HOUSE BILL No. 6570
December 4, 2018, Introduced by Rep. Bellino and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 7333, 16221, 16226, and 17754 (MCL 333.7333,
333.16221, 333.16226, and 333.17754), section 7333 as amended by
2018 PA 34, sections 16221 and 16226 as amended by 2017 PA 249, and
section 17754 as amended by 2014 PA 525.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 7333. (1) As used in this section, "good faith" means the
2 prescribing or dispensing of a controlled substance by a
3 practitioner licensed under section 7303 in the regular course of
4 professional treatment to or for an individual who is under
5 treatment by the practitioner for a pathology or condition other
6 than that individual's physical or psychological dependence upon or
1 addiction to a controlled substance, except as provided in this
2 article. Application of good faith to a pharmacist means the
3 dispensing of a controlled substance pursuant to a prescriber's
4 order which, in the professional judgment of the pharmacist, is
5 lawful. The pharmacist shall be guided by nationally accepted
6 professional standards including, but not limited to, all of the
7 following, in making the judgment:
8 (a) Lack of consistency in the doctor-patient relationship.
9 (b) Frequency of prescriptions for the same drug by 1
10 prescriber for larger numbers of patients.
11 (c) Quantities beyond those normally prescribed for the same
12 drug.
13 (d) Unusual dosages.
14 (e) Unusual geographic distances between patient, pharmacist,
15 and prescriber.
16 (2) Except as otherwise provided in this section, a
17 practitioner, in good faith, may dispense a controlled substance
18 included in schedule 2 that is a prescription drug as determined
19 under section 503(b) of the federal food, drug, and cosmetic act,
20 21 USC 353, or section 17708, upon receipt of a either of the
21 following:
22 (a) A prescription of a practitioner licensed under section
23 7303 on a prescription form. A practitioner may issue more More
24 than 1 prescription for a controlled substance may be included in
25 schedule 2 on a single prescription form.
26 (b) A prescription that is electronically transmitted under
27 section 17754.
1 (3) In an emergency situation, as described in R 338.3165 of
2 the Michigan Administrative Code, a controlled substance included
3 in schedule 2 may be dispensed upon the oral prescription of a
4 practitioner if the prescribing practitioner promptly fills out a
5 prescription form and forwards the prescription form to the
6 dispensing pharmacy within 7 days after the oral prescription is
7 issued. A prescription for a controlled substance included in
8 schedule 2 must not be filled more than 90 days after the date on
9 which the prescription was issued. A pharmacist, consistent with
10 federal law and regulations on the partial filling of a controlled
11 substance included in schedule 2, may partially fill in increments
12 a prescription for a controlled substance included in schedule 2.
13 (4) A practitioner, in good faith, may dispense a controlled
14 substance included in schedule 3, 4, or 5 that is a prescription
15 drug as determined under section 503(b) of the federal food, drug,
16 and cosmetic act, 21 USC 353, or section 17708, upon receipt of a
17 any of the following:
18 (a) A prescription on a prescription form. or an
19 (b) An oral prescription of a practitioner.
20 (c) A prescription that is electronically transmitted under
21 section 17754.
22 (5) A prescription for a controlled substance included in
23 schedule 3 or 4 must not be filled or refilled without specific
24 refill instructions noted by the prescriber. A prescription for a
25 controlled substance included in schedule 3 or 4 must not be filled
26 or refilled later than 6 months after the date of the prescription
27 or be refilled more than 5 times, unless renewed by the prescriber
1 in accordance with rules promulgated by the administrator.
2 (6) (5) A controlled substance included in schedule 5 must not
3 be distributed or dispensed other than for a medical purpose, or in
4 any manner except in accordance with rules promulgated by the
5 administrator.
6 (7) (6) If a prescription is required under this section, the
7 prescription must contain the quantity of the controlled substance
8 prescribed in both written and numerical terms. A prescription is
9 in compliance with this subsection if, in addition to containing
10 the quantity of the controlled substance prescribed in written
11 terms, it contains preprinted numbers representative of the
12 quantity of the controlled substance prescribed next to which is a
13 box or line the prescriber may check.
14 (8) (7) A prescribing practitioner shall not use a
15 prescription form for a purpose other than prescribing. A
16 prescribing practitioner shall not postdate a prescription form
17 that contains a prescription for a controlled substance. A
18 prescriber may transmit a prescription by facsimile of a printed
19 prescription form and by electronic transmission of a printed
20 prescription form, if not prohibited by federal law. If, with the
21 patient's consent, a prescription is electronically transmitted, it
22 must be transmitted directly to a pharmacy of the patient's choice
23 by the prescriber or the prescriber's authorized agent, and the
24 data must not be altered, modified, or extracted in the
25 transmission process.
26 (9) (8) Notwithstanding subsections (1) to (5), (6), a class B
27 dealer may acquire a limited permit only for the purpose of buying,
1 possessing, and administering a commercially prepared, premixed
2 solution of sodium pentobarbital to perform euthanasia on injured,
3 sick, homeless, or unwanted domestic pets and other animals, if the
4 class B dealer does all of the following:
5 (a) Applies to the administrator for a permit in accordance
6 with rules promulgated under this part. The application must
7 contain the name of the individual in charge of the day-to-day
8 operations of the class B dealer's facilities and the name of the
9 individual responsible for designating employees who will be
10 performing euthanasia on animals pursuant to this act.
11 (b) Complies with the rules promulgated by the administrator
12 for the storage, handling, and use of a commercially prepared,
13 premixed solution of sodium pentobarbital to perform euthanasia on
14 animals. The class B dealer shall maintain a record of use and
15 shall make the record available for inspection by the department of
16 licensing and regulatory affairs, the department of agriculture and
17 rural development, and the United States Department of Agriculture.
18 (c) Subject to subdivision (d), certifies that the class B
19 dealer or an employee of the class B dealer has received, and can
20 document completion of, a minimum of 16 hours of training,
21 including at least 12 hours of content training and at least 4
22 hours of practical training, in the use of a commercially prepared,
23 premixed solution of sodium pentobarbital and an animal
24 tranquilizer to perform euthanasia on animals from a training
25 program approved by the state veterinarian, in consultation with
26 the Michigan board of veterinary medicine, and given by a licensed
27 veterinarian pursuant to rules promulgated by the administrator.
1 The training described in this subdivision shall comply with the
2 American Veterinary Medical Association's guidelines for the
3 euthanasia of animals.
4 (d) Until December 31, 2021, ensures that the class B dealer
5 or an employee of the class B dealer who received, and can document
6 the completion of, the 8 hours of training required immediately
7 before the effective date of the 2018 amendatory act that amended
8 this section May 22, 2018 only administers a commercially prepared,
9 premixed solution of sodium pentobarbital to perform euthanasia on
10 the animals described in this subsection. Beginning January 1,
11 2022, the individuals described in this subdivision must have
12 received, and be able to document the completion of, the training
13 described in subdivision (c) to administer a commercially prepared,
14 premixed solution of sodium pentobarbital or an animal tranquilizer
15 to perform euthanasia on the animals described in this subsection.
16 (e) Certifies that only an individual described in subdivision
17 (c) or (d) or an individual otherwise permitted to use a controlled
18 substance pursuant to this article will administer the commercially
19 prepared, premixed solution of sodium pentobarbital or an animal
20 tranquilizer according to written procedures established by the
21 class B dealer.
22 (f) Beginning January 1, 2022, certifies that the individual
23 in charge of the day-to-day operations of the class B dealer's
24 facilities has received, and can document the completion of, the
25 training described in subdivision (c).
26 (g) Complies with all state and federal laws, rules, and
27 regulations regarding the acquisition, use, and security of
1 controlled substances.
2 (10) (9) Notwithstanding subsections (1) to (5), (6), an
3 animal control shelter or animal protection shelter registered with
4 the department of agriculture and rural development pursuant to
5 1969 PA 287, MCL 287.331 to 287.340, may acquire a limited permit
6 only for the purpose of buying, possessing, and administering a
7 commercially prepared, premixed solution of sodium pentobarbital,
8 or an animal tranquilizer, to use exclusively as an adjunct in the
9 process of performing euthanasia on injured, sick, homeless, or
10 unwanted domestic pets and other animals, if the animal control
11 shelter or animal protection shelter does all of the following:
12 (a) Applies to the administrator for a permit in accordance
13 with rules promulgated under this part. The application must
14 contain the name of the individual in charge of the day-to-day
15 operations of the animal control shelter or animal protection
16 shelter and the name of the individual responsible for designating
17 employees who will be performing euthanasia on animals pursuant to
18 this act.
19 (b) Complies with the rules promulgated by the administrator
20 for the storage, handling, and use of a commercially prepared,
21 premixed solution of sodium pentobarbital or an animal tranquilizer
22 to perform euthanasia on animals. The animal control shelter or
23 animal protection shelter shall maintain a record of use and make
24 the record available for inspection by the department of licensing
25 and regulatory affairs and the department of agriculture and rural
26 development.
27 (c) Subject to subdivision (d), certifies that an employee of
1 the animal control shelter or animal protection shelter has
2 received, and can document completion of, a minimum of 16 hours of
3 training, including at least 12 hours of content training and at
4 least 4 hours of practical training, in the use of a commercially
5 prepared, premixed solution of sodium pentobarbital and an animal
6 tranquilizer to perform euthanasia on animals from a training
7 program approved by the state veterinarian, in consultation with
8 the Michigan board of veterinary medicine, and given by a licensed
9 veterinarian pursuant to rules promulgated by the administrator.
10 The training described in this subdivision must comply with the
11 American Veterinary Medical Association's guidelines for the
12 euthanasia of animals.
13 (d) Until December 31, 2021, ensures that an employee of the
14 animal control shelter or animal protection shelter who received,
15 and can document the completion of, the training required
16 immediately before the effective date of the 2018 amendatory act
17 that amended this section May 22, 2018 only administers a
18 commercially prepared solution of xylazine hydrochloride or a
19 commercially prepared, premixed solution of sodium pentobarbital to
20 perform euthanasia on the animals described in this subsection in
21 accordance with his or her training. Beginning January 1, 2022, the
22 employee described in this subdivision must have received, and be
23 able to document the completion of, the training described in
24 subdivision (c) to administer a commercially prepared, premixed
25 solution of sodium pentobarbital or an animal tranquilizer to
26 perform euthanasia on the animals described in this subsection.
27 (e) Certifies that only an individual described in subdivision
1 (c) or (d) or an individual otherwise permitted to use a controlled
2 substance pursuant to this article will administer a commercially
3 prepared, premixed solution of sodium pentobarbital or an animal
4 tranquilizer according to written procedures established by the
5 animal control shelter or animal protection shelter.
6 (f) Beginning January 1, 2022, certifies that the individual
7 in charge of the day-to-day operations of the animal control
8 shelter or animal protection shelter has received, and can document
9 the completion of, the training described in subdivision (c).
10 (g) Complies with all state and federal laws and regulations
11 regarding the acquisition, use, and security of controlled
12 substances.
13 (11) (10) The application described in subsection (8) or (9)
14 or (10) must include the names and addresses of all individuals
15 employed by the animal control shelter or animal protection shelter
16 or class B dealer who have been trained as described in subsection
17 (8)(c), (9)(c), (d), and (f) or (9)(c), (10)(c), (d), and (f) and
18 the name of the veterinarian who trained them. The list of names
19 and addresses must be updated every 6 months.
20 (12) (11) If an animal control shelter or animal protection
21 shelter or class B dealer issued a permit pursuant to subsection
22 (8) or (9) or (10) does not have in its employ an individual
23 trained as described in subsection (8)(c) (9)(c) or (d) and (8)(f),
24 (9)(f), or (9)(c) (10)(c) or (d) and (9)(f), (10)(f), the animal
25 control shelter or animal protection shelter or class B dealer
26 shall immediately notify the administrator and shall cease to
27 administer a commercially prepared, premixed solution of sodium
1 pentobarbital or an animal tranquilizer for the purposes described
2 in subsection (8) or (9) or (10) until the administrator is
3 notified that 1 of the following has occurred:
4 (a) An individual trained as described in subsection (8)(c),
5 (9)(c), (d), or (f) or (9)(c), (10)(c), (d), or (f) has been hired
6 by the animal control shelter or animal protection shelter or class
7 B dealer.
8 (b) An individual employed by the animal control shelter or
9 animal protection shelter or class B dealer has been trained as
10 described in subsection (8)(c) (9)(c) or (f) or (9)(c) (10)(c) or
11 (f).
12 (13) (12) A veterinarian, including a veterinarian who trains
13 individuals as described in subsection (8)(c), (9)(c), (d), or (f),
14 or (9)(c), (10)(c), (d), or (f), is not civilly or criminally
15 liable for the use of a commercially prepared, premixed solution of
16 sodium pentobarbital or an animal tranquilizer by an animal control
17 shelter or animal protection shelter or a class B dealer, unless
18 the veterinarian is employed by or under contract with the animal
19 control shelter or animal protection shelter or class B dealer and
20 the terms of the veterinarian's employment or the contract require
21 the veterinarian to be responsible for the use or administration of
22 the commercially prepared, premixed solution of sodium
23 pentobarbital or animal tranquilizer.
24 (14) (13) A person shall not knowingly use or permit the use
25 of a commercially prepared, premixed solution of sodium
26 pentobarbital or an animal tranquilizer in violation of this
27 section.
1 (15) (14) This section does not require that a veterinarian be
2 employed by or under contract with an animal control shelter or
3 animal protection shelter or class B dealer to obtain, possess, or
4 administer a commercially prepared, premixed solution of sodium
5 pentobarbital or an animal tranquilizer pursuant to this section.
6 (16) (15) Notwithstanding subsections (1) to (5), (6), an
7 animal control shelter registered with the department of
8 agriculture and rural development pursuant to 1969 PA 287, MCL
9 287.331 to 287.340, may acquire a limited permit only for the
10 purpose of buying, possessing, and administering an animal
11 tranquilizer to sedate or immobilize an animal running at large
12 that is dangerous or difficult to capture, if the animal control
13 shelter does all of the following:
14 (a) Applies to the administrator for a permit in accordance
15 with the rules promulgated under this part. The application must
16 contain the name of the individual in charge of the day-to-day
17 operations of the animal control shelter and the name of the
18 individual responsible for designating employees who will be
19 administering an animal tranquilizer pursuant to this act.
20 (b) Complies with the rules promulgated by the administrator
21 for the storage, handling, and use of an animal tranquilizer. The
22 animal control shelter shall maintain a record of use and shall
23 make the record available for inspection by the department of
24 licensing and regulatory affairs and the department of agriculture
25 and rural development.
26 (c) Subject to subdivision (d), certifies that an employee of
27 the animal control shelter has received, and can document
1 completion of, both of the following in the following order:
2 (i) The training described in subsection (9)(c).(10)(c).
3 (ii) A minimum of 16 hours of training, including at least 12
4 hours of content training and at least 4 hours of practical
5 training, in the use of animal tranquilizers to sedate or
6 immobilize the animals described in this subsection from a training
7 program approved by the state veterinarian, in consultation with
8 the Michigan board of veterinary medicine, and given by a licensed
9 veterinarian pursuant to rules promulgated by the administrator.
10 (d) Until December 31, 2021, ensures that an employee of the
11 animal control shelter who received, and can document the
12 completion of, the training required immediately before the
13 effective date of the 2018 amendatory act that amended this section
14 May 22, 2018 only administers a commercially prepared solution of
15 xylazine hydrochloride to sedate or immobilize the animals
16 described in this subsection. Beginning January 1, 2022, the
17 employee described in this subdivision must have received, and be
18 able to document the completion of, the training described in
19 subdivision (c) to administer an animal tranquilizer to perform
20 euthanasia on the animals described in this subsection.
21 (e) Certifies that only an individual described in subdivision
22 (c) or (d) or an individual otherwise permitted to use a controlled
23 substance pursuant to this article will administer an animal
24 tranquilizer according to written procedures established by the
25 animal control shelter.
26 (f) Beginning January 1, 2022, certifies that the individual
27 in charge of the day-to-day operations of the animal control
1 shelter has received, and can document the completion of, the
2 training described in subdivision (c).
3 (g) Complies with all state and federal laws, rules, and
4 regulations regarding the acquisition, use, and security of
5 controlled substances.
6 (17) (16) The application described in subsection (15) (16)
7 must include the names and business addresses of all individuals
8 employed by the animal control shelter who have been trained as
9 described in subsection (15)(c), (16)(c), (d), and (f) and must
10 include documented proof of the training. The list of names and
11 business addresses must be updated every 6 months.
12 (18) (17) If an animal control shelter issued a permit
13 pursuant to subsection (15) (16) does not have in its employ an
14 individual trained as described in subsection (15)(c), (16)(c) or
15 (d) and (15)(f), (16)(f), the animal control shelter shall
16 immediately notify the administrator and shall cease to administer
17 an animal tranquilizer for the purposes described in subsection
18 (15) (16) until the administrator is notified that 1 of the
19 following has occurred:
20 (a) An individual trained as described in subsection (15)(c),
21 (16)(c), (d), or (f) has been hired by the animal control shelter.
22 (b) An individual employed by the animal control shelter has
23 been trained as described in subsection (15)(c) (16)(c) or (f).
24 (19) (18) A veterinarian, including a veterinarian who trains
25 individuals as described in subsection (15)(c), (16)(c), (d), or
26 (f), is not civilly or criminally liable for the use of an animal
27 tranquilizer by an animal control shelter unless the veterinarian
1 is employed by or under contract with the animal control shelter
2 and the terms of the veterinarian's employment or the contract
3 require the veterinarian to be responsible for the use or
4 administration of an animal tranquilizer.
5 (20) (19) As used in this section:
6 (a) "Animal tranquilizer" means a commercially prepared
7 solution of xylazine hydrochloride, a commercially prepared
8 solution of ketamine, or a commercially prepared compound
9 containing tiletamine and zolazepam.
10 (b) "Class B dealer" means a class B dealer licensed by the
11 United States Department of Agriculture pursuant to the animal
12 welfare act, 7 USC 2131 to 2159 and the department of agriculture
13 and rural development pursuant to 1969 PA 224, MCL 287.381 to
14 287.395.
15 Sec. 16221. Subject to section 16221b, the department shall
16 investigate any allegation that 1 or more of the grounds for
17 disciplinary subcommittee action under this section exist, and may
18 investigate activities related to the practice of a health
19 profession by a licensee, a registrant, or an applicant for
20 licensure or registration. The department may hold hearings,
21 administer oaths, and order the taking of relevant testimony. After
22 its investigation, the department shall provide a copy of the
23 administrative complaint to the appropriate disciplinary
24 subcommittee. The disciplinary subcommittee shall proceed under
25 section 16226 if it finds that 1 or more of the following grounds
26 exist:
27 (a) Except as otherwise specifically provided in this section,
1 a violation of general duty, consisting of negligence or failure to
2 exercise due care, including negligent delegation to or supervision
3 of employees or other individuals, whether or not injury results,
4 or any conduct, practice, or condition that impairs, or may impair,
5 the ability to safely and skillfully engage in the practice of the
6 health profession.
7 (b) Personal disqualifications, consisting of 1 or more of the
8 following:
9 (i) Incompetence.
10 (ii) Subject to sections 16165 to 16170a, substance use
11 disorder as defined in section 100d of the mental health code, 1974
12 PA 258, MCL 330.1100d.
13 (iii) Mental or physical inability reasonably related to and
14 adversely affecting the licensee's or registrant's ability to
15 practice in a safe and competent manner.
16 (iv) Declaration of mental incompetence by a court of
17 competent jurisdiction.
18 (v) Conviction of a misdemeanor punishable by imprisonment for
19 a maximum term of 2 years; conviction of a misdemeanor involving
20 the illegal delivery, possession, or use of a controlled substance;
21 or conviction of any felony other than a felony listed or described
22 in another subparagraph of this subdivision. A certified copy of
23 the court record is conclusive evidence of the conviction.
24 (vi) Lack of good moral character.
25 (vii) Conviction of a criminal offense under section 520e or
26 520g of the Michigan penal code, 1931 PA 328, MCL 750.520e and
27 750.520g. A certified copy of the court record is conclusive
1 evidence of the conviction.
2 (viii) Conviction of a violation of section 492a of the
3 Michigan penal code, 1931 PA 328, MCL 750.492a. A certified copy of
4 the court record is conclusive evidence of the conviction.
5 (ix) Conviction of a misdemeanor or felony involving fraud in
6 obtaining or attempting to obtain fees related to the practice of a
7 health profession. A certified copy of the court record is
8 conclusive evidence of the conviction.
9 (x) Final adverse administrative action by a licensure,
10 registration, disciplinary, or certification board involving the
11 holder of, or an applicant for, a license or registration regulated
12 by another state or a territory of the United States, by the United
13 States military, by the federal government, or by another country.
14 A certified copy of the record of the board is conclusive evidence
15 of the final action.
16 (xi) Conviction of a misdemeanor that is reasonably related to
17 or that adversely affects the licensee's or registrant's ability to
18 practice in a safe and competent manner. A certified copy of the
19 court record is conclusive evidence of the conviction.
20 (xii) Conviction of a violation of section 430 of the Michigan
21 penal code, 1931 PA 328, MCL 750.430. A certified copy of the court
22 record is conclusive evidence of the conviction.
23 (xiii) Conviction of a criminal offense under section 83, 84,
24 316, 317, 321, 520b, 520c, 520d, or 520f of the Michigan penal
25 code, 1931 PA 328, MCL 750.83, 750.84, 750.316, 750.317, 750.321,
26 750.520b, 750.520c, 750.520d, and 750.520f. A certified copy of the
27 court record is conclusive evidence of the conviction.
1 (xiv) Conviction of a violation of section 136 or 136a of the
2 Michigan penal code, 1931 PA 328, MCL 750.136 and 750.136a. A
3 certified copy of the court record is conclusive evidence of the
4 conviction.
5 (c) Prohibited acts, consisting of 1 or more of the following:
6 (i) Fraud or deceit in obtaining or renewing a license or
7 registration.
8 (ii) Permitting a license or registration to be used by an
9 unauthorized person.
10 (iii) Practice outside the scope of a license.
11 (iv) Obtaining, possessing, or attempting to obtain or possess
12 a controlled substance as defined in section 7104 or a drug as
13 defined in section 7105 without lawful authority; or selling,
14 prescribing, giving away, or administering drugs for other than
15 lawful diagnostic or therapeutic purposes.
16 (d) Except as otherwise specifically provided in this section,
17 unethical business practices, consisting of 1 or more of the
18 following:
19 (i) False or misleading advertising.
20 (ii) Dividing fees for referral of patients or accepting
21 kickbacks on medical or surgical services, appliances, or
22 medications purchased by or in behalf of patients.
23 (iii) Fraud or deceit in obtaining or attempting to obtain
24 third party reimbursement.
25 (e) Except as otherwise specifically provided in this section,
26 unprofessional conduct, consisting of 1 or more of the following:
27 (i) Misrepresentation to a consumer or patient or in obtaining
1 or attempting to obtain third party reimbursement in the course of
2 professional practice.
3 (ii) Betrayal of a professional confidence.
4 (iii) Promotion for personal gain of an unnecessary drug,
5 device, treatment, procedure, or service.
6 (iv) Either of the following:
7 (A) A requirement by a licensee other than a physician or a
8 registrant that an individual purchase or secure a drug, device,
9 treatment, procedure, or service from another person, place,
10 facility, or business in which the licensee or registrant has a
11 financial interest.
12 (B) A referral by a physician for a designated health service
13 that violates 42 USC 1395nn or a regulation promulgated under that
14 section. For purposes of this subdivision, 42 USC 1395nn and the
15 regulations promulgated under that section as they exist on June 3,
16 2002 are incorporated by reference. A disciplinary subcommittee
17 shall apply 42 USC 1395nn and the regulations promulgated under
18 that section regardless of the source of payment for the designated
19 health service referred and rendered. If 42 USC 1395nn or a
20 regulation promulgated under that section is revised after June 3,
21 2002, the department shall officially take notice of the revision.
22 Within 30 days after taking notice of the revision, the department
23 shall decide whether or not the revision pertains to referral by
24 physicians for designated health services and continues to protect
25 the public from inappropriate referrals by physicians. If the
26 department decides that the revision does both of those things, the
27 department may promulgate rules to incorporate the revision by
1 reference. If the department does promulgate rules to incorporate
2 the revision by reference, the department shall not make any
3 changes to the revision. As used in this sub-subparagraph,
4 "designated health service" means that term as defined in 42 USC
5 1395nn and the regulations promulgated under that section and
6 "physician" means that term as defined in sections 17001 and 17501.
7 (v) For a physician who makes referrals under 42 USC 1395nn or
8 a regulation promulgated under that section, refusing to accept a
9 reasonable proportion of patients eligible for Medicaid and
10 refusing to accept payment from Medicaid or Medicare as payment in
11 full for a treatment, procedure, or service for which the physician
12 refers the individual and in which the physician has a financial
13 interest. A physician who owns all or part of a facility in which
14 he or she provides surgical services is not subject to this
15 subparagraph if a referred surgical procedure he or she performs in
16 the facility is not reimbursed at a minimum of the appropriate
17 Medicaid or Medicare outpatient fee schedule, including the
18 combined technical and professional components.
19 (vi) Any conduct by a health professional with a patient while
20 he or she is acting within the health profession for which he or
21 she is licensed or registered, including conduct initiated by a
22 patient or to which the patient consents, that is sexual or may
23 reasonably be interpreted as sexual, including, but not limited to,
24 sexual intercourse, kissing in a sexual manner, or touching of a
25 body part for any purpose other than appropriate examination,
26 treatment, or comfort.
27 (vii) Offering to provide practice-related services, such as
1 drugs, in exchange for sexual favors.
2 (f) Failure to notify under section 16222(3) or (4).
3 (g) Failure to report a change of name or mailing address as
4 required in section 16192.
5 (h) A violation, or aiding or abetting in a violation, of this
6 article or of a rule promulgated under this article.
7 (i) Failure to comply with a subpoena issued pursuant to this
8 part, failure to respond to a complaint issued under this article,
9 article 7, or article 8, failure to appear at a compliance
10 conference or an administrative hearing, or failure to report under
11 section 16222(1) or 16223.
12 (j) Failure to pay an installment of an assessment levied
13 under the insurance code of 1956, 1956 PA 218, MCL 500.100 to
14 500.8302, within 60 days after notice by the appropriate board.
15 (k) A violation of section 17013 or 17513.
16 (l) Failure to meet 1 or more of the requirements for
17 licensure or registration under section 16174.
18 (m) A violation of section 17015, 17015a, 17017, 17515, or
19 17517.
20 (n) A violation of section 17016 or 17516.
21 (o) Failure to comply with section 9206(3).
22 (p) A violation of section 5654 or 5655.
23 (q) A violation of section 16274.
24 (r) A violation of section 17020 or 17520.
25 (s) A violation of the medical records access act, 2004 PA 47,
26 MCL 333.26261 to 333.26271.
27 (t) A violation of section 17764(2).
1 (u) Failure to comply with the terms of a practice agreement
2 described in section 17047(2)(a) or (b), 17547(2)(a) or (b), or
3 18047(2)(a) or (b).
4 (v) A violation of section 7303a(2).
5 (w) A violation of section 7303a(4) or (5).
6 (x) A violation of section 7303b.
7 (y) A violation of section 17754.
8 Sec. 16226. (1) After finding the existence of 1 or more of
9 the grounds for disciplinary subcommittee action listed in section
10 16221, a disciplinary subcommittee shall impose 1 or more of the
11 following sanctions for each violation:
12
Violations of Section 16221
Sanctions
13
Subdivision (a), (b)(i),
Probation, limitation, denial,
14
(b)(ii), (b)(iii), (b)(iv),
suspension, revocation,
15
(b)(v), (b)(vi), (b)(vii),
permanent revocation,
16
(b)(ix), (b)(x), (b)(xi),
restitution, or fine.
17
or (b)(xii)
18
19
Subdivision (b)(viii)
Revocation, permanent revocation,
20
or denial.
21
22
Subdivision (b)(xiii)
Permanent revocation
23
for a violation described in
24
subsection (5); otherwise,
25
probation, limitation, denial,
26
suspension, revocation,
27
restitution, or fine.
1
2
Subdivision (b)(xiv)
Permanent revocation.
3
4
Subdivision (c)(i)
Denial, revocation, suspension,
5
probation, limitation, or fine.
6
7
Subdivision (c)(ii)
Denial, suspension, revocation,
8
restitution, or fine.
9
10
Subdivision (c)(iii)
Probation, denial, suspension,
11
revocation, restitution, or fine.
12
13
Subdivision (c)(iv)
Fine, probation, denial,
14
or (d)(iii)
suspension, revocation, permanent
15
revocation, or restitution.
16
17
Subdivision (d)(i)
Reprimand, fine, probation,
18
or (d)(ii)
denial, or restitution.
19
20
Subdivision (e)(i),
Reprimand, fine, probation,
21
(e)(iii), (e)(iv), (e)(v),
limitation, suspension,
22
(h), or (s)
revocation, permanent revocation,
23
denial, or restitution.
24
25
Subdivision (e)(ii)
Reprimand, probation, suspension,
26
or (i)
revocation, permanent
27
revocation, restitution,
1
denial, or fine.
2
3
Subdivision (e)(vi)
Probation, suspension, revocation,
4
or (e)(vii)
limitation, denial,
5
restitution, or fine.
6
7
Subdivision (f)
Reprimand, denial, limitation,
8
probation, or fine.
9
10
Subdivision (g)
Reprimand or fine.
11
12
Subdivision (j)
Suspension or fine.
13
14
Subdivision (k), (p),
Reprimand, probation, suspension,
15
or (r)
revocation, permanent revocation,
16
or fine.
17
18
Subdivision (l)
Reprimand, denial, or
19
limitation.
20
21
Subdivision (m) or (o)
Denial, revocation, restitution,
22
probation, suspension,
23
limitation, reprimand, or fine.
24
25
Subdivision (n)
Revocation or denial.
26
27
Subdivision (q)
Revocation.
1
2
Subdivision (t)
Revocation, permanent revocation,
3
fine, or restitution.
4
5
Subdivision (u)
Denial, revocation, probation,
6
suspension, limitation, reprimand,
7
or fine.
8
9
Subdivision (v) or (x)
Probation, limitation, denial,
10
fine, suspension, revocation, or
11
permanent revocation.
12
13
Subdivision (w)
Denial, fine, reprimand,
14
probation, limitation,
15
suspension, revocation, or
16
permanent revocation.
17
18
Subdivision (y)
Subject to subsection (7), fine.
19 (2) Determination of sanctions for violations under this
20 section shall be made by a disciplinary subcommittee. If, during
21 judicial review, the court of appeals determines that a final
22 decision or order of a disciplinary subcommittee prejudices
23 substantial rights of the petitioner for 1 or more of the grounds
24 listed in section 106 of the administrative procedures act of 1969,
25 1969 PA 306, MCL 24.306, and holds that the final decision or order
26 is unlawful and is to be set aside, the court shall state on the
27 record the reasons for the holding and may remand the case to the
1 disciplinary subcommittee for further consideration.
2 (3) A disciplinary subcommittee may impose a fine in an amount
3 that does not exceed $250,000.00 for a violation of section
4 16221(a) or (b). A disciplinary subcommittee shall impose a fine of
5 at least $25,000.00 if the violation of section 16221(a) or (b)
6 results in the death of 1 or more patients.
7 (4) A disciplinary subcommittee may require a licensee or
8 registrant or an applicant for licensure or registration who has
9 violated this article, article 7, or article 8 or a rule
10 promulgated under this article, article 7, or article 8 to
11 satisfactorily complete an educational program, a training program,
12 or a treatment program, a mental, physical, or professional
13 competence examination, or a combination of those programs and
14 examinations.
15 (5) A disciplinary subcommittee shall impose the sanction of
16 permanent revocation for a violation of section 16221(b)(xiii) if
17 the violation occurred while the licensee or registrant was acting
18 within the health profession for which he or she was licensed or
19 registered.
20 (6) Except as otherwise provided in subsection (5) and this
21 subsection, a disciplinary subcommittee shall not impose the
22 sanction of permanent revocation under this section without a
23 finding that the licensee or registrant engaged in a pattern of
24 intentional acts of fraud or deceit resulting in personal financial
25 gain to the licensee or registrant and harm to the health of
26 patients under the licensee's or registrant's care. This subsection
27 does not apply if a disciplinary subcommittee finds that a licensee
1 or registrant has violated section 16221(b)(xiv).
2 (7) A disciplinary subcommittee shall impose a fine of $250.00
3 for each violation of section 16221(y). However, the aggregate fine
4 that a disciplinary subcommittee imposes on a licensee or
5 registrant for multiple violations of section 16221(y) must not
6 exceed $5,000.00 in 1 calendar year.
7 Sec. 17754. (1) Except as otherwise provided under article 7,
8 article 8, and the federal act, or subsection (5), beginning
9 January 1, 2020, a prescriber or his or her agent shall
10 electronically transmit a prescription, may be transmitted
11 electronically if the prescription is transmitted including a
12 prescription for a controlled substance, directly to a pharmacy of
13 the patient's choice. A prescription that is transmitted
14 electronically under this section must be in compliance with the
15 health insurance portability and accountability act of 1996, Public
16 Law 104-191, or regulations promulgated under that act, 45 CFR
17 parts 160 and 164, by a prescriber or his or her agent and the data
18 are must not be altered or modified in the transmission process.
19 The electronically transmitted prescription shall must include all
20 of the following information:
21 (a) The name, address, and telephone number of the prescriber.
22 (b) Except as otherwise authorized under section 5110, 17744a,
23 or 17744b, the full name of the patient for whom the prescription
24 is issued.
25 (c) An electronic signature or other identifier that
26 specifically identifies and authenticates the prescriber or his or
27 her agent.
1 (d) The time and date of the transmission.
2 (e) The identity of the pharmacy intended to receive the
3 transmission.
4 (f) Any other information required by the federal act or state
5 law.
6 (2) The electronic equipment or system utilized in the
7 transmission and communication of prescriptions shall must provide
8 adequate confidentiality safeguards and be maintained to protect
9 patient confidentiality as required under any applicable federal
10 and state law and to ensure against unauthorized access. The
11 electronic transmission of a prescription shall must be
12 communicated in a retrievable, recognizable form acceptable to the
13 intended recipient. The electronic form utilized in the
14 transmission of a prescription shall must not include "dispense as
15 written" or "d.a.w." as the default setting.
16 (3) Before dispensing a prescription that is electronically
17 transmitted, the pharmacist shall exercise professional judgment
18 regarding the accuracy, validity, and authenticity of the
19 transmitted prescription.
20 (4) An electronically transmitted prescription that meets the
21 requirements of this section is the original prescription.
22 (5) The requirement to transmit a prescription electronically
23 under subsection (1) does not apply under any of the following
24 circumstances:
25 (a) If the prescription is issued by a prescriber who is a
26 veterinarian licensed under this article.
27 (b) If the prescription is issued under a circumstance in
1 which electronic transmission is not available due to a temporary
2 technological or electrical failure.
3 (c) If the prescription is issued by a prescriber who has
4 received a waiver from the department under subsection (6).
5 (d) If the prescription is issued by a prescriber who
6 reasonably believes that electronically transmitting the
7 prescription would make it impractical for the patient who is the
8 subject of the prescription to obtain the prescription drug in a
9 timely manner and that the delay would adversely affect the
10 patient's medical condition.
11 (e) If the prescription is orally prescribed under section
12 7333(3) or (4).
13 (f) If the prescription is issued by a prescriber to be
14 dispensed outside of this state.
15 (g) If the prescription is issued by a prescriber who is
16 located outside of this state to be dispensed by a pharmacy located
17 inside of this state.
18 (h) If the prescription is issued and dispensed in the same
19 health care facility and the individual for whom the prescription
20 is issued uses the drug exclusively in the health care facility. As
21 used in this subdivision, "health care facility" includes, but is
22 not limited to, a hospital, hospice, or another long-term care
23 facility that provides rehabilitative, restorative, or ongoing
24 skilled nursing care to an individual who is in need of assistance
25 with activities of daily living.
26 (i) If the prescription contains content that is not supported
27 by the National Council for Prescription Drug Programs
1 Prescriber/Pharmacist Interface SCRIPT Standard.
2 (j) If the prescription is for a drug for which the FDA
3 requires the prescription to contain content that cannot be
4 transmitted electronically.
5 (k) If the prescription is issued under circumstances in which
6 the prescriber is not required to include on the prescription a
7 name of a patient for whom the prescription is issued.
8 (l) If the prescription is issued by a prescriber who is
9 prescribing the drug under a research protocol.
10 (m) If the prescription is for a drug that is administered to
11 the individual for whom the drug is prescribed in a hospital,
12 nursing home, hospice, dialysis treatment clinic, freestanding
13 surgical outpatient facility, or assisted living residence.
14 (6) If a prescriber cannot meet the requirements of subsection
15 (1) or (2), the prescriber may apply to the department for a
16 waiver. The department shall grant a waiver to a prescriber, if the
17 department determines that the prescriber cannot meet the
18 requirements of subsection (1) or (2) due to an economic hardship,
19 a technological limitation that is not reasonably within the
20 control of the prescriber, or another exceptional circumstance. A
21 prescriber who is granted a waiver under this subsection shall
22 notify the department in writing if he or she is subsequently able
23 to meet the requirements of subsections (1) and (2). A waiver that
24 is granted under this subsection is valid for a period not to
25 exceed 1 year and is renewable.
26 (7) A pharmacist who receives a prescription that was not
27 transmitted electronically to the pharmacy may dispense the
1 prescription without determining whether an exception under
2 subsection (5) applies.
3 (8) The department, in consultation with the board, shall
4 promulgate rules to implement this section.
5 Enacting section 1. This amendatory act takes effect 90 days
6 after the date it is enacted into law.