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Board of Medical Examiners

Legislative Updates


Legislative Updates:Current through December 18, 2013

If you wish to review any of the following Public Chapters in their entirety, please visit:  http://www.tennessee.gov/sos/acts/index.htm.

Board Specific Updates

PUBLIC CHAPTER NO. 254

AN ACT to amend Tennessee Code Annotated, Title 32, Chapter 11; Title 34, Chapter 6 and Title 68, Chapter 11, relative to health care decisions.

SECTION 1. Tennessee Code Annotated, Section 68-11-224, is amended by deleting the section in its entirety and by substituting instead the following:

(a) For the purposes of this section:

(1) "Clinical nurse specialist" means a nurse duly licensed under title 63, chapter 7 who has a master's degree or higher in a nursing specialty, has national specialty certification as a clinical nurse specialist, and is recognized by the board of nursing as an advanced practice nurse under § 63-7 -126; and

(2) "Do-not-resuscitate order' means a written order, other than a "POST' as defined by this section, not to resuscitate a patient in the event of cardiac or respiratory arrest in accordance with accepted medical practices; and

(3) "Emergency responder" means a paid or volunteer firefighter, law enforcement officer, or other public safety official or volunteer operating within the scope of the person's proper function under the law or rendering emergency care at the scene of an emergency; and

(4) "Health care provider'' shall have the same meaning as ascribed to that term in § 68-11-1802(a), and shall include, but shall not be limited to, qualified emergency medical services personnel; and

(5) "Nurse practitioner'' means a nurse duly licensed under title 63, chapter 7 who has a master's degree or higher in a nursing specialty, has national specialty certification as a nurse practitioner, and is recognized by the board of nursing as an advanced practice nurse under§ 63-7-126;

(6) "Person authorized to consent on the patient's behalf' means any person authorized by law to consent on behalf of the patient incapable of making any informed decision or, in the case of a minor child, the parent or parents having custody of the child or the child's legal guardian or as otherwise provided bylaw;

(7) "Physician assistant" means a person who has graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant, has passed the Physician Assistant National Certifying Examination, and is currently licensed in Tennessee as a physician assistant under title 63, chapter 19;

(8) "Physician orders for scope of treatment" or "POST' means written orders that:

(A) Are on a form approved by the board for licensing health care facilities;

(B) Apply regardless of the treatment setting that are signed as required herein by the patient's physician, physician assistant, nurse practitioner, or clinical nurse specialist; and

(C) (i) Specify whether, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should or should not be attempted;

(ii) Specify other medical interventions that are to be provided or withheld; or

(iii) Specify both (i) and (ii); and

(9) "Qualified emergency medical service personnel" includes, but is not limited to, emergency medical technicians, paramedics, or other emergency services personnel, providers, or entities acting within the course of their professions, and other emergency responders; and

(10) "Unlicensed individuals who provide direct care and support to persons supported" means the unlicensed individuals, including their unlicensed direct care and support supervisors, who are employed to provide direct care and support to persons supported within the department of intellectual and developmental disabilities ICF/ID homes and facilities or by agencies that are licensed under title 33 and under contract with this department.

(b) Physician orders for scope of treatment (POST) may be issued by a physician for a patient with whom the physician has a bona fide physician-patient relationship, but only:

(1) With the informed consent of the patient;

(2) If the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act, compiled in part 18 of this chapter; or

(3) Where the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order and the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act, is not reasonably available, if the physician determines that the provision of cardio pulmonary resuscitation would be contrary to accepted medical standards.

(c) A POST may be issued by a physician assistant, nurse practitioner or clinical nurse specialist for a patient with whom such physician assistant, nurse practitioner or clinical nurse specialist has a bona fide physician assistant-patient or nurse-patient relationship, but only if:

(1) No physician who has a bona fide physician-patient relationship with the patient is present and available for discussion with the patient (or if the patient is a minor or is otherwise incapable of making an informed decision, with the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act;

(2) Such authority to issue is contained in the physician assistant's, nurse practitioner's or clinical nurse specialist's protocols;

(3) Either:

(A) The patient is a resident of a nursing home licensed under this title or an ICF/MR facility licensed under title 33 and is in the process of being discharged from the nursing home or transferred to another facility at the time the POST is being issued; or

(B) The patient is a hospital patient and is in the process of being discharged from the hospital or transferred to another facility at the time the POST is being issued; and

(4) Either:

(A) With the informed consent of the patient;

(B) If the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act; or

(C) If the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order and the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act. is not reasonably available and such authority to issue is contained in the physician assistant, nurse practitioner or clinical nurse specialist's protocols and the physician assistant or nurse determines that the provision of cardio pulmonary resuscitation would be contrary to accepted medical standards.

(d) If the patient is an adult who is capable of making an informed decision, the patient's expression of the desire to be resuscitated in the event of cardiac or respiratory arrest shall revoke any contrary order in the POST. If the patient is a minor or is otherwise incapable of making an informed decision, the expression of the desire that the patient be resuscitated by the person authorized to consent on the patient's behalf shall revoke any contrary order in the POST. Nothing in this section shall be construed to require cardiopulmonary resuscitation of a patient for whom the physician or physician assistant or nurse practitioner or clinical nurse specialist determines cardiopulmonary resuscitation is not medically appropriate.

(e) (1) A POST issued in accordance with this section shall remain valid and in effect until revoked. In accordance with this section and applicable regulations, qualified emergency medical services personnel; and licensed health care practitioners in any facility, program, or organization operated or licensed by the board for licensing health care facilities, the department of mental health and substance abuse services, or the department of intellectual and developmental disabilities, or operated, licensed, or owned by another state agency, shall follow a POST that is available to such persons in a form approved by the board for licensing health care facilities.

(2) The department of intellectual and developmental disabilities shall allow unlicensed individuals who provide direct support and care to persons supported and who are employed by agencies that are licensed under title 33 and under contract to provide residential or adult day programs and personal assistance or who provide direct support and care to persons supported within the ICE/10 homes and department facilities, to follow universal do not resuscitate orders that are made available to them in a form approved by the board.

(f) Nothing in this section shall authorize the withholding of other medical interventions, such as medications, positioning, wound care, oxygen, suction, treatment of airway obstruction or other therapies deemed necessary to provide comfort care or to alleviate pain.

(g) If a person has a do-not-resuscitate order in effect at the time of such person's discharge from a health care facility, the facility shall complete a POST prior to discharge. If a person with a POST is transferred from one health care facility to another health care facility, the health care facility initiating the transfer shall communicate the existence of the POST to qualified emergency medical service personnel and to the receiving facility prior to the transfer. The transferring facility shall provide a copy of the POST that accompanies the patient in transport to the receiving health care facility. Upon admission, the receiving facility shall make the POST a part of the patient's record.

(h) This section shall not prevent, prohibit, or limit a physician from using a written order, other than a POST, not to resuscitate a patient in the event of cardiac or respiratory arrest in accordance with accepted medical practices. This action shall have no application to any do not resuscitate order that is not a POST, as defined in this section.

(i) Valid do not resuscitate orders or emergency medical services do not resuscitate orders issued before July 1, 2004, pursuant to the then-current law, shall remain valid and shall be given effect as provided, in this section.

(1) The board for licensing health care facilities shall promulgate rules and create forms regarding procedures for the withholding of resuscitative services from patients in accordance with the Tennessee Health Care Decisions Act, and this section.

(2) The rules shall address:

(A) The mechanism or mechanisms for reaching decisions about the withholding of resuscitative services from individual patients;

(B) The mechanism or mechanisms for resolving conflicts in decision making, should they arise: and

(C) The roles of physicians, physician assistant, nurse practitioner or clinical nurse specialists and, when applicable, other nursing personnel, other appropriate staff, and family members in the decision to withhold resuscitative services.

(3) The rules shall include provisions designed to assure that patients' rights are respected when decisions are made to withhold resuscitative services and shall include the requirement that appropriate orders be written by the physician, physician assistant, nurse practitioner or clinical nurse specialist, primarily responsible for the patient, and that documentation be made in the patient's current clinical record if resuscitative services are to be withheld.

(4) This section shall not be construed or implemented in any manner which restricts or impairs the decision-making authority of the agent, surrogate, or other person designated in the Tennessee Health Care Decisions Act. This section does not authorize a surrogate to give consent for or take any action on behalf of a patient on any matter governed by title 33.

(k) A health care provider or institution acting in good faith and in accordance with generally accepted health care standards applicable to the health care provider or institution is not subject to civil or criminal liability for:

(1) Complying with a POST;

(2) Declining to comply with a POST based on reasonable belief that the order then lacked validity; or

(3) Complying with a POST and assuming that the order was valid when made and has not been revoked or terminated.

SECTION 2. For purposes of rulemaking this act shall take effect on becoming a law, for all other purposes this act shall take effect July 1, 2013, the public welfare requiring it.

PUBLIC CHAPTER NO. 197

AN ACT to amend Tennessee Code Annotated, Title 63 and Title 68, relative to cardiopulmonary resuscitation for infants.

SECTION 1. Tennessee Code Annotated, Title 68, Chapter 5, Part 1, is amended by adding the following language as a new, appropriately designated section: 68-5-_.(a) Hospitals, birthing centers, health care facilities, physicians, nurse practitioners, physician assistants or other health care practitioners who provide medical care to newborns as well as obstetricians who provide routine care for prenatal patients shall make available information and instruction concerning the appropriate use and techniques of infant cardiopulmonary resuscitation (CPR) to at least one (1) parent or caregiver of a newborn infant. Nothing in this section shall require classes in certification of infant CPR. This section shall also not constitute a requirement to be assessed during any inspection under chapter 11, part 2 of this title.

(b) Any facility or practitioner acting within the scope of their licensure or practice shall be immune from any civil liability under this section and shall have an affirmative defense to any criminal liability arising from making such information available.

SECTION 2. This act shall take effect July 1, 2013, the public welfare requiring it.

PUBLIC CHAPTER NO. 430

AN ACT to amend Tennessee Code Annotated, Title 39; Title 53 and Title 63, relative to prescription drug abuse.

SECTION 1. This act shall be known and may be cited as the "Addison Sharp Prescription Regulatory Act of 2013."
SECTION 2. Tennessee Code Annotated, Title 63, Chapter 1, is amended by adding a new
Part 4 as follows:  63-1-401. (a) As used in this part:

(1) "Commissioner" means the commissioner of the department of health; and

(2) "Treatment guidelines" means systematically developed statements to assist health care providers in making patient decisions concerning appropriate medical care for specific clinical circumstances.

(b) By January 1, 2014, the commissioner shall develop recommended treatment guidelines for prescribing of opioids, benzodiazepines, barbiturates, and carisoprodol that can be used by prescribers in the state as a guide for caring for patients. This subsection shall not apply to veterinarians.

(c) The commissioner shall review and update the guidelines by September 30th of each year, and shall cause them to be posted on the department's website.

(d) The treatment guidelines shall be submitted to each prescribing board that licenses health professionals who can legally prescribe controlled substances and to the board of pharmacy. Each board shall be charged with review of the treatment guidelines and determining how the guidelines are to be used by its licensees.

(e) Each board shall notify all of its licensees through routine bulletins or newsletters of the existence of the guidelines. 63-1-402.

(a) On or after July 1, 2014, all prescribers who hold a current federal drug enforcement administration (DEA) license and who prescribe controlled substances shall be required to complete a minimum of two (2) hours of continuing education related to controlled substance prescribing biennially to count toward the licensees' mandatory continuing education.

(b) The continuing education must include instruction in the department's treatment guidelines on opioids, benzodiazepines, barbiturates, and carisoprodol, and may include such other topics as medicine addiction, risk management tools, and other topics as approved by the respective licensing boards.

(c) This section shall not apply to veterinarians, providers practicing at a registered pain management clinic as defined in § 63-1-301 or to medical doctors or osteopathic physicians board certified by the American Board of Medical Specialties (ABMS), or American Osteopathic Association (AOA), or the American Board of Physician Specialties (ABPS) in one or more of the following specialties or subspecialties:

(1) Pain management;
(2) Anesthesiology;
(3) Physical medicine and rehabilitation;
(4) Neurology; or
(5) Rheumatology.

SECTION 3. Tennessee Code Annotated, Section 53-10-302(10), is deleted in its entirety and replaced with the following language:

(10) "Healthcare practitioner extender'' means any registered or licensed healthcare professional, and up to two (2) unlicensed persons per prescriber or dispenser designated by the prescriber or dispenser to act as agents of such prescriber or dispenser. A prescriber shall have the ability to authorize a healthcare practitioner extender to check the controlled substance database as stipulated in § 53-1 0-31 0( e) for other prescribers in the authorizing prescriber's practice. Notwithstanding the provisions of Section 28 of Chapter 880 of the Public Acts of 2012, any one-time costs required to be made to effectuate the provisions of this act specific to system modifications required by changes in this subdivision shall be shared on a pro-rata basis, excluding the pharmacy board, by the appropriate prescribing boards as enumerated in title 53, chapter 1 0, part 3. The prescriber or dispenser shall be responsible for actions taken by their agents pursuant to this part;

SECTION 4. Tennessee Code Annotated, Section 53-11-308, is amended by adding the following language as new subsections at the end of the current section:

(e) No prescription for any opioids or benzodiazepines may be dispensed in quantities greater than a thirty (30) day supply.

(f) If a prescriber dispenses any opioids, benzodiazepines, barbiturates, or carisoprodol, then the prescriber shall submit the transaction to the controlled substances monitoring database operated under title 53, chapter 10, part 3.

(g) Any prescribers of opioids, benzodiazepines, barbiturates or carisoprodol, either alone, concurrently, or sequentially with any other opioids, benzodiazepines, barbiturates, or carisoprodol to patients who are chronic, long-term drug therapy for ninety (90) days or longer shall consider mandatory urine drug testing. This subsection shall not supersede any rules promulgated by the commissioner for urine drug testing by registered pain management clinics.

SECTION 5. Tennessee Code Annotated, Section 53-10-302, is hereby amended by adding the following new language as new subsections at the end of the current section:

U "Manufacturer" means any person, except a pharmacist compounding in the normal course of professional practice, engaged in the commercial production, preparation, propagation, conversion, or processing of a drug, either directly or indirectly, by extraction from substances of natural origin or independently by means of chemical synthesis, or both, and includes any packaging or repackaging of a drug or the labeling or relabeling of its container and the promotion and marketing of such drugs or devices;

(_) 'Wholesaler" means a person whose principal business is buying or otherwise acquiring drugs or devices for resale or distribution to persons other than consumers.

SECTION 6. Tennessee Code Annotated, Title 53, Chapter 10, Part 3, is amended by adding the following language as a new section:53-10-312.
(a) Wholesalers and manufacturers, as defined in § 63-10-204, that sell controlled substances at wholesale must at least report the following information to the committee in Automation of Reports and Consolidated Orders System (ARCOS) format or other mutually acceptable format:

(1) Wholesaler or manufacturer with a drug enforcement administration registration number; provided that if this number is not applicable, then another mutually acceptable identifier;

(2) Purchaser's drug enforcement administration registration number; provided that if this number is not applicable, then another mutually acceptable identifier;

(3) National drug code number of the actual drug sold;

(4) Quantity of the drug sold;

(5) Date of sale; and

(6) Transaction identifier or invoice number.

(b) The department of health will establish such rules as are necessary to specify which medications shall be reported, the time frames for such reporting, and other reporting requirements as required.

SECTION 7. Tennessee Code Annotated, Section 63-1-301(5), is amended by deleting subdivision (5) in its entirety and by substituting instead the following:

(5) "Pain management clinic" means a privately-owned facility in which a medical doctor, an osteopathic physician, an advanced practice nurse, a physician assistant, or any other health care provider licensed under title 63 provides pain management services to patients, a majority of whom are issued a prescription for, or are dispensed, opioids, benzodiazepines, barbiturates, or carisoprodol and provides prescriptions for more than ninety (90) days in a twelve-month period. For purposes of determining if a clinic should be registered under this part, patients of health care providers who do not prescribe controlled substances shall be excluded from the count. "Pain management clinic" shall also mean any privately owned clinic, facility, or office which advertises in any medium for any type pain management services and in which one (1) or more employees or contractors prescribe controlled substances; and

SECTION 8. Tennessee Code Annotated, Section 63-1-303(c), is amended by deleting subsection (c) in its entirety and by substituting instead the following:

(c) The rules adopted pursuant to subsection (b) shall address the following topics, among others:

(1) The operation of the clinic, including requirements:

(A) That patients have current and valid government issued identification or current health insurance card issued by either a government or private carrier; and

(B) That providers conduct urine drug screening in accordance with a written drug screening and compliance plan, which may include testing on initial assessment or upon new admission;

(2) Personnel requirements for the clinic;

(3) Training requirements for clinic providers who are regulated by that board;

(4) Patient records;

(5) Standards to ensure quality of patient care;

(6) Infection control;

(7) Health and safety requirements;

(8) Certificate application and renewal procedures and requirements;

(9) Data collection and reporting requirements;

(1 0) Inspections and complaint investigations; and

(11) Patient billing procedures.

SECTION 9. Tennessee Code Annotated, Section 63-1-309(d), is amended by adding the following language at the end of the subsection: A medical director shall serve as medical director and provide services for no more than four (4) pain management clinics.

SECTION 10. Tennessee Code Annotated, Section 63-1-310(a), is amended by deleting the subsection in its entirety and by substituting instead the following:

(a) A pain management clinic may accept only a check or credit card in payment for services provided at the clinic, except as provided in subsection (b).

SECTION 11. The department of health, the board of pharmacy or any board operating under Tennessee Code Annotated, Title 63, is authorized to use emergency rules under Tennessee Code Annotated, Section 4-5-208(a)(5), in order to promulgate any rules required by this act.

SECTION 12. Tennessee Code Annotated, Section 63-1-311 (b), is amended by deleting the language "an administrative penalty of one thousand dollars ($1,000) per day," and by substituting instead the language "an administrative penalty of no less than one thousand dollars ($1,000) per day and which shall not exceed five thousand dollars ($5,000) per day."

SECTION 13. Tennessee Code Annotated, Section 63-1-311, is amended by adding the following as a new subsection (c):

(c) An owner, co-owner, or operator of an uncertified pain management clinic is subject to an administrative penalty of no less than one thousand dollars ($1 ,000) per day and which shall not exceed five thousand dollars ($5,000) per day, imposed by the department of health, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Before such a penalty may be assessed by the department, the department shall give at least thirty (30) days notice to the owner, co-owner, or operator of the alleged violation of this part.

SECTION 14. Tennessee Code Annotated, Title 63, Chapter 1, Part 3, is amended by adding the following as a new subsection: 63-1-313. The commissioner of health and each appropriate occupational professional licensing board governing licensees who may legally prescribe or dispense controlled substances shall prepare a comprehensive report on actions relative to prescription drug abuse and pain management clinics to the general assembly no later than January 31st for actions in the prior calendar year. This report shall summarize the number of complaints received, frequent findings, and actions taken.

SECTION 15. Tennessee Code Annotated, Section 53-10-310(e)(5), is amended by adding the following new subdivision:

(E) The controlled substance is prescribed for administration directly to a patient during the course of inpatient or residential treatment in a hospital or nursing home licensed under title 68 or a mental health hospital licensed under title 33.

SECTION 16. For the purpose of promulgating rules and regulations, this act shall take effect upon becoming a law, the public welfare requiring it. The section added to this act by the amendment with draft # 6707 shall take effect upon becoming a law, the public welfare requiring it. All other sections of this act shall take effect October 1, 2013, the public welfare requiring it.

PUBLIC CHAPTER NO. 336

AN ACT to amend Tennessee Code Annotated, Title 39, Chapter 17, Part 4; Title 53; Title 63 and Chapter 880 of the Private Acts of 2012, relative to dispensing prescription medicines.

SECTION 1. Tennessee Code Annotated, Title 63, Chapter 1, Part 3, is amended by adding the following as a new section: 63-1-313.

(a) Notwithstanding any provision of this title or title 53, chapters 10 and 11 to the contrary, no pain management clinic or medical doctor, osteopathic physician, advanced practice nurse with certificates of fitness to prescribe, or physician assistant working at a pain management clinic shall be permitted to dispense controlled substances; provided, however, this subsection shall not prohibit a medical doctor, osteopathic physician, advanced practice nurse with certificates of fitness to prescribe, or physician assistant working at a pain management clinic from providing to that practitioner's patient, without charge, a sample of a schedule IV or schedule V controlled substance in a quantity limited to an amount that is adequate to treat the patient for a· maximum· of seventy-two(72) hours. (b) For the purposes of this section, "controlled substance" has the meaning given in§ 39-17-402.

SECTION 2. Tennessee Code Annotated, Title 63-1-301(5), is amended by deleting the language "or dispensed," in its entirety.

SECTION 3. Tennessee Code Annotated, Section 63-1-309(c), is amended by deleting the language "dispenses or'' and "or dispensing" in their entireties.

SECTION 4. Tennessee Code Annotated, Section 63-1-309(c), is amended by deleting the language "dispenses or" and "or dispensing" in their entireties.

SECTION 5. Section 4 of this act shall take effect 12:01 a.m. July 1, 2016, the public welfare requiring it. The remainder of this act shall take effect July 1, 2013, the public welfare
requiring it.

PUBLIC CHAPTER NO. 232

AN ACT to amend Tennessee Code Annotated, Title 63, relative to review of certain conduct of
health care practitioners by licensing boards.

SECTION 1. Tennessee Code Annotated, Title 63, Chapter 1, Part 1, is amended by adding the following as a new, appropriately designated section:

(a)(1) Notwithstanding any other provision of this chapter or of chapters 3, 5, 6, 7, 8, 9 or 19 of this title, when a practitioner licensed under any of such chapters is under state or federal indictment in this state for an offense involving the sale or dispensing of controlled substances under state or federal law, the practitioner shall report the indictment to the practitioner's licensing board in writing within seven (7) calendar days of acquiring actual knowledge of the indictment. Such report shall include the jurisdiction in which the indictment is pending, if known, and shall also be accompanied by a copy of the indictment, if the practitioner has one. (2) A district attorney general and appropriate attorneys for the federal government are strongly encouraged, when appropriate, to promptly notify a practitioner's licensing board when a practitioner covered under subdivision (a)(1) is indicted in this state for an offense involving the sale or dispensing of controlled substances under state or federal law.

(b) The knowing failure of a practitioner to submit the report required in subdivision (a)(1) above to the licensing board shall be considered unprofessional, dishonorable or unethical conduct and may be grounds for such licensing board to take disciplinary action against the practitioner's license. The fact an indictment was sealed and the practitioner could not have actual knowledge of its existence excuses the practitioner from discipline based on the failure of the practitioner to submit a report. However, the claim that the practitioner was not aware of the obligation required in subdivision (a)(1) may not excuse the practitioner from discipline based on the failure of the practitioner to submit a report. (c) Upon receiving a report of an indictment pursuant to subdivision (a)(1), (a)(2) or from any other source, the practitioner's licensing board, through the board's consultant or other person designated by the board, shall within fifteen (15) calendar days, conduct an expedited review of the practitioner's conduct alleged in the indictment. The purpose of such expedited review shall be to determine if the matter merits an expedited investigation by the board. If so, such a directive shall be given to the department of health's office of investigations. All review activity under this subsection (c) shall be confidential pursuant to § 63-1-117(f). (d) For the purposes of this section, "controlled substances" means substances regulated as controlled substances under title 39, chapter 17, part 4, or title 53, chapters 10 and 11, or the federal Controlled Substances Act, compiled at 21 U.S. C. § 801, et seq.
SECTION 2. This act shall take effect July 1, 2013, the public welfare requiring it.

PUBLIC CHAPTER NO. 396

AN ACT to amend Tennessee Code Annotated, Title 63, relative to the healing arts.

SECTION 1. Tennessee Code Annotated, Section 63-7-123(b)(2), is amended by deleting the subdivision and substituting instead the following:

(2)(A) The nurse practitioner who holds a certificate of fitness shall be authorized to prescribe and/or issue controlled substances listed in Schedules II, Ill, IV and V of title 39, chapter 17, part 4 upon joint adoption of physician supervisory rules concerning controlled substances pursuant to subsection (d).

(B) Notwithstanding subdivision (b)(2)(A), a nurse practitioner shall not prescribe Schedules II, Ill and IV controlled substances unless such prescription is specifically authorized by the formulary or expressly approved after consultation with the supervising physician before the initial issuance of the prescription or dispensing of the medication.

(C) A nurse practitioner who had been issued a certificate of fitness may only prescribe or issue a Schedule II or Ill opioid listed on the formulary for a maximum of a non-refillable, thirty-day course of treatment unless specifically approved after consultation with the supervising physician before the initial issuance of the prescription or dispensing of the medication. This subdivision (C) shall not apply to prescriptions issued in a hospital, a nursing home licensed under title 68, or inpatient facilities licensed under title 33.

SECTION 2. Tennessee Code Annotated, Section 63-19-107(2)(B), is amended by deleting the subdivision and by substituting instead the following:

(B)(i) A physician assistant to whom the authority to prescribe legend drugs and controlled substances has been delegated by the supervising physician shall file a notice with the committee containing the name of the physician assistant, the name of the licensed physician having supervision, control and responsibility for prescriptive services rendered by the physician assistant and a copy of the formulary describing the categories of legend drugs and controlled substances to be prescribed and/or issued, by the physician assistant. The physician assistant shall be responsible for updating this information;

(ii) Notwithstanding any other rule or law, a physician assistant shall not prescribe Schedules II, Ill and IV controlled substances unless such prescription is specifically authorized by the formulary or expressly approved after consultation with the supervising physician before the initial issuance of the prescription or dispensing of the medication;

(iii) Any physician assistant to whom the authority to prescribe controlled drugs has been delegated by the supervising physician may only prescribe or issue a Schedule II or Ill opioid listed on the formulary for a maximum of a non-refillable, thirty-day course of treatment, unless specifically approved after consultation with the supervising physician before the initial issuance of the prescription or dispensing of the medication. This subdivision (iii) shall not apply to prescriptions issued in a hospital, a nursing home licensed under title 68, or inpatient facilities licensed under title 33. SECTION 3. Tennessee Code Annotated, Title 63, is amended by adding the following as a new section to be appropriately designated:

(a) No later than July 31, 2013, and at least annually thereafter but more often at the discretion of the commissioner, the department of health shall:

(1) Identify the top fifty (50) prescribers who have unique DEA numbers of controlled substances in the previous calendar year, or if implemented more frequently for the relevant time period as determined by the department, from the data available in the controlled substances database established pursuant to title 53, chapter 10, part 3; and (2) Send a letter through registered mail to each prescriber identified in subdivision (1), and to the physician supervisor as found on the provider's profile established in title 63, chapter 51 of each advanced practice nurse and each physician assistant identified in subdivision (1) that notifies the prescribers and, where appropriate, the supervising physician that the prescriber has been identified pursuant to subdivision (1) and includes the following information:

(A) The significant controlled substances prescribed by the prescriber;
(B) The number of patients prescribed these controlled substances by the prescriber;
(C) The total milligrams in morphine equivalents of controlled substances prescribed during the relevant period of time; and
(D) Any other relevant information sought by the department.

(3) If there is an active investigation against the prescriber or, where appropriate the supervising physician, on the list of prescribers identified in (a)(1) above, the department is authorized to withhold any communication required under this act until such time as charges are brought or the investigation is closed. (b)(1)(A) At the discretion of the department, each prescriber and each supervising physician of an advanced practice nurse and physician assistant who appear on the top fifty (50) prescribers of controlled substances in the relevant period of time shall submit to the department within fifteen (15) business days through registered mail or electronic mail an explanation justifying the amounts of controlled substances prescribed in the relevant period of time by the prescriber demonstrating that these amounts were medically necessary for the patients treated and that, for advanced practice nurses and physician assistants, the supervising physician had reviewed and approved the prescribing amounts. The department shall consider the prescriber's specialty and the patients' ages to make a determination as to whether the explanation of the prescriber and, where appropriate the supervising physician, for the prescribing habits of the prescriber of controlled substances is justifiable.

(B) The department is authorized to develop a model form to assist the prescriber and where appropriate the supervising physician in completing the  explanation required by this subsection (b).

(C) The department is authorized to contract with an expert reviewer to determine if the explanation is acceptable. Should charges ultimately be filed against the prescriber or, where appropriate the supervising physician, any report of the expert reviewer shall be discoverable by the licensee.

(2) If the department is not satisfied with any explanation by the prescriber or where appropriate a supervising physician, it shall communicate via registered mail such concerns to the prescriber and, if appropriate, the supervising physician. The prescriber and, if appropriate, the supervising physician shall have fifteen (15) business days to attempt to rectify the department's stated concerns.

(3) If the department remains unsatisfied after receiving a justification pursuant to subdivision (2), the department may submit its concerns to the member of the controlled substance database committee who represents the board which has licensed the individual. This member shall have access to all of the documents pertaining to the concerns of the department and the expert reviewer. If that member also believes that the explanations which have been provided are not sufficient to justify the prescribing pattern of the prescriber, the concerns may be forwarded to the department's office of investigations. Investigations are conducted by the entity responsible for licensure of that prescriber. (c) All data, reports and correspondence under this section shall be confidential and shall not be considered to be a public record for purposes of title 10, chapter 7. (d) All correspondence and reports can be used by the department's office of investigations and/or the respective entity responsible for licensure to develop a disciplinary case against the prescriber and, where appropriate, the supervising physician of an advanced practice nurse or physician assistant. (e) The failure of a prescriber or, where appropriate, a supervising physician to respond to the department's request for information in a timely fashion may be a cause for disciplinary action by the prescriber's, or where appropriate the supervising physician's, licensing board and may include a penalty of up to one thousand dollars ($1 ,000) per day for failure to respond or failure to respond in a timely manner. (f) All correspondence shall be maintained for five (5) years and kept organized by prescriber so that information on a prescriber who appears on multiple lists compiled pursuant to subsection (a) may be aggregated.

SECTION 4. If any provision of this act or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of the act which can be given effect without the invalid provision or application, and to that end the provisions of this act are declared to be severable.

SECTION 5. This act shall take effect July 1, 2013, the public welfare requiring it.

PUBLIC CHAPTER NO. 197

AN ACT to amend Tennessee Code Annotated, Title 63 and Title 68, relative to cardiopulmonary
resuscitation for infants.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

SECTION 1. Tennessee Code Annotated, Title 68, Chapter 5, Part 1, is amended by adding the following language as a new, appropriately designated section: 68-5-_.

(a) Hospitals, birthing centers, health care facilities, physicians, nurse practitioners, physician assistants or other health care practitioners who provide medical care to newborns as well as obstetricians who provide routine care for prenatal patients shall make available information and instruction concerning the appropriate use and techniques of infant cardiopulmonary resuscitation (CPR) to at least one (1) parent or caregiver of a newborn infant. Nothing in this section shall require classes in certification of infant CPR. This section shall also not constitute a requirement to be assessed during any inspection under chapter 11, part 2 of this title.

(b) Any facility or practitioner acting within the scope of their licensure or practice shall be immune from any civil liability under this section and shall have an affirmative defense to any criminal liability arising from making such information available.

SECTION 2. This act shall take effect July 1, 2013, the public welfare requiring it.

PUBLIC CHAPTER NO. 113

AN ACT to amend Tennessee Code Annotated, Title 63, Chapter 2 and Title 68, Chapter 11, relative to medical records.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:

SECTION 1. Tennessee Code Annotated, Section 68-11-305, is amended by adding the following language as a new, appropriately designated subsection (c) and by re-numbering existing subsections accordingly:

(c) Notwithstanding any law or rule to the contrary, mammography records shall be retained for the same period as other hospital records under subsection (a).

SECTION 2. Tennessee Code Annotated, Title 63, Chapter 2, is amended by adding the following language as a new, appropriately designated section: 63-2-103.

(a) The board of medical examiners is authorized to promulgate regulations regarding the retention of physician medical records as defined in Section 63-2-101(c).

(b) Notwithstanding any law or rule to the contrary, such retention of mammography records shall not exceed ten (1 0) years.

SECTION 3. This act shall take effect upon becoming a law, the public welfare requiring it.

Public Chapter 67- Removes the “Tennessee Peer Review Law of 1967” formerly codified in T.C.A. §63-6-219 and creates the “Tennessee Patient Safety and Quality Improvement Act of 2011” codified in T.C.A. §68-11-272 (relative to licensed health care facilities).  The new law provides that any healthcare organization, including, but not limited to a licensed health care facility as defined in T.C.A. §68-11-201(18); an entity owning a hospital or healthcare facility; an entity that contracts with a healthcare organization to perform quality improvement committee functions; an entity that maintains a patient safety evaluation system; or a professional assistance program that maintains a quality improvement committee shall have the records, testimony and statements relating to the committee protected from discovery, subpoena, or admission into evidence.  The new law also provides that the healthcare organization’s officers, director, trustee, healthcare providers, administrative staff, employee or other committee members or attendees shall not be held liable in any action for damages or relief arising from the provision of information provided to the committee in any judicial or administrative proceeding if such information is provided in good faith and without malice and on the basis of facts reasonably known or reasonably believed to exist. 

Public Chapter 75- Provides that each licensed physician shall conspicuously display an original or a copy of his/her license or certification displayed in the office or place of practice and shall conspicuously display a sign in intelligible lettering and not less than one inch (1”) in height, containing the name of such licensee immediately followed by the recognized abbreviation indicating the professional degree, if any held by such licensee, and containing immediately below the licensee’s name, in equal size lettering, the following words:  “Medical doctor”, “physician”, “medical doctor and surgeon”, “medicine” or “surgeon”, as applicable, for practitioners of medicine and surgery.  A licensee may substitute a specialist designation for these words for any specialized field that is recognized or approved by the appropriate board licensing that profession.  The licensee shall also affirmatively communicate the licensee’s specific licensure through one (1) of the following methods:  (1)  licensee shall wear a photo identification name tag during all patient encounters that contains a recent photograph of the licensee with the licensee’s full name and license type; or (2)  licensee shall communicate to a patient the licensee’s full name and license type in writing at the patient’s initial office visit after January 1, 2012.  In communicating the license type, the licensee shall use one of more of these words:  “Medical doctor”, “physician”, “medical doctor and surgeon”, “medicine” or “surgeon”, as applicable, for practitioners of medicine and surgery.   All licensees are required to comply with these requirements at each practice setting.  These requirements do not apply to licensees working in licensed health care facilities or to licensees who are not working in patient care settings who have no direct patient care interactions.  A licensee who provides information regarding healthcare services on the internet that is directly controlled or administered by the licensee or licensee’s agent, shall prominently display on the internet the licensee’s full name and type of license using one (1) or more of the following words:  “Medical doctor”, “physician”, “medical doctor and surgeon”, “medicine” or “surgeon”, as applicable, for practitioners of medicine and surgery.   A licensee who violates the provisions of this law may be subject to disciplinary action by the Board of Medical Examiners.  The provisions of this law shall become effective January 1, 2012. 

Public Chapter 166- Provides that a prescription label for any legend drug for all patients shall contain an indication or indications for which the drug is being prescribed if the indication or indications are requested by the prescriber, patient or patient’s caregiver and the prescriber, patient or caregiver provides the indications to the pharmacist dispensing the drug. 

Public Chapter 218- Amends the law to provide that a restriction on the right of an employed or contracted healthcare provider to practice the healthcare provider’s profession upon the termination or conclusion of the employment or contractual relationship shall apply to osteopathic physicians as well as podiatrists, chiropractors, dentists, medical doctors, optometrists, and psychologists.  The new law also removes the provision contained in the prior law that did not have the restriction apply to a healthcare provider who had been employed by, or under contract with, the employing or contracting entity for at least six (6) years. 

Public Chapter 271- Amends the law to provide that for physicians employed independently of a bona fide practice purchase, then the employing entity shall only restrict the employed physician’s right to practice medicine at the conclusion of the employment or contract pursuant to T.C.A. §63-1-148 (See Public Chapter 218).  The new law also removes an employing entity’s ability to only restrict an employed physician’s right to directly solicit by telephone or by mail the patients treated during the course of employment for only one (1) year or less following the termination or conclusion of employment and only if the physician has practiced for less than five (5) years where the hospital or primary practice is located. 

Public Chapter 434- New law provides that notwithstanding any other provision contained in the board of medical examiners practice act, a licensed physician shall not perform or attempt to perform any abortion, including a medically induced abortion, or shall prescribe any drug or device intended to cause a medical abortion, except in the physical presence of the pregnant woman.  No drug or device intended to cause a medical abortion shall be administered or dispensed to a pregnant woman except in the physical presence of her physician.

Public Chapter 818 —  Provides medical and osteopathic physicians immunity from civil liability when reporting to law enforcement suspected unauthorized use of the physician’s DEA registration when such report is made in good faith.

Public Chapter 650 —  Continues the Board of Medical Examiners until June 30, 2016.  Revises certain provisions regarding appointments to the board.

Public Chapter 836—  Provides that all hormone replacement therapy, as defined in the statute, must be performed by medical or osteopathic physicians or by certified nurse practitioners or physician assistants acting under a delegation of such a physician and under written protocols.  If delegated to a certified nurse practitioner or physician assistant, the patient must be provided certain information. Requires a physician supervising hormone replacement therapy in hormone replacement therapy clinics, as defined in the statute, to ensure that appropriate physical examinations and medical histories are taken and documented, that appropriate written informed consent is obtained, and that a written order for hormone replacement therapy is contained in the record and documented by a diagnosis justifying the order.  The supervising physician must review the patient chart and so certify in the chart within seven days of the order.  Hormone replacement therapy clinic is defined as a medical office in which a majority of the clinic’s patients receive hormone replacement therapy, but does not include a medical office in which the providers are primarily engaged in obstetrics and gynecology, urology or primary care.

Public Chapter 961 — Regulates the practice of interventional pain management, defined as the performance of invasive procedures involving any portion of the spine, spinal cord, sympathetic nerves of the spine or block of major peripheral nerves of the spine, outside of facilities licensed under Title 68.  Provides that advanced practice nurses and physician assistants may only perform such procedures under the direct supervision of an appropriately qualified medical or osteopathic physician (as defined under the statute).  These restrictions do not apply to the performance of major joint injections other than sacroiliac injections or to soft tissue injections or epidurals for surgical anesthesia or labor.  Direct supervision requires the supervising physician to be physically present in the same building at the time of the procedure.   Medical and osteopathic physicians may only practice or supervise the practice of interventional pain management  if the physician is board certified  by certain enumerated boards, is in a practice relationship with a physician who is so qualified,  is board certified by a board other than those enumerated and has completed an approved post-graduate training program, is a clinical instruction in pain medicine at a Tennessee accredited medical training program, or is in the active practice of pain management in a clinic accredited by the Accreditation of Rehabilitation Facilities  in outpatient interdisciplinary pain rehabilitation. 

Public Chapter 869 —  Amends definition of pain management clinic.  Amends and clarifies exemptions for schools and hospitals and their associated clinics and training programs.  Extends deadline to register as a pain management clinic to October 1, 2012 for those operating prior to January 1, 2012.  Provides a right to appeal under the Uniform Administrative Procedures Act for those denied a certificate or denied renewal of a certificate. Provides that certificate holders may inactivate the certificate upon notice to the department.


Updates Applicable to All Boards

Public Chapter 340 -

Establishes the regulation of pain management clinics by the Department, authorizing the Department to grant, deny, renew and discipline a clinic license. A pain management clinic is defined as a privately-owned facility in which a medical doctor, osteopathic physician, advanced practice nurse and/or physician assistant who provide pain management services. Each pain management clinic must have a medical director who provides onsite supervision. On or before October 1, 2011, the Commissioner of Health, in consultation with the Board of Medical Examiners, the Board of Osteopathic Examination, the Board of Nursing, and the Committee on Physician Assistants, shall promulgate rules to implement the law.

Public Chapter 230 -

Provides that each health-related board shall establish a procedure to expedite the issuance of a license, certificate, or permit for an applicant who is certified or licensed in another state to perform the same profession that is the subject of the application; whose spouse is a member of the armed forces; whose spouse is the subject of a military transfer to Tennessee; and who has left employment to accompany the person’s spouse to Tennessee. The procedure shall include issuing the applicant a license, certificate, or permit if the licensure requirements in the other state are substantially equivalent to Tennessee’s requirements or developing a method to authorize the applicant to practice in Tennessee with a temporary permit in accordance with current law (T.C.A. §63-1-142).

Public Chapter 435 -

Provides that any governmental entity or private business or establishment that provides or offers a place of assembly or entertainment, transportation, lodging, dining, educational, medical or leisure activities or services, or any business or any establishment licensed by the State or any political subdivision thereof, or that is engaged in commerce in this State is strongly encouraged to post a sign indicating that certain information regarding the Tennessee human trafficking resource center hotline is in a location within the establishment that is visible to employees and the general public. The Department of Labor and Workforce Development shall provide the sign authorized by this section on its internet website for entities or establishments to print as needed.


Statutes and Rules

Statutes

Statutes are proposed and made law by the Tennessee State General Assembly (Legislature). The Board, following specific notice requirements and hearings, adopts rules. Both have the force of law and may be used in the regulation of a profession. The statutes pertaining to this Board are found at T. C. A. 63-1 (Division of Health Related Boards), T.C.A. 63-6 (Medicine and Surgery) and T.C.A. 63-2 (Medical Records).

Click here to review the Tennessee Code Annotated. (This link will take you to a website that is not maintained by the Tennessee Department of Health).

 

 

Rules

Click here for Rules and Regulations pertaining to the Tennessee Board of Medical Examiners

Office Based Surgery


Office Based Surgery

Pursuant to Board of Medical Examiners Rules relative to Office Based Surgery, the Board must post on its website a list, including the names and locations of physician offices that have qualified as sites for Level III surgeries and have been issued certification by the Board.

The following are certified office based surgical suites:

Shire Facial Plastic Surgery
6151 Shallowford Road, Suite 101
Chattanooga, TN  37421

Maxwell Aesthetics
2020 21st Avenue South
Nashville, TN   38212

Aesthetic Surgery and Laser Center
2204 Crestmoor Road
Nashville, TN  37215

Dr. Ronald Gilmer
310 25th Avenue North, Suite 100
Nashville, TN  37203

Cumberland Surgical Arts
2285 Rudolphtown Road
Suite 200
Clarksville, TN  37043

Paris Surgical Specialists
235 Tyson Avenue
Paris, TN  37242

Aesthetic Plastic Surgery Associates, PA
801 Weisgarber Road, Suite 500
Knoxville, TN  37909

Michael W. Goodman, MD, PC
979 East Third Street #C630
Chattanooga, TN  37403

The Plastic Surgery Center of East Tennessee
One Sheridan Square, Suite 200
Kingsport, TN  37660

Larry A. Sargent, MD
The Plastic Surgery Group, P.C.
979 East Third Street, C-920
Chattanooga, TN  37403

Colleen Maclin Schmitt, MD
Galen Medical Group
Gastroenterology East Office
1651 Gunbarrel Road, Suite 102
Chattanooga, TN  37421

Steven H. Smith, MD
Parkwest Plastic Surgery
9239 Park West Boulevard
Knoxville, TN  37923

Advanced Surgical Concepts
7446 Shallowford road, Suite 205
Chattnooga, TN  37421

PCET Surgery Center, LLC
1128 e. Weisgarber road
Suite 110
Knoxville, TN  37909