Legislative Update June 17, 2011

House Bills HB 62: Health Care Worker Assault

Sponsor: Representative Anne Gonzales Status: Pending in House Criminal Justice ONA Position: Supports This legislation mirrors the language of legislation ONA supported in the last General Assembly, HB 450. The bill would increase the penalty for assaulting a health care professional or worker from a first degree misdemeanor to a fourth degree felony. The bill was amended to include all healthcare professionals and workers and now mirrors similar legislation in the Ohio Senate. ONA supports this legislation as a critical step in reducing workplace violence against nurses. As frontline health care providers, RNs see the impact of violence in our society every day. Increasingly, they themselves are becoming the victims as a result of workplace violence. Currently, the Ohio Revised Code (2903.13) makes assault of a police, fire or EMS worker, and certain school employees a felony and provides for a mandatory 12 month prison sentence. The legislation would afford similar protections to nurses. The legislation passed out of the House Criminal Justice Committee on May 18 and the Ohio House of Representatives on June 1, 2011 (85-12). The bill has been referred to the Senate JudiciaryCriminal Justice Committee but is not yet slated for a hearing as the legislature focuses on passing the state budget with the deadline (June 30, 2011) quickly approaching. Hearings were held on the companion bill, SB 111, in early May. Committee members demonstrated significant interest in the issue and many seemed supportive.

HB 244: EMS Flu Shots

Sponsor: Representatives Anne Gonzales and Kristin Roegner Status: Pending in House Health ONA Position: Pending

The Ohio Nurses Association was approached about this issue by one of the sponsors of the bill in late winter. Immunization administration by various health care professionals and workers has been an issue of long-standing concern to ONA because of the potential safety risk to patients. The issue was discussed at the February 25th meeting of the Health Policy Council. The bulk of the discussion centered on what parameters are necessary for immunizations to be administered. Concerns were raised as to what level of EMT would be administering the immunization, who would determine the protocols and ensure they were followed, what need was there and impact on public health, and concerns over the lack of patient assessment and observation. There was enough agreement to call for a vote and a motion was made by Linda Warino that ONA support that EMTs may give flu immunizations when a qualified person can delegate the administration and only to firefighters. Barb Paulic seconded the motion and the motion carried by a vote of 7-1. ONA shared the concerns outlined during the HPC meeting and parameters necessary to gain ONA support or at minimum garner a neutral position with the sponsor. Since that time, the bill which was drafted and introduced, HB 244, ultimately reflects ONAs criteria. The bill limits immunizations to influenza, The bill authorizes only the EMT-paramedic to administer immunizations. EMT-basic and EMTintermediate are not authorized to administer immunizations, They may only administer the immunization to firefighters (full and part-time paid and volunteer) and EMTs (basic, intermediate, paramedic), The medical director or cooperating physician advisory board of each EMS organization shall establish written protocols and training necessary for a paramedic to administer the immunization.

Sponsor testimony is schedule for June 22, 2011 in the House Health and Aging Committee. ONA can, upon clarifying its position, send a letter reflecting that position, to the sponsor and committee members. As this is the same committee dealing with APN prescriptive authority, ONA may want to consider the potential impact communications on this legislation could have on SB 83/HB 141.

Senate Bills SB 5: Collective Bargaining LawRevise

Sponsor: Senator Shannon Jones Status: Passed both chambers, signed by governor 3-31-11, effective 7-1-11 ONA Position: Opposed ONA opposed this legislation because it has the potential to remove the voice of registered nurses as patient advocates, threatens patient safety and care, and weakens the ability of nurses to address their working conditions. ONA has committed to being part of the coalition of labor organizations seeking a referendum. As such, ONA staff has been directed to sign the referendum petition and assist in the gathering of signatures to get the issue on the ballot in November 2011. 2

SB 83/HB 141: Modify the Authority of Certain Advanced Practice Nurses to Prescribe Schedule II Controlled Substances
Sponsor: Senator Oelslager/Representatives Goodwin and Boyd Status: Pending in Senate Health, Human Services & Aging Committee/House Health and Aging ONA Position: Support This bill removes the existing limitations on the prescriptive authority of APNs for schedule II controlled substances. Key provisions address educational requirements, prohibitions on prescribing Schedule II drugs in convenience clinics, and direct the Board of Nursings Committee on Prescriptive Governance to make recommendations that include provisions for Schedule II and the BON to adopt rules for implementation. The Senate version of the bill, SB 83, appears to have become the vehicle. Amendments adopted recently which prohibit APNs from writing prescriptions in convenience care clinics have removed significant barriers to the bills passage, most notably strong opposition from the Ohio State Medical Association. Following the adoption of the amendment in committee on June 15, OSMA said the revision enabled them to change their position to neutral. According to Tim Maglione, senior director of government relations, "This compromise achieves the increased efficiencies and benefits that team-based care provides in health care facilities like hospitals and mental health centers, yet maintains the essential patient safety standards in settings where this advanced prescriptive authority for APNs may not be safe or appropriate.

SB 129: Qualified Immunity

Sponsor: Senator Kevin Bacon Status: Pending in Senate JudiciaryCivil Justice ONA Position: Supports disaster provisions The legislation addresses immunity for various health professionals in two distinct sets of circumstanceswhen providing care in compliance with the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and in disaster situations. The bill is similar to SB 86 from the last General Assembly. As introduced, the legislation provides registered nurses are not liable for damages to any person in a tort action for injury, death or loss to a person or property by an act or omission when providing care or medical treatment as a result of a disaster so long as the act or omission does not constitute willful or wanton misconductmeaning conduct that is intentional or with reckless disregard for the safety of others. Likewise, it does not offer immunity when acting outside ones respective scope of practice. The other part of the bill provides immunity for physicians, physician assistants, dentists and optometrists when providing care in compliance with EMTALA so long as the act or omission of treatment or care does not constitute reckless disregardmeaning conduct that the person knew or should have known, at that time, created an unreasonable risk of injury, death or loss to a person that affects the life or health and that risk is substantially greater than that which is necessary to make the 3

conduct negligent. In short, the EMTALA statute requires a patient presenting in the ER have a medical examination and be stabilized if they have an emergency medical conditionwhich could include active labor. The statue also allows the hospital to, through rule or regulation, to determine who can conduct the examination and provide that care; usually a physician but it can be a nurse. Because of this, ONA believes nurses should be amended into the bill to be included as a practitioner under the EMTALA section of the bill with physicians, optometrists, physician assistants, and dentists. ONA has met with the sponsors staff and expressed our desire to see nurses included in the EMTALA portion of the bill. According to Bacons office, they are agreeable to including nurses and are meeting with others who have raised concerns. They expect to draft an omnibus amendment to be offered at the next hearing. However, based on the Senates focus on the state budget, many committees are not meeting right now and the bill has not been on the committee agenda since May 4th.