SENATE BILL No. 248
March 21, 2019, Introduced by Senators JOHNSON, DALEY, HOLLIER and GEISS and referred to the Committee on Health Policy and Human Services.
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
2 the 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
7 or addiction to a controlled substance, except as provided in
1 this article. Application of good faith to a pharmacist means the
2 dispensing of a controlled substance pursuant to a prescriber's
3 order which, in the professional judgment of the pharmacist, is
4 lawful. The pharmacist shall be guided by nationally accepted
5 professional standards including, but not limited to, all of the
6 following, in making the judgment:
7 (a) Lack of consistency in the doctor-patient relationship.
8 (b) Frequency of prescriptions for the same drug by 1
9 prescriber for larger numbers of patients.
10 (c) Quantities beyond those normally prescribed for the same
11 drug.
12 (d) Unusual dosages.
13 (e) Unusual geographic distances between patient,
14 pharmacist, and prescriber.
15 (2) Except as otherwise provided in this section, a
16 practitioner, in good faith, may dispense a controlled substance
17 included in schedule 2 that is a prescription drug as determined
18 under section 503(b) of the federal food, drug, and cosmetic act,
19 21 USC 353, or section 17708, upon receipt of a either of the
20 following:
21 (a) A prescription of a practitioner licensed under section
22 7303 on a prescription form. A practitioner may issue more More
23 than 1 prescription for a controlled substance may be included in
24 schedule 2 on a single prescription form.
25 (b) A prescription that is electronically transmitted under
26 section 17754.
27 (3) In an emergency situation, as described in R 338.3165 of
1 the Michigan Administrative Code, a controlled substance included
2 in schedule 2 may be dispensed upon the oral prescription of a
3 practitioner if the prescribing practitioner promptly fills out a
4 prescription form and forwards the prescription form to the
5 dispensing pharmacy within 7 days after the oral prescription is
6 issued. A prescription for a controlled substance included in
7 schedule 2 must not be filled more than 90 days after the date on
8 which the prescription was issued. A pharmacist, consistent with
9 federal law and regulations on the partial filling of a
10 controlled substance included in schedule 2, may partially fill
11 in increments a prescription for a controlled substance included
12 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,
16 drug, and cosmetic act, 21 USC 353, or section 17708, upon
17 receipt of a 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
26 filled or refilled later than 6 months after the date of the
27 prescription or be refilled more than 5 times, unless renewed by
1 the prescriber in accordance with rules promulgated by the
2 administrator.
3 (6) (5) A controlled substance included in schedule 5 must
4 not be distributed or dispensed other than for a medical purpose,
5 or in any manner except in accordance with rules promulgated by
6 the administrator.
7 (7) (6) If a prescription is required under this section,
8 the prescription must contain the quantity of the controlled
9 substance prescribed in both written and numerical terms. A
10 prescription is in compliance with this subsection if, in
11 addition to containing the quantity of the controlled substance
12 prescribed in written terms, it contains preprinted numbers
13 representative of the quantity of the controlled substance
14 prescribed next to which is a box or line the prescriber may
15 check.
16 (8) (7) A prescribing practitioner shall not use a
17 prescription form for a purpose other than prescribing. A
18 prescribing practitioner shall not postdate a prescription form
19 that contains a prescription for a controlled substance. A
20 prescriber may transmit a prescription by facsimile of a printed
21 prescription form and by electronic transmission of a printed
22 prescription form, if not prohibited by federal law. If, with the
23 patient's consent, a prescription is electronically transmitted,
24 it must be transmitted directly to a pharmacy of the patient's
25 choice by the prescriber or the prescriber's authorized agent,
26 and the data must not be altered, modified, or extracted in the
27 transmission process.
1 (9) (8) Notwithstanding subsections (1) to (5), (6), a class
2 B dealer may acquire a limited permit only for the purpose of
3 buying, possessing, and administering a commercially prepared,
4 premixed solution of sodium pentobarbital to perform euthanasia
5 on injured, sick, homeless, or unwanted domestic pets and other
6 animals, if the class B dealer does all of the following:
7 (a) Applies to the administrator for a permit in accordance
8 with rules promulgated under this part. The application must
9 contain the name of the individual in charge of the day-to-day
10 operations of the class B dealer's facilities and the name of the
11 individual responsible for designating employees who will be
12 performing euthanasia on animals pursuant to this act.
13 (b) Complies with the rules promulgated by the administrator
14 for the storage, handling, and use of a commercially prepared,
15 premixed solution of sodium pentobarbital to perform euthanasia
16 on animals. The class B dealer shall maintain a record of use and
17 shall make the record available for inspection by the department
18 of licensing and regulatory affairs, the department of
19 agriculture and rural development, and the United States
20 Department of Agriculture.
21 (c) Subject to subdivision (d), certifies that the class B
22 dealer or an employee of the class B dealer has received, and can
23 document completion of, a minimum of 16 hours of training,
24 including at least 12 hours of content training and at least 4
25 hours of practical training, in the use of a commercially
26 prepared, premixed solution of sodium pentobarbital and an animal
27 tranquilizer to perform euthanasia on animals from a training
1 program approved by the state veterinarian, in consultation with
2 the Michigan board of veterinary medicine, and given by a
3 licensed veterinarian pursuant to rules promulgated by the
4 administrator. The training described in this subdivision shall
5 comply with the American Veterinary Medical Association's
6 guidelines for the euthanasia of animals.
7 (d) Until December 31, 2021, ensures that the class B dealer
8 or an employee of the class B dealer who received, and can
9 document the completion of, the 8 hours of training required
10 immediately before the effective date of the 2018 amendatory act
11 that amended this section May 22, 2018 only administers a
12 commercially prepared, premixed solution of sodium pentobarbital
13 to perform euthanasia on the animals described in this
14 subsection. Beginning January 1, 2022, the individuals described
15 in this subdivision must have received, and be able to document
16 the completion of, the training described in subdivision (c) to
17 administer a commercially prepared, premixed solution of sodium
18 pentobarbital or an animal tranquilizer to perform euthanasia on
19 the animals described in this subsection.
20 (e) Certifies that only an individual described in
21 subdivision (c) or (d) or an individual otherwise permitted to
22 use a controlled substance pursuant to this article will
23 administer the commercially prepared, premixed solution of sodium
24 pentobarbital or an animal tranquilizer according to written
25 procedures established by the class B dealer.
26 (f) Beginning January 1, 2022, certifies that the individual
27 in charge of the day-to-day operations of the class B dealer's
1 facilities 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 (10) (9) Notwithstanding subsections (1) to (5), (6), an
7 animal control shelter or animal protection shelter registered
8 with the department of agriculture and rural development pursuant
9 to 1969 PA 287, MCL 287.331 to 287.340, may acquire a limited
10 permit only for the purpose of buying, possessing, and
11 administering a commercially prepared, premixed solution of
12 sodium pentobarbital, or an animal tranquilizer, to use
13 exclusively as an adjunct in the process of performing euthanasia
14 on injured, sick, homeless, or unwanted domestic pets and other
15 animals, if the animal control shelter or animal protection
16 shelter does all of the following:
17 (a) Applies to the administrator for a permit in accordance
18 with rules promulgated under this part. The application must
19 contain the name of the individual in charge of the day-to-day
20 operations of the animal control shelter or animal protection
21 shelter and the name of the individual responsible for
22 designating employees who will be performing euthanasia on
23 animals pursuant to this act.
24 (b) Complies with the rules promulgated by the administrator
25 for the storage, handling, and use of a commercially prepared,
26 premixed solution of sodium pentobarbital or an animal
27 tranquilizer to perform euthanasia on animals. The animal control
1 shelter or animal protection shelter shall maintain a record of
2 use and make the record available for inspection by the
3 department of licensing and regulatory affairs and the department
4 of agriculture and rural development.
5 (c) Subject to subdivision (d), certifies that an employee
6 of the animal control shelter or animal protection shelter has
7 received, and can document completion of, a minimum of 16 hours
8 of training, including at least 12 hours of content training and
9 at least 4 hours of practical training, in the use of a
10 commercially prepared, premixed solution of sodium pentobarbital
11 and an animal tranquilizer to perform euthanasia on animals from
12 a training program approved by the state veterinarian, in
13 consultation with the Michigan board of veterinary medicine, and
14 given by a licensed veterinarian pursuant to rules promulgated by
15 the administrator. The training described in this subdivision
16 must comply with the American Veterinary Medical Association's
17 guidelines for the euthanasia of animals.
18 (d) Until December 31, 2021, ensures that an employee of the
19 animal control shelter or animal protection shelter who received,
20 and can document the completion of, the training required
21 immediately before the effective date of the 2018 amendatory act
22 that amended this section May 22, 2018 only administers a
23 commercially prepared solution of xylazine hydrochloride or a
24 commercially prepared, premixed solution of sodium pentobarbital
25 to perform euthanasia on the animals described in this subsection
26 in accordance with his or her training. Beginning January 1,
27 2022, the employee described in this subdivision must have
1 received, and be able to document the completion of, the training
2 described in subdivision (c) to administer a commercially
3 prepared, premixed solution of sodium pentobarbital or an animal
4 tranquilizer to perform euthanasia on the animals described in
5 this subsection.
6 (e) Certifies that only an individual described in
7 subdivision (c) or (d) or an individual otherwise permitted to
8 use a controlled substance pursuant to this article will
9 administer a commercially prepared, premixed solution of sodium
10 pentobarbital or an animal tranquilizer according to written
11 procedures established by the animal control shelter or animal
12 protection shelter.
13 (f) Beginning January 1, 2022, certifies that the individual
14 in charge of the day-to-day operations of the animal control
15 shelter or animal protection shelter has received, and can
16 document the completion of, the training described in subdivision
17 (c).
18 (g) Complies with all state and federal laws and regulations
19 regarding the acquisition, use, and security of controlled
20 substances.
21 (11) (10) The application described in subsection (8) or (9)
22 or (10) must include the names and addresses of all individuals
23 employed by the animal control shelter or animal protection
24 shelter or class B dealer who have been trained as described in
25 subsection (8)(c), (9)(c), (d), and (f) or (9)(c), (10)(c), (d),
26 and (f) and the name of the veterinarian who trained them. The
27 list of names and addresses must be updated every 6 months.
1 (12) (11) If an animal control shelter or animal protection
2 shelter or class B dealer issued a permit pursuant to subsection
3 (8) or (9) or (10) does not have in its employ an individual
4 trained as described in subsection (8)(c) (9)(c) or (d) and
5 (8)(f), (9)(f), or (9)(c) (10)(c) or (d) and (9)(f), (10)(f), the
6 animal control shelter or animal protection shelter or class B
7 dealer shall immediately notify the administrator and shall cease
8 to administer a commercially prepared, premixed solution of
9 sodium pentobarbital or an animal tranquilizer for the purposes
10 described in subsection (8) or (9) or (10) until the
11 administrator is notified that 1 of the following has occurred:
12 (a) An individual trained as described in subsection (8)(c),
13 (9)(c), (d), or (f) or (9)(c), (10)(c), (d), or (f) has been
14 hired by the animal control shelter or animal protection shelter
15 or class B dealer.
16 (b) An individual employed by the animal control shelter or
17 animal protection shelter or class B dealer has been trained as
18 described in subsection (8)(c) (9)(c) or (f) or (9)(c) (10)(c) or
19 (f).
20 (13) (12) A veterinarian, including a veterinarian who
21 trains individuals as described in subsection (8)(c), (9)(c),
22 (d), or (f), or (9)(c), (10)(c), (d), or (f), is not civilly or
23 criminally liable for the use of a commercially prepared,
24 premixed solution of sodium pentobarbital or an animal
25 tranquilizer by an animal control shelter or animal protection
26 shelter or a class B dealer, unless the veterinarian is employed
27 by or under contract with the animal control shelter or animal
1 protection shelter or class B dealer and the terms of the
2 veterinarian's employment or the contract require the
3 veterinarian to be responsible for the use or administration of
4 the commercially prepared, premixed solution of sodium
5 pentobarbital or animal tranquilizer.
6 (14) (13) A person shall not knowingly use or permit the use
7 of a commercially prepared, premixed solution of sodium
8 pentobarbital or an animal tranquilizer in violation of this
9 section.
10 (15) (14) This section does not require that a veterinarian
11 be employed by or under contract with an animal control shelter
12 or animal protection shelter or class B dealer to obtain,
13 possess, or administer a commercially prepared, premixed solution
14 of sodium pentobarbital or an animal tranquilizer pursuant to
15 this section.
16 (16) (15) Notwithstanding subsections (1) to (5), (6), an
17 animal control shelter registered with the department of
18 agriculture and rural development pursuant to 1969 PA 287, MCL
19 287.331 to 287.340, may acquire a limited permit only for the
20 purpose of buying, possessing, and administering an animal
21 tranquilizer to sedate or immobilize an animal running at large
22 that is dangerous or difficult to capture, if the animal control
23 shelter does all of the following:
24 (a) Applies to the administrator for a permit in accordance
25 with the rules promulgated under this part. The application must
26 contain the name of the individual in charge of the day-to-day
27 operations of the animal control shelter and the name of the
1 individual responsible for designating employees who will be
2 administering an animal tranquilizer pursuant to this act.
3 (b) Complies with the rules promulgated by the administrator
4 for the storage, handling, and use of an animal tranquilizer. The
5 animal control shelter shall maintain a record of use and shall
6 make the record available for inspection by the department of
7 licensing and regulatory affairs and the department of
8 agriculture and rural development.
9 (c) Subject to subdivision (d), certifies that an employee
10 of the animal control shelter has received, and can document
11 completion of, both of the following in the following order:
12 (i) The training described in subsection (9)(c).(10)(c).
13 (ii) A minimum of 16 hours of training, including at least 12
14 hours of content training and at least 4 hours of practical
15 training, in the use of animal tranquilizers to sedate or
16 immobilize the animals described in this subsection from a
17 training program approved by the state veterinarian, in
18 consultation with the Michigan board of veterinary medicine, and
19 given by a licensed veterinarian pursuant to rules promulgated by
20 the administrator.
21 (d) Until December 31, 2021, ensures that an employee of the
22 animal control shelter who received, and can document the
23 completion of, the training required immediately before the
24 effective date of the 2018 amendatory act that amended this
25 section May 22, 2018 only administers a commercially prepared
26 solution of xylazine hydrochloride to sedate or immobilize the
27 animals described in this subsection. Beginning January 1, 2022,
1 the employee described in this subdivision must have received,
2 and be able to document the completion of, the training described
3 in subdivision (c) to administer an animal tranquilizer to
4 perform euthanasia on the animals described in this subsection.
5 (e) Certifies that only an individual described in
6 subdivision (c) or (d) or an individual otherwise permitted to
7 use a controlled substance pursuant to this article will
8 administer an animal tranquilizer according to written procedures
9 established by the animal control shelter.
10 (f) Beginning January 1, 2022, certifies that the individual
11 in charge of the day-to-day operations of the animal control
12 shelter has received, and can document the completion of, the
13 training described in subdivision (c).
14 (g) Complies with all state and federal laws, rules, and
15 regulations regarding the acquisition, use, and security of
16 controlled substances.
17 (17) (16) The application described in subsection (15) (16)
18 must include the names and business addresses of all individuals
19 employed by the animal control shelter who have been trained as
20 described in subsection (15)(c), (16)(c), (d), and (f) and must
21 include documented proof of the training. The list of names and
22 business addresses must be updated every 6 months.
23 (18) (17) If an animal control shelter issued a permit
24 pursuant to subsection (15) (16) does not have in its employ an
25 individual trained as described in subsection (15)(c), (16)(c) or
26 (d) and (15)(f), (16)(f), the animal control shelter shall
27 immediately notify the administrator and shall cease to
1 administer an animal tranquilizer for the purposes described in
2 subsection (15) (16) until the administrator is notified that 1
3 of the following has occurred:
4 (a) An individual trained as described in subsection
5 (15)(c), (16)(c), (d), or (f) has been hired by the animal
6 control shelter.
7 (b) An individual employed by the animal control shelter has
8 been trained as described in subsection (15)(c) (16)(c) or (f).
9 (19) (18) A veterinarian, including a veterinarian who
10 trains individuals as described in subsection (15)(c), (16)(c),
11 (d), or (f), is not civilly or criminally liable for the use of
12 an animal tranquilizer by an animal control shelter unless the
13 veterinarian is employed by or under contract with the animal
14 control shelter and the terms of the veterinarian's employment or
15 the contract require the veterinarian to be responsible for the
16 use or administration of an animal tranquilizer.
17 (20) (19) As used in this section:
18 (a) "Animal tranquilizer" means a commercially prepared
19 solution of xylazine hydrochloride, a commercially prepared
20 solution of ketamine, or a commercially prepared compound
21 containing tiletamine and zolazepam.
22 (b) "Class B dealer" means a class B dealer licensed by the
23 United States Department of Agriculture pursuant to the animal
24 welfare act, 7 USC 2131 to 2159 and the department of agriculture
25 and rural development pursuant to 1969 PA 224, MCL 287.381 to
26 287.395.
27 Sec. 16221. Subject to section 16221b, the department shall
1 investigate any allegation that 1 or more of the grounds for
2 disciplinary subcommittee action under this section exist, and
3 may investigate activities related to the practice of a health
4 profession by a licensee, a registrant, or an applicant for
5 licensure or registration. The department may hold hearings,
6 administer oaths, and order the taking of relevant testimony.
7 After its investigation, the department shall provide a copy of
8 the administrative complaint to the appropriate disciplinary
9 subcommittee. The disciplinary subcommittee shall proceed under
10 section 16226 if it finds that 1 or more of the following grounds
11 exist:
12 (a) Except as otherwise specifically provided in this
13 section, a violation of general duty, consisting of negligence or
14 failure to exercise due care, including negligent delegation to
15 or supervision of employees or other individuals, whether or not
16 injury results, or any conduct, practice, or condition that
17 impairs, or may impair, the ability to safely and skillfully
18 engage in the practice of the health profession.
19 (b) Personal disqualifications, consisting of 1 or more of
20 the following:
21 (i) Incompetence.
22 (ii) Subject to sections 16165 to 16170a, substance use
23 disorder as defined in section 100d of the mental health code,
24 1974 PA 258, MCL 330.1100d.
25 (iii) Mental or physical inability reasonably related to and
26 adversely affecting the licensee's or registrant's ability to
27 practice in a safe and competent manner.
1 (iv) Declaration of mental incompetence by a court of
2 competent jurisdiction.
3 (v) Conviction of a misdemeanor punishable by imprisonment
4 for a maximum term of 2 years; conviction of a misdemeanor
5 involving the illegal delivery, possession, or use of a
6 controlled substance; or conviction of any felony other than a
7 felony listed or described in another subparagraph of this
8 subdivision. A certified copy of the court record is conclusive
9 evidence of the conviction.
10 (vi) Lack of good moral character.
11 (vii) Conviction of a criminal offense under section 520e or
12 520g of the Michigan penal code, 1931 PA 328, MCL 750.520e and
13 750.520g. A certified copy of the court record is conclusive
14 evidence of the conviction.
15 (viii) Conviction of a violation of section 492a of the
16 Michigan penal code, 1931 PA 328, MCL 750.492a. A certified copy
17 of the court record is conclusive evidence of the conviction.
18 (ix) Conviction of a misdemeanor or felony involving fraud in
19 obtaining or attempting to obtain fees related to the practice of
20 a health profession. A certified copy of the court record is
21 conclusive evidence of the conviction.
22 (x) Final adverse administrative action by a licensure,
23 registration, disciplinary, or certification board involving the
24 holder of, or an applicant for, a license or registration
25 regulated by another state or a territory of the United States,
26 by the United States military, by the federal government, or by
27 another country. A certified copy of the record of the board is
1 conclusive evidence of the final action.
2 (xi) Conviction of a misdemeanor that is reasonably related
3 to or that adversely affects the licensee's or registrant's
4 ability to practice in a safe and competent manner. A certified
5 copy of the court record is conclusive evidence of the
6 conviction.
7 (xii) Conviction of a violation of section 430 of the
8 Michigan penal code, 1931 PA 328, MCL 750.430. A certified copy
9 of the court record is conclusive evidence of the conviction.
10 (xiii) Conviction of a criminal offense under section 83, 84,
11 316, 317, 321, 520b, 520c, 520d, or 520f of the Michigan penal
12 code, 1931 PA 328, MCL 750.83, 750.84, 750.316, 750.317, 750.321,
13 750.520b, 750.520c, 750.520d, and 750.520f. A certified copy of
14 the court record is conclusive evidence of the conviction.
15 (xiv) Conviction of a violation of section 136 or 136a of the
16 Michigan penal code, 1931 PA 328, MCL 750.136 and 750.136a. A
17 certified copy of the court record is conclusive evidence of the
18 conviction.
19 (c) Prohibited acts, consisting of 1 or more of the
20 following:
21 (i) Fraud or deceit in obtaining or renewing a license or
22 registration.
23 (ii) Permitting a license or registration to be used by an
24 unauthorized person.
25 (iii) Practice outside the scope of a license.
26 (iv) Obtaining, possessing, or attempting to obtain or
27 possess a controlled substance as defined in section 7104 or a
1 drug as defined in section 7105 without lawful authority; or
2 selling, prescribing, giving away, or administering drugs for
3 other than lawful diagnostic or therapeutic purposes.
4 (d) Except as otherwise specifically provided in this
5 section, unethical business practices, consisting of 1 or more of
6 the following:
7 (i) False or misleading advertising.
8 (ii) Dividing fees for referral of patients or accepting
9 kickbacks on medical or surgical services, appliances, or
10 medications purchased by or in behalf of patients.
11 (iii) Fraud or deceit in obtaining or attempting to obtain
12 third party reimbursement.
13 (e) Except as otherwise specifically provided in this
14 section, unprofessional conduct, consisting of 1 or more of the
15 following:
16 (i) Misrepresentation to a consumer or patient or in
17 obtaining or attempting to obtain third party reimbursement in
18 the course of professional practice.
19 (ii) Betrayal of a professional confidence.
20 (iii) Promotion for personal gain of an unnecessary drug,
21 device, treatment, procedure, or service.
22 (iv) Either of the following:
23 (A) A requirement by a licensee other than a physician or a
24 registrant that an individual purchase or secure a drug, device,
25 treatment, procedure, or service from another person, place,
26 facility, or business in which the licensee or registrant has a
27 financial interest.
1 (B) A referral by a physician for a designated health
2 service that violates 42 USC 1395nn or a regulation promulgated
3 under that section. For purposes of this subdivision, 42 USC
4 1395nn and the regulations promulgated under that section as they
5 exist on June 3, 2002 are incorporated by reference. A
6 disciplinary subcommittee shall apply 42 USC 1395nn and the
7 regulations promulgated under that section regardless of the
8 source of payment for the designated health service referred and
9 rendered. If 42 USC 1395nn or a regulation promulgated under that
10 section is revised after June 3, 2002, the department shall
11 officially take notice of the revision. Within 30 days after
12 taking notice of the revision, the department shall decide
13 whether or not the revision pertains to referral by physicians
14 for designated health services and continues to protect the
15 public from inappropriate referrals by physicians. If the
16 department decides that the revision does both of those things,
17 the department may promulgate rules to incorporate the revision
18 by reference. If the department does promulgate rules to
19 incorporate the revision by reference, the department shall not
20 make any changes to the revision. As used in this sub-
21 subparagraph, "designated health service" means that term as
22 defined in 42 USC 1395nn and the regulations promulgated under
23 that section and "physician" means that term as defined in
24 sections 17001 and 17501.
25 (v) For a physician who makes referrals under 42 USC 1395nn
26 or a regulation promulgated under that section, refusing to
27 accept a reasonable proportion of patients eligible for Medicaid
1 and refusing to accept payment from Medicaid or Medicare as
2 payment in full for a treatment, procedure, or service for which
3 the physician refers the individual and in which the physician
4 has a financial interest. A physician who owns all or part of a
5 facility in which he or she provides surgical services is not
6 subject to this subparagraph if a referred surgical procedure he
7 or she performs in the facility is not reimbursed at a minimum of
8 the appropriate Medicaid or Medicare outpatient fee schedule,
9 including the combined technical and professional components.
10 (vi) Any conduct by a health professional with a patient
11 while he or she is acting within the health profession for which
12 he or she is licensed or registered, including conduct initiated
13 by a patient or to which the patient consents, that is sexual or
14 may reasonably be interpreted as sexual, including, but not
15 limited to, sexual intercourse, kissing in a sexual manner, or
16 touching of a body part for any purpose other than appropriate
17 examination, treatment, or comfort.
18 (vii) Offering to provide practice-related services, such as
19 drugs, in exchange for sexual favors.
20 (f) Failure to notify under section 16222(3) or (4).
21 (g) Failure to report a change of name or mailing address as
22 required in section 16192.
23 (h) A violation, or aiding or abetting in a violation, of
24 this article or of a rule promulgated under this article.
25 (i) Failure to comply with a subpoena issued pursuant to
26 this part, failure to respond to a complaint issued under this
27 article, article 7, or article 8, failure to appear at a
1 compliance conference or an administrative hearing, or failure to
2 report under section 16222(1) or 16223.
3 (j) Failure to pay an installment of an assessment levied
4 under the insurance code of 1956, 1956 PA 218, MCL 500.100 to
5 500.8302, within 60 days after notice by the appropriate board.
6 (k) A violation of section 17013 or 17513.
7 (l) Failure to meet 1 or more of the requirements for
8 licensure or registration under section 16174.
9 (m) A violation of section 17015, 17015a, 17017, 17515, or
10 17517.
11 (n) A violation of section 17016 or 17516.
12 (o) Failure to comply with section 9206(3).
13 (p) A violation of section 5654 or 5655.
14 (q) A violation of section 16274.
15 (r) A violation of section 17020 or 17520.
16 (s) A violation of the medical records access act, 2004 PA
17 47, MCL 333.26261 to 333.26271.
18 (t) A violation of section 17764(2).
19 (u) Failure to comply with the terms of a practice agreement
20 described in section 17047(2)(a) or (b), 17547(2)(a) or (b), or
21 18047(2)(a) or (b).
22 (v) A violation of section 7303a(2).
23 (w) A violation of section 7303a(4) or (5).
24 (x) A violation of section 7303b.
25 (y) A violation of section 17754.
26 Sec. 16226. (1) After finding the existence of 1 or more of
27 the grounds for disciplinary subcommittee action listed in
1 section 16221, a disciplinary subcommittee shall impose 1 or more
2 of the following sanctions for each violation:
3
Violations of Section 16221
Sanctions
4
Subdivision (a), (b)(i),
Probation, limitation, denial,
5
(b)(ii), (b)(iii), (b)(iv),
suspension, revocation,
6
(b)(v), (b)(vi), (b)(vii),
permanent revocation,
7
(b)(ix), (b)(x), (b)(xi),
restitution, or fine.
8
or (b)(xii)
9
10
Subdivision (b)(viii)
Revocation, permanent revocation,
11
or denial.
12
13
Subdivision (b)(xiii)
Permanent revocation
14
for a violation described in
15
subsection (5); otherwise,
16
probation, limitation, denial,
17
suspension, revocation,
18
restitution, or fine.
19
20
Subdivision (b)(xiv)
Permanent revocation.
21
22
Subdivision (c)(i)
Denial, revocation, suspension,
23
probation, limitation, or fine.
24
25
Subdivision (c)(ii)
Denial, suspension, revocation,
26
restitution, or fine.
27
28
Subdivision (c)(iii)
Probation, denial, suspension,
1
revocation, restitution, or fine.
2
3
Subdivision (c)(iv)
Fine, probation, denial,
4
or (d)(iii)
suspension, revocation, permanent
5
revocation, or restitution.
6
7
Subdivision (d)(i)
Reprimand, fine, probation,
8
or (d)(ii)
denial, or restitution.
9
10
Subdivision (e)(i),
Reprimand, fine, probation,
11
(e)(iii), (e)(iv), (e)(v),
limitation, suspension,
12
(h), or (s)
revocation, permanent revocation,
13
denial, or restitution.
14
15
Subdivision (e)(ii)
Reprimand, probation, suspension,
16
or (i)
revocation, permanent
17
revocation, restitution,
18
denial, or fine.
19
20
Subdivision (e)(vi)
Probation, suspension, revocation,
21
or (e)(vii)
limitation, denial,
22
restitution, or fine.
23
24
Subdivision (f)
Reprimand, denial, limitation,
25
probation, or fine.
26
27
Subdivision (g)
Reprimand or fine.
28
29
Subdivision (j)
Suspension or fine.
1
2
Subdivision (k), (p),
Reprimand, probation, suspension,
3
or (r)
revocation, permanent revocation,
4
or fine.
5
6
Subdivision (l)
Reprimand, denial, or
7
limitation.
8
9
Subdivision (m) or (o)
Denial, revocation, restitution,
10
probation, suspension,
11
limitation, reprimand, or fine.
12
13
Subdivision (n)
Revocation or denial.
14
15
Subdivision (q)
Revocation.
16
17
Subdivision (t)
Revocation, permanent revocation,
18
fine, or restitution.
19
20
Subdivision (u)
Denial, revocation, probation,
21
suspension, limitation, reprimand,
22
or fine.
23
24
Subdivision (v) or (x)
Probation, limitation, denial,
25
fine, suspension, revocation, or
26
permanent revocation.
27
28
Subdivision (w)
Denial, fine, reprimand,
29
probation, limitation,
1
suspension, revocation, or
2
permanent revocation.
3
4
Subdivision (y)
Subject to subsection (7), fine.
5 (2) Determination of sanctions for violations under this
6 section shall be made by a disciplinary subcommittee. If, during
7 judicial review, the court of appeals determines that a final
8 decision or order of a disciplinary subcommittee prejudices
9 substantial rights of the petitioner for 1 or more of the grounds
10 listed in section 106 of the administrative procedures act of
11 1969, 1969 PA 306, MCL 24.306, and holds that the final decision
12 or order is unlawful and is to be set aside, the court shall
13 state on the record the reasons for the holding and may remand
14 the case to the disciplinary subcommittee for further
15 consideration.
16 (3) A disciplinary subcommittee may impose a fine in an
17 amount that does not exceed $250,000.00 for a violation of
18 section 16221(a) or (b). A disciplinary subcommittee shall impose
19 a fine of at least $25,000.00 if the violation of section
20 16221(a) or (b) results in the death of 1 or more patients.
21 (4) A disciplinary subcommittee may require a licensee or
22 registrant or an applicant for licensure or registration who has
23 violated this article, article 7, or article 8 or a rule
24 promulgated under this article, article 7, or article 8 to
25 satisfactorily complete an educational program, a training
26 program, or a treatment program, a mental, physical, or
1 professional competence examination, or a combination of those
2 programs and examinations.
3 (5) A disciplinary subcommittee shall impose the sanction of
4 permanent revocation for a violation of section 16221(b)(xiii) if
5 the violation occurred while the licensee or registrant was
6 acting within the health profession for which he or she was
7 licensed or registered.
8 (6) Except as otherwise provided in subsection (5) and this
9 subsection, a disciplinary subcommittee shall not impose the
10 sanction of permanent revocation under this section without a
11 finding that the licensee or registrant engaged in a pattern of
12 intentional acts of fraud or deceit resulting in personal
13 financial gain to the licensee or registrant and harm to the
14 health of patients under the licensee's or registrant's care.
15 This subsection does not apply if a disciplinary subcommittee
16 finds that a licensee or registrant has violated section
17 16221(b)(xiv).
18 (7) A disciplinary subcommittee shall impose a fine of
19 $250.00 for each violation of section 16221(y). However, the
20 aggregate fine that a disciplinary subcommittee imposes on a
21 licensee or registrant for multiple violations of section
22 16221(y) must not exceed $5,000.00 in 1 calendar year.
23 Sec. 17754. (1) Except as otherwise provided under article
24 7, article 8, and the federal act, or subsection (5), beginning
25 January 1, 2020, a prescriber or his or her agent shall
26 electronically transmit a prescription, may be transmitted
27 electronically if the prescription is transmitted including a
1 prescription for a controlled substance, directly to a pharmacy
2 of the patient's choice. A prescription that is transmitted
3 electronically under this section must be in compliance with the
4 health insurance portability and accountability act of 1996,
5 Public Law 104-191, or regulations promulgated under that act, 45
6 CFR parts 160 and 164, by a prescriber or his or her agent and
7 the data are must not be altered or modified in the transmission
8 process. The electronically transmitted prescription shall must
9 include all of the following information:
10 (a) The name, address, and telephone number of the
11 prescriber.
12 (b) Except as otherwise authorized under section 5110,
13 17744a, or 17744b, the full name of the patient for whom the
14 prescription is issued.
15 (c) An electronic signature or other identifier that
16 specifically identifies and authenticates the prescriber or his
17 or her agent.
18 (d) The time and date of the transmission.
19 (e) The identity of the pharmacy intended to receive the
20 transmission.
21 (f) Any other information required by the federal act or
22 state law.
23 (2) The electronic equipment or system utilized in the
24 transmission and communication of prescriptions shall must
25 provide adequate confidentiality safeguards and be maintained to
26 protect patient confidentiality as required under any applicable
27 federal and state law and to ensure against unauthorized access.
1 The electronic transmission of a prescription shall must be
2 communicated in a retrievable, recognizable form acceptable to
3 the intended recipient. The electronic form utilized in the
4 transmission of a prescription shall must not include "dispense
5 as written" or "d.a.w." as the default setting.
6 (3) Before dispensing a prescription that is electronically
7 transmitted, the pharmacist shall exercise professional judgment
8 regarding the accuracy, validity, and authenticity of the
9 transmitted prescription.
10 (4) An electronically transmitted prescription that meets
11 the requirements of this section is the original prescription.
12 (5) The requirement to transmit a prescription
13 electronically under subsection (1) does not apply under any of
14 the following circumstances:
15 (a) If the prescription is issued by a prescriber who is a
16 veterinarian licensed under this article.
17 (b) If the prescription is issued under a circumstance in
18 which electronic transmission is not available due to a temporary
19 technological or electrical failure.
20 (c) If the prescription is issued by a prescriber who has
21 received a waiver from the department under subsection (6).
22 (d) If the prescription is issued by a prescriber who
23 reasonably believes that electronically transmitting the
24 prescription would make it impractical for the patient who is the
25 subject of the prescription to obtain the prescription drug in a
26 timely manner and that the delay would adversely affect the
27 patient's medical condition.
1 (e) If the prescription is orally prescribed under section
2 7333(3) or (4).
3 (f) If the prescription is issued by a prescriber to be
4 dispensed outside of this state.
5 (g) If the prescription is issued by a prescriber who is
6 located outside of this state to be dispensed by a pharmacy
7 located inside of this state.
8 (h) If the prescription is issued and dispensed in the same
9 health care facility and the individual for whom the prescription
10 is issued uses the drug exclusively in the health care facility.
11 As used in this subdivision, "health care facility" includes, but
12 is not limited to, a hospital, hospice, or another long-term care
13 facility that provides rehabilitative, restorative, or ongoing
14 skilled nursing care to an individual who is in need of
15 assistance with activities of daily living.
16 (i) If the prescription contains content that is not
17 supported by the National Council for Prescription Drug Programs
18 Prescriber/Pharmacist Interface SCRIPT Standard.
19 (j) If the prescription is for a drug for which the FDA
20 requires the prescription to contain content that cannot be
21 transmitted electronically.
22 (k) If the prescription is issued under circumstances in
23 which the prescriber is not required to include on the
24 prescription a name of a patient for whom the prescription is
25 issued.
26 (l) If the prescription is issued by a prescriber who is
27 prescribing the drug under a research protocol.
1 (m) If the prescription is for a drug that is administered
2 to the individual for whom the drug is prescribed in a hospital,
3 nursing home, hospice, dialysis treatment clinic, freestanding
4 surgical outpatient facility, or assisted living residence.
5 (6) If a prescriber cannot meet the requirements of
6 subsection (1) or (2), the prescriber may apply to the department
7 for a waiver. The department shall grant a waiver to a
8 prescriber, if the department determines that the prescriber
9 cannot meet the requirements of subsection (1) or (2) due to an
10 economic hardship, a technological limitation that is not
11 reasonably within the control of the prescriber, or another
12 exceptional circumstance. A prescriber who is granted a waiver
13 under this subsection shall notify the department in writing if
14 he or she is subsequently able to meet the requirements of
15 subsections (1) and (2). A waiver that is granted under this
16 subsection is valid for a period not to exceed 1 year and is
17 renewable.
18 (7) A pharmacist who receives a prescription that was not
19 transmitted electronically to the pharmacy may dispense the
20 prescription without determining whether an exception under
21 subsection (5) applies.
22 (8) The department, in consultation with the board, shall
23 promulgate rules to implement this section.
24 Enacting section 1. This amendatory act takes effect 90 days
25 after the date it is enacted into law.