53
maternity services, in considering and acting upon applications  54
for clinical privileges, shall not discriminate against a  55
qualified person solely on the basis that the person is  56
authorized to practice nurse-midwifery or midwifery. An  57
application from a certified nurse-midwife or certified midwife  58
who is not employed by the hospital shall contain the name of a  59
physician member of the hospital's medical staff who holds  60
clinical privileges in obstetrics at that hospital and who has  61
agreed to be the collaborating physician for the applicant in  62
accordance with section 4723.43 4723.431 of the Revised Code.  63
       (D) Any person may apply to the court of common pleas for  64
temporary or permanent injunctions restraining a violation of  65
division (A), (B), or (C) of this section. This action is an  66
additional remedy not dependent on the adequacy of the remedy at  67
law.  68
       (E)(1) If a hospital does not provide or permit the  69
provision of any diagnostic or treatment service for mental or  70
emotional disorders or any other service that may be legally  71
performed by a psychologist licensed under Chapter 4732. of the  72
Revised Code, this section does not require the hospital to  73
provide or permit the provision of any such service and the  74
hospital shall be exempt from requirements of this section  75
pertaining to psychologists.  76
       (2) This section does not impair the right of a hospital  77
to enter into an employment, personal service, or any other kind  78
of contract with a licensed psychologist, upon any such terms as  79
the parties may mutually agree, for the provision of any service  80
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that may be legally performed by a licensed psychologist.  81
       Sec. 3702.30. (A) As used in this section:  82
       (1) "Ambulatory surgical facility" means a facility in  83
which surgical services are provided to patients who do not  84
require hospitalization for inpatient care, the duration of  85
services for any patient does not extend beyond twenty-four  86
hours after the patient's admission, and to which any of the  87
following apply:  88
       (a) The surgical services are provided in a building that  89
is separate from another building in which inpatient care is  90
provided, regardless of whether the separate building is part of  91
the same organization as the building in which inpatient care is  92
provided.  93
       (b) The surgical services are provided within a building  94
in which inpatient care is provided and the entity that operates  95
the portion of the building where the surgical services are  96
provided is not the entity that operates the remainder of the  97
building.  98
       (c) The facility is held out to any person or government  99
entity as an ambulatory surgical facility or similar facility by  100
means of signage, advertising, or other promotional efforts.  101
       "Ambulatory surgical facility" does not include a hospital  102
emergency department, hospital provider-based department that is  103
otherwise licensed under Chapter 3722. of the Revised Code, or  104
an office of a physician, podiatrist, or dentist.  105
       (2) "Health care facility" means any of the following:  106
       (a) An ambulatory surgical facility;  107
       (b) A freestanding dialysis center;  108
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       (c) A freestanding inpatient rehabilitation facility;  109
       (d) A freestanding birthing center;  110
       (e) A freestanding radiation therapy center;  111
       (f) A freestanding or mobile diagnostic imaging center.  112
       (B) By rule adopted in accordance with sections 3702.12  113
and 3702.13 of the Revised Code, the director of health shall  114
establish quality standards for health care facilities. The  115
standards may incorporate accreditation standards or other  116
quality standards established by any entity recognized by the  117
director.  118
       (1) In the case of an ambulatory surgical facility, the  119
standards shall require the ambulatory surgical facility to  120
maintain an infection control program. The purposes of the  121
program are to minimize infections and communicable diseases and  122
facilitate a functional and sanitary environment consistent with  123
standards of professional practice. To achieve these purposes,  124
ambulatory surgical facility staff managing the program shall  125
create and administer a plan designed to prevent, identify, and  126
manage infections and communicable diseases; ensure that the  127
program is directed by a qualified professional trained in  128
infection control; ensure that the program is an integral part  129
of the ambulatory surgical facility's quality assessment and  130
performance improvement program; and implement in an expeditious  131
manner corrective and preventive measures that result in  132
improvement.  133
       (2) In the case of a freestanding birthing center, the  134
standards shall require both of the following:  135
       (a) At least one of the following to attend each birth:  136
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       (i) A physician licensed under Chapter 4731. of the  137
Revised Code to practice medicine and surgery or osteopathic  138
medicine and surgery;  139
       (ii) A certified nurse-midwife licensed under Chapter  140
4723. of the Revised Code;  141
       (iii) A certified midwife licensed under Chapter 4723. of  142
the Revised Code;  143
       (iv) A licensed midwife licensed under Chapter 4724. of  144
the Revised Code.  145
       (b) That each freestanding birthing center have a director  146
of patient services who is one of the following:  147
       (i) A physician licensed under Chapter 4731. of the  148
Revised Code to practice medicine and surgery or osteopathic  149
medicine and surgery;  150
       (ii) A certified nurse-midwife licensed under Chapter  151
4723. of the Revised Code who has contracted with a  152
collaborating physician;  153
       (iii) A certified midwife licensed under Chapter 4723. of  154
the Revised Code who has contracted with a collaborating  155
physician.  156
       (C) Every ambulatory surgical facility shall require that  157
each physician who practices at the facility comply with all  158
relevant provisions in the Revised Code that relate to the  159
obtaining of informed consent from a patient.  160
       (D) The director shall issue a license to each health care  161
facility that makes application for a license and demonstrates  162
to the director that it meets the quality standards established  163
by the rules adopted under division (B) of this section and  164
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satisfies the informed consent compliance requirements specified  165
in division (C) of this section.  166
       (E)(1) Except as provided in division (H) of this section  167
and in section 3702.301 of the Revised Code, no health care  168
facility shall operate without a license issued under this  169
section.  170
       The general assembly does not intend for the provisions of  171
this section or section 3702.301 of the Revised Code that  172
establish health care facility licensing requirements or  173
exemptions to have an effect on any third-party payments that  174
may be available for the services provided by either a licensed  175
health care facility or an entity exempt from licensure.  176
       (2) If the department of health finds that a physician who  177
practices at a health care facility is not complying with any  178
provision of the Revised Code related to the obtaining of  179
informed consent from a patient, the department shall report its  180
finding to the state medical board, the physician, and the  181
health care facility.  182
       (3) Division (E)(2) of this section does not create, and  183
shall not be construed as creating, a new cause of action or  184
substantive legal right against a health care facility and in  185
favor of a patient who allegedly sustains harm as a result of  186
the failure of the patient's physician to obtain informed  187
consent from the patient prior to performing a procedure on or  188
otherwise caring for the patient in the health care facility.  189
       (F) The rules adopted under division (B) of this section  190
shall include all of the following:  191
       (1) Provisions governing application for, renewal,  192
suspension, and revocation of a license under this section;  193
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       (2) Provisions governing orders issued pursuant to section  194
3702.32 of the Revised Code for a health care facility to cease  195
its operations or to prohibit certain types of services provided  196
by a health care facility;  197
       (3) Provisions governing the imposition under section  198
3702.32 of the Revised Code of civil penalties for violations of  199
this section or the rules adopted under this section, including  200
a scale for determining the amount of the penalties;  201
       (4) Provisions specifying the form inspectors must use  202
when conducting inspections of ambulatory surgical facilities.  203
       (G) An ambulatory surgical facility that performs or  204
induces abortions shall comply with section 3701.791 of the  205
Revised Code.  206
       (H) The following entities are not required to obtain a  207
license as a freestanding diagnostic imaging center issued under  208
this section:  209
       (1) A hospital registered under section 3701.07 of the  210
Revised Code that provides diagnostic imaging;  211
       (2) An entity that is reviewed as part of a hospital  212
accreditation or certification program and that provides  213
diagnostic imaging;  214
       (3) An ambulatory surgical facility that provides  215
diagnostic imaging in conjunction with or during any portion of  216
a surgical procedure.  217
       Sec. 3722.15. (A) A hospital that is a medicaid provider  218
and that operates a maternity unit shall agree to a written  219
transfer agreement with any freestanding birthing center if both  220
of the following apply:  221
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       (1) The freestanding birthing center is located within a  222
thirty mile radius of the hospital.  223
       (2) The freestanding birthing center has requested a  224
transfer agreement.  225
       (B) A transfer agreement shall specify an effective  226
procedure for the safe and immediate transfer of patients from  227
the freestanding birthing center to the hospital when medical  228
care beyond the care that can be provided at the freestanding  229
birthing center is necessary, including when emergency  230
situations occur or medical complications arise.  231
       (C) The freestanding birthing center shall file a copy of  232
the transfer agreement with the director of health.  233
       Sec. 4723.01. As used in this chapter:  234
       (A) "Registered nurse" means an individual who holds a  235
current, valid license issued under this chapter that authorizes  236
the practice of nursing as a registered nurse.  237
       (B) "Practice of nursing as a registered nurse" means  238
providing to individuals and groups nursing care requiring  239
specialized knowledge, judgment, and skill derived from the  240
principles of biological, physical, behavioral, social, and  241
nursing sciences. Such nursing care includes:  242
       (1) Identifying patterns of human responses to actual or  243
potential health problems amenable to a nursing regimen;  244
       (2) Executing a nursing regimen through the selection,  245
performance, management, and evaluation of nursing actions;  246
       (3) Assessing health status for the purpose of providing  247
nursing care;  248
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       (4) Providing health counseling and health teaching;  249
       (5) Administering medications, treatments, and executing  250
regimens authorized by an individual who is authorized to  251
practice in this state and is acting within the course of the  252
individual's professional practice;  253
       (6) Teaching, administering, supervising, delegating, and  254
evaluating nursing practice.  255
       (C) "Nursing regimen" may include preventative,  256
restorative, and health-promotion activities.  257
       (D) "Assessing health status" means the collection of data  258
through nursing assessment techniques, which may include  259
interviews, observation, and physical evaluations for the  260
purpose of providing nursing care.  261
       (E) "Licensed practical nurse" means an individual who  262
holds a current, valid license issued under this chapter that  263
authorizes the practice of nursing as a licensed practical  264
nurse.  265
       (F) "The practice of nursing as a licensed practical  266
nurse" means providing to individuals and groups nursing care  267
requiring the application of basic knowledge of the biological,  268
physical, behavioral, social, and nursing sciences at the  269
direction of a registered nurse or any of the following who is  270
authorized to practice in this state: a physician, physician  271
assistant, dentist, podiatrist, optometrist, or chiropractor.  272
Such nursing care includes:  273
       (1) Observation, patient teaching, and care in a diversity  274
of health care settings;  275
       (2) Contributions to the planning, implementation, and  276
H. B. No. 537  Page 11
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evaluation of nursing;  277
       (3) Administration of medications and treatments  278
authorized by an individual who is authorized to practice in  279
this state and is acting within the course of the individual's  280
professional practice;  281
       (4) Administration to an adult of intravenous therapy  282
authorized by an individual who is authorized to practice in  283
this state and is acting within the course of the individual's  284
professional practice, on the condition that the licensed  285
practical nurse is authorized under section 4723.18 or 4723.181  286
of the Revised Code to perform intravenous therapy and performs  287
intravenous therapy only in accordance with those sections;  288
       (5) Delegation of nursing tasks as directed by a  289
registered nurse;  290
       (6) Teaching nursing tasks to licensed practical nurses  291
and individuals to whom the licensed practical nurse is  292
authorized to delegate nursing tasks as directed by a registered  293
nurse.  294
       (G) "Certified registered nurse anesthetist" means an  295
advanced practice registered nurse who holds a current, valid  296
license issued under this chapter and is designated as a  297
certified registered nurse anesthetist in accordance with  298
section 4723.42 of the Revised Code and rules adopted by the  299
board of nursing.  300
       (H) "Clinical nurse specialist" means an advanced practice  301
registered nurse who holds a current, valid license issued under  302
this chapter and is designated as a clinical nurse specialist in  303
accordance with section 4723.42 of the Revised Code and rules  304
adopted by the board of nursing.  305
H. B. No. 537  Page 12
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       (I) "Certified nurse-midwife" means an advanced practice  306
registered nurse who holds a current, valid license issued under  307
this chapter and is designated as a certified nurse-midwife in  308
accordance with section 4723.42 of the Revised Code and rules  309
adopted by the board of nursing. A certified nurse-midwife does  310
not include a certified midwife, licensed midwife, or  311
traditional midwife.  312
       (J) "Certified nurse practitioner" means an advanced  313
practice registered nurse who holds a current, valid license  314
issued under this chapter and is designated as a certified nurse  315
practitioner in accordance with section 4723.42 of the Revised  316
Code and rules adopted by the board of nursing.  317
       (K) "Physician" means an individual authorized under  318
Chapter 4731. of the Revised Code to practice medicine and  319
surgery or osteopathic medicine and surgery.  320
       (L) "Collaboration" or "collaborating" means the  321
following:  322
       (1) In the case of a clinical nurse specialist or a  323
certified nurse practitioner, that one or more podiatrists  324
acting within the scope of practice of podiatry in accordance  325
with section 4731.51 of the Revised Code and with whom the nurse  326
has entered into a standard care arrangement or one or more  327
physicians with whom the nurse has entered into a standard care  328
arrangement are continuously available to communicate with the  329
clinical nurse specialist or certified nurse practitioner either  330
in person or by electronic communication;  331
       (2) In the case of a certified nurse-midwife or certified  332
midwife, that one or more physicians with whom the certified  333
nurse-midwife or certified midwife has entered into a standard  334
H. B. No. 537  Page 13
As Introduced
care arrangement are continuously available to communicate with  335
the certified nurse-midwife or certified midwife either in  336
person or by electronic communication.  337
       (M) "Supervision," as it pertains to a certified  338
registered nurse anesthetist, means that the certified  339
registered nurse anesthetist is under the direction of a  340
podiatrist acting within the podiatrist's scope of practice in  341
accordance with section 4731.51 of the Revised Code, a dentist  342
acting within the dentist's scope of practice in accordance with  343
Chapter 4715. of the Revised Code, or a physician, and, when  344
administering anesthesia, the certified registered nurse  345
anesthetist is in the immediate presence of the podiatrist,  346
dentist, or physician.  347
       (N) "Standard care arrangement" means a written, formal  348
guide for planning and evaluating a patient's health care that  349
is developed by one or more collaborating physicians or  350
podiatrists and a clinical nurse specialist, certified nurse-  351
midwife, certified midwife, or certified nurse practitioner and  352
meets the requirements of section 4723.431 of the Revised Code.  353
       (O) "Advanced practice registered nurse" means an  354
individual who holds a current, valid license issued under this  355
chapter that authorizes the practice of nursing as an advanced  356
practice registered nurse and is designated as any of the  357
following:  358
       (1) A certified registered nurse anesthetist;  359
       (2) A clinical nurse specialist;  360
       (3) A certified nurse-midwife;  361
       (4) A certified nurse practitioner.  362
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       (P) "Practice of nursing as an advanced practice  363
registered nurse" means providing to individuals and groups  364
nursing care that requires knowledge and skill obtained from  365
advanced formal education, training, and clinical experience.  366
Such nursing care includes the care described in section 4723.43  367
of the Revised Code.  368
       (Q) "Dialysis care" means the care and procedures that a  369
dialysis technician or dialysis technician intern is authorized  370
to provide and perform, as specified in section 4723.72 of the  371
Revised Code.  372
       (R) "Dialysis technician" means an individual who holds a  373
current, valid certificate to practice as a dialysis technician  374
issued under section 4723.75 of the Revised Code.  375
       (S) "Dialysis technician intern" means an individual who  376
has not passed the dialysis technician certification examination  377
required by section 4723.751 of the Revised Code, but who has  378
successfully completed a dialysis training program approved by  379
the board of nursing under section 4723.74 of the Revised Code  380
within the previous eighteen months.  381
       (T) "Certified community health worker" means an  382
individual who holds a current, valid certificate as a community  383
health worker issued under section 4723.85 of the Revised Code.  384
       (U) "Medication aide" means an individual who holds a  385
current, valid certificate issued under this chapter that  386
authorizes the individual to administer medication in accordance  387
with section 4723.67 of the Revised Code;  388
       (V) "Nursing specialty" means a specialty in practice as a  389
certified registered nurse anesthetist, clinical nurse  390
specialist, certified nurse-midwife, or certified nurse  391
H. B. No. 537  Page 15
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practitioner.  392
       (W) "Physician assistant" means an individual who is  393
licensed to practice as a physician assistant under Chapter  394
4730. of the Revised Code.  395
       (X) "Certified midwife" means an individual who is  396
licensed under section 4723.56 of the Revised Code and engages  397
in one or more of the activities described in that section. A  398
certified midwife does not include a certified nurse-midwife,  399
licensed midwife, or traditional midwife.  400
       (Y) "Licensed midwife" has the same meaning as in section  401
4724.01 of the Revised Code. A licensed midwife does not include  402
a certified nurse-midwife, certified midwife, or traditional  403
midwife.  404
       (Z) "Traditional midwife" has the same meaning as in  405
section 4724.01 of the Revised Code.  406
       Sec. 4723.02. The board of nursing shall assume and  407
exercise all the powers and perform all the duties conferred and  408
imposed on it by this chapter.  409
       The board shall consist of thirteen fifteen members who  410
shall be citizens of the United States and residents of Ohio.  411
Eight members shall be registered nurses, each of whom shall be  412
a graduate of an approved program of nursing education that  413
prepares persons for licensure as a registered nurse, shall hold  414
a currently active license issued under this chapter to practice  415
nursing as a registered nurse, and shall have been actively  416
engaged in the practice of nursing as a registered nurse for the  417
five years immediately preceding the member's initial  418
appointment to the board. Of the eight members who are  419
registered nurses, at least two shall hold a current, valid  420
H. B. No. 537  Page 16
As Introduced
license issued under this chapter that authorizes the practice  421
of nursing as an advanced practice registered nurse. Four  422
members shall be licensed practical nurses, each of whom shall  423
be a graduate of an approved program of nursing education that  424
prepares persons for licensure as a practical nurse, shall hold  425
a currently active license issued under this chapter to practice  426
nursing as a licensed practical nurse, and shall have been  427
actively engaged in the practice of nursing as a licensed  428
practical nurse for the five years immediately preceding the  429
member's initial appointment to the board. One member shall be a  430
certified nurse-midwife or a certified midwife practicing in an  431
urban setting. One member shall be a certified nurse-midwife or  432
a certified midwife practicing in a rural setting. One member  433
shall represent the interests of consumers of health care.  434
Neither this member nor any person in the member's immediate  435
family shall be a member of or associated with a health care  436
provider or profession or shall have a financial interest in the  437
delivery or financing of health care. Representation of nursing  438
service and nursing education and of the various geographical  439
areas of the state shall be considered in making appointments.  440
        As the term of any member of the board expires, a  441
successor shall be appointed who has the qualifications the  442
vacancy requires. Terms of office shall be for four years,  443
commencing on the first day of January and ending on the thirty-  444
first day of December.  445
        A current or former board member who has served not more  446
than one full term or one full term and not more than thirty  447
months of another term may be reappointed for one additional  448
term.  449
        Each member shall hold office from the date of appointment  450
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until the end of the term for which the member was appointed.  451
The term of a member shall expire if the member ceases to meet  452
any requirement of this section for the member's position on the  453
board. Any member appointed to fill a vacancy occurring prior to  454
the expiration of the term for which the member's predecessor  455
was appointed shall hold office for the remainder of such term.  456
Any member shall continue in office subsequent to the expiration  457
date of the member's term until the member's successor takes  458
office, or until a period of sixty days has elapsed, whichever  459
occurs first.  460
       Nursing organizations of this state may each submit to the  461
governor the names of not more than five nominees for each  462
position to be filled on the board. From the names so submitted  463
or from others, at the governor's discretion, the governor with  464
the advice and consent of the senate shall make such  465
appointments.  466
       Any member of the board may be removed by the governor for  467
neglect of any duty required by law or for incompetency or  468
unprofessional or dishonorable conduct, after a hearing as  469
provided in Chapter 119. of the Revised Code.  470
       Seven Eight members of the board, including at least four  471
registered nurses and at least one licensed practical nurse,  472
shall at all times constitute a quorum.  473
       Each member of the board shall receive an amount fixed  474
pursuant to division (J) of section 124.15 of the Revised Code  475
for each day in attendance at board meetings and in discharge of  476
official duties, and in addition thereto, necessary expense  477
incurred in the performance of such duties.  478
       The board shall elect one of its nurse members as  479
H. B. No. 537  Page 18
As Introduced
president and one as vice-president. The board shall elect one  480
of its registered nurse members to serve as the supervising  481
member for disciplinary matters.  482
       The board may establish advisory groups to serve in  483
consultation with the board or the executive director. Each  484
advisory group shall be given a specific charge in writing and  485
shall report to the board. Members of advisory groups shall  486
serve without compensation but shall receive their actual and  487
necessary expenses incurred in the performance of their official  488
duties.  489
       Sec. 4723.03. (A) No person shall engage in the practice  490
of nursing as a registered nurse, represent the person as being  491
a registered nurse, or use the title "registered nurse," the  492
initials "R.N.," or any other title implying that the person is  493
a registered nurse, for a fee, salary, or other consideration,  494
or as a volunteer, without holding a current, valid license as a  495
registered nurse under this chapter.  496
       (B) No person shall knowingly do any of the following  497
without holding a current, valid license to practice nursing as  498
an advanced practice registered nurse issued under this chapter:  499
       (1) Engage in the practice of nursing as an advanced  500
practice registered nurse;  501
       (2) Represent the person as being an advanced practice  502
registered nurse;  503
       (3) Use the title "advanced practice registered nurse,"  504
the initials "A.P.R.N.," or any other title implying that the  505
person is an advanced practice registered nurse, for a fee,  506
salary, or other consideration, or as a volunteer.  507
       (C) No person who is not otherwise authorized to do so  508
H. B. No. 537  Page 19
As Introduced
shall knowingly prescribe or personally furnish drugs or  509
therapeutic devices without holding a current, valid license to  510
practice nursing as an advanced practice registered nurse issued  511
under this chapter and being designated as a clinical nurse  512
specialist, certified nurse-midwife, or certified nurse  513
practitioner under section 4723.42 of the Revised Code;  514
       (D) No person shall engage in the practice of nursing as a  515
licensed practical nurse, represent the person as being a  516
licensed practical nurse, or use the title "licensed practical  517
nurse," the initials "L.P.N.," or any other title implying that  518
the person is a licensed practical nurse, for a fee, salary, or  519
other consideration, or as a volunteer, without holding a  520
current, valid license as a practical nurse under this chapter.  521
       (E) No person shall use the titles or initials "graduate  522
nurse," "G.N.," "professional nurse," "P.N.," "graduate  523
practical nurse," "G.P.N.," "practical nurse," "P.N.," "trained  524
nurse," "T.N.," or any other statement, title, or initials that  525
would imply or represent to the public that the person is  526
authorized to practice nursing in this state, except as follows:  527
       (1) A person licensed under this chapter to practice  528
nursing as a registered nurse may use that title and the  529
initials "R.N.";  530
       (2) A person licensed under this chapter to practice  531
nursing as a licensed practical nurse may use that title and the  532
initials "L.P.N.";  533
       (3) A person licensed under this chapter to practice  534
nursing as an advanced practice registered nurse and designated  535
as a certified registered nurse anesthetist may use that title  536
or the initials "A.P.R.N.-C.R.N.A.";  537
H. B. No. 537  Page 20
As Introduced
       (4) A person licensed under this chapter to practice  538
nursing as an advanced practice registered nurse and designated  539
as a clinical nurse specialist may use that title or the  540
initials "A.P.R.N.-C.N.S.";  541
       (5) A person licensed under this chapter to practice  542
nursing as an advanced practice registered nurse and designated  543
as a certified nurse-midwife may use that title or the initials  544
"A.P.R.N.-C.N.M.";  545
       (6) A person licensed under this chapter to practice  546
nursing as an advanced practice registered nurse and designated  547
as a certified nurse practitioner may use that title or the  548
initials "A.P.R.N.-C.N.P.";  549
       (7) A person licensed under this chapter to practice  550
nursing as an advanced practice registered nurse may use the  551
title "advanced practice registered nurse" or the initials  552
"A.P.R.N."  553
       (F) No person shall employ a person not licensed as a  554
registered nurse under this chapter to engage in the practice of  555
nursing as a registered nurse.  556
       No person shall knowingly employ a person not licensed as  557
an advanced practice registered nurse under this chapter to  558
engage in the practice of nursing as an advanced practice  559
registered nurse.  560
       No person shall employ a person not licensed as a  561
practical nurse under this chapter to engage in the practice of  562
nursing as a licensed practical nurse.  563
       (G) No person shall sell or fraudulently obtain or furnish  564
any nursing diploma, license, certificate, renewal, or record,  565
or aid or abet such acts.  566
H. B. No. 537  Page 21
As Introduced
       (H)(1) No person shall knowingly use the title "certified  567
nurse-midwife," the initials "C.N.M.," or any other title  568
implying that the person is a certified nurse-midwife without  569
holding a current, valid license as a certified nurse-midwife  570
under this chapter.  571
       (2) No person shall knowingly use the title "certified  572
midwife," the initials "C.M.," or any other title implying that  573
the person is a certified midwife without holding a current,  574
valid license as a certified midwife under this chapter.  575
       Sec. 4723.06. (A) The board of nursing shall:  576
       (1) Administer and enforce the provisions of this chapter,  577
including the taking of disciplinary action for violations of  578
section 4723.28 of the Revised Code, any other provisions of  579
this chapter, or rules adopted under this chapter;  580
       (2) Develop criteria that an applicant must meet to be  581
eligible to sit for the examination for licensure to practice as  582
a registered nurse or as a licensed practical nurse;  583
       (3) Issue and renew nursing licenses, certified midwife  584
licenses, dialysis technician certificates, medication aide  585
certificates, and community health worker certificates, as  586
provided in this chapter;  587
       (4) Define the minimum educational standards for the  588
schools and programs of registered nursing and practical nursing  589
in this state;  590
       (5) Survey, inspect, and grant full approval to  591
prelicensure nursing education programs in this state that meet  592
the standards established by rules adopted under section 4723.07  593
of the Revised Code. Prelicensure nursing education programs  594
include, but are not limited to, diploma, associate degree,  595
H. B. No. 537  Page 22
As Introduced
baccalaureate degree, master's degree, and doctor of nursing  596
programs leading to initial licensure to practice nursing as a  597
registered nurse and practical nurse programs leading to initial  598
licensure to practice nursing as a licensed practical nurse.  599
       (6) Grant conditional approval, by a vote of a quorum of  600
the board, to a new prelicensure nursing education program or a  601
program that is being reestablished after having ceased to  602
operate, if the program meets and maintains the minimum  603
standards of the board established by rules adopted under  604
section 4723.07 of the Revised Code. If the board does not grant  605
conditional approval, it shall hold an adjudication under  606
Chapter 119. of the Revised Code to consider conditional  607
approval of the program. If the board grants conditional  608
approval, at the first meeting following completion of the  609
survey process required by division (A)(5) of this section, the  610
board shall determine whether to grant full approval to the  611
program. If the board does not grant full approval or if it  612
appears that the program has failed to meet and maintain  613
standards established by rules adopted under section 4723.07 of  614
the Revised Code, the board shall hold an adjudication under  615
Chapter 119. of the Revised Code to consider the program. Based  616
on results of the adjudication, the board may continue or  617
withdraw conditional approval, or grant full approval.  618
       (7) Place on provisional approval, for a period of time  619
specified by the board, a prelicensure nursing education program  620
that has ceased to meet and maintain the minimum standards of  621
the board established by rules adopted under section 4723.07 of  622
the Revised Code. Prior to or at the end of the period, the  623
board shall reconsider whether the program meets the standards  624
and shall grant full approval if it does. If it does not, the  625
board may withdraw approval, pursuant to an adjudication under  626
H. B. No. 537  Page 23
As Introduced
Chapter 119. of the Revised Code.  627
       (8) Approve continuing education programs and courses  628
under standards established in rules adopted under sections  629
4723.07, 4723.69, 4723.79, and 4723.88 of the Revised Code;  630
       (9) Establish the safe haven program in accordance with  631
sections 4723.35 and 4723.351 of the Revised Code;  632
       (10) Establish the practice intervention and improvement  633
program in accordance with section 4723.282 of the Revised Code;  634
       (11) Grant approval to the course of study in advanced  635
pharmacology and related topics described in section 4723.482 or  636
4723.551 of the Revised Code;  637
       (12) Make an annual edition of the exclusionary formulary  638
established in rules adopted under section 4723.50 of the  639
Revised Code available to the public by electronic means and, as  640
soon as possible after any revision of the formulary becomes  641
effective, make the revision available to the public by  642
electronic means;  643
       (13) Approve under section 4723.46 of the Revised Code  644
national certifying organizations for examination and licensure  645
of advanced practice registered nurses, which may include  646
separate organizations for each nursing specialty;  647
       (14) Provide guidance and make recommendations to the  648
general assembly, the governor, state agencies, and the federal  649
government with respect to the regulation of the practice of  650
nursing and the enforcement of this chapter;  651
       (15) Make an annual report to the governor, which shall be  652
open for public inspection;  653
       (16) Maintain and have open for public inspection the  654
H. B. No. 537  Page 24
As Introduced
following records:  655
       (a) A record of all its meetings and proceedings;  656
       (b) A record of all applicants for, and holders of,  657
licenses and certificates issued by the board under this chapter  658
or in accordance with rules adopted under this chapter. The  659
record shall be maintained in a format determined by the board.  660
       (c) A list of education and training programs approved by  661
the board.  662
       (17) Deny conditional approval to a new prelicensure  663
nursing education program or a program that is being  664
reestablished after having ceased to operate if the program or a  665
person acting on behalf of the program submits or causes to be  666
submitted to the board false, misleading, or deceptive  667
statements, information, or documentation in the process of  668
applying for approval of the program. If the board proposes to  669
deny approval of the program, it shall do so pursuant to an  670
adjudication conducted under Chapter 119. of the Revised Code.  671
       (B) The board may fulfill the requirement of division (A)  672
(8) of this section by authorizing persons who meet the  673
standards established in rules adopted under section 4723.07 of  674
the Revised Code to approve continuing education programs and  675
courses. Persons so authorized shall approve continuing  676
education programs and courses in accordance with standards  677
established in rules adopted under section 4723.07 of the  678
Revised Code.  679
       Persons seeking authorization to approve continuing  680
education programs and courses shall apply to the board and pay  681
the appropriate fee established under section 4723.08 of the  682
Revised Code. Authorizations to approve continuing education  683
H. B. No. 537  Page 25
As Introduced
programs and courses shall expire and may be renewed according  684
to the schedule established in rules adopted under section  685
4723.07 of the Revised Code.  686
        In addition to approving continuing education programs  687
under division (A)(8) of this section, the board may sponsor  688
continuing education activities that are directly related to the  689
statutes and rules the board enforces.  690
        (C)(1) The board may deny conditional approval to a new  691
prelicensure nursing education program or program that is being  692
reestablished after having ceased to operate if the program is  693
controlled by a person who controls or has controlled a program  694
that had its approval withdrawn, revoked, suspended, or  695
restricted by the board or a board of another jurisdiction that  696
is a member of the national council of state boards of nursing.  697
If the board proposes to deny approval, it shall do so pursuant  698
to an adjudication conducted under Chapter 119. of the Revised  699
Code.  700
        (2) As used in this division, "control" means any of the  701
following:  702
        (a) Holding fifty per cent or more of the outstanding  703
voting securities or membership interest of a prelicensure  704
nursing education program;  705
        (b) In the case of an unincorporated prelicensure nursing  706
education program, having the right to fifty per cent or more of  707
the program's profits or in the event of a dissolution, fifty  708
per cent or more of the program's assets;  709
        (c) In the case of a prelicensure nursing education  710
program that is a for-profit or not-for-profit corporation,  711
having the contractual authority presently to designate fifty  712
H. B. No. 537  Page 26
As Introduced
per cent or more of its directors;  713
       (d) In the case of a prelicensure nursing education  714
program that is a trust, having the contractual authority  715
presently to designate fifty per cent or more of its trustees;  716
       (e) Having the authority to direct the management,  717
policies, or investments of a prelicensure nursing education  718
program.  719
       (D)(1) When an action taken by the board under division  720
(A)(6), (7), or (17) or (C)(1) of this section is required to be  721
taken pursuant to an adjudication conducted under Chapter 119.  722
of the Revised Code, the board may, in lieu of an adjudication  723
hearing, enter into a consent agreement to resolve the matter. A  724
consent agreement, when ratified by a vote of a quorum of the  725
board, constitutes the findings and order of the board with  726
respect to the matter addressed in the agreement. If the board  727
refuses to ratify a consent agreement, the admissions and  728
findings contained in the agreement are of no effect.  729
       (2) In any instance in which the board is required under  730
Chapter 119. of the Revised Code to give notice to a person  731
seeking approval of a prelicensure nursing education program of  732
an opportunity for a hearing and the person does not make a  733
timely request for a hearing in accordance with section 119.07  734
of the Revised Code, the board is not required to hold a  735
hearing, but may adopt, by a vote of a quorum, a final order  736
that contains the board's findings.  737
       (3) When the board denies or withdraws approval of a  738
prelicensure nursing education program, the board may specify  739
that its action is permanent. A program subject to a permanent  740
action taken by the board is forever ineligible for approval and  741
H. B. No. 537  Page 27
As Introduced
the board shall not accept an application for the program's  742
reinstatement or approval.  743
       Sec. 4723.07. In accordance with Chapter 119. of the  744
Revised Code, the board of nursing shall adopt and may amend and  745
rescind rules that establish all of the following:  746
       (A) Provisions for the board's government and control of  747
its actions and business affairs;  748
       (B) Subject to section 4723.072 of the Revised Code,  749
minimum standards for nursing education programs that prepare  750
graduates to be licensed under this chapter and procedures for  751
granting, renewing, and withdrawing approval of those programs;  752
       (C) Criteria that applicants for licensure must meet to be  753
eligible to take examinations for licensure;  754
       (D) Standards and procedures for renewal of the licenses  755
and certificates issued by the board;  756
       (E) Standards for approval of continuing nursing education  757
programs and courses for registered nurses, advanced practice  758
registered nurses, and licensed practical nurses. The standards  759
may provide for approval of continuing nursing education  760
programs and courses that have been approved by other state  761
boards of nursing or by national accreditation systems for  762
nursing, including, but not limited to, the American nurses'  763
credentialing center and the national association for practical  764
nurse education and service.  765
       (F) Standards that persons must meet to be authorized by  766
the board to approve continuing education programs and courses  767
and a schedule by which that authorization expires and may be  768
renewed;  769
H. B. No. 537  Page 28
As Introduced
       (G) Requirements, including continuing education  770
requirements, for reactivating inactive licenses or  771
certificates, and for reinstating licenses or certificates that  772
have lapsed;  773
       (H) Conditions that may be imposed for reinstatement of a  774
license or certificate following action taken under section  775
3123.47, 4723.28, 4723.281, 4723.652, or 4723.86 of the Revised  776
Code resulting in a license or certificate suspension;  777
       (I) Criteria for evaluating the qualifications of an  778
applicant for a license to practice nursing as a registered  779
nurse, a license to practice nursing as an advanced practice  780
registered nurse, or a license to practice nursing as a licensed  781
practical nurse for the purpose of issuing the license by the  782
board's endorsement of the applicant's authority to practice  783
issued by the licensing agency of another state;  784
       (J) Universal and standard precautions that shall be used  785
by each licensee or certificate holder. The rules shall define  786
and establish requirements for universal and standard  787
precautions that include the following:  788
       (1) Appropriate use of hand washing;  789
       (2) Disinfection and sterilization of equipment;  790
       (3) Handling and disposal of needles and other sharp  791
instruments;  792
       (4) Wearing and disposal of gloves and other protective  793
garments and devices.  794
       (K) Quality assurance standards for advanced practice  795
registered nurses;  796
       (L) Additional criteria for the standard care arrangement  797
H. B. No. 537  Page 29
As Introduced
required by section 4723.431 of the Revised Code entered into by  798
a certified midwife, clinical nurse specialist, certified nurse-  799
midwife, or certified nurse practitioner and the nurse's  800
collaborating physician or podiatrist;  801
       (M) For purposes of division (B)(31) of section 4723.28 of  802
the Revised Code, the actions, omissions, or other circumstances  803
that constitute failure to establish and maintain professional  804
boundaries with a patient;  805
       (N) Standards and procedures for delegation under section  806
4723.48 of the Revised Code of the authority to administer  807
drugs.  808
       The board may adopt other rules necessary to carry out the  809
provisions of this chapter. The rules shall be adopted in  810
accordance with Chapter 119. of the Revised Code.  811
       Sec. 4723.08. (A) The board of nursing may impose fees not  812
to exceed the following limits:  813
       (1) For application for licensure by examination or  814
endorsement to practice nursing as a registered nurse or as a  815
licensed practical nurse submitted under division (A) or (B) of  816
section 4723.09 of the Revised Code, seventy-five dollars;  817
       (2) For application for licensure to practice nursing as  818
an advanced practice registered nurse submitted under division  819
(A) or (B)(2) of section 4723.41 of the Revised Code, one  820
hundred fifty dollars;  821
       (3) For application for a dialysis technician certificate,  822
the amount specified in rules adopted under section 4723.79 of  823
the Revised Code;  824
       (4) For providing, pursuant to division (B) of section  825
H. B. No. 537  Page 30
As Introduced
4723.271 of the Revised Code, written verification of a nursing  826
license, dialysis technician certificate, medication aide  827
certificate, or community health worker certificate to another  828
jurisdiction, fifteen dollars;  829
       (5) For providing, pursuant to division (A) of section  830
4723.271 of the Revised Code, a replacement copy of a wall  831
certificate suitable for framing as described in that division,  832
twenty-five dollars;  833
       (6) For renewal of a license to practice as a registered  834
nurse or licensed practical nurse, sixty-five dollars;  835
       (7) For renewal of a license to practice as an advanced  836
practice registered nurse, one hundred thirty-five dollars;  837
       (8) For renewal of a dialysis technician certificate, the  838
amount specified in rules adopted under section 4723.79 of the  839
Revised Code;  840
       (9) For processing a late application for renewal of a  841
nursing license or dialysis technician certificate, fifty  842
dollars;  843
       (10) For application for authorization to approve  844
continuing education programs and courses from an applicant  845
accredited by a national accreditation system for nursing, five  846
hundred dollars;  847
       (11) For application for authorization to approve  848
continuing education programs and courses from an applicant not  849
accredited by a national accreditation system for nursing, one  850
thousand dollars;  851
       (12) For each year for which authorization to approve  852
continuing education programs and courses is renewed, one  853
H. B. No. 537  Page 31
As Introduced
hundred fifty dollars;  854
       (13) For application for approval to operate a dialysis  855
training program, the amount specified in rules adopted under  856
section 4723.79 of the Revised Code;  857
       (14) For reinstatement of a lapsed license or certificate  858
issued under this chapter, one hundred dollars except as  859
provided in section 5903.10 of the Revised Code;  860
       (15) For processing a check returned to the board by a  861
financial institution, twenty-five dollars;  862
       (16) The amounts specified in rules adopted under section  863
4723.88 of the Revised Code pertaining to the issuance of  864
certificates to community health workers, including fees for  865
application for a certificate, renewal of a certificate,  866
processing a late application for renewal of a certificate,  867
reinstatement of a lapsed certificate, application for approval  868
of a community health worker training program for community  869
health workers, and renewal of the approval of a training  870
program for community health workers;  871
       (17) For application for licensure to practice as a  872
certified midwife, an amount equal to the fee for licensure to  873
practice as an advanced practice registered nurse;  874
       (18) For renewal of a license to practice as a certified  875
midwife, an amount equal to the fee for renewal of a license to  876
practice as an advanced practice registered nurse.  877
       (B) Each quarter, for purposes of transferring funds under  878
section 4743.05 of the Revised Code to the nurse education  879
assistance fund created in section 3333.28 of the Revised Code,  880
the board of nursing shall certify to the director of budget and  881
management the number of licenses renewed under this chapter  882
H. B. No. 537  Page 32
As Introduced
during the preceding quarter and the amount equal to that number  883
times five dollars.  884
       (C) The board may charge a participant in a board-  885
sponsored continuing education activity an amount not exceeding  886
fifteen dollars for each activity.  887
       (D) The board may contract for services pertaining to the  888
process of providing written verification of a license or  889
certificate when the verification is performed for purposes  890
other than providing verification to another jurisdiction. The  891
contract may include provisions pertaining to the collection of  892
the fee charged for providing the written verification. As part  893
of these provisions, the board may permit the contractor to  894
retain a portion of the fees as compensation, before any amounts  895
are deposited into the state treasury.  896
       Sec. 4723.271. (A) Upon request of the holder of a nursing  897
license, certified midwife license, dialysis technician  898
certificate, medication aide certificate, or community health  899
worker certificate issued under this chapter, the presentment of  900
proper identification as prescribed in rules adopted by the  901
board of nursing, and payment of the fee authorized under  902
section 4723.08 of the Revised Code, the board of nursing shall  903
provide to the requestor a replacement copy of a wall  904
certificate suitable for framing.  905
       (B) Upon request of the holder of a nursing license,  906
certified midwife license, volunteer's certificate, dialysis  907
technician certificate, medication aide certificate, or  908
community health worker certificate issued under this chapter  909
and payment of the fee authorized under section 4723.08 of the  910
Revised Code, the board shall verify to an agency of another  911
jurisdiction or foreign country the fact that the person holds  912
H. B. No. 537  Page 33
As Introduced
such nursing license, certified midwife license, volunteer's  913
certificate, dialysis technician certificate, medication aide  914
certificate, or community health worker certificate.  915
       Sec. 4723.28. (A) The board of nursing, by a vote of a  916
quorum, may impose one or more of the following sanctions if it  917
finds that a person committed fraud in passing an examination  918
required to obtain a license or dialysis technician certificate  919
issued by the board or to have committed fraud,  920
misrepresentation, or deception in applying for or securing any  921
nursing license, certified midwife license, or dialysis  922
technician certificate issued by the board: deny, revoke,  923
suspend, or place restrictions on any nursing license, certified  924
midwife license, or dialysis technician certificate issued by  925
the board; reprimand or otherwise discipline a holder of a  926
nursing license, certified midwife license, or dialysis  927
technician certificate; or impose a fine of not more than five  928
hundred dollars per violation.  929
       (B) Except as provided in section 4723.092 of the Revised  930
Code, the board of nursing, by a vote of a quorum, may impose  931
one or more of the following sanctions: deny, revoke, suspend,  932
or place restrictions on any nursing license, certified midwife  933
license, or dialysis technician certificate issued by the board;  934
reprimand or otherwise discipline a holder of a nursing license,  935
certified midwife license, or dialysis technician certificate;  936
or impose a fine of not more than five hundred dollars per  937
violation. The sanctions may be imposed for any of the  938
following:  939
       (1) Denial, revocation, suspension, or restriction of  940
authority to engage in a licensed profession or practice a  941
health care occupation, including nursing or practice as a  942
H. B. No. 537  Page 34
As Introduced
certified midwife or dialysis technician, for any reason other  943
than a failure to renew, in Ohio or another state or  944
jurisdiction;  945
       (2) Engaging in the practice of nursing or engaging in  946
practice as a certified midwife or dialysis technician, having  947
failed to renew a nursing license, certified midwife license, or  948
dialysis technician certificate issued under this chapter, or  949
while a nursing license, certified midwife license, or dialysis  950
technician certificate is under suspension;  951
       (3) Conviction of, a plea of guilty to, a judicial finding  952
of guilt of, a judicial finding of guilt resulting from a plea  953
of no contest to, or a judicial finding of eligibility for a  954
pretrial diversion or similar program or for intervention in  955
lieu of conviction for, a misdemeanor committed in the course of  956
practice;  957
       (4) Conviction of, a plea of guilty to, a judicial finding  958
of guilt of, a judicial finding of guilt resulting from a plea  959
of no contest to, or a judicial finding of eligibility for a  960
pretrial diversion or similar program or for intervention in  961
lieu of conviction for, any felony or of any crime involving  962
gross immorality or moral turpitude;  963
       (5) Selling, giving away, or administering drugs or  964
therapeutic devices for other than legal and legitimate  965
therapeutic purposes; or conviction of, a plea of guilty to, a  966
judicial finding of guilt of, a judicial finding of guilt  967
resulting from a plea of no contest to, or a judicial finding of  968
eligibility for a pretrial diversion or similar program or for  969
intervention in lieu of conviction for, violating any municipal,  970
state, county, or federal drug law;  971
H. B. No. 537  Page 35
As Introduced
        (6) Conviction of, a plea of guilty to, a judicial finding  972
of guilt of, a judicial finding of guilt resulting from a plea  973
of no contest to, or a judicial finding of eligibility for a  974
pretrial diversion or similar program or for intervention in  975
lieu of conviction for, an act in another jurisdiction that  976
would constitute a felony or a crime of moral turpitude in Ohio;  977
        (7) Conviction of, a plea of guilty to, a judicial finding  978
of guilt of, a judicial finding of guilt resulting from a plea  979
of no contest to, or a judicial finding of eligibility for a  980
pretrial diversion or similar program or for intervention in  981
lieu of conviction for, an act in the course of practice in  982
another jurisdiction that would constitute a misdemeanor in  983
Ohio;  984
        (8) Self-administering or otherwise taking into the body  985
any dangerous drug, as defined in section 4729.01 of the Revised  986
Code, in any way that is not in accordance with a legal, valid  987
prescription issued for that individual, or self-administering  988
or otherwise taking into the body any drug that is a schedule I  989
controlled substance;  990
        (9) Habitual or excessive use of controlled substances,  991
other habit-forming drugs, or alcohol or other chemical  992
substances to an extent that impairs the individual's ability to  993
provide safe nursing care, safe care as a certified midwife, or  994
safe dialysis care;  995
        (10) Impairment of the ability to practice according to  996
acceptable and prevailing standards of safe nursing care, safe  997
care as a certified midwife, or safe dialysis care because of  998
the use of drugs, alcohol, or other chemical substances;  999
        (11) Impairment of the ability to practice according to  1000
H. B. No. 537  Page 36
As Introduced
acceptable and prevailing standards of safe nursing care or safe  1001
dialysis care because of a physical or mental disability;  1002
       (12) Assaulting or causing harm to a patient or depriving  1003
a patient of the means to summon assistance;  1004
       (13) Misappropriation or attempted misappropriation of  1005
money or anything of value in the course of practice;  1006
       (14) Adjudication by a probate court of being mentally ill  1007
or mentally incompetent. The board may reinstate the person's  1008
nursing license, certified midwife license, or dialysis  1009
technician certificate upon adjudication by a probate court of  1010
the person's restoration to competency or upon submission to the  1011
board of other proof of competency.  1012
       (15) The suspension or termination of employment by the  1013
United States department of defense or department of veterans  1014
affairs for any act that violates or would violate this chapter;  1015
       (16) Violation of this chapter or any rules adopted under  1016
it;  1017
       (17) Violation of any restrictions placed by the board on  1018
a nursing license, certified midwife license, or dialysis  1019
technician certificate;  1020
       (18) Failure to use universal and standard precautions  1021
established by rules adopted under section 4723.07 of the  1022
Revised Code;  1023
       (19) Failure to practice in accordance with acceptable and  1024
prevailing standards of safe nursing care, safe care as a  1025
certified midwife, or safe dialysis care;  1026
       (20) In the case of a registered nurse, engaging in  1027
activities that exceed the practice of nursing as a registered  1028
H. B. No. 537  Page 37
As Introduced
nurse;  1029
       (21) In the case of a licensed practical nurse, engaging  1030
in activities that exceed the practice of nursing as a licensed  1031
practical nurse;  1032
       (22) In the case of a dialysis technician, engaging in  1033
activities that exceed those permitted under section 4723.72 of  1034
the Revised Code;  1035
       (23) Aiding and abetting a person in that person's  1036
practice of nursing or as a certified midwife without a license  1037
or practice as a dialysis technician without a certificate  1038
issued under this chapter;  1039
       (24) In the case of an advanced practice registered nurse,  1040
except as provided in division (M) of this section, either of  1041
the following:  1042
       (a) Waiving the payment of all or any part of a deductible  1043
or copayment that a patient, pursuant to a health insurance or  1044
health care policy, contract, or plan that covers such nursing  1045
services, would otherwise be required to pay if the waiver is  1046
used as an enticement to a patient or group of patients to  1047
receive health care services from that provider;  1048
       (b) Advertising that the nurse will waive the payment of  1049
all or any part of a deductible or copayment that a patient,  1050
pursuant to a health insurance or health care policy, contract,  1051
or plan that covers such nursing services, would otherwise be  1052
required to pay.  1053
       (25) Failure to comply with the terms and conditions of  1054
participation in the safe haven program conducted under sections  1055
4723.35 and 4723.351 of the Revised Code;  1056
H. B. No. 537  Page 38
As Introduced
       (26) Failure to comply with the terms and conditions  1057
required under the practice intervention and improvement program  1058
established under section 4723.282 of the Revised Code;  1059
       (27) In the case of an advanced practice registered nurse:  1060
       (a) Engaging in activities that exceed those permitted for  1061
the nurse's nursing specialty under section 4723.43 of the  1062
Revised Code;  1063
       (b) Failure to meet the quality assurance standards  1064
established under section 4723.07 of the Revised Code.  1065
       (28) In the case of an advanced practice registered nurse  1066
other than a certified registered nurse anesthetist, failure to  1067
maintain a standard care arrangement in accordance with section  1068
4723.431 of the Revised Code or to practice in accordance with  1069
the standard care arrangement;  1070
       (29) In the case of an advanced practice registered nurse  1071
who is designated as a clinical nurse specialist, certified  1072
nurse-midwife, or certified nurse practitioner, failure to  1073
prescribe drugs and therapeutic devices in accordance with  1074
section 4723.481 of the Revised Code;  1075
       (30) Prescribing any drug or device to perform or induce  1076
an abortion, or otherwise performing or inducing an abortion;  1077
       (31) Failure to establish and maintain professional  1078
boundaries with a patient, as specified in rules adopted under  1079
section 4723.07 of the Revised Code;  1080
       (32) Regardless of whether the contact or verbal behavior  1081
is consensual, engaging with a patient other than the spouse of  1082
the registered nurse, licensed practical nurse, certified  1083
midwife, or dialysis technician in any of the following:  1084
H. B. No. 537  Page 39
As Introduced
       (a) Sexual contact, as defined in section 2907.01 of the  1085
Revised Code;  1086
       (b) Verbal behavior that is sexually demeaning to the  1087
patient or may be reasonably interpreted by the patient as  1088
sexually demeaning.  1089
       (33) Assisting suicide, as defined in section 3795.01 of  1090
the Revised Code;  1091
       (34) Failure to comply with the requirements in section  1092
3719.061 of the Revised Code before issuing for a minor a  1093
prescription for an opioid analgesic, as defined in section  1094
3719.01 of the Revised Code;  1095
       (35) Failure to comply with section 4723.487 of the  1096
Revised Code, unless the state board of pharmacy no longer  1097
maintains a drug database pursuant to section 4729.75 of the  1098
Revised Code;  1099
       (36) The revocation, suspension, restriction, reduction,  1100
or termination of clinical privileges by the United States  1101
department of defense or department of veterans affairs or the  1102
termination or suspension of a certificate of registration to  1103
prescribe drugs by the drug enforcement administration of the  1104
United States department of justice;  1105
       (37) In the case of an advanced practice registered nurse  1106
who is designated as a clinical nurse specialist, certified  1107
nurse-midwife, or certified nurse practitioner, failure to  1108
comply with the terms of a consult agreement entered into with a  1109
pharmacist pursuant to section 4729.39 of the Revised Code;  1110
       (38) Violation of section 4723.93 of the Revised Code;  1111
       (39) Failure to cooperate with an investigation conducted  1112
H. B. No. 537  Page 40
As Introduced
by the board under this chapter, including failure to comply  1113
with a subpoena or order issued by the board or failure to  1114
answer truthfully a question presented by the board in an  1115
investigative interview, in an investigative office conference,  1116
at a deposition, or in written interrogatories, except that  1117
failure to cooperate with an investigation does not constitute  1118
grounds for discipline if a court of competent jurisdiction has  1119
issued an order that either quashes a subpoena or permits the  1120
individual to withhold testimony or evidence at issue;  1121
       (40) In the case of a certified midwife:  1122
       (a) Engaging in activities that exceed those permitted  1123
under section 4723.57 of the Revised Code;  1124
       (b) Failure to prescribe drugs and therapeutic devices in  1125
accordance with section 4723.481 of the Revised Code;  1126
       (c) Failure to maintain a standard care arrangement in  1127
accordance with section 4723.431 of the Revised Code or to  1128
practice in accordance with the standard care arrangement.  1129
       (C) Disciplinary actions taken by the board under  1130
divisions (A) and (B) of this section shall be taken pursuant to  1131
an adjudication conducted under Chapter 119. of the Revised  1132
Code, except that in lieu of a hearing, the board may enter into  1133
a consent agreement with an individual to resolve an allegation  1134
of a violation of this chapter or any rule adopted under it. A  1135
consent agreement, when ratified by a vote of a quorum, shall  1136
constitute the findings and order of the board with respect to  1137
the matter addressed in the agreement. If the board refuses to  1138
ratify a consent agreement, the admissions and findings  1139
contained in the agreement shall be of no effect.  1140
       (D) The hearings of the board shall be conducted in  1141
H. B. No. 537  Page 41
As Introduced
accordance with Chapter 119. of the Revised Code, the board may  1142
appoint a hearing examiner, as provided in section 119.09 of the  1143
Revised Code, to conduct any hearing the board is authorized to  1144
hold under Chapter 119. of the Revised Code.  1145
       In any instance in which the board is required under  1146
Chapter 119. of the Revised Code to give notice of an  1147
opportunity for a hearing and the applicant, licensee, or  1148
certificate holder does not make a timely request for a hearing  1149
in accordance with section 119.07 of the Revised Code, the board  1150
is not required to hold a hearing, but may adopt, by a vote of a  1151
quorum, a final order that contains the board's findings. In the  1152
final order, the board may order any of the sanctions listed in  1153
division (A) or (B) of this section.  1154
       (E) If a criminal action is brought against a registered  1155
nurse, licensed practical nurse, certified midwife, or dialysis  1156
technician for an act or crime described in divisions (B)(3) to  1157
(7) of this section and the action is dismissed by the trial  1158
court other than on the merits, the board shall conduct an  1159
adjudication to determine whether the registered nurse, licensed  1160
practical nurse, certified midwife, or dialysis technician  1161
committed the act on which the action was based. If the board  1162
determines on the basis of the adjudication that the registered  1163
nurse, licensed practical nurse, certified midwife, or dialysis  1164
technician committed the act, or if the registered nurse,  1165
licensed practical nurse, certified midwife, or dialysis  1166
technician fails to participate in the adjudication, the board  1167
may take action as though the registered nurse, licensed  1168
practical nurse, certified midwife, or dialysis technician had  1169
been convicted of the act.  1170
       If the board takes action on the basis of a conviction,  1171
H. B. No. 537  Page 42
As Introduced
plea, or a judicial finding as described in divisions (B)(3) to  1172
(7) of this section that is overturned on appeal, the registered  1173
nurse, licensed practical nurse, certified midwife, or dialysis  1174
technician may, on exhaustion of the appeal process, petition  1175
the board for reconsideration of its action. On receipt of the  1176
petition and supporting court documents, the board shall  1177
temporarily rescind its action. If the board determines that the  1178
decision on appeal was a decision on the merits, it shall  1179
permanently rescind its action. If the board determines that the  1180
decision on appeal was not a decision on the merits, it shall  1181
conduct an adjudication to determine whether the registered  1182
nurse, licensed practical nurse, certified midwife, or dialysis  1183
technician committed the act on which the original conviction,  1184
plea, or judicial finding was based. If the board determines on  1185
the basis of the adjudication that the registered nurse,  1186
licensed practical nurse, certified midwife, or dialysis  1187
technician committed such act, or if the registered nurse,  1188
licensed practical nurse, certified midwife, or dialysis  1189
technician does not request an adjudication, the board shall  1190
reinstate its action; otherwise, the board shall permanently  1191
rescind its action.  1192
       Notwithstanding the provision of division (D)(2) of  1193
section 2953.32 or division (F)(1) of section 2953.39 of the  1194
Revised Code specifying that if records pertaining to a criminal  1195
case are sealed or expunged under that section the proceedings  1196
in the case shall be deemed not to have occurred, sealing or  1197
expungement of the following records on which the board has  1198
based an action under this section shall have no effect on the  1199
board's action or any sanction imposed by the board under this  1200
section: records of any conviction, guilty plea, judicial  1201
finding of guilt resulting from a plea of no contest, or a  1202
H. B. No. 537  Page 43
As Introduced
judicial finding of eligibility for a pretrial diversion program  1203
or intervention in lieu of conviction.  1204
       The board shall not be required to seal, destroy, redact,  1205
or otherwise modify its records to reflect the court's sealing  1206
or expungement of conviction records.  1207
       (F) The board may investigate an individual's criminal  1208
background in performing its duties under this section. As part  1209
of such investigation, the board may order the individual to  1210
submit, at the individual's expense, a request to the bureau of  1211
criminal identification and investigation for a criminal records  1212
check and check of federal bureau of investigation records in  1213
accordance with the procedure described in section 4723.091 of  1214
the Revised Code.  1215
       (G) During the course of an investigation conducted under  1216
this section, the board may compel any registered nurse,  1217
licensed practical nurse, certified midwife, or dialysis  1218
technician or applicant under this chapter to submit to a mental  1219
or physical examination, or both, as required by the board and  1220
at the expense of the individual, if the board finds reason to  1221
believe that the individual under investigation may have a  1222
physical or mental impairment that may affect the individual's  1223
ability to provide safe nursing care.  1224
       The board shall not compel an individual who has been  1225
referred to the safe haven program as described in sections  1226
4723.35 and 4723.351 of the Revised Code to submit to a mental  1227
or physical examination.  1228
       Failure of any individual to submit to a mental or  1229
physical examination when directed constitutes an admission of  1230
the allegations, unless the failure is due to circumstances  1231
H. B. No. 537  Page 44
As Introduced
beyond the individual's control, and a default and final order  1232
may be entered without the taking of testimony or presentation  1233
of evidence.  1234
       If the board finds that an individual is impaired, the  1235
board shall require the individual to submit to care,  1236
counseling, or treatment approved or designated by the board, as  1237
a condition for initial, continued, reinstated, or renewed  1238
authority to practice. The individual shall be afforded an  1239
opportunity to demonstrate to the board that the individual can  1240
begin or resume the individual's occupation in compliance with  1241
acceptable and prevailing standards of care under the provisions  1242
of the individual's authority to practice.  1243
       For purposes of this division, any registered nurse,  1244
licensed practical nurse, certified midwife, or dialysis  1245
technician or applicant under this chapter shall be deemed to  1246
have given consent to submit to a mental or physical examination  1247
when directed to do so in writing by the board, and to have  1248
waived all objections to the admissibility of testimony or  1249
examination reports that constitute a privileged communication.  1250
       (H) The board shall investigate evidence that appears to  1251
show that any person has violated any provision of this chapter  1252
or any rule of the board. Any person may report to the board any  1253
information the person may have that appears to show a violation  1254
of any provision of this chapter or rule of the board. In the  1255
absence of bad faith, any person who reports such information or  1256
who testifies before the board in any adjudication conducted  1257
under Chapter 119. of the Revised Code shall not be liable for  1258
civil damages as a result of the report or testimony.  1259
       (I) All of the following apply under this chapter with  1260
respect to the confidentiality of information:  1261
H. B. No. 537  Page 45
As Introduced
       (1) Information received by the board pursuant to a  1262
complaint or an investigation is confidential and not subject to  1263
discovery in any civil action, except that the board may  1264
disclose information to law enforcement officers and government  1265
entities for purposes of an investigation of either a licensed  1266
health care professional, including a registered nurse, licensed  1267
practical nurse, certified midwife, or dialysis technician, or a  1268
person who may have engaged in the unauthorized practice of  1269
nursing, certified midwifery, or dialysis care. No law  1270
enforcement officer or government entity with knowledge of any  1271
information disclosed by the board pursuant to this division  1272
shall divulge the information to any other person or government  1273
entity except for the purpose of a government investigation, a  1274
prosecution, or an adjudication by a court or government entity.  1275
       (2) If an investigation requires a review of patient  1276
records, the investigation and proceeding shall be conducted in  1277
such a manner as to protect patient confidentiality.  1278
       (3) All adjudications and investigations of the board  1279
shall be considered civil actions for the purposes of section  1280
2305.252 of the Revised Code.  1281
       (4) Any board activity that involves continued monitoring  1282
of an individual as part of or following any disciplinary action  1283
taken under this section shall be conducted in a manner that  1284
maintains the individual's confidentiality. Information received  1285
or maintained by the board with respect to the board's  1286
monitoring activities is not subject to discovery in any civil  1287
action and is confidential, except that the board may disclose  1288
information to law enforcement officers and government entities  1289
for purposes of an investigation of a licensee or certificate  1290
holder.  1291
H. B. No. 537  Page 46
As Introduced
       (J) Any action taken by the board under this section  1292
resulting in a suspension from practice shall be accompanied by  1293
a written statement of the conditions under which the person may  1294
be reinstated to practice.  1295
       (K) When the board refuses to grant a license or  1296
certificate to an applicant, revokes a license or certificate,  1297
or refuses to reinstate a license or certificate, the board may  1298
specify that its action is permanent. An individual subject to  1299
permanent action taken by the board is forever ineligible to  1300
hold a license or certificate of the type that was refused or  1301
revoked and the board shall not accept from the individual an  1302
application for reinstatement of the license or certificate or  1303
for a new license or certificate.  1304
       (L) No unilateral surrender of a nursing license,  1305
certified midwife license, or dialysis technician certificate  1306
issued under this chapter shall be effective unless accepted by  1307
majority vote of the board. No application for a nursing  1308
license, certified midwife license, or dialysis technician  1309
certificate issued under this chapter may be withdrawn without a  1310
majority vote of the board. The board's jurisdiction to take  1311
disciplinary action under this section is not removed or limited  1312
when an individual has a license or certificate classified as  1313
inactive or fails to renew a license or certificate.  1314
       (M) Sanctions shall not be imposed under division (B)(24)  1315
of this section against any licensee who waives deductibles and  1316
copayments as follows:  1317
       (1) In compliance with the health benefit plan that  1318
expressly allows such a practice. Waiver of the deductibles or  1319
copayments shall be made only with the full knowledge and  1320
consent of the plan purchaser, payer, and third-party  1321
H. B. No. 537  Page 47
As Introduced
administrator. Documentation of the consent shall be made  1322
available to the board upon request.  1323
       (2) For professional services rendered to any other person  1324
licensed pursuant to this chapter to the extent allowed by this  1325
chapter and the rules of the board.  1326
       Sec. 4723.282. (A) As used in this section, "practice  1327
deficiency" means any activity that does not meet acceptable and  1328
prevailing standards of safe and effective nursing care or  1329
dialysis care or safe and effective care as a certified midwife.  1330
       (B) The board of nursing may abstain from taking  1331
disciplinary action under section 4723.28 of the Revised Code  1332
against the holder of a license or certificate issued under this  1333
chapter who has a practice deficiency that has been identified  1334
by the board through an investigation conducted under section  1335
4723.28 of the Revised Code. The board may abstain from taking  1336
action only if the board has reason to believe that the  1337
individual's practice deficiency can be corrected through  1338
remediation, and if the individual enters into an agreement with  1339
the board to seek remediation as prescribed by the board,  1340
complies with the terms and conditions of the remediation, and  1341
successfully completes the remediation. If an individual fails  1342
to complete the remediation or the board determines that  1343
remediation cannot correct the individual's practice deficiency,  1344
the board shall proceed with disciplinary action in accordance  1345
with section 4723.28 of the Revised Code.  1346
       (C) To implement its authority under this section to  1347
abstain from taking disciplinary action, the board shall  1348
establish a practice intervention and improvement program. The  1349
board shall designate an administrator to operate the program  1350
and, in accordance with Chapter 119. of the Revised Code, adopt  1351
H. B. No. 537  Page 48
As Introduced
rules for the program that establish the following:  1352
       (1) Criteria for use in identifying an individual's  1353
practice deficiency;  1354
       (2) Requirements that an individual must meet to be  1355
eligible for remediation and the board's abstention from  1356
disciplinary action;  1357
       (3) Standards and procedures for prescribing remediation  1358
that is appropriate for an individual's identified practice  1359
deficiency;  1360
       (4) Terms and conditions that an individual must meet to  1361
be successful in completing the remediation prescribed;  1362
       (5) Procedures for the board's monitoring of the  1363
individual's remediation;  1364
       (6) Procedures for maintaining confidential records  1365
regarding individuals who participate in remediation;  1366
       (7) Any other requirements or procedures necessary to  1367
develop and administer the program.  1368
       (D) All records held by the board for purposes of the  1369
program shall be confidential, are not public records for  1370
purposes of section 149.43 of the Revised Code, and are not  1371
subject to discovery by subpoena or admissible as evidence in  1372
any judicial proceeding. The administrator of the program shall  1373
maintain all records in the board's office in accordance with  1374
the board's record retention schedule.  1375
       (E) When an individual begins the remediation prescribed  1376
by the board, the individual shall sign a waiver permitting any  1377
entity that provides services related to the remediation to  1378
release to the board information regarding the individual's  1379
H. B. No. 537  Page 49
As Introduced
progress. An entity that provides services related to  1380
remediation shall report to the board if the individual fails to  1381
complete the remediation or does not make satisfactory progress  1382
in remediation.  1383
       In the absence of fraud or bad faith, an entity that  1384
reports to the board regarding an individual's practice  1385
deficiency, or progress or lack of progress in remediation, is  1386
not liable in damages to any person as a result of making the  1387
report.  1388
       (F) An individual participating in remediation prescribed  1389
under this section is responsible for all financial obligations  1390
that may arise from obtaining or completing the remediation.  1391
       Sec. 4723.33. A registered nurse, licensed practical  1392
nurse, certified midwife, dialysis technician, community health  1393
worker, or medication aide who in good faith makes a report  1394
under this chapter or any other provision of the Revised Code  1395
regarding a violation of this chapter or any other provision of  1396
the Revised Code, or participates in any investigation,  1397
administrative proceeding, or judicial proceeding resulting from  1398
the report, has the full protection against retaliatory action  1399
provided by sections 4113.51 to 4113.53 of the Revised Code.  1400
       Sec. 4723.34. (A) A person or governmental entity that  1401
employs, or contracts directly or through another person or  1402
governmental entity for the provision of services by, registered  1403
nurses, licensed practical nurses, nurses holding multistate  1404
licenses to practice registered or licensed practical nursing  1405
issued pursuant to section 4723.11 of the Revised Code,  1406
certified midwives, dialysis technicians, medication aides, or  1407
certified community health workers and that knows or has reason  1408
to believe that a current or former employee or person providing  1409
H. B. No. 537  Page 50
As Introduced
services under a contract who holds a license or certificate  1410
issued under this chapter engaged in conduct that would be  1411
grounds for disciplinary action by the board of nursing under  1412
this chapter or rules adopted under it shall report to the board  1413
of nursing the name of such current or former employee or person  1414
providing services under a contract. The report shall be made on  1415
the person's or governmental entity's behalf by an individual  1416
licensed by the board who the person or governmental entity has  1417
designated to make such reports.  1418
       A prosecutor in a case described in divisions (B)(3) to  1419
(5) of section 4723.28 of the Revised Code, or in a case where  1420
the trial court issued an order of dismissal upon technical or  1421
procedural grounds of a charge of a misdemeanor committed in the  1422
course of practice, a felony charge, or a charge of gross  1423
immorality or moral turpitude, who knows or has reason to  1424
believe that the person charged is licensed under this chapter  1425
to practice nursing as a registered nurse or as a licensed  1426
practical nurse, is licensed under this chapter to practice as a  1427
certified midwife, or holds a certificate issued under this  1428
chapter to practice as a dialysis technician shall notify the  1429
board of nursing of the charge. With regard to certified  1430
community health workers and medication aides, the prosecutor in  1431
a case involving a charge of a misdemeanor committed in the  1432
course of employment, a felony charge, or a charge of gross  1433
immorality or moral turpitude, including a case dismissed on  1434
technical or procedural grounds, who knows or has reason to  1435
believe that the person charged holds a community health worker  1436
or medication aide certificate issued under this chapter shall  1437
notify the board of the charge.  1438
       Each notification from a prosecutor shall be made on forms  1439
prescribed and provided by the board. The report shall include  1440
H. B. No. 537  Page 51
As Introduced
the name and address of the license or certificate holder, the  1441
charge, and the certified court documents recording the action.  1442
       (B) If any person or governmental entity fails to provide  1443
a report required by this section, the board may seek an order  1444
from a court of competent jurisdiction compelling submission of  1445
the report.  1446
       Sec. 4723.341. (A) As used in this section, "person" has  1447
the same meaning as in section 1.59 of the Revised Code and also  1448
includes the board of nursing and its members and employees;  1449
health care facilities, associations, and societies; insurers;  1450
and individuals.  1451
       (B) In the absence of fraud or bad faith, no person  1452
reporting to the board of nursing or testifying in an  1453
adjudication conducted under Chapter 119. of the Revised Code  1454
with regard to alleged incidents of negligence or malpractice or  1455
matters subject to this chapter or sections 3123.41 to 3123.50  1456
of the Revised Code and any applicable rules adopted under  1457
section 3123.63 of the Revised Code shall be subject to either  1458
of the following based on making the report or testifying:  1459
       (1) Liability in damages in a civil action for injury,  1460
death, or loss to person or property;  1461
       (2) Discipline or dismissal by an employer.  1462
       (C) An individual who is disciplined or dismissed in  1463
violation of division (B)(2) of this section has the same rights  1464
and duties accorded an employee under sections 4113.52 and  1465
4113.53 of the Revised Code.  1466
       (D) In the absence of fraud or bad faith, no professional  1467
association of registered nurses, advanced practice registered  1468
nurses, licensed practical nurses, certified midwives, dialysis  1469
H. B. No. 537  Page 52
As Introduced
technicians, community health workers, or medication aides that  1470
sponsors a committee or program to provide peer assistance to  1471
individuals with substance abuse problems, no representative or  1472
agent of such a committee or program, and no member of the board  1473
of nursing shall be liable to any person for damages in a civil  1474
action by reason of actions taken to refer a nurse, certified  1475
midwife, dialysis technician, community health worker, or  1476
medication aide to a treatment provider or actions or omissions  1477
of the provider in treating a nurse, certified midwife, dialysis  1478
technician, community health worker, or medication aide.  1479
       Sec. 4723.35. (A) As used in this section and section  1480
4723.351 of the Revised Code:  1481
       (1) "Applicant" means an individual who has applied for a  1482
license or certificate to practice issued under this chapter.  1483
"Applicant" may include an individual who has been granted  1484
authority by the board of nursing to practice as one type of  1485
practitioner, but has applied for authority to practice as  1486
another type of practitioner.  1487
       (2) "Impaired" or "impairment" means either or both of the  1488
following:  1489
       (a) Impairment of the ability to practice as described in  1490
division (B)(10) of section 4723.28 of the Revised Code;  1491
       (b) Impairment of the ability to practice as described in  1492
division (B)(11) of section 4723.28 of the Revised Code.  1493
       (3) "Practitioner" means an individual authorized under  1494
this chapter to practice as a registered nurse, including as an  1495
advanced practice registered nurse, licensed practical nurse,  1496
certified midwife, dialysis technician, community health worker,  1497
or medication aide.  1498
H. B. No. 537  Page 53
As Introduced
       (B) The board of nursing shall establish the safe haven  1499
program to monitor applicants and practitioners who are or may  1500
be impaired, but against whom the board has abstained from  1501
taking disciplinary action. The program is to be conducted by  1502
the monitoring organization under contract with the board as  1503
described in section 4723.351 of the Revised Code.  1504
       (C)(1) On the establishment of the program, the board may  1505
transfer to the monitoring organization, in whole or in part,  1506
either or both of the following responsibilities:  1507
       (a) The monitoring and oversight of licensees as part of  1508
the substance use disorder program as that program existed on or  1509
before the effective date of this section September 20, 2024;  1510
       (b) The monitoring and oversight of licensees under terms  1511
specified in a board adjudication order or consent agreement.  1512
       (2) If the board transfers the responsibilities described  1513
in division (C)(1) of this section, both of the following apply:  1514
       (a) The monitoring organization shall provide to the board  1515
quarterly reports regarding the compliance of transferred  1516
licensees.  1517
       (b) The monitoring organization shall immediately report  1518
to the board any licensee who is not in compliance with the  1519
terms and conditions of monitoring.  1520
       (D) The board shall refer to the monitoring organization  1521
any applicant or practitioner whose health and effectiveness  1522
show signs of impairment or potential impairment, but only if  1523
the applicant or practitioner meets the eligibility conditions  1524
of division (G) of this section.  1525
       (E) Determinations regarding an applicant's or  1526
H. B. No. 537  Page 54
As Introduced
practitioner's eligibility for admission to, continued  1527
participation in, and successful completion of the safe haven  1528
program shall be made by the monitoring organization in  1529
accordance with rules adopted under section 4723.351 of the  1530
Revised Code.  1531
       (F) The board shall abstain from taking disciplinary  1532
action under section 4723.28, 4723.652, or 4723.86 of the  1533
Revised Code against an individual whose health and  1534
effectiveness show signs of impairment or potential impairment,  1535
but who is not currently under the terms of a consent agreement  1536
with the board for impairment or an order issued by the board  1537
for impairment if the individual is participating in the safe  1538
haven program.  1539
       An applicant's or practitioner's impairment neither  1540
excuses an applicant or practitioner who has committed other  1541
violations of this chapter nor precludes the board from  1542
investigating or taking disciplinary action against an applicant  1543
or practitioner for other violations of this chapter.  1544
       (G) An applicant or practitioner is eligible to  1545
participate in the safe haven program if both of the following  1546
conditions are met:  1547
       (1) The applicant or practitioner needs assistance with  1548
impairment or potential impairment.  1549
       (2) The applicant or practitioner has an unencumbered  1550
license and is not currently under the terms of a consent  1551
agreement with the board for impairment or an order issued by  1552
the board for impairment.  1553
       Sec. 4723.41. (A) Each person who desires to practice  1554
nursing as a certified nurse-midwife and has not been authorized  1555
H. B. No. 537  Page 55
As Introduced
to practice midwifery nurse-midwifery prior to December 1, 1967,  1556
and each person who desires to practice nursing as a certified  1557
registered nurse anesthetist, clinical nurse specialist, or  1558
certified nurse practitioner shall file with the board of  1559
nursing a written application for a license to practice nursing  1560
as an advanced practice registered nurse and designation in the  1561
desired specialty. The application must be filed, under oath, on  1562
a form prescribed by the board accompanied by the application  1563
fee required by section 4723.08 of the Revised Code.  1564
       Except as provided in division (B), (C), or (D) of this  1565
section, at the time of making application, the applicant shall  1566
meet all of the following requirements:  1567
       (1) Be a registered nurse;  1568
       (2) Submit documentation satisfactory to the board that  1569
the applicant has earned a master's or doctoral degree with a  1570
major in a nursing specialty or in a related field that  1571
qualifies the applicant to sit for the certification examination  1572
of a national certifying organization approved by the board  1573
under section 4723.46 of the Revised Code;  1574
       (3) Submit documentation satisfactory to the board of  1575
having passed the certification examination of a national  1576
certifying organization approved by the board under section  1577
4723.46 of the Revised Code to examine and certify, as  1578
applicable, nurse-midwives, registered nurse anesthetists,  1579
clinical nurse specialists, or nurse practitioners;  1580
       (4) Submit an affidavit with the application that states  1581
all of the following:  1582
       (a) That the applicant is the person named in the  1583
documents submitted under this section and is the lawful  1584
H. B. No. 537  Page 56
As Introduced
possessor thereof;  1585
       (b) The applicant's age, residence, the school at which  1586
the applicant obtained education in the applicant's nursing  1587
specialty, and any other facts that the board requires;  1588
       (c) The specialty in which the applicant seeks  1589
designation.  1590
       (B)(1) A certified registered nurse anesthetist, clinical  1591
nurse specialist, certified nurse-midwife, or certified nurse  1592
practitioner who is practicing or has practiced as such in  1593
another jurisdiction other than another state may apply for a  1594
license by endorsement to practice nursing as an advanced  1595
practice registered nurse and designation as a certified  1596
registered nurse anesthetist, clinical nurse specialist,  1597
certified nurse-midwife, or certified nurse practitioner in this  1598
state if the nurse meets the requirements set forth in division  1599
(A) of this section or division (B)(2) of this section.  1600
       (2) If an applicant who is practicing or has practiced in  1601
another jurisdiction other than another state applies for  1602
designation under division (B)(2) of this section, the  1603
application shall be submitted to the board in the form  1604
prescribed by rules of the board and be accompanied by the  1605
application fee required by section 4723.08 of the Revised Code.  1606
The application shall include evidence that the applicant meets  1607
the requirements of division (B)(2) of this section, holds  1608
authority to practice nursing and is in good standing in another  1609
jurisdiction other than another state granted after meeting  1610
requirements approved by the entity of that jurisdiction that  1611
regulates nurses, and other information required by rules of the  1612
board of nursing.  1613
H. B. No. 537  Page 57
As Introduced
       With respect to the educational requirements and national  1614
certification requirements that an applicant under division (B)  1615
(2) of this section must meet, both of the following apply:  1616
       (a) If the applicant is a certified registered nurse  1617
anesthetist, certified nurse-midwife, or certified nurse  1618
practitioner who, on or before December 31, 2000, obtained  1619
certification in the applicant's nursing specialty with a  1620
national certifying organization listed in division (A)(3) of  1621
section 4723.41 of the Revised Code as that division existed  1622
prior to March 20, 2013, or that was at that time approved by  1623
the board under section 4723.46 of the Revised Code, the  1624
applicant must have maintained the certification. The applicant  1625
is not required to have earned a master's or doctoral degree  1626
with a major in a nursing specialty or in a related field that  1627
qualifies the applicant to sit for the certification  1628
examination.  1629
       (b) If the applicant is a clinical nurse specialist, one  1630
of the following must apply to the applicant:  1631
       (i) On or before December 31, 2000, the applicant obtained  1632
a master's or doctoral degree with a major in a clinical area of  1633
nursing from an educational institution accredited by a national  1634
or regional accrediting organization. The applicant is not  1635
required to have passed a certification examination.  1636
       (ii) On or before December 31, 2000, the applicant  1637
obtained a master's or doctoral degree in nursing or a related  1638
field and was certified as a clinical nurse specialist by the  1639
American nurses credentialing center or another national  1640
certifying organization that was at that time approved by the  1641
board under section 4723.46 of the Revised Code.  1642
H. B. No. 537  Page 58
As Introduced
       (3) The board shall grant a license to practice nursing as  1643
an advanced practice registered nurse in accordance with Chapter  1644
4796. of the Revised Code to an applicant if either of the  1645
following applies:  1646
       (a) The applicant holds a license in another state.  1647
       (b) The applicant has satisfactory work experience, a  1648
government certification, or a private certification as  1649
described in that chapter as an advanced practice registered  1650
nurse in a state that does not issue that license.  1651
       (4) The board may grant a nonrenewable temporary permit to  1652
practice nursing as an advanced practice registered nurse to an  1653
applicant for licensure under division (B)(2) or (3) of this  1654
section if the board is satisfied by the evidence that the  1655
applicant holds a valid, unrestricted license in or equivalent  1656
authorization from another jurisdiction. Chapter 4796. of the  1657
Revised Code does not apply to a temporary permit issued under  1658
this division. The temporary permit shall expire at the earlier  1659
of one hundred eighty days after issuance or upon the issuance  1660
of a license under division (B)(2) or (3) of this section.  1661
       (C) An applicant who desires to practice nursing as a  1662
certified registered nurse anesthetist, certified nurse-midwife,  1663
or certified nurse practitioner is exempt from the educational  1664
requirements in division (A)(2) of this section if all of the  1665
following are the case:  1666
       (1) Before January 1, 2001, the board issued to the  1667
applicant a certificate of authority to practice as a certified  1668
registered nurse anesthetist, certified nurse-midwife, or  1669
certified nurse practitioner;  1670
       (2) The applicant submits documentation satisfactory to  1671
H. B. No. 537  Page 59
As Introduced
the board that the applicant obtained certification in the  1672
applicant's nursing specialty with a national certifying  1673
organization listed in division (A)(3) of section 4723.41 of the  1674
Revised Code as that division existed prior to March 20, 2013,  1675
or that was at that time approved by the board under section  1676
4723.46 of the Revised Code;  1677
        (3) The applicant submits documentation satisfactory to  1678
the board that the applicant has maintained the certification  1679
described in division (C)(2) of this section.  1680
        (D) An applicant who desires to practice as a clinical  1681
nurse specialist is exempt from the examination requirement in  1682
division (A)(3) of this section if both of the following are the  1683
case:  1684
        (1) Before January 1, 2001, the board issued to the  1685
applicant a certificate of authority to practice as a clinical  1686
nurse specialist;  1687
        (2) The applicant submits documentation satisfactory to  1688
the board that the applicant earned either of the following:  1689
        (a) A master's or doctoral degree with a major in a  1690
clinical area of nursing from an educational institution  1691
accredited by a national or regional accrediting organization;  1692
        (b) A master's or doctoral degree in nursing or a related  1693
field and was certified as a clinical nurse specialist by the  1694
American nurses credentialing center or another national  1695
certifying organization that was at that time approved by the  1696
board under section 4723.46 of the Revised Code.  1697
        Sec. 4723.43. A certified registered nurse anesthetist,  1698
clinical nurse specialist, certified nurse-midwife, or certified  1699
nurse practitioner may provide to individuals and groups nursing  1700
H. B. No. 537  Page 60
As Introduced
care that requires knowledge and skill obtained from advanced  1701
formal education and clinical experience. In this capacity as an  1702
advanced practice registered nurse, a certified nurse-midwife is  1703
subject to division (A) of this section, a certified registered  1704
nurse anesthetist is subject to division (B) of this section, a  1705
certified nurse practitioner is subject to division (C) of this  1706
section, and a clinical nurse specialist is subject to division  1707
(D) of this section.  1708
       (A) A Subject to sections 4723.58 to 4723.584 of the  1709
Revised Code, a nurse authorized to practice as a certified  1710
nurse-midwife, in collaboration with one or more physicians, may  1711
provide the management of preventive services and those primary  1712
care services necessary to provide health care to women  1713
antepartally, intrapartally, postpartally, and gynecologically,  1714
consistent with the nurse's education and certification, and in  1715
accordance with rules adopted by the board of nursing.  1716
       No certified nurse-midwife may perform version, deliver  1717
breech or face presentation, use forceps, do any obstetric  1718
operation, or treat any other abnormal condition outside of the  1719
scope of practice for certified nurse-midwives established by  1720
the American college of nurse-midwives, except in emergencies.  1721
No certified nurse-midwife may deliver breech or face  1722
presentation except in an emergency or as provided in section  1723
4723.581 of the Revised Code. Division (A) of this section does  1724
not prohibit a certified nurse-midwife from performing  1725
episiotomies or normal vaginal deliveries, or repairing vaginal  1726
tears. A certified nurse-midwife may, in collaboration with one  1727
or more physicians, prescribe drugs and therapeutic devices in  1728
accordance with section 4723.481 of the Revised Code. A  1729
certified nurse-midwife may, in collaboration with one or more  1730
physicians, attend births in hospitals, homes, medical offices,  1731
H. B. No. 537  Page 61
As Introduced
and freestanding birthing centers and provide care for normal  1732
newborns during the period consistent with the scope of practice  1733
for certified nurse-midwives established by the American college  1734
of nurse-midwives.  1735
       (B) A nurse authorized to practice as a certified  1736
registered nurse anesthetist, consistent with the nurse's  1737
education and certification and in accordance with rules adopted  1738
by the board, may do the following:  1739
       (1) With supervision and in the immediate presence of a  1740
physician, podiatrist, or dentist, administer anesthesia and  1741
perform anesthesia induction, maintenance, and emergence;  1742
       (2) With supervision, obtain informed consent for  1743
anesthesia care and perform preanesthetic preparation and  1744
evaluation, postanesthetic preparation and evaluation,  1745
postanesthesia care, and, subject to section 4723.433 of the  1746
Revised Code, clinical support functions;  1747
       (3) With supervision and in accordance with section  1748
4723.434 of the Revised Code, engage in the activities described  1749
in division (A) of that section.  1750
       The physician, podiatrist, or dentist supervising a  1751
certified registered nurse anesthetist must be actively engaged  1752
in practice in this state. When a certified registered nurse  1753
anesthetist is supervised by a podiatrist, the nurse's scope of  1754
practice is limited to the anesthesia procedures that the  1755
podiatrist has the authority under section 4731.51 of the  1756
Revised Code to perform. A certified registered nurse  1757
anesthetist may not administer general anesthesia under the  1758
supervision of a podiatrist in a podiatrist's office. When a  1759
certified registered nurse anesthetist is supervised by a  1760
H. B. No. 537  Page 62
As Introduced
dentist, the nurse's scope of practice is limited to the  1761
anesthesia procedures that the dentist has the authority under  1762
Chapter 4715. of the Revised Code to perform.  1763
       (C) A nurse authorized to practice as a certified nurse  1764
practitioner, in collaboration with one or more physicians or  1765
podiatrists, may provide preventive and primary care services,  1766
provide services for acute illnesses, and evaluate and promote  1767
patient wellness within the nurse's nursing specialty,  1768
consistent with the nurse's education and certification, and in  1769
accordance with rules adopted by the board. A certified nurse  1770
practitioner may, in collaboration with one or more physicians  1771
or podiatrists, prescribe drugs and therapeutic devices in  1772
accordance with section 4723.481 of the Revised Code.  1773
       When a certified nurse practitioner is collaborating with  1774
a podiatrist, the nurse's scope of practice is limited to the  1775
procedures that the podiatrist has the authority under section  1776
4731.51 of the Revised Code to perform.  1777
       (D) A nurse authorized to practice as a clinical nurse  1778
specialist, in collaboration with one or more physicians or  1779
podiatrists, may provide and manage the care of individuals and  1780
groups with complex health problems and provide health care  1781
services that promote, improve, and manage health care within  1782
the nurse's nursing specialty, consistent with the nurse's  1783
education and in accordance with rules adopted by the board. A  1784
clinical nurse specialist may, in collaboration with one or more  1785
physicians or podiatrists, prescribe drugs and therapeutic  1786
devices in accordance with section 4723.481 of the Revised Code.  1787
       When a clinical nurse specialist is collaborating with a  1788
podiatrist, the nurse's scope of practice is limited to the  1789
procedures that the podiatrist has the authority under section  1790
H. B. No. 537  Page 63
As Introduced
4731.51 of the Revised Code to perform.  1791
       Sec. 4723.431. (A)(1) An A certified midwife or an  1792
advanced practice registered nurse who is designated as a  1793
clinical nurse specialist, certified nurse-midwife, or certified  1794
nurse practitioner may practice only in accordance with a  1795
standard care arrangement entered into with each physician or  1796
podiatrist with whom the certified midwife or nurse  1797
collaborates. A copy of the standard care arrangement shall be  1798
retained on file by the certified midwife's or nurse's employer.  1799
Prior approval of the standard care arrangement by the board of  1800
nursing is not required, but the board may periodically review  1801
it for compliance with this section.  1802
       A certified midwife, clinical nurse specialist, certified  1803
nurse-midwife, or certified nurse practitioner may enter into a  1804
standard care arrangement with one or more collaborating  1805
physicians or podiatrists. If a collaborating physician or  1806
podiatrist enters into standard care arrangements with more than  1807
five certified midwives or nurses, the physician or podiatrist  1808
shall not collaborate at the same time with more than five  1809
certified midwives or nurses in the prescribing component of  1810
their practices.  1811
       Not later than thirty days after first engaging in the  1812
practice of midwifery as a certified midwife or the practice of  1813
nursing as a clinical nurse specialist, certified nurse-midwife,  1814
or certified nurse practitioner, the certified midwife or nurse  1815
shall submit to the board the name and business address of each  1816
collaborating physician or podiatrist. Thereafter, the certified  1817
midwife or nurse shall notify the board of any additions or  1818
deletions to the midwife's or nurse's collaborating physicians  1819
or podiatrists. Except as provided in division (D) of this  1820
H. B. No. 537  Page 64
As Introduced
section, the notice must be provided not later than thirty days  1821
after the change takes effect.  1822
       (2) All of the following conditions apply with respect to  1823
the practice of a collaborating physician or podiatrist with  1824
whom a certified midwife, clinical nurse specialist, certified  1825
nurse-midwife, or certified nurse practitioner may enter into a  1826
standard care arrangement:  1827
       (a) The physician or podiatrist must be authorized to  1828
practice in this state.  1829
       (b) Except as provided in division (A)(2)(c) of this  1830
section, the physician or podiatrist must be practicing in a  1831
specialty that is the same as or similar to the certified  1832
midwife's specialty or nurse's nursing specialty.  1833
       (c) If the nurse is a clinical nurse specialist who is  1834
certified as a psychiatric-mental health CNS or the equivalent  1835
of such title by the American nurses credentialing center or a  1836
certified nurse practitioner who is certified as a psychiatric-  1837
mental health NP or the equivalent of such title by the American  1838
nurses credentialing center or American academy of nurse  1839
practitioners certification board, the nurse may enter into a  1840
standard care arrangement with a physician but not a podiatrist  1841
and the collaborating physician must be practicing in one of the  1842
following specialties:  1843
       (i) Psychiatry;  1844
       (ii) Pediatrics;  1845
       (iii) Primary care or family practice.  1846
       (B) A standard care arrangement shall be in writing and  1847
shall contain all of the following:  1848
H. B. No. 537  Page 65
As Introduced
        (1) Criteria for referral of a patient by the certified  1849
midwife, clinical nurse specialist, certified nurse-midwife, or  1850
certified nurse practitioner to a collaborating physician or  1851
podiatrist or another physician or podiatrist;  1852
        (2) A process for the certified midwife, clinical nurse  1853
specialist, certified nurse-midwife, or certified nurse  1854
practitioner to obtain a consultation with a collaborating  1855
physician or podiatrist or another physician or podiatrist;  1856
        (3) A plan for coverage in instances of emergency or  1857
planned absences of either the certified midwife, clinical nurse  1858
specialist, certified nurse-midwife, or certified nurse  1859
practitioner or a collaborating physician or podiatrist that  1860
provides the means whereby a physician or podiatrist is  1861
available for emergency care;  1862
        (4) The process for resolution of disagreements regarding  1863
matters of patient management between the certified midwife,  1864
clinical nurse specialist, certified nurse-midwife, or certified  1865
nurse practitioner and a collaborating physician or podiatrist;  1866
        (5) An agreement that the collaborating physician shall  1867
complete and sign the medical certificate of death pursuant to  1868
section 3705.16 of the Revised Code;  1869
        (6) Any other criteria required by rule of the board  1870
adopted pursuant to section 4723.07 or 4723.50 of the Revised  1871
Code.  1872
        (C) A standard care arrangement entered into pursuant to  1873
this section may permit a clinical nurse specialist, certified  1874
nurse-midwife, or certified nurse practitioner to do any of the  1875
following:  1876
        (1) Supervise services provided by a home health agency as  1877
H. B. No. 537  Page 66
As Introduced
defined in section 3740.01 of the Revised Code;  1878
       (2) Admit a patient to a hospital in accordance with  1879
section 3727.06 of the Revised Code;  1880
       (3) Sign any document relating to the admission,  1881
treatment, or discharge of an inpatient receiving psychiatric or  1882
other behavioral health care services, but only if the  1883
conditions of section 4723.436 of the Revised Code have been  1884
met.  1885
       (D)(1) Except as provided in division (D)(2) of this  1886
section, if a physician or podiatrist terminates the  1887
collaboration between the physician or podiatrist and a  1888
certified midwife, certified nurse-midwife, certified nurse  1889
practitioner, or clinical nurse specialist before their standard  1890
care arrangement expires, all of the following apply:  1891
       (a) The physician or podiatrist must give the certified  1892
midwife or nurse written or electronic notice of the  1893
termination.  1894
       (b) Once the certified midwife or nurse receives the  1895
termination notice, the certified midwife or nurse must notify  1896
the board of nursing of the termination as soon as practicable  1897
by submitting to the board a copy of the physician's or  1898
podiatrist's termination notice.  1899
       (c) Notwithstanding the requirement requirements of  1900
section sections 4723.43 and 4723.57 of the Revised Code that  1901
the certified midwife or nurse practice in collaboration with a  1902
physician or podiatrist, the certified midwife or nurse may  1903
continue to practice under the existing standard care  1904
arrangement without a collaborating physician or podiatrist for  1905
not more than one hundred twenty days after submitting to the  1906
H. B. No. 537  Page 67
As Introduced
board a copy of the termination notice.  1907
       (2) In the event that the collaboration between a  1908
physician or podiatrist and a certified midwife, certified  1909
nurse-midwife, certified nurse practitioner, or clinical nurse  1910
specialist terminates because of the physician's or podiatrist's  1911
death, the certified midwife or nurse must notify the board of  1912
the death as soon as practicable. The certified midwife or nurse  1913
may continue to practice under the existing standard care  1914
arrangement without a collaborating physician or podiatrist for  1915
not more than one hundred twenty days after notifying the board  1916
of the physician's or podiatrist's death.  1917
       (E)(1) Nothing in this section prohibits a hospital from  1918
hiring a certified midwife, clinical nurse specialist, certified  1919
nurse-midwife, or certified nurse practitioner as an employee  1920
and negotiating standard care arrangements on behalf of the  1921
employee as necessary to meet the requirements of this section.  1922
A standard care arrangement between the hospital's employee and  1923
the employee's collaborating physician is subject to approval by  1924
the medical staff and governing body of the hospital prior to  1925
implementation of the arrangement at the hospital.  1926
       (2) Nothing in this section prohibits a standard care  1927
arrangement from specifying actions that a clinical nurse  1928
specialist, certified nurse-midwife, or certified nurse  1929
practitioner is authorized to take, or is prohibited from  1930
taking, as part of the nurse's practice in collaboration with a  1931
physician or podiatrist. In specifying such actions, the  1932
standard care arrangement shall not authorize the nurse to take  1933
any action that is otherwise prohibited by the Revised Code or  1934
rule of the board.  1935
       Sec. 4723.432. (A) An A certified midwife or an advanced  1936
H. B. No. 537  Page 68
As Introduced
practice registered nurse who is designated as a clinical nurse  1937
specialist, certified nurse-midwife, or certified nurse  1938
practitioner shall cooperate with the state medical board in any  1939
investigation the board conducts with respect to a physician or  1940
podiatrist who collaborates with the certified midwife or nurse.  1941
The certified midwife or nurse shall cooperate with the board in  1942
any investigation the board conducts with respect to the  1943
unauthorized practice of medicine by the certified midwife or  1944
nurse.  1945
       (B) An advanced practice registered nurse who is  1946
designated as a certified registered nurse anesthetist shall  1947
cooperate with the state medical board or state dental board in  1948
any investigation either board conducts with respect to a  1949
physician, podiatrist, or dentist who permits the nurse to  1950
practice with the supervision of that physician, podiatrist, or  1951
dentist. The nurse shall cooperate with either board in any  1952
investigation it conducts with respect to the unauthorized  1953
practice of medicine or dentistry by the nurse.  1954
       Sec. 4723.481. This section establishes standards and  1955
conditions regarding the authority of an advanced practice  1956
registered nurse who is designated as a clinical nurse  1957
specialist, certified nurse-midwife, or certified nurse  1958
practitioner to prescribe and personally furnish drugs and  1959
therapeutic devices under a license issued under section 4723.42  1960
of the Revised Code.  1961
       This section also establishes standards and conditions  1962
regarding the authority of a certified midwife to prescribe and  1963
personally furnish drugs and therapeutic devices under a license  1964
issued under section 4723.56 of the Revised Code.  1965
       (A) A clinical nurse specialist, certified nurse-midwife,  1966
H. B. No. 537  Page 69
As Introduced
or certified nurse practitioner, or certified midwife shall not  1967
prescribe or furnish any drug or therapeutic device that is  1968
listed on the exclusionary formulary established in rules  1969
adopted under section 4723.50 of the Revised Code.  1970
       (B) The prescriptive authority of a clinical nurse  1971
specialist, certified nurse-midwife, or certified nurse  1972
practitioner, or certified midwife shall not exceed the  1973
prescriptive authority of the collaborating physician or  1974
podiatrist, including the collaborating physician's authority to  1975
treat chronic pain with controlled substances and products  1976
containing tramadol as described in section 4731.052 of the  1977
Revised Code.  1978
       (C)(1) Except as provided in division (C)(2) or (3) of  1979
this section, a clinical nurse specialist, certified nurse-  1980
midwife, or certified nurse practitioner, or certified midwife  1981
may prescribe to a patient a schedule II controlled substance  1982
only if all of the following are the case:  1983
       (a) The patient has a terminal condition, as defined in  1984
section 2133.01 of the Revised Code.  1985
       (b) A physician initially prescribed the substance for the  1986
patient.  1987
       (c) The prescription is for an amount that does not exceed  1988
the amount necessary for the patient's use in a single, seventy-  1989
two-hour period.  1990
       (2) The restrictions on prescriptive authority in division  1991
(C)(1) of this section do not apply if a clinical nurse  1992
specialist, certified nurse-midwife, or certified nurse  1993
practitioner, or certified midwife issues the prescription to  1994
the patient from any of the following entities:  1995
H. B. No. 537  Page 70
As Introduced
       (a) A hospital as defined in section 3722.01 of the  1996
Revised Code;  1997
       (b) An entity owned or controlled, in whole or in part, by  1998
a hospital or by an entity that owns or controls, in whole or in  1999
part, one or more hospitals;  2000
       (c) A health care facility operated by the department of  2001
mental health and addiction services or the department of  2002
developmental disabilities;  2003
       (d) A nursing home licensed under section 3721.02 of the  2004
Revised Code or by a political subdivision certified under  2005
section 3721.09 of the Revised Code;  2006
       (e) A county home or district home operated under Chapter  2007
5155. of the Revised Code that is certified under the medicare  2008
or medicaid program;  2009
       (f) A hospice care program, as defined in section 3712.01  2010
of the Revised Code;  2011
       (g) A community mental health services provider, as  2012
defined in section 5122.01 of the Revised Code;  2013
       (h) An ambulatory surgical facility, as defined in section  2014
3702.30 of the Revised Code;  2015
       (i) A freestanding birthing center, as defined in section  2016
3701.503 of the Revised Code;  2017
       (j) A federally qualified health center, as defined in  2018
section 3701.047 of the Revised Code;  2019
       (k) A federally qualified health center look-alike, as  2020
defined in section 3701.047 of the Revised Code;  2021
       (l) A health care office or facility operated by the board  2022
H. B. No. 537  Page 71
As Introduced
of health of a city or general health district or the authority  2023
having the duties of a board of health under section 3709.05 of  2024
the Revised Code;  2025
       (m) A site where a medical practice is operated, but only  2026
if the practice is comprised of one or more physicians who also  2027
are owners of the practice; the practice is organized to provide  2028
direct patient care; and the clinical nurse specialist,  2029
certified nurse-midwife, or certified nurse practitioner, or  2030
certified midwife providing services at the site has a standard  2031
care arrangement and collaborates with at least one of the  2032
physician owners who practices primarily at that site;  2033
       (n) A site where a behavioral health practice is operated  2034
that does not qualify as a location otherwise described in  2035
division (C)(2) of this section, but only if the practice is  2036
organized to provide outpatient services for the treatment of  2037
mental health conditions, substance use disorders, or both, and  2038
the clinical nurse specialist, certified nurse-midwife, or  2039
certified nurse practitioner, or certified midwife providing  2040
services at the site of the practice has a standard care  2041
arrangement and collaborates with at least one physician who is  2042
employed by that practice;  2043
       (o) A residential care facility, as defined in section  2044
3721.01 of the Revised Code.  2045
       (3) A clinical nurse specialist, certified nurse-midwife,  2046
or certified nurse practitioner, or certified midwife shall not  2047
issue to a patient a prescription for a schedule II controlled  2048
substance from a convenience care clinic even if the clinic is  2049
owned or operated by an entity specified in division (C)(2) of  2050
this section.  2051
H. B. No. 537  Page 72
As Introduced
        (D) A pharmacist who acts in good faith reliance on a  2052
prescription issued by a clinical nurse specialist, certified  2053
nurse-midwife, or certified nurse practitioner, or certified  2054
midwife under division (C)(2) of this section is not liable for  2055
or subject to any of the following for relying on the  2056
prescription: damages in any civil action, prosecution in any  2057
criminal proceeding, or professional disciplinary action by the  2058
state board of pharmacy under Chapter 4729. of the Revised Code.  2059
        (E) A clinical nurse specialist, certified nurse-midwife,  2060
or certified nurse practitioner, or certified midwife shall  2061
comply with section 3719.061 of the Revised Code if the nurse  2062
prescribes for a minor, as defined in that section, an opioid  2063
analgesic, as defined in section 3719.01 of the Revised Code.  2064
        Sec. 4723.483. (A)(1) Subject to division (A)(2) of this  2065
section, and notwithstanding any provision of this chapter or  2066
rule adopted by the board of nursing, a clinical nurse  2067
specialist, certified nurse-midwife, or certified nurse  2068
practitioner who holds a certificate to prescribe issued under  2069
section 4723.48 of the Revised Code, or certified midwife may do  2070
either of the following without having examined an individual to  2071
whom epinephrine may be administered:  2072
        (a) Personally furnish a supply of epinephrine  2073
autoinjectors for use in accordance with sections 3313.7110,  2074
3313.7111, 3314.143, 3326.28, 3328.29, 3728.03 to 3728.05, and  2075
5180.26 of the Revised Code;  2076
        (b) Issue a prescription for epinephrine autoinjectors for  2077
use in accordance with sections 3313.7110, 3313.7111, 3314.143,  2078
3326.28, 3328.29, 3728.03 to 3728.05, and 5180.26 of the Revised  2079
Code.  2080
H. B. No. 537  Page 73
As Introduced
       (2) An epinephrine autoinjector personally furnished or  2081
prescribed under division (A)(1) of this section must be  2082
furnished or prescribed in such a manner that it may be  2083
administered only in a manufactured dosage form.  2084
       (B) A nurse or certified midwife who acts in good faith in  2085
accordance with this section is not liable for or subject to any  2086
of the following for any action or omission of an entity to  2087
which an epinephrine autoinjector is furnished or a prescription  2088
is issued: damages in any civil action, prosecution in any  2089
criminal proceeding, or professional disciplinary action.  2090
       Sec. 4723.487. (A) As used in this section:  2091
       (1) "Drug database" means the database established and  2092
maintained by the state board of pharmacy pursuant to section  2093
4729.75 of the Revised Code.  2094
       (2) "Opioid analgesic" and "benzodiazepine" have the same  2095
meanings as in section 3719.01 of the Revised Code.  2096
       (B) Except as provided in divisions (C) and (E) of this  2097
section, an advanced practice registered nurse who is designated  2098
as a clinical nurse specialist, certified nurse-midwife, or  2099
certified nurse practitioner or a certified midwife shall comply  2100
with all of the following as conditions of prescribing a drug  2101
that is either an opioid analgesic or a benzodiazepine as part  2102
of a patient's course of treatment for a particular condition:  2103
       (1) Before initially prescribing the drug, the advanced  2104
practice registered nurse or certified midwife or the advanced  2105
practice registered nurse's or certified midwife's delegate  2106
shall request from the drug database a report of information  2107
related to the patient that covers at least the twelve months  2108
immediately preceding the date of the request. If the advanced  2109
H. B. No. 537  Page 74
As Introduced
practice registered nurse or certified midwife practices  2110
primarily in a county of this state that adjoins another state,  2111
the advanced practice registered nurse or certified midwife or  2112
delegate also shall request a report of any information  2113
available in the drug database that pertains to prescriptions  2114
issued or drugs furnished to the patient in the state adjoining  2115
that county.  2116
       (2) If the patient's course of treatment for the condition  2117
continues for more than ninety days after the initial report is  2118
requested, the advanced practice registered nurse or certified  2119
midwife or delegate shall make periodic requests for reports of  2120
information from the drug database until the course of treatment  2121
has ended. The requests shall be made at intervals not exceeding  2122
ninety days, determined according to the date the initial  2123
request was made. The request shall be made in the same manner  2124
provided in division (B)(1) of this section for requesting the  2125
initial report of information from the drug database.  2126
       (3) On receipt of a report under division (B)(1) or (2) of  2127
this section, the advanced practice registered nurse or  2128
certified midwife shall assess the information in the report.  2129
The advanced practice registered nurse or certified midwife  2130
shall document in the patient's record that the report was  2131
received and the information was assessed.  2132
       (C) Division (B) of this section does not apply if in any  2133
of the following circumstances:  2134
       (1) A drug database report regarding the patient is not  2135
available, in which case the advanced practice registered nurse  2136
or certified midwife shall document in the patient's record the  2137
reason that the report is not available.  2138
H. B. No. 537  Page 75
As Introduced
       (2) The drug is prescribed in an amount indicated for a  2139
period not to exceed seven days.  2140
       (3) The drug is prescribed for the treatment of cancer or  2141
another condition associated with cancer.  2142
       (4) The drug is prescribed to a hospice patient in a  2143
hospice care program, as those terms are defined in section  2144
3712.01 of the Revised Code, or any other patient diagnosed as  2145
terminally ill.  2146
       (5) The drug is prescribed for administration in a  2147
hospital, nursing home, or residential care facility.  2148
       (D) The board of nursing may adopt rules, in accordance  2149
with Chapter 119. of the Revised Code, that establish standards  2150
and procedures to be followed by an advanced practice registered  2151
nurse or certified midwife regarding the review of patient  2152
information available through the drug database under division  2153
(A)(5) of section 4729.80 of the Revised Code. The rules shall  2154
be adopted in accordance with Chapter 119. of the Revised Code.  2155
       (E) This section and any rules adopted under it do not  2156
apply if the state board of pharmacy no longer maintains the  2157
drug database.  2158
       Sec. 4723.488. (A) Except as provided in division (B) of  2159
this section, in the case of a license holder who is seeking  2160
renewal of a license to practice nursing as an advanced practice  2161
registered nurse or a license to practice as a certified midwife  2162
and who prescribes opioid analgesics or benzodiazepines, as  2163
defined in section 3719.01 of the Revised Code, the holder shall  2164
certify to the board whether the holder has been granted access  2165
to the drug database established and maintained by the state  2166
board of pharmacy pursuant to section 4729.75 of the Revised  2167
H. B. No. 537  Page 76
As Introduced
Code.  2168
        (B) The requirement in division (A) of this section does  2169
not apply if any of the following is the case:  2170
        (1) The state board of pharmacy notifies the board of  2171
nursing pursuant to section 4729.861 of the Revised Code that  2172
the license holder has been restricted from obtaining further  2173
information from the drug database.  2174
        (2) The state board of pharmacy no longer maintains the  2175
drug database.  2176
        (3) The license holder does not practice nursing as an  2177
advanced practice registered nurse or certified midwife in this  2178
state.  2179
        (C) If a license holder certifies to the board of nursing  2180
that the holder has been granted access to the drug database and  2181
the board finds through an audit or other means that the holder  2182
has not been granted access, the board may take action under  2183
section 4723.28 of the Revised Code.  2184
        Sec. 4723.4810. (A)(1) Notwithstanding any conflicting  2185
provision of this chapter or rule adopted by the board of  2186
nursing, a clinical nurse specialist, certified nurse-midwife,  2187
or certified nurse practitioner, who holds a license to practice  2188
nursing as an advanced practice registered nurse issued under  2189
section 4723.42 of the Revised Code or certified midwife may  2190
issue a prescription for or personally furnish a complete or  2191
partial supply of a drug to treat chlamydia, gonorrhea, or  2192
trichomoniasis, without having examined the individual for whom  2193
the drug is intended, if all of the following conditions are  2194
met:  2195
        (a) The individual is a sexual partner of the nurse's or  2196
H. B. No. 537  Page 77
As Introduced
certified midwife's patient.  2197
       (b) The patient has been diagnosed with chlamydia,  2198
gonorrhea, or trichomoniasis.  2199
       (c) The patient reports to the nurse or certified midwife  2200
that the individual is unable or unlikely to be evaluated or  2201
treated by a health professional.  2202
       (2) A prescription issued under this section shall include  2203
the individual's name and address, if known. If the nurse or  2204
certified midwife is unable to obtain the individual's name and  2205
address, the prescription shall include the patient's name and  2206
address and the words "expedited partner therapy" or the letters  2207
"EPT."  2208
       (3) A nurse or certified midwife may prescribe or  2209
personally furnish a drug under this section for not more than a  2210
total of two individuals who are sexual partners of the nurse's  2211
or certified midwife's patient.  2212
       (B) For each drug prescribed or personally furnished under  2213
this section, the nurse or certified midwife shall do all of the  2214
following:  2215
       (1) Provide the patient with information concerning the  2216
drug for the purpose of sharing the information with the  2217
individual, including directions for use of the drug and any  2218
side effects, adverse reactions, or known contraindications  2219
associated with the drug;  2220
       (2) Recommend to the patient that the individual seek  2221
treatment from a health professional;  2222
       (3) Document all of the following in the patient's record:  2223
       (a) The name of the drug prescribed or furnished and its  2224
H. B. No. 537  Page 78
As Introduced
dosage;  2225
       (b) That information concerning the drug was provided to  2226
the patient for the purpose of sharing the information with the  2227
individual;  2228
       (c) If known, any adverse reactions the individual  2229
experiences from treatment with the drug.  2230
       (C) A nurse or certified midwife who prescribes or  2231
personally furnishes a drug under this section may contact the  2232
individual for whom the drug is intended.  2233
       (1) If the nurse or certified midwife contacts the  2234
individual, the nurse or certified midwife shall do all of the  2235
following:  2236
       (a) Inform the individual that the individual may have  2237
been exposed to chlamydia, gonorrhea, or trichomoniasis;  2238
       (b) Encourage the individual to seek treatment from a  2239
health professional;  2240
       (c) Explain the treatment options available to the  2241
individual, including treatment with a prescription drug,  2242
directions for use of the drug, and any side effects, adverse  2243
reactions, or known contraindications associated with the drug;  2244
       (d) Document in the patient's record that the nurse or  2245
certified midwife contacted the individual.  2246
       (2) If the nurse or certified midwife does not contact the  2247
individual, the nurse or certified midwife shall document that  2248
fact in the patient's record.  2249
       (D) A nurse or certified midwife who in good faith  2250
prescribes or personally furnishes a drug under this section is  2251
H. B. No. 537  Page 79
As Introduced
not liable for or subject to any of the following:  2252
       (1) Damages in any civil action;  2253
       (2) Prosecution in any criminal proceeding;  2254
       (3) Professional disciplinary action.  2255
       Sec. 4723.4811. (A)(1) Subject to division (A)(2) of this  2256
section, and notwithstanding any provision of this chapter or  2257
rule adopted by the board of nursing, a clinical nurse  2258
specialist, certified nurse-midwife, or certified nurse  2259
practitioner licensed as an advanced practice registered nurse  2260
under Chapter 4723. of the Revised Code, or certified midwife  2261
may do either of the following without having examined an  2262
individual to whom glucagon may be administered:  2263
       (a) Personally furnish a supply of injectable or nasally  2264
administered glucagon for use in accordance with sections  2265
3313.7115, 3313.7116, 3314.147, 3326.60, 3328.38, and 5180.262  2266
of the Revised Code;  2267
       (b) Issue a prescription for injectable or nasally  2268
administered glucagon for use in accordance with sections  2269
3313.7115, 3313.7116, 3314.147, 3326.60, 3328.38, and 5180.262  2270
of the Revised Code.  2271
       (2) Injectable or nasally administered glucagon personally  2272
furnished or prescribed under division (A)(1) of this section  2273
must be furnished or prescribed in such a manner that it may be  2274
administered only in a manufactured dosage form.  2275
       (B) A nurse or certified midwife who acts in good faith in  2276
accordance with this section is not liable for or subject to any  2277
of the following for any action or omission of an entity to  2278
which injectable or nasally administered glucagon is furnished  2279
H. B. No. 537  Page 80
As Introduced
or a prescription is issued: damages in any civil action,  2280
prosecution in any criminal proceeding, or professional  2281
disciplinary action.  2282
       Sec. 4723.50. (A) As used in this section:  2283
       (1) "Controlled substance" has the same meaning as in  2284
section 3719.01 of the Revised Code.  2285
       (2) "Medication-assisted treatment" has the same meaning  2286
as in section 340.01 of the Revised Code.  2287
       (B) In accordance with Chapter 119. of the Revised Code,  2288
the board of nursing shall adopt rules as necessary to implement  2289
the provisions of this chapter pertaining to the authority of  2290
advanced practice registered nurses who are designated as  2291
clinical nurse specialists, certified nurse-midwives, and  2292
certified nurse practitioners, and certified midwives to  2293
prescribe and furnish drugs and therapeutic devices.  2294
       The board shall adopt rules establishing an exclusionary  2295
formulary. The exclusionary formulary shall permit, in a manner  2296
consistent with section 4723.481 of the Revised Code, the  2297
prescribing of controlled substances, including drugs that  2298
contain buprenorphine used in medication-assisted treatment and  2299
both oral and long-acting opioid antagonists. The formulary  2300
shall not permit the prescribing or furnishing of any of the  2301
following:  2302
       (1) A drug or device to perform or induce an abortion;  2303
       (2) A drug or device prohibited by federal or state law.  2304
       (C) In addition to the rules described in division (B) of  2305
this section, the board shall adopt rules under this section  2306
that do the following:  2307
H. B. No. 537  Page 81
As Introduced
       (1) Establish standards for board approval of the course  2308
of study in advanced pharmacology and related topics required by  2309
section sections 4723.482 and 4723.551 of the Revised Code;  2310
       (2) Establish requirements for board approval of the two-  2311
hour course of instruction in the laws of this state as required  2312
under division (C)(1) of section 4723.482 of the Revised Code;  2313
       (3) Establish criteria for the components of the standard  2314
care arrangements described in section 4723.431 of the Revised  2315
Code that apply to the authority to prescribe, including the  2316
components that apply to the authority to prescribe schedule II  2317
controlled substances. The rules shall be consistent with that  2318
section and include all of the following:  2319
       (a) Quality assurance standards;  2320
       (b) Standards for periodic review by a collaborating  2321
physician or podiatrist of the records of patients treated by  2322
the clinical nurse specialist, certified nurse-midwife, or  2323
certified nurse practitioner, or certified midwife;  2324
       (c) Acceptable travel time between the location at which  2325
the clinical nurse specialist, certified nurse-midwife, or  2326
certified nurse practitioner, or certified midwife is engaging  2327
in the prescribing components of the nurse's practice and the  2328
location of the nurse's or certified midwife's collaborating  2329
physician or podiatrist.  2330
       Sec. 4723.53. As used in sections 4723.43 and 4723.53 to  2331
4723.60 of the Revised Code:  2332
       (A) "Accreditation commission for midwifery education"  2333
means the organization known by that name or its successor  2334
organization.  2335
H. B. No. 537  Page 82
As Introduced
       (B) "American college of nurse-midwives" means the  2336
organization known by that name or its successor organization.  2337
       (C) "American midwifery certification board" means the  2338
organization known by that name or its successor organization.  2339
       Sec. 4723.54. (A) Except as provided in division (B) of  2340
this section, no individual shall knowingly practice as a  2341
certified midwife unless the individual holds a current, valid  2342
license to practice as a certified midwife issued under section  2343
4723.56 of the Revised Code.  2344
       (B) Division (A) of this section does not apply to any of  2345
the following:  2346
       (1) A physician authorized under Chapter 4731. of the  2347
Revised Code to practice medicine and surgery, osteopathic  2348
medicine and surgery, or podiatric medicine and surgery;  2349
       (2) A physician assistant authorized under Chapter 4730.  2350
of the Revised Code to practice as a physician assistant;  2351
       (3) A registered nurse, advanced practice registered  2352
nurse, or licensed practical nurse authorized under this chapter  2353
to practice nursing as a registered nurse, advanced practice  2354
registered nurse, or licensed practical nurse;  2355
       (4) A licensed midwife;  2356
       (5) A traditional midwife;  2357
       (6) A student who is participating in a midwifery  2358
education program accredited by the accreditation commission for  2359
midwifery education and who provides midwifery services under  2360
the auspices of the program and under the supervision of a  2361
certified midwife serving for the program as a faculty member,  2362
instructor, teaching assistant, or preceptor.  2363
H. B. No. 537  Page 83
As Introduced
       Sec. 4723.55. (A) An individual seeking a license to  2364
practice as a certified midwife shall file with the board of  2365
nursing an application in a manner prescribed by the board. The  2366
application shall include all the information the board  2367
considers necessary to process the application, including  2368
evidence satisfactory to the board that the applicant meets the  2369
requirements specified in division (B) of this section.  2370
       (B) To be eligible to receive a license to practice as a  2371
certified midwife, an applicant shall demonstrate to the board  2372
that the applicant meets all of the following requirements:  2373
       (1) Is at least eighteen years of age;  2374
       (2) Has attained a master's degree or higher;  2375
       (3) Has graduated from a midwifery education program  2376
accredited by the accreditation commission for midwifery  2377
education;  2378
       (4) Is certified by the American midwifery certification  2379
board;  2380
       (5) Is certified in neonatal and adult cardiopulmonary  2381
resuscitation;  2382
       (6) Has successfully completed the course of study in  2383
advanced pharmacology required by section 4723.551 of the  2384
Revised Code.  2385
       (C) The board shall review all applications received under  2386
this section. After receiving an application it considers  2387
complete, the board shall determine whether the applicant meets  2388
the requirements for a license to practice as a certified  2389
midwife.  2390
       Sec. 4723.551. (A) An applicant for a license to practice  2391
H. B. No. 537  Page 84
As Introduced
as a certified midwife shall include with the application  2392
submitted under section 4723.55 of the Revised Code evidence of  2393
successfully completing the course of study in advanced  2394
pharmacology and related topics in accordance with the  2395
requirements specified in division (B) of this section.  2396
       (B) With respect to the course of study in advanced  2397
pharmacology and related topics, all of the following  2398
requirements apply:  2399
       (1) The course of study shall be completed not more than  2400
five years before the application is filed.  2401
       (2) The course of study shall include at least forty-five  2402
contact hours.  2403
       (3) The course of study shall meet the requirements to be  2404
approved by the board in accordance with standards established  2405
in rules adopted under section 4723.50 of the Revised Code.  2406
       (4) The content of the course of study shall be specific  2407
to midwifery.  2408
       (5) The instruction provided in the course of study shall  2409
include all of the following:  2410
       (a) A minimum of thirty-six contact hours of instruction  2411
in advanced pharmacology that includes pharmacokinetic  2412
principles and clinical application and the use of drugs and  2413
therapeutic devices in the prevention of illness and maintenance  2414
of health;  2415
       (b) Instruction in the fiscal and ethical implications of  2416
prescribing drugs and therapeutic devices;  2417
       (c) Instruction in the state and federal laws that apply  2418
to the authority to prescribe;  2419
H. B. No. 537  Page 85
As Introduced
       (d) Instruction that is specific to schedule II controlled  2420
substances, including instruction in all of the following:  2421
       (i) Indications for the use of schedule II controlled  2422
substances in drug therapies;  2423
       (ii) The most recent guidelines for pain management  2424
therapies, as established by state and national organizations  2425
such as the Ohio pain initiative and the American pain society;  2426
       (iii) Fiscal and ethical implications of prescribing  2427
schedule II controlled substances;  2428
       (iv) State and federal laws that apply to the authority to  2429
prescribe schedule II controlled substances;  2430
       (v) Prevention of abuse and diversion of schedule II  2431
controlled substances, including identification of the risk of  2432
abuse and diversion, recognition of abuse and diversion, types  2433
of assistance available for prevention of abuse and diversion,  2434
and methods of establishing safeguards against abuse and  2435
diversion.  2436
       Sec. 4723.56. (A) If the board of nursing determines under  2437
section 4723.55 of the Revised Code that an applicant meets the  2438
requirements for a license to practice as a certified midwife,  2439
the secretary of the board shall issue the license to the  2440
applicant.  2441
       (B) Each license shall be valid for a two-year period  2442
unless revoked or suspended, shall expire on the date that is  2443
two years after the date of issuance, and may be renewed for  2444
additional two-year periods in accordance with rules adopted  2445
under section 4723.59 of the Revised Code.  2446
       (C) To renew a license to practice as a certified midwife,  2447
H. B. No. 537  Page 86
As Introduced
an applicant for renewal shall demonstrate both of the following  2448
to the board:  2449
       (1) That the applicant has maintained certification in  2450
neonatal and adult cardiopulmonary resuscitation;  2451
       (2) That the applicant has satisfied the continuing  2452
education requirements of the American midwifery certification  2453
board.  2454
       Sec. 4723.57. (A) An individual who holds a current, valid  2455
license to practice as a certified midwife may, in collaboration  2456
with one or more physicians, engage in one or more of the  2457
following activities:  2458
       (1) Providing primary health care services for women from  2459
adolescence and beyond menopause, including the independent  2460
provision of gynecologic and family planning services,  2461
preconception care, and care during pregnancy, childbirth, and  2462
the postpartum period;  2463
       (2) Attending births in hospitals, homes, medical offices,  2464
and freestanding birthing centers;  2465
       (3) Providing care for normal newborns during the period  2466
consistent with the scope of practice for certified nurse-  2467
midwives established by the American college of nurse-midwives;  2468
       (4) Providing initial and ongoing comprehensive  2469
assessment, diagnosis, and treatment;  2470
       (5) Conducting physical examinations;  2471
       (6) Ordering and interpreting laboratory and diagnostic  2472
tests;  2473
       (7) Administering medications, treatments, and executing  2474
H. B. No. 537  Page 87
As Introduced
regimens authorized by an individual who is authorized to  2475
practice in this state and is acting within the course of the  2476
individual's professional practice;  2477
       (8) Providing care that includes health promotion, disease  2478
prevention, and individualized wellness education and  2479
counseling.  2480
       (B) When engaging in any of the activities permitted under  2481
this section, a certified midwife shall maintain appropriate  2482
medical records regarding patient history, treatment, and  2483
outcomes.  2484
       Sec. 4723.58. (A) This section establishes the process by  2485
which a certified nurse-midwife or certified midwife obtains a  2486
patient's consent to treatment authorized by section 4723.43 or  2487
4723.57 of the Revised Code, but only when the certified nurse-  2488
midwife or certified midwife seeks to provide the treatment in a  2489
setting other than a hospital or facility.  2490
       (B) The following information shall be exchanged in  2491
writing between a certified nurse-midwife or certified midwife  2492
and patient when obtaining consent to treatment as described in  2493
division (A) of this section:  2494
       (1) The name and license number of the certified nurse-  2495
midwife or certified midwife;  2496
       (2) The patient's name, address, telephone number, and  2497
primary care provider, if the patient has one;  2498
       (3) A description of the certified nurse-midwife's or  2499
certified midwife's education, training, and experience in  2500
nurse-midwifery or midwifery;  2501
       (4) The certified nurse-midwife's or certified midwife's  2502
H. B. No. 537  Page 88
As Introduced
practice philosophy;  2503
       (5) A promise to provide the patient, upon request, with  2504
separate documents describing the rules governing the practice  2505
of a certified nurse-midwife or certified midwife, including a  2506
list of conditions indicating the need for consultation,  2507
referral, transfer, or mandatory transfer and the certified  2508
nurse-midwife's or certified midwife's personal written practice  2509
guidelines;  2510
       (6) A written plan for medical consultation and transfer  2511
of care;  2512
       (7) A description of any hospital care and procedures that  2513
may be necessary in the event of an emergency transfer or care;  2514
       (8) A description of the services provided to the patient  2515
by the certified nurse-midwife or certified midwife;  2516
       (9) That the certified nurse-midwife or certified midwife  2517
holds a current, valid license to practice issued under this  2518
chapter;  2519
       (10) The availability of a grievance process;  2520
       (11) Whether the certified nurse-midwife or certified  2521
midwife is covered by professional liability insurance;  2522
       (12) Any other information required in rules adopted by  2523
the board.  2524
       (C) Once the required information has been exchanged and  2525
if the patient consents to treatment, the patient and certified  2526
nurse-midwife or certified midwife shall sign a written document  2527
to indicate as such. The certified nurse-midwife or certified  2528
midwife shall retain a copy of the document for at least four  2529
years from the date on which the document was signed.  2530
H. B. No. 537  Page 89
As Introduced
       Sec. 4723.581. (A) The board of nursing shall adopt rules  2531
establishing the circumstances in which a certified nurse-  2532
midwife or certified midwife shall be prohibited from attending  2533
a home birth, which may include a high-risk pregnancy. In  2534
adopting the rules, the board shall allow a certified nurse-  2535
midwife or certified midwife to attend any of the following as a  2536
home birth only if the conditions described in division (B) of  2537
this section are satisfied: a vaginal birth after cesarean,  2538
birth of twins, or breech birth.  2539
       (B) In the event of a home birth described in division (A)  2540
of this section, a certified nurse-midwife or certified midwife  2541
may attend the birth only if all of the following conditions are  2542
satisfied:  2543
       (1) In addition to the informed consent required under  2544
section 4723.58 of the Revised Code, the certified nurse-midwife  2545
or certified midwife obtains the patient's written informed  2546
consent for the vaginal birth after cesarean, birth of twins, or  2547
breech birth, including a description of risks associated with  2548
the procedure.  2549
       (2) The certified nurse-midwife or certified midwife  2550
consults with a physician about the patient and together with  2551
the physician determines whether referral is appropriate for the  2552
patient.  2553
       If a referral is determined to be appropriate and the  2554
patient consents to the referral, the certified nurse-midwife or  2555
certified midwife shall refer the patient to the physician. If  2556
the patient refuses the referral, the certified nurse-midwife or  2557
certified midwife shall document the refusal and may continue to  2558
provide care to the patient, including attending the vaginal  2559
birth after cesarean, birth of twins, or breech birth at home.  2560
H. B. No. 537  Page 90
As Introduced
       (3) The certified nurse-midwife or certified midwife  2561
satisfies any other conditions required in rules adopted by the  2562
board of nursing.  2563
       (C) In adopting rules under this section, the board of  2564
nursing shall do both of the following:  2565
       (1) Consider any relevant peer-reviewed medical  2566
literature;  2567
       (2) Specify the content and format of the document to be  2568
used when obtaining informed consent as described in this  2569
section.  2570
       Sec. 4723.582. (A) As used in this section and section  2571
4723.583 of the Revised Code, "emergency medical service,"  2572
"emergency medical service personnel," and "emergency medical  2573
service organization" have the same meanings as in section  2574
4765.01 of the Revised Code.  2575
       (B) For any pregnancy or childbirth in which a certified  2576
nurse-midwife or certified midwife provides care and a home  2577
birth is planned, both of the following apply:  2578
       (1) The certified nurse-midwife or certified midwife shall  2579
create an individualized transfer of care plan with each  2580
patient.  2581
       (2) The certified nurse-midwife or certified midwife shall  2582
assess the status of the patient, fetus, and newborn throughout  2583
the maternity care cycle and shall determine when or if a  2584
transfer to a hospital is necessary.  2585
       (C) Each individualized transfer of care plan shall  2586
contain all of the following:  2587
       (1) The name and location of geographically adjacent  2588
H. B. No. 537  Page 91
As Introduced
hospitals that are appropriately equipped to provide emergency  2589
care, obstetrical care, and newborn care;  2590
       (2) The approximate travel time to each hospital;  2591
       (3) A list of the modes of transport services available,  2592
including an emergency medical service organization available by  2593
calling 9-1-1;  2594
       (4) The requirements for activating each mode of  2595
transportation;  2596
       (5) The mechanism by which medical records and other  2597
information concerning the patient may be rapidly transmitted to  2598
each hospital;  2599
       (6) Confirmation that the certified nurse-midwife or  2600
certified midwife has recommended that the patient pre-register  2601
with the hospital closest to the patient's home that is  2602
appropriately equipped to provide emergency care, obstetrical  2603
care, and newborn care;  2604
       (7) Contact information for either a health care provider  2605
or practice group who has agreed in advance to accept patients  2606
in transfer, or a hospital's preferred method of accessing care  2607
by the hospital's designated provider on call;  2608
       (8) Any other information required in rules adopted by the  2609
board of nursing.  2610
       (D) When it becomes necessary to transfer a patient, a  2611
certified nurse-midwife or certified midwife shall notify the  2612
receiving provider or hospital of all of the following:  2613
       (1) The incoming transfer;  2614
       (2) The reason for the transfer;  2615
H. B. No. 537  Page 92
As Introduced
       (3) A brief relevant clinical history;  2616
       (4) The planned mode of transport;  2617
       (5) The expected time of arrival;  2618
       (6) Any other information required in rules adopted by the  2619
board.  2620
       The certified nurse-midwife or certified midwife shall  2621
continue to provide routine or urgent care en route in  2622
coordination with any emergency medical services personnel or  2623
emergency medical service organization and shall address the  2624
psychosocial needs of the patient during the change of birth  2625
setting.  2626
       (E) On arrival at the hospital, the certified nurse-  2627
midwife or certified midwife shall do all of the following:  2628
       (1) Provide a verbal report that includes details on the  2629
patient's current health status and the need for urgent care;  2630
       (2) Provide a legible copy of relevant prenatal and labor  2631
medical records;  2632
       (3) Transfer clinical responsibility to the receiving  2633
provider or hospital;  2634
       (4) Satisfy any other requirement established in rules  2635
adopted by the board of nursing.  2636
       If the patient chooses, the certified nurse-midwife or  2637
certified midwife may remain at the hospital to provide  2638
continuous support. The certified nurse-midwife or certified  2639
midwife also may continue to provide midwifery services, but  2640
only if the hospital has granted the certified nurse-midwife or  2641
certified midwife clinical privileges. Whenever possible, the  2642
H. B. No. 537  Page 93
As Introduced
patient and her newborn shall be together during the transfer  2643
and after admission to the hospital.  2644
       Sec. 4723.583. Emergency medical service personnel or an  2645
emergency medical service organization, hospital, facility,  2646
physician, advanced practice registered nurse, or certified  2647
midwife that provides services or care following an adverse  2648
incident as defined in section 4723.584 of the Revised Code or  2649
during and after a transfer of care as described in section  2650
4723.582 of the Revised Code are not liable in damages in a tort  2651
or other civil action for injury or loss to person or property  2652
arising from the services or care, unless the services or care  2653
are provided in a manner that constitutes willful or wanton  2654
misconduct.  2655
       Sec. 4723.584. (A) As used in this section, "adverse  2656
incident" means an incident over which a certified nurse-midwife  2657
or certified midwife could exercise control, that is associated  2658
with an attempted or completed birth in a setting or facility  2659
other than a hospital, and that results in one or more of the  2660
following injuries or conditions:  2661
       (1) A maternal death that occurs during delivery or within  2662
forty-two days after delivery;  2663
       (2) The transfer of a maternal patient to a hospital  2664
intensive care unit;  2665
       (3) A maternal patient experiencing hemorrhagic shock or  2666
requiring a transfusion of more than two units of blood or blood  2667
products;  2668
       (4) A fetal or newborn death, including a stillbirth,  2669
associated with an obstetrical delivery;  2670
       (5) A transfer of a newborn to a neonatal intensive care  2671
H. B. No. 537  Page 94
As Introduced
unit due to a traumatic physical or neurological birth injury,  2672
including any degree of a brachial plexus injury;  2673
       (6) A transfer of a newborn to a neonatal intensive care  2674
unit within the first seventy-two hours after birth if the  2675
newborn remains in such unit for more than seventy-two hours;  2676
       (7) Any other condition as determined by the board of  2677
nursing in rules adopted under section 4723.07 or 4723.59 of the  2678
Revised Code.  2679
       (B) Beginning July 1, 2027, a certified nurse-midwife or  2680
certified midwife who attends a birth planned for a facility or  2681
setting other than a hospital must report any adverse incident,  2682
along with a medical summary of events, to both of the following  2683
within fifteen days after the adverse incident occurs:  2684
       (1) The department of health;  2685
       (2) The Ohio perinatal quality collaborative.  2686
       (C) Beginning July 1, 2027, each certified nurse-midwife  2687
or certified midwife shall report annually to the department of  2688
health the following information regarding cases in which the  2689
midwife provided services when the intended place of birth at  2690
the onset of care was in a facility or setting other than a  2691
hospital:  2692
       (1) The total number of patients provided nurse-midwifery  2693
or certified midwifery services at the onset of care;  2694
       (2) The number of live births attended;  2695
       (3) The number of cases of fetal demise, newborn deaths,  2696
and maternal deaths attended as a certified nurse-midwife or  2697
certified midwife at the discovery of the demise or death;  2698
H. B. No. 537  Page 95
As Introduced
       (4) The number, reason for, and outcome of each transport  2699
of a patient in the antepartum, intrapartum period, or immediate  2700
postpartum period;  2701
       (5) A brief description of any complications resulting in  2702
the morbidity or mortality of a maternal patient or a newborn;  2703
       (6) The planned delivery setting and the actual setting;  2704
       (7) Any other information required in rules adopted by the  2705
department.  2706
       (D) The department shall adopt rules to implement this  2707
section and shall develop a form to be used for the reporting  2708
required under divisions (B) and (C) of this section.  2709
       Sec. 4723.59. (A) In addition to the rules described in  2710
section 4723.07 of the Revised Code, the board of nursing shall  2711
adopt rules establishing standards and procedures for the  2712
licensure and regulation of certified midwives, including those  2713
establishing license application and renewal procedures. The  2714
rules shall be adopted in accordance with Chapter 119. of the  2715
Revised Code.  2716
       (B) The board also may adopt, in accordance with Chapter  2717
119. of the Revised Code, any other rules it considers necessary  2718
to implement and administer sections 4723.53 to 4723.60 of the  2719
Revised Code. The rules may require the completion of a criminal  2720
records check and, in the case of a license to practice as a  2721
certified midwife issued by another jurisdiction, may provide  2722
for licensure by endorsement.  2723
       Sec. 4723.60. Sections 4723.53 to 4723.59 of the Revised  2724
Code do not abridge, change, or limit in any way the right of a  2725
parent to deliver the parent's baby where, when, how, and with  2726
whom the parent chooses, regardless of the licensure  2727
H. B. No. 537  Page 96
As Introduced
requirements established in those sections.  2728
       Sec. 4723.91. On receipt of a notice pursuant to section  2729
3123.43 of the Revised Code, the board of nursing shall comply  2730
with sections 3123.41 to 3123.50 of the Revised Code and any  2731
applicable rules adopted under section 3123.63 of the Revised  2732
Code with respect to a nursing license, certified midwife  2733
license, medication aide certificate, dialysis technician  2734
certificate, or community health worker certificate issued  2735
pursuant to this chapter.  2736
       Sec. 4723.99. (A) Except as provided in division (B) or  2737
(C) of this section, whoever violates section 4723.03, 4723.44,  2738
4723.54, 4723.653, or 4723.73 of the Revised Code is guilty of a  2739
felony of the fifth degree on a first offense and a felony of  2740
the fourth degree on each subsequent offense.  2741
       (B) Each of the following is guilty of a minor  2742
misdemeanor:  2743
       (1) A registered nurse, advanced practice registered  2744
nurse, or licensed practical nurse who violates division (A),  2745
(B), (C), or (D) of section 4723.03 of the Revised Code by  2746
reason of a license to practice nursing that has lapsed for  2747
failure to renew or by practicing nursing after a license has  2748
been classified as inactive;  2749
       (2) A medication aide who violates section 4723.653 of the  2750
Revised Code by reason of a medication aide certificate that has  2751
lapsed for failure to renew or by administering medication as a  2752
medication aide after a certificate has been classified as  2753
inactive.  2754
       (C) Whoever violates division (H) of section 4723.03 of  2755
the Revised Code is guilty of a misdemeanor of the first degree.  2756
H. B. No. 537  Page 97
As Introduced
        Sec. 4724.01. As used in this chapter:  2757
        (A) "Certified international midwife" means an individual  2758
who is certified by the international registry of midwives but  2759
is not a licensed midwife.  2760
        (B) "Certified professional midwife" means an individual  2761
who is certified by the north American registry of midwives but  2762
is not a licensed midwife.  2763
        (C) "International registry of midwives" means the  2764
organization known by that name or its successor organization.  2765
        (D) "Licensed midwife" means an individual holding a  2766
license to practice issued under section 4724.04 of the Revised  2767
Code.  2768
        (E) "Midwifery education accreditation council" means the  2769
organization known by that name or its successor organization.  2770
        (F) "North American registry of midwives" means the  2771
organization known by that name or its successor organization.  2772
        (G) "Physician" means an individual authorized under  2773
Chapter 4731. of the Revised Code to practice medicine and  2774
surgery or osteopathic medicine and surgery.  2775
        (H) "Traditional midwife" means an individual who provides  2776
traditional midwifery services pursuant to sections 4724.14 and  2777
4724.15 of the Revised Code, does not hold a license to practice  2778
as a licensed midwife issued under this chapter, and does not  2779
hold a license to practice as a certified nurse-midwife or  2780
certified midwife issued under Chapter 4723. of the Revised  2781
Code.  2782
        Sec. 4724.02. (A) Except as provided in division (B) of  2783
this section, no individual shall knowingly practice as a  2784
H. B. No. 537  Page 98
As Introduced
licensed midwife unless the individual holds a current, valid  2785
license to practice issued under section 4724.04 of the Revised  2786
Code.  2787
        (B) Division (A) of this section does not apply to any of  2788
the following:  2789
        (1) A physician;  2790
        (2) A physician assistant authorized under Chapter 4730.  2791
of the Revised Code to practice as a physician assistant;  2792
        (3) A registered nurse, advanced practice registered  2793
nurse, or licensed practical nurse authorized under Chapter  2794
4723. of the Revised Code to practice nursing as a registered  2795
nurse, advanced practice registered nurse, or licensed practical  2796
nurse;  2797
        (4) A certified midwife authorized under Chapter 4723. of  2798
the Revised Code to practice as a certified midwife;  2799
        (5) A student who is participating in a professional  2800
midwifery education program and who provides midwifery services  2801
under the auspices of the program and under the supervision of a  2802
licensed midwife serving for the program as a faculty member,  2803
instructor, teaching assistant, or preceptor;  2804
        (6) An individual who is participating in a professional  2805
midwifery apprenticeship and who provides midwifery services as  2806
part of the apprenticeship program and under the supervision of  2807
a licensed midwife serving for the program as an instructor,  2808
teaching assistant, or preceptor;  2809
        (7) An individual who provides midwifery services without  2810
a license while engaging in good faith in the practice of the  2811
religious tenets of any church or in any religious act;  2812
H. B. No. 537  Page 99
As Introduced
        (8) An individual who is not engaged in the practice of  2813
the religious tenets of any church or in any religious act but  2814
who provides midwifery services without a license to others  2815
engaging in good faith in the practice of the religious tenets  2816
of any church or in any religious act;  2817
        (9) An individual who is a member of a Native American  2818
community and provides midwifery services without a license to  2819
another member of the community;  2820
        (10) A traditional midwife;  2821
        (11) An individual who is participating in a midwifery  2822
apprenticeship under the supervision of a traditional midwife  2823
and who provides midwifery services as part of the  2824
apprenticeship program under the supervision of a traditional  2825
midwife;  2826
        (12) A certified professional midwife or certified  2827
international midwife, but only if the certified professional  2828
midwife or certified international midwife does not, as a part  2829
of the midwife's practice, obtain or administer drugs or perform  2830
surgical suturing.  2831
        (C) No individual shall knowingly use the title "licensed  2832
midwife" or any other title implying that the individual is a  2833
licensed midwife unless the individual holds a current, valid  2834
license to practice issued under section 4724.04 of the Revised  2835
Code.  2836
        Sec. 4724.03. (A) An individual seeking a license to  2837
practice as a licensed midwife shall file with the department of  2838
commerce an application in a manner prescribed by the  2839
department. The application shall include all the information  2840
the department considers necessary to process the application,  2841
H. B. No. 537  Page 100
As Introduced
including evidence satisfactory to the department that the  2842
applicant meets the requirements specified in division (B)(1) or  2843
(2) of this section.  2844
       (B)(1) To be eligible to receive a license to practice as  2845
a licensed midwife, an applicant shall demonstrate to the  2846
department that the applicant meets all of the following  2847
requirements:  2848
       (a) Is at least eighteen years of age;  2849
       (b) Has attained a high school degree or equivalent;  2850
       (c) Is certified by the north American registry of  2851
midwives, international registry of midwives, or another  2852
certifying organization approved by the department in rules  2853
adopted under section 4724.11 of the Revised Code;  2854
       (d) Is certified in neonatal and adult cardiopulmonary  2855
resuscitation;  2856
       (e) Has successfully completed a course of study in breech  2857
births approved by the department in rules adopted under section  2858
4724.11 of the Revised Code;  2859
       (f) Has successfully completed a course of study in  2860
pharmacology approved by the department in rules adopted under  2861
section 4724.11 of the Revised Code.  2862
       (2) In lieu of meeting the requirements described in  2863
division (B)(1)(c) of this section, an applicant may demonstrate  2864
either of the following:  2865
       (a) That the applicant holds a current, valid license to  2866
practice as a licensed midwife issued by another state and the  2867
department has determined that the other state's requirements  2868
for licensure are substantially similar to those described in  2869
H. B. No. 537  Page 101
As Introduced
division (B)(1) of this section;  2870
        (b) That the applicant is certified by the north American  2871
registry of midwives and holds a midwifery bridge certificate.  2872
        (C) The department shall review all applications received  2873
under this section. After receiving an application it considers  2874
complete, the department shall determine whether the applicant  2875
meets the requirements for a license to practice as a licensed  2876
midwife.  2877
        Sec. 4724.04. (A) If the department of commerce determines  2878
under section 4724.03 of the Revised Code that an applicant  2879
meets the requirements for a license to practice as a licensed  2880
midwife, the department shall issue the license to the  2881
applicant.  2882
        (B) Each license shall be valid for a two-year period  2883
unless revoked or suspended, shall expire on the date that is  2884
two years after the date of issuance, and may be renewed for  2885
additional two-year periods in accordance with rules adopted  2886
under section 4724.11 of the Revised Code.  2887
        (C) To renew a license to practice as a licensed midwife,  2888
an applicant for renewal shall demonstrate both of the following  2889
to the department:  2890
        (1) That the applicant has maintained certification in  2891
neonatal and adult cardiopulmonary resuscitation;  2892
        (2) That the applicant has maintained certification with  2893
the north American registry of midwives, international registry  2894
of midwives, or another certifying organization approved by the  2895
department in rules adopted under section 4724.11 of the Revised  2896
Code.  2897
H. B. No. 537  Page 102
As Introduced
       (D) In the event a license issued under this section is  2898
not renewed and is therefore expired or inactive, the department  2899
shall reinstate or restore the license if the individual seeking  2900
reinstatement or restoration satisfies the conditions specified  2901
in rules adopted under section 4724.11 of the Revised Code.  2902
       Sec. 4724.05. (A) An individual who holds a current, valid  2903
license to practice as a licensed midwife may engage in one or  2904
more of the following activities during the antepartum,  2905
intrapartum, postpartum, and newborn period as part of the scope  2906
of practice for a licensed midwife:  2907
       (1) Offering care, education, counseling, and support to  2908
women and newborns during pregnancy, birth, and the postpartum  2909
period;  2910
       (2) Attending births in hospitals, homes, medical offices,  2911
and freestanding birthing centers;  2912
       (3) Providing ongoing and routine prenatal care throughout  2913
pregnancy and hands on care during labor, birth, and the  2914
immediate postpartum period;  2915
       (4) Providing maternal and newborn assessment for the six-  2916
to eight-week period following delivery;  2917
       (5) Providing initial and ongoing comprehensive  2918
assessment, diagnosis, and treatment;  2919
       (6) Recognizing abnormal or dangerous conditions requiring  2920
consultations with or referrals to other licensed health care  2921
professionals;  2922
       (7) Conducting maternal and newborn physical examinations;  2923
       (8) Ordering and interpreting laboratory and diagnostic  2924
tests without a physician's order.  2925
H. B. No. 537  Page 103
As Introduced
       (B) An individual who holds a current, valid license to  2926
practice as a licensed midwife shall not engage in any of the  2927
following activities:  2928
       (1) Administering cytotec or oxytocics, including pitocin  2929
and methergine, except when indicated during the postpartum  2930
period;  2931
       (2) Using forceps or vacuum extraction to assist with  2932
birth;  2933
       (3) Performing any operative procedures or surgical  2934
repairs other than the following: artificial rupture of  2935
membranes; episiotomies; first or second degree perineal,  2936
vaginal, or labial repairs; clamping or cutting the umbilical  2937
cord; or frenotomies.  2938
       (C) For the purpose of engaging in one or more of the  2939
activities permitted under division (A) of this section, the  2940
scope of practice for a licensed midwife shall include the  2941
ability to purchase, obtain, possess, and administer the  2942
following:  2943
       (1) Subject to division (B) of this section, an  2944
antihemorraghic agent or device, including tranexamic acid,  2945
pitocin, oxytocin, misoprostol, and methergine;  2946
       (2) Intravenous fluids to stabilize the laboring or  2947
postpartum patient or as necessary to administer another drug  2948
authorized by this division;  2949
       (3) Neonatal injectable vitamin K;  2950
       (4) Newborn antibiotic eye prophylaxis;  2951
       (5) Oxygen;  2952
H. B. No. 537  Page 104
As Introduced
       (6) Intravenous antibiotics for group B streptococcal  2953
prophylaxis;  2954
       (7) Rho (D) immune globulin;  2955
       (8) Local anesthesia;  2956
       (9) Epinephrine, but only to address an adverse reaction  2957
to a medication;  2958
       (10) A drug prescribed for the patient by a prescriber.  2959
       A licensed midwife also may obtain, without a physician's  2960
order, one or more supplies necessary to administer any of the  2961
drugs described in division (C) of this section.  2962
       (D) This section does not authorize a licensed midwife to  2963
prescribe, personally furnish, obtain, or administer either of  2964
the following:  2965
       (1) Any controlled substance as defined in section 3719.01  2966
of the Revised Code;  2967
       (2) A drug or device to perform or induce an abortion.  2968
       (E) When engaging in any of the activities permitted under  2969
this section, a licensed midwife shall maintain appropriate  2970
medical records regarding patient history, treatment, and  2971
outcomes.  2972
       Sec. 4724.06. The department of commerce shall limit,  2973
revoke, or suspend an individual's license to practice as a  2974
licensed midwife, refuse to issue a license to an applicant,  2975
refuse to renew a license, refuse to reinstate or restore a  2976
license, or reprimand or place on probation the holder of a  2977
license for any of the reasons specified in rules adopted under  2978
section 4724.11 of the Revised Code.  2979
H. B. No. 537  Page 105
As Introduced
       Sec. 4724.07. (A) This section establishes the process by  2980
which a licensed midwife obtains a patient's consent to  2981
treatment authorized by section 4724.05 of the Revised Code,  2982
including attending a home birth or providing care during a  2983
high-risk pregnancy.  2984
       (B) The following information shall be exchanged in  2985
writing between a licensed midwife and patient when obtaining  2986
consent to treatment as described in division (A) of this  2987
section:  2988
       (1) The name and license number of the licensed midwife;  2989
       (2) The patient's name, address, telephone number, and  2990
primary care provider, if the patient has one;  2991
       (3) A description of the licensed midwife's education,  2992
training, and experience in midwifery;  2993
       (4) The licensed midwife's practice philosophy;  2994
       (5) A promise to provide the patient, upon request, with  2995
separate documents describing the rules governing the practice  2996
of midwifery, including a list of conditions indicating the need  2997
for consultation, referral, transfer, or mandatory transfer and  2998
the licensed midwife's personal written practice guidelines;  2999
       (6) A written plan for medical consultation and transfer  3000
of care;  3001
       (7) A description of any hospital care and procedures that  3002
may be necessary in the event of an emergency transfer or care;  3003
       (8) A description of the services provided to the patient  3004
by the licensed midwife;  3005
       (9) That the licensed midwife holds a current, valid  3006
H. B. No. 537  Page 106
As Introduced
license to practice issued under this chapter;  3007
       (10) The availability of a grievance process;  3008
       (11) Whether the licensed midwife is covered by  3009
professional liability insurance;  3010
       (12) Any other information required in rules adopted by  3011
the department.  3012
       (C) Once the required information has been exchanged and  3013
if the patient consents to treatment, the patient and licensed  3014
midwife shall sign a written document to indicate as such. The  3015
licensed midwife shall retain a copy of the document for at  3016
least four years from the date on which the document was signed.  3017
       Sec. 4724.08. (A) The department of commerce shall adopt  3018
rules establishing the circumstances in which a licensed midwife  3019
shall be prohibited from attending a home birth, which may  3020
include a high-risk pregnancy. In adopting the rules, the  3021
department shall allow a licensed midwife to attend a vaginal  3022
birth after cesarean, birth of twins, or breech birth as a home  3023
birth if the conditions described in division (B) of this  3024
section are satisfied.  3025
       (B) In the event of a home birth described in division (A)  3026
of this section, a licensed midwife may attend the birth only if  3027
all of the following conditions are satisfied:  3028
       (1) In addition to the informed consent required under  3029
section 4724.07 of the Revised Code, the licensed midwife  3030
obtains the patient's written informed consent for the vaginal  3031
birth after cesarean, birth of twins, or breech birth, including  3032
a description of risks associated with the procedure.  3033
       (2) The licensed midwife consults with a physician,  3034
H. B. No. 537  Page 107
As Introduced
certified nurse-midwife, or certified midwife about the patient  3035
and together with the physician or midwife determines whether  3036
referral is appropriate for the patient. If a referral is  3037
determined to be appropriate and the patient consents to the  3038
referral, the licensed midwife shall refer the patient to the  3039
physician or provider. If the patient refuses the referral, the  3040
licensed midwife shall document the refusal and may continue to  3041
provide care to the patient, including attending the vaginal  3042
birth after cesarean, birth of twins, or breech birth.  3043
       (3) The licensed midwife satisfies any other conditions  3044
required in rules adopted by the department.  3045
       (C) In adopting rules under this section, the department  3046
shall do both of the following:  3047
       (1) Adhere to the recommendations of the licensed  3048
midwifery advisory council and any relevant peer-reviewed  3049
medical literature;  3050
       (2) Specify the content and format of the document to be  3051
used when obtaining informed consent as described in this  3052
section.  3053
       Sec. 4724.09. (A) As used in this section and section  3054
4724.10 of the Revised Code, "emergency medical service,"  3055
"emergency medical service personnel," and "emergency medical  3056
service organization" have the same meanings as in section  3057
4765.01 of the Revised Code.  3058
       (B) For any pregnancy or childbirth in which a licensed  3059
midwife provides care and a home birth is planned, both of the  3060
following apply:  3061
       (1) The licensed midwife shall create an individualized  3062
transfer of care plan with each patient.  3063
H. B. No. 537  Page 108
As Introduced
       (2) The licensed midwife shall assess the status of the  3064
patient, fetus, and newborn throughout the maternity care cycle  3065
and shall determine when or if a transfer to a hospital is  3066
necessary.  3067
       (C) Each individualized transfer of care plan shall  3068
contain all of the following:  3069
       (1) The name and location of geographically adjacent  3070
hospitals that are appropriately equipped to provide emergency  3071
care, obstetrical care, and newborn care;  3072
       (2) The approximate travel time to each hospital;  3073
       (3) A list of the modes of transport services available,  3074
including an emergency medical service organization available by  3075
calling 9-1-1;  3076
       (4) The requirements for activating each mode of  3077
transportation;  3078
       (5) The mechanism by which medical records and other  3079
information concerning the patient may be rapidly transmitted to  3080
each hospital;  3081
       (6) Confirmation that the licensed midwife has recommended  3082
that the patient pre-register with the hospital closest to the  3083
patient's home that is appropriately equipped to provide  3084
emergency care, obstetrical care, and newborn care;  3085
       (7) Contact information for either a health care provider  3086
or practice group who has agreed in advance to accept patients  3087
in transfer, or a hospital's preferred method of accessing care  3088
by the hospital's designated provider on call;  3089
       (8) Any other information required in rules adopted by the  3090
department of commerce.  3091
H. B. No. 537  Page 109
As Introduced
       (D) When it becomes necessary to transfer a patient, a  3092
licensed midwife shall notify the receiving provider or hospital  3093
of all of the following:  3094
       (1) The incoming transfer;  3095
       (2) The reason for the transfer;  3096
       (3) A brief relevant clinical history;  3097
       (4) The planned mode of transport;  3098
       (5) The expected time of arrival;  3099
       (6) Any other information required in rules adopted by the  3100
department.  3101
       The licensed midwife may continue to provide routine or  3102
urgent care en route in coordination with any emergency medical  3103
services personnel or emergency medical service organization  3104
and, if continued care is provided, the licensed midwife shall  3105
address the psychosocial needs of the patient during the change  3106
of birth setting.  3107
       (E) On arrival at the hospital, the licensed midwife shall  3108
do all of the following:  3109
       (1) Provide a verbal report that includes details on the  3110
patient's current health status and the need for urgent care;  3111
       (2) Provide a legible copy of relevant prenatal and labor  3112
medical records;  3113
       (3) Transfer clinical responsibility to the receiving  3114
provider or hospital;  3115
       (4) Satisfy any other requirement established in rules  3116
adopted by the department.  3117
H. B. No. 537  Page 110
As Introduced
       If the patient chooses, the licensed midwife may remain at  3118
the hospital to provide continuous support. The licensed midwife  3119
also may continue to provide midwifery services, but only if the  3120
hospital has granted the licensed midwife clinical privileges.  3121
Whenever possible, the patient and her newborn shall be together  3122
during the transfer and after admission to the hospital.  3123
       Sec. 4724.10. (A) As used in this section, "adverse  3124
incident" means an incident over which a licensed midwife could  3125
exercise control, that is associated with an attempted or  3126
completed birth in a setting or facility other than a hospital,  3127
and that results in one or more of the following injuries or  3128
conditions:  3129
       (1) A maternal death that occurs during delivery or within  3130
forty-two days after delivery;  3131
       (2) The transfer of a maternal patient to a hospital  3132
intensive care unit;  3133
       (3) A maternal patient experiencing hemorrhagic shock or  3134
requiring a transfusion of more than two units of blood or blood  3135
products;  3136
       (4) A fetal or neonatal death, including a stillbirth,  3137
associated with an obstetrical delivery;  3138
       (5) A transfer of a newborn to a neonatal intensive care  3139
unit due to a traumatic physical or neurological birth injury,  3140
including any degree of a brachial plexus injury;  3141
       (6) A transfer of a newborn to a neonatal intensive care  3142
unit within the first seventy-two hours after birth if the  3143
newborn remains in such unit for more than seventy-two hours;  3144
       (7) Any other condition as determined by the department of  3145
H. B. No. 537  Page 111
As Introduced
commerce in rules adopted under section 4724.11 of the Revised  3146
Code.  3147
        (B) Beginning July 1, 2027, a licensed midwife who attends  3148
a birth planned for a facility or setting other than a hospital  3149
must report any adverse incident, along with a medical summary  3150
of events, to both of the following within fifteen days after  3151
the adverse incident occurs:  3152
        (1) The licensed midwifery advisory council;  3153
        (2) The Ohio perinatal quality collaborative.  3154
        (C) Beginning July 1, 2027, each licensed midwife shall  3155
report annually to the licensed midwifery advisory council the  3156
following information regarding cases in which the licensed  3157
midwife provided services when the intended place of birth at  3158
the onset of care was in a facility or setting other than a  3159
hospital:  3160
        (1) The total number of patients provided licensed  3161
midwifery services at the onset of care;  3162
        (2) The number of live births attended;  3163
        (3) The number of cases of fetal demise, newborn deaths,  3164
and maternal deaths attended as a licensed midwife at the  3165
discovery of the demise or death;  3166
        (4) The number, reason for, and outcome of each transport  3167
of a patient in the antepartum, intrapartum period, or immediate  3168
postpartum period;  3169
        (5) A brief description of any complications resulting in  3170
the morbidity or mortality of a maternal patient or a newborn;  3171
        (6) The planned delivery setting and the actual setting;  3172
H. B. No. 537  Page 112
As Introduced
       (7) Any other information required in rules adopted by the  3173
department of commerce.  3174
       (D) The department shall adopt rules to implement this  3175
section and shall develop a form to be used for the reporting  3176
required under divisions (B) and (C) of this section.  3177
       Sec. 4724.11. (A) In accordance with Chapter 119. of the  3178
Revised Code, the department of commerce shall adopt rules that  3179
establish all of the following:  3180
       (1) Standards and procedures for applying for, renewing,  3181
reinstating, or restoring a license to practice as a licensed  3182
midwife;  3183
       (2) Application, renewal, reinstatement, and restoration  3184
fee amounts for a license to practice as a licensed midwife,  3185
with the amount of the application fee not to exceed forty-five  3186
dollars and the amount of the renewal fee not to exceed twenty  3187
dollars;  3188
       (3) Standards and procedures for approving and  3189
successfully completing a course of study in breech births and a  3190
course of study in pharmacology, each as described in section  3191
4724.03 of the Revised Code;  3192
       (4) Subject to division (C) of this section, standards and  3193
procedures for approving certifying organizations as described  3194
in section 4724.03 of the Revised Code;  3195
       (5) Reasons for which the department may refuse to issue,  3196
or renew, suspend, or revoke a license or otherwise impose  3197
discipline on a licensed midwife;  3198
       (6) Conditions to be satisfied before the department  3199
reinstates or restores an expired or inactive license;  3200
H. B. No. 537  Page 113
As Introduced
       (7) Procedures for reporting to the department license  3201
holder misconduct;  3202
       (8) Procedures by which the department conducts  3203
disciplinary investigations.  3204
       (B) In adopting rules establishing standards and  3205
procedures for the approval of certifying organizations, the  3206
department shall approve an organization only if its  3207
certification requirements meet or exceed those of the north  3208
American registry of midwives or the international registry of  3209
midwives.  3210
       (C) The department also may adopt, in accordance with  3211
Chapter 119. of the Revised Code, any other rules it considers  3212
necessary to implement and administer this chapter. The rules  3213
may require the completion of a criminal records check.  3214
       Sec. 4724.12. This chapter does not abridge, change, or  3215
limit in any way the right of a parent to deliver the parent's  3216
baby where, when, how, and with whom the parent chooses,  3217
regardless of the licensure requirements established in this  3218
chapter.  3219
       Sec. 4724.13. (A) There is hereby created within the  3220
department of commerce the licensed midwifery advisory council.  3221
The council shall consist of all of the following members:  3222
       (1) One certified nurse-midwife and one certified midwife  3223
or certified nurse-midwife, preferably with experience attending  3224
a birth in a setting or facility other than a hospital;  3225
       (2) Four licensed midwives, including one practicing in an  3226
urban setting and one serving a plain Amish or Mennonite  3227
community;  3228
H. B. No. 537  Page 114
As Introduced
       (3) One physician who is board-certified in obstetrics and  3229
gynecology, as those designations are issued by a medical  3230
specialty certifying board recognized by the American board of  3231
medical specialties or American osteopathic association, and  3232
with experience consulting with midwives who provide midwifery  3233
services in locations other than hospitals;  3234
       (4) One physician who is board-certified in neonatal  3235
medicine, as that designation is issued by a medical specialty  3236
certifying board recognized by the American board of medical  3237
specialties or American osteopathic association, and with  3238
experience consulting with midwives who provide midwifery  3239
services in locations other than hospitals;  3240
       (5) One member of the public who has experience utilizing  3241
or receiving midwifery services in locations other than  3242
hospitals.  3243
       Of the members who are licensed midwives, each shall  3244
obtain licensure as a licensed midwife under this chapter not  3245
later than January 1, 2028.  3246
       (B) The department shall appoint the members described in  3247
division (A) of this section. The department may solicit  3248
nominations for initial appointments and for filling any  3249
vacancies from individuals or organizations with an interest in  3250
midwifery services. If the department does not receive any  3251
nominations or receives an insufficient number of nominations,  3252
the department shall appoint members and fill vacancies on its  3253
own advice.  3254
       Of the physician members described in divisions (A)(3) and  3255
(4) of this section, if the department does not receive any  3256
nominations for physicians with experience consulting with  3257
H. B. No. 537  Page 115
As Introduced
midwives who provide midwifery services in locations other than  3258
hospitals, the department shall appoint physicians without such  3259
experience, but only if the department determines that each  3260
physician satisfies the other requirements of division (A)(3) or  3261
(4) of this section.  3262
       Initial appointments to the council shall be made not  3263
later than ninety days after the effective date of this section.  3264
Of the initial appointments described in division (A) of this  3265
section, four shall be for terms of three years and five shall  3266
be for terms of four years. Thereafter, terms shall be for four  3267
years, with each term ending on the same day of the same month  3268
as did the term that it succeeds. Vacancies shall be filled in  3269
the same manner as appointments.  3270
       When the term of any member expires, a successor shall be  3271
appointed in the same manner as the initial appointment. Any  3272
member appointed to fill a vacancy occurring prior to the  3273
expiration of the term for which the member's predecessor was  3274
appointed shall hold office for the remainder of that term. A  3275
member shall continue in office subsequent to the expiration  3276
date of the member's term until the member's successor takes  3277
office or until a period of sixty days has elapsed, whichever  3278
occurs first. A member may be reappointed.  3279
       (C) The council shall organize by selecting a chairperson  3280
from among its members. The council may select a new chairperson  3281
at any time. Four members constitute a quorum for the  3282
transaction of official business. Members shall serve without  3283
compensation but shall receive payment for their actual and  3284
necessary expenses incurred in the performance of their official  3285
duties. The expenses shall be paid by the department.  3286
       (D) The council shall advise and make recommendations to  3287
H. B. No. 537  Page 116
As Introduced
the department regarding the practice and regulation of licensed  3288
midwives. The department shall adhere to such advice and  3289
recommendations when adopting any rules governing the practice  3290
of licensed midwives, including rules to address the following:  3291
       (1) Circumstances in which attending a home birth is  3292
prohibited, as described in section 4724.08 of the Revised Code;  3293
       (2) Limitations on providing care during a high-risk  3294
pregnancy, including when a home birth is planned;  3295
       (3) Adverse incident reporting and annual reporting, both  3296
required under section 4724.10 of the Revised Code;  3297
       (4) Obtaining a patient's informed consent, as described  3298
in section 4724.07 of the Revised Code;  3299
       (5) Creating an individualized transfer of care plan, as  3300
described in section 4724.09 of the Revised Code.  3301
       (E) The council shall review each adverse incident report  3302
submitted to the council as described in section 4724.10 of the  3303
Revised Code. As soon as practicable after the required review,  3304
the council shall make a recommendation to the department  3305
regarding whether discipline should be imposed on the licensed  3306
midwife, and if so, the type of discipline to be imposed.  3307
       The council shall develop a policy by which it addresses  3308
and considers adverse incident reports.  3309
       Sec. 4724.14. A traditional midwife may engage in one or  3310
more of the following activities during the antepartum,  3311
intrapartum, postpartum, and newborn period as part of the scope  3312
of practice for a traditional midwife:  3313
       (A) Offering care, education, counseling, and support  3314
during pregnancy, birth, and the postpartum period;  3315
H. B. No. 537  Page 117
As Introduced
       (B) Attending births in locations other than hospitals;  3316
       (C) Providing ongoing and routine prenatal care throughout  3317
pregnancy and hands on care during labor, birth, and the  3318
immediate postpartum period;  3319
       (D) Providing maternal and newborn assessment for the six-  3320
to eight-week period following delivery;  3321
       (E) Recognizing abnormal or dangerous conditions requiring  3322
consultations with or referrals to licensed health care  3323
professionals.  3324
       Sec. 4724.15. (A) This section establishes the process by  3325
which a traditional midwife obtains a patient's consent to  3326
treatment authorized by section 4724.14 of the Revised Code.  3327
       (B) The following information shall be exchanged in  3328
writing between a traditional midwife and patient when obtaining  3329
consent to treatment as described in division (A) of this  3330
section:  3331
       (1) The name of the traditional midwife;  3332
       (2) The patient's name, address, telephone number, and  3333
primary care provider, if the patient has one;  3334
       (3) A description of the traditional midwife's education,  3335
training, and experience in midwifery;  3336
       (4) The traditional midwife's practice philosophy;  3337
       (5) A promise to provide the patient, upon request, with  3338
separate documents describing a traditional midwife's scope of  3339
practice;  3340
       (6) A written plan for medical consultation and transfer  3341
of care;  3342
H. B. No. 537  Page 118
As Introduced
       (7) A description of any hospital care and procedures that  3343
may be necessary in the event of an emergency transfer of care;  3344
       (8) A description of the services provided to the patient  3345
by the traditional midwife;  3346
       (9) Whether the traditional midwife is covered by  3347
professional liability insurance;  3348
       (10) Any other information required in rules adopted by  3349
the department.  3350
       (C) Once the required information has been exchanged and  3351
if the patient consents to treatment, the patient and  3352
traditional midwife shall sign a written document to indicate as  3353
such. The traditional midwife shall retain a copy of the  3354
document for at least four years from the date on which the  3355
document was signed.  3356
       (D) The rights and liabilities arising from the provision  3357
of traditional midwifery services shall be governed exclusively  3358
by the agreement between the traditional midwife and the patient  3359
entered pursuant to division (C) of this section.  3360
       Sec. 4724.16. Emergency medical service personnel or an  3361
emergency medical service organization, hospital, facility,  3362
physician, advanced practice registered nurse, licensed midwife,  3363
or traditional midwife that provides services or care following  3364
an adverse incident as defined in section 4724.10 of the Revised  3365
Code, or during and after a transfer of care as described in  3366
section 4724.09 of the Revised Code, are not liable in damages  3367
in a tort or other civil action for injury or loss to person or  3368
property arising from the services or care, unless the services  3369
or care are provided in a manner that constitutes willful or  3370
wanton misconduct.  3371
H. B. No. 537  Page 119
As Introduced
       Sec. 4724.99. (A) Whoever violates division (A) of section  3372
4724.02 of the Revised Code is guilty of a felony of the fifth  3373
degree on a first offense and a felony of the fourth degree on  3374
each subsequent offense.  3375
       (B) Whoever violates division (C) of section 4724.02 of  3376
the Revised Code is guilty of a misdemeanor of the first degree  3377
and is subject to a fine in the amount of one thousand dollars  3378
and a jail term of not more than one hundred eighty days.  3379
       Sec. 4731.22. (A) The state medical board, by an  3380
affirmative vote of not fewer than six of its members, may  3381
limit, revoke, or suspend a license or certificate to practice  3382
or certificate to recommend, refuse to grant a license or  3383
certificate, refuse to renew a license or certificate, refuse to  3384
reinstate a license or certificate, or reprimand or place on  3385
probation the holder of a license or certificate if the  3386
individual applying for or holding the license or certificate is  3387
found by the board to have committed fraud during the  3388
administration of the examination for a license or certificate  3389
to practice or to have committed fraud, misrepresentation, or  3390
deception in applying for, renewing, or securing any license or  3391
certificate to practice or certificate to recommend issued by  3392
the board.  3393
       (B) Except as provided in division (P) of this section,  3394
the board, by an affirmative vote of not fewer than six members,  3395
shall, to the extent permitted by law, limit, revoke, or suspend  3396
a license or certificate to practice or certificate to  3397
recommend, refuse to issue a license or certificate, refuse to  3398
renew a license or certificate, refuse to reinstate a license or  3399
certificate, or reprimand or place on probation the holder of a  3400
license or certificate for one or more of the following reasons:  3401
H. B. No. 537  Page 120
As Introduced
       (1) Permitting one's name or one's license or certificate  3402
to practice to be used by a person, group, or corporation when  3403
the individual concerned is not actually directing the treatment  3404
given;  3405
       (2) Failure to maintain minimal standards applicable to  3406
the selection or administration of drugs, or failure to employ  3407
acceptable scientific methods in the selection of drugs or other  3408
modalities for treatment of disease;  3409
       (3) Except as provided in section 4731.97 of the Revised  3410
Code, selling, giving away, personally furnishing, prescribing,  3411
or administering drugs for other than legal and legitimate  3412
therapeutic purposes or a plea of guilty to, a judicial finding  3413
of guilt of, or a judicial finding of eligibility for  3414
intervention in lieu of conviction of, a violation of any  3415
federal or state law regulating the possession, distribution, or  3416
use of any drug;  3417
       (4) Willfully betraying a professional confidence.  3418
       For purposes of this division, "willfully betraying a  3419
professional confidence" does not include providing any  3420
information, documents, or reports under sections 307.621 to  3421
307.629 of the Revised Code to a child fatality review board;  3422
does not include providing any information, documents, or  3423
reports under sections 307.631 to 307.6410 of the Revised Code  3424
to a drug overdose fatality review committee, a suicide fatality  3425
review committee, or hybrid drug overdose fatality and suicide  3426
fatality review committee; does not include providing any  3427
information, documents, or reports under sections 307.651 to  3428
307.659 of the Revised Code to a domestic violence fatality  3429
review board; does not include providing any information,  3430
documents, or reports to the director of health pursuant to  3431
H. B. No. 537  Page 121
As Introduced
guidelines established under section 3701.70 of the Revised  3432
Code; does not include written notice to a mental health  3433
professional under section 4731.62 of the Revised Code; does not  3434
include making a report as described in division (F) of section  3435
2921.22 and section 4731.224 of the Revised Code; and does not  3436
include the making of a report of an employee's use of a drug of  3437
abuse, or a report of a condition of an employee other than one  3438
involving the use of a drug of abuse, to the employer of the  3439
employee as described in division (B) of section 2305.33 of the  3440
Revised Code. Nothing in this division affects the immunity from  3441
civil liability conferred by section 2305.33 or 4731.62 of the  3442
Revised Code upon a physician who makes a report in accordance  3443
with section 2305.33 or notifies a mental health professional in  3444
accordance with section 4731.62 of the Revised Code. As used in  3445
this division, "employee," "employer," and "physician" have the  3446
same meanings as in section 2305.33 of the Revised Code.  3447
       (5) Making a false, fraudulent, deceptive, or misleading  3448
statement in the solicitation of or advertising for patients; in  3449
relation to the practice of medicine and surgery, osteopathic  3450
medicine and surgery, podiatric medicine and surgery, or a  3451
limited branch of medicine; or in securing or attempting to  3452
secure any license or certificate to practice issued by the  3453
board.  3454
       As used in this division, "false, fraudulent, deceptive,  3455
or misleading statement" means a statement that includes a  3456
misrepresentation of fact, is likely to mislead or deceive  3457
because of a failure to disclose material facts, is intended or  3458
is likely to create false or unjustified expectations of  3459
favorable results, or includes representations or implications  3460
that in reasonable probability will cause an ordinarily prudent  3461
person to misunderstand or be deceived.  3462
H. B. No. 537  Page 122
As Introduced
       (6) A departure from, or the failure to conform to,  3463
minimal standards of care of similar practitioners under the  3464
same or similar circumstances, whether or not actual injury to a  3465
patient is established;  3466
       (7) Representing, with the purpose of obtaining  3467
compensation or other advantage as personal gain or for any  3468
other person, that an incurable disease or injury, or other  3469
incurable condition, can be permanently cured;  3470
       (8) The obtaining of, or attempting to obtain, money or  3471
anything of value by fraudulent misrepresentations in the course  3472
of practice;  3473
       (9) A plea of guilty to, a judicial finding of guilt of,  3474
or a judicial finding of eligibility for intervention in lieu of  3475
conviction for, a felony;  3476
       (10) Commission of an act that constitutes a felony in  3477
this state, regardless of the jurisdiction in which the act was  3478
committed;  3479
       (11) A plea of guilty to, a judicial finding of guilt of,  3480
or a judicial finding of eligibility for intervention in lieu of  3481
conviction for, a misdemeanor committed in the course of  3482
practice;  3483
       (12) Commission of an act in the course of practice that  3484
constitutes a misdemeanor in this state, regardless of the  3485
jurisdiction in which the act was committed;  3486
       (13) A plea of guilty to, a judicial finding of guilt of,  3487
or a judicial finding of eligibility for intervention in lieu of  3488
conviction for, a misdemeanor involving moral turpitude;  3489
       (14) Commission of an act involving moral turpitude that  3490
H. B. No. 537  Page 123
As Introduced
constitutes a misdemeanor in this state, regardless of the  3491
jurisdiction in which the act was committed;  3492
       (15) Violation of the conditions of limitation placed by  3493
the board upon a license or certificate to practice;  3494
       (16) Failure to pay license renewal fees specified in this  3495
chapter;  3496
       (17) Except as authorized in section 4731.31 of the  3497
Revised Code, engaging in the division of fees for referral of  3498
patients, or the receiving of a thing of value in return for a  3499
specific referral of a patient to utilize a particular service  3500
or business;  3501
       (18) Subject to section 4731.226 of the Revised Code,  3502
violation of any provision of a code of ethics of the American  3503
medical association, the American osteopathic association, the  3504
American podiatric medical association, or any other national  3505
professional organizations that the board specifies by rule. The  3506
state medical board shall obtain and keep on file current copies  3507
of the codes of ethics of the various national professional  3508
organizations. The individual whose license or certificate is  3509
being suspended or revoked shall not be found to have violated  3510
any provision of a code of ethics of an organization not  3511
appropriate to the individual's profession.  3512
       For purposes of this division, a "provision of a code of  3513
ethics of a national professional organization" does not include  3514
any provision that would preclude the making of a report by a  3515
physician of an employee's use of a drug of abuse, or of a  3516
condition of an employee other than one involving the use of a  3517
drug of abuse, to the employer of the employee as described in  3518
division (B) of section 2305.33 of the Revised Code. Nothing in  3519
H. B. No. 537  Page 124
As Introduced
this division affects the immunity from civil liability  3520
conferred by that section upon a physician who makes either type  3521
of report in accordance with division (B) of that section. As  3522
used in this division, "employee," "employer," and "physician"  3523
have the same meanings as in section 2305.33 of the Revised  3524
Code.  3525
        (19) Inability to practice according to acceptable and  3526
prevailing standards of care by reason of mental illness or  3527
physical illness, including, but not limited to, physical  3528
deterioration that adversely affects cognitive, motor, or  3529
perceptive skills.  3530
        In enforcing this division, the board, upon a showing of a  3531
possible violation, shall refer any individual who is authorized  3532
to practice by this chapter or who has submitted an application  3533
pursuant to this chapter to the monitoring organization that  3534
conducts the confidential monitoring program established under  3535
section 4731.25 of the Revised Code. The board also may compel  3536
the individual to submit to a mental examination, physical  3537
examination, including an HIV test, or both a mental and a  3538
physical examination. The expense of the examination is the  3539
responsibility of the individual compelled to be examined.  3540
Failure to submit to a mental or physical examination or consent  3541
to an HIV test ordered by the board constitutes an admission of  3542
the allegations against the individual unless the failure is due  3543
to circumstances beyond the individual's control, and a default  3544
and final order may be entered without the taking of testimony  3545
or presentation of evidence. If the board finds an individual  3546
unable to practice because of the reasons set forth in this  3547
division, the board shall require the individual to submit to  3548
care, counseling, or treatment by physicians approved or  3549
designated by the board, as a condition for initial, continued,  3550
H. B. No. 537  Page 125
As Introduced
reinstated, or renewed authority to practice. An individual  3551
affected under this division shall be afforded an opportunity to  3552
demonstrate to the board the ability to resume practice in  3553
compliance with acceptable and prevailing standards under the  3554
provisions of the individual's license or certificate. For the  3555
purpose of this division, any individual who applies for or  3556
receives a license or certificate to practice under this chapter  3557
accepts the privilege of practicing in this state and, by so  3558
doing, shall be deemed to have given consent to submit to a  3559
mental or physical examination when directed to do so in writing  3560
by the board, and to have waived all objections to the  3561
admissibility of testimony or examination reports that  3562
constitute a privileged communication.  3563
       (20) Except as provided in division (F)(1)(b) of section  3564
4731.282 of the Revised Code or when civil penalties are imposed  3565
under section 4731.225 of the Revised Code, and subject to  3566
section 4731.226 of the Revised Code, violating or attempting to  3567
violate, directly or indirectly, or assisting in or abetting the  3568
violation of, or conspiring to violate, any provisions of this  3569
chapter or any rule promulgated by the board.  3570
       This division does not apply to a violation or attempted  3571
violation of, assisting in or abetting the violation of, or a  3572
conspiracy to violate, any provision of this chapter or any rule  3573
adopted by the board that would preclude the making of a report  3574
by a physician of an employee's use of a drug of abuse, or of a  3575
condition of an employee other than one involving the use of a  3576
drug of abuse, to the employer of the employee as described in  3577
division (B) of section 2305.33 of the Revised Code. Nothing in  3578
this division affects the immunity from civil liability  3579
conferred by that section upon a physician who makes either type  3580
of report in accordance with division (B) of that section. As  3581
H. B. No. 537  Page 126
As Introduced
used in this division, "employee," "employer," and "physician"  3582
have the same meanings as in section 2305.33 of the Revised  3583
Code.  3584
        (21) The violation of section 3701.79 of the Revised Code  3585
or of any abortion rule adopted by the director of health  3586
pursuant to section 3701.341 of the Revised Code;  3587
        (22) Any of the following actions taken by an agency  3588
responsible for authorizing, certifying, or regulating an  3589
individual to practice a health care occupation or provide  3590
health care services in this state or another jurisdiction, for  3591
any reason other than the nonpayment of fees: the limitation,  3592
revocation, or suspension of an individual's license to  3593
practice; acceptance of an individual's license surrender;  3594
denial of a license; refusal to renew or reinstate a license;  3595
imposition of probation; or issuance of an order of censure or  3596
other reprimand;  3597
        (23) The violation of section 2919.12 of the Revised Code  3598
or the performance or inducement of an abortion upon a pregnant  3599
woman with actual knowledge that the conditions specified in  3600
division (B) of section 2317.56 of the Revised Code have not  3601
been satisfied or with a heedless indifference as to whether  3602
those conditions have been satisfied, unless an affirmative  3603
defense as specified in division (H)(2) of that section would  3604
apply in a civil action authorized by division (H)(1) of that  3605
section;  3606
        (24) The revocation, suspension, restriction, reduction,  3607
or termination of clinical privileges by the United States  3608
department of defense or department of veterans affairs or the  3609
termination or suspension of a certificate of registration to  3610
prescribe drugs by the drug enforcement administration of the  3611
H. B. No. 537  Page 127
As Introduced
United States department of justice;  3612
       (25) Termination or suspension from participation in the  3613
medicare or medicaid programs by the department of health and  3614
human services or other responsible agency;  3615
       (26) Impairment of ability to practice according to  3616
acceptable and prevailing standards of care because of substance  3617
use disorder or excessive use or abuse of drugs, alcohol, or  3618
other substances that may impair ability to practice.  3619
       For the purposes of this division, any individual  3620
authorized to practice by this chapter accepts the privilege of  3621
practicing in this state subject to supervision by the board. By  3622
filing an application for or holding a license or certificate to  3623
practice under this chapter, an individual shall be deemed to  3624
have given consent to submit to a mental or physical examination  3625
when ordered to do so by the board in writing, and to have  3626
waived all objections to the admissibility of testimony or  3627
examination reports that constitute privileged communications.  3628
       If it has reason to believe that any individual authorized  3629
to practice by this chapter or any applicant for licensure or  3630
certification to practice suffers such impairment, the board  3631
shall refer the individual to the monitoring organization that  3632
conducts the confidential monitoring program established under  3633
section 4731.25 of the Revised Code. The board also may compel  3634
the individual to submit to a mental or physical examination, or  3635
both. The expense of the examination is the responsibility of  3636
the individual compelled to be examined. Any mental or physical  3637
examination required under this division shall be undertaken by  3638
a treatment provider or physician who is qualified to conduct  3639
the examination and who is approved under section 4731.251 of  3640
the Revised Code.  3641
H. B. No. 537  Page 128
As Introduced
       Failure to submit to a mental or physical examination  3642
ordered by the board constitutes an admission of the allegations  3643
against the individual unless the failure is due to  3644
circumstances beyond the individual's control, and a default and  3645
final order may be entered without the taking of testimony or  3646
presentation of evidence. If the board determines that the  3647
individual's ability to practice is impaired, the board shall  3648
suspend the individual's license or certificate or deny the  3649
individual's application and shall require the individual, as a  3650
condition for initial, continued, reinstated, or renewed  3651
licensure or certification to practice, to submit to treatment.  3652
       Before being eligible to apply for reinstatement of a  3653
license or certificate suspended under this division, the  3654
impaired practitioner shall demonstrate to the board the ability  3655
to resume practice in compliance with acceptable and prevailing  3656
standards of care under the provisions of the practitioner's  3657
license or certificate. The demonstration shall include, but  3658
shall not be limited to, the following:  3659
       (a) Certification from a treatment provider approved under  3660
section 4731.251 of the Revised Code that the individual has  3661
successfully completed any required inpatient treatment;  3662
       (b) Evidence of continuing full compliance with an  3663
aftercare contract or consent agreement;  3664
       (c) Two written reports indicating that the individual's  3665
ability to practice has been assessed and that the individual  3666
has been found capable of practicing according to acceptable and  3667
prevailing standards of care. The reports shall be made by  3668
individuals or providers approved by the board for making the  3669
assessments and shall describe the basis for their  3670
determination.  3671
H. B. No. 537  Page 129
As Introduced
       The board may reinstate a license or certificate suspended  3672
under this division after that demonstration and after the  3673
individual has entered into a written consent agreement.  3674
       When the impaired practitioner resumes practice, the board  3675
shall require continued monitoring of the individual. The  3676
monitoring shall include, but not be limited to, compliance with  3677
the written consent agreement entered into before reinstatement  3678
or with conditions imposed by board order after a hearing, and,  3679
upon termination of the consent agreement, submission to the  3680
board for at least two years of annual written progress reports  3681
made under penalty of perjury stating whether the individual has  3682
maintained sobriety.  3683
       (27) A second or subsequent violation of section 4731.66  3684
or 4731.69 of the Revised Code;  3685
       (28) Except as provided in division (N) of this section:  3686
       (a) Waiving the payment of all or any part of a deductible  3687
or copayment that a patient, pursuant to a health insurance or  3688
health care policy, contract, or plan that covers the  3689
individual's services, otherwise would be required to pay if the  3690
waiver is used as an enticement to a patient or group of  3691
patients to receive health care services from that individual;  3692
       (b) Advertising that the individual will waive the payment  3693
of all or any part of a deductible or copayment that a patient,  3694
pursuant to a health insurance or health care policy, contract,  3695
or plan that covers the individual's services, otherwise would  3696
be required to pay.  3697
       (29) Failure to use universal blood and body fluid  3698
precautions established by rules adopted under section 4731.051  3699
of the Revised Code;  3700
H. B. No. 537  Page 130
As Introduced
       (30) Failure to provide notice to, and receive  3701
acknowledgment of the notice from, a patient when required by  3702
section 4731.143 of the Revised Code prior to providing  3703
nonemergency professional services, or failure to maintain that  3704
notice in the patient's medical record;  3705
       (31) Failure of a physician supervising a physician  3706
assistant to maintain supervision in accordance with the  3707
requirements of Chapter 4730. of the Revised Code and the rules  3708
adopted under that chapter;  3709
       (32) Failure of a physician or podiatrist to enter into a  3710
standard care arrangement with a certified midwife, clinical  3711
nurse specialist, certified nurse-midwife, or certified nurse  3712
practitioner with whom the physician or podiatrist is in  3713
collaboration pursuant to section 4731.27 of the Revised Code or  3714
failure to fulfill the responsibilities of collaboration after  3715
entering into a standard care arrangement;  3716
       (33) Failure to comply with the terms of a consult  3717
agreement entered into with a pharmacist pursuant to section  3718
4729.39 of the Revised Code;  3719
       (34) Failure to cooperate in an investigation conducted by  3720
the board under division (F) of this section, including failure  3721
to comply with a subpoena or order issued by the board or  3722
failure to answer truthfully a question presented by the board  3723
in an investigative interview, an investigative office  3724
conference, at a deposition, or in written interrogatories,  3725
except that failure to cooperate with an investigation shall not  3726
constitute grounds for discipline under this section if a court  3727
of competent jurisdiction has issued an order that either  3728
quashes a subpoena or permits the individual to withhold the  3729
testimony or evidence in issue;  3730
H. B. No. 537  Page 131
As Introduced
        (35) Failure to supervise an anesthesiologist assistant in  3731
accordance with Chapter 4760. of the Revised Code and the  3732
board's rules for supervision of an anesthesiologist assistant;  3733
        (36) Assisting suicide, as defined in section 3795.01 of  3734
the Revised Code;  3735
        (37) Failure to comply with the requirements of section  3736
2317.561 of the Revised Code;  3737
        (38) Failure to supervise a radiologist assistant in  3738
accordance with Chapter 4774. of the Revised Code and the  3739
board's rules for supervision of radiologist assistants;  3740
        (39) Performing or inducing an abortion at an office or  3741
facility with knowledge that the office or facility fails to  3742
post the notice required under section 3701.791 of the Revised  3743
Code;  3744
        (40) Failure to comply with the standards and procedures  3745
established in rules under section 4731.054 of the Revised Code  3746
for the operation of or the provision of care at a pain  3747
management clinic;  3748
        (41) Failure to comply with the standards and procedures  3749
established in rules under section 4731.054 of the Revised Code  3750
for providing supervision, direction, and control of individuals  3751
at a pain management clinic;  3752
        (42) Failure to comply with the requirements of section  3753
4729.79 or 4731.055 of the Revised Code, unless the state board  3754
of pharmacy no longer maintains a drug database pursuant to  3755
section 4729.75 of the Revised Code;  3756
        (43) Failure to comply with the requirements of section  3757
2919.171, 2919.202, or 2919.203 of the Revised Code or failure  3758
H. B. No. 537  Page 132
As Introduced
to submit to the department of health in accordance with a court  3759
order a complete report as described in section 2919.171 or  3760
2919.202 of the Revised Code;  3761
       (44) Practicing at a facility that is subject to licensure  3762
as a category III terminal distributor of dangerous drugs with a  3763
pain management clinic classification unless the person  3764
operating the facility has obtained and maintains the license  3765
with the classification;  3766
       (45) Owning a facility that is subject to licensure as a  3767
category III terminal distributor of dangerous drugs with a pain  3768
management clinic classification unless the facility is licensed  3769
with the classification;  3770
       (46) Failure to comply with any of the requirements  3771
regarding making or maintaining medical records or documents  3772
described in division (A) of section 2919.192, division (C) of  3773
section 2919.193, division (B) of section 2919.195, or division  3774
(A) of section 2919.196 of the Revised Code;  3775
       (47) Failure to comply with the requirements in section  3776
3719.061 of the Revised Code before issuing for a minor a  3777
prescription for an opioid analgesic, as defined in section  3778
3719.01 of the Revised Code;  3779
       (48) Failure to comply with the requirements of section  3780
4731.30 of the Revised Code or rules adopted under section  3781
4731.301 of the Revised Code when recommending treatment with  3782
medical marijuana;  3783
       (49) A pattern of continuous or repeated violations of  3784
division (E)(2) or (3) of section 3963.02 of the Revised Code;  3785
       (50) Failure to fulfill the responsibilities of a  3786
collaboration agreement entered into with an athletic trainer as  3787
H. B. No. 537  Page 133
As Introduced
described in section 4755.621 of the Revised Code;  3788
       (51) Failure to take the steps specified in section  3789
4731.911 of the Revised Code following an abortion or attempted  3790
abortion in an ambulatory surgical facility or other location  3791
that is not a hospital when a child is born alive;  3792
       (52) Violation of section 4731.77 of the Revised Code;  3793
       (53) Failure of a physician supervising a certified mental  3794
health assistant to maintain supervision in accordance with the  3795
requirements of Chapter 4772. of the Revised Code and the rules  3796
adopted under that chapter;  3797
       (54) Failure to comply with the requirements of section  3798
3705.16 of the Revised Code when certifying a decedent's cause  3799
of death and completing and signing the medical certificate of  3800
death.  3801
       (C) Disciplinary actions taken by the board under  3802
divisions (A) and (B) of this section shall be taken pursuant to  3803
an adjudication under Chapter 119. of the Revised Code, except  3804
that in lieu of an adjudication, the board may enter into a  3805
consent agreement with an individual to resolve an allegation of  3806
a violation of this chapter or any rule adopted under it. A  3807
consent agreement, when ratified by an affirmative vote of not  3808
fewer than six members of the board, shall constitute the  3809
findings and order of the board with respect to the matter  3810
addressed in the agreement. If the board refuses to ratify a  3811
consent agreement, the admissions and findings contained in the  3812
consent agreement shall be of no force or effect.  3813
       A telephone conference call may be utilized for  3814
ratification of a consent agreement that revokes or suspends an  3815
individual's license or certificate to practice or certificate  3816
H. B. No. 537  Page 134
As Introduced
to recommend. The telephone conference call shall be considered  3817
a special meeting under division (F) of section 121.22 of the  3818
Revised Code.  3819
       If the board takes disciplinary action against an  3820
individual under division (B) of this section for a second or  3821
subsequent plea of guilty to, or judicial finding of guilt of, a  3822
violation of section 2919.123 or 2919.124 of the Revised Code,  3823
the disciplinary action shall consist of a suspension of the  3824
individual's license or certificate to practice for a period of  3825
at least one year or, if determined appropriate by the board, a  3826
more serious sanction involving the individual's license or  3827
certificate to practice. Any consent agreement entered into  3828
under this division with an individual that pertains to a second  3829
or subsequent plea of guilty to, or judicial finding of guilt  3830
of, a violation of that section shall provide for a suspension  3831
of the individual's license or certificate to practice for a  3832
period of at least one year or, if determined appropriate by the  3833
board, a more serious sanction involving the individual's  3834
license or certificate to practice.  3835
       (D) For purposes of divisions (B)(10), (12), and (14) of  3836
this section, the commission of the act may be established by a  3837
finding by the board, pursuant to an adjudication under Chapter  3838
119. of the Revised Code, that the individual committed the act.  3839
The board does not have jurisdiction under those divisions if  3840
the trial court renders a final judgment in the individual's  3841
favor and that judgment is based upon an adjudication on the  3842
merits. The board has jurisdiction under those divisions if the  3843
trial court issues an order of dismissal upon technical or  3844
procedural grounds.  3845
       (E) The sealing or expungement of conviction records by  3846
H. B. No. 537  Page 135
As Introduced
any court shall have no effect upon a prior board order entered  3847
under this section or upon the board's jurisdiction to take  3848
action under this section if, based upon a plea of guilty, a  3849
judicial finding of guilt, or a judicial finding of eligibility  3850
for intervention in lieu of conviction, the board issued a  3851
notice of opportunity for a hearing prior to the court's order  3852
to seal or expunge the records. The board shall not be required  3853
to seal, expunge, destroy, redact, or otherwise modify its  3854
records to reflect the court's sealing of conviction records.  3855
       (F)(1) The board shall investigate evidence that appears  3856
to show that a person has violated any provision of this chapter  3857
or any rule adopted under it. Any person may report to the board  3858
in a signed writing any information that the person may have  3859
that appears to show a violation of any provision of this  3860
chapter or any rule adopted under it. In the absence of bad  3861
faith, any person who reports information of that nature or who  3862
testifies before the board in any adjudication conducted under  3863
Chapter 119. of the Revised Code shall not be liable in damages  3864
in a civil action as a result of the report or testimony. Each  3865
complaint or allegation of a violation received by the board  3866
shall be assigned a case number and shall be recorded by the  3867
board.  3868
       (2) Investigations of alleged violations of this chapter  3869
or any rule adopted under it shall be supervised by the  3870
supervising member elected by the board in accordance with  3871
section 4731.02 of the Revised Code and by the secretary as  3872
provided in section 4731.39 of the Revised Code. The president  3873
may designate another member of the board to supervise the  3874
investigation in place of the supervising member. Upon a vote of  3875
the majority of the board to authorize the addition of a  3876
consumer member in the supervision of any part of any  3877
H. B. No. 537  Page 136
As Introduced
investigation, the president shall designate a consumer member  3878
for supervision of investigations as determined by the  3879
president. The authorization of consumer member participation in  3880
investigation supervision may be rescinded by a majority vote of  3881
the board. No member of the board who supervises the  3882
investigation of a case shall participate in further  3883
adjudication of the case.  3884
       (3) In investigating a possible violation of this chapter  3885
or any rule adopted under this chapter, or in conducting an  3886
inspection under division (E) of section 4731.054 of the Revised  3887
Code, the board may question witnesses, conduct interviews,  3888
administer oaths, order the taking of depositions, inspect and  3889
copy any books, accounts, papers, records, or documents, issue  3890
subpoenas, and compel the attendance of witnesses and production  3891
of books, accounts, papers, records, documents, and testimony,  3892
except that a subpoena for patient record information shall not  3893
be issued without consultation with the attorney general's  3894
office and approval of the secretary of the board.  3895
       (a) Before issuance of a subpoena for patient record  3896
information, the secretary shall determine whether there is  3897
probable cause to believe that the complaint filed alleges a  3898
violation of this chapter or any rule adopted under it and that  3899
the records sought are relevant to the alleged violation and  3900
material to the investigation. The subpoena may apply only to  3901
records that cover a reasonable period of time surrounding the  3902
alleged violation.  3903
       (b) On failure to comply with any subpoena issued by the  3904
board and after reasonable notice to the person being  3905
subpoenaed, the board may move for an order compelling the  3906
production of persons or records pursuant to the Rules of Civil  3907
H. B. No. 537  Page 137
As Introduced
Procedure.  3908
       (c) A subpoena issued by the board may be served by a  3909
sheriff, the sheriff's deputy, or a board employee or agent  3910
designated by the board. Service of a subpoena issued by the  3911
board may be made by delivering a copy of the subpoena to the  3912
person named therein, reading it to the person, or leaving it at  3913
the person's usual place of residence, usual place of business,  3914
or address on file with the board. When serving a subpoena to an  3915
applicant for or the holder of a license or certificate issued  3916
under this chapter, service of the subpoena may be made by  3917
certified mail, return receipt requested, and the subpoena shall  3918
be deemed served on the date delivery is made or the date the  3919
person refuses to accept delivery. If the person being served  3920
refuses to accept the subpoena or is not located, service may be  3921
made to an attorney who notifies the board that the attorney is  3922
representing the person.  3923
       (d) A sheriff's deputy who serves a subpoena shall receive  3924
the same fees as a sheriff. Each witness who appears before the  3925
board in obedience to a subpoena shall receive the fees and  3926
mileage provided for under section 119.094 of the Revised Code.  3927
       (4) All hearings, investigations, and inspections of the  3928
board shall be considered civil actions for the purposes of  3929
section 2305.252 of the Revised Code.  3930
       (5) A report required to be submitted to the board under  3931
this chapter, a complaint, or information received by the board  3932
pursuant to an investigation or pursuant to an inspection under  3933
division (E) of section 4731.054 of the Revised Code is  3934
confidential and not subject to discovery in any civil action.  3935
       The board shall conduct all investigations or inspections  3936
H. B. No. 537  Page 138
As Introduced
and proceedings in a manner that protects the confidentiality of  3937
patients and persons who file complaints with the board. The  3938
board shall not make public the names or any other identifying  3939
information about patients or complainants unless proper consent  3940
is given or, in the case of a patient, a waiver of the patient  3941
privilege exists under division (B) of section 2317.02 of the  3942
Revised Code, except that consent or a waiver of that nature is  3943
not required if the board possesses reliable and substantial  3944
evidence that no bona fide physician-patient relationship  3945
exists.  3946
       The board may share any information it receives pursuant  3947
to an investigation or inspection, including patient records and  3948
patient record information, with law enforcement agencies, other  3949
licensing boards, and other governmental agencies that are  3950
prosecuting, adjudicating, or investigating alleged violations  3951
of statutes or administrative rules. An agency or board that  3952
receives the information shall comply with the same requirements  3953
regarding confidentiality as those with which the state medical  3954
board must comply, notwithstanding any conflicting provision of  3955
the Revised Code or procedure of the agency or board that  3956
applies when it is dealing with other information in its  3957
possession. In a judicial proceeding, the information may be  3958
admitted into evidence only in accordance with the Rules of  3959
Evidence, but the court shall require that appropriate measures  3960
are taken to ensure that confidentiality is maintained with  3961
respect to any part of the information that contains names or  3962
other identifying information about patients or complainants  3963
whose confidentiality was protected by the state medical board  3964
when the information was in the board's possession. Measures to  3965
ensure confidentiality that may be taken by the court include  3966
sealing its records or deleting specific information from its  3967
H. B. No. 537  Page 139
As Introduced
records.  3968
       No person shall knowingly access, use, or disclose  3969
confidential investigatory information in a manner prohibited by  3970
law.  3971
       (6) On a quarterly basis, the board shall prepare a report  3972
that documents the disposition of all cases during the preceding  3973
three months. The report shall contain the following information  3974
for each case with which the board has completed its activities:  3975
       (a) The case number assigned to the complaint or alleged  3976
violation;  3977
       (b) The type of license or certificate to practice, if  3978
any, held by the individual against whom the complaint is  3979
directed;  3980
       (c) A description of the allegations contained in the  3981
complaint;  3982
       (d) Whether witnesses were interviewed;  3983
       (e) Whether the individual against whom the complaint is  3984
directed is the subject of any pending complaints;  3985
       (f) The disposition of the case.  3986
       The report shall state how many cases are still pending  3987
and shall be prepared in a manner that protects the identity of  3988
each person involved in each case. The report shall be a public  3989
record under section 149.43 of the Revised Code.  3990
       (7) The board may provide a status update regarding an  3991
investigation to a complainant on request if the board verifies  3992
the complainant's identity.  3993
       (G)(1) If either of the following circumstances occur, the  3994
H. B. No. 537  Page 140
As Introduced
secretary and supervising member may recommend that the board  3995
suspend an individual's license or certificate to practice or  3996
certificate to recommend without a prior hearing:  3997
       (a) The secretary and supervising member determine both of  3998
the following:  3999
       (i) That there is clear and convincing evidence that an  4000
individual has violated division (B) of this section;  4001
       (ii) That the individual's continued practice presents a  4002
danger of immediate and serious harm to the public.  4003
       (b) The board receives verifiable information that a  4004
licensee has been charged in any state or federal court with a  4005
crime classified as a felony under the charging court's law and  4006
the conduct constitutes a violation of division (B) of this  4007
section.  4008
       (2) If a recommendation is made to suspend without a prior  4009
hearing pursuant to division (G)(1) of this section, written  4010
allegations shall be prepared for consideration by the board.  4011
The board, upon review of those allegations and by an  4012
affirmative vote of not fewer than six of its members, excluding  4013
the secretary and supervising member, may suspend a license or  4014
certificate without a prior hearing. A telephone conference call  4015
may be utilized for reviewing the allegations and taking the  4016
vote on the summary suspension.  4017
       The board shall serve a written order of suspension in  4018
accordance with sections 119.05 and 119.07 of the Revised Code.  4019
If the individual subject to the summary suspension requests an  4020
adjudicatory hearing by the board, the date set for the hearing  4021
shall be within fifteen days, but not earlier than seven days,  4022
after the individual requests the hearing, unless otherwise  4023
H. B. No. 537  Page 141
As Introduced
agreed to by both the board and the individual.  4024
       (3) Any summary suspension imposed under division (G)(2)  4025
of this section is not a final appealable order and is not an  4026
adjudication that may be appealed under section 119.12 of the  4027
Revised Code. The summary suspension shall remain in effect  4028
until a final adjudicative order issued by the board pursuant to  4029
this section and Chapter 119. of the Revised Code becomes  4030
effective. Once a final adjudicative order has been issued by  4031
the board, any party adversely affected by it may file an appeal  4032
in accordance with the requirements of Chapter 119. of the  4033
Revised Code.  4034
       The board shall issue its final adjudicative order within  4035
seventy-five days after completion of its hearing. A failure to  4036
issue the order within seventy-five days shall result in  4037
dissolution of the summary suspension order but shall not  4038
invalidate any subsequent, final adjudicative order.  4039
       (H) If the board takes action under division (B)(9), (11),  4040
or (13) of this section and the judicial finding of guilt,  4041
guilty plea, or judicial finding of eligibility for intervention  4042
in lieu of conviction is overturned on appeal, upon exhaustion  4043
of the criminal appeal, a petition for reconsideration of the  4044
order may be filed with the board along with appropriate court  4045
documents. Upon receipt of a petition of that nature and  4046
supporting court documents, the board shall reinstate the  4047
individual's license or certificate to practice. The board may  4048
then hold an adjudication under Chapter 119. of the Revised Code  4049
to determine whether the individual committed the act in  4050
question. Notice of an opportunity for a hearing shall be given  4051
in accordance with Chapter 119. of the Revised Code. If the  4052
board finds, pursuant to an adjudication held under this  4053
H. B. No. 537  Page 142
As Introduced
division, that the individual committed the act or if no hearing  4054
is requested, the board may order any of the sanctions  4055
identified under division (B) of this section.  4056
       (I) The license or certificate to practice issued to an  4057
individual under this chapter and the individual's practice in  4058
this state are automatically suspended as of the date of the  4059
individual's second or subsequent plea of guilty to, or judicial  4060
finding of guilt of, a violation of section 2919.123 or 2919.124  4061
of the Revised Code. In addition, the license or certificate to  4062
practice or certificate to recommend issued to an individual  4063
under this chapter and the individual's practice in this state  4064
are automatically suspended as of the date the individual pleads  4065
guilty to, is found by a judge or jury to be guilty of, or is  4066
subject to a judicial finding of eligibility for intervention in  4067
lieu of conviction in this state or treatment or intervention in  4068
lieu of conviction in another jurisdiction for any of the  4069
following criminal offenses in this state or a substantially  4070
equivalent criminal offense in another jurisdiction: aggravated  4071
murder, murder, voluntary manslaughter, felonious assault,  4072
trafficking in persons, kidnapping, rape, sexual battery, gross  4073
sexual imposition, aggravated arson, aggravated robbery, or  4074
aggravated burglary. Continued practice after suspension shall  4075
be considered practicing without a license or certificate.  4076
       The board shall notify the individual subject to the  4077
suspension in accordance with sections 119.05 and 119.07 of the  4078
Revised Code. If an individual whose license or certificate is  4079
automatically suspended under this division fails to make a  4080
timely request for an adjudication under Chapter 119. of the  4081
Revised Code, the board shall do whichever of the following is  4082
applicable:  4083
H. B. No. 537  Page 143
As Introduced
       (1) If the automatic suspension under this division is for  4084
a second or subsequent plea of guilty to, or judicial finding of  4085
guilt of, a violation of section 2919.123 or 2919.124 of the  4086
Revised Code, the board shall enter an order suspending the  4087
individual's license or certificate to practice for a period of  4088
at least one year or, if determined appropriate by the board,  4089
imposing a more serious sanction involving the individual's  4090
license or certificate to practice.  4091
       (2) In all circumstances in which division (I)(1) of this  4092
section does not apply, enter a final order permanently revoking  4093
the individual's license or certificate to practice.  4094
       (J) If the board is required by Chapter 119. of the  4095
Revised Code to give notice of an opportunity for a hearing and  4096
if the individual subject to the notice does not timely request  4097
a hearing in accordance with section 119.07 of the Revised Code,  4098
the board is not required to hold a hearing, but may adopt, by  4099
an affirmative vote of not fewer than six of its members, a  4100
final order that contains the board's findings. In that final  4101
order, the board may order any of the sanctions identified under  4102
division (A) or (B) of this section.  4103
       (K) Any action taken by the board under division (B) of  4104
this section resulting in a suspension from practice shall be  4105
accompanied by a written statement of the conditions under which  4106
the individual's license or certificate to practice may be  4107
reinstated. The board shall adopt rules governing conditions to  4108
be imposed for reinstatement. Reinstatement of a license or  4109
certificate suspended pursuant to division (B) of this section  4110
requires an affirmative vote of not fewer than six members of  4111
the board.  4112
       (L) When the board refuses to grant or issue a license or  4113
H. B. No. 537  Page 144
As Introduced
certificate to practice to an applicant, revokes an individual's  4114
license or certificate to practice, refuses to renew an  4115
individual's license or certificate to practice, or refuses to  4116
reinstate an individual's license or certificate to practice,  4117
the board may specify that its action is permanent. An  4118
individual subject to a permanent action taken by the board is  4119
forever thereafter ineligible to hold a license or certificate  4120
to practice and the board shall not accept an application for  4121
reinstatement of the license or certificate or for issuance of a  4122
new license or certificate.  4123
       (M) Notwithstanding any other provision of the Revised  4124
Code, all of the following apply:  4125
       (1) The surrender of a license or certificate issued under  4126
this chapter shall not be effective unless or until accepted by  4127
the board. A telephone conference call may be utilized for  4128
acceptance of the surrender of an individual's license or  4129
certificate to practice. The telephone conference call shall be  4130
considered a special meeting under division (F) of section  4131
121.22 of the Revised Code. Reinstatement of a license or  4132
certificate surrendered to the board requires an affirmative  4133
vote of not fewer than six members of the board.  4134
       (2) An application for a license or certificate made under  4135
the provisions of this chapter may not be withdrawn without  4136
approval of the board.  4137
       (3) Failure by an individual to renew a license or  4138
certificate to practice in accordance with this chapter or a  4139
certificate to recommend in accordance with rules adopted under  4140
section 4731.301 of the Revised Code does not remove or limit  4141
the board's jurisdiction to take any disciplinary action under  4142
this section against the individual.  4143
H. B. No. 537  Page 145
As Introduced
       (4) The placement of an individual's license on retired  4144
status, as described in section 4731.283 of the Revised Code,  4145
does not remove or limit the board's jurisdiction to take any  4146
disciplinary action against the individual with regard to the  4147
license as it existed before being placed on retired status.  4148
       (5) At the request of the board, a license or certificate  4149
holder shall immediately surrender to the board a license or  4150
certificate that the board has suspended, revoked, or  4151
permanently revoked.  4152
       (N) Sanctions shall not be imposed under division (B)(28)  4153
of this section against any person who waives deductibles and  4154
copayments as follows:  4155
       (1) In compliance with the health benefit plan that  4156
expressly allows such a practice. Waiver of the deductibles or  4157
copayments shall be made only with the full knowledge and  4158
consent of the plan purchaser, payer, and third-party  4159
administrator. Documentation of the consent shall be made  4160
available to the board upon request.  4161
       (2) For professional services rendered to any other person  4162
authorized to practice pursuant to this chapter, to the extent  4163
allowed by this chapter and rules adopted by the board.  4164
       (O) Under the board's investigative duties described in  4165
this section and subject to division (F) of this section, the  4166
board shall develop and implement a quality intervention program  4167
designed to improve through remedial education the clinical and  4168
communication skills of individuals authorized under this  4169
chapter to practice medicine and surgery, osteopathic medicine  4170
and surgery, and podiatric medicine and surgery. In developing  4171
and implementing the quality intervention program, the board may  4172
H. B. No. 537  Page 146
As Introduced
do all of the following:  4173
       (1) Offer in appropriate cases as determined by the board  4174
an educational and assessment program pursuant to an  4175
investigation the board conducts under this section;  4176
       (2) Select providers of educational and assessment  4177
services, including a quality intervention program panel of case  4178
reviewers;  4179
       (3) Make referrals to educational and assessment service  4180
providers and approve individual educational programs  4181
recommended by those providers. The board shall monitor the  4182
progress of each individual undertaking a recommended individual  4183
educational program.  4184
       (4) Determine what constitutes successful completion of an  4185
individual educational program and require further monitoring of  4186
the individual who completed the program or other action that  4187
the board determines to be appropriate;  4188
       (5) Adopt rules in accordance with Chapter 119. of the  4189
Revised Code to further implement the quality intervention  4190
program.  4191
       An individual who participates in an individual  4192
educational program pursuant to this division shall pay the  4193
financial obligations arising from that educational program.  4194
       (P) The board shall not refuse to issue a license to an  4195
applicant because of a conviction, plea of guilty, judicial  4196
finding of guilt, judicial finding of eligibility for  4197
intervention in lieu of conviction, or the commission of an act  4198
that constitutes a criminal offense, unless the refusal is in  4199
accordance with section 9.79 of the Revised Code.  4200
H. B. No. 537  Page 147
As Introduced
       (Q) A license or certificate to practice or certificate to  4201
recommend issued to an individual under this chapter and an  4202
individual's practice under this chapter in this state are  4203
automatically suspended if the individual's license or  4204
certificate to practice a health care occupation or provide  4205
health care services is suspended, revoked, or surrendered or  4206
relinquished in lieu of discipline by an agency responsible for  4207
authorizing, certifying, or regulating an individual to practice  4208
a health care occupation or provide health care services in this  4209
state or another jurisdiction. The automatic suspension begins  4210
immediately upon entry of the order by the agency and lasts for  4211
ninety days to permit the board to investigate the basis for the  4212
action under this chapter. Continued practice during the  4213
automatic suspension shall be considered practicing without a  4214
license or certificate.  4215
       The board shall notify the individual subject to the  4216
automatic suspension by certified mail or in person in  4217
accordance with section 119.07 of the Revised Code. If an  4218
individual subject to an automatic suspension under this  4219
division fails to make a timely request for an adjudication  4220
under Chapter 119. of the Revised Code, the board is not  4221
required to hold a hearing, but may adopt, by an affirmative  4222
vote of not fewer than six of its members, a final order that  4223
contains the board's findings. In that final order, the board  4224
may order any of the sanctions identified under division (A) or  4225
(B) of this section.  4226
       Sec. 4731.27. (A) As used in this section,  4227
"collaboration," "physician," "standard care arrangement," and  4228
"supervision" have the same meanings as in section 4723.01 of  4229
the Revised Code.  4230
H. B. No. 537  Page 148
As Introduced
        (B) A physician or podiatrist shall enter into a standard  4231
care arrangement with each certified midwife, clinical nurse  4232
specialist, certified nurse-midwife, or certified nurse  4233
practitioner with whom the physician or podiatrist is in  4234
collaboration.  4235
        The collaborating physician or podiatrist shall fulfill  4236
the responsibilities of collaboration, as specified in the  4237
arrangement and in accordance with division (A) of section  4238
4723.431 of the Revised Code. A copy of the standard care  4239
arrangement shall be retained on file by the certified midwife's  4240
or nurse's employer. Prior approval of the standard care  4241
arrangement by the state medical board is not required, but the  4242
board may periodically review it.  4243
        A physician or podiatrist who terminates collaboration  4244
with a certified midwife, certified nurse-midwife, certified  4245
nurse practitioner, or clinical nurse specialist before their  4246
standard care arrangement expires shall give the certified  4247
midwife or nurse the written or electronic notice of termination  4248
required by division (D)(1) of section 4723.431 of the Revised  4249
Code.  4250
        Nothing in this division prohibits a hospital from hiring  4251
a certified midwife, clinical nurse specialist, certified nurse-  4252
midwife, or certified nurse practitioner as an employee and  4253
negotiating standard care arrangements on behalf of the employee  4254
as necessary to meet the requirements of this section. A  4255
standard care arrangement between the hospital's employee and  4256
the employee's collaborating physician is subject to approval by  4257
the medical staff and governing body of the hospital prior to  4258
implementation of the arrangement at the hospital.  4259
        (C) A physician or podiatrist shall cooperate with the  4260
H. B. No. 537  Page 149
As Introduced
board of nursing in any investigation the board conducts with  4261
respect to a certified midwife, clinical nurse specialist,  4262
certified nurse-midwife, or certified nurse practitioner who  4263
collaborates with the physician or podiatrist or with respect to  4264
a certified registered nurse anesthetist who practices with the  4265
supervision of the physician or podiatrist.  4266
       Section 2. That existing sections 3701.351, 3702.30,  4267
4723.01, 4723.02, 4723.03, 4723.06, 4723.07, 4723.08, 4723.271,  4268
4723.28, 4723.282, 4723.33, 4723.34, 4723.341, 4723.35, 4723.41,  4269
4723.43, 4723.431, 4723.432, 4723.481, 4723.483, 4723.487,  4270
4723.488, 4723.4810, 4723.4811, 4723.50, 4723.91, 4723.99,  4271
4731.22, and 4731.27 of the Revised Code are hereby repealed.  4272
       Section 3. Sections 4723.54 and 4724.02 of the Revised  4273
Code, as enacted by this act, take effect January 1, 2028.  4274
       Section 4. The General Assembly, applying the principle  4275
stated in division (B) of section 1.52 of the Revised Code that  4276
amendments are to be harmonized if reasonably capable of  4277
simultaneous operation, finds that the following sections,  4278
presented in this act as composites of the sections as amended  4279
by the acts indicated, are the resulting versions of the  4280
sections in effect prior to the effective date of the sections  4281
as presented in this act:  4282
       Section 4723.08 of the Revised Code as amended by both  4283
H.B. 509 and S.B. 131 of the 134th General Assembly.  4284
       Section 4723.431 of the Revised Code as amended by both  4285
H.B. 497 and S.B. 196 of the 135th General Assembly.  4286
       Section 4723.481 of the Revised Code as amended by H.B. 33  4287
of the 135th General Assembly and by H.B. 110 and H.B. 509 of  4288
the 134th General Assembly.  4289