SB488: Certified nurse midwives; clarifies relationship with licensed physicians.
Be it enacted by the General Assembly of Virginia:
1. That §§ 54.1-2901 and 54.1-2957 of the Code of Virginia are amended and reenacted as follows:
§ 54.1-2901. Exceptions and exemptions generally.
A. The provisions of this chapter shall not prevent or prohibit:
1. Any person entitled to practice his profession under any prior law on June 24, 1944, from continuing such practice within the scope of the definition of his particular school of practice;
2. Any person licensed to practice naturopathy prior to June 30, 1980, from continuing such practice in accordance with regulations promulgated by the Board;
3. Any licensed nurse practitioner from rendering care under the supervision of a duly licensed physician when such services are authorized by regulations promulgated jointly by the Board of Medicine and the Board of Nursing;
4. Any licensed nurse practitioner in the category of certified nurse midwife from rendering care in collaboration and consultation with a duly licensed physician when such services are authorized by regulations promulgated jointly by the Board of Medicine and the Board of Nursing;
45. Any
registered professional nurse, licensed nurse practitioner, graduate laboratory
technician or other technical personnel who have been properly trained from
rendering care or services within the scope of their usual professional
activities which shall include the taking of blood, the giving of intravenous
infusions and intravenous injections, and the insertion of tubes when performed
under the orders of a person licensed to practice medicine;
56. Any
dentist, pharmacist or optometrist from rendering care or services within the
scope of his usual professional activities;
67. Any
practitioner licensed or certified by the Board from delegating to personnel
supervised by him, such activities or functions as are nondiscretionary and do
not require the exercise of professional judgment for their performance and
which are usually or customarily delegated to such persons by practitioners of
the healing arts, if such activities or functions are authorized by and
performed for such practitioners of the healing arts and responsibility for
such activities or functions is assumed by such practitioners of the healing
arts;
78. The
rendering of medical advice or information through telecommunications from a
physician licensed to practice medicine in Virginia or an adjoining state to
emergency medical personnel acting in an emergency situation;
89. The domestic
administration of family remedies;
910. The
giving or use of massages, steam baths, dry heat rooms, infrared heat or
ultraviolet lamps in public or private health clubs and spas;
1011. The
manufacture or sale of proprietary medicines in this Commonwealth by licensed
pharmacists or druggists;
1112. The
advertising or sale of commercial appliances or remedies;
1213. The
fitting by nonitinerant persons or manufacturers of artificial eyes, limbs or
other apparatus or appliances or the fitting of plaster cast counterparts of
deformed portions of the body by a nonitinerant bracemaker or prosthetist for
the purpose of having a three-dimensional record of the deformity, when such
bracemaker or prosthetist has received a prescription from a licensed physician
directing the fitting of such casts and such activities are conducted in
conformity with the laws of Virginia;
1314. Any
person from the rendering of first aid or medical assistance in an emergency in
the absence of a person licensed to practice medicine or osteopathy under the
provisions of this chapter;
1415. The
practice of the religious tenets of any church in the ministration to the sick
and suffering by mental or spiritual means without the use of any drug or
material remedy, whether gratuitously or for compensation;
1516. Any
legally qualified out-of-state or foreign practitioner from meeting in
consultation with legally licensed practitioners in this Commonwealth;
1617. Any
practitioner of the healing arts licensed or certified and in good standing
with the applicable regulatory agency in another state or Canada when that
practitioner of the healing arts is in Virginia temporarily and such
practitioner has been issued a temporary license or certification by the Board
from practicing medicine or the duties of the profession for which he is
licensed or certified (i) in a summer camp or in conjunction with patients who
are participating in recreational activities, (ii) while participating in
continuing educational programs prescribed by the Board, or (iii) by rendering
at any site any health care services within the limits of his license,
voluntarily and without compensation, to any patient of any clinic which is
organized in whole or in part for the delivery of health care services without
charge as provided in § 54.1-106;
1718. The
performance of the duties of any commissioned or contract medical officer, or
podiatrist in active service in the army, navy, coast guard, marine corps, air
force, or public health service of the United States while such individual is
so commissioned or serving;
1819. Any
masseur, who publicly represents himself as such, from performing services
within the scope of his usual professional activities and in conformance with
state law;
1920. Any
person from performing services in the lawful conduct of his particular
profession or business under state law;
2021. Any
person from rendering emergency care pursuant to the provisions of § 8.01-225;
2122.
Qualified emergency medical services personnel, when acting within the scope of
their certification, and licensed health care practitioners, when acting within
their scope of practice, from following Durable Do Not Resuscitate Orders
issued in accordance with § 54.1-2987.1 and Board of Health regulations, or
licensed health care practitioners from following any other written order of a
physician not to resuscitate a patient in the event of cardiac or respiratory
arrest;
2223. Any
commissioned or contract medical officer of the army, navy, coast guard or air
force rendering services voluntarily and without compensation while deemed to
be licensed pursuant to § 54.1-106;
2324. Any
provider of a chemical dependency treatment program who is certified as an
"acupuncture detoxification specialist" by the National Acupuncture
Detoxification Association or an equivalent certifying body, from administering
auricular acupuncture treatment under the appropriate supervision of a National
Acupuncture Detoxification Association certified licensed physician or licensed
acupuncturist;
2425. Any
employee of any assisted living facility who is certified in cardiopulmonary
resuscitation (CPR) acting in compliance with the patient's individualized
service plan and with the written order of the attending physician not to
resuscitate a patient in the event of cardiac or respiratory arrest;
2526. Any
person working as a health assistant under the direction of a licensed medical
or osteopathic doctor within the Department of Corrections, the Department of
Juvenile Justice or local correctional facilities;
2627. Any
employee of a school board, authorized by a prescriber and trained in the
administration of insulin and glucagon, when, upon the authorization of a
prescriber and the written request of the parents as defined in § 22.1-1,
assisting with the administration of insulin or administrating glucagon to a
student diagnosed as having diabetes and who requires insulin injections during
the school day or for whom glucagon has been prescribed for the emergency
treatment of hypoglycemia;
2728. Any
practitioner of the healing arts or other profession regulated by the Board
from rendering free health care to an underserved population of Virginia who
(i) does not regularly practice his profession in Virginia, (ii) holds a
current valid license or certificate to practice his profession in another
state, territory, district or possession of the United States, (iii) volunteers
to provide free health care to an underserved area of this Commonwealth under
the auspices of a publicly supported all volunteer, nonprofit organization with
no paid employees that sponsors the provision of health care to populations of
underserved people throughout the world, (iv) files a copy of the license or
certification issued in such other jurisdiction with the Board, (v) notifies the
Board at least 15 days prior to the voluntary provision of services of the
dates and location of such service, and (vi) acknowledges, in writing, that
such licensure exemption shall only be valid, in compliance with the Board's
regulations, during the limited period that such free health care is made
available through the volunteer, nonprofit organization on the dates and at the
location filed with the Board. The Board may deny the right to practice in
Virginia to any practitioner of the healing arts whose license or certificate
has been previously suspended or revoked, who has been convicted of a felony or
who is otherwise found to be in violation of applicable laws or regulations;
2829. Any
registered nurse, acting as an agent of the Department of Health, from
obtaining specimens of sputum or other bodily fluid from persons in whom the
diagnosis of active tuberculosis disease, as defined in § 32.1-49.1, is
suspected and submitting orders for testing of such specimens to the Division
of Consolidated Laboratories or other public health laboratories, designated by
the State Health Commissioner, for the purpose of determining the presence or
absence of tubercle bacilli as defined in § 32.1-49.1;
2930. Any
physician of medicine or osteopathy or nurse practitioner from delegating to a
registered nurse under his supervision the screening and testing of children
for elevated blood-lead levels when such testing is conducted (i) in accordance
with a written protocol between the physician or nurse practitioner and the
registered nurse and (ii) in compliance with the Board of Health's regulations
promulgated pursuant to §§ 32.1-46.1 and 32.1-46.2. Any follow-up testing or
treatment shall be conducted at the direction of a physician or nurse
practitioner; or
3031. Any
practitioner of one of the professions regulated by the Board of Medicine who
is in good standing with the applicable regulatory agency in another state or
Canada from engaging in the practice of that profession when the practitioner
is in Virginia temporarily with an out-of-state athletic team or athlete for
the duration of the athletic tournament, game, or event in which the team or
athlete is competing.
B. Notwithstanding any provision of law or regulation to the contrary, a nurse practitioner licensed by the Boards of Nursing and Medicine in the category of certified nurse midwife may practice without the requirement for physician supervision while participating in a pilot program approved by the Board of Health pursuant to § 32.1-11.5.
§ 54.1-2957. Licensure of nurse practitioners.
A. The Board of Medicine and the Board of Nursing shall jointly prescribe the regulations governing the licensure of nurse practitioners. It shall be unlawful for a person to practice as a nurse practitioner in this Commonwealth unless he holds such a joint license.
B. The Board of Medicine and the Board of Nursing shall jointly promulgate regulations specifying collaboration and consultation among physicians and certified nurse midwives that shall include the development of, and periodic review and revision of, a written protocol; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered; e.g., chart review and review of patient care outcomes.
C. The Boards may issue a license by endorsement to an applicant to practice as a nurse practitioner if the applicant has been licensed as a nurse practitioner under the laws of another state and, in the opinion of the Boards, the applicant meets the qualifications for licensure required of nurse practitioners in this Commonwealth.
Pending the outcome of the next National Specialty Examination, the Boards may jointly grant temporary licensure to nurse practitioners.
2. That the Boards of Medicine and Nursing shall promulgate regulations to implement the provisions of this act to be effective within 280 days of its enactment.