MD
Maryland House Bill HB55

Maryland 2022 Regular Session

Maryland House Bill HB55 Compare Versions

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1- LAWRENCE J. HOGAN, JR., Governor Ch. 686
21
3-– 1 –
4-Chapter 686
5-(House Bill 55)
62
7-AN ACT concerning
3+EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4+ [Brackets] indicate matter deleted from existing law.
5+ Underlining indicates amendments to bill.
6+ Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7+amendment.
8+ *hb0055*
89
9-Health Occupations – Nurse Anesthetists – Drug Authority and Collaboration
10+HOUSE BILL 55
11+J2 2lr1059
12+ (PRE–FILED) CF SB 312
13+By: Delegate Cullison
14+Requested: October 29, 2021
15+Introduced and read first time: January 12, 2022
16+Assigned to: Health and Government Operations
17+Committee Report: Favorable with amendments
18+House action: Adopted
19+Read second time: February 15, 2022
1020
11-FOR the purpose of authorizing a nurse anesthetist to prescribe, order, and administer
12-drugs, including controlled dangerous substances, without obtaining approval from
13-a practitioner with whom the nurse anesthetist collaborates, subject to certain
14-limitations; authorizing a nurse anesthetist to collaborate with a podiatrist; and
15-generally relating to nurse anesthetists.
21+CHAPTER ______
1622
17-BY repealing and reenacting, with amendments,
18- Article – Health Occupations
19-Section 8–513, 12–101(b), and 12–102(e)
20- Annotated Code of Maryland
21- (2021 Replacement Volume)
23+AN ACT concerning 1
2224
23- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
24-That the Laws of Maryland read as follows:
25+Health Occupations – Nurse Anesthetists – Drug Authority and Collaboration 2
2526
26-Article – Health Occupations
27+FOR the purpose of authorizing a nurse anesthetist to prescribe, order, and administer 3
28+drugs, including controlled dangerous substances, without obtaining approval from 4
29+a practitioner with whom the nurse anesthetist collaborates, subject to certain 5
30+limitations; authorizing a nurse anesthetist to collaborate with a podiatrist; and 6
31+generally relating to nurse anesthetists. 7
2732
28-8–513.
33+BY repealing and reenacting, with amendments, 8
34+ Article – Health Occupations 9
35+Section 8–513, 12–101(b), and 12–102(e) 10
36+ Annotated Code of Maryland 11
37+ (2021 Replacement Volume) 12
2938
30- (a) In this section, “perioperative assessment and management” means the
31-assessment and management of a patient preoperatively, intraoperatively, and
32-postoperatively.
39+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 13
40+That the Laws of Maryland read as follows: 14
3341
34- (b) (1) A nurse anesthetist may perform the following functions:
42+Article – Health Occupations 15
3543
36- (i) Perioperative assessment and management of patients requiring
37-anesthesia services;
44+8–513. 16
3845
39- (ii) Administration of anesthetic agents;
46+ (a) In this section, “perioperative assessment and management” means the 17
47+assessment and management of a patient preoperatively, intraoperatively, and 18
48+postoperatively. 19 2 HOUSE BILL 55
4049
41- (iii) Management of fluids in intravenous therapy; [and]
4250
43- (iv) Respiratory care; AND
4451
45- (V) SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION ,
46-PRESCRIPTION , ORDERING, AND ADMINISTRATION O F DRUGS, INCLUDING A DRU G
47-THAT IS CLASSIFIED A S A CONTROLLED DANGE ROUS SUBSTANCE UNDER TITLE 5,
48-SUBTITLE 4 OF THE CRIMINAL LAW ARTICLE. Ch. 686 2022 LAWS OF MARYLAND
52+ (b) (1) A nurse anesthetist may perform the following functions: 1
4953
50-– 2 –
54+ (i) Perioperative assessment and management of patients requiring 2
55+anesthesia services; 3
5156
52- (2) A nurse anesthetist has the right and obligation to refuse to perform a
53-delegated act if in the nurse anesthetist’s judgment, the act is:
57+ (ii) Administration of anesthetic agents; 4
5458
55- (i) Unsafe;
59+ (iii) Management of fluids in intravenous therapy; [and] 5
5660
57- (ii) An invalidly prescribed medical act; or
61+ (iv) Respiratory care; AND 6
5862
59- (iii) Beyond the clinical skills of the nurse anesthetist.
63+ (V) SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION , 7
64+PRESCRIPTION , ORDERING, AND ADMINISTRATION O F DRUGS, INCLUDING A DRUG 8
65+THAT IS CLASSIFIED A S A CONTROLLED DANGE ROUS SUBSTANCE UNDER TITLE 5, 9
66+SUBTITLE 4 OF THE CRIMINAL LAW ARTICLE. 10
6067
61- (3) Paragraph (1) of this subsection may not be construed to authorize a
62-nurse anesthetist to:
68+ (2) A nurse anesthetist has the right and obligation to refuse to perform a 11
69+delegated act if in the nurse anesthetist’s judgment, the act is: 12
6370
64- (i) Diagnose a medical condition;
71+ (i) Unsafe; 13
6572
66- (ii) Provide care that is not consistent with the scope of practice of
67-nurse anesthetists; or
73+ (ii) An invalidly prescribed medical act; or 14
6874
69- (iii) Provide care for which the nurse anesthetist does not have proper
70-education and experience.
75+ (iii) Beyond the clinical skills of the nurse anesthetist. 15
7176
72- (4) A NURSE ANESTHETIST MA Y PRESCRIBE DRUGS UNDER
73-PARAGRAPH (1) OF THIS SUBSECTION :
77+ (3) Paragraph (1) of this subsection may not be construed to authorize a 16
78+nurse anesthetist to: 17
7479
75- (I) ONLY IN AN AMOUNT THA T DOES NOT EXCEED A 10–DAY
76-SUPPLY;
80+ (i) Diagnose a medical condition; 18
7781
78- (II) ONLY FOR AN INDIVIDUA L WITH WHOM THE NURS E
79-ANESTHETIST HAS , AT THE TIME OF PRESC RIPTION, ESTABLISHED A CLIENT OR
80-PATIENT RECORD ; AND
82+ (ii) Provide care that is not consistent with the scope of practice of 19
83+nurse anesthetists; or 20
8184
82- (III) ONLY IN CONNECTION WI TH THE DELIVERY OF A NESTHESIA
83-SERVICES; AND
85+ (iii) Provide care for which the nurse anesthetist does not have proper 21
86+education and experience. 22
8487
85- (IV) WITHOUT OBTAINING APP ROVAL FROM A PRACTIT IONER
86-WITH WHOM THE NURSE ANESTHETIST COLLABOR ATES UNDER SUBSECTIO N (C) OF
87-THIS SECTION.
88+ (4) A NURSE ANESTHETIST MA Y PRESCRIBE DRUGS UNDER 23
89+PARAGRAPH (1) OF THIS SUBSECTION : 24
8890
89- (c) A nurse anesthetist shall collaborate with an anesthesiologist, a licensed
90-physician, [or] a dentist, OR A PODIATRIST in the following manner:
91+ (I) ONLY IN AN AMOUNT THA T DOES NOT EXCEED A 10–DAY 25
92+SUPPLY; 26
9193
92- (1) An anesthesiologist, a licensed physician, [or] a dentist, OR A
93-PODIATRIST shall be physically available to the nurse anesthetist for consultation at all
94-times during the administration of, and recovery from, anesthesia;
95- LAWRENCE J. HOGAN, JR., Governor Ch. 686
94+ (II) ONLY FOR AN INDIVIDUA L WITH WHOM THE NURS E 27
95+ANESTHETIST HAS , AT THE TIME OF PRESC RIPTION, ESTABLISHED A CLIENT OR 28
96+PATIENT RECORD ; AND 29 HOUSE BILL 55 3
9697
97-– 3 –
98- (2) An anesthesiologist shall be available for consultation to the nurse
99-anesthetist for other aspects of the practice of nurse anesthesia; and
10098
101- (3) If an anesthesiologist is not available, a licensed physician [or], dentist,
102-OR PODIATRIST shall be available to provide this type of consultation.
10399
104- (d) The nurse anesthetist shall ensure that a qualified anesthesia provider:
100+ (III) ONLY IN CONNECTION WI TH THE DELIVERY OF A NESTHESIA 1
101+SERVICES; AND 2
105102
106- (1) Performs a thorough and complete preanesthetic assessment;
103+ (IV) WITHOUT OBTAINING APP ROVAL FROM A PRACTIT IONER 3
104+WITH WHOM THE NURSE ANESTHETIST COLLABOR ATES UNDER SUBSECTIO N (C) OF 4
105+THIS SECTION. 5
107106
108- (2) Obtains informed consent for the planned anesthetic intervention from
109-the patient or an individual responsible for the patient; and
107+ (c) A nurse anesthetist shall collaborate with an anesthesiologist, a licensed 6
108+physician, [or] a dentist, OR A PODIATRIST in the following manner: 7
110109
111- (3) Formulates a patient–specific plan for anesthesia care.
110+ (1) An anesthesiologist, a licensed physician, [or] a dentist, OR A 8
111+PODIATRIST shall be physically available to the nurse anesthetist for consultation at all 9
112+times during the administration of, and recovery from, anesthesia; 10
112113
113- (e) The nurse anesthetist as part of the standards of practice shall:
114+ (2) An anesthesiologist shall be available for consultation to the nurse 11
115+anesthetist for other aspects of the practice of nurse anesthesia; and 12
114116
115- (1) Implement and adjust an anesthesia care plan as needed to adapt to
116-the patient’s response to the anesthesia;
117+ (3) If an anesthesiologist is not available, a licensed physician [or], dentist, 13
118+OR PODIATRIST shall be available to provide this type of consultation. 14
117119
118- (2) Monitor a patient’s physiologic condition for untoward identifiable
119-reactions and initiate appropriate corrective actions as required;
120+ (d) The nurse anesthetist shall ensure that a qualified anesthesia provider: 15
120121
121- (3) Enter prompt, complete, and accurate documentation of pertinent
122-information on a patient’s record;
122+ (1) Performs a thorough and complete preanesthetic assessment; 16
123123
124- (4) Transfer responsibility for care of a patient to other qualified providers
125-in a manner that ensures continuity of care and patient safety;
124+ (2) Obtains informed consent for the planned anesthetic intervention from 17
125+the patient or an individual responsible for the patient; and 18
126126
127- (5) Ensure that appropriate safety precautions are taken to minimize the
128-risks of fire, explosion, electrical shock, and equipment malfunction;
127+ (3) Formulates a patient–specific plan for anesthesia care. 19
129128
130- (6) Maintain appropriate infection control standards;
129+ (e) The nurse anesthetist as part of the standards of practice shall: 20
131130
132- (7) Evaluate anesthesia care to ensure its quality;
131+ (1) Implement and adjust an anesthesia care plan as needed to adapt to 21
132+the patient’s response to the anesthesia; 22
133133
134- (8) Maintain continual competence in anesthesia practice; and
134+ (2) Monitor a patient’s physiologic condition for untoward identifiable 23
135+reactions and initiate appropriate corrective actions as required; 24
135136
136- (9) Respect and maintain the basic rights of patients.
137+ (3) Enter prompt, complete, and accurate documentation of pertinent 25
138+information on a patient’s record; 26
137139
138- (f) This section may not be construed to require a written collaboration
139-agreement between a nurse anesthetist and an anesthesiologist, a physician, [or] a dentist,
140-OR A PODIATRIST .
140+ (4) Transfer responsibility for care of a patient to other qualified providers 27
141+in a manner that ensures continuity of care and patient safety; 28
141142
142-12–101.
143- Ch. 686 2022 LAWS OF MARYLAND
143+ (5) Ensure that appropriate safety precautions are taken to minimize the 29
144+risks of fire, explosion, electrical shock, and equipment malfunction; 30 4 HOUSE BILL 55
144145
145-– 4 –
146- (b) “Authorized prescriber” means any licensed dentist, licensed dental hygienist
147-with prescriptive authority under § 4–206.4 of this article, licensed physician, licensed
148-podiatrist, licensed veterinarian, advanced practice nurse with prescriptive authority
149-under § 8–508 of this article, LICENSED NURSE ANEST HETIST, or other individual
150-authorized by law to prescribe prescription or nonprescription drugs or devices.
151146
152-12–102.
153147
154- (e) (1) This title does not prohibit:
148+ (6) Maintain appropriate infection control standards; 1
155149
156- (i) A dentist, physician, or podiatrist from administering a
157-prescription drug or device in the course of treating a patient; [or]
150+ (7) Evaluate anesthesia care to ensure its quality; 2
158151
159- (ii) A licensed dental hygienist from administering medication under
160-§ 4–206.4 of this article; OR
152+ (8) Maintain continual competence in anesthesia practice; and 3
161153
162- (III) A NURSE ANESTHETIST FR OM ADMINISTERING
163-MEDICATION UNDER § 8–513 OF THIS ARTICLE .
154+ (9) Respect and maintain the basic rights of patients. 4
164155
165- (2) For the purposes of paragraph (1)(i) of this subsection, “administering”
166-means the direct introduction of a single dosage of a drug or device at a given time, whether
167-by injection or other means, and whether in liquid, tablet, capsule, or other form.
156+ (f) This section may not be construed to require a written collaboration 5
157+agreement between a nurse anesthetist and an anesthesiologist, a physician, [or] a dentist, 6
158+OR A PODIATRIST . 7
168159
169- SECTION 2. AND BE IT FURTHER ENACTED, That this Act shal l take effect
170-October 1, 2022.
160+12–101. 8
171161
172-Enacted under Article II, § 17(c) of the Maryland Constitution, May 29, 2022.
162+ (b) “Authorized prescriber” means any licensed dentist, licensed dental hygienist 9
163+with prescriptive authority under § 4–206.4 of this article, licensed physician, licensed 10
164+podiatrist, licensed veterinarian, advanced practice nurse with prescriptive authority 11
165+under § 8–508 of this article, LICENSED NURSE ANEST HETIST, or other individual 12
166+authorized by law to prescribe prescription or nonprescription drugs or devices. 13
167+
168+12–102. 14
169+
170+ (e) (1) This title does not prohibit: 15
171+
172+ (i) A dentist, physician, or podiatrist from administering a 16
173+prescription drug or device in the course of treating a patient; [or] 17
174+
175+ (ii) A licensed dental hygienist from administering medication under 18
176+§ 4–206.4 of this article; OR 19
177+
178+ (III) A NURSE ANESTHETIST FR OM ADMINISTERING 20
179+MEDICATION UNDER § 8–513 OF THIS ARTICLE . 21
180+
181+ (2) For the purposes of paragraph (1)(i) of this subsection, “administering” 22
182+means the direct introduction of a single dosage of a drug or device at a given time, whether 23
183+by injection or other means, and whether in liquid, tablet, capsule, or other form. 24
184+
185+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 25
186+October 1, 2022. 26
187+
188+
189+