SB 438

As Introduced
136th General Assembly
   Regular Session  S. B. No. 438
       2025-2026
  Senator Reynolds
  To amend sections 3701.351, 3702.30, 3702.301,  1
  4723.01, 4723.02, 4723.03, 4723.06, 4723.07,  2
  4723.08, 4723.271, 4723.28, 4723.282, 4723.33,  3
  4723.34, 4723.341, 4723.35, 4723.41, 4723.43,  4
  4723.431, 4723.432, 4723.481, 4723.483,  5
  4723.487, 4723.488, 4723.4810, 4723.4811,  6
  4723.50, 4723.91, 4723.99, 4731.22, and 4731.27  7
  and to enact sections 5.2324, 3702.35, 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, 3702.301,  19
4723.01, 4723.02, 4723.03, 4723.06, 4723.07, 4723.08, 4723.271,  20
4723.28, 4723.282, 4723.33, 4723.34, 4723.341, 4723.35, 4723.41,  21
S. B. No. 438  Page 2
As Introduced
4723.43, 4723.431, 4723.432, 4723.481, 4723.483, 4723.487,  22
4723.488, 4723.4810, 4723.4811, 4723.50, 4723.91, 4723.99,  23
4731.22, and 4731.27 be amended and sections 5.2324, 3702.35,  24
4723.53, 4723.54, 4723.55, 4723.551, 4723.56, 4723.57, 4723.58,  25
4723.581, 4723.582, 4723.583, 4723.584, 4723.59, 4723.60,  26
4724.01, 4724.02, 4724.03, 4724.04, 4724.05, 4724.06, 4724.07,  27
4724.08, 4724.09, 4724.10, 4724.11, 4724.12, 4724.13, 4724.14,  28
4724.15, 4724.16, and 4724.99 of the Revised Code be enacted to  29
read as 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
does not permit a psychologist to admit a patient to a hospital  51
S. B. No. 438  Page 3
As Introduced
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
that may be legally performed by a licensed psychologist.  81
S. B. No. 438  Page 4
As Introduced
       Sec. 3702.30. (A) As used in this sectionsections 3702.30  82
to 3702.511 of the Revised Code:  83
       (1) "Ambulatory surgical facility" means a facility in  84
which surgical services are provided to patients who do not  85
require hospitalization for inpatient care, the duration of  86
services for any patient does not extend beyond twenty-four  87
hours after the patient's admission, and to which any of the  88
following apply:  89
       (a) The surgical services are provided in a building that  90
is separate from another building in which inpatient care is  91
provided, regardless of whether the separate building is part of  92
the same organization as the building in which inpatient care is  93
provided.  94
       (b) The surgical services are provided within a building  95
in which inpatient care is provided and the entity that operates  96
the portion of the building where the surgical services are  97
provided is not the entity that operates the remainder of the  98
building.  99
       (c) The facility is held out to any person or government  100
entity as an ambulatory surgical facility or similar facility by  101
means of signage, advertising, or other promotional efforts.  102
       "Ambulatory surgical facility" does not include a  103
freestanding birthing center, a hospital emergency department,  104
hospital provider-based department that is otherwise licensed  105
under Chapter 3722. of the Revised Code, or an office of a  106
physician, podiatrist, or dentist.  107
       (2) "Freestanding birthing center" means an independent  108
health care facility, separate from a hospital licensed under  109
Chapter 3722. of the Revised Code, that provides prenatal,  110
S. B. No. 438  Page 5
As Introduced
labor, delivery, and postpartum care for low-risk pregnancies.  111
       (3) "Health care facility" means any of the following:  112
       (a) An ambulatory surgical facility;  113
       (b) A freestanding dialysis center;  114
       (c) A freestanding inpatient rehabilitation facility;  115
       (d) A freestanding birthing center;  116
       (e) A freestanding radiation therapy center;  117
       (f) A freestanding or mobile diagnostic imaging center.  118
       (B) By rule adopted in accordance with sections 3702.12  119
and 3702.13 of the Revised Code, the director of health shall  120
establish quality standards for health care facilities. The  121
standards may incorporate accreditation standards or other  122
quality standards established by any entity recognized by the  123
director.  124
       (1) In the case of an ambulatory surgical facility, the  125
standards shall require the ambulatory surgical facility to  126
maintain an infection control program. The purposes of the  127
program are to minimize infections and communicable diseases and  128
facilitate a functional and sanitary environment consistent with  129
standards of professional practice. To achieve these purposes,  130
ambulatory surgical facility staff managing the program shall  131
create and administer a plan designed to prevent, identify, and  132
manage infections and communicable diseases; ensure that the  133
program is directed by a qualified professional trained in  134
infection control; ensure that the program is an integral part  135
of the ambulatory surgical facility's quality assessment and  136
performance improvement program; and implement in an expeditious  137
manner corrective and preventive measures that result in  138
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As Introduced
improvement.  139
       (2) In the case of a licensed freestanding birthing  140
center, the standards shall require both of the following:  141
       (a) At least one of the following to attend each birth:  142
       (i) A physician licensed under Chapter 4731. of the  143
Revised Code to practice medicine and surgery or osteopathic  144
medicine and surgery;  145
       (ii) A certified nurse-midwife licensed under Chapter  146
4723. of the Revised Code;  147
       (iii) A certified midwife licensed under Chapter 4723. of  148
the Revised Code;  149
       (iv) A licensed midwife licensed under Chapter 4724. of  150
the Revised Code.  151
       (b) That each licensed freestanding birthing center have a  152
director of patient services who is one of the following:  153
       (i) A physician licensed under Chapter 4731. of the  154
Revised Code to practice medicine and surgery or osteopathic  155
medicine and surgery;  156
       (ii) A certified nurse-midwife licensed under Chapter  157
4723. of the Revised Code who has contracted with a  158
collaborating physician;  159
       (iii) A certified midwife licensed under Chapter 4723. of  160
the Revised Code who has contracted with a collaborating  161
physician.  162
       (C) Every ambulatory surgical facility shall require that  163
each physician who practices at the facility comply with all  164
relevant provisions in the Revised Code that relate to the  165
S. B. No. 438  Page 7
As Introduced
obtaining of informed consent from a patient.  166
       (D) The director shall issue a license to each health care  167
facility that makes application for a license and demonstrates  168
to the director that it meets the quality standards established  169
by the rules adopted under division (B) of this section and  170
satisfies the informed consent compliance requirements specified  171
in division (C) of this section.  172
       (E)(1) Except as provided in division (H) of this section  173
and in section 3702.301 of the Revised Code, no health care  174
facility shall operate without a license issued under this  175
section.  176
       The general assembly does not intend for the provisions of  177
this section or section 3702.301 of the Revised Code that  178
establish health care facility licensing requirements or  179
exemptions to have an effect on any third-party payments that  180
may be available for the services provided by either a licensed  181
health care facility or an entity exempt from licensure.  182
       (2) If the department of health finds that a physician who  183
practices at a health care facility is not complying with any  184
provision of the Revised Code related to the obtaining of  185
informed consent from a patient, the department shall report its  186
finding to the state medical board, the physician, and the  187
health care facility.  188
       (3) Division (E)(2) of this section does not create, and  189
shall not be construed as creating, a new cause of action or  190
substantive legal right against a health care facility and in  191
favor of a patient who allegedly sustains harm as a result of  192
the failure of the patient's physician to obtain informed  193
consent from the patient prior to performing a procedure on or  194
S. B. No. 438  Page 8
As Introduced
otherwise caring for the patient in the health care facility.  195
       (F) The rules adopted under division (B) of this section  196
shall include all of the following:  197
       (1) Provisions governing application for, renewal,  198
suspension, and revocation of a license under this section;  199
       (2) Provisions governing orders issued pursuant to section  200
3702.32 of the Revised Code for a health care facility to cease  201
its operations or to prohibit certain types of services provided  202
by a health care facility;  203
       (3) Provisions governing the imposition under section  204
3702.32 of the Revised Code of civil penalties for violations of  205
this section or the rules adopted under this section, including  206
a scale for determining the amount of the penalties;  207
       (4) Provisions specifying the form inspectors must use  208
when conducting inspections of ambulatory surgical facilities.  209
       (G) An ambulatory surgical facility that performs or  210
induces abortions shall comply with section 3701.791 of the  211
Revised Code.  212
       (H) The following entities are not required to obtain a  213
license as a freestanding diagnostic imaging center issued under  214
this section:  215
       (1) A hospital registered under section 3701.07 of the  216
Revised Code that provides diagnostic imaging;  217
       (2) An entity that is reviewed as part of a hospital  218
accreditation or certification program and that provides  219
diagnostic imaging;  220
       (3) An ambulatory surgical facility that provides  221
S. B. No. 438  Page 9
As Introduced
diagnostic imaging in conjunction with or during any portion of  222
a surgical procedure.  223
       Sec. 3702.301. (A) Except as provided in division (C) of  224
this section, a freestanding birthing center is not required to  225
obtain a license under section 3702.30 of the Revised Code if  226
all of the following are the case:  227
       (1) A religious denomination, sect, or group owns and  228
operates the center.  229
       (2) Requiring that the center be licensed significantly  230
abridges or infringes on the religious practices or beliefs of  231
that religious denomination, sect, or group.  232
       (3) The center provides care only during low-risk  233
pregnancy, delivery, and the immediate postpartum period  234
exclusively to women who  235
       are members of that religious denomination, sect, or  236
group.  237
       (4) The center monitors and evaluates the care provided to  238
its patients in accordance with at least the minimum patient  239
safety monitoring and evaluation requirements established in  240
rules adopted under division (D) of this section.  241
       (5) The center meets the quality assessment and  242
improvement standards established in rules adopted under  243
division (D) of this section.  244
       (B) If the director determines that a freestanding  245
birthing center is no longer exempt from the requirement to  246
obtain a license under section 3702.30 of the Revised Code  247
because the center ceases to comply with division (A)(4) or (5)  248
of this section, the director may order the center to come into  249
S. B. No. 438  Page 10
As Introduced
compliance. In the order, the director may do all of the  250
following:  251
       (1) Identify what the center is not in compliance with and  252
what the center needs to do to come into compliance;  253
       (2) Require that the center come into compliance within a  254
period of time specified in the order;  255
       (3) Require that the center provide the director a written  256
notice within a period of time specified in the order that  257
contains all of the following:  258
       (a) Certification that the center has come into  259
compliance;  260
       (b) The signature of the center's administrator or medical  261
director and certification that the administrator or medical  262
director, whichever signs the notice, is the center's authorized  263
representative;  264
       (c) Certification that the information contained in the  265
notice and in any accompanying documentation is true and  266
accurate;  267
       (d) Any other information or documentation that the  268
director may require to verify that the center has come into  269
compliance.  270
       (C) If the director issues an order to a freestanding  271
birthing center under division (B) of this section and the  272
center fails to comply with the order within the time specified  273
in the order, the director may issue a second order that  274
requires the center to cease operations until the center obtains  275
a license under section 3702.30 of the Revised Code.  276
       (D) The director of health shall adopt rules in accordance  277
S. B. No. 438  Page 11
As Introduced
with Chapter 119. of the Revised Code as necessary to implement  278
this section. The rules shall establish all of the following:  279
       (1) Minimum patient safety monitoring and evaluation  280
requirements;  281
       (2) Quality assessment and improvement standards;,  282
including standards that require both of the following:  283
       (a) At least one of the following to attend each birth:  284
       (i) A physician licensed under Chapter 4731. of the  285
Revised Code to practice medicine and surgery or osteopathic  286
medicine and surgery;  287
       (ii) A certified nurse-midwife licensed under Chapter  288
4723. of the Revised Code;  289
       (iii) A certified midwife licensed under Chapter 4723. of  290
the Revised Code;  291
       (iv) A licensed midwife licensed under Chapter 4724. of  292
the Revised Code;  293
       (v) A traditional midwife as defined in section 4724.01 of  294
the Revised Code.  295
       (b) That each center have a director of patient services  296
who is one of the following:  297
       (i) A physician licensed under Chapter 4731. of the  298
Revised Code to practice medicine and surgery or osteopathic  299
medicine and surgery;  300
       (ii) A certified nurse-midwife licensed under Chapter  301
4723. of the Revised Code;  302
       (iii) A registered nurse licensed under Chapter 4723. of  303
the Revised Code;  304
S. B. No. 438  Page 12
As Introduced
       (iv) A certified midwife licensed under Chapter 4723. of  305
the Revised Code;  306
       (v) A licensed midwife licensed under Chapter 4724. of the  307
Revised Code;  308
       (vi) A traditional midwife as defined in section 4724.01  309
of the Revised Code.  310
       (3) Procedures for determining whether freestanding  311
birthing centers are in compliance with the rules.  312
       Sec. 3702.35. (A) Each freestanding birthing center shall  313
have a written plan for the transfer of a mother or a newborn to  314
a hospital in the event of medical complications, emergency  315
situations, or as the need arises.  316
       (B) No licensed freestanding birthing center shall be  317
required to establish a written transfer agreement with a  318
hospital if it is both of the following:  319
       (1) Accredited by the commission for the accreditation of  320
birth centers or its successor organization;  321
       (2) Located within thirty miles of a hospital subject to  322
the provisions of the "Emergency Medical Treatment and Labor  323
Act," 42 U.S.C. 1395dd.  324
       (C) A licensed freestanding birthing center that is not  325
accredited by the commission for the accreditation of birth  326
centers or its successor organization shall have a written  327
transfer agreement with a local hospital.  328
       (D) No freestanding birthing center that is exempt from  329
licensure under section 3702.301 of the Revised Code shall be  330
required to establish a written transfer agreement with a  331
hospital.  332
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As Introduced
       Sec. 4723.01. As used in this chapter:  333
       (A) "Registered nurse" means an individual who holds a  334
current, valid license issued under this chapter that authorizes  335
the practice of nursing as a registered nurse.  336
       (B) "Practice of nursing as a registered nurse" means  337
providing to individuals and groups nursing care requiring  338
specialized knowledge, judgment, and skill derived from the  339
principles of biological, physical, behavioral, social, and  340
nursing sciences. Such nursing care includes:  341
       (1) Identifying patterns of human responses to actual or  342
potential health problems amenable to a nursing regimen;  343
       (2) Executing a nursing regimen through the selection,  344
performance, management, and evaluation of nursing actions;  345
       (3) Assessing health status for the purpose of providing  346
nursing care;  347
       (4) Providing health counseling and health teaching;  348
       (5) Administering medications, treatments, and executing  349
regimens authorized by an individual who is authorized to  350
practice in this state and is acting within the course of the  351
individual's professional practice;  352
       (6) Teaching, administering, supervising, delegating, and  353
evaluating nursing practice.  354
       (C) "Nursing regimen" may include preventative,  355
restorative, and health-promotion activities.  356
       (D) "Assessing health status" means the collection of data  357
through nursing assessment techniques, which may include  358
interviews, observation, and physical evaluations for the  359
S. B. No. 438  Page 14
As Introduced
purpose of providing nursing care.  360
       (E) "Licensed practical nurse" means an individual who  361
holds a current, valid license issued under this chapter that  362
authorizes the practice of nursing as a licensed practical  363
nurse.  364
       (F) "The practice of nursing as a licensed practical  365
nurse" means providing to individuals and groups nursing care  366
requiring the application of basic knowledge of the biological,  367
physical, behavioral, social, and nursing sciences at the  368
direction of a registered nurse or any of the following who is  369
authorized to practice in this state: a physician, physician  370
assistant, dentist, podiatrist, optometrist, or chiropractor.  371
Such nursing care includes:  372
       (1) Observation, patient teaching, and care in a diversity  373
of health care settings;  374
       (2) Contributions to the planning, implementation, and  375
evaluation of nursing;  376
       (3) Administration of medications and treatments  377
authorized by an individual who is authorized to practice in  378
this state and is acting within the course of the individual's  379
professional practice;  380
       (4) Administration to an adult of intravenous therapy  381
authorized by an individual who is authorized to practice in  382
this state and is acting within the course of the individual's  383
professional practice, on the condition that the licensed  384
practical nurse is authorized under section 4723.18 or 4723.181  385
of the Revised Code to perform intravenous therapy and performs  386
intravenous therapy only in accordance with those sections;  387
       (5) Delegation of nursing tasks as directed by a  388
S. B. No. 438  Page 15
As Introduced
registered nurse;  389
       (6) Teaching nursing tasks to licensed practical nurses  390
and individuals to whom the licensed practical nurse is  391
authorized to delegate nursing tasks as directed by a registered  392
nurse.  393
       (G) "Certified registered nurse anesthetist" means an  394
advanced practice registered nurse who holds a current, valid  395
license issued under this chapter and is designated as a  396
certified registered nurse anesthetist in accordance with  397
section 4723.42 of the Revised Code and rules adopted by the  398
board of nursing.  399
       (H) "Clinical nurse specialist" means an advanced practice  400
registered nurse who holds a current, valid license issued under  401
this chapter and is designated as a clinical nurse specialist in  402
accordance with section 4723.42 of the Revised Code and rules  403
adopted by the board of nursing.  404
       (I) "Certified nurse-midwife" means an advanced practice  405
registered nurse who holds a current, valid license issued under  406
this chapter and is designated as a certified nurse-midwife in  407
accordance with section 4723.42 of the Revised Code and rules  408
adopted by the board of nursing. A certified nurse-midwife does  409
not include a certified midwife, licensed midwife, or  410
traditional midwife.  411
       (J) "Certified nurse practitioner" means an advanced  412
practice registered nurse who holds a current, valid license  413
issued under this chapter and is designated as a certified nurse  414
practitioner in accordance with section 4723.42 of the Revised  415
Code and rules adopted by the board of nursing.  416
       (K) "Physician" means an individual authorized under  417
S. B. No. 438  Page 16
As Introduced
Chapter 4731. of the Revised Code to practice medicine and  418
surgery or osteopathic medicine and surgery.  419
       (L) "Collaboration" or "collaborating" means the  420
following:  421
       (1) In the case of a clinical nurse specialist or a  422
certified nurse practitioner, that one or more podiatrists  423
acting within the scope of practice of podiatry in accordance  424
with section 4731.51 of the Revised Code and with whom the nurse  425
has entered into a standard care arrangement or one or more  426
physicians with whom the nurse has entered into a standard care  427
arrangement are continuously available to communicate with the  428
clinical nurse specialist or certified nurse practitioner either  429
in person or by electronic communication;  430
       (2) In the case of a certified nurse-midwife or certified  431
midwife, that one or more physicians with whom the certified  432
nurse-midwife or certified midwife has entered into a standard  433
care arrangement are continuously available to communicate with  434
the certified nurse-midwife or certified midwife either in  435
person or by electronic communication.  436
       (M) "Supervision," as it pertains to a certified  437
registered nurse anesthetist, means that the certified  438
registered nurse anesthetist is under the direction of a  439
podiatrist acting within the podiatrist's scope of practice in  440
accordance with section 4731.51 of the Revised Code, a dentist  441
acting within the dentist's scope of practice in accordance with  442
Chapter 4715. of the Revised Code, or a physician, and, when  443
administering anesthesia, the certified registered nurse  444
anesthetist is in the immediate presence of the podiatrist,  445
dentist, or physician.  446
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As Introduced
       (N) "Standard care arrangement" means a written, formal  447
guide for planning and evaluating a patient's health care that  448
is developed by one or more collaborating physicians or  449
podiatrists and a clinical nurse specialist, certified nurse-  450
midwife, certified midwife, or certified nurse practitioner and  451
meets the requirements of section 4723.431 of the Revised Code.  452
       (O) "Advanced practice registered nurse" means an  453
individual who holds a current, valid license issued under this  454
chapter that authorizes the practice of nursing as an advanced  455
practice registered nurse and is designated as any of the  456
following:  457
       (1) A certified registered nurse anesthetist;  458
       (2) A clinical nurse specialist;  459
       (3) A certified nurse-midwife;  460
       (4) A certified nurse practitioner.  461
       (P) "Practice of nursing as an advanced practice  462
registered nurse" means providing to individuals and groups  463
nursing care that requires knowledge and skill obtained from  464
advanced formal education, training, and clinical experience.  465
Such nursing care includes the care described in section 4723.43  466
of the Revised Code.  467
       (Q) "Dialysis care" means the care and procedures that a  468
dialysis technician or dialysis technician intern is authorized  469
to provide and perform, as specified in section 4723.72 of the  470
Revised Code.  471
       (R) "Dialysis technician" means an individual who holds a  472
current, valid certificate to practice as a dialysis technician  473
issued under section 4723.75 of the Revised Code.  474
S. B. No. 438  Page 18
As Introduced
       (S) "Dialysis technician intern" means an individual who  475
has not passed the dialysis technician certification examination  476
required by section 4723.751 of the Revised Code, but who has  477
successfully completed a dialysis training program approved by  478
the board of nursing under section 4723.74 of the Revised Code  479
within the previous eighteen months.  480
       (T) "Certified community health worker" means an  481
individual who holds a current, valid certificate as a community  482
health worker issued under section 4723.85 of the Revised Code.  483
       (U) "Medication aide" means an individual who holds a  484
current, valid certificate issued under this chapter that  485
authorizes the individual to administer medication in accordance  486
with section 4723.67 of the Revised Code;  487
       (V) "Nursing specialty" means a specialty in practice as a  488
certified registered nurse anesthetist, clinical nurse  489
specialist, certified nurse-midwife, or certified nurse  490
practitioner.  491
       (W) "Physician assistant" means an individual who is  492
licensed to practice as a physician assistant under Chapter  493
4730. of the Revised Code.  494
       (X) "Certified midwife" means an individual who is  495
licensed under section 4723.56 of the Revised Code and engages  496
in one or more of the activities described in that section. A  497
certified midwife does not include a certified nurse-midwife,  498
licensed midwife, or traditional midwife.  499
       (Y) "Licensed midwife" has the same meaning as in section  500
4724.01 of the Revised Code. A licensed midwife does not include  501
a certified nurse-midwife, certified midwife, or traditional  502
midwife.  503
S. B. No. 438  Page 19
As Introduced
       (Z) "Traditional midwife" has the same meaning as in  504
section 4724.01 of the Revised Code.  505
       Sec. 4723.02. The board of nursing shall assume and  506
exercise all the powers and perform all the duties conferred and  507
imposed on it by this chapter.  508
       The board shall consist of thirteen fifteen members who  509
shall be citizens of the United States and residents of Ohio.  510
Eight members shall be registered nurses, each of whom shall be  511
a graduate of an approved program of nursing education that  512
prepares persons for licensure as a registered nurse, shall hold  513
a currently active license issued under this chapter to practice  514
nursing as a registered nurse, and shall have been actively  515
engaged in the practice of nursing as a registered nurse for the  516
five years immediately preceding the member's initial  517
appointment to the board. Of the eight members who are  518
registered nurses, at least two shall hold a current, valid  519
license issued under this chapter that authorizes the practice  520
of nursing as an advanced practice registered nurse. Four  521
members shall be licensed practical nurses, each of whom shall  522
be a graduate of an approved program of nursing education that  523
prepares persons for licensure as a practical nurse, shall hold  524
a currently active license issued under this chapter to practice  525
nursing as a licensed practical nurse, and shall have been  526
actively engaged in the practice of nursing as a licensed  527
practical nurse for the five years immediately preceding the  528
member's initial appointment to the board. One member shall be a  529
certified nurse-midwife or a certified midwife practicing in an  530
urban setting. One member shall be a certified nurse-midwife or  531
a certified midwife practicing in a rural setting. One member  532
shall represent the interests of consumers of health care.  533
Neither this member nor any person in the member's immediate  534
S. B. No. 438  Page 20
As Introduced
family shall be a member of or associated with a health care  535
provider or profession or shall have a financial interest in the  536
delivery or financing of health care. Representation of nursing  537
service and nursing education and of the various geographical  538
areas of the state shall be considered in making appointments.  539
        As the term of any member of the board expires, a  540
successor shall be appointed who has the qualifications the  541
vacancy requires. Terms of office shall be for four years,  542
commencing on the first day of January and ending on the thirty-  543
first day of December.  544
        A current or former board member who has served not more  545
than one full term or one full term and not more than thirty  546
months of another term may be reappointed for one additional  547
term.  548
        Each member shall hold office from the date of appointment  549
until the end of the term for which the member was appointed.  550
The term of a member shall expire if the member ceases to meet  551
any requirement of this section for the member's position on the  552
board. Any member appointed to fill a vacancy occurring prior to  553
the expiration of the term for which the member's predecessor  554
was appointed shall hold office for the remainder of such term.  555
Any member shall continue in office subsequent to the expiration  556
date of the member's term until the member's successor takes  557
office, or until a period of sixty days has elapsed, whichever  558
occurs first.  559
        Nursing organizations of this state may each submit to the  560
governor the names of not more than five nominees for each  561
position to be filled on the board. From the names so submitted  562
or from others, at the governor's discretion, the governor with  563
the advice and consent of the senate shall make such  564
S. B. No. 438  Page 21
As Introduced
appointments.  565
       Any member of the board may be removed by the governor for  566
neglect of any duty required by law or for incompetency or  567
unprofessional or dishonorable conduct, after a hearing as  568
provided in Chapter 119. of the Revised Code.  569
       Seven Eight members of the board, including at least four  570
registered nurses and at least one licensed practical nurse,  571
shall at all times constitute a quorum.  572
       Each member of the board shall receive an amount fixed  573
pursuant to division (J) of section 124.15 of the Revised Code  574
for each day in attendance at board meetings and in discharge of  575
official duties, and in addition thereto, necessary expense  576
incurred in the performance of such duties.  577
       The board shall elect one of its nurse members as  578
president and one as vice-president. The board shall elect one  579
of its registered nurse members to serve as the supervising  580
member for disciplinary matters.  581
       The board may establish advisory groups to serve in  582
consultation with the board or the executive director. Each  583
advisory group shall be given a specific charge in writing and  584
shall report to the board. Members of advisory groups shall  585
serve without compensation but shall receive their actual and  586
necessary expenses incurred in the performance of their official  587
duties.  588
       Sec. 4723.03. (A) No person shall engage in the practice  589
of nursing as a registered nurse, represent the person as being  590
a registered nurse, or use the title "registered nurse," the  591
initials "R.N.," or any other title implying that the person is  592
a registered nurse, for a fee, salary, or other consideration,  593
S. B. No. 438  Page 22
As Introduced
or as a volunteer, without holding a current, valid license as a  594
registered nurse under this chapter.  595
       (B) No person shall knowingly do any of the following  596
without holding a current, valid license to practice nursing as  597
an advanced practice registered nurse issued under this chapter:  598
       (1) Engage in the practice of nursing as an advanced  599
practice registered nurse;  600
       (2) Represent the person as being an advanced practice  601
registered nurse;  602
       (3) Use the title "advanced practice registered nurse,"  603
the initials "A.P.R.N.," or any other title implying that the  604
person is an advanced practice registered nurse, for a fee,  605
salary, or other consideration, or as a volunteer.  606
       (C) No person who is not otherwise authorized to do so  607
shall knowingly prescribe or personally furnish drugs or  608
therapeutic devices without holding a current, valid license to  609
practice nursing as an advanced practice registered nurse issued  610
under this chapter and being designated as a clinical nurse  611
specialist, certified nurse-midwife, or certified nurse  612
practitioner under section 4723.42 of the Revised Code;  613
       (D) No person shall engage in the practice of nursing as a  614
licensed practical nurse, represent the person as being a  615
licensed practical nurse, or use the title "licensed practical  616
nurse," the initials "L.P.N.," or any other title implying that  617
the person is a licensed practical nurse, for a fee, salary, or  618
other consideration, or as a volunteer, without holding a  619
current, valid license as a practical nurse under this chapter.  620
       (E) No person shall use the titles or initials "graduate  621
nurse," "G.N.," "professional nurse," "P.N.," "graduate  622
S. B. No. 438  Page 23
As Introduced
practical nurse," "G.P.N.," "practical nurse," "P.N.," "trained  623
nurse," "T.N.," or any other statement, title, or initials that  624
would imply or represent to the public that the person is  625
authorized to practice nursing in this state, except as follows:  626
       (1) A person licensed under this chapter to practice  627
nursing as a registered nurse may use that title and the  628
initials "R.N.";  629
       (2) A person licensed under this chapter to practice  630
nursing as a licensed practical nurse may use that title and the  631
initials "L.P.N.";  632
       (3) A person licensed under this chapter to practice  633
nursing as an advanced practice registered nurse and designated  634
as a certified registered nurse anesthetist may use that title  635
or the initials "A.P.R.N.-C.R.N.A.";  636
       (4) A person licensed under this chapter to practice  637
nursing as an advanced practice registered nurse and designated  638
as a clinical nurse specialist may use that title or the  639
initials "A.P.R.N.-C.N.S.";  640
       (5) A person licensed under this chapter to practice  641
nursing as an advanced practice registered nurse and designated  642
as a certified nurse-midwife may use that title or the initials  643
"A.P.R.N.-C.N.M.";  644
       (6) A person licensed under this chapter to practice  645
nursing as an advanced practice registered nurse and designated  646
as a certified nurse practitioner may use that title or the  647
initials "A.P.R.N.-C.N.P.";  648
       (7) A person licensed under this chapter to practice  649
nursing as an advanced practice registered nurse may use the  650
title "advanced practice registered nurse" or the initials  651
S. B. No. 438  Page 24
As Introduced
"A.P.R.N."  652
       (F) No person shall employ a person not licensed as a  653
registered nurse under this chapter to engage in the practice of  654
nursing as a registered nurse.  655
       No person shall knowingly employ a person not licensed as  656
an advanced practice registered nurse under this chapter to  657
engage in the practice of nursing as an advanced practice  658
registered nurse.  659
       No person shall employ a person not licensed as a  660
practical nurse under this chapter to engage in the practice of  661
nursing as a licensed practical nurse.  662
       (G) No person shall sell or fraudulently obtain or furnish  663
any nursing diploma, license, certificate, renewal, or record,  664
or aid or abet such acts.  665
       (H)(1) No person shall knowingly use the title "certified  666
nurse-midwife," the initials "C.N.M.," or any other title  667
implying that the person is a certified nurse-midwife without  668
holding a current, valid license as a certified nurse-midwife  669
under this chapter.  670
       (2) No person shall knowingly use the title "certified  671
midwife," the initials "C.M.," or any other title implying that  672
the person is a certified midwife without holding a current,  673
valid license as a certified midwife under this chapter.  674
       Sec. 4723.06. (A) The board of nursing shall:  675
       (1) Administer and enforce the provisions of this chapter,  676
including the taking of disciplinary action for violations of  677
section 4723.28 of the Revised Code, any other provisions of  678
this chapter, or rules adopted under this chapter;  679
S. B. No. 438  Page 25
As Introduced
       (2) Develop criteria that an applicant must meet to be  680
eligible to sit for the examination for licensure to practice as  681
a registered nurse or as a licensed practical nurse;  682
       (3) Issue and renew nursing licenses, certified midwife  683
licenses, dialysis technician certificates, medication aide  684
certificates, and community health worker certificates, as  685
provided in this chapter;  686
       (4) Define the minimum educational standards for the  687
schools and programs of registered nursing and practical nursing  688
in this state;  689
       (5) Survey, inspect, and grant full approval to  690
prelicensure nursing education programs in this state that meet  691
the standards established by rules adopted under section 4723.07  692
of the Revised Code. Prelicensure nursing education programs  693
include, but are not limited to, diploma, associate degree,  694
baccalaureate degree, master's degree, and doctor of nursing  695
programs leading to initial licensure to practice nursing as a  696
registered nurse and practical nurse programs leading to initial  697
licensure to practice nursing as a licensed practical nurse.  698
       (6) Grant conditional approval, by a vote of a quorum of  699
the board, to a new prelicensure nursing education program or a  700
program that is being reestablished after having ceased to  701
operate, if the program meets and maintains the minimum  702
standards of the board established by rules adopted under  703
section 4723.07 of the Revised Code. If the board does not grant  704
conditional approval, it shall hold an adjudication under  705
Chapter 119. of the Revised Code to consider conditional  706
approval of the program. If the board grants conditional  707
approval, at the first meeting following completion of the  708
survey process required by division (A)(5) of this section, the  709
S. B. No. 438  Page 26
As Introduced
board shall determine whether to grant full approval to the  710
program. If the board does not grant full approval or if it  711
appears that the program has failed to meet and maintain  712
standards established by rules adopted under section 4723.07 of  713
the Revised Code, the board shall hold an adjudication under  714
Chapter 119. of the Revised Code to consider the program. Based  715
on results of the adjudication, the board may continue or  716
withdraw conditional approval, or grant full approval.  717
       (7) Place on provisional approval, for a period of time  718
specified by the board, a prelicensure nursing education program  719
that has ceased to meet and maintain the minimum standards of  720
the board established by rules adopted under section 4723.07 of  721
the Revised Code. Prior to or at the end of the period, the  722
board shall reconsider whether the program meets the standards  723
and shall grant full approval if it does. If it does not, the  724
board may withdraw approval, pursuant to an adjudication under  725
Chapter 119. of the Revised Code.  726
       (8) Approve continuing education programs and courses  727
under standards established in rules adopted under sections  728
4723.07, 4723.69, 4723.79, and 4723.88 of the Revised Code;  729
       (9) Establish the safe haven program in accordance with  730
sections 4723.35 and 4723.351 of the Revised Code;  731
       (10) Establish the practice intervention and improvement  732
program in accordance with section 4723.282 of the Revised Code;  733
       (11) Grant approval to the course of study in advanced  734
pharmacology and related topics described in section 4723.482 or  735
4723.551 of the Revised Code;  736
       (12) Make an annual edition of the exclusionary formulary  737
established in rules adopted under section 4723.50 of the  738
S. B. No. 438  Page 27
As Introduced
Revised Code available to the public by electronic means and, as  739
soon as possible after any revision of the formulary becomes  740
effective, make the revision available to the public by  741
electronic means;  742
       (13) Approve under section 4723.46 of the Revised Code  743
national certifying organizations for examination and licensure  744
of advanced practice registered nurses, which may include  745
separate organizations for each nursing specialty;  746
       (14) Provide guidance and make recommendations to the  747
general assembly, the governor, state agencies, and the federal  748
government with respect to the regulation of the practice of  749
nursing and the enforcement of this chapter;  750
       (15) Make an annual report to the governor, which shall be  751
open for public inspection;  752
       (16) Maintain and have open for public inspection the  753
following records:  754
       (a) A record of all its meetings and proceedings;  755
       (b) A record of all applicants for, and holders of,  756
licenses and certificates issued by the board under this chapter  757
or in accordance with rules adopted under this chapter. The  758
record shall be maintained in a format determined by the board.  759
       (c) A list of education and training programs approved by  760
the board.  761
       (17) Deny conditional approval to a new prelicensure  762
nursing education program or a program that is being  763
reestablished after having ceased to operate if the program or a  764
person acting on behalf of the program submits or causes to be  765
submitted to the board false, misleading, or deceptive  766
S. B. No. 438  Page 28
As Introduced
statements, information, or documentation in the process of  767
applying for approval of the program. If the board proposes to  768
deny approval of the program, it shall do so pursuant to an  769
adjudication conducted under Chapter 119. of the Revised Code.  770
       (B) The board may fulfill the requirement of division (A)  771
(8) of this section by authorizing persons who meet the  772
standards established in rules adopted under section 4723.07 of  773
the Revised Code to approve continuing education programs and  774
courses. Persons so authorized shall approve continuing  775
education programs and courses in accordance with standards  776
established in rules adopted under section 4723.07 of the  777
Revised Code.  778
       Persons seeking authorization to approve continuing  779
education programs and courses shall apply to the board and pay  780
the appropriate fee established under section 4723.08 of the  781
Revised Code. Authorizations to approve continuing education  782
programs and courses shall expire and may be renewed according  783
to the schedule established in rules adopted under section  784
4723.07 of the Revised Code.  785
       In addition to approving continuing education programs  786
under division (A)(8) of this section, the board may sponsor  787
continuing education activities that are directly related to the  788
statutes and rules the board enforces.  789
       (C)(1) The board may deny conditional approval to a new  790
prelicensure nursing education program or program that is being  791
reestablished after having ceased to operate if the program is  792
controlled by a person who controls or has controlled a program  793
that had its approval withdrawn, revoked, suspended, or  794
restricted by the board or a board of another jurisdiction that  795
is a member of the national council of state boards of nursing.  796
S. B. No. 438  Page 29
As Introduced
If the board proposes to deny approval, it shall do so pursuant  797
to an adjudication conducted under Chapter 119. of the Revised  798
Code.  799
        (2) As used in this division, "control" means any of the  800
following:  801
        (a) Holding fifty per cent or more of the outstanding  802
voting securities or membership interest of a prelicensure  803
nursing education program;  804
        (b) In the case of an unincorporated prelicensure nursing  805
education program, having the right to fifty per cent or more of  806
the program's profits or in the event of a dissolution, fifty  807
per cent or more of the program's assets;  808
        (c) In the case of a prelicensure nursing education  809
program that is a for-profit or not-for-profit corporation,  810
having the contractual authority presently to designate fifty  811
per cent or more of its directors;  812
        (d) In the case of a prelicensure nursing education  813
program that is a trust, having the contractual authority  814
presently to designate fifty per cent or more of its trustees;  815
        (e) Having the authority to direct the management,  816
policies, or investments of a prelicensure nursing education  817
program.  818
        (D)(1) When an action taken by the board under division  819
(A)(6), (7), or (17) or (C)(1) of this section is required to be  820
taken pursuant to an adjudication conducted under Chapter 119.  821
of the Revised Code, the board may, in lieu of an adjudication  822
hearing, enter into a consent agreement to resolve the matter. A  823
consent agreement, when ratified by a vote of a quorum of the  824
board, constitutes the findings and order of the board with  825
S. B. No. 438  Page 30
As Introduced
respect to the matter addressed in the agreement. If the board  826
refuses to ratify a consent agreement, the admissions and  827
findings contained in the agreement are of no effect.  828
       (2) In any instance in which the board is required under  829
Chapter 119. of the Revised Code to give notice to a person  830
seeking approval of a prelicensure nursing education program of  831
an opportunity for a hearing and the person does not make a  832
timely request for a hearing in accordance with section 119.07  833
of the Revised Code, the board is not required to hold a  834
hearing, but may adopt, by a vote of a quorum, a final order  835
that contains the board's findings.  836
       (3) When the board denies or withdraws approval of a  837
prelicensure nursing education program, the board may specify  838
that its action is permanent. A program subject to a permanent  839
action taken by the board is forever ineligible for approval and  840
the board shall not accept an application for the program's  841
reinstatement or approval.  842
       Sec. 4723.07. In accordance with Chapter 119. of the  843
Revised Code, the board of nursing shall adopt and may amend and  844
rescind rules that establish all of the following:  845
       (A) Provisions for the board's government and control of  846
its actions and business affairs;  847
       (B) Subject to section 4723.072 of the Revised Code,  848
minimum standards for nursing education programs that prepare  849
graduates to be licensed under this chapter and procedures for  850
granting, renewing, and withdrawing approval of those programs;  851
       (C) Criteria that applicants for licensure must meet to be  852
eligible to take examinations for licensure;  853
       (D) Standards and procedures for renewal of the licenses  854
S. B. No. 438  Page 31
As Introduced
and certificates issued by the board;  855
       (E) Standards for approval of continuing nursing education  856
programs and courses for registered nurses, advanced practice  857
registered nurses, and licensed practical nurses. The standards  858
may provide for approval of continuing nursing education  859
programs and courses that have been approved by other state  860
boards of nursing or by national accreditation systems for  861
nursing, including, but not limited to, the American nurses'  862
credentialing center and the national association for practical  863
nurse education and service.  864
       (F) Standards that persons must meet to be authorized by  865
the board to approve continuing education programs and courses  866
and a schedule by which that authorization expires and may be  867
renewed;  868
       (G) Requirements, including continuing education  869
requirements, for reactivating inactive licenses or  870
certificates, and for reinstating licenses or certificates that  871
have lapsed;  872
       (H) Conditions that may be imposed for reinstatement of a  873
license or certificate following action taken under section  874
3123.47, 4723.28, 4723.281, 4723.652, or 4723.86 of the Revised  875
Code resulting in a license or certificate suspension;  876
       (I) Criteria for evaluating the qualifications of an  877
applicant for a license to practice nursing as a registered  878
nurse, a license to practice nursing as an advanced practice  879
registered nurse, or a license to practice nursing as a licensed  880
practical nurse for the purpose of issuing the license by the  881
board's endorsement of the applicant's authority to practice  882
issued by the licensing agency of another state;  883
S. B. No. 438  Page 32
As Introduced
       (J) Universal and standard precautions that shall be used  884
by each licensee or certificate holder. The rules shall define  885
and establish requirements for universal and standard  886
precautions that include the following:  887
       (1) Appropriate use of hand washing;  888
       (2) Disinfection and sterilization of equipment;  889
       (3) Handling and disposal of needles and other sharp  890
instruments;  891
       (4) Wearing and disposal of gloves and other protective  892
garments and devices.  893
       (K) Quality assurance standards for advanced practice  894
registered nurses;  895
       (L) Additional criteria for the standard care arrangement  896
required by section 4723.431 of the Revised Code entered into by  897
a certified midwife, clinical nurse specialist, certified nurse-  898
midwife, or certified nurse practitioner and the nurse's  899
collaborating physician or podiatrist;  900
       (M) For purposes of division (B)(31) of section 4723.28 of  901
the Revised Code, the actions, omissions, or other circumstances  902
that constitute failure to establish and maintain professional  903
boundaries with a patient;  904
       (N) Standards and procedures for delegation under section  905
4723.48 of the Revised Code of the authority to administer  906
drugs.  907
       The board may adopt other rules necessary to carry out the  908
provisions of this chapter. The rules shall be adopted in  909
accordance with Chapter 119. of the Revised Code.  910
S. B. No. 438  Page 33
As Introduced
       Sec. 4723.08. (A) The board of nursing may impose fees not  911
to exceed the following limits:  912
       (1) For application for licensure by examination or  913
endorsement to practice nursing as a registered nurse or as a  914
licensed practical nurse submitted under division (A) or (B) of  915
section 4723.09 of the Revised Code, seventy-five dollars;  916
       (2) For application for licensure to practice nursing as  917
an advanced practice registered nurse submitted under division  918
(A) or (B)(2) of section 4723.41 of the Revised Code, one  919
hundred fifty dollars;  920
       (3) For application for a dialysis technician certificate,  921
the amount specified in rules adopted under section 4723.79 of  922
the Revised Code;  923
       (4) For providing, pursuant to division (B) of section  924
4723.271 of the Revised Code, written verification of a nursing  925
license, dialysis technician certificate, medication aide  926
certificate, or community health worker certificate to another  927
jurisdiction, fifteen dollars;  928
       (5) For providing, pursuant to division (A) of section  929
4723.271 of the Revised Code, a replacement copy of a wall  930
certificate suitable for framing as described in that division,  931
twenty-five dollars;  932
       (6) For renewal of a license to practice as a registered  933
nurse or licensed practical nurse, sixty-five dollars;  934
       (7) For renewal of a license to practice as an advanced  935
practice registered nurse, one hundred thirty-five dollars;  936
       (8) For renewal of a dialysis technician certificate, the  937
amount specified in rules adopted under section 4723.79 of the  938
S. B. No. 438  Page 34
As Introduced
Revised Code;  939
       (9) For processing a late application for renewal of a  940
nursing license or dialysis technician certificate, fifty  941
dollars;  942
       (10) For application for authorization to approve  943
continuing education programs and courses from an applicant  944
accredited by a national accreditation system for nursing, five  945
hundred dollars;  946
       (11) For application for authorization to approve  947
continuing education programs and courses from an applicant not  948
accredited by a national accreditation system for nursing, one  949
thousand dollars;  950
       (12) For each year for which authorization to approve  951
continuing education programs and courses is renewed, one  952
hundred fifty dollars;  953
       (13) For application for approval to operate a dialysis  954
training program, the amount specified in rules adopted under  955
section 4723.79 of the Revised Code;  956
       (14) For reinstatement of a lapsed license or certificate  957
issued under this chapter, one hundred dollars except as  958
provided in section 5903.10 of the Revised Code;  959
       (15) For processing a check returned to the board by a  960
financial institution, twenty-five dollars;  961
       (16) The amounts specified in rules adopted under section  962
4723.88 of the Revised Code pertaining to the issuance of  963
certificates to community health workers, including fees for  964
application for a certificate, renewal of a certificate,  965
processing a late application for renewal of a certificate,  966
S. B. No. 438  Page 35
As Introduced
reinstatement of a lapsed certificate, application for approval  967
of a community health worker training program for community  968
health workers, and renewal of the approval of a training  969
program for community health workers;  970
       (17) For application for licensure to practice as a  971
certified midwife, an amount equal to the fee for licensure to  972
practice as an advanced practice registered nurse;  973
       (18) For renewal of a license to practice as a certified  974
midwife, an amount equal to the fee for renewal of a license to  975
practice as an advanced practice registered nurse.  976
       (B) Each quarter, for purposes of transferring funds under  977
section 4743.05 of the Revised Code to the nurse education  978
assistance fund created in section 3333.28 of the Revised Code,  979
the board of nursing shall certify to the director of budget and  980
management the number of licenses renewed under this chapter  981
during the preceding quarter and the amount equal to that number  982
times five dollars.  983
       (C) The board may charge a participant in a board-  984
sponsored continuing education activity an amount not exceeding  985
fifteen dollars for each activity.  986
       (D) The board may contract for services pertaining to the  987
process of providing written verification of a license or  988
certificate when the verification is performed for purposes  989
other than providing verification to another jurisdiction. The  990
contract may include provisions pertaining to the collection of  991
the fee charged for providing the written verification. As part  992
of these provisions, the board may permit the contractor to  993
retain a portion of the fees as compensation, before any amounts  994
are deposited into the state treasury.  995
S. B. No. 438  Page 36
As Introduced
       Sec. 4723.271. (A) Upon request of the holder of a nursing  996
license, certified midwife license, dialysis technician  997
certificate, medication aide certificate, or community health  998
worker certificate issued under this chapter, the presentment of  999
proper identification as prescribed in rules adopted by the  1000
board of nursing, and payment of the fee authorized under  1001
section 4723.08 of the Revised Code, the board of nursing shall  1002
provide to the requestor a replacement copy of a wall  1003
certificate suitable for framing.  1004
       (B) Upon request of the holder of a nursing license,  1005
certified midwife license, volunteer's certificate, dialysis  1006
technician certificate, medication aide certificate, or  1007
community health worker certificate issued under this chapter  1008
and payment of the fee authorized under section 4723.08 of the  1009
Revised Code, the board shall verify to an agency of another  1010
jurisdiction or foreign country the fact that the person holds  1011
such nursing license, certified midwife license, volunteer's  1012
certificate, dialysis technician certificate, medication aide  1013
certificate, or community health worker certificate.  1014
       Sec. 4723.28. (A) The board of nursing, by a vote of a  1015
quorum, may impose one or more of the following sanctions if it  1016
finds that a person committed fraud in passing an examination  1017
required to obtain a nursing license, certified midwife license,  1018
or dialysis technician certificate issued by the board or  1019
committed fraud, misrepresentation, or deception in applying for  1020
or securing a nursing license, certified midwife license, or  1021
dialysis technician certificate issued by the board: deny,  1022
revoke, suspend, or place restrictions on any nursing license,  1023
certified midwife license, or dialysis technician certificate  1024
issued by the board; reprimand or otherwise discipline a holder  1025
of a nursing license, certified midwife license, or dialysis  1026
S. B. No. 438  Page 37
As Introduced
technician certificate; or impose a fine of not more than five  1027
hundred dollars per violation.  1028
       (B) Except as provided in section 4723.092 of the Revised  1029
Code, the board of nursing, by a vote of a quorum, may impose  1030
one or more of the following sanctions: deny, revoke, suspend,  1031
or place restrictions on any nursing license, certified midwife  1032
license, or dialysis technician certificate issued by the board;  1033
reprimand or otherwise discipline a holder of a nursing license,  1034
certified midwife license, or dialysis technician certificate;  1035
or impose a fine of not more than five hundred dollars per  1036
violation. The sanctions may be imposed for any of the  1037
following:  1038
       (1) Denial, revocation, suspension, or restriction of  1039
authority to engage in a licensed profession or practice a  1040
health care occupation, including nursing or practice as a  1041
certified midwife or dialysis technician, for any reason other  1042
than a failure to renew, in Ohio or another state or  1043
jurisdiction;  1044
       (2) Engaging in the practice of nursing or engaging in  1045
practice as a certified midwife or dialysis technician, having  1046
failed to renew a nursing license, certified midwife license, or  1047
dialysis technician certificate issued under this chapter, or  1048
while a nursing license, certified midwife license, or dialysis  1049
technician certificate is under suspension;  1050
       (3) Conviction of, a plea of guilty to, a judicial finding  1051
of guilt of, a judicial finding of guilt resulting from a plea  1052
of no contest to, or a judicial finding of eligibility for a  1053
pretrial diversion or similar program or for intervention in  1054
lieu of conviction for, a misdemeanor committed in the course of  1055
practice;  1056
S. B. No. 438  Page 38
As Introduced
        (4) Conviction of, a plea of guilty to, a judicial finding  1057
of guilt of, a judicial finding of guilt resulting from a plea  1058
of no contest to, or a judicial finding of eligibility for a  1059
pretrial diversion or similar program or for intervention in  1060
lieu of conviction for, any felony or of any crime involving  1061
gross immorality or moral turpitude;  1062
        (5) Selling, giving away, or administering drugs or  1063
therapeutic devices for other than legal and legitimate  1064
therapeutic purposes; or conviction of, a plea of guilty to, a  1065
judicial finding of guilt of, a judicial finding of guilt  1066
resulting from a plea of no contest to, or a judicial finding of  1067
eligibility for a pretrial diversion or similar program or for  1068
intervention in lieu of conviction for, violating any municipal,  1069
state, county, or federal drug law;  1070
        (6) Conviction of, a plea of guilty to, a judicial finding  1071
of guilt of, a judicial finding of guilt resulting from a plea  1072
of no contest to, or a judicial finding of eligibility for a  1073
pretrial diversion or similar program or for intervention in  1074
lieu of conviction for, an act in another jurisdiction that  1075
would constitute a felony or a crime of moral turpitude in Ohio;  1076
        (7) Conviction of, a plea of guilty to, a judicial finding  1077
of guilt of, a judicial finding of guilt resulting from a plea  1078
of no contest to, or a judicial finding of eligibility for a  1079
pretrial diversion or similar program or for intervention in  1080
lieu of conviction for, an act in the course of practice in  1081
another jurisdiction that would constitute a misdemeanor in  1082
Ohio;  1083
        (8) Self-administering or otherwise taking into the body  1084
any dangerous drug, as defined in section 4729.01 of the Revised  1085
Code, in any way that is not in accordance with a legal, valid  1086
S. B. No. 438  Page 39
As Introduced
prescription issued for that individual, or self-administering  1087
or otherwise taking into the body any drug that is a schedule I  1088
controlled substance;  1089
       (9) Habitual or excessive use of controlled substances,  1090
other habit-forming drugs, or alcohol or other chemical  1091
substances to an extent that impairs the individual's ability to  1092
provide safe nursing care, safe care as a certified midwife, or  1093
safe dialysis care;  1094
       (10) Impairment of the ability to practice according to  1095
acceptable and prevailing standards of safe nursing care, safe  1096
care as a certified midwife, or safe dialysis care because of  1097
the use of drugs, alcohol, or other chemical substances;  1098
       (11) Impairment of the ability to practice according to  1099
acceptable and prevailing standards of safe nursing care, safe  1100
care as a certified midwife, or safe dialysis care because of a  1101
physical or mental disability;  1102
       (12) Assaulting or causing harm to a patient or depriving  1103
a patient of the means to summon assistance;  1104
       (13) Misappropriation or attempted misappropriation of  1105
money or anything of value in the course of practice;  1106
       (14) Adjudication by a probate court of being mentally ill  1107
or mentally incompetent. The board may reinstate the person's  1108
nursing license, certified midwife license, or dialysis  1109
technician certificate upon adjudication by a probate court of  1110
the person's restoration to competency or upon submission to the  1111
board of other proof of competency.  1112
       (15) The suspension or termination of employment by the  1113
United States department of defense or department of veterans  1114
affairs for any act that violates or would violate this chapter;  1115
S. B. No. 438  Page 40
As Introduced
       (16) Violation of this chapter or any rules adopted under  1116
it;  1117
       (17) Violation of any restrictions placed by the board on  1118
a nursing license, certified midwife license, or dialysis  1119
technician certificate;  1120
       (18) Failure to use universal and standard precautions  1121
established by rules adopted under section 4723.07 of the  1122
Revised Code;  1123
       (19) Failure to practice in accordance with acceptable and  1124
prevailing standards of safe nursing care, safe care as a  1125
certified midwife, or safe dialysis care;  1126
       (20) In the case of a registered nurse, engaging in  1127
activities that exceed the practice of nursing as a registered  1128
nurse;  1129
       (21) In the case of a licensed practical nurse, engaging  1130
in activities that exceed the practice of nursing as a licensed  1131
practical nurse;  1132
       (22) In the case of a dialysis technician, engaging in  1133
activities that exceed those permitted under section 4723.72 of  1134
the Revised Code;  1135
       (23) Aiding and abetting a person in that person's  1136
practice of nursing or as a certified midwife without a license  1137
or practice as a dialysis technician without a certificate  1138
issued under this chapter;  1139
       (24) In the case of an advanced practice registered nurse,  1140
except as provided in division (M) of this section, either of  1141
the following:  1142
       (a) Waiving the payment of all or any part of a deductible  1143
S. B. No. 438  Page 41
As Introduced
or copayment that a patient, pursuant to a health insurance or  1144
health care policy, contract, or plan that covers such nursing  1145
services, would otherwise be required to pay if the waiver is  1146
used as an enticement to a patient or group of patients to  1147
receive health care services from that provider;  1148
       (b) Advertising that the nurse will waive the payment of  1149
all or any part of a deductible or copayment that a patient,  1150
pursuant to a health insurance or health care policy, contract,  1151
or plan that covers such nursing services, would otherwise be  1152
required to pay.  1153
       (25) Failure to comply with the terms and conditions of  1154
participation in the safe haven program conducted under sections  1155
4723.35 and 4723.351 of the Revised Code;  1156
       (26) Failure to comply with the terms and conditions  1157
required under the practice intervention and improvement program  1158
established under section 4723.282 of the Revised Code;  1159
       (27) In the case of an advanced practice registered nurse:  1160
       (a) Engaging in activities that exceed those permitted for  1161
the nurse's nursing specialty under section 4723.43 of the  1162
Revised Code;  1163
       (b) Failure to meet the quality assurance standards  1164
established under section 4723.07 of the Revised Code.  1165
       (28) In the case of an advanced practice registered nurse  1166
other than a certified registered nurse anesthetist, failure to  1167
maintain a standard care arrangement in accordance with section  1168
4723.431 of the Revised Code or to practice in accordance with  1169
the standard care arrangement;  1170
       (29) In the case of an advanced practice registered nurse  1171
S. B. No. 438  Page 42
As Introduced
who is designated as a clinical nurse specialist, certified  1172
nurse-midwife, or certified nurse practitioner, failure to  1173
prescribe drugs and therapeutic devices in accordance with  1174
section 4723.481 of the Revised Code;  1175
       (30) Prescribing any drug or device to perform or induce  1176
an abortion, or otherwise performing or inducing an abortion;  1177
       (31) Failure to establish and maintain professional  1178
boundaries with a patient, as specified in rules adopted under  1179
section 4723.07 of the Revised Code;  1180
       (32) Regardless of whether the contact or verbal behavior  1181
is consensual, engaging with a patient other than the spouse of  1182
the registered nurse, licensed practical nurse, certified  1183
midwife, or dialysis technician in any of the following:  1184
       (a) Sexual contact, as defined in section 2907.01 of the  1185
Revised Code;  1186
       (b) Verbal behavior that is sexually demeaning to the  1187
patient or may be reasonably interpreted by the patient as  1188
sexually demeaning.  1189
       (33) Assisting suicide, as defined in section 3795.01 of  1190
the Revised Code;  1191
       (34) Failure to comply with the requirements in section  1192
3719.061 of the Revised Code before issuing for a minor a  1193
prescription for an opioid analgesic, as defined in section  1194
3719.01 of the Revised Code;  1195
       (35) Failure to comply with section 4723.487 of the  1196
Revised Code, unless the state board of pharmacy no longer  1197
maintains a drug database pursuant to section 4729.75 of the  1198
Revised Code;  1199
S. B. No. 438  Page 43
As Introduced
       (36) The revocation, suspension, restriction, reduction,  1200
or termination of clinical privileges by the United States  1201
department of defense or department of veterans affairs or the  1202
termination or suspension of a certificate of registration to  1203
prescribe drugs by the drug enforcement administration of the  1204
United States department of justice;  1205
       (37) In the case of an advanced practice registered nurse  1206
who is designated as a clinical nurse specialist, certified  1207
nurse-midwife, or certified nurse practitioner, failure to  1208
comply with the terms of a consult agreement entered into with a  1209
pharmacist pursuant to section 4729.39 of the Revised Code;  1210
       (38) Violation of section 4723.93 of the Revised Code;  1211
       (39) Failure to cooperate with an investigation conducted  1212
by the board under this chapter, including failure to comply  1213
with a subpoena or order issued by the board or failure to  1214
answer truthfully a question presented by the board in an  1215
investigative interview, in an investigative office conference,  1216
at a deposition, or in written interrogatories, except that  1217
failure to cooperate with an investigation does not constitute  1218
grounds for discipline if a court of competent jurisdiction has  1219
issued an order that either quashes a subpoena or permits the  1220
individual to withhold testimony or evidence at issue;  1221
       (40) In the case of a certified midwife:  1222
       (a) Engaging in activities that exceed those permitted  1223
under section 4723.57 of the Revised Code;  1224
       (b) Failure to prescribe drugs and therapeutic devices in  1225
accordance with section 4723.481 of the Revised Code;  1226
       (c) Failure to maintain a standard care arrangement in  1227
accordance with section 4723.431 of the Revised Code or to  1228
S. B. No. 438  Page 44
As Introduced
practice in accordance with the standard care arrangement.  1229
       (C) Disciplinary actions taken by the board under  1230
divisions (A) and (B) of this section shall be taken pursuant to  1231
an adjudication conducted under Chapter 119. of the Revised  1232
Code, except that in lieu of a hearing, the board may enter into  1233
a consent agreement with an individual to resolve an allegation  1234
of a violation of this chapter or any rule adopted under it. A  1235
consent agreement, when ratified by a vote of a quorum, shall  1236
constitute the findings and order of the board with respect to  1237
the matter addressed in the agreement. If the board refuses to  1238
ratify a consent agreement, the admissions and findings  1239
contained in the agreement shall be of no effect.  1240
       (D) The hearings of the board shall be conducted in  1241
accordance with Chapter 119. of the Revised Code, the board may  1242
appoint a hearing examiner, as provided in section 119.09 of the  1243
Revised Code, to conduct any hearing the board is authorized to  1244
hold under Chapter 119. of the Revised Code.  1245
       In any instance in which the board is required under  1246
Chapter 119. of the Revised Code to give notice of an  1247
opportunity for a hearing and the applicant, licensee, or  1248
certificate holder does not make a timely request for a hearing  1249
in accordance with section 119.07 of the Revised Code, the board  1250
is not required to hold a hearing, but may adopt, by a vote of a  1251
quorum, a final order that contains the board's findings. In the  1252
final order, the board may order any of the sanctions listed in  1253
division (A) or (B) of this section.  1254
       (E) If a criminal action is brought against a registered  1255
nurse, licensed practical nurse, certified midwife, or dialysis  1256
technician for an act or crime described in divisions (B)(3) to  1257
(7) of this section and the action is dismissed by the trial  1258
S. B. No. 438  Page 45
As Introduced
court other than on the merits, the board shall conduct an  1259
adjudication to determine whether the registered nurse, licensed  1260
practical nurse, certified midwife, or dialysis technician  1261
committed the act on which the action was based. If the board  1262
determines on the basis of the adjudication that the registered  1263
nurse, licensed practical nurse, certified midwife, or dialysis  1264
technician committed the act, or if the registered nurse,  1265
licensed practical nurse, certified midwife, or dialysis  1266
technician fails to participate in the adjudication, the board  1267
may take action as though the registered nurse, licensed  1268
practical nurse, certified midwife, or dialysis technician had  1269
been convicted of the act.  1270
       If the board takes action on the basis of a conviction,  1271
plea, or a judicial finding as described in divisions (B)(3) to  1272
(7) of this section that is overturned on appeal, the registered  1273
nurse, licensed practical nurse, certified midwife, or dialysis  1274
technician may, on exhaustion of the appeal process, petition  1275
the board for reconsideration of its action. On receipt of the  1276
petition and supporting court documents, the board shall  1277
temporarily rescind its action. If the board determines that the  1278
decision on appeal was a decision on the merits, it shall  1279
permanently rescind its action. If the board determines that the  1280
decision on appeal was not a decision on the merits, it shall  1281
conduct an adjudication to determine whether the registered  1282
nurse, licensed practical nurse, certified midwife, or dialysis  1283
technician committed the act on which the original conviction,  1284
plea, or judicial finding was based. If the board determines on  1285
the basis of the adjudication that the registered nurse,  1286
licensed practical nurse, certified midwife, or dialysis  1287
technician committed such act, or if the registered nurse,  1288
licensed practical nurse, certified midwife, or dialysis  1289
S. B. No. 438  Page 46
As Introduced
technician does not request an adjudication, the board shall  1290
reinstate its action; otherwise, the board shall permanently  1291
rescind its action.  1292
       Notwithstanding the provision of division (D)(2) of  1293
section 2953.32 or division (F)(1) of section 2953.39 of the  1294
Revised Code specifying that if records pertaining to a criminal  1295
case are sealed or expunged under that section the proceedings  1296
in the case shall be deemed not to have occurred, sealing or  1297
expungement of the following records on which the board has  1298
based an action under this section shall have no effect on the  1299
board's action or any sanction imposed by the board under this  1300
section: records of any conviction, guilty plea, judicial  1301
finding of guilt resulting from a plea of no contest, or a  1302
judicial finding of eligibility for a pretrial diversion program  1303
or intervention in lieu of conviction.  1304
       The board shall not be required to seal, destroy, redact,  1305
or otherwise modify its records to reflect the court's sealing  1306
or expungement of conviction records.  1307
       (F) The board may investigate an individual's criminal  1308
background in performing its duties under this section. As part  1309
of such investigation, the board may order the individual to  1310
submit, at the individual's expense, a request to the bureau of  1311
criminal identification and investigation for a criminal records  1312
check and check of federal bureau of investigation records  1313
pursuant to section 4723.091 of the Revised Code.  1314
       (G) During the course of an investigation conducted under  1315
this section, the board may compel any registered nurse,  1316
licensed practical nurse, certified midwife, or dialysis  1317
technician or applicant under this chapter to submit to a mental  1318
or physical examination, or both, as required by the board and  1319
S. B. No. 438  Page 47
As Introduced
at the expense of the individual, if the board finds reason to  1320
believe that the individual under investigation may have a  1321
physical or mental impairment that may affect the individual's  1322
ability to provide safe nursing, certified midwifery, or  1323
dialysis care.  1324
       The board shall not compel an individual who has been  1325
referred to the safe haven program as described in sections  1326
4723.35 and 4723.351 of the Revised Code to submit to a mental  1327
or physical examination.  1328
       Failure of any individual to submit to a mental or  1329
physical examination when directed constitutes an admission of  1330
the allegations, unless the failure is due to circumstances  1331
beyond the individual's control, and a default and final order  1332
may be entered without the taking of testimony or presentation  1333
of evidence.  1334
       If the board finds that an individual is impaired, the  1335
board shall require the individual to submit to care,  1336
counseling, or treatment approved or designated by the board, as  1337
a condition for initial, continued, reinstated, or renewed  1338
authority to practice. The individual shall be afforded an  1339
opportunity to demonstrate to the board that the individual can  1340
begin or resume the individual's occupation in compliance with  1341
acceptable and prevailing standards of care under the provisions  1342
of the individual's authority to practice.  1343
       For purposes of this division, any registered nurse,  1344
licensed practical nurse, certified midwife, or dialysis  1345
technician or applicant under this chapter shall be deemed to  1346
have given consent to submit to a mental or physical examination  1347
when directed to do so in writing by the board, and to have  1348
waived all objections to the admissibility of testimony or  1349
S. B. No. 438  Page 48
As Introduced
examination reports that constitute a privileged communication.  1350
       (H) The board shall investigate evidence that appears to  1351
show that any person has violated any provision of this chapter  1352
or any rule of the board. Any person may report to the board any  1353
information the person may have that appears to show a violation  1354
of any provision of this chapter or rule of the board. In the  1355
absence of bad faith, any person who reports such information or  1356
who testifies before the board in any adjudication conducted  1357
under Chapter 119. of the Revised Code shall not be liable for  1358
civil damages as a result of the report or testimony.  1359
       (I) All of the following apply under this chapter with  1360
respect to the confidentiality of information:  1361
       (1) Information received by the board pursuant to a  1362
complaint or an investigation is confidential and not subject to  1363
discovery in any civil action, except that the board may  1364
disclose information to law enforcement officers and government  1365
entities for purposes of an investigation of either a licensed  1366
health care professional, including a registered nurse, licensed  1367
practical nurse, certified midwife, or dialysis technician, or a  1368
person who may have engaged in the unauthorized practice of  1369
nursing, certified midwifery, or dialysis care. No law  1370
enforcement officer or government entity with knowledge of any  1371
information disclosed by the board pursuant to this division  1372
shall divulge the information to any other person or government  1373
entity except for the purpose of a government investigation, a  1374
prosecution, or an adjudication by a court or government entity.  1375
       (2) If an investigation requires a review of patient  1376
records, the investigation and proceeding shall be conducted in  1377
such a manner as to protect patient confidentiality.  1378
S. B. No. 438  Page 49
As Introduced
       (3) All adjudications and investigations of the board  1379
shall be considered civil actions for the purposes of section  1380
2305.252 of the Revised Code.  1381
       (4) Any board activity that involves continued monitoring  1382
of an individual as part of or following any disciplinary action  1383
taken under this section shall be conducted in a manner that  1384
maintains the individual's confidentiality. Information received  1385
or maintained by the board with respect to the board's  1386
monitoring activities is not subject to discovery in any civil  1387
action and is confidential, except that the board may disclose  1388
information to law enforcement officers and government entities  1389
for purposes of an investigation of a licensee or certificate  1390
holder.  1391
       (J) Any action taken by the board under this section  1392
resulting in a suspension from practice shall be accompanied by  1393
a written statement of the conditions under which the person may  1394
be reinstated to practice.  1395
       (K) When the board refuses to grant a license or  1396
certificate to an applicant, revokes a license or certificate,  1397
or refuses to reinstate a license or certificate, the board may  1398
specify that its action is permanent. An individual subject to  1399
permanent action taken by the board is forever ineligible to  1400
hold a license or certificate of the type that was refused or  1401
revoked and the board shall not accept from the individual an  1402
application for reinstatement of the license or certificate or  1403
for a new license or certificate.  1404
       (L) No unilateral surrender of a nursing license,  1405
certified midwife license, or dialysis technician certificate  1406
issued under this chapter shall be effective unless accepted by  1407
majority vote of the board. No application for a nursing  1408
S. B. No. 438  Page 50
As Introduced
license, certified midwife license, or dialysis technician  1409
certificate issued under this chapter may be withdrawn without a  1410
majority vote of the board. The board's jurisdiction to take  1411
disciplinary action under this section is not removed or limited  1412
when an individual has a license or certificate classified as  1413
inactive or fails to renew a license or certificate.  1414
       (M) Sanctions shall not be imposed under division (B)(24)  1415
of this section against any licensee who waives deductibles and  1416
copayments as follows:  1417
       (1) In compliance with the health benefit plan that  1418
expressly allows such a practice. Waiver of the deductibles or  1419
copayments shall be made only with the full knowledge and  1420
consent of the plan purchaser, payer, and third-party  1421
administrator. Documentation of the consent shall be made  1422
available to the board upon request.  1423
       (2) For professional services rendered to any other person  1424
licensed pursuant to this chapter to the extent allowed by this  1425
chapter and the rules of the board.  1426
       Sec. 4723.282. (A) As used in this section, "practice  1427
deficiency" means any activity that does not meet acceptable and  1428
prevailing standards of safe and effective nursing care or  1429
dialysis care or safe and effective care as a certified midwife.  1430
       (B) The board of nursing may abstain from taking  1431
disciplinary action under section 4723.28 of the Revised Code  1432
against the holder of a license or certificate issued under this  1433
chapter who has a practice deficiency that has been identified  1434
by the board through an investigation conducted under section  1435
4723.28 of the Revised Code. The board may abstain from taking  1436
action only if the board has reason to believe that the  1437
S. B. No. 438  Page 51
As Introduced
individual's practice deficiency can be corrected through  1438
remediation, and if the individual enters into an agreement with  1439
the board to seek remediation as prescribed by the board,  1440
complies with the terms and conditions of the remediation, and  1441
successfully completes the remediation. If an individual fails  1442
to complete the remediation or the board determines that  1443
remediation cannot correct the individual's practice deficiency,  1444
the board shall proceed with disciplinary action in accordance  1445
with section 4723.28 of the Revised Code.  1446
       (C) To implement its authority under this section to  1447
abstain from taking disciplinary action, the board shall  1448
establish a practice intervention and improvement program. The  1449
board shall designate an administrator to operate the program  1450
and, in accordance with Chapter 119. of the Revised Code, adopt  1451
rules for the program that establish the following:  1452
       (1) Criteria for use in identifying an individual's  1453
practice deficiency;  1454
       (2) Requirements that an individual must meet to be  1455
eligible for remediation and the board's abstention from  1456
disciplinary action;  1457
       (3) Standards and procedures for prescribing remediation  1458
that is appropriate for an individual's identified practice  1459
deficiency;  1460
       (4) Terms and conditions that an individual must meet to  1461
be successful in completing the remediation prescribed;  1462
       (5) Procedures for the board's monitoring of the  1463
individual's remediation;  1464
       (6) Procedures for maintaining confidential records  1465
regarding individuals who participate in remediation;  1466
S. B. No. 438  Page 52
As Introduced
       (7) Any other requirements or procedures necessary to  1467
develop and administer the program.  1468
       (D) All records held by the board for purposes of the  1469
program shall be confidential, are not public records for  1470
purposes of section 149.43 of the Revised Code, and are not  1471
subject to discovery by subpoena or admissible as evidence in  1472
any judicial proceeding. The administrator of the program shall  1473
maintain all records in the board's office in accordance with  1474
the board's record retention schedule.  1475
       (E) When an individual begins the remediation prescribed  1476
by the board, the individual shall sign a waiver permitting any  1477
entity that provides services related to the remediation to  1478
release to the board information regarding the individual's  1479
progress. An entity that provides services related to  1480
remediation shall report to the board if the individual fails to  1481
complete the remediation or does not make satisfactory progress  1482
in remediation.  1483
       In the absence of fraud or bad faith, an entity that  1484
reports to the board regarding an individual's practice  1485
deficiency, or progress or lack of progress in remediation, is  1486
not liable in damages to any person as a result of making the  1487
report.  1488
       (F) An individual participating in remediation prescribed  1489
under this section is responsible for all financial obligations  1490
that may arise from obtaining or completing the remediation.  1491
       Sec. 4723.33. A registered nurse, licensed practical  1492
nurse, certified midwife, dialysis technician, community health  1493
worker, or medication aide who in good faith makes a report  1494
under this chapter or any other provision of the Revised Code  1495
S. B. No. 438  Page 53
As Introduced
regarding a violation of this chapter or any other provision of  1496
the Revised Code, or participates in any investigation,  1497
administrative proceeding, or judicial proceeding resulting from  1498
the report, has the full protection against retaliatory action  1499
provided by sections 4113.51 to 4113.53 of the Revised Code.  1500
       Sec. 4723.34. (A) A person or governmental entity that  1501
employs, or contracts directly or through another person or  1502
governmental entity for the provision of services by, registered  1503
nurses, licensed practical nurses, nurses holding multistate  1504
licenses to practice registered or licensed practical nursing  1505
issued pursuant to section 4723.11 of the Revised Code,  1506
certified midwives, dialysis technicians, medication aides, or  1507
certified community health workers and that knows or has reason  1508
to believe that a current or former employee or person providing  1509
services under a contract who holds a license or certificate  1510
issued under this chapter engaged in conduct that would be  1511
grounds for disciplinary action by the board of nursing under  1512
this chapter or rules adopted under it shall report to the board  1513
of nursing the name of such current or former employee or person  1514
providing services under a contract. The report shall be made on  1515
the person's or governmental entity's behalf by an individual  1516
licensed by the board who the person or governmental entity has  1517
designated to make such reports.  1518
       A prosecutor in a case described in divisions (B)(3) to  1519
(5) of section 4723.28 of the Revised Code, or in a case where  1520
the trial court issued an order of dismissal upon technical or  1521
procedural grounds of a charge of a misdemeanor committed in the  1522
course of practice, a felony charge, or a charge of gross  1523
immorality or moral turpitude, who knows or has reason to  1524
believe that the person charged is licensed under this chapter  1525
to practice nursing as a registered nurse or as a licensed  1526
S. B. No. 438  Page 54
As Introduced
practical nurse, is licensed under this chapter to practice as a  1527
certified midwife, or holds a certificate issued under this  1528
chapter to practice as a dialysis technician shall notify the  1529
board of nursing of the charge. With regard to certified  1530
community health workers and medication aides, the prosecutor in  1531
a case involving a charge of a misdemeanor committed in the  1532
course of employment, a felony charge, or a charge of gross  1533
immorality or moral turpitude, including a case dismissed on  1534
technical or procedural grounds, who knows or has reason to  1535
believe that the person charged holds a community health worker  1536
or medication aide certificate issued under this chapter shall  1537
notify the board of the charge.  1538
       Each notification from a prosecutor shall be made on forms  1539
prescribed and provided by the board. The report shall include  1540
the name and address of the license or certificate holder, the  1541
charge, and the certified court documents recording the action.  1542
       (B) If any person or governmental entity fails to provide  1543
a report required by this section, the board may seek an order  1544
from a court of competent jurisdiction compelling submission of  1545
the report.  1546
       Sec. 4723.341. (A) As used in this section, "person" has  1547
the same meaning as in section 1.59 of the Revised Code and also  1548
includes the board of nursing and its members and employees;  1549
health care facilities, associations, and societies; insurers;  1550
and individuals.  1551
       (B) In the absence of fraud or bad faith, no person  1552
reporting to the board of nursing or testifying in an  1553
adjudication conducted under Chapter 119. of the Revised Code  1554
with regard to alleged incidents of negligence or malpractice or  1555
matters subject to this chapter or sections 3123.41 to 3123.50  1556
S. B. No. 438  Page 55
As Introduced
of the Revised Code and any applicable rules adopted under  1557
section 3123.63 of the Revised Code shall be subject to either  1558
of the following based on making the report or testifying:  1559
       (1) Liability in damages in a civil action for injury,  1560
death, or loss to person or property;  1561
       (2) Discipline or dismissal by an employer.  1562
       (C) An individual who is disciplined or dismissed in  1563
violation of division (B)(2) of this section has the same rights  1564
and duties accorded an employee under sections 4113.52 and  1565
4113.53 of the Revised Code.  1566
       (D) In the absence of fraud or bad faith, no professional  1567
association of registered nurses, advanced practice registered  1568
nurses, licensed practical nurses, certified midwives, dialysis  1569
technicians, community health workers, or medication aides that  1570
sponsors a committee or program to provide peer assistance to  1571
individuals with substance abuse problems, no representative or  1572
agent of such a committee or program, and no member of the board  1573
of nursing shall be liable to any person for damages in a civil  1574
action by reason of actions taken to refer a nurse, certified  1575
midwife, dialysis technician, community health worker, or  1576
medication aide to a treatment provider or actions or omissions  1577
of the provider in treating a nurse, certified midwife, dialysis  1578
technician, community health worker, or medication aide.  1579
       Sec. 4723.35. (A) As used in this section and section  1580
4723.351 of the Revised Code:  1581
       (1) "Applicant" means an individual who has applied for a  1582
license or certificate to practice issued under this chapter.  1583
"Applicant" may include an individual who has been granted  1584
authority by the board of nursing to practice as one type of  1585
S. B. No. 438  Page 56
As Introduced
practitioner, but has applied for authority to practice as  1586
another type of practitioner.  1587
       (2) "Impaired" or "impairment" means either or both of the  1588
following:  1589
       (a) Impairment of the ability to practice as described in  1590
division (B)(10) of section 4723.28 of the Revised Code;  1591
       (b) Impairment of the ability to practice as described in  1592
division (B)(11) of section 4723.28 of the Revised Code.  1593
       (3) "Practitioner" means an individual authorized under  1594
this chapter to practice as a registered nurse, including as an  1595
advanced practice registered nurse, licensed practical nurse,  1596
certified midwife, dialysis technician, community health worker,  1597
or medication aide.  1598
       (B) The board of nursing shall establish the safe haven  1599
program to monitor applicants and practitioners who are or may  1600
be impaired, but against whom the board has abstained from  1601
taking disciplinary action. The program is to be conducted by  1602
the monitoring organization under contract with the board as  1603
described in section 4723.351 of the Revised Code.  1604
       (C)(1) On the establishment of the program, the board may  1605
transfer to the monitoring organization, in whole or in part,  1606
either or both of the following responsibilities:  1607
       (a) The monitoring and oversight of licensees as part of  1608
the substance use disorder program as that program existed on or  1609
before the effective date of this section September 20, 2024;  1610
       (b) The monitoring and oversight of licensees under terms  1611
specified in a board adjudication order or consent agreement.  1612
       (2) If the board transfers the responsibilities described  1613
S. B. No. 438  Page 57
As Introduced
in division (C)(1) of this section, both of the following apply:  1614
       (a) The monitoring organization shall provide to the board  1615
quarterly reports regarding the compliance of transferred  1616
licensees.  1617
       (b) The monitoring organization shall immediately report  1618
to the board any licensee who is not in compliance with the  1619
terms and conditions of monitoring.  1620
       (D) The board shall refer to the monitoring organization  1621
any applicant or practitioner whose health and effectiveness  1622
show signs of impairment or potential impairment, but only if  1623
the applicant or practitioner meets the eligibility conditions  1624
of division (G) of this section.  1625
       (E) Determinations regarding an applicant's or  1626
practitioner's eligibility for admission to, continued  1627
participation in, and successful completion of the safe haven  1628
program shall be made by the monitoring organization in  1629
accordance with rules adopted under section 4723.351 of the  1630
Revised Code.  1631
       (F) The board shall abstain from taking disciplinary  1632
action under section 4723.28, 4723.652, or 4723.86 of the  1633
Revised Code against an individual whose health and  1634
effectiveness show signs of impairment or potential impairment,  1635
but who is not currently under the terms of a consent agreement  1636
with the board for impairment or an order issued by the board  1637
for impairment if the individual is participating in the safe  1638
haven program.  1639
       An applicant's or practitioner's impairment neither  1640
excuses an applicant or practitioner who has committed other  1641
violations of this chapter nor precludes the board from  1642
S. B. No. 438  Page 58
As Introduced
investigating or taking disciplinary action against an applicant  1643
or practitioner for other violations of this chapter.  1644
       (G) An applicant or practitioner is eligible to  1645
participate in the safe haven program if both of the following  1646
conditions are met:  1647
       (1) The applicant or practitioner needs assistance with  1648
impairment or potential impairment.  1649
       (2) The applicant or practitioner has an unencumbered  1650
license and is not currently under the terms of a consent  1651
agreement with the board for impairment or an order issued by  1652
the board for impairment.  1653
       Sec. 4723.41. (A) Each person who desires to practice  1654
nursing as a certified nurse-midwife and has not been authorized  1655
to practice midwifery nurse-midwifery prior to December 1, 1967,  1656
and each person who desires to practice nursing as a certified  1657
registered nurse anesthetist, clinical nurse specialist, or  1658
certified nurse practitioner shall file with the board of  1659
nursing a written application for a license to practice nursing  1660
as an advanced practice registered nurse and designation in the  1661
desired specialty. The application must be filed, under oath, on  1662
a form prescribed by the board accompanied by the application  1663
fee required by section 4723.08 of the Revised Code.  1664
       Except as provided in division (B), (C), or (D) of this  1665
section, at the time of making application, the applicant shall  1666
meet all of the following requirements:  1667
       (1) Be a registered nurse;  1668
       (2) Submit documentation satisfactory to the board that  1669
the applicant has earned a master's or doctoral degree with a  1670
major in a nursing specialty or in a related field that  1671
S. B. No. 438  Page 59
As Introduced
qualifies the applicant to sit for the certification examination  1672
of a national certifying organization approved by the board  1673
under section 4723.46 of the Revised Code;  1674
       (3) Submit documentation satisfactory to the board of  1675
having passed the certification examination of a national  1676
certifying organization approved by the board under section  1677
4723.46 of the Revised Code to examine and certify, as  1678
applicable, nurse-midwives, registered nurse anesthetists,  1679
clinical nurse specialists, or nurse practitioners;  1680
       (4) Submit an affidavit with the application that states  1681
all of the following:  1682
       (a) That the applicant is the person named in the  1683
documents submitted under this section and is the lawful  1684
possessor thereof;  1685
       (b) The applicant's age, residence, the school at which  1686
the applicant obtained education in the applicant's nursing  1687
specialty, and any other facts that the board requires;  1688
       (c) The specialty in which the applicant seeks  1689
designation.  1690
       (B)(1) A certified registered nurse anesthetist, clinical  1691
nurse specialist, certified nurse-midwife, or certified nurse  1692
practitioner who is practicing or has practiced as such in  1693
another jurisdiction other than another state may apply for a  1694
license by endorsement to practice nursing as an advanced  1695
practice registered nurse and designation as a certified  1696
registered nurse anesthetist, clinical nurse specialist,  1697
certified nurse-midwife, or certified nurse practitioner in this  1698
state if the nurse meets the requirements set forth in division  1699
(A) of this section or division (B)(2) of this section.  1700
S. B. No. 438  Page 60
As Introduced
       (2) If an applicant who is practicing or has practiced in  1701
another jurisdiction other than another state applies for  1702
designation under division (B)(2) of this section, the  1703
application shall be submitted to the board in the form  1704
prescribed by rules of the board and be accompanied by the  1705
application fee required by section 4723.08 of the Revised Code.  1706
The application shall include evidence that the applicant meets  1707
the requirements of division (B)(2) of this section, holds  1708
authority to practice nursing and is in good standing in another  1709
jurisdiction other than another state granted after meeting  1710
requirements approved by the entity of that jurisdiction that  1711
regulates nurses, and other information required by rules of the  1712
board of nursing.  1713
       With respect to the educational requirements and national  1714
certification requirements that an applicant under division (B)  1715
(2) of this section must meet, both of the following apply:  1716
       (a) If the applicant is a certified registered nurse  1717
anesthetist, certified nurse-midwife, or certified nurse  1718
practitioner who, on or before December 31, 2000, obtained  1719
certification in the applicant's nursing specialty with a  1720
national certifying organization listed in division (A)(3) of  1721
section 4723.41 of the Revised Code as that division existed  1722
prior to March 20, 2013, or that was at that time approved by  1723
the board under section 4723.46 of the Revised Code, the  1724
applicant must have maintained the certification. The applicant  1725
is not required to have earned a master's or doctoral degree  1726
with a major in a nursing specialty or in a related field that  1727
qualifies the applicant to sit for the certification  1728
examination.  1729
       (b) If the applicant is a clinical nurse specialist, one  1730
S. B. No. 438  Page 61
As Introduced
of the following must apply to the applicant:  1731
       (i) On or before December 31, 2000, the applicant obtained  1732
a master's or doctoral degree with a major in a clinical area of  1733
nursing from an educational institution accredited by a national  1734
or regional accrediting organization. The applicant is not  1735
required to have passed a certification examination.  1736
       (ii) On or before December 31, 2000, the applicant  1737
obtained a master's or doctoral degree in nursing or a related  1738
field and was certified as a clinical nurse specialist by the  1739
American nurses credentialing center or another national  1740
certifying organization that was at that time approved by the  1741
board under section 4723.46 of the Revised Code.  1742
       (3) The board shall grant a license to practice nursing as  1743
an advanced practice registered nurse in accordance with Chapter  1744
4796. of the Revised Code to an applicant if either of the  1745
following applies:  1746
       (a) The applicant holds a license in another state.  1747
       (b) The applicant has satisfactory work experience, a  1748
government certification, or a private certification as  1749
described in that chapter as an advanced practice registered  1750
nurse in a state that does not issue that license.  1751
       (4) The board may grant a nonrenewable temporary permit to  1752
practice nursing as an advanced practice registered nurse to an  1753
applicant for licensure under division (B)(2) or (3) of this  1754
section if the board is satisfied by the evidence that the  1755
applicant holds a valid, unrestricted license in or equivalent  1756
authorization from another jurisdiction. Chapter 4796. of the  1757
Revised Code does not apply to a temporary permit issued under  1758
this division. The temporary permit shall expire at the earlier  1759
S. B. No. 438  Page 62
As Introduced
of one hundred eighty days after issuance or upon the issuance  1760
of a license under division (B)(2) or (3) of this section.  1761
        (C) An applicant who desires to practice nursing as a  1762
certified registered nurse anesthetist, certified nurse-midwife,  1763
or certified nurse practitioner is exempt from the educational  1764
requirements in division (A)(2) of this section if all of the  1765
following are the case:  1766
        (1) Before January 1, 2001, the board issued to the  1767
applicant a certificate of authority to practice as a certified  1768
registered nurse anesthetist, certified nurse-midwife, or  1769
certified nurse practitioner;  1770
        (2) The applicant submits documentation satisfactory to  1771
the board that the applicant obtained certification in the  1772
applicant's nursing specialty with a national certifying  1773
organization listed in division (A)(3) of section 4723.41 of the  1774
Revised Code as that division existed prior to March 20, 2013,  1775
or that was at that time approved by the board under section  1776
4723.46 of the Revised Code;  1777
        (3) The applicant submits documentation satisfactory to  1778
the board that the applicant has maintained the certification  1779
described in division (C)(2) of this section.  1780
        (D) An applicant who desires to practice as a clinical  1781
nurse specialist is exempt from the examination requirement in  1782
division (A)(3) of this section if both of the following are the  1783
case:  1784
        (1) Before January 1, 2001, the board issued to the  1785
applicant a certificate of authority to practice as a clinical  1786
nurse specialist;  1787
        (2) The applicant submits documentation satisfactory to  1788
S. B. No. 438  Page 63
As Introduced
the board that the applicant earned either of the following:  1789
       (a) A master's or doctoral degree with a major in a  1790
clinical area of nursing from an educational institution  1791
accredited by a national or regional accrediting organization;  1792
       (b) A master's or doctoral degree in nursing or a related  1793
field and was certified as a clinical nurse specialist by the  1794
American nurses credentialing center or another national  1795
certifying organization that was at that time approved by the  1796
board under section 4723.46 of the Revised Code.  1797
       Sec. 4723.43. A certified registered nurse anesthetist,  1798
clinical nurse specialist, certified nurse-midwife, or certified  1799
nurse practitioner may provide to individuals and groups nursing  1800
care that requires knowledge and skill obtained from advanced  1801
formal education and clinical experience. In this capacity as an  1802
advanced practice registered nurse, a certified nurse-midwife is  1803
subject to division (A) of this section, a certified registered  1804
nurse anesthetist is subject to division (B) of this section, a  1805
certified nurse practitioner is subject to division (C) of this  1806
section, and a clinical nurse specialist is subject to division  1807
(D) of this section.  1808
       (A) A Subject to sections 4723.58 to 4723.584 of the  1809
Revised Code, a nurse authorized to practice as a certified  1810
nurse-midwife, in collaboration with one or more physicians, may  1811
provide the management of preventive services and those primary  1812
care services necessary to provide health care to women  1813
antepartally, intrapartally, postpartally, and gynecologically,  1814
consistent with the nurse's education and certification, and in  1815
accordance with rules adopted by the board of nursing.  1816
       No certified nurse-midwife may perform version, deliver  1817
S. B. No. 438  Page 64
As Introduced
breech or face presentation, use forceps, do any obstetric  1818
operation, or treat any other abnormal condition outside of the  1819
scope of practice for certified nurse-midwives established by  1820
the American college of nurse-midwives, except in emergencies.  1821
No certified nurse-midwife may deliver breech or face  1822
presentation except in an emergency or as provided in section  1823
4723.581 of the Revised Code. Division (A) of this section does  1824
not prohibit a certified nurse-midwife from performing  1825
episiotomies or normal vaginal deliveries, or repairing vaginal  1826
tears. A certified nurse-midwife may, in collaboration with one  1827
or more physicians, prescribe drugs and therapeutic devices in  1828
accordance with section 4723.481 of the Revised Code. A  1829
certified nurse-midwife may, in collaboration with one or more  1830
physicians, attend births in hospitals, homes, medical offices,  1831
and freestanding birthing centers and provide care for normal  1832
newborns during the period consistent with the scope of practice  1833
for certified nurse-midwives established by the American college  1834
of nurse-midwives.  1835
       (B) A nurse authorized to practice as a certified  1836
registered nurse anesthetist, consistent with the nurse's  1837
education and certification and in accordance with rules adopted  1838
by the board, may do the following:  1839
       (1) With supervision and in the immediate presence of a  1840
physician, podiatrist, or dentist, administer anesthesia and  1841
perform anesthesia induction, maintenance, and emergence;  1842
       (2) With supervision, obtain informed consent for  1843
anesthesia care and perform preanesthetic preparation and  1844
evaluation, postanesthetic preparation and evaluation,  1845
postanesthesia care, and, subject to section 4723.433 of the  1846
Revised Code, clinical support functions;  1847
S. B. No. 438  Page 65
As Introduced
       (3) With supervision and in accordance with section  1848
4723.434 of the Revised Code, engage in the activities described  1849
in division (A) of that section.  1850
       The physician, podiatrist, or dentist supervising a  1851
certified registered nurse anesthetist must be actively engaged  1852
in practice in this state. When a certified registered nurse  1853
anesthetist is supervised by a podiatrist, the nurse's scope of  1854
practice is limited to the anesthesia procedures that the  1855
podiatrist has the authority under section 4731.51 of the  1856
Revised Code to perform. A certified registered nurse  1857
anesthetist may not administer general anesthesia under the  1858
supervision of a podiatrist in a podiatrist's office. When a  1859
certified registered nurse anesthetist is supervised by a  1860
dentist, the nurse's scope of practice is limited to the  1861
anesthesia procedures that the dentist has the authority under  1862
Chapter 4715. of the Revised Code to perform.  1863
       (C) A nurse authorized to practice as a certified nurse  1864
practitioner, in collaboration with one or more physicians or  1865
podiatrists, may provide preventive and primary care services,  1866
provide services for acute illnesses, and evaluate and promote  1867
patient wellness within the nurse's nursing specialty,  1868
consistent with the nurse's education and certification, and in  1869
accordance with rules adopted by the board. A certified nurse  1870
practitioner may, in collaboration with one or more physicians  1871
or podiatrists, prescribe drugs and therapeutic devices in  1872
accordance with section 4723.481 of the Revised Code.  1873
       When a certified nurse practitioner is collaborating with  1874
a podiatrist, the nurse's scope of practice is limited to the  1875
procedures that the podiatrist has the authority under section  1876
4731.51 of the Revised Code to perform.  1877
S. B. No. 438  Page 66
As Introduced
       (D) A nurse authorized to practice as a clinical nurse  1878
specialist, in collaboration with one or more physicians or  1879
podiatrists, may provide and manage the care of individuals and  1880
groups with complex health problems and provide health care  1881
services that promote, improve, and manage health care within  1882
the nurse's nursing specialty, consistent with the nurse's  1883
education and in accordance with rules adopted by the board. A  1884
clinical nurse specialist may, in collaboration with one or more  1885
physicians or podiatrists, prescribe drugs and therapeutic  1886
devices in accordance with section 4723.481 of the Revised Code.  1887
       When a clinical nurse specialist is collaborating with a  1888
podiatrist, the nurse's scope of practice is limited to the  1889
procedures that the podiatrist has the authority under section  1890
4731.51 of the Revised Code to perform.  1891
       Sec. 4723.431. (A)(1) An A certified midwife or an  1892
advanced practice registered nurse who is designated as a  1893
clinical nurse specialist, certified nurse-midwife, or certified  1894
nurse practitioner may practice only in accordance with a  1895
standard care arrangement entered into with each physician or  1896
podiatrist with whom the certified midwife or nurse  1897
collaborates. A copy of the standard care arrangement shall be  1898
retained on file by the certified midwife's or nurse's employer.  1899
Prior approval of the standard care arrangement by the board of  1900
nursing is not required, but the board may periodically review  1901
it for compliance with this section.  1902
       A certified midwife, clinical nurse specialist, certified  1903
nurse-midwife, or certified nurse practitioner may enter into a  1904
standard care arrangement with one or more collaborating  1905
physicians or podiatrists. If a collaborating physician or  1906
podiatrist enters into standard care arrangements with more than  1907
S. B. No. 438  Page 67
As Introduced
five certified midwives or nurses, the physician or podiatrist  1908
shall not collaborate at the same time with more than five  1909
certified midwives or nurses in the prescribing component of  1910
their practices.  1911
       Not later than thirty days after first engaging in the  1912
practice of midwifery as a certified midwife or the practice of  1913
nursing as a clinical nurse specialist, certified nurse-midwife,  1914
or certified nurse practitioner, the certified midwife or nurse  1915
shall submit to the board the name and business address of each  1916
collaborating physician or podiatrist. Thereafter, the certified  1917
midwife or nurse shall notify the board of any additions or  1918
deletions to the midwife's or nurse's collaborating physicians  1919
or podiatrists. Except as provided in division (D) of this  1920
section, the notice must be provided not later than thirty days  1921
after the change takes effect.  1922
       (2) All of the following conditions apply with respect to  1923
the practice of a collaborating physician or podiatrist with  1924
whom a certified midwife, clinical nurse specialist, certified  1925
nurse-midwife, or certified nurse practitioner may enter into a  1926
standard care arrangement:  1927
       (a) The physician or podiatrist must be authorized to  1928
practice in this state.  1929
       (b) Except as provided in division (A)(2)(c) of this  1930
section, the physician or podiatrist must be practicing in a  1931
specialty that is the same as or similar to the certified  1932
midwife's specialty or nurse's nursing specialty.  1933
       (c) If the nurse is a clinical nurse specialist who is  1934
certified as a psychiatric-mental health CNS or the equivalent  1935
of such title by the American nurses credentialing center or a  1936
S. B. No. 438  Page 68
As Introduced
certified nurse practitioner who is certified as a psychiatric-  1937
mental health NP or the equivalent of such title by the American  1938
nurses credentialing center or American academy of nurse  1939
practitioners certification board, the nurse may enter into a  1940
standard care arrangement with a physician but not a podiatrist  1941
and the collaborating physician must be practicing in one of the  1942
following specialties:  1943
       (i) Psychiatry;  1944
       (ii) Pediatrics;  1945
       (iii) Primary care or family practice.  1946
       (B) A standard care arrangement shall be in writing and  1947
shall contain all of the following:  1948
       (1) Criteria for referral of a patient by the certified  1949
midwife, clinical nurse specialist, certified nurse-midwife, or  1950
certified nurse practitioner to a collaborating physician or  1951
podiatrist or another physician or podiatrist;  1952
       (2) A process for the certified midwife, clinical nurse  1953
specialist, certified nurse-midwife, or certified nurse  1954
practitioner to obtain a consultation with a collaborating  1955
physician or podiatrist or another physician or podiatrist;  1956
       (3) A plan for coverage in instances of emergency or  1957
planned absences of either the certified midwife, clinical nurse  1958
specialist, certified nurse-midwife, or certified nurse  1959
practitioner or a collaborating physician or podiatrist that  1960
provides the means whereby a physician or podiatrist is  1961
available for emergency care;  1962
       (4) The process for resolution of disagreements regarding  1963
matters of patient management between the certified midwife,  1964
S. B. No. 438  Page 69
As Introduced
clinical nurse specialist, certified nurse-midwife, or certified  1965
nurse practitioner and a collaborating physician or podiatrist;  1966
        (5) An agreement that the collaborating physician shall  1967
complete and sign the medical certificate of death pursuant to  1968
section 3705.16 of the Revised Code;  1969
        (6) Any other criteria required by rule of the board  1970
adopted pursuant to section 4723.07 or 4723.50 of the Revised  1971
Code.  1972
        (C) A standard care arrangement entered into pursuant to  1973
this section may permit a clinical nurse specialist, certified  1974
nurse-midwife, or certified nurse practitioner to do any of the  1975
following:  1976
        (1) Supervise services provided by a home health agency as  1977
defined in section 3740.01 of the Revised Code;  1978
        (2) Admit a patient to a hospital in accordance with  1979
section 3727.06 of the Revised Code;  1980
        (3) Sign any document relating to the admission,  1981
treatment, or discharge of an inpatient receiving psychiatric or  1982
other behavioral health care services, but only if the  1983
conditions of section 4723.436 of the Revised Code have been  1984
met.  1985
        (D)(1) Except as provided in division (D)(2) of this  1986
section, if a physician or podiatrist terminates the  1987
collaboration between the physician or podiatrist and a  1988
certified midwife, certified nurse-midwife, certified nurse  1989
practitioner, or clinical nurse specialist before their standard  1990
care arrangement expires, all of the following apply:  1991
        (a) The physician or podiatrist must give the certified  1992
S. B. No. 438  Page 70
As Introduced
midwife or nurse written or electronic notice of the  1993
termination.  1994
       (b) Once the certified midwife or nurse receives the  1995
termination notice, the certified midwife or nurse must notify  1996
the board of nursing of the termination as soon as practicable  1997
by submitting to the board a copy of the physician's or  1998
podiatrist's termination notice.  1999
       (c) Notwithstanding the requirement requirements of  2000
section sections 4723.43 and 4723.57 of the Revised Code that  2001
the certified midwife or nurse practice in collaboration with a  2002
physician or podiatrist, the certified midwife or nurse may  2003
continue to practice under the existing standard care  2004
arrangement without a collaborating physician or podiatrist for  2005
not more than one hundred twenty days after submitting to the  2006
board a copy of the termination notice.  2007
       (2) In the event that the collaboration between a  2008
physician or podiatrist and a certified midwife, certified  2009
nurse-midwife, certified nurse practitioner, or clinical nurse  2010
specialist terminates because of the physician's or podiatrist's  2011
death, the certified midwife or nurse must notify the board of  2012
the death as soon as practicable. The certified midwife or nurse  2013
may continue to practice under the existing standard care  2014
arrangement without a collaborating physician or podiatrist for  2015
not more than one hundred twenty days after notifying the board  2016
of the physician's or podiatrist's death.  2017
       (E)(1) Nothing in this section prohibits a hospital from  2018
hiring a certified midwife, clinical nurse specialist, certified  2019
nurse-midwife, or certified nurse practitioner as an employee  2020
and negotiating standard care arrangements on behalf of the  2021
employee as necessary to meet the requirements of this section.  2022
S. B. No. 438  Page 71
As Introduced
A standard care arrangement between the hospital's employee and  2023
the employee's collaborating physician is subject to approval by  2024
the medical staff and governing body of the hospital prior to  2025
implementation of the arrangement at the hospital.  2026
       (2) Nothing in this section prohibits a standard care  2027
arrangement from specifying actions that a clinical nurse  2028
specialist, certified nurse-midwife, or certified nurse  2029
practitioner is authorized to take, or is prohibited from  2030
taking, as part of the nurse's practice in collaboration with a  2031
physician or podiatrist. In specifying such actions, the  2032
standard care arrangement shall not authorize the nurse to take  2033
any action that is otherwise prohibited by the Revised Code or  2034
rule of the board.  2035
       Sec. 4723.432. (A) An A certified midwife or an advanced  2036
practice registered nurse who is designated as a clinical nurse  2037
specialist, certified nurse-midwife, or certified nurse  2038
practitioner shall cooperate with the state medical board in any  2039
investigation the board conducts with respect to a physician or  2040
podiatrist who collaborates with the certified midwife or nurse.  2041
The certified midwife or nurse shall cooperate with the board in  2042
any investigation the board conducts with respect to the  2043
unauthorized practice of medicine by the certified midwife or  2044
nurse.  2045
       (B) An advanced practice registered nurse who is  2046
designated as a certified registered nurse anesthetist shall  2047
cooperate with the state medical board or state dental board in  2048
any investigation either board conducts with respect to a  2049
physician, podiatrist, or dentist who permits the nurse to  2050
practice with the supervision of that physician, podiatrist, or  2051
dentist. The nurse shall cooperate with either board in any  2052
S. B. No. 438  Page 72
As Introduced
investigation it conducts with respect to the unauthorized  2053
practice of medicine or dentistry by the nurse.  2054
       Sec. 4723.481. This section establishes standards and  2055
conditions regarding the authority of an advanced practice  2056
registered nurse who is designated as a clinical nurse  2057
specialist, certified nurse-midwife, or certified nurse  2058
practitioner to prescribe and personally furnish drugs and  2059
therapeutic devices under a license issued under section 4723.42  2060
of the Revised Code.  2061
       This section also establishes standards and conditions  2062
regarding the authority of a certified midwife to prescribe and  2063
personally furnish drugs and therapeutic devices under a license  2064
issued under section 4723.56 of the Revised Code.  2065
       (A) A clinical nurse specialist, certified nurse-midwife,  2066
or certified nurse practitioner, or certified midwife shall not  2067
prescribe or furnish any drug or therapeutic device that is  2068
listed on the exclusionary formulary established in rules  2069
adopted under section 4723.50 of the Revised Code.  2070
       (B) The prescriptive authority of a clinical nurse  2071
specialist, certified nurse-midwife, or certified nurse  2072
practitioner, or certified midwife shall not exceed the  2073
prescriptive authority of the collaborating physician or  2074
podiatrist, including the collaborating physician's authority to  2075
treat chronic pain with controlled substances and products  2076
containing tramadol as described in section 4731.052 of the  2077
Revised Code.  2078
       (C)(1) Except as provided in division (C)(2) or (3) of  2079
this section, a clinical nurse specialist, certified nurse-  2080
midwife, or certified nurse practitioner, or certified midwife  2081
S. B. No. 438  Page 73
As Introduced
may prescribe to a patient a schedule II controlled substance  2082
only if all of the following are the case:  2083
       (a) The patient has a terminal condition, as defined in  2084
section 2133.01 of the Revised Code.  2085
       (b) A physician initially prescribed the substance for the  2086
patient.  2087
       (c) The prescription is for an amount that does not exceed  2088
the amount necessary for the patient's use in a single, seventy-  2089
two-hour period.  2090
       (2) The restrictions on prescriptive authority in division  2091
(C)(1) of this section do not apply if a clinical nurse  2092
specialist, certified nurse-midwife, or certified nurse  2093
practitioner, or certified midwife issues the prescription to  2094
the patient from any of the following entities:  2095
       (a) A hospital as defined in section 3722.01 of the  2096
Revised Code;  2097
       (b) An entity owned or controlled, in whole or in part, by  2098
a hospital or by an entity that owns or controls, in whole or in  2099
part, one or more hospitals;  2100
       (c) A health care facility operated by the department of  2101
mental health and addiction services or the department of  2102
developmental disabilities;  2103
       (d) A nursing home licensed under section 3721.02 of the  2104
Revised Code or by a political subdivision certified under  2105
section 3721.09 of the Revised Code;  2106
       (e) A county home or district home operated under Chapter  2107
5155. of the Revised Code that is certified under the medicare  2108
or medicaid program;  2109
S. B. No. 438  Page 74
As Introduced
       (f) A hospice care program, as defined in section 3712.01  2110
of the Revised Code;  2111
       (g) A community mental health services provider, as  2112
defined in section 5122.01 of the Revised Code;  2113
       (h) An ambulatory surgical facility, as defined in section  2114
3702.30 of the Revised Code;  2115
       (i) A freestanding birthing center, as defined in section  2116
3701.503 of the Revised Code;  2117
       (j) A federally qualified health center, as defined in  2118
section 3701.047 of the Revised Code;  2119
       (k) A federally qualified health center look-alike, as  2120
defined in section 3701.047 of the Revised Code;  2121
       (l) A health care office or facility operated by the board  2122
of health of a city or general health district or the authority  2123
having the duties of a board of health under section 3709.05 of  2124
the Revised Code;  2125
       (m) A site where a medical practice is operated, but only  2126
if the practice is comprised of one or more physicians who also  2127
are owners of the practice; the practice is organized to provide  2128
direct patient care; and the clinical nurse specialist,  2129
certified nurse-midwife, or certified nurse practitioner, or  2130
certified midwife providing services at the site has a standard  2131
care arrangement and collaborates with at least one of the  2132
physician owners who practices primarily at that site;  2133
       (n) A site where a behavioral health practice is operated  2134
that does not qualify as a location otherwise described in  2135
division (C)(2) of this section, but only if the practice is  2136
organized to provide outpatient services for the treatment of  2137
S. B. No. 438  Page 75
As Introduced
mental health conditions, substance use disorders, or both, and  2138
the clinical nurse specialist, certified nurse-midwife, or  2139
certified nurse practitioner, or certified midwife providing  2140
services at the site of the practice has a standard care  2141
arrangement and collaborates with at least one physician who is  2142
employed by that practice;  2143
       (o) A residential care facility, as defined in section  2144
3721.01 of the Revised Code.  2145
       (3) A clinical nurse specialist, certified nurse-midwife,  2146
or certified nurse practitioner, or certified midwife shall not  2147
issue to a patient a prescription for a schedule II controlled  2148
substance from a convenience care clinic even if the clinic is  2149
owned or operated by an entity specified in division (C)(2) of  2150
this section.  2151
       (D) A pharmacist who acts in good faith reliance on a  2152
prescription issued by a clinical nurse specialist, certified  2153
nurse-midwife, or certified nurse practitioner, or certified  2154
midwife under division (C)(2) of this section is not liable for  2155
or subject to any of the following for relying on the  2156
prescription: damages in any civil action, prosecution in any  2157
criminal proceeding, or professional disciplinary action by the  2158
state board of pharmacy under Chapter 4729. of the Revised Code.  2159
       (E) A clinical nurse specialist, certified nurse-midwife,  2160
or certified nurse practitioner, or certified midwife shall  2161
comply with section 3719.061 of the Revised Code if the nurse  2162
prescribes for a minor, as defined in that section, an opioid  2163
analgesic, as defined in section 3719.01 of the Revised Code.  2164
       Sec. 4723.483. (A)(1) Subject to division (A)(2) of this  2165
section, and notwithstanding any provision of this chapter or  2166
S. B. No. 438  Page 76
As Introduced
rule adopted by the board of nursing, a clinical nurse  2167
specialist, certified nurse-midwife, or certified nurse  2168
practitioner who holds a certificate to prescribe issued under  2169
section 4723.48 of the Revised Code, or certified midwife may do  2170
either of the following without having examined an individual to  2171
whom epinephrine may be administered:  2172
        (a) Personally furnish a supply of epinephrine  2173
autoinjectors for use in accordance with sections 3313.7110,  2174
3313.7111, 3314.143, 3326.28, 3328.29, 3728.03 to 3728.05, and  2175
5180.26 of the Revised Code;  2176
        (b) Issue a prescription for epinephrine autoinjectors for  2177
use in accordance with sections 3313.7110, 3313.7111, 3314.143,  2178
3326.28, 3328.29, 3728.03 to 3728.05, and 5180.26 of the Revised  2179
Code.  2180
        (2) An epinephrine autoinjector personally furnished or  2181
prescribed under division (A)(1) of this section must be  2182
furnished or prescribed in such a manner that it may be  2183
administered only in a manufactured dosage form.  2184
        (B) A nurse or certified midwife who acts in good faith in  2185
accordance with this section is not liable for or subject to any  2186
of the following for any action or omission of an entity to  2187
which an epinephrine autoinjector is furnished or a prescription  2188
is issued: damages in any civil action, prosecution in any  2189
criminal proceeding, or professional disciplinary action.  2190
        Sec. 4723.487. (A) As used in this section:  2191
        (1) "Drug database" means the database established and  2192
maintained by the state board of pharmacy pursuant to section  2193
4729.75 of the Revised Code.  2194
        (2) "Opioid analgesic" and "benzodiazepine" have the same  2195
S. B. No. 438  Page 77
As Introduced
meanings as in section 3719.01 of the Revised Code.  2196
       (B) Except as provided in divisions (C) and (E) of this  2197
section, an advanced practice registered nurse who is designated  2198
as a clinical nurse specialist, certified nurse-midwife, or  2199
certified nurse practitioner or a certified midwife shall comply  2200
with all of the following as conditions of prescribing a drug  2201
that is either an opioid analgesic or a benzodiazepine as part  2202
of a patient's course of treatment for a particular condition:  2203
       (1) Before initially prescribing the drug, the advanced  2204
practice registered nurse or certified midwife or the advanced  2205
practice registered nurse's or certified midwife's delegate  2206
shall request from the drug database a report of information  2207
related to the patient that covers at least the twelve months  2208
immediately preceding the date of the request. If the advanced  2209
practice registered nurse or certified midwife practices  2210
primarily in a county of this state that adjoins another state,  2211
the advanced practice registered nurse or certified midwife or  2212
delegate also shall request a report of any information  2213
available in the drug database that pertains to prescriptions  2214
issued or drugs furnished to the patient in the state adjoining  2215
that county.  2216
       (2) If the patient's course of treatment for the condition  2217
continues for more than ninety days after the initial report is  2218
requested, the advanced practice registered nurse or certified  2219
midwife or delegate shall make periodic requests for reports of  2220
information from the drug database until the course of treatment  2221
has ended. The requests shall be made at intervals not exceeding  2222
ninety days, determined according to the date the initial  2223
request was made. The request shall be made in the same manner  2224
provided in division (B)(1) of this section for requesting the  2225
S. B. No. 438  Page 78
As Introduced
initial report of information from the drug database.  2226
       (3) On receipt of a report under division (B)(1) or (2) of  2227
this section, the advanced practice registered nurse or  2228
certified midwife shall assess the information in the report.  2229
The advanced practice registered nurse or certified midwife  2230
shall document in the patient's record that the report was  2231
received and the information was assessed.  2232
       (C) Division (B) of this section does not apply if in any  2233
of the following circumstances:  2234
       (1) A drug database report regarding the patient is not  2235
available, in which case the advanced practice registered nurse  2236
or certified midwife shall document in the patient's record the  2237
reason that the report is not available.  2238
       (2) The drug is prescribed in an amount indicated for a  2239
period not to exceed seven days.  2240
       (3) The drug is prescribed for the treatment of cancer or  2241
another condition associated with cancer.  2242
       (4) The drug is prescribed to a hospice patient in a  2243
hospice care program, as those terms are defined in section  2244
3712.01 of the Revised Code, or any other patient diagnosed as  2245
terminally ill.  2246
       (5) The drug is prescribed for administration in a  2247
hospital, nursing home, or residential care facility.  2248
       (D) The board of nursing may adopt rules, in accordance  2249
with Chapter 119. of the Revised Code, that establish standards  2250
and procedures to be followed by an advanced practice registered  2251
nurse or certified midwife regarding the review of patient  2252
information available through the drug database under division  2253
S. B. No. 438  Page 79
As Introduced
(A)(5) of section 4729.80 of the Revised Code. The rules shall  2254
be adopted in accordance with Chapter 119. of the Revised Code.  2255
        (E) This section and any rules adopted under it do not  2256
apply if the state board of pharmacy no longer maintains the  2257
drug database.  2258
        Sec. 4723.488. (A) Except as provided in division (B) of  2259
this section, in the case of a license holder who is seeking  2260
renewal of a license to practice nursing as an advanced practice  2261
registered nurse or a license to practice as a certified midwife  2262
and who prescribes opioid analgesics or benzodiazepines, as  2263
defined in section 3719.01 of the Revised Code, the holder shall  2264
certify to the board whether the holder has been granted access  2265
to the drug database established and maintained by the state  2266
board of pharmacy pursuant to section 4729.75 of the Revised  2267
Code.  2268
        (B) The requirement in division (A) of this section does  2269
not apply if any of the following is the case:  2270
        (1) The state board of pharmacy notifies the board of  2271
nursing pursuant to section 4729.861 of the Revised Code that  2272
the license holder has been restricted from obtaining further  2273
information from the drug database.  2274
        (2) The state board of pharmacy no longer maintains the  2275
drug database.  2276
        (3) The license holder does not practice nursing as an  2277
advanced practice registered nurse or certified midwife in this  2278
state.  2279
        (C) If a license holder certifies to the board of nursing  2280
that the holder has been granted access to the drug database and  2281
the board finds through an audit or other means that the holder  2282
S. B. No. 438  Page 80
As Introduced
has not been granted access, the board may take action under  2283
section 4723.28 of the Revised Code.  2284
       Sec. 4723.4810. (A)(1) Notwithstanding any conflicting  2285
provision of this chapter or rule adopted by the board of  2286
nursing, a clinical nurse specialist, certified nurse-midwife,  2287
or certified nurse practitioner, who holds a license to practice  2288
nursing as an advanced practice registered nurse issued under  2289
section 4723.42 of the Revised Code or certified midwife may  2290
issue a prescription for or personally furnish a complete or  2291
partial supply of a drug to treat chlamydia, gonorrhea, or  2292
trichomoniasis, without having examined the individual for whom  2293
the drug is intended, if all of the following conditions are  2294
met:  2295
       (a) The individual is a sexual partner of the nurse's or  2296
certified midwife's patient.  2297
       (b) The patient has been diagnosed with chlamydia,  2298
gonorrhea, or trichomoniasis.  2299
       (c) The patient reports to the nurse or certified midwife  2300
that the individual is unable or unlikely to be evaluated or  2301
treated by a health professional.  2302
       (2) A prescription issued under this section shall include  2303
the individual's name and address, if known. If the nurse or  2304
certified midwife is unable to obtain the individual's name and  2305
address, the prescription shall include the patient's name and  2306
address and the words "expedited partner therapy" or the letters  2307
"EPT."  2308
       (3) A nurse or certified midwife may prescribe or  2309
personally furnish a drug under this section for not more than a  2310
total of two individuals who are sexual partners of the nurse's  2311
S. B. No. 438  Page 81
As Introduced
or certified midwife's patient.  2312
       (B) For each drug prescribed or personally furnished under  2313
this section, the nurse or certified midwife shall do all of the  2314
following:  2315
       (1) Provide the patient with information concerning the  2316
drug for the purpose of sharing the information with the  2317
individual, including directions for use of the drug and any  2318
side effects, adverse reactions, or known contraindications  2319
associated with the drug;  2320
       (2) Recommend to the patient that the individual seek  2321
treatment from a health professional;  2322
       (3) Document all of the following in the patient's record:  2323
       (a) The name of the drug prescribed or furnished and its  2324
dosage;  2325
       (b) That information concerning the drug was provided to  2326
the patient for the purpose of sharing the information with the  2327
individual;  2328
       (c) If known, any adverse reactions the individual  2329
experiences from treatment with the drug.  2330
       (C) A nurse or certified midwife who prescribes or  2331
personally furnishes a drug under this section may contact the  2332
individual for whom the drug is intended.  2333
       (1) If the nurse or certified midwife contacts the  2334
individual, the nurse or certified midwife shall do all of the  2335
following:  2336
       (a) Inform the individual that the individual may have  2337
been exposed to chlamydia, gonorrhea, or trichomoniasis;  2338
S. B. No. 438  Page 82
As Introduced
       (b) Encourage the individual to seek treatment from a  2339
health professional;  2340
       (c) Explain the treatment options available to the  2341
individual, including treatment with a prescription drug,  2342
directions for use of the drug, and any side effects, adverse  2343
reactions, or known contraindications associated with the drug;  2344
       (d) Document in the patient's record that the nurse or  2345
certified midwife contacted the individual.  2346
       (2) If the nurse or certified midwife does not contact the  2347
individual, the nurse or certified midwife shall document that  2348
fact in the patient's record.  2349
       (D) A nurse or certified midwife who in good faith  2350
prescribes or personally furnishes a drug under this section is  2351
not liable for or subject to any of the following:  2352
       (1) Damages in any civil action;  2353
       (2) Prosecution in any criminal proceeding;  2354
       (3) Professional disciplinary action.  2355
       Sec. 4723.4811. (A)(1) Subject to division (A)(2) of this  2356
section, and notwithstanding any provision of this chapter or  2357
rule adopted by the board of nursing, a clinical nurse  2358
specialist, certified nurse-midwife, or certified nurse  2359
practitioner licensed as an advanced practice registered nurse  2360
under Chapter 4723. of the Revised Code, or certified midwife  2361
may do either of the following without having examined an  2362
individual to whom glucagon may be administered:  2363
       (a) Personally furnish a supply of injectable or nasally  2364
administered glucagon for use in accordance with sections  2365
3313.7115, 3313.7116, 3314.147, 3326.60, 3328.38, and 5180.262  2366
S. B. No. 438  Page 83
As Introduced
of the Revised Code;  2367
       (b) Issue a prescription for injectable or nasally  2368
administered glucagon for use in accordance with sections  2369
3313.7115, 3313.7116, 3314.147, 3326.60, 3328.38, and 5180.262  2370
of the Revised Code.  2371
       (2) Injectable or nasally administered glucagon personally  2372
furnished or prescribed under division (A)(1) of this section  2373
must be furnished or prescribed in such a manner that it may be  2374
administered only in a manufactured dosage form.  2375
       (B) A nurse or certified midwife who acts in good faith in  2376
accordance with this section is not liable for or subject to any  2377
of the following for any action or omission of an entity to  2378
which injectable or nasally administered glucagon is furnished  2379
or a prescription is issued: damages in any civil action,  2380
prosecution in any criminal proceeding, or professional  2381
disciplinary action.  2382
       Sec. 4723.50. (A) As used in this section:  2383
       (1) "Controlled substance" has the same meaning as in  2384
section 3719.01 of the Revised Code.  2385
       (2) "Medication-assisted treatment" has the same meaning  2386
as in section 340.01 of the Revised Code.  2387
       (B) In accordance with Chapter 119. of the Revised Code,  2388
the board of nursing shall adopt rules as necessary to implement  2389
the provisions of this chapter pertaining to the authority of  2390
advanced practice registered nurses who are designated as  2391
clinical nurse specialists, certified nurse-midwives, and  2392
certified nurse practitioners, and certified midwives to  2393
prescribe and furnish drugs and therapeutic devices.  2394
S. B. No. 438  Page 84
As Introduced
       The board shall adopt rules establishing an exclusionary  2395
formulary. The exclusionary formulary shall permit, in a manner  2396
consistent with section 4723.481 of the Revised Code, the  2397
prescribing of controlled substances, including drugs that  2398
contain buprenorphine used in medication-assisted treatment and  2399
both oral and long-acting opioid antagonists. The formulary  2400
shall not permit the prescribing or furnishing of any of the  2401
following:  2402
       (1) A drug or device to perform or induce an abortion;  2403
       (2) A drug or device prohibited by federal or state law.  2404
       (C) In addition to the rules described in division (B) of  2405
this section, the board shall adopt rules under this section  2406
that do the following:  2407
       (1) Establish standards for board approval of the course  2408
of study in advanced pharmacology and related topics required by  2409
section sections 4723.482 and 4723.551 of the Revised Code;  2410
       (2) Establish requirements for board approval of the two-  2411
hour course of instruction in the laws of this state as required  2412
under division (C)(1) of section 4723.482 of the Revised Code;  2413
       (3) Establish criteria for the components of the standard  2414
care arrangements described in section 4723.431 of the Revised  2415
Code that apply to the authority to prescribe, including the  2416
components that apply to the authority to prescribe schedule II  2417
controlled substances. The rules shall be consistent with that  2418
section and include all of the following:  2419
       (a) Quality assurance standards;  2420
       (b) Standards for periodic review by a collaborating  2421
physician or podiatrist of the records of patients treated by  2422
S. B. No. 438  Page 85
As Introduced
the clinical nurse specialist, certified nurse-midwife, or  2423
certified nurse practitioner, or certified midwife;  2424
       (c) Acceptable travel time between the location at which  2425
the clinical nurse specialist, certified nurse-midwife, or  2426
certified nurse practitioner, or certified midwife is engaging  2427
in the prescribing components of the nurse's practice and the  2428
location of the nurse's or certified midwife's collaborating  2429
physician or podiatrist.  2430
       Sec. 4723.53. As used in sections 4723.43 and 4723.53 to  2431
4723.60 of the Revised Code:  2432
       (A) "Accreditation commission for midwifery education"  2433
means the organization known by that name or its successor  2434
organization.  2435
       (B) "American college of nurse-midwives" means the  2436
organization known by that name or its successor organization.  2437
       (C) "American midwifery certification board" means the  2438
organization known by that name or its successor organization.  2439
       Sec. 4723.54. (A) Except as provided in division (B) of  2440
this section, no individual shall knowingly practice as a  2441
certified midwife unless the individual holds a current, valid  2442
license to practice as a certified midwife issued under section  2443
4723.56 of the Revised Code.  2444
       (B) Division (A) of this section does not apply to any of  2445
the following:  2446
       (1) A physician authorized under Chapter 4731. of the  2447
Revised Code to practice medicine and surgery, osteopathic  2448
medicine and surgery, or podiatric medicine and surgery;  2449
       (2) A physician assistant authorized under Chapter 4730.  2450
S. B. No. 438  Page 86
As Introduced
of the Revised Code to practice as a physician assistant;  2451
       (3) A registered nurse, advanced practice registered  2452
nurse, or licensed practical nurse authorized under this chapter  2453
to practice nursing as a registered nurse, advanced practice  2454
registered nurse, or licensed practical nurse;  2455
       (4) A licensed midwife;  2456
       (5) A traditional midwife;  2457
       (6) A student who is participating in a midwifery  2458
education program accredited by the accreditation commission for  2459
midwifery education and who provides midwifery services under  2460
the auspices of the program and under the supervision of a  2461
certified midwife serving for the program as a faculty member,  2462
instructor, teaching assistant, or preceptor.  2463
       Sec. 4723.55. (A) An individual seeking a license to  2464
practice as a certified midwife shall file with the board of  2465
nursing an application in a manner prescribed by the board. The  2466
application shall include all the information the board  2467
considers necessary to process the application, including  2468
evidence satisfactory to the board that the applicant meets the  2469
requirements specified in division (B) of this section.  2470
       (B) To be eligible to receive a license to practice as a  2471
certified midwife, an applicant shall demonstrate to the board  2472
that the applicant meets all of the following requirements:  2473
       (1) Is at least eighteen years of age;  2474
       (2) Has attained a master's degree or higher;  2475
       (3) Has graduated from a midwifery education program  2476
accredited by the accreditation commission for midwifery  2477
education;  2478
S. B. No. 438  Page 87
As Introduced
       (4) Is certified by the American midwifery certification  2479
board;  2480
       (5) Is certified in neonatal and adult cardiopulmonary  2481
resuscitation;  2482
       (6) Has successfully completed the course of study in  2483
advanced pharmacology required by section 4723.551 of the  2484
Revised Code.  2485
       (C) The board shall review all applications received under  2486
this section. After receiving an application it considers  2487
complete, the board shall determine whether the applicant meets  2488
the requirements for a license to practice as a certified  2489
midwife.  2490
       Sec. 4723.551. (A) An applicant for a license to practice  2491
as a certified midwife shall include with the application  2492
submitted under section 4723.55 of the Revised Code evidence of  2493
successfully completing the course of study in advanced  2494
pharmacology and related topics in accordance with the  2495
requirements specified in division (B) of this section.  2496
       (B) With respect to the course of study in advanced  2497
pharmacology and related topics, all of the following  2498
requirements apply:  2499
       (1) The course of study shall be completed not more than  2500
five years before the application is filed.  2501
       (2) The course of study shall include at least forty-five  2502
contact hours.  2503
       (3) The course of study shall meet the requirements to be  2504
approved by the board in accordance with standards established  2505
in rules adopted under section 4723.50 of the Revised Code.  2506
S. B. No. 438  Page 88
As Introduced
       (4) The content of the course of study shall be specific  2507
to midwifery.  2508
       (5) The instruction provided in the course of study shall  2509
include all of the following:  2510
       (a) A minimum of thirty-six contact hours of instruction  2511
in advanced pharmacology that includes pharmacokinetic  2512
principles and clinical application and the use of drugs and  2513
therapeutic devices in the prevention of illness and maintenance  2514
of health;  2515
       (b) Instruction in the fiscal and ethical implications of  2516
prescribing drugs and therapeutic devices;  2517
       (c) Instruction in the state and federal laws that apply  2518
to the authority to prescribe;  2519
       (d) Instruction that is specific to schedule II controlled  2520
substances, including instruction in all of the following:  2521
       (i) Indications for the use of schedule II controlled  2522
substances in drug therapies;  2523
       (ii) The most recent guidelines for pain management  2524
therapies, as established by state and national organizations  2525
such as the Ohio pain initiative and the American pain society;  2526
       (iii) Fiscal and ethical implications of prescribing  2527
schedule II controlled substances;  2528
       (iv) State and federal laws that apply to the authority to  2529
prescribe schedule II controlled substances;  2530
       (v) Prevention of abuse and diversion of schedule II  2531
controlled substances, including identification of the risk of  2532
abuse and diversion, recognition of abuse and diversion, types  2533
S. B. No. 438  Page 89
As Introduced
of assistance available for prevention of abuse and diversion,  2534
and methods of establishing safeguards against abuse and  2535
diversion.  2536
       Sec. 4723.56. (A) If the board of nursing determines under  2537
section 4723.55 of the Revised Code that an applicant meets the  2538
requirements for a license to practice as a certified midwife,  2539
the secretary of the board shall issue the license to the  2540
applicant.  2541
       (B) Each license shall be valid for a two-year period  2542
unless revoked or suspended, shall expire on the date that is  2543
two years after the date of issuance, and may be renewed for  2544
additional two-year periods in accordance with rules adopted  2545
under section 4723.59 of the Revised Code.  2546
       (C) To renew a license to practice as a certified midwife,  2547
an applicant for renewal shall demonstrate both of the following  2548
to the board:  2549
       (1) That the applicant has maintained certification in  2550
neonatal and adult cardiopulmonary resuscitation;  2551
       (2) That the applicant has satisfied the continuing  2552
education requirements of the American midwifery certification  2553
board.  2554
       Sec. 4723.57. (A) An individual who holds a current, valid  2555
license to practice as a certified midwife may, in collaboration  2556
with one or more physicians, engage in one or more of the  2557
following activities:  2558
       (1) Providing primary health care services for women from  2559
adolescence and beyond menopause, including the independent  2560
provision of gynecologic and family planning services,  2561
preconception care, and care during pregnancy, childbirth, and  2562
S. B. No. 438  Page 90
As Introduced
the postpartum period;  2563
       (2) Attending births in hospitals, homes, medical offices,  2564
and freestanding birthing centers;  2565
       (3) Providing care for normal newborns during the period  2566
consistent with the scope of practice for certified nurse-  2567
midwives established by the American college of nurse-midwives;  2568
       (4) Providing initial and ongoing comprehensive  2569
assessment, diagnosis, and treatment;  2570
       (5) Conducting physical examinations;  2571
       (6) Ordering and interpreting laboratory and diagnostic  2572
tests;  2573
       (7) Administering medications, treatments, and executing  2574
regimens authorized by an individual who is authorized to  2575
practice in this state and is acting within the course of the  2576
individual's professional practice;  2577
       (8) Providing care that includes health promotion, disease  2578
prevention, and individualized wellness education and  2579
counseling.  2580
       (B) When engaging in any of the activities permitted under  2581
this section, a certified midwife shall maintain appropriate  2582
medical records regarding patient history, treatment, and  2583
outcomes.  2584
       Sec. 4723.58. (A) This section establishes the process by  2585
which a certified nurse-midwife or certified midwife obtains a  2586
patient's consent to treatment authorized by section 4723.43 or  2587
4723.57 of the Revised Code, but only when the certified nurse-  2588
midwife or certified midwife seeks to provide the treatment in a  2589
setting other than a hospital or facility.  2590
S. B. No. 438  Page 91
As Introduced
       (B) The following information shall be exchanged in  2591
writing between a certified nurse-midwife or certified midwife  2592
and patient when obtaining consent to treatment as described in  2593
division (A) of this section:  2594
       (1) The name and license number of the certified nurse-  2595
midwife or certified midwife;  2596
       (2) The patient's name, address, telephone number, and  2597
primary care provider, if the patient has one;  2598
       (3) A description of the certified nurse-midwife's or  2599
certified midwife's education, training, and experience in  2600
nurse-midwifery or midwifery;  2601
       (4) The certified nurse-midwife's or certified midwife's  2602
practice philosophy;  2603
       (5) A promise to provide the patient, upon request, with  2604
separate documents describing the rules governing the practice  2605
of a certified nurse-midwife or certified midwife, including a  2606
list of conditions indicating the need for consultation,  2607
referral, transfer, or mandatory transfer and the certified  2608
nurse-midwife's or certified midwife's personal written practice  2609
guidelines;  2610
       (6) A written plan for medical consultation and transfer  2611
of care;  2612
       (7) A description of any hospital care and procedures that  2613
may be necessary in the event of an emergency transfer or care;  2614
       (8) A description of the services provided to the patient  2615
by the certified nurse-midwife or certified midwife;  2616
       (9) That the certified nurse-midwife or certified midwife  2617
holds a current, valid license to practice issued under this  2618
S. B. No. 438  Page 92
As Introduced
chapter;  2619
       (10) The availability of a grievance process;  2620
       (11) Whether the certified nurse-midwife or certified  2621
midwife is covered by professional liability insurance;  2622
       (12) Any other information required in rules adopted by  2623
the board.  2624
       (C) Once the required information has been exchanged and  2625
if the patient consents to treatment, the patient and certified  2626
nurse-midwife or certified midwife shall sign a written document  2627
to indicate as such. The certified nurse-midwife or certified  2628
midwife shall retain a copy of the document for at least four  2629
years from the date on which the document was signed.  2630
       Sec. 4723.581. (A) The board of nursing shall adopt rules  2631
establishing the circumstances in which a certified nurse-  2632
midwife or certified midwife shall be prohibited from attending  2633
a home birth, which may include a high-risk pregnancy. In  2634
adopting the rules, the board shall allow a certified nurse-  2635
midwife or certified midwife to attend any of the following as a  2636
home birth only if the conditions described in division (B) of  2637
this section are satisfied: a vaginal birth after cesarean,  2638
birth of twins, or breech birth.  2639
       (B) In the event of a home birth described in division (A)  2640
of this section, a certified nurse-midwife or certified midwife  2641
may attend the birth only if all of the following conditions are  2642
satisfied:  2643
       (1) In addition to the informed consent required under  2644
section 4723.58 of the Revised Code, the certified nurse-midwife  2645
or certified midwife obtains the patient's written informed  2646
consent for the vaginal birth after cesarean, birth of twins, or  2647
S. B. No. 438  Page 93
As Introduced
breech birth, including a description of risks associated with  2648
the procedure.  2649
       (2) The certified nurse-midwife or certified midwife  2650
consults with a physician about the patient and together with  2651
the physician determines whether referral is appropriate for the  2652
patient.  2653
       If a referral is determined to be appropriate and the  2654
patient consents to the referral, the certified nurse-midwife or  2655
certified midwife shall refer the patient to the physician. If  2656
the patient refuses the referral, the certified nurse-midwife or  2657
certified midwife shall document the refusal and may continue to  2658
provide care to the patient, including attending the vaginal  2659
birth after cesarean, birth of twins, or breech birth at home.  2660
       (3) The certified nurse-midwife or certified midwife  2661
satisfies any other conditions required in rules adopted by the  2662
board of nursing.  2663
       (C) In adopting rules under this section, the board of  2664
nursing shall do both of the following:  2665
       (1) Consider any relevant peer-reviewed medical  2666
literature;  2667
       (2) Specify the content and format of the document to be  2668
used when obtaining informed consent as described in this  2669
section.  2670
       Sec. 4723.582. (A) As used in this section and section  2671
4723.583 of the Revised Code, "emergency medical service,"  2672
"emergency medical service personnel," and "emergency medical  2673
service organization" have the same meanings as in section  2674
4765.01 of the Revised Code.  2675
S. B. No. 438  Page 94
As Introduced
       (B) For any pregnancy or childbirth in which a certified  2676
nurse-midwife or certified midwife provides care and a home  2677
birth is planned, both of the following apply:  2678
       (1) The certified nurse-midwife or certified midwife shall  2679
create an individualized transfer of care plan with each  2680
patient.  2681
       (2) The certified nurse-midwife or certified midwife shall  2682
assess the status of the patient, fetus, and newborn throughout  2683
the maternity care cycle and shall determine when or if a  2684
transfer to a hospital is necessary.  2685
       (C) Each individualized transfer of care plan shall  2686
contain all of the following:  2687
       (1) The name and location of geographically adjacent  2688
hospitals that are appropriately equipped to provide emergency  2689
care, obstetrical care, and newborn care;  2690
       (2) The approximate travel time to each hospital;  2691
       (3) A list of the modes of transport services available,  2692
including an emergency medical service organization available by  2693
calling 9-1-1;  2694
       (4) The requirements for activating each mode of  2695
transportation;  2696
       (5) The mechanism by which medical records and other  2697
information concerning the patient may be rapidly transmitted to  2698
each hospital;  2699
       (6) Confirmation that the certified nurse-midwife or  2700
certified midwife has recommended that the patient pre-register  2701
with the hospital closest to the patient's home that is  2702
appropriately equipped to provide emergency care, obstetrical  2703
S. B. No. 438  Page 95
As Introduced
care, and newborn care;  2704
       (7) Contact information for either a health care provider  2705
or practice group who has agreed in advance to accept patients  2706
in transfer, or a hospital's preferred method of accessing care  2707
by the hospital's designated provider on call;  2708
       (8) Any other information required in rules adopted by the  2709
board of nursing.  2710
       (D) When it becomes necessary to transfer a patient, a  2711
certified nurse-midwife or certified midwife shall notify the  2712
receiving provider or hospital of all of the following:  2713
       (1) The incoming transfer;  2714
       (2) The reason for the transfer;  2715
       (3) A brief relevant clinical history;  2716
       (4) The planned mode of transport;  2717
       (5) The expected time of arrival;  2718
       (6) Any other information required in rules adopted by the  2719
board.  2720
       The certified nurse-midwife or certified midwife shall  2721
continue to provide routine or urgent care en route in  2722
coordination with any emergency medical services personnel or  2723
emergency medical service organization and shall address the  2724
psychosocial needs of the patient during the change of birth  2725
setting.  2726
       (E) On arrival at the hospital, the certified nurse-  2727
midwife or certified midwife shall do all of the following:  2728
       (1) Provide a verbal report that includes details on the  2729
patient's current health status and the need for urgent care;  2730
S. B. No. 438  Page 96
As Introduced
       (2) Provide a legible copy of relevant prenatal and labor  2731
medical records;  2732
       (3) Transfer clinical responsibility to the receiving  2733
provider or hospital;  2734
       (4) Satisfy any other requirement established in rules  2735
adopted by the board of nursing.  2736
       If the patient chooses, the certified nurse-midwife or  2737
certified midwife may remain at the hospital to provide  2738
continuous support. The certified nurse-midwife or certified  2739
midwife also may continue to provide midwifery services, but  2740
only if the hospital has granted the certified nurse-midwife or  2741
certified midwife clinical privileges. Whenever possible, the  2742
patient and her newborn shall be together during the transfer  2743
and after admission to the hospital.  2744
       Sec. 4723.583. Emergency medical service personnel or an  2745
emergency medical service organization, hospital, facility,  2746
physician, advanced practice registered nurse, or certified  2747
midwife that provides services or care following an adverse  2748
incident as defined in section 4723.584 of the Revised Code or  2749
during and after a transfer of care as described in section  2750
4723.582 of the Revised Code are not liable in damages in a tort  2751
or other civil action for injury or loss to person or property  2752
arising from the services or care, unless the services or care  2753
are provided in a manner that constitutes willful or wanton  2754
misconduct.  2755
       Sec. 4723.584. (A) As used in this section, "adverse  2756
incident" means an incident over which a certified nurse-midwife  2757
or certified midwife could exercise control, that is associated  2758
with an attempted or completed birth in a setting or facility  2759
S. B. No. 438  Page 97
As Introduced
other than a hospital, and that results in one or more of the  2760
following injuries or conditions:  2761
       (1) A maternal death that occurs during delivery or within  2762
forty-two days after delivery;  2763
       (2) The transfer of a maternal patient to a hospital  2764
intensive care unit;  2765
       (3) A maternal patient experiencing hemorrhagic shock or  2766
requiring a transfusion of more than two units of blood or blood  2767
products;  2768
       (4) A fetal or newborn death, including a stillbirth,  2769
associated with an obstetrical delivery;  2770
       (5) A transfer of a newborn to a neonatal intensive care  2771
unit due to a traumatic physical or neurological birth injury,  2772
including any degree of a brachial plexus injury;  2773
       (6) A transfer of a newborn to a neonatal intensive care  2774
unit within the first seventy-two hours after birth if the  2775
newborn remains in such unit for more than seventy-two hours;  2776
       (7) Any other condition as determined by the board of  2777
nursing in rules adopted under section 4723.07 or 4723.59 of the  2778
Revised Code.  2779
       (B) Beginning July 1, 2027, a certified nurse-midwife or  2780
certified midwife who attends a birth planned for a facility or  2781
setting other than a hospital must report any adverse incident,  2782
along with a medical summary of events, to the board of nursing  2783
within fifteen days after the adverse incident occurs.  2784
       (C) Beginning July 1, 2027, each certified nurse-midwife  2785
or certified midwife shall report annually to the board the  2786
following information regarding cases in which the midwife  2787
S. B. No. 438  Page 98
As Introduced
provided services when the intended place of birth at the onset  2788
of care was in a facility or setting other than a hospital:  2789
       (1) The total number of patients provided nurse-midwifery  2790
or certified midwifery services at the onset of care;  2791
       (2) The number of live births attended;  2792
       (3) The number of cases of fetal demise, newborn deaths,  2793
and maternal deaths attended as a certified nurse-midwife or  2794
certified midwife at the discovery of the demise or death;  2795
       (4) The number, reason for, and outcome of each transport  2796
of a patient in the antepartum, intrapartum period, or immediate  2797
postpartum period;  2798
       (5) A brief description of any complications resulting in  2799
the morbidity or mortality of a maternal patient or a newborn;  2800
       (6) The planned delivery setting and the actual setting;  2801
       (7) Any other information required in rules adopted by the  2802
department.  2803
       (D) Beginning eighteen months after the effective date of  2804
this section, the board shall submit an annual report to the  2805
department of health that compiles all information submitted to  2806
the board pursuant to divisions (B) and (C) of this section in  2807
the preceding calendar year.  2808
       (E) The department shall adopt rules to implement this  2809
section and shall develop a form to be used for the reporting  2810
required under divisions (B) and (C) of this section.  2811
       Sec. 4723.59. (A) In addition to the rules described in  2812
section 4723.07 of the Revised Code, the board of nursing shall  2813
adopt rules establishing standards and procedures for the  2814
S. B. No. 438  Page 99
As Introduced
licensure and regulation of certified midwives, including those  2815
establishing license application and renewal procedures. The  2816
rules shall be adopted in accordance with Chapter 119. of the  2817
Revised Code.  2818
       (B) The board also may adopt, in accordance with Chapter  2819
119. of the Revised Code, any other rules it considers necessary  2820
to implement and administer sections 4723.53 to 4723.60 of the  2821
Revised Code. The rules may require the completion of a criminal  2822
records check and, in the case of a license to practice as a  2823
certified midwife issued by another jurisdiction, may provide  2824
for licensure by endorsement.  2825
       Sec. 4723.60. Sections 4723.53 to 4723.59 of the Revised  2826
Code do not abridge, change, or limit in any way the right of a  2827
parent to deliver the parent's baby where, when, how, and with  2828
whom the parent chooses, regardless of the licensure  2829
requirements established in those sections.  2830
       Sec. 4723.91. On receipt of a notice pursuant to section  2831
3123.43 of the Revised Code, the board of nursing shall comply  2832
with sections 3123.41 to 3123.50 of the Revised Code and any  2833
applicable rules adopted under section 3123.63 of the Revised  2834
Code with respect to a nursing license, certified midwife  2835
license, medication aide certificate, dialysis technician  2836
certificate, or community health worker certificate issued  2837
pursuant to this chapter.  2838
       Sec. 4723.99. (A) Except as provided in division (B) or  2839
(C) of this section, whoever violates section 4723.03, 4723.44,  2840
4723.54, 4723.653, or 4723.73 of the Revised Code is guilty of a  2841
felony of the fifth degree on a first offense and a felony of  2842
the fourth degree on each subsequent offense.  2843
S. B. No. 438  Page 100
As Introduced
        (B) Each of the following is guilty of a minor  2844
misdemeanor:  2845
        (1) A registered nurse, advanced practice registered  2846
nurse, or licensed practical nurse who violates division (A),  2847
(B), (C), or (D) of section 4723.03 of the Revised Code by  2848
reason of a license to practice nursing that has lapsed for  2849
failure to renew or by practicing nursing after a license has  2850
been classified as inactive;  2851
        (2) A medication aide who violates section 4723.653 of the  2852
Revised Code by reason of a medication aide certificate that has  2853
lapsed for failure to renew or by administering medication as a  2854
medication aide after a certificate has been classified as  2855
inactive.  2856
        (C) Whoever violates division (H) of section 4723.03 of  2857
the Revised Code is guilty of a misdemeanor of the first degree.  2858
        Sec. 4724.01. As used in this chapter:  2859
        (A) "Certified international midwife" means an individual  2860
who is certified by the international registry of midwives but  2861
is not a licensed midwife.  2862
        (B) "Certified professional midwife" means an individual  2863
who is certified by the north American registry of midwives but  2864
is not a licensed midwife.  2865
        (C) "International registry of midwives" means the  2866
organization known by that name or its successor organization.  2867
        (D) "Licensed midwife" means an individual holding a  2868
license to practice issued under section 4724.04 of the Revised  2869
Code.  2870
        (E) "Midwifery education accreditation council" means the  2871
S. B. No. 438  Page 101
As Introduced
organization known by that name or its successor organization.  2872
        (F) "North American registry of midwives" means the  2873
organization known by that name or its successor organization.  2874
        (G) "Physician" means an individual authorized under  2875
Chapter 4731. of the Revised Code to practice medicine and  2876
surgery or osteopathic medicine and surgery.  2877
        (H) "Traditional midwife" means an individual who provides  2878
traditional midwifery services pursuant to sections 4724.14 and  2879
4724.15 of the Revised Code, does not hold a license to practice  2880
as a licensed midwife issued under this chapter, and does not  2881
hold a license to practice as a certified nurse-midwife or  2882
certified midwife issued under Chapter 4723. of the Revised  2883
Code.  2884
        Sec. 4724.02. (A) Except as provided in division (B) of  2885
this section, no individual shall knowingly practice as a  2886
licensed midwife unless the individual holds a current, valid  2887
license to practice issued under section 4724.04 of the Revised  2888
Code.  2889
        (B) Division (A) of this section does not apply to any of  2890
the following:  2891
        (1) A physician;  2892
        (2) A physician assistant authorized under Chapter 4730.  2893
of the Revised Code to practice as a physician assistant;  2894
        (3) A registered nurse, advanced practice registered  2895
nurse, or licensed practical nurse authorized under Chapter  2896
4723. of the Revised Code to practice nursing as a registered  2897
nurse, advanced practice registered nurse, or licensed practical  2898
nurse;  2899
S. B. No. 438  Page 102
As Introduced
       (4) A certified midwife authorized under Chapter 4723. of  2900
the Revised Code to practice as a certified midwife;  2901
       (5) A student who is participating in a professional  2902
midwifery education program and who provides midwifery services  2903
under the auspices of the program and under the supervision of a  2904
licensed midwife serving for the program as a faculty member,  2905
instructor, teaching assistant, or preceptor;  2906
       (6) An individual who is participating in a professional  2907
midwifery apprenticeship and who provides midwifery services as  2908
part of the apprenticeship program and under the supervision of  2909
a licensed midwife serving for the program as an instructor,  2910
teaching assistant, or preceptor;  2911
       (7) An individual who provides midwifery services without  2912
a license while engaging in good faith in the practice of the  2913
religious tenets of any church or in any religious act;  2914
       (8) An individual who is not engaged in the practice of  2915
the religious tenets of any church or in any religious act but  2916
who provides midwifery services without a license to others  2917
engaging in good faith in the practice of the religious tenets  2918
of any church or in any religious act;  2919
       (9) An individual who is a member of a Native American  2920
community and provides midwifery services without a license to  2921
another member of the community;  2922
       (10) A traditional midwife;  2923
       (11) An individual who is participating in a midwifery  2924
apprenticeship under the supervision of a traditional midwife  2925
and who provides midwifery services as part of the  2926
apprenticeship program under the supervision of a traditional  2927
midwife;  2928
S. B. No. 438  Page 103
As Introduced
        (12) A certified professional midwife or certified  2929
international midwife, but only if the certified professional  2930
midwife or certified international midwife does not, as a part  2931
of the midwife's practice, obtain or administer drugs or perform  2932
surgical suturing.  2933
        (C) No individual shall knowingly use the title "licensed  2934
midwife" or any other title implying that the individual is a  2935
licensed midwife unless the individual holds a current, valid  2936
license to practice issued under section 4724.04 of the Revised  2937
Code.  2938
        Sec. 4724.03. (A) An individual seeking a license to  2939
practice as a licensed midwife shall file with the department of  2940
commerce an application in a manner prescribed by the  2941
department. The application shall include all the information  2942
the department considers necessary to process the application,  2943
including evidence satisfactory to the department that the  2944
applicant meets the requirements specified in division (B)(1) or  2945
(2) of this section.  2946
        (B)(1) To be eligible to receive a license to practice as  2947
a licensed midwife, an applicant shall demonstrate to the  2948
department that the applicant meets all of the following  2949
requirements:  2950
        (a) Is at least eighteen years of age;  2951
        (b) Has attained a high school degree or equivalent;  2952
        (c) Is certified by the north American registry of  2953
midwives, international registry of midwives, or another  2954
certifying organization approved by the department in rules  2955
adopted under section 4724.11 of the Revised Code;  2956
        (d) Is certified in neonatal and adult cardiopulmonary  2957
S. B. No. 438  Page 104
As Introduced
resuscitation;  2958
       (e) Has successfully completed a course of study in breech  2959
births approved by the department in rules adopted under section  2960
4724.11 of the Revised Code;  2961
       (f) Has successfully completed a course of study in  2962
pharmacology approved by the department in rules adopted under  2963
section 4724.11 of the Revised Code.  2964
       (2) In lieu of meeting the requirements described in  2965
division (B)(1)(c) of this section, an applicant may demonstrate  2966
either of the following:  2967
       (a) That the applicant holds a current, valid license to  2968
practice as a licensed midwife issued by another state and the  2969
department has determined that the other state's requirements  2970
for licensure are substantially similar to those described in  2971
division (B)(1) of this section;  2972
       (b) That the applicant is certified by the north American  2973
registry of midwives and holds a midwifery bridge certificate.  2974
       (C) The department shall review all applications received  2975
under this section. After receiving an application it considers  2976
complete, the department shall determine whether the applicant  2977
meets the requirements for a license to practice as a licensed  2978
midwife.  2979
       Sec. 4724.04. (A) If the department of commerce determines  2980
under section 4724.03 of the Revised Code that an applicant  2981
meets the requirements for a license to practice as a licensed  2982
midwife, the department shall issue the license to the  2983
applicant.  2984
       (B) Each license shall be valid for a two-year period  2985
S. B. No. 438  Page 105
As Introduced
unless revoked or suspended, shall expire on the date that is  2986
two years after the date of issuance, and may be renewed for  2987
additional two-year periods in accordance with rules adopted  2988
under section 4724.11 of the Revised Code.  2989
        (C) To renew a license to practice as a licensed midwife,  2990
an applicant for renewal shall demonstrate both of the following  2991
to the department:  2992
        (1) That the applicant has maintained certification in  2993
neonatal and adult cardiopulmonary resuscitation;  2994
        (2) That the applicant has maintained certification with  2995
the north American registry of midwives, international registry  2996
of midwives, or another certifying organization approved by the  2997
department in rules adopted under section 4724.11 of the Revised  2998
Code.  2999
        (D) In the event a license issued under this section is  3000
not renewed and is therefore expired or inactive, the department  3001
shall reinstate or restore the license if the individual seeking  3002
reinstatement or restoration satisfies the conditions specified  3003
in rules adopted under section 4724.11 of the Revised Code.  3004
        Sec. 4724.05. (A) An individual who holds a current, valid  3005
license to practice as a licensed midwife may engage in one or  3006
more of the following activities during the antepartum,  3007
intrapartum, postpartum, and newborn period as part of the scope  3008
of practice for a licensed midwife:  3009
        (1) Offering care, education, counseling, and support to  3010
women and newborns during pregnancy, birth, and the postpartum  3011
period;  3012
        (2) Attending births in hospitals, homes, medical offices,  3013
and freestanding birthing centers;  3014
S. B. No. 438  Page 106
As Introduced
       (3) Providing ongoing and routine prenatal care throughout  3015
pregnancy and hands on care during labor, birth, and the  3016
immediate postpartum period;  3017
       (4) Providing maternal and newborn assessment for the six-  3018
to eight-week period following delivery;  3019
       (5) Providing initial and ongoing comprehensive  3020
assessment, diagnosis, and treatment;  3021
       (6) Recognizing abnormal or dangerous conditions requiring  3022
consultations with or referrals to other licensed health care  3023
professionals;  3024
       (7) Conducting maternal and newborn physical examinations;  3025
       (8) Ordering and interpreting laboratory and diagnostic  3026
tests without a physician's order.  3027
       (B) An individual who holds a current, valid license to  3028
practice as a licensed midwife shall not engage in any of the  3029
following activities:  3030
       (1) Administering cytotec or oxytocics, including pitocin  3031
and methergine, except when indicated during the postpartum  3032
period;  3033
       (2) Using forceps or vacuum extraction to assist with  3034
birth;  3035
       (3) Performing any operative procedures or surgical  3036
repairs other than the following: artificial rupture of  3037
membranes; episiotomies; first or second degree perineal,  3038
vaginal, or labial repairs; clamping or cutting the umbilical  3039
cord; or frenotomies.  3040
       (C) For the purpose of engaging in one or more of the  3041
S. B. No. 438  Page 107
As Introduced
activities permitted under division (A) of this section, the  3042
scope of practice for a licensed midwife shall include the  3043
ability to purchase, obtain, possess, and administer the  3044
following:  3045
       (1) Subject to division (B) of this section, an  3046
antihemorraghic agent or device, including tranexamic acid,  3047
pitocin, oxytocin, misoprostol, and methergine;  3048
       (2) Intravenous fluids to stabilize the laboring or  3049
postpartum patient or as necessary to administer another drug  3050
authorized by this division;  3051
       (3) Neonatal injectable vitamin K;  3052
       (4) Newborn antibiotic eye prophylaxis;  3053
       (5) Oxygen;  3054
       (6) Intravenous antibiotics for group B streptococcal  3055
prophylaxis;  3056
       (7) Rho (D) immune globulin;  3057
       (8) Local anesthesia;  3058
       (9) Epinephrine;  3059
       (10) A drug prescribed for the patient by a prescriber.  3060
       A licensed midwife also may obtain, without a physician's  3061
order, one or more supplies necessary to administer any of the  3062
drugs described in division (C) of this section.  3063
       (D) This section does not authorize a licensed midwife to  3064
prescribe, personally furnish, obtain, or administer either of  3065
the following:  3066
       (1) Any controlled substance as defined in section 3719.01  3067
S. B. No. 438  Page 108
As Introduced
of the Revised Code;  3068
       (2) A drug or device to perform or induce an abortion.  3069
       (E) When engaging in any of the activities permitted under  3070
this section, a licensed midwife shall maintain appropriate  3071
medical records regarding patient history, treatment, and  3072
outcomes.  3073
       Sec. 4724.06. (A) The department of commerce shall limit,  3074
revoke, or suspend an individual's license to practice as a  3075
licensed midwife, refuse to issue a license to an applicant,  3076
refuse to renew a license, refuse to reinstate or restore a  3077
license, or reprimand or place on probation the holder of a  3078
license for any of the reasons specified in rules adopted under  3079
section 4724.11 of the Revised Code.  3080
       (B) The department may limit, revoke, or suspend an  3081
individual's license to practice as a licensed midwife, refuse  3082
to issue a license to an applicant, refuse to renew a license,  3083
refuse to reinstate or restore a license, or reprimand or place  3084
on probation the holder of a license on the recommendation of  3085
the licensed midwifery advisory council pursuant to section  3086
4724.13 of the Revised Code.  3087
       Sec. 4724.07. (A) This section establishes the process by  3088
which a licensed midwife obtains a patient's consent to  3089
treatment authorized by section 4724.05 of the Revised Code,  3090
including attending a home birth or providing care during a  3091
high-risk pregnancy.  3092
       (B) The following information shall be exchanged in  3093
writing between a licensed midwife and patient when obtaining  3094
consent to treatment as described in division (A) of this  3095
section:  3096
S. B. No. 438  Page 109
As Introduced
       (1) The name and license number of the licensed midwife;  3097
       (2) The patient's name, address, telephone number, and  3098
primary care provider, if the patient has one;  3099
       (3) A description of the licensed midwife's education,  3100
training, and experience in midwifery;  3101
       (4) The licensed midwife's practice philosophy;  3102
       (5) A promise to provide the patient, upon request, with  3103
separate documents describing the rules governing the practice  3104
of midwifery, including a list of conditions indicating the need  3105
for consultation, referral, transfer, or mandatory transfer and  3106
the licensed midwife's personal written practice guidelines;  3107
       (6) A written plan for medical consultation and transfer  3108
of care;  3109
       (7) A description of any hospital care and procedures that  3110
may be necessary in the event of an emergency transfer or care;  3111
       (8) A description of the services provided to the patient  3112
by the licensed midwife;  3113
       (9) That the licensed midwife holds a current, valid  3114
license to practice issued under this chapter;  3115
       (10) The availability of a grievance process;  3116
       (11) Whether the licensed midwife is covered by  3117
professional liability insurance;  3118
       (12) Any other information required in rules adopted by  3119
the department.  3120
       (C) Once the required information has been exchanged and  3121
if the patient consents to treatment, the patient and licensed  3122
midwife shall sign a written document to indicate as such. The  3123
S. B. No. 438  Page 110
As Introduced
licensed midwife shall retain a copy of the document for at  3124
least four years from the date on which the document was signed.  3125
       Sec. 4724.08. (A) The department of commerce shall adopt  3126
rules establishing the circumstances in which a licensed midwife  3127
shall be prohibited from attending a home birth, which may  3128
include a high-risk pregnancy. In adopting the rules, the  3129
department shall allow a licensed midwife to attend a vaginal  3130
birth after cesarean, birth of twins, or breech birth as a home  3131
birth if the conditions described in division (B) of this  3132
section are satisfied.  3133
       (B) In the event of a home birth described in division (A)  3134
of this section, a licensed midwife may attend the birth only if  3135
all of the following conditions are satisfied:  3136
       (1) In addition to the informed consent required under  3137
section 4724.07 of the Revised Code, the licensed midwife  3138
obtains the patient's written informed consent for the vaginal  3139
birth after cesarean, birth of twins, or breech birth, including  3140
a description of risks associated with the procedure.  3141
       (2) The licensed midwife consults with a physician,  3142
certified nurse-midwife, or certified midwife about the patient  3143
and together with the physician or midwife determines whether  3144
referral is appropriate for the patient. If a referral is  3145
determined to be appropriate and the patient consents to the  3146
referral, the licensed midwife shall refer the patient to the  3147
physician or provider. If the patient refuses the referral, the  3148
licensed midwife shall document the refusal and may continue to  3149
provide care to the patient, including attending the vaginal  3150
birth after cesarean, birth of twins, or breech birth.  3151
       (3) The licensed midwife satisfies any other conditions  3152
S. B. No. 438  Page 111
As Introduced
required in rules adopted by the department.  3153
       (C) In adopting rules under this section, the department  3154
shall do both of the following:  3155
       (1) Adhere to the recommendations of the licensed  3156
midwifery advisory council and any relevant peer-reviewed  3157
medical literature;  3158
       (2) Specify the content and format of the document to be  3159
used when obtaining informed consent as described in this  3160
section.  3161
       Sec. 4724.09. (A) As used in this section and section  3162
4724.10 of the Revised Code, "emergency medical service,"  3163
"emergency medical service personnel," and "emergency medical  3164
service organization" have the same meanings as in section  3165
4765.01 of the Revised Code.  3166
       (B) For any pregnancy or childbirth in which a licensed  3167
midwife provides care and a home birth is planned, both of the  3168
following apply:  3169
       (1) The licensed midwife shall create an individualized  3170
transfer of care plan with each patient.  3171
       (2) The licensed midwife shall assess the status of the  3172
patient, fetus, and newborn throughout the maternity care cycle  3173
and shall determine when or if a transfer to a hospital is  3174
necessary.  3175
       (C) Each individualized transfer of care plan shall  3176
contain all of the following:  3177
       (1) The name and location of geographically adjacent  3178
hospitals that are appropriately equipped to provide emergency  3179
care, obstetrical care, and newborn care;  3180
S. B. No. 438  Page 112
As Introduced
       (2) The approximate travel time to each hospital;  3181
       (3) A list of the modes of transport services available,  3182
including an emergency medical service organization available by  3183
calling 9-1-1;  3184
       (4) The requirements for activating each mode of  3185
transportation;  3186
       (5) The mechanism by which medical records and other  3187
information concerning the patient may be rapidly transmitted to  3188
each hospital;  3189
       (6) Confirmation that the licensed midwife has recommended  3190
that the patient pre-register with the hospital closest to the  3191
patient's home that is appropriately equipped to provide  3192
emergency care, obstetrical care, and newborn care;  3193
       (7) Contact information for either a health care provider  3194
or practice group who has agreed in advance to accept patients  3195
in transfer, or a hospital's preferred method of accessing care  3196
by the hospital's designated provider on call;  3197
       (8) Any other information required in rules adopted by the  3198
department of commerce.  3199
       (D) When it becomes necessary to transfer a patient, a  3200
licensed midwife shall notify the receiving provider or hospital  3201
of all of the following:  3202
       (1) The incoming transfer;  3203
       (2) The reason for the transfer;  3204
       (3) A brief relevant clinical history;  3205
       (4) The planned mode of transport;  3206
       (5) The expected time of arrival;  3207
S. B. No. 438  Page 113
As Introduced
       (6) Any other information required in rules adopted by the  3208
department.  3209
       The licensed midwife may continue to provide routine or  3210
urgent care en route in coordination with any emergency medical  3211
services personnel or emergency medical service organization  3212
and, if continued care is provided, the licensed midwife shall  3213
address the psychosocial needs of the patient during the change  3214
of birth setting.  3215
       (E) On arrival at the hospital, the licensed midwife shall  3216
do all of the following:  3217
       (1) Provide a verbal report that includes details on the  3218
patient's current health status and the need for urgent care;  3219
       (2) Provide a legible copy of relevant prenatal and labor  3220
medical records;  3221
       (3) Transfer clinical responsibility to the receiving  3222
provider or hospital;  3223
       (4) Satisfy any other requirement established in rules  3224
adopted by the department.  3225
       If the patient chooses, the licensed midwife may remain at  3226
the hospital to provide continuous support. The licensed midwife  3227
also may continue to provide midwifery services, but only if the  3228
hospital has granted the licensed midwife clinical privileges.  3229
Whenever possible, the patient and her newborn shall be together  3230
during the transfer and after admission to the hospital.  3231
       Sec. 4724.10. (A) As used in this section, "adverse  3232
incident" means an incident over which a licensed midwife could  3233
exercise control, that is associated with an attempted or  3234
completed birth in a setting or facility other than a hospital,  3235
S. B. No. 438  Page 114
As Introduced
and that results in one or more of the following injuries or  3236
conditions:  3237
        (1) A maternal death that occurs during delivery or within  3238
forty-two days after delivery;  3239
        (2) The transfer of a maternal patient to a hospital  3240
intensive care unit;  3241
        (3) A maternal patient experiencing hemorrhagic shock or  3242
requiring a transfusion of more than two units of blood or blood  3243
products;  3244
        (4) A fetal or neonatal death, including a stillbirth,  3245
associated with an obstetrical delivery;  3246
        (5) A transfer of a newborn to a neonatal intensive care  3247
unit due to a traumatic physical or neurological birth injury,  3248
including any degree of a brachial plexus injury;  3249
        (6) A transfer of a newborn to a neonatal intensive care  3250
unit within the first seventy-two hours after birth if the  3251
newborn remains in such unit for more than seventy-two hours;  3252
        (7) Any other condition as determined by the department of  3253
commerce in rules adopted under section 4724.11 of the Revised  3254
Code.  3255
        (B) Beginning July 1, 2027, a licensed midwife who attends  3256
a birth planned for a facility or setting other than a hospital  3257
must report any adverse incident, along with a medical summary  3258
of events, to the licensed midwifery advisory council within  3259
fifteen days after the adverse incident occurs.  3260
        (C) Beginning July 1, 2027, each licensed midwife shall  3261
report annually to the licensed midwifery advisory council the  3262
following information regarding cases in which the licensed  3263
S. B. No. 438  Page 115
As Introduced
midwife provided services when the intended place of birth at  3264
the onset of care was in a facility or setting other than a  3265
hospital:  3266
       (1) The total number of patients provided licensed  3267
midwifery services at the onset of care;  3268
       (2) The number of live births attended;  3269
       (3) The number of cases of fetal demise, newborn deaths,  3270
and maternal deaths attended as a licensed midwife at the  3271
discovery of the demise or death;  3272
       (4) The number, reason for, and outcome of each transport  3273
of a patient in the antepartum, intrapartum period, or immediate  3274
postpartum period;  3275
       (5) A brief description of any complications resulting in  3276
the morbidity or mortality of a maternal patient or a newborn;  3277
       (6) The planned delivery setting and the actual setting;  3278
       (7) Any other information required in rules adopted by the  3279
department of commerce.  3280
       (D) The department shall adopt rules to implement this  3281
section and shall develop a form to be used for the reporting  3282
required under divisions (B) and (C) of this section.  3283
       Sec. 4724.11. (A) In accordance with Chapter 119. of the  3284
Revised Code, the department of commerce shall adopt rules that  3285
establish all of the following:  3286
       (1) Standards and procedures for applying for, renewing,  3287
reinstating, or restoring a license to practice as a licensed  3288
midwife;  3289
       (2) Application, renewal, reinstatement, and restoration  3290
S. B. No. 438  Page 116
As Introduced
fee amounts for a license to practice as a licensed midwife,  3291
with the amount of the application fee not to exceed forty-five  3292
dollars and the amount of the renewal fee not to exceed twenty  3293
dollars;  3294
       (3) Standards and procedures for approving and  3295
successfully completing a course of study in breech births and a  3296
course of study in pharmacology, each as described in section  3297
4724.03 of the Revised Code;  3298
       (4) Subject to division (C) of this section, standards and  3299
procedures for approving certifying organizations as described  3300
in section 4724.03 of the Revised Code;  3301
       (5) Reasons for which the department may refuse to issue,  3302
or renew, suspend, or revoke a license or otherwise impose  3303
discipline on a licensed midwife;  3304
       (6) Conditions to be satisfied before the department  3305
reinstates or restores an expired or inactive license;  3306
       (7) Procedures for reporting to the licensed midwifery  3307
advisory council license holder misconduct;  3308
       (8) Procedures by which the department conducts  3309
disciplinary investigations.  3310
       (B) In adopting rules establishing standards and  3311
procedures for the approval of certifying organizations, the  3312
department shall approve an organization only if its  3313
certification requirements meet or exceed those of the north  3314
American registry of midwives or the international registry of  3315
midwives.  3316
       (C) The department also may adopt, in accordance with  3317
Chapter 119. of the Revised Code, any other rules it considers  3318
S. B. No. 438  Page 117
As Introduced
necessary to implement and administer this chapter. The rules  3319
may require the completion of a criminal records check.  3320
       Sec. 4724.12. This chapter does not abridge, change, or  3321
limit in any way the right of a parent to deliver the parent's  3322
baby where, when, how, and with whom the parent chooses,  3323
regardless of the licensure requirements established in this  3324
chapter.  3325
       Sec. 4724.13. (A) There is hereby created within the  3326
department of commerce the licensed midwifery advisory council.  3327
The council shall consist of all of the following members:  3328
       (1) One certified nurse-midwife and one certified midwife  3329
or certified nurse-midwife, preferably with experience attending  3330
a birth in a setting or facility other than a hospital;  3331
       (2) Four licensed midwives, including one practicing in an  3332
urban setting and one serving a plain Amish or Mennonite  3333
community;  3334
       (3) One physician who is board-certified in obstetrics and  3335
gynecology, as those designations are issued by a medical  3336
specialty certifying board recognized by the American board of  3337
medical specialties or American osteopathic association, and  3338
with experience consulting with midwives who provide midwifery  3339
services in locations other than hospitals;  3340
       (4) One physician who is board-certified in neonatal  3341
medicine, as that designation is issued by a medical specialty  3342
certifying board recognized by the American board of medical  3343
specialties or American osteopathic association, and with  3344
experience consulting with midwives who provide midwifery  3345
services in locations other than hospitals;  3346
       (5) One member of the public who has experience utilizing  3347
S. B. No. 438  Page 118
As Introduced
or receiving midwifery services in locations other than  3348
hospitals.  3349
       Of the members who are licensed midwives, each shall  3350
obtain licensure as a licensed midwife under this chapter not  3351
later than January 1, 2028.  3352
       (B) The department shall appoint the members described in  3353
division (A) of this section. The department may solicit  3354
nominations for initial appointments and for filling any  3355
vacancies from individuals or organizations with an interest in  3356
midwifery services. If the department does not receive any  3357
nominations or receives an insufficient number of nominations,  3358
the department shall appoint members and fill vacancies on its  3359
own advice.  3360
       Of the physician members described in divisions (A)(3) and  3361
(4) of this section, if the department does not receive any  3362
nominations for physicians with experience consulting with  3363
midwives who provide midwifery services in locations other than  3364
hospitals, the department shall appoint physicians without such  3365
experience, but only if the department determines that each  3366
physician satisfies the other requirements of division (A)(3) or  3367
(4) of this section.  3368
       Initial appointments to the council shall be made not  3369
later than ninety days after the effective date of this section.  3370
Of the initial appointments described in division (A) of this  3371
section, four shall be for terms of three years and five shall  3372
be for terms of four years. Thereafter, terms shall be for four  3373
years, with each term ending on the same day of the same month  3374
as did the term that it succeeds. Vacancies shall be filled in  3375
the same manner as appointments.  3376
S. B. No. 438  Page 119
As Introduced
       When the term of any member expires, a successor shall be  3377
appointed in the same manner as the initial appointment. Any  3378
member appointed to fill a vacancy occurring prior to the  3379
expiration of the term for which the member's predecessor was  3380
appointed shall hold office for the remainder of that term. A  3381
member shall continue in office subsequent to the expiration  3382
date of the member's term until the member's successor takes  3383
office or until a period of sixty days has elapsed, whichever  3384
occurs first. A member may be reappointed.  3385
       (C) The council shall organize by selecting a chairperson  3386
from among its members. The council may select a new chairperson  3387
at any time. Four members constitute a quorum for the  3388
transaction of official business. Members shall serve without  3389
compensation but shall receive payment for their actual and  3390
necessary expenses incurred in the performance of their official  3391
duties. The expenses shall be paid by the department.  3392
       (D) The council shall advise and make recommendations to  3393
the department regarding the practice and regulation of licensed  3394
midwives. The department shall adhere to such advice and  3395
recommendations when adopting any rules governing the practice  3396
of licensed midwives, including rules to address the following:  3397
       (1) Circumstances in which attending a home birth is  3398
prohibited, as described in section 4724.08 of the Revised Code;  3399
       (2) Limitations on providing care during a high-risk  3400
pregnancy, including when a home birth is planned;  3401
       (3) Adverse incident reporting and annual reporting, both  3402
required under section 4724.10 of the Revised Code;  3403
       (4) Obtaining a patient's informed consent, as described  3404
in section 4724.07 of the Revised Code;  3405
S. B. No. 438  Page 120
As Introduced
       (5) Creating an individualized transfer of care plan, as  3406
described in section 4724.09 of the Revised Code.  3407
       (E)(1) The council shall review each adverse incident  3408
report submitted to the council as described in section 4724.10  3409
of the Revised Code. As soon as practicable after the required  3410
review, the council shall make a recommendation to the  3411
department regarding whether discipline should be imposed on the  3412
licensed midwife, and if so, the type of discipline to be  3413
imposed.  3414
       The council shall develop a policy by which it addresses  3415
and considers adverse incident reports.  3416
       (2) Beginning eighteen months after the effective date of  3417
this section, the council shall submit an annual report to the  3418
department of health that compiles all information submitted to  3419
the council pursuant to divisions (B) and (C) of section 4724.10  3420
of the Revised Code in the preceding calendar year.  3421
       (F)(1) Any person who wishes to make a complaint against a  3422
licensed midwife shall submit the complaint in writing to the  3423
council within one year after the date of the action or event  3424
upon which the complaint is based. The council shall review each  3425
complaint submitted to the council. As soon as practicable after  3426
the required review, the council shall make a recommendation to  3427
the department of commerce regarding whether discipline should  3428
be imposed on the licensed midwife, and if so, the type of  3429
discipline to be imposed.  3430
       (2) The council shall investigate any alleged  3431
irregularities in the practice of midwifery by a licensed  3432
midwife and any violations of this chapter or rules adopted by  3433
the department.  3434
S. B. No. 438  Page 121
As Introduced
       (3) The council shall not investigate any person exempted  3435
from licensure under section 4724.02 of the Revised Code.  3436
       Sec. 4724.14. A traditional midwife may engage in one or  3437
more of the following activities during the antepartum,  3438
intrapartum, postpartum, and newborn period as part of the scope  3439
of practice for a traditional midwife:  3440
       (A) Offering care, education, counseling, and support  3441
during pregnancy, birth, and the postpartum period;  3442
       (B) Attending births in locations other than hospitals;  3443
       (C) Providing ongoing and routine prenatal care throughout  3444
pregnancy and hands on care during labor, birth, and the  3445
immediate postpartum period;  3446
       (D) Providing maternal and newborn assessment for the six-  3447
to eight-week period following delivery;  3448
       (E) Recognizing abnormal or dangerous conditions requiring  3449
consultations with or referrals to licensed health care  3450
professionals.  3451
       Sec. 4724.15. (A) This section establishes the process by  3452
which a traditional midwife obtains a patient's consent to  3453
treatment authorized by section 4724.14 of the Revised Code.  3454
       (B) The following information shall be exchanged in  3455
writing between a traditional midwife and patient when obtaining  3456
consent to treatment as described in division (A) of this  3457
section:  3458
       (1) The name of the traditional midwife;  3459
       (2) The patient's name, address, telephone number, and  3460
primary care provider, if the patient has one;  3461
S. B. No. 438  Page 122
As Introduced
       (3) A description of the traditional midwife's education,  3462
training, and experience in midwifery;  3463
       (4) The traditional midwife's practice philosophy;  3464
       (5) A promise to provide the patient, upon request, with  3465
separate documents describing a traditional midwife's scope of  3466
practice;  3467
       (6) A written plan for medical consultation and transfer  3468
of care;  3469
       (7) A description of any hospital care and procedures that  3470
may be necessary in the event of an emergency transfer of care;  3471
       (8) A description of the services provided to the patient  3472
by the traditional midwife;  3473
       (9) Whether the traditional midwife is covered by  3474
professional liability insurance;  3475
       (10) Any other information required in rules adopted by  3476
the department.  3477
       (C) Once the required information has been exchanged and  3478
if the patient consents to treatment, the patient and  3479
traditional midwife shall sign a written document to indicate as  3480
such. The traditional midwife shall retain a copy of the  3481
document for at least four years from the date on which the  3482
document was signed.  3483
       (D) The rights and liabilities arising from the provision  3484
of traditional midwifery services shall be governed exclusively  3485
by the agreement between the traditional midwife and the patient  3486
entered pursuant to division (C) of this section.  3487
       Sec. 4724.16. Emergency medical service personnel or an  3488
S. B. No. 438  Page 123
As Introduced
emergency medical service organization, hospital, facility,  3489
physician, advanced practice registered nurse, licensed midwife,  3490
or traditional midwife that provides services or care following  3491
an adverse incident as defined in section 4724.10 of the Revised  3492
Code, or during and after a transfer of care as described in  3493
section 4724.09 of the Revised Code, are not liable in damages  3494
in a tort or other civil action for injury or loss to person or  3495
property arising from the services or care, unless the services  3496
or care are provided in a manner that constitutes willful or  3497
wanton misconduct.  3498
       Sec. 4724.99. (A) Whoever violates division (A) of section  3499
4724.02 of the Revised Code is guilty of a felony of the fifth  3500
degree on a first offense and a felony of the fourth degree on  3501
each subsequent offense.  3502
       (B) Whoever violates division (C) of section 4724.02 of  3503
the Revised Code is guilty of a misdemeanor of the first degree  3504
and is subject to a fine in the amount of one thousand dollars  3505
and a jail term of not more than one hundred eighty days.  3506
       Sec. 4731.22. (A) The state medical board, by an  3507
affirmative vote of not fewer than six of its members, may  3508
limit, revoke, or suspend a license or certificate to practice  3509
or certificate to recommend, refuse to grant a license or  3510
certificate, refuse to renew a license or certificate, refuse to  3511
reinstate a license or certificate, or reprimand or place on  3512
probation the holder of a license or certificate if the  3513
individual applying for or holding the license or certificate is  3514
found by the board to have committed fraud during the  3515
administration of the examination for a license or certificate  3516
to practice or to have committed fraud, misrepresentation, or  3517
deception in applying for, renewing, or securing any license or  3518
S. B. No. 438  Page 124
As Introduced
certificate to practice or certificate to recommend issued by  3519
the board.  3520
       (B) Except as provided in division (P) of this section,  3521
the board, by an affirmative vote of not fewer than six members,  3522
shall, to the extent permitted by law, limit, revoke, or suspend  3523
a license or certificate to practice or certificate to  3524
recommend, refuse to issue a license or certificate, refuse to  3525
renew a license or certificate, refuse to reinstate a license or  3526
certificate, or reprimand or place on probation the holder of a  3527
license or certificate for one or more of the following reasons:  3528
       (1) Permitting one's name or one's license or certificate  3529
to practice to be used by a person, group, or corporation when  3530
the individual concerned is not actually directing the treatment  3531
given;  3532
       (2) Failure to maintain minimal standards applicable to  3533
the selection or administration of drugs, or failure to employ  3534
acceptable scientific methods in the selection of drugs or other  3535
modalities for treatment of disease;  3536
       (3) Except as provided in section 4731.97 of the Revised  3537
Code, selling, giving away, personally furnishing, prescribing,  3538
or administering drugs for other than legal and legitimate  3539
therapeutic purposes or a plea of guilty to, a judicial finding  3540
of guilt of, or a judicial finding of eligibility for  3541
intervention in lieu of conviction of, a violation of any  3542
federal or state law regulating the possession, distribution, or  3543
use of any drug;  3544
       (4) Willfully betraying a professional confidence.  3545
       For purposes of this division, "willfully betraying a  3546
professional confidence" does not include providing any  3547
S. B. No. 438  Page 125
As Introduced
information, documents, or reports under sections 307.621 to  3548
307.629 of the Revised Code to a child fatality review board;  3549
does not include providing any information, documents, or  3550
reports under sections 307.631 to 307.6410 of the Revised Code  3551
to a drug overdose fatality review committee, a suicide fatality  3552
review committee, or hybrid drug overdose fatality and suicide  3553
fatality review committee; does not include providing any  3554
information, documents, or reports under sections 307.651 to  3555
307.659 of the Revised Code to a domestic violence fatality  3556
review board; does not include providing any information,  3557
documents, or reports to the director of health pursuant to  3558
guidelines established under section 3701.70 of the Revised  3559
Code; does not include written notice to a mental health  3560
professional under section 4731.62 of the Revised Code; does not  3561
include making a report as described in division (F) of section  3562
2921.22 and section 4731.224 of the Revised Code; and does not  3563
include the making of a report of an employee's use of a drug of  3564
abuse, or a report of a condition of an employee other than one  3565
involving the use of a drug of abuse, to the employer of the  3566
employee as described in division (B) of section 2305.33 of the  3567
Revised Code. Nothing in this division affects the immunity from  3568
civil liability conferred by section 2305.33 or 4731.62 of the  3569
Revised Code upon a physician who makes a report in accordance  3570
with section 2305.33 or notifies a mental health professional in  3571
accordance with section 4731.62 of the Revised Code. As used in  3572
this division, "employee," "employer," and "physician" have the  3573
same meanings as in section 2305.33 of the Revised Code.  3574
       (5) Making a false, fraudulent, deceptive, or misleading  3575
statement in the solicitation of or advertising for patients; in  3576
relation to the practice of medicine and surgery, osteopathic  3577
medicine and surgery, podiatric medicine and surgery, or a  3578
S. B. No. 438  Page 126
As Introduced
limited branch of medicine; or in securing or attempting to  3579
secure any license or certificate to practice issued by the  3580
board.  3581
       As used in this division, "false, fraudulent, deceptive,  3582
or misleading statement" means a statement that includes a  3583
misrepresentation of fact, is likely to mislead or deceive  3584
because of a failure to disclose material facts, is intended or  3585
is likely to create false or unjustified expectations of  3586
favorable results, or includes representations or implications  3587
that in reasonable probability will cause an ordinarily prudent  3588
person to misunderstand or be deceived.  3589
       (6) A departure from, or the failure to conform to,  3590
minimal standards of care of similar practitioners under the  3591
same or similar circumstances, whether or not actual injury to a  3592
patient is established;  3593
       (7) Representing, with the purpose of obtaining  3594
compensation or other advantage as personal gain or for any  3595
other person, that an incurable disease or injury, or other  3596
incurable condition, can be permanently cured;  3597
       (8) The obtaining of, or attempting to obtain, money or  3598
anything of value by fraudulent misrepresentations in the course  3599
of practice;  3600
       (9) A plea of guilty to, a judicial finding of guilt of,  3601
or a judicial finding of eligibility for intervention in lieu of  3602
conviction for, a felony;  3603
       (10) Commission of an act that constitutes a felony in  3604
this state, regardless of the jurisdiction in which the act was  3605
committed;  3606
       (11) A plea of guilty to, a judicial finding of guilt of,  3607
S. B. No. 438  Page 127
As Introduced
or a judicial finding of eligibility for intervention in lieu of  3608
conviction for, a misdemeanor committed in the course of  3609
practice;  3610
       (12) Commission of an act in the course of practice that  3611
constitutes a misdemeanor in this state, regardless of the  3612
jurisdiction in which the act was committed;  3613
       (13) A plea of guilty to, a judicial finding of guilt of,  3614
or a judicial finding of eligibility for intervention in lieu of  3615
conviction for, a misdemeanor involving moral turpitude;  3616
       (14) Commission of an act involving moral turpitude that  3617
constitutes a misdemeanor in this state, regardless of the  3618
jurisdiction in which the act was committed;  3619
       (15) Violation of the conditions of limitation placed by  3620
the board upon a license or certificate to practice;  3621
       (16) Failure to pay license renewal fees specified in this  3622
chapter;  3623
       (17) Except as authorized in section 4731.31 of the  3624
Revised Code, engaging in the division of fees for referral of  3625
patients, or the receiving of a thing of value in return for a  3626
specific referral of a patient to utilize a particular service  3627
or business;  3628
       (18) Subject to section 4731.226 of the Revised Code,  3629
violation of any provision of a code of ethics of the American  3630
medical association, the American osteopathic association, the  3631
American podiatric medical association, or any other national  3632
professional organizations that the board specifies by rule. The  3633
state medical board shall obtain and keep on file current copies  3634
of the codes of ethics of the various national professional  3635
organizations. The individual whose license or certificate is  3636
S. B. No. 438  Page 128
As Introduced
being suspended or revoked shall not be found to have violated  3637
any provision of a code of ethics of an organization not  3638
appropriate to the individual's profession.  3639
        For purposes of this division, a "provision of a code of  3640
ethics of a national professional organization" does not include  3641
any provision that would preclude the making of a report by a  3642
physician of an employee's use of a drug of abuse, or of a  3643
condition of an employee other than one involving the use of a  3644
drug of abuse, to the employer of the employee as described in  3645
division (B) of section 2305.33 of the Revised Code. Nothing in  3646
this division affects the immunity from civil liability  3647
conferred by that section upon a physician who makes either type  3648
of report in accordance with division (B) of that section. As  3649
used in this division, "employee," "employer," and "physician"  3650
have the same meanings as in section 2305.33 of the Revised  3651
Code.  3652
        (19) Inability to practice according to acceptable and  3653
prevailing standards of care by reason of mental illness or  3654
physical illness, including, but not limited to, physical  3655
deterioration that adversely affects cognitive, motor, or  3656
perceptive skills.  3657
        In enforcing this division, the board, upon a showing of a  3658
possible violation, shall refer any individual who is authorized  3659
to practice by this chapter or who has submitted an application  3660
pursuant to this chapter to the monitoring organization that  3661
conducts the confidential monitoring program established under  3662
section 4731.25 of the Revised Code. The board also may compel  3663
the individual to submit to a mental examination, physical  3664
examination, including an HIV test, or both a mental and a  3665
physical examination. The expense of the examination is the  3666
S. B. No. 438  Page 129
As Introduced
responsibility of the individual compelled to be examined.  3667
Failure to submit to a mental or physical examination or consent  3668
to an HIV test ordered by the board constitutes an admission of  3669
the allegations against the individual unless the failure is due  3670
to circumstances beyond the individual's control, and a default  3671
and final order may be entered without the taking of testimony  3672
or presentation of evidence. If the board finds an individual  3673
unable to practice because of the reasons set forth in this  3674
division, the board shall require the individual to submit to  3675
care, counseling, or treatment by physicians approved or  3676
designated by the board, as a condition for initial, continued,  3677
reinstated, or renewed authority to practice. An individual  3678
affected under this division shall be afforded an opportunity to  3679
demonstrate to the board the ability to resume practice in  3680
compliance with acceptable and prevailing standards under the  3681
provisions of the individual's license or certificate. For the  3682
purpose of this division, any individual who applies for or  3683
receives a license or certificate to practice under this chapter  3684
accepts the privilege of practicing in this state and, by so  3685
doing, shall be deemed to have given consent to submit to a  3686
mental or physical examination when directed to do so in writing  3687
by the board, and to have waived all objections to the  3688
admissibility of testimony or examination reports that  3689
constitute a privileged communication.  3690
       (20) Except as provided in division (F)(1)(b) of section  3691
4731.282 of the Revised Code or when civil penalties are imposed  3692
under section 4731.225 of the Revised Code, and subject to  3693
section 4731.226 of the Revised Code, violating or attempting to  3694
violate, directly or indirectly, or assisting in or abetting the  3695
violation of, or conspiring to violate, any provisions of this  3696
chapter or any rule promulgated by the board.  3697
S. B. No. 438  Page 130
As Introduced
        This division does not apply to a violation or attempted  3698
violation of, assisting in or abetting the violation of, or a  3699
conspiracy to violate, any provision of this chapter or any rule  3700
adopted by the board that would preclude the making of a report  3701
by a physician of an employee's use of a drug of abuse, or of a  3702
condition of an employee other than one involving the use of a  3703
drug of abuse, to the employer of the employee as described in  3704
division (B) of section 2305.33 of the Revised Code. Nothing in  3705
this division affects the immunity from civil liability  3706
conferred by that section upon a physician who makes either type  3707
of report in accordance with division (B) of that section. As  3708
used in this division, "employee," "employer," and "physician"  3709
have the same meanings as in section 2305.33 of the Revised  3710
Code.  3711
        (21) The violation of section 3701.79 of the Revised Code  3712
or of any abortion rule adopted by the director of health  3713
pursuant to section 3701.341 of the Revised Code;  3714
        (22) Any of the following actions taken by an agency  3715
responsible for authorizing, certifying, or regulating an  3716
individual to practice a health care occupation or provide  3717
health care services in this state or another jurisdiction, for  3718
any reason other than the nonpayment of fees: the limitation,  3719
revocation, or suspension of an individual's license to  3720
practice; acceptance of an individual's license surrender;  3721
denial of a license; refusal to renew or reinstate a license;  3722
imposition of probation; or issuance of an order of censure or  3723
other reprimand;  3724
        (23) The violation of section 2919.12 of the Revised Code  3725
or the performance or inducement of an abortion upon a pregnant  3726
woman with actual knowledge that the conditions specified in  3727
S. B. No. 438  Page 131
As Introduced
division (B) of section 2317.56 of the Revised Code have not  3728
been satisfied or with a heedless indifference as to whether  3729
those conditions have been satisfied, unless an affirmative  3730
defense as specified in division (H)(2) of that section would  3731
apply in a civil action authorized by division (H)(1) of that  3732
section;  3733
       (24) The revocation, suspension, restriction, reduction,  3734
or termination of clinical privileges by the United States  3735
department of defense or department of veterans affairs or the  3736
termination or suspension of a certificate of registration to  3737
prescribe drugs by the drug enforcement administration of the  3738
United States department of justice;  3739
       (25) Termination or suspension from participation in the  3740
medicare or medicaid programs by the department of health and  3741
human services or other responsible agency;  3742
       (26) Impairment of ability to practice according to  3743
acceptable and prevailing standards of care because of substance  3744
use disorder or excessive use or abuse of drugs, alcohol, or  3745
other substances that may impair ability to practice.  3746
       For the purposes of this division, any individual  3747
authorized to practice by this chapter accepts the privilege of  3748
practicing in this state subject to supervision by the board. By  3749
filing an application for or holding a license or certificate to  3750
practice under this chapter, an individual shall be deemed to  3751
have given consent to submit to a mental or physical examination  3752
when ordered to do so by the board in writing, and to have  3753
waived all objections to the admissibility of testimony or  3754
examination reports that constitute privileged communications.  3755
       If it has reason to believe that any individual authorized  3756
S. B. No. 438  Page 132
As Introduced
to practice by this chapter or any applicant for licensure or  3757
certification to practice suffers such impairment, the board  3758
shall refer the individual to the monitoring organization that  3759
conducts the confidential monitoring program established under  3760
section 4731.25 of the Revised Code. The board also may compel  3761
the individual to submit to a mental or physical examination, or  3762
both. The expense of the examination is the responsibility of  3763
the individual compelled to be examined. Any mental or physical  3764
examination required under this division shall be undertaken by  3765
a treatment provider or physician who is qualified to conduct  3766
the examination and who is approved under section 4731.251 of  3767
the Revised Code.  3768
       Failure to submit to a mental or physical examination  3769
ordered by the board constitutes an admission of the allegations  3770
against the individual unless the failure is due to  3771
circumstances beyond the individual's control, and a default and  3772
final order may be entered without the taking of testimony or  3773
presentation of evidence. If the board determines that the  3774
individual's ability to practice is impaired, the board shall  3775
suspend the individual's license or certificate or deny the  3776
individual's application and shall require the individual, as a  3777
condition for initial, continued, reinstated, or renewed  3778
licensure or certification to practice, to submit to treatment.  3779
       Before being eligible to apply for reinstatement of a  3780
license or certificate suspended under this division, the  3781
impaired practitioner shall demonstrate to the board the ability  3782
to resume practice in compliance with acceptable and prevailing  3783
standards of care under the provisions of the practitioner's  3784
license or certificate. The demonstration shall include, but  3785
shall not be limited to, the following:  3786
S. B. No. 438  Page 133
As Introduced
       (a) Certification from a treatment provider approved under  3787
section 4731.251 of the Revised Code that the individual has  3788
successfully completed any required inpatient treatment;  3789
       (b) Evidence of continuing full compliance with an  3790
aftercare contract or consent agreement;  3791
       (c) Two written reports indicating that the individual's  3792
ability to practice has been assessed and that the individual  3793
has been found capable of practicing according to acceptable and  3794
prevailing standards of care. The reports shall be made by  3795
individuals or providers approved by the board for making the  3796
assessments and shall describe the basis for their  3797
determination.  3798
       The board may reinstate a license or certificate suspended  3799
under this division after that demonstration and after the  3800
individual has entered into a written consent agreement.  3801
       When the impaired practitioner resumes practice, the board  3802
shall require continued monitoring of the individual. The  3803
monitoring shall include, but not be limited to, compliance with  3804
the written consent agreement entered into before reinstatement  3805
or with conditions imposed by board order after a hearing, and,  3806
upon termination of the consent agreement, submission to the  3807
board for at least two years of annual written progress reports  3808
made under penalty of perjury stating whether the individual has  3809
maintained sobriety.  3810
       (27) A second or subsequent violation of section 4731.66  3811
or 4731.69 of the Revised Code;  3812
       (28) Except as provided in division (N) of this section:  3813
       (a) Waiving the payment of all or any part of a deductible  3814
or copayment that a patient, pursuant to a health insurance or  3815
S. B. No. 438  Page 134
As Introduced
health care policy, contract, or plan that covers the  3816
individual's services, otherwise would be required to pay if the  3817
waiver is used as an enticement to a patient or group of  3818
patients to receive health care services from that individual;  3819
       (b) Advertising that the individual will waive the payment  3820
of all or any part of a deductible or copayment that a patient,  3821
pursuant to a health insurance or health care policy, contract,  3822
or plan that covers the individual's services, otherwise would  3823
be required to pay.  3824
       (29) Failure to use universal blood and body fluid  3825
precautions established by rules adopted under section 4731.051  3826
of the Revised Code;  3827
       (30) Failure to provide notice to, and receive  3828
acknowledgment of the notice from, a patient when required by  3829
section 4731.143 of the Revised Code prior to providing  3830
nonemergency professional services, or failure to maintain that  3831
notice in the patient's medical record;  3832
       (31) Failure of a physician supervising a physician  3833
assistant to maintain supervision in accordance with the  3834
requirements of Chapter 4730. of the Revised Code and the rules  3835
adopted under that chapter;  3836
       (32) Failure of a physician or podiatrist to enter into a  3837
standard care arrangement with a certified midwife, clinical  3838
nurse specialist, certified nurse-midwife, or certified nurse  3839
practitioner with whom the physician or podiatrist is in  3840
collaboration pursuant to section 4731.27 of the Revised Code or  3841
failure to fulfill the responsibilities of collaboration after  3842
entering into a standard care arrangement;  3843
       (33) Failure to comply with the terms of a consult  3844
S. B. No. 438  Page 135
As Introduced
agreement entered into with a pharmacist pursuant to section  3845
4729.39 of the Revised Code;  3846
        (34) Failure to cooperate in an investigation conducted by  3847
the board under division (F) of this section, including failure  3848
to comply with a subpoena or order issued by the board or  3849
failure to answer truthfully a question presented by the board  3850
in an investigative interview, an investigative office  3851
conference, at a deposition, or in written interrogatories,  3852
except that failure to cooperate with an investigation shall not  3853
constitute grounds for discipline under this section if a court  3854
of competent jurisdiction has issued an order that either  3855
quashes a subpoena or permits the individual to withhold the  3856
testimony or evidence in issue;  3857
        (35) Failure to supervise an anesthesiologist assistant in  3858
accordance with Chapter 4760. of the Revised Code and the  3859
board's rules for supervision of an anesthesiologist assistant;  3860
        (36) Assisting suicide, as defined in section 3795.01 of  3861
the Revised Code;  3862
        (37) Failure to comply with the requirements of section  3863
2317.561 of the Revised Code;  3864
        (38) Failure to supervise a radiologist assistant in  3865
accordance with Chapter 4774. of the Revised Code and the  3866
board's rules for supervision of radiologist assistants;  3867
        (39) Performing or inducing an abortion at an office or  3868
facility with knowledge that the office or facility fails to  3869
post the notice required under section 3701.791 of the Revised  3870
Code;  3871
        (40) Failure to comply with the standards and procedures  3872
established in rules under section 4731.054 of the Revised Code  3873
S. B. No. 438  Page 136
As Introduced
for the operation of or the provision of care at a pain  3874
management clinic;  3875
       (41) Failure to comply with the standards and procedures  3876
established in rules under section 4731.054 of the Revised Code  3877
for providing supervision, direction, and control of individuals  3878
at a pain management clinic;  3879
       (42) Failure to comply with the requirements of section  3880
4729.79 or 4731.055 of the Revised Code, unless the state board  3881
of pharmacy no longer maintains a drug database pursuant to  3882
section 4729.75 of the Revised Code;  3883
       (43) Failure to comply with the requirements of section  3884
2919.171, 2919.202, or 2919.203 of the Revised Code or failure  3885
to submit to the department of health in accordance with a court  3886
order a complete report as described in section 2919.171 or  3887
2919.202 of the Revised Code;  3888
       (44) Practicing at a facility that is subject to licensure  3889
as a category III terminal distributor of dangerous drugs with a  3890
pain management clinic classification unless the person  3891
operating the facility has obtained and maintains the license  3892
with the classification;  3893
       (45) Owning a facility that is subject to licensure as a  3894
category III terminal distributor of dangerous drugs with a pain  3895
management clinic classification unless the facility is licensed  3896
with the classification;  3897
       (46) Failure to comply with any of the requirements  3898
regarding making or maintaining medical records or documents  3899
described in division (A) of section 2919.192, division (C) of  3900
section 2919.193, division (B) of section 2919.195, or division  3901
(A) of section 2919.196 of the Revised Code;  3902
S. B. No. 438  Page 137
As Introduced
       (47) Failure to comply with the requirements in section  3903
3719.061 of the Revised Code before issuing for a minor a  3904
prescription for an opioid analgesic, as defined in section  3905
3719.01 of the Revised Code;  3906
       (48) Failure to comply with the requirements of section  3907
4731.30 of the Revised Code or rules adopted under section  3908
4731.301 of the Revised Code when recommending treatment with  3909
medical marijuana;  3910
       (49) A pattern of continuous or repeated violations of  3911
division (E)(2) or (3) of section 3963.02 of the Revised Code;  3912
       (50) Failure to fulfill the responsibilities of a  3913
collaboration agreement entered into with an athletic trainer as  3914
described in section 4755.621 of the Revised Code;  3915
       (51) Failure to take the steps specified in section  3916
4731.911 of the Revised Code following an abortion or attempted  3917
abortion in an ambulatory surgical facility or other location  3918
that is not a hospital when a child is born alive;  3919
       (52) Violation of section 4731.77 of the Revised Code;  3920
       (53) Failure of a physician supervising a certified mental  3921
health assistant to maintain supervision in accordance with the  3922
requirements of Chapter 4772. of the Revised Code and the rules  3923
adopted under that chapter;  3924
       (54) Failure to comply with the requirements of section  3925
3705.16 of the Revised Code when certifying a decedent's cause  3926
of death and completing and signing the medical certificate of  3927
death.  3928
       (C) Disciplinary actions taken by the board under  3929
divisions (A) and (B) of this section shall be taken pursuant to  3930
S. B. No. 438  Page 138
As Introduced
an adjudication under Chapter 119. of the Revised Code, except  3931
that in lieu of an adjudication, the board may enter into a  3932
consent agreement with an individual to resolve an allegation of  3933
a violation of this chapter or any rule adopted under it. A  3934
consent agreement, when ratified by an affirmative vote of not  3935
fewer than six members of the board, shall constitute the  3936
findings and order of the board with respect to the matter  3937
addressed in the agreement. If the board refuses to ratify a  3938
consent agreement, the admissions and findings contained in the  3939
consent agreement shall be of no force or effect.  3940
       A telephone conference call may be utilized for  3941
ratification of a consent agreement that revokes or suspends an  3942
individual's license or certificate to practice or certificate  3943
to recommend. The telephone conference call shall be considered  3944
a special meeting under division (F) of section 121.22 of the  3945
Revised Code.  3946
       If the board takes disciplinary action against an  3947
individual under division (B) of this section for a second or  3948
subsequent plea of guilty to, or judicial finding of guilt of, a  3949
violation of section 2919.123 or 2919.124 of the Revised Code,  3950
the disciplinary action shall consist of a suspension of the  3951
individual's license or certificate to practice for a period of  3952
at least one year or, if determined appropriate by the board, a  3953
more serious sanction involving the individual's license or  3954
certificate to practice. Any consent agreement entered into  3955
under this division with an individual that pertains to a second  3956
or subsequent plea of guilty to, or judicial finding of guilt  3957
of, a violation of that section shall provide for a suspension  3958
of the individual's license or certificate to practice for a  3959
period of at least one year or, if determined appropriate by the  3960
board, a more serious sanction involving the individual's  3961
S. B. No. 438  Page 139
As Introduced
license or certificate to practice.  3962
       (D) For purposes of divisions (B)(10), (12), and (14) of  3963
this section, the commission of the act may be established by a  3964
finding by the board, pursuant to an adjudication under Chapter  3965
119. of the Revised Code, that the individual committed the act.  3966
The board does not have jurisdiction under those divisions if  3967
the trial court renders a final judgment in the individual's  3968
favor and that judgment is based upon an adjudication on the  3969
merits. The board has jurisdiction under those divisions if the  3970
trial court issues an order of dismissal upon technical or  3971
procedural grounds.  3972
       (E) The sealing or expungement of conviction records by  3973
any court shall have no effect upon a prior board order entered  3974
under this section or upon the board's jurisdiction to take  3975
action under this section if, based upon a plea of guilty, a  3976
judicial finding of guilt, or a judicial finding of eligibility  3977
for intervention in lieu of conviction, the board issued a  3978
notice of opportunity for a hearing prior to the court's order  3979
to seal or expunge the records. The board shall not be required  3980
to seal, expunge, destroy, redact, or otherwise modify its  3981
records to reflect the court's sealing of conviction records.  3982
       (F)(1) The board shall investigate evidence that appears  3983
to show that a person has violated any provision of this chapter  3984
or any rule adopted under it. Any person may report to the board  3985
in a signed writing any information that the person may have  3986
that appears to show a violation of any provision of this  3987
chapter or any rule adopted under it. In the absence of bad  3988
faith, any person who reports information of that nature or who  3989
testifies before the board in any adjudication conducted under  3990
Chapter 119. of the Revised Code shall not be liable in damages  3991
S. B. No. 438  Page 140
As Introduced
in a civil action as a result of the report or testimony. Each  3992
complaint or allegation of a violation received by the board  3993
shall be assigned a case number and shall be recorded by the  3994
board.  3995
       (2) Investigations of alleged violations of this chapter  3996
or any rule adopted under it shall be supervised by the  3997
supervising member elected by the board in accordance with  3998
section 4731.02 of the Revised Code and by the secretary as  3999
provided in section 4731.39 of the Revised Code. The president  4000
may designate another member of the board to supervise the  4001
investigation in place of the supervising member. Upon a vote of  4002
the majority of the board to authorize the addition of a  4003
consumer member in the supervision of any part of any  4004
investigation, the president shall designate a consumer member  4005
for supervision of investigations as determined by the  4006
president. The authorization of consumer member participation in  4007
investigation supervision may be rescinded by a majority vote of  4008
the board. No member of the board who supervises the  4009
investigation of a case shall participate in further  4010
adjudication of the case.  4011
       (3) In investigating a possible violation of this chapter  4012
or any rule adopted under this chapter, or in conducting an  4013
inspection under division (E) of section 4731.054 of the Revised  4014
Code, the board may question witnesses, conduct interviews,  4015
administer oaths, order the taking of depositions, inspect and  4016
copy any books, accounts, papers, records, or documents, issue  4017
subpoenas, and compel the attendance of witnesses and production  4018
of books, accounts, papers, records, documents, and testimony,  4019
except that a subpoena for patient record information shall not  4020
be issued without consultation with the attorney general's  4021
office and approval of the secretary of the board.  4022
S. B. No. 438  Page 141
As Introduced
       (a) Before issuance of a subpoena for patient record  4023
information, the secretary shall determine whether there is  4024
probable cause to believe that the complaint filed alleges a  4025
violation of this chapter or any rule adopted under it and that  4026
the records sought are relevant to the alleged violation and  4027
material to the investigation. The subpoena may apply only to  4028
records that cover a reasonable period of time surrounding the  4029
alleged violation.  4030
       (b) On failure to comply with any subpoena issued by the  4031
board and after reasonable notice to the person being  4032
subpoenaed, the board may move for an order compelling the  4033
production of persons or records pursuant to the Rules of Civil  4034
Procedure.  4035
       (c) A subpoena issued by the board may be served by a  4036
sheriff, the sheriff's deputy, or a board employee or agent  4037
designated by the board. Service of a subpoena issued by the  4038
board may be made by delivering a copy of the subpoena to the  4039
person named therein, reading it to the person, or leaving it at  4040
the person's usual place of residence, usual place of business,  4041
or address on file with the board. When serving a subpoena to an  4042
applicant for or the holder of a license or certificate issued  4043
under this chapter, service of the subpoena may be made by  4044
certified mail, return receipt requested, and the subpoena shall  4045
be deemed served on the date delivery is made or the date the  4046
person refuses to accept delivery. If the person being served  4047
refuses to accept the subpoena or is not located, service may be  4048
made to an attorney who notifies the board that the attorney is  4049
representing the person.  4050
       (d) A sheriff's deputy who serves a subpoena shall receive  4051
the same fees as a sheriff. Each witness who appears before the  4052
S. B. No. 438  Page 142
As Introduced
board in obedience to a subpoena shall receive the fees and  4053
mileage provided for under section 119.094 of the Revised Code.  4054
       (4) All hearings, investigations, and inspections of the  4055
board shall be considered civil actions for the purposes of  4056
section 2305.252 of the Revised Code.  4057
       (5) A report required to be submitted to the board under  4058
this chapter, a complaint, or information received by the board  4059
pursuant to an investigation or pursuant to an inspection under  4060
division (E) of section 4731.054 of the Revised Code is  4061
confidential and not subject to discovery in any civil action.  4062
       The board shall conduct all investigations or inspections  4063
and proceedings in a manner that protects the confidentiality of  4064
patients and persons who file complaints with the board. The  4065
board shall not make public the names or any other identifying  4066
information about patients or complainants unless proper consent  4067
is given or, in the case of a patient, a waiver of the patient  4068
privilege exists under division (B) of section 2317.02 of the  4069
Revised Code, except that consent or a waiver of that nature is  4070
not required if the board possesses reliable and substantial  4071
evidence that no bona fide physician-patient relationship  4072
exists.  4073
       The board may share any information it receives pursuant  4074
to an investigation or inspection, including patient records and  4075
patient record information, with law enforcement agencies, other  4076
licensing boards, and other governmental agencies that are  4077
prosecuting, adjudicating, or investigating alleged violations  4078
of statutes or administrative rules. An agency or board that  4079
receives the information shall comply with the same requirements  4080
regarding confidentiality as those with which the state medical  4081
board must comply, notwithstanding any conflicting provision of  4082
S. B. No. 438  Page 143
As Introduced
the Revised Code or procedure of the agency or board that  4083
applies when it is dealing with other information in its  4084
possession. In a judicial proceeding, the information may be  4085
admitted into evidence only in accordance with the Rules of  4086
Evidence, but the court shall require that appropriate measures  4087
are taken to ensure that confidentiality is maintained with  4088
respect to any part of the information that contains names or  4089
other identifying information about patients or complainants  4090
whose confidentiality was protected by the state medical board  4091
when the information was in the board's possession. Measures to  4092
ensure confidentiality that may be taken by the court include  4093
sealing its records or deleting specific information from its  4094
records.  4095
       No person shall knowingly access, use, or disclose  4096
confidential investigatory information in a manner prohibited by  4097
law.  4098
       (6) On a quarterly basis, the board shall prepare a report  4099
that documents the disposition of all cases during the preceding  4100
three months. The report shall contain the following information  4101
for each case with which the board has completed its activities:  4102
       (a) The case number assigned to the complaint or alleged  4103
violation;  4104
       (b) The type of license or certificate to practice, if  4105
any, held by the individual against whom the complaint is  4106
directed;  4107
       (c) A description of the allegations contained in the  4108
complaint;  4109
       (d) Whether witnesses were interviewed;  4110
       (e) Whether the individual against whom the complaint is  4111
S. B. No. 438  Page 144
As Introduced
directed is the subject of any pending complaints;  4112
       (f) The disposition of the case.  4113
       The report shall state how many cases are still pending  4114
and shall be prepared in a manner that protects the identity of  4115
each person involved in each case. The report shall be a public  4116
record under section 149.43 of the Revised Code.  4117
       (7) The board may provide a status update regarding an  4118
investigation to a complainant on request if the board verifies  4119
the complainant's identity.  4120
       (G)(1) If either of the following circumstances occur, the  4121
secretary and supervising member may recommend that the board  4122
suspend an individual's license or certificate to practice or  4123
certificate to recommend without a prior hearing:  4124
       (a) The secretary and supervising member determine both of  4125
the following:  4126
       (i) That there is clear and convincing evidence that an  4127
individual has violated division (B) of this section;  4128
       (ii) That the individual's continued practice presents a  4129
danger of immediate and serious harm to the public.  4130
       (b) The board receives verifiable information that a  4131
licensee has been charged in any state or federal court with a  4132
crime classified as a felony under the charging court's law and  4133
the conduct constitutes a violation of division (B) of this  4134
section.  4135
       (2) If a recommendation is made to suspend without a prior  4136
hearing pursuant to division (G)(1) of this section, written  4137
allegations shall be prepared for consideration by the board.  4138
The board, upon review of those allegations and by an  4139
S. B. No. 438  Page 145
As Introduced
affirmative vote of not fewer than six of its members, excluding  4140
the secretary and supervising member, may suspend a license or  4141
certificate without a prior hearing. A telephone conference call  4142
may be utilized for reviewing the allegations and taking the  4143
vote on the summary suspension.  4144
       The board shall serve a written order of suspension in  4145
accordance with sections 119.05 and 119.07 of the Revised Code.  4146
If the individual subject to the summary suspension requests an  4147
adjudicatory hearing by the board, the date set for the hearing  4148
shall be within fifteen days, but not earlier than seven days,  4149
after the individual requests the hearing, unless otherwise  4150
agreed to by both the board and the individual.  4151
       (3) Any summary suspension imposed under division (G)(2)  4152
of this section is not a final appealable order and is not an  4153
adjudication that may be appealed under section 119.12 of the  4154
Revised Code. The summary suspension shall remain in effect  4155
until a final adjudicative order issued by the board pursuant to  4156
this section and Chapter 119. of the Revised Code becomes  4157
effective. Once a final adjudicative order has been issued by  4158
the board, any party adversely affected by it may file an appeal  4159
in accordance with the requirements of Chapter 119. of the  4160
Revised Code.  4161
       The board shall issue its final adjudicative order within  4162
seventy-five days after completion of its hearing. A failure to  4163
issue the order within seventy-five days shall result in  4164
dissolution of the summary suspension order but shall not  4165
invalidate any subsequent, final adjudicative order.  4166
       (H) If the board takes action under division (B)(9), (11),  4167
or (13) of this section and the judicial finding of guilt,  4168
guilty plea, or judicial finding of eligibility for intervention  4169
S. B. No. 438  Page 146
As Introduced
in lieu of conviction is overturned on appeal, upon exhaustion  4170
of the criminal appeal, a petition for reconsideration of the  4171
order may be filed with the board along with appropriate court  4172
documents. Upon receipt of a petition of that nature and  4173
supporting court documents, the board shall reinstate the  4174
individual's license or certificate to practice. The board may  4175
then hold an adjudication under Chapter 119. of the Revised Code  4176
to determine whether the individual committed the act in  4177
question. Notice of an opportunity for a hearing shall be given  4178
in accordance with Chapter 119. of the Revised Code. If the  4179
board finds, pursuant to an adjudication held under this  4180
division, that the individual committed the act or if no hearing  4181
is requested, the board may order any of the sanctions  4182
identified under division (B) of this section.  4183
       (I) The license or certificate to practice issued to an  4184
individual under this chapter and the individual's practice in  4185
this state are automatically suspended as of the date of the  4186
individual's second or subsequent plea of guilty to, or judicial  4187
finding of guilt of, a violation of section 2919.123 or 2919.124  4188
of the Revised Code. In addition, the license or certificate to  4189
practice or certificate to recommend issued to an individual  4190
under this chapter and the individual's practice in this state  4191
are automatically suspended as of the date the individual pleads  4192
guilty to, is found by a judge or jury to be guilty of, or is  4193
subject to a judicial finding of eligibility for intervention in  4194
lieu of conviction in this state or treatment or intervention in  4195
lieu of conviction in another jurisdiction for any of the  4196
following criminal offenses in this state or a substantially  4197
equivalent criminal offense in another jurisdiction: aggravated  4198
murder, murder, voluntary manslaughter, felonious assault,  4199
trafficking in persons, kidnapping, rape, sexual battery, gross  4200
S. B. No. 438  Page 147
As Introduced
sexual imposition, aggravated arson, aggravated robbery, or  4201
aggravated burglary. Continued practice after suspension shall  4202
be considered practicing without a license or certificate.  4203
       The board shall notify the individual subject to the  4204
suspension in accordance with sections 119.05 and 119.07 of the  4205
Revised Code. If an individual whose license or certificate is  4206
automatically suspended under this division fails to make a  4207
timely request for an adjudication under Chapter 119. of the  4208
Revised Code, the board shall do whichever of the following is  4209
applicable:  4210
       (1) If the automatic suspension under this division is for  4211
a second or subsequent plea of guilty to, or judicial finding of  4212
guilt of, a violation of section 2919.123 or 2919.124 of the  4213
Revised Code, the board shall enter an order suspending the  4214
individual's license or certificate to practice for a period of  4215
at least one year or, if determined appropriate by the board,  4216
imposing a more serious sanction involving the individual's  4217
license or certificate to practice.  4218
       (2) In all circumstances in which division (I)(1) of this  4219
section does not apply, enter a final order permanently revoking  4220
the individual's license or certificate to practice.  4221
       (J) If the board is required by Chapter 119. of the  4222
Revised Code to give notice of an opportunity for a hearing and  4223
if the individual subject to the notice does not timely request  4224
a hearing in accordance with section 119.07 of the Revised Code,  4225
the board is not required to hold a hearing, but may adopt, by  4226
an affirmative vote of not fewer than six of its members, a  4227
final order that contains the board's findings. In that final  4228
order, the board may order any of the sanctions identified under  4229
division (A) or (B) of this section.  4230
S. B. No. 438  Page 148
As Introduced
       (K) Any action taken by the board under division (B) of  4231
this section resulting in a suspension from practice shall be  4232
accompanied by a written statement of the conditions under which  4233
the individual's license or certificate to practice may be  4234
reinstated. The board shall adopt rules governing conditions to  4235
be imposed for reinstatement. Reinstatement of a license or  4236
certificate suspended pursuant to division (B) of this section  4237
requires an affirmative vote of not fewer than six members of  4238
the board.  4239
       (L) When the board refuses to grant or issue a license or  4240
certificate to practice to an applicant, revokes an individual's  4241
license or certificate to practice, refuses to renew an  4242
individual's license or certificate to practice, or refuses to  4243
reinstate an individual's license or certificate to practice,  4244
the board may specify that its action is permanent. An  4245
individual subject to a permanent action taken by the board is  4246
forever thereafter ineligible to hold a license or certificate  4247
to practice and the board shall not accept an application for  4248
reinstatement of the license or certificate or for issuance of a  4249
new license or certificate.  4250
       (M) Notwithstanding any other provision of the Revised  4251
Code, all of the following apply:  4252
       (1) The surrender of a license or certificate issued under  4253
this chapter shall not be effective unless or until accepted by  4254
the board. A telephone conference call may be utilized for  4255
acceptance of the surrender of an individual's license or  4256
certificate to practice. The telephone conference call shall be  4257
considered a special meeting under division (F) of section  4258
121.22 of the Revised Code. Reinstatement of a license or  4259
certificate surrendered to the board requires an affirmative  4260
S. B. No. 438  Page 149
As Introduced
vote of not fewer than six members of the board.  4261
       (2) An application for a license or certificate made under  4262
the provisions of this chapter may not be withdrawn without  4263
approval of the board.  4264
       (3) Failure by an individual to renew a license or  4265
certificate to practice in accordance with this chapter or a  4266
certificate to recommend in accordance with rules adopted under  4267
section 4731.301 of the Revised Code does not remove or limit  4268
the board's jurisdiction to take any disciplinary action under  4269
this section against the individual.  4270
       (4) The placement of an individual's license on retired  4271
status, as described in section 4731.283 of the Revised Code,  4272
does not remove or limit the board's jurisdiction to take any  4273
disciplinary action against the individual with regard to the  4274
license as it existed before being placed on retired status.  4275
       (5) At the request of the board, a license or certificate  4276
holder shall immediately surrender to the board a license or  4277
certificate that the board has suspended, revoked, or  4278
permanently revoked.  4279
       (N) Sanctions shall not be imposed under division (B)(28)  4280
of this section against any person who waives deductibles and  4281
copayments as follows:  4282
       (1) In compliance with the health benefit plan that  4283
expressly allows such a practice. Waiver of the deductibles or  4284
copayments shall be made only with the full knowledge and  4285
consent of the plan purchaser, payer, and third-party  4286
administrator. Documentation of the consent shall be made  4287
available to the board upon request.  4288
       (2) For professional services rendered to any other person  4289
S. B. No. 438  Page 150
As Introduced
authorized to practice pursuant to this chapter, to the extent  4290
allowed by this chapter and rules adopted by the board.  4291
       (O) Under the board's investigative duties described in  4292
this section and subject to division (F) of this section, the  4293
board shall develop and implement a quality intervention program  4294
designed to improve through remedial education the clinical and  4295
communication skills of individuals authorized under this  4296
chapter to practice medicine and surgery, osteopathic medicine  4297
and surgery, and podiatric medicine and surgery. In developing  4298
and implementing the quality intervention program, the board may  4299
do all of the following:  4300
       (1) Offer in appropriate cases as determined by the board  4301
an educational and assessment program pursuant to an  4302
investigation the board conducts under this section;  4303
       (2) Select providers of educational and assessment  4304
services, including a quality intervention program panel of case  4305
reviewers;  4306
       (3) Make referrals to educational and assessment service  4307
providers and approve individual educational programs  4308
recommended by those providers. The board shall monitor the  4309
progress of each individual undertaking a recommended individual  4310
educational program.  4311
       (4) Determine what constitutes successful completion of an  4312
individual educational program and require further monitoring of  4313
the individual who completed the program or other action that  4314
the board determines to be appropriate;  4315
       (5) Adopt rules in accordance with Chapter 119. of the  4316
Revised Code to further implement the quality intervention  4317
program.  4318
S. B. No. 438  Page 151
As Introduced
       An individual who participates in an individual  4319
educational program pursuant to this division shall pay the  4320
financial obligations arising from that educational program.  4321
       (P) The board shall not refuse to issue a license to an  4322
applicant because of a conviction, plea of guilty, judicial  4323
finding of guilt, judicial finding of eligibility for  4324
intervention in lieu of conviction, or the commission of an act  4325
that constitutes a criminal offense, unless the refusal is in  4326
accordance with section 9.79 of the Revised Code.  4327
       (Q) A license or certificate to practice or certificate to  4328
recommend issued to an individual under this chapter and an  4329
individual's practice under this chapter in this state are  4330
automatically suspended if the individual's license or  4331
certificate to practice a health care occupation or provide  4332
health care services is suspended, revoked, or surrendered or  4333
relinquished in lieu of discipline by an agency responsible for  4334
authorizing, certifying, or regulating an individual to practice  4335
a health care occupation or provide health care services in this  4336
state or another jurisdiction. The automatic suspension begins  4337
immediately upon entry of the order by the agency and lasts for  4338
ninety days to permit the board to investigate the basis for the  4339
action under this chapter. Continued practice during the  4340
automatic suspension shall be considered practicing without a  4341
license or certificate.  4342
       The board shall notify the individual subject to the  4343
automatic suspension by certified mail or in person in  4344
accordance with section 119.07 of the Revised Code. If an  4345
individual subject to an automatic suspension under this  4346
division fails to make a timely request for an adjudication  4347
under Chapter 119. of the Revised Code, the board is not  4348
S. B. No. 438  Page 152
As Introduced
required to hold a hearing, but may adopt, by an affirmative  4349
vote of not fewer than six of its members, a final order that  4350
contains the board's findings. In that final order, the board  4351
may order any of the sanctions identified under division (A) or  4352
(B) of this section.  4353
        Sec. 4731.27. (A) As used in this section,  4354
"collaboration," "physician," "standard care arrangement," and  4355
"supervision" have the same meanings as in section 4723.01 of  4356
the Revised Code.  4357
        (B) A physician or podiatrist shall enter into a standard  4358
care arrangement with each certified midwife, clinical nurse  4359
specialist, certified nurse-midwife, or certified nurse  4360
practitioner with whom the physician or podiatrist is in  4361
collaboration.  4362
        The collaborating physician or podiatrist shall fulfill  4363
the responsibilities of collaboration, as specified in the  4364
arrangement and in accordance with division (A) of section  4365
4723.431 of the Revised Code. A copy of the standard care  4366
arrangement shall be retained on file by the certified midwife's  4367
or nurse's employer. Prior approval of the standard care  4368
arrangement by the state medical board is not required, but the  4369
board may periodically review it.  4370
        A physician or podiatrist who terminates collaboration  4371
with a certified midwife, certified nurse-midwife, certified  4372
nurse practitioner, or clinical nurse specialist before their  4373
standard care arrangement expires shall give the certified  4374
midwife or nurse the written or electronic notice of termination  4375
required by division (D)(1) of section 4723.431 of the Revised  4376
Code.  4377
S. B. No. 438  Page 153
As Introduced
       Nothing in this division prohibits a hospital from hiring  4378
a certified midwife, clinical nurse specialist, certified nurse-  4379
midwife, or certified nurse practitioner as an employee and  4380
negotiating standard care arrangements on behalf of the employee  4381
as necessary to meet the requirements of this section. A  4382
standard care arrangement between the hospital's employee and  4383
the employee's collaborating physician is subject to approval by  4384
the medical staff and governing body of the hospital prior to  4385
implementation of the arrangement at the hospital.  4386
       (C) A physician or podiatrist shall cooperate with the  4387
board of nursing in any investigation the board conducts with  4388
respect to a certified midwife, clinical nurse specialist,  4389
certified nurse-midwife, or certified nurse practitioner who  4390
collaborates with the physician or podiatrist or with respect to  4391
a certified registered nurse anesthetist who practices with the  4392
supervision of the physician or podiatrist.  4393
       Section 2. That existing sections 3701.351, 3702.30,  4394
3702.301, 4723.01, 4723.02, 4723.03, 4723.06, 4723.07, 4723.08,  4395
4723.271, 4723.28, 4723.282, 4723.33, 4723.34, 4723.341,  4396
4723.35, 4723.41, 4723.43, 4723.431, 4723.432, 4723.481,  4397
4723.483, 4723.487, 4723.488, 4723.4810, 4723.4811, 4723.50,  4398
4723.91, 4723.99, 4731.22, and 4731.27 of the Revised Code are  4399
hereby repealed.  4400
       Section 3. Sections 4723.54 and 4724.02 of the Revised  4401
Code, as enacted by this act, take effect January 1, 2028.  4402
       Section 4. The General Assembly, applying the principle  4403
stated in division (B) of section 1.52 of the Revised Code that  4404
amendments are to be harmonized if reasonably capable of  4405
simultaneous operation, finds that the following sections,  4406
presented in this act as composites of the sections as amended  4407
S. B. No. 438  Page 154
As Introduced
by the acts indicated, are the resulting versions of the  4408
sections in effect prior to the effective date of the sections  4409
as presented in this act:  4410
       Section 4723.08 of the Revised Code as amended by both  4411
H.B. 509 and S.B. 131 of the 134th General Assembly.  4412
       Section 4723.431 of the Revised Code as amended by both  4413
H.B. 497 and S.B. 196 of the 135th General Assembly.  4414
       Section 4723.481 of the Revised Code as amended by H.B. 33  4415
of the 135th General Assembly and by H.B. 110 and H.B. 509 of  4416
the 134th General Assembly.  4417