1.1                          A bill for an act 
  1.2             relating to health; authorizing the administration of 
  1.3             epinephrine on ambulances; requiring training; 
  1.4             modifying certain protocols for nurses; authorizing 
  1.5             transfer of certain nursing facility beds; amending 
  1.6             Minnesota Statutes 2000, sections 144E.101, 
  1.7             subdivision 7, by adding a subdivision; 144E.28, 
  1.8             subdivision 7; 148.235, by adding subdivisions; 
  1.9             148.281, subdivision 1; 151.37, subdivision 2; 
  1.10            Minnesota Statutes 2001 Supplement, sections 144E.101, 
  1.11            subdivision 6; 148.284; 256B.437, by adding a 
  1.12            subdivision. 
  1.13  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.14     Section 1.  Minnesota Statutes 2001 Supplement, section 
  1.15  144E.101, subdivision 6, is amended to read: 
  1.16     Subd. 6.  [BASIC LIFE SUPPORT.] (a) Except as provided in 
  1.17  paragraph (e), a basic life support ambulance shall be staffed 
  1.18  by at least two ambulance service personnel, at least one of 
  1.19  which must be an EMT, who provide a level of care so as to 
  1.20  ensure that: 
  1.21     (1) life-threatening situations and potentially serious 
  1.22  injuries are recognized; 
  1.23     (2) patients are protected from additional hazards; 
  1.24     (3) basic treatment to reduce the seriousness of emergency 
  1.25  situations is administered; and 
  1.26     (4) patients are transported to an appropriate medical 
  1.27  facility for treatment. 
  1.28     (b) A basic life support service shall provide basic airway 
  1.29  management and administration of epinephrine to treat an 
  2.1   allergic reaction according to subdivision 14.  
  2.2      (c) By January 1, 2001, a basic life support service shall 
  2.3   provide automatic defibrillation, as provided in section 
  2.4   144E.103, subdivision 1, paragraph (b).  
  2.5      (d) A basic life support service licensee's medical 
  2.6   director may authorize the ambulance service personnel to carry 
  2.7   and to use medical antishock trousers and to perform intravenous 
  2.8   infusion if the ambulance service personnel have been properly 
  2.9   trained. 
  2.10     (e) Upon application from an ambulance service that 
  2.11  includes evidence demonstrating hardship, the board may grant a 
  2.12  temporary variance from the staff requirements in paragraph (a) 
  2.13  and may authorize a basic life support ambulance to be staffed 
  2.14  by one EMT and one first responder.  The variance shall apply to 
  2.15  basic life support ambulances operated by the ambulance service 
  2.16  for up to one year from the date of the variance's issuance.  
  2.17  When a variance expires, an ambulance service may apply for a 
  2.18  new variance under this paragraph.  For purposes of this 
  2.19  paragraph, "ambulance service" means either an ambulance service 
  2.20  whose primary service area is located outside the metropolitan 
  2.21  counties listed in section 473.121, subdivision 4, and outside 
  2.22  the cities of Duluth, Mankato, Moorhead, Rochester, and St. 
  2.23  Cloud; or an ambulance service based in a community with a 
  2.24  population of less than 1,000. 
  2.25     Sec. 2.  Minnesota Statutes 2000, section 144E.101, 
  2.26  subdivision 7, is amended to read: 
  2.27     Subd. 7.  [ADVANCED LIFE SUPPORT.] (a) An advanced life 
  2.28  support ambulance shall be staffed by at least: 
  2.29     (1) one EMT and one EMT-P; 
  2.30     (2) one EMT and one registered nurse who is an EMT, is 
  2.31  currently practicing nursing, and has passed a paramedic 
  2.32  practical skills test approved by the board and administered by 
  2.33  a training program; or 
  2.34     (3) one EMT and one physician assistant who is an EMT, is 
  2.35  currently practicing as a physician assistant, and has passed a 
  2.36  paramedic practical skills test approved by the board and 
  3.1   administered by a training program. 
  3.2      (b) An advanced life support service shall provide basic 
  3.3   life support, as specified under subdivision 6, paragraph (a), 
  3.4   advanced airway management, manual defibrillation, and 
  3.5   administration of intravenous fluids and pharmaceuticals, 
  3.6   including epinephrine to treat an allergic reaction according to 
  3.7   subdivision 14. 
  3.8      (c) In addition to providing advanced life support, an 
  3.9   advanced life support service may staff additional ambulances to 
  3.10  provide basic life support according to subdivision 6.  When 
  3.11  routinely staffed and equipped as a basic life support service 
  3.12  according to subdivision 6 and section 144E.103, subdivision 1, 
  3.13  the vehicle shall not be marked as advanced life support.  
  3.14     (d) An ambulance service providing advanced life support 
  3.15  shall have a written agreement with its medical director to 
  3.16  ensure medical control for patient care 24 hours a day, seven 
  3.17  days a week.  The terms of the agreement shall include a written 
  3.18  policy on the administration of medical control for the 
  3.19  service.  The policy shall address the following issues:  
  3.20     (i) two-way communication for physician direction of 
  3.21  ambulance service personnel; 
  3.22     (ii) patient triage, treatment, and transport; 
  3.23     (iii) use of standing orders; and 
  3.24     (iv) the means by which medical control will be provided 24 
  3.25  hours a day. 
  3.26     The agreement shall be signed by the licensee's medical 
  3.27  director and the licensee or the licensee's designee and 
  3.28  maintained in the files of the licensee. 
  3.29     (e) When an ambulance service provides advanced life 
  3.30  support, the authority of an EMT-P, Minnesota registered 
  3.31  nurse-EMT, or Minnesota registered physician assistant-EMT to 
  3.32  determine the delivery of patient care prevails over the 
  3.33  authority of an EMT. 
  3.34     Sec. 3.  Minnesota Statutes 2000, section 144E.101, is 
  3.35  amended by adding a subdivision to read: 
  3.36     Subd. 14.  [EPINEPHRINE ADMINISTRATION.] Notwithstanding 
  4.1   any law regarding scope of practice or administration of drugs 
  4.2   to the contrary, ambulance service personnel trained according 
  4.3   to this subdivision may administer epinephrine to treat an 
  4.4   allergic reaction.  An ambulance service licensee's medical 
  4.5   director shall ensure that: 
  4.6      (1) all ambulance service personnel who administer 
  4.7   epinephrine have satisfactorily completed board-approved 
  4.8   training in the administration of epinephrine to treat an 
  4.9   allergic reaction; 
  4.10     (2) at least one ambulance service personnel who is trained 
  4.11  to administer epinephrine is on duty at all times; 
  4.12     (3) ambulance service personnel who administer epinephrine 
  4.13  receive, at least every two years, continuing education or 
  4.14  clinical training in the administration of epinephrine to treat 
  4.15  an allergic reaction; and 
  4.16     (4) the ambulance service maintains standing orders for the 
  4.17  administration of epinephrine to treat an allergic reaction. 
  4.18     Sec. 4.  Minnesota Statutes 2000, section 144E.28, 
  4.19  subdivision 7, is amended to read: 
  4.20     Subd. 7.  [RENEWAL.] (a) Before the expiration date of 
  4.21  certification, an applicant for renewal of certification as an 
  4.22  EMT shall:  
  4.23     (1) successfully complete a course in cardiopulmonary 
  4.24  resuscitation that is approved by the board or the licensee's 
  4.25  medical director; and 
  4.26     (2) take the United States Department of Transportation EMT 
  4.27  refresher course and successfully pass the practical skills test 
  4.28  portion of the course, or successfully complete 48 hours of 
  4.29  continuing education in EMT programs that are consistent with 
  4.30  the United States Department of Transportation National Standard 
  4.31  Curriculum or its equivalent as approved by the board or as 
  4.32  approved by the licensee's medical director and pass a practical 
  4.33  skills test approved by the board and administered by a training 
  4.34  program approved by the board.  The cardiopulmonary 
  4.35  resuscitation course and practical skills test may be included 
  4.36  as part of the refresher course or continuing education renewal 
  5.1   requirements.  At least one of the 48 hours must include 
  5.2   instruction in the administration of epinephrine to treat an 
  5.3   allergic reaction.  Twenty-four of the 48 hours must include at 
  5.4   least four hours of instruction in each of the following six 
  5.5   categories: 
  5.6      (i) airway management and resuscitation procedures; 
  5.7      (ii) circulation, bleeding control, and shock; 
  5.8      (iii) human anatomy and physiology, patient assessment, and 
  5.9   medical emergencies; 
  5.10     (iv) injuries involving musculoskeletal, nervous, 
  5.11  digestive, and genito-urinary systems; 
  5.12     (v) environmental emergencies and rescue techniques; and 
  5.13     (vi) emergency childbirth and other special situations. 
  5.14     (b) Before the expiration date of certification, an 
  5.15  applicant for renewal of certification as an EMT-I or EMT-P 
  5.16  shall:  
  5.17     (1) for an EMT-I, successfully complete a course in 
  5.18  cardiopulmonary resuscitation that is approved by the board or 
  5.19  the licensee's medical director and for an EMT-P, successfully 
  5.20  complete a course in advanced cardiac life support that is 
  5.21  approved by the board or the licensee's medical director; and 
  5.22     (2) successfully complete 48 hours of continuing education 
  5.23  in emergency medical training programs, appropriate to the level 
  5.24  of the applicant's EMT-I or EMT-P certification, that are 
  5.25  consistent with the United States Department of Transportation 
  5.26  National Standard Curriculum or its equivalent as approved by 
  5.27  the board or as approved by the licensee's medical director.  An 
  5.28  applicant may take the United States Department of 
  5.29  Transportation Emergency Medical Technician refresher course or 
  5.30  its equivalent without the written or practical test as approved 
  5.31  by the board, and as appropriate to the applicant's level of 
  5.32  certification, as part of the 48 hours of continuing education.  
  5.33  Each hour of the refresher course, the cardiopulmonary 
  5.34  resuscitation course, and the advanced cardiac life support 
  5.35  course counts toward the 48-hour continuing education 
  5.36  requirement.  At least one of the 48 hours must include 
  6.1   instruction in the administration of epinephrine to treat an 
  6.2   allergic reaction. 
  6.3      (c) Certification shall be renewed every two years. 
  6.4      (d) If the applicant does not meet the renewal requirements 
  6.5   under this subdivision, the applicant's certification expires. 
  6.6      Sec. 5.  Minnesota Statutes 2000, section 148.235, is 
  6.7   amended by adding a subdivision to read: 
  6.8      Subd. 8.  [PRESCRIPTION BY PROTOCOL.] A registered nurse 
  6.9   may implement a protocol that does not reference a specific 
  6.10  patient and results in a prescription of a legend drug that has 
  6.11  been predetermined and delegated by a licensed practitioner as 
  6.12  defined under section 151.01, subdivision 23, when caring for a 
  6.13  patient whose condition falls within the protocol and when the 
  6.14  protocol specifies the circumstances under which the drug is to 
  6.15  be prescribed or administered. 
  6.16     Sec. 6.  Minnesota Statutes 2000, section 148.235, is 
  6.17  amended by adding a subdivision to read: 
  6.18     Subd. 9.  [VACCINE BY PROTOCOL.] A nurse may implement a 
  6.19  protocol that does not reference a specific patient and results 
  6.20  in the administration of a vaccine that has been predetermined 
  6.21  and delegated by a licensed practitioner as defined in section 
  6.22  151.01, subdivision 23, when caring for a patient whose 
  6.23  characteristics fall within the protocol and when the protocol 
  6.24  specifies the contraindications for implementation, including 
  6.25  patients or populations of patients for whom the vaccine must 
  6.26  not be administered and the conditions under which the vaccine 
  6.27  must not be administered. 
  6.28     Sec. 7.  Minnesota Statutes 2000, section 148.281, 
  6.29  subdivision 1, is amended to read: 
  6.30     Subdivision 1.  [VIOLATIONS DESCRIBED.] It shall be 
  6.31  unlawful for any person, corporation, firm, or association, to: 
  6.32     (1) sell or fraudulently obtain or furnish any nursing 
  6.33  diploma, license or record, or aid or abet therein; 
  6.34     (2) practice professional or practical nursing, practice as 
  6.35  a public health nurse, or practice as a certified clinical nurse 
  6.36  specialist, certified nurse-midwife, certified nurse 
  7.1   practitioner, or certified registered nurse anesthetist under 
  7.2   cover of any diploma, permit, license, registration certificate, 
  7.3   advanced practice credential, or record illegally or 
  7.4   fraudulently obtained or signed or issued unlawfully or under 
  7.5   fraudulent representation; 
  7.6      (3) practice professional or practical nursing unless the 
  7.7   person has been issued a temporary permit under the provisions 
  7.8   of section 148.212 or is duly licensed and currently registered 
  7.9   to do so under the provisions of sections 148.171 to 148.285; 
  7.10     (4) use the title nurse unless duly licensed and currently 
  7.11  registered to practice professional or practical nursing under 
  7.12  the provisions of sections 148.171 to 148.285, except as 
  7.13  authorized by the board by rule; 
  7.14     (5) use any abbreviation or other designation tending to 
  7.15  imply licensure as a registered nurse or licensed practical 
  7.16  nurse unless duly licensed and currently registered so to 
  7.17  practice professional or practical nursing under the provisions 
  7.18  of sections 148.171 to 148.285 except as authorized by the board 
  7.19  by rule; 
  7.20     (5) (6) use any title, abbreviation, or other designation 
  7.21  tending to imply certification as a certified registered nurse 
  7.22  as defined in section 148.171, subdivision 22, unless duly 
  7.23  certified by a national nurse certification organization; 
  7.24     (6) (7) use any abbreviation or other designation tending 
  7.25  to imply registration as a public health nurse unless duly 
  7.26  registered by the board; 
  7.27     (7) (8) practice professional, advanced practice 
  7.28  registered, or practical nursing in a manner prohibited by the 
  7.29  board in any limitation of a license or registration issued 
  7.30  under the provisions of sections 148.171 to 148.285; 
  7.31     (8) (9) practice professional, advanced practice 
  7.32  registered, or practical nursing during the time a license or 
  7.33  current registration issued under the provisions of sections 
  7.34  148.171 to 148.285 shall be suspended or revoked; 
  7.35     (9) (10) conduct a nursing program for the education of 
  7.36  persons to become registered nurses or licensed practical nurses 
  8.1   unless the program has been approved by the board; 
  8.2      (10) (11) knowingly employ persons in the practice of 
  8.3   professional or practical nursing who have not been issued a 
  8.4   current permit, license, or registration certificate to practice 
  8.5   as a nurse in this state; and 
  8.6      (11) (12) knowingly employ a person in advanced practice 
  8.7   registered nursing unless the person meets the standards and 
  8.8   practices of sections 148.171 to 148.285. 
  8.9      Sec. 8.  Minnesota Statutes 2001 Supplement, section 
  8.10  148.284, is amended to read: 
  8.11     148.284 [CERTIFICATION OF ADVANCED PRACTICE REGISTERED 
  8.12  NURSES.] 
  8.13     (a) No person shall practice advanced practice registered 
  8.14  nursing or use any title, abbreviation, or other designation 
  8.15  tending to imply that the person is an advanced practice 
  8.16  registered nurse, clinical nurse specialist, nurse anesthetist, 
  8.17  nurse-midwife, or nurse practitioner unless the person is 
  8.18  certified for such advanced practice registered nursing by a 
  8.19  national nurse certification organization. 
  8.20     (b) Paragraph (a) does not apply to an advanced practice 
  8.21  registered nurse who is within six months after completion of an 
  8.22  advanced practice registered nurse course of study and is 
  8.23  awaiting certification, provided that the person has not 
  8.24  previously failed the certification examination.  
  8.25     (c) An advanced practice registered nurse who has completed 
  8.26  a formal course of study as an advanced practice registered 
  8.27  nurse and has been certified by a national nurse certification 
  8.28  organization prior to January 1, 1999, may continue to practice 
  8.29  in the field of nursing in which the advanced practice 
  8.30  registered nurse is practicing as of July 1, 1999, regardless of 
  8.31  the type of certification held if the advanced practice 
  8.32  registered nurse is not eligible for the proper certification. 
  8.33     (d) Prior to July 1, 2007, a clinical nurse specialist may 
  8.34  petition for waiver from the certification requirement in 
  8.35  paragraph (a) if the clinical nurse specialist is academically 
  8.36  prepared as a clinical nurse specialist in a specialty area for 
  9.1   which there is no certification within the clinical nurse 
  9.2   specialist role and specialty or a related specialty.  The board 
  9.3   may determine that an available certification as a clinical 
  9.4   nurse specialist in a related specialty must be obtained in lieu 
  9.5   of the specific specialty or subspecialty.  The petitioner must 
  9.6   be academically prepared as a clinical nurse specialist in a 
  9.7   specific field of clinical nurse specialist practice with a 
  9.8   master's degree in nursing that included clinical experience in 
  9.9   the clinical specialty, and have 1,000 hours of supervised 
  9.10  clinical experience in the clinical specialty for which the 
  9.11  individual was academically prepared with a minimum of 500 hours 
  9.12  of supervised clinical practice after graduation.  The board may 
  9.13  grant a nonrenewable permit for no longer than 12 months for the 
  9.14  supervised postgraduate clinical experience.  The board may 
  9.15  renew the waiver for three-year periods provided the clinical 
  9.16  nurse specialist continues to be ineligible for certification as 
  9.17  a clinical nurse specialist by an organization acceptable to the 
  9.18  board. 
  9.19     Sec. 9.  Minnesota Statutes 2000, section 151.37, 
  9.20  subdivision 2, is amended to read: 
  9.21     Subd. 2.  [PRESCRIBING AND FILING.] (a) A licensed 
  9.22  practitioner in the course of professional practice only, may 
  9.23  prescribe, administer, and dispense a legend drug, and may cause 
  9.24  the same to be administered by a nurse, a physician assistant, 
  9.25  or medical student or resident under the practitioner's 
  9.26  direction and supervision, and may cause a person who is an 
  9.27  appropriately certified, registered, or licensed health care 
  9.28  professional to prescribe, dispense, and administer the same 
  9.29  within the expressed legal scope of the person's practice as 
  9.30  defined in Minnesota Statutes.  A licensed practitioner may 
  9.31  prescribe a legend drug, without reference to a specific 
  9.32  patient, by directing a registered nurse, pursuant to section 
  9.33  148.235, subdivisions 8 and 9, physician assistant, or medical 
  9.34  student or resident to adhere to a particular practice guideline 
  9.35  or protocol when treating patients whose condition falls within 
  9.36  such guideline or protocol, and when such guideline or protocol 
 10.1   specifies the circumstances under which the legend drug is to be 
 10.2   prescribed and administered.  An individual who verbally, 
 10.3   electronically, or otherwise transmits a written, oral, or 
 10.4   electronic order, as an agent of a prescriber, shall not be 
 10.5   deemed to have prescribed the legend drug.  This paragraph 
 10.6   applies to a physician assistant only if the physician assistant 
 10.7   meets the requirements of section 147A.18. 
 10.8      (b) A licensed practitioner that dispenses for profit a 
 10.9   legend drug that is to be administered orally, is ordinarily 
 10.10  dispensed by a pharmacist, and is not a vaccine, must file with 
 10.11  the practitioner's licensing board a statement indicating that 
 10.12  the practitioner dispenses legend drugs for profit, the general 
 10.13  circumstances under which the practitioner dispenses for profit, 
 10.14  and the types of legend drugs generally dispensed.  It is 
 10.15  unlawful to dispense legend drugs for profit after July 31, 
 10.16  1990, unless the statement has been filed with the appropriate 
 10.17  licensing board.  For purposes of this paragraph, "profit" means 
 10.18  (1) any amount received by the practitioner in excess of the 
 10.19  acquisition cost of a legend drug for legend drugs that are 
 10.20  purchased in prepackaged form, or (2) any amount received by the 
 10.21  practitioner in excess of the acquisition cost of a legend drug 
 10.22  plus the cost of making the drug available if the legend drug 
 10.23  requires compounding, packaging, or other treatment.  The 
 10.24  statement filed under this paragraph is public data under 
 10.25  section 13.03.  This paragraph does not apply to a licensed 
 10.26  doctor of veterinary medicine or a registered pharmacist.  Any 
 10.27  person other than a licensed practitioner with the authority to 
 10.28  prescribe, dispense, and administer a legend drug under 
 10.29  paragraph (a) shall not dispense for profit.  To dispense for 
 10.30  profit does not include dispensing by a community health clinic 
 10.31  when the profit from dispensing is used to meet operating 
 10.32  expenses. 
 10.33     Sec. 10.  Minnesota Statutes 2001 Supplement, section 
 10.34  256B.437, is amended by adding a subdivision to read: 
 10.35     Subd. 9.  [TRANSFER OF BEDS.] The board of commissioners of 
 10.36  Saint Louis county may amend their planned closure rate 
 11.1   adjustment application to allow up to 50 beds of a 159-licensed 
 11.2   bed county-owned nursing facility that is in the process of 
 11.3   closing to be transferred to a hospital-attached nursing 
 11.4   facility in Aurora and up to 50 beds to a 235-bed nursing 
 11.5   facility in Duluth, and may also assign all or a portion of the 
 11.6   planned closure rate adjustment that would be received as a 
 11.7   result of closure to the Aurora facility or the Duluth facility. 
 11.8      Sec. 11.  [EFFECTIVE DATE.] 
 11.9      Sections 1 to 4 are effective September 1, 2003.