PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Committee on Physician Assistants

Legislative

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

 

Public Chapter 154

This act allows would allow the Commissioner of Health or his designee to have electronic access to medical records in order to facilitate investigations when responding to an immediate threat to public health. Today the Commissioner of Health or his designee already has this authority but must go to the facility to review the medical records.

 

Public Chapter 94

This act defines “abuse” and “neglect” for purposes of placing a person on the registry of persons who have abused, neglected, or misappropriated the property of vulnerable individuals specifically within the statutes that govern the Dept. of Health. It does not impact the definitions within the statutes that govern the Dept. of Intellectual and Developmental Disabilities nor the Dept. of Human Services.  It also increases the time within which placement on the registry may be appealed from 30 to 60 days.

Public Chapter 26

This legislation deletes the Intractable Pain Act. 

Public Chapter 352

This legislation would decriminalize the possession of cannabis oil as long as all of the following are met:

  • The oil contains less than 0.9% of THC and is labeled as such by the manufacturer
  • The person in possession retains proof of the legal order or recommendation from the issuing state
  • The person in possession retains proof that the person or person’s family member has been diagnosed with intractable seizures or epilepsy by a physician licensed to practice in TN

This legislation does not allow a physician in TN to prescribe, order or recommend the oil. 

This act became effective on April 16, 2015.

Public Chapter 502

This act allows the Joint Government Operations Committee (the legislative committee that reviews all rules) to stay a rule up to 75 days instead of 60 days.  Present law authorizes the Joint Government Operations Committee to consider the following factors when reviewing rules: authority, clarity, consistency, justification, necessity and reference. This act adds arbitrariness and capriciousness as two new considerations.

Public Chapter 321

This act authorizes a student to self-administer and self-manage prescribed pancreatic enzyme therapy directed by a licensed healthcare provider. An emergency care plan must accompany the student’s individualized healthcare plan which is developed by a registered nurse in collaboration with the family, student, student healthcare providers and school personnel.

Public Chapter 376

This creates the “Tennessee Right to Try Act.” It authorizes eligible patients to utilize investigational drugs, biological products or devices that have completed phase 1 of a clinical trial, but has not yet been approved for general us by the FDA. The clinical trial must be documented by the National Institutes of Health.  An eligible patient is:

  • someone with an advanced illness that is attested to by the patient’s treating physician and confirmed by a second physician
  • has considered all other FDA-approved treatment options
  • has received a recommendation from the patient’s physician for an investigational drug, biological product, or device
  • has given written, informed consent for the use of an investigational drug, biological product, or device
  • has documentation from such physician that the patient meets all the aforementioned requirements.

All expenses related to the use of investigational treatment will be borne by the patient.  Manufacturers are authorized to make investigational products available to patients with or without compensation.  This bill specifically prohibits Medicare or any licensing board from taking any adverse action against a licensee based solely on a recommendation for treatment with an investigational product and holds manufacturers and providers harmless if operating in good faith.  This act takes effect on July 1, 2015.

Public Chapter 268

This act makes disclosures of protected healthcare information permissible in medical malpractice lawsuits.

Public Chapter 513

This act clarifies that certified registered nurse anesthetists (CRNA) are not required to obtain authorization to prescribe in order to select, order and administer drugs during services ordered by a physician, dentist, or podiatrist and requires the CRNA to collaborate with those physicians.

Public Chapter 277

This act authorizes licensed health care authorized by the Volunteer Health Care Services Act or a licensed healthcare provider who is a member of the national guard to provide healthcare services to veterans and others who lack health insurance at a free clinic operated on the site of an armory. These services are limited to primary care and not emergency or urgent care. The act permits the military department the ability to use the armory, offer the free clinic and accept donations of medical supplies to use at the free clinic.

Public Chapter 473

This legislation specifies that, except for a medical emergency, no induced termination of pregnancy (ITOP) shall be performed unless the woman has been informed in-person by the attending physician, and has given informed consent of:

  • the woman is pregnant
  • the probable gestation time
  • the viability of the child
  • the public and private agencies and services available to assist with pregnancy and adoption
  • medical benefits and/or risks of undergoing the procedure or carrying full term
  • a general description of the method of ITOP to be used

This bill places a 48 hour waiting period from the time of informed consent to the time the procedure may be performed, unless it is a medical emergency.  The patient is required to sign a consent form after the waiting period but before the procedure.  The physician is required to give the woman a copy of the signed consent forms.

A medical emergency is defined as a condition that complicates the medical condition of a pregnant woman as to necessitate an immediate procedure to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of major bodily function, as determined by the physician.  When a medical emergency arises, the physician is required to inform the woman of and document the medical reasons supporting the physician’s determination.

This bill creates a new Class E felony for a physician who performs an ITOP and fails to provide the required information, wait the 48 hours, or receive written informed consent.  It creates a Class E misdemeanor if a physician fails to provide a copy of the signed informed consent document.  Any physician who intentionally, knowingly, or recklessly violates any requirement of this bill is guilty of unprofessional conduct and shall be subject to license suspension or revocation.

This bill has a springing provision where, if the 48 hour waiting period is declared unconstitutional, it is rolled back to a 24 hour waiting period.  If that decision is vacated or reversed, the 48 hour provision is reinstated.  The legislation takes effect on July 1, 2015.

Public Chapter 261

The act provides for the practice of telehealth. It outlines the following:

  • Defines a healthcare provider
  • Establishes a provider-patient relationship by mutual consent and mutual communication
  • Specifies that telehealth does not create a new standard care
  • Prohibits any board from creating a more restrictive standard of professional practice for telehealth service
  • Allows a physician to prescribe by means of telemedicine and follow all prescribing applicable statutes such as checking the Controlled Substance Monitoring Database; however, pain management clinics are not permitted

Public Chapter 475

  • Changes the requirements for who can become a certificate holder of a pain clinic. Certificate holders:
    • Must be a Tennessee licensed Medical Doctor, Doctor of Osteopathy, Advanced Practice Nurse or Physician’s Assistant and
    • Must have an unrestricted unencumbered license
  • Requires anyone with any ownership interest in a pain clinic to be eligible to meet the requirements of the certificate holder
  • Adds requirements to be a pain medicine specialist to the law
    • ABMS certification
    • ABPM diplomate
    • ABIPP exam 1 passage
    • An active pain management practice in a clinic accredited in outpatient interdisciplinary pain rehabilitation by the commission on accreditation of rehabilitation facilities
  • All medical directors of pain clinics must be pain medicine specialists by July 1, 2016
  • All Physicians Assistants and Advanced Practice Nurses must be supervised by any pain medicine specialist to practice in a certified pain clinic
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  • Requires the pain clinic certificate holder to be an owner of the clinic for which he or she holds the certificate
  • Requires the pain clinic certificate to show that the pain clinic has a medical director that is a pain specialist

Directs the commissioner of the department of health to develop pain clinic standards that can be used by a pain clinic as guidelines for operation.

Public Chapter 476

Currently, the top 50 prescribers of controlled substances in the state are annually identified and sent a letter notifying them of their inclusion on this list and asked to respond with a justification for their prescribing patterns.  This legislation expands on this list and requires the top 10 prescribers from all of the combined counties having populations of fewer than 50,000 to also be on this annual list.

Separate from this provision, the bill also specifies that a provider of home medical equipment or services that provides its own company-branded insulin pumps and related supplies does not have to have a physical place of business in the state if the provider maintains an employee presence in the state, is accredited by the Joint Commission on Accreditation of Healthcare Organizations and maintains a 24-7 service telephone number.