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House Engrossed State of Arizona House of Representatives Fifty-second Legislature Second Regular Session 2016

HOUSE BILL 2355

AN ACT

AMENDING SECTIONS 15-341, 32-1401, 32-1854 AND 32-1901.01, ARIZONA REVISED STATUTES; AMENDING TITLE 32, CHAPTER 18, ARTICLE 3, ARIZONA REVISED STATUTES, BY ADDING SECTION 32-1979; AMENDING SECTION 36-2228, ARIZONA REVISED STATUTES; AMENDING TITLE 36, CHAPTER 21.1, ARIZONA REVISED STATUTES, BY ADDING ARTICLE 4; RELATING TO OPIOID ANTAGONISTS.

(TEXT OF BILL BEGINS ON NEXT PAGE)

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Be it enacted by the Legislature of the State of Arizona: 1 Section 1. Section 15-341, Arizona Revised Statutes, is amended to 2

read: 3 15-341. General powers and duties; immunity; delegation 4 A. The governing board shall: 5 1. Prescribe and enforce policies and procedures for the governance of 6

the schools, not inconsistent with law or rules prescribed by the state board 7 of education. 8

2. Exclude from schools all books, publications, papers or audiovisual 9 materials of a sectarian, partisan or denominational character. This 10 paragraph shall not be construed to prohibit the elective course permitted by 11 section 15-717.01. 12

3. Manage and control the school property within its district. 13 4. Acquire school furniture, apparatus, equipment, library books and 14

supplies for the use of the schools. 15 5. Prescribe the curricula and criteria for the promotion and 16

graduation of pupils as provided in sections 15-701 and 15-701.01. 17 6. Furnish, repair and insure, at full insurable value, the school 18

property of the district. 19 7. Construct school buildings on approval by a vote of the district 20

electors. 21 8. Make in the name of the district conveyances of property belonging 22

to the district and sold by the board. 23 9. Purchase school sites when authorized by a vote of the district at 24

an election conducted as nearly as practicable in the same manner as the 25 election provided in section 15-481 and held on a date prescribed in section 26 15-491, subsection E, but such authorization shall not necessarily specify 27 the site to be purchased and such authorization shall not be necessary to 28 exchange unimproved property as provided in section 15-342, paragraph 23. 29

10. Construct, improve and furnish buildings used for school purposes 30 when such buildings or premises are leased from the national park service. 31

11. Purchase school sites or construct, improve and furnish school 32 buildings from the proceeds of the sale of school property only on approval 33 by a vote of the district electors. 34

12. Hold pupils to strict account for disorderly conduct on school 35 property. 36

13. Discipline students for disorderly conduct on the way to and from 37 school. 38

14. Except as provided in section 15-1224, deposit all monies received 39 by the district as gifts, grants and devises with the county treasurer who 40 shall credit the deposits as designated in the uniform system of financial 41 records. If not inconsistent with the terms of the gifts, grants and devises 42 given, any balance remaining after expenditures for the intended purpose of 43 the monies have been made shall be used for reduction of school district 44 taxes for the budget year, except that in the case of accommodation schools 45

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the county treasurer shall carry the balance forward for use by the county 1 school superintendent for accommodation schools for the budget year. 2

15. Provide that, if a parent or legal guardian chooses not to accept 3 a decision of the teacher as provided in section 15-521, paragraph 4, the 4 parent or legal guardian may request in writing that the governing board 5 review the teacher's decision. This paragraph shall not be construed to 6 release school districts from any liability relating to a child's promotion 7 or retention. 8

16. Provide for adequate supervision over pupils in instructional and 9 noninstructional activities by certificated or noncertificated personnel. 10

17. Use school monies received from the state and county school 11 apportionment exclusively for payment of salaries of teachers and other 12 employees and contingent expenses of the district. 13

18. Make an annual report to the county school superintendent on or 14 before October 1 in the manner and form and on the blanks prescribed by the 15 superintendent of public instruction or county school superintendent. The 16 board shall also make reports directly to the county school superintendent or 17 the superintendent of public instruction whenever required. 18

19. Deposit all monies received by school districts other than student 19 activities monies or monies from auxiliary operations as provided in sections 20 15-1125 and 15-1126 with the county treasurer to the credit of the school 21 district except as provided in paragraph 20 of this subsection and sections 22 15-1223 and 15-1224, and the board shall expend the monies as provided by law 23 for other school funds. 24

20. Establish bank accounts in which the board during a month may 25 deposit miscellaneous monies received directly by the district. The board 26 shall remit monies deposited in the bank accounts at least monthly to the 27 county treasurer for deposit as provided in paragraph 19 of this subsection 28 and in accordance with the uniform system of financial records. 29

21. Prescribe and enforce policies and procedures for disciplinary 30 action against a teacher who engages in conduct that is a violation of the 31 policies of the governing board but that is not cause for dismissal of the 32 teacher or for revocation of the certificate of the teacher. Disciplinary 33 action may include suspension without pay for a period of time not to exceed 34 ten school days. Disciplinary action shall not include suspension with pay 35 or suspension without pay for a period of time longer than ten school days. 36 The procedures shall include notice, hearing and appeal provisions for 37 violations that are cause for disciplinary action. The governing board may 38 designate a person or persons to act on behalf of the board on these matters. 39

22. Prescribe and enforce policies and procedures for disciplinary 40 action against an administrator who engages in conduct that is a violation of 41 the policies of the governing board regarding duties of administrators but 42 that is not cause for dismissal of the administrator or for revocation of the 43 certificate of the administrator. Disciplinary action may include suspension 44 without pay for a period of time not to exceed ten school days. Disciplinary 45

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action shall not include suspension with pay or suspension without pay for a 1 period of time longer than ten school days. The procedures shall include 2 notice, hearing and appeal provisions for violations that are cause for 3 disciplinary action. The governing board may designate a person or persons 4 to act on behalf of the board on these matters. For violations that are 5 cause for dismissal, the provisions of notice, hearing and appeal in chapter 6 5, article 3 of this title shall apply. The filing of a timely request for a 7 hearing suspends the imposition of a suspension without pay or a dismissal 8 pending completion of the hearing. 9

23. Notwithstanding sections 13-3108 and 13-3120, prescribe and 10 enforce policies and procedures that prohibit a person from carrying or 11 possessing a weapon on school grounds unless the person is a peace officer or 12 has obtained specific authorization from the school administrator. 13

24. Prescribe and enforce policies and procedures relating to the 14 health and safety of all pupils participating in district sponsored practice 15 sessions or games or other interscholastic athletic activities, including: 16

(a) The provision of water. 17 (b) Guidelines, information and forms, developed in consultation with 18

a statewide private entity that supervises interscholastic activities, to 19 inform and educate coaches, pupils and parents of the dangers of concussions 20 and head injuries and the risks of continued participation in athletic 21 activity after a concussion. The policies and procedures shall require that, 22 before a pupil participates in an athletic activity, the pupil and the 23 pupil's parent must sign an information form at least once each school year 24 that states that the parent is aware of the nature and risk of concussion. 25 The policies and procedures shall require that a pupil who is suspected of 26 sustaining a concussion in a practice session, game or other interscholastic 27 athletic activity be immediately removed from the athletic activity. A coach 28 from the pupil's team or an official or a licensed health care provider may 29 remove a pupil from play. A team parent may also remove the parent's own 30 child from play. A pupil may return to play on the same day if a health care 31 provider rules out a suspected concussion at the time the pupil is removed 32 from play. On a subsequent day, the pupil may return to play if the pupil 33 has been evaluated by and received written clearance to resume participation 34 in athletic activity from a health care provider who has been trained in the 35 evaluation and management of concussions and head injuries. A health care 36 provider who is a volunteer and who provides clearance to participate in 37 athletic activity on the day of the suspected injury or on a subsequent day 38 is immune from civil liability with respect to all decisions made and actions 39 taken that are based on good faith implementation of the requirements of this 40 subdivision, except in cases of gross negligence or wanton or wilful neglect. 41 A school district, school district employee, team coach, official or team 42 volunteer or a parent or guardian of a team member is not subject to civil 43 liability for any act, omission or policy undertaken in good faith to comply 44 with the requirements of this subdivision or for a decision made or an action 45

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taken by a health care provider. A group or organization that uses property 1 or facilities owned or operated by a school district for athletic activities 2 shall comply with the requirements of this subdivision. A school district 3 and its employees and volunteers are not subject to civil liability for any 4 other person or organization's failure or alleged failure to comply with the 5 requirements of this subdivision. This subdivision does not apply to teams 6 that are based in another state and that participate in an athletic activity 7 in this state. For the purposes of this subdivision, athletic activity does 8 not include dance, rhythmic gymnastics, competitions or exhibitions of 9 academic skills or knowledge or other similar forms of physical noncontact 10 activities, civic activities or academic activities, whether engaged in for 11 the purposes of competition or recreation. For the purposes of this 12 subdivision, "health care provider" means a physician who is licensed 13 pursuant to title 32, chapter 13 or 17, an athletic trainer who is licensed 14 pursuant to title 32, chapter 41, a nurse practitioner who is licensed 15 pursuant to title 32, chapter 15, and a physician assistant who is licensed 16 pursuant to title 32, chapter 25. 17

25. Prescribe and enforce policies and procedures regarding the 18 smoking of tobacco within school buildings. The policies and procedures 19 shall be adopted in consultation with school district personnel and members 20 of the community and shall state whether smoking is prohibited in school 21 buildings. If smoking in school buildings is not prohibited, the policies and 22 procedures shall clearly state the conditions and circumstances under which 23 smoking is permitted, those areas in a school building that may be designated 24 as smoking areas and those areas in a school building that may not be 25 designated as smoking areas. 26

26. Establish an assessment, data gathering and reporting system as 27 prescribed in chapter 7, article 3 of this title. 28

27. Provide special education programs and related services pursuant 29 to section 15-764, subsection A to all children with disabilities as defined 30 in section 15-761. 31

28. Administer competency tests prescribed by the state board of 32 education for the graduation of pupils from high school. 33

29. Ensure that insurance coverage is secured for all construction 34 projects for purposes of general liability, property damage and workers' 35 compensation and secure performance and payment bonds for all construction 36 projects. 37

30. Keep on file the resumes of all current and former employees who 38 provide instruction to pupils at a school. Resumes shall include an 39 individual's educational and teaching background and experience in a 40 particular academic content subject area. A school district shall inform 41 parents and guardians of the availability of the resume information and shall 42 make the resume information available for inspection on request of parents 43 and guardians of pupils enrolled at a school. This paragraph shall not be 44 construed to require any school to release personally identifiable 45

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information in relation to any teacher or employee, including the teacher's 1 or employee's address, salary, social security number or telephone number. 2

31. Report to local law enforcement agencies any suspected crime 3 against a person or property that is a serious offense as defined in section 4 13-706 or that involves a deadly weapon or dangerous instrument or serious 5 physical injury and any conduct that poses a threat of death or serious 6 physical injury to employees, students or anyone on the property of the 7 school. This paragraph does not limit or preclude the reporting by a school 8 district or an employee of a school district of suspected crimes other than 9 those required to be reported by this paragraph. For the purposes of this 10 paragraph, "dangerous instrument", "deadly weapon" and "serious physical 11 injury" have the same meanings prescribed in section 13-105. 12

32. In conjunction with local law enforcement agencies and local 13 medical facilities, develop an emergency response plan for each school in the 14 school district in accordance with minimum standards developed jointly by the 15 department of education and the division of emergency management within the 16 department of emergency and military affairs. 17

33. Provide written notice to the parents or guardians of all students 18 affected in the school district at least ten days prior to a public meeting 19 to discuss closing a school within the school district. The notice shall 20 include the reasons for the proposed closure and the time and place of the 21 meeting. The governing board shall fix a time for a public meeting on the 22 proposed closure no less than ten days before voting in a public meeting to 23 close the school. The school district governing board shall give notice of 24 the time and place of the meeting. At the time and place designated in the 25 notice, the school district governing board shall hear reasons for or against 26 closing the school. The school district governing board is exempt from this 27 paragraph if it is determined by the governing board that the school shall be 28 closed because it poses a danger to the health or safety of the pupils or 29 employees of the school. A governing board may consult with the school 30 facilities board for technical assistance and for information on the impact 31 of closing a school. The information provided from the school facilities 32 board shall not require the governing board to take or not take any action. 33

34. Incorporate instruction on Native American history into 34 appropriate existing curricula. 35

35. Prescribe and enforce policies and procedures: 36 (a) Allowing pupils who have been diagnosed with anaphylaxis by a 37

health care provider licensed pursuant to title 32, chapter 13, 14, 17 or 25 38 or by a registered nurse practitioner licensed and certified pursuant to 39 title 32, chapter 15 to carry and self-administer emergency medications, 40 including auto-injectable epinephrine AUTO-INJECTORS, while at school and at 41 school-sponsored activities. The pupil's name on the prescription label on 42 the medication container or on the medication device and annual written 43 documentation from the pupil's parent or guardian to the school that 44 authorizes possession and self-administration is sufficient proof that the 45

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pupil is entitled to the possession and self-administration of the 1 medication. The policies shall require a pupil who uses auto-injectable AN 2 epinephrine AUTO-INJECTOR while at school and at school-sponsored activities 3 to notify the nurse or the designated school staff person of the use of the 4 medication as soon as practicable. A school district and its employees are 5 immune from civil liability with respect to all decisions made and actions 6 taken that are based on good faith implementation of the requirements of this 7 subdivision, except in cases of wanton or wilful neglect. 8

(b) For the emergency administration of auto-injectable epinephrine 9 AUTO-INJECTORS by a trained employee of a school district pursuant to section 10 15-157. 11

36. Allow the possession and self-administration of prescription 12 medication for breathing disorders in handheld inhaler devices by pupils who 13 have been prescribed that medication by a health care professional licensed 14 pursuant to title 32. The pupil's name on the prescription label on the 15 medication container or on the handheld inhaler device and annual written 16 documentation from the pupil's parent or guardian to the school that 17 authorizes possession and self-administration shall be sufficient proof that 18 the pupil is entitled to the possession and self-administration of the 19 medication. A school district and its employees are immune from civil 20 liability with respect to all decisions made and actions taken that are based 21 on a good faith implementation of the requirements of this paragraph. 22

37. Prescribe and enforce policies and procedures to prohibit pupils 23 from harassing, intimidating and bullying other pupils on school grounds, on 24 school property, on school buses, at school bus stops, at school-sponsored 25 events and activities and through the use of electronic technology or 26 electronic communication on school computers, networks, forums and mailing 27 lists that include the following components: 28

(a) A procedure for pupils, parents and school district employees to 29 confidentially report to school officials incidents of harassment, 30 intimidation or bullying. The school shall make available written forms 31 designed to provide a full and detailed description of the incident and any 32 other relevant information about the incident. 33

(b) A requirement that school district employees report in writing 34 suspected incidents of harassment, intimidation or bullying to the 35 appropriate school official and a description of appropriate disciplinary 36 procedures for employees who fail to report suspected incidents that are 37 known to the employee. 38

(c) A requirement that, at the beginning of each school year, school 39 officials provide all pupils with a written copy of the rights, protections 40 and support services available to a pupil who is an alleged victim of an 41 incident reported pursuant to this paragraph. 42

(d) If an incident is reported pursuant to this paragraph, a 43 requirement that school officials provide a pupil who is an alleged victim of 44

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the incident with a written copy of the rights, protections and support 1 services available to that pupil. 2

(e) A formal process for the documentation of reported incidents of 3 harassment, intimidation or bullying and for the confidentiality, maintenance 4 and disposition of this documentation. School districts shall maintain 5 documentation of all incidents reported pursuant to this paragraph for at 6 least six years. The school shall not use that documentation to impose 7 disciplinary action unless the appropriate school official has investigated 8 and determined that the reported incidents of harassment, intimidation or 9 bullying occurred. If a school provides documentation of reported incidents 10 to persons other than school officials or law enforcement, all individually 11 identifiable information shall be redacted. 12

(f) A formal process for the investigation by the appropriate school 13 officials of suspected incidents of harassment, intimidation or bullying, 14 including procedures for notifying the alleged victim on completion and 15 disposition of the investigation. 16

(g) Disciplinary procedures for pupils who have admitted or been found 17 to have committed incidents of harassment, intimidation or bullying. 18

(h) A procedure that sets forth consequences for submitting false 19 reports of incidents of harassment, intimidation or bullying. 20

(i) Procedures designed to protect the health and safety of pupils who 21 are physically harmed as the result of incidents of harassment, intimidation 22 and bullying, including, if appropriate, procedures to contact emergency 23 medical services or law enforcement agencies, or both. 24

(j) Definitions of harassment, intimidation and bullying. 25 38. Prescribe and enforce policies and procedures regarding changing 26

or adopting attendance boundaries that include the following components: 27 (a) A procedure for holding public meetings to discuss attendance 28

boundary changes or adoptions that allows public comments. 29 (b) A procedure to notify the parents or guardians of the students 30

affected. 31 (c) A procedure to notify the residents of the households affected by 32

the attendance boundary changes. 33 (d) A process for placing public meeting notices and proposed maps on 34

the school district's website for public review, if the school district 35 maintains a website. 36

(e) A formal process for presenting the attendance boundaries of the 37 affected area in public meetings that allows public comments. 38

(f) A formal process for notifying the residents and parents or 39 guardians of the affected area as to the decision of the governing board on 40 the school district's website, if the school district maintains a website. 41

(g) A formal process for updating attendance boundaries on the school 42 district's website within ninety days of an adopted boundary change. The 43 school district shall send a direct link to the school district's attendance 44 boundaries website to the department of real estate. 45

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(h) If the land that a school was built on was donated within the past 1 five years, a formal process to notify the entity that donated the land 2 affected by the decision of the governing board. 3

39. If the state board of education determines that the school 4 district has committed an overexpenditure as defined in section 15-107, 5 provide a copy of the fiscal management report submitted pursuant to section 6 15-107, subsection H on its website and make copies available to the public 7 on request. The school district shall comply with a request within five 8 business days after receipt. 9

40. Ensure that the contract for the superintendent is structured in a 10 manner in which up to twenty per cent PERCENT of the total annual salary 11 included for the superintendent in the contract is classified as performance 12 pay. This paragraph shall not be construed to require school districts to 13 increase total compensation for superintendents. Unless the school district 14 governing board votes to implement an alternative procedure at a public 15 meeting called for this purpose, the performance pay portion of the 16 superintendent's total annual compensation shall be determined as follows: 17

(a) Twenty-five per cent PERCENT of the performance pay shall be 18 determined based on the percentage of academic gain determined by the 19 department of education of pupils who are enrolled in the school district 20 compared to the academic gain achieved by the highest ranking of the fifty 21 largest school districts in this state. For the purposes of this 22 subdivision, the department of education shall determine academic gain by the 23 academic growth achieved by each pupil who has been enrolled at the same 24 school in a school district for at least five consecutive months measured 25 against that pupil's academic results in the 2008-2009 school year. For the 26 purposes of this subdivision, of the fifty largest school districts in this 27 state, the school district with pupils who demonstrate the highest statewide 28 percentage of overall academic gain measured against academic results for the 29 2008-2009 school year shall be assigned a score of 100 and the school 30 district with pupils who demonstrate the lowest statewide percentage of 31 overall academic gain measured against academic results for the 2008-2009 32 school year shall be assigned a score of 0. 33

(b) Twenty-five per cent PERCENT of the performance pay shall be 34 determined by the percentage of parents of pupils who are enrolled at the 35 school district who assign a letter grade of "A" to the school on a survey of 36 parental satisfaction with the school district. The parental satisfaction 37 survey shall be administered and scored by an independent entity that is 38 selected by the governing board and that demonstrates sufficient expertise 39 and experience to accurately measure the results of the survey. The parental 40 satisfaction survey shall use standard random sampling procedures and provide 41 anonymity and confidentiality to each parent who participates in the 42 survey. The letter grade scale used on the parental satisfaction survey 43 shall direct parents to assign one of the following letter grades: 44

(i) A letter grade of "A" if the school district is excellent. 45

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(ii) A letter grade of "B" if the school district is above average. 1 (iii) A letter grade of "C" if the school district is average. 2 (iv) A letter grade of "D" if the school district is below average. 3 (v) A letter grade of "F" if the school district is a failure. 4 (c) Twenty-five per cent PERCENT of the performance pay shall be 5

determined by the percentage of teachers who are employed at the school 6 district and who assign a letter grade of "A" to the school on a survey of 7 teacher satisfaction with the school. The teacher satisfaction survey shall 8 be administered and scored by an independent entity that is selected by the 9 governing board and that demonstrates sufficient expertise and experience to 10 accurately measure the results of the survey. The teacher satisfaction 11 survey shall use standard random sampling procedures and provide anonymity 12 and confidentiality to each teacher who participates in the survey. The 13 letter grade scale used on the teacher satisfaction survey shall direct 14 teachers to assign one of the following letter grades: 15

(i) A letter grade of "A" if the school district is excellent. 16 (ii) A letter grade of "B" if the school district is above average. 17 (iii) A letter grade of "C" if the school district is average. 18 (iv) A letter grade of "D" if the school district is below average. 19 (v) A letter grade of "F" if the school district is a failure. 20 (d) Twenty-five per cent PERCENT of the performance pay shall be 21

determined by other criteria selected by the governing board. 22 41. Maintain and store permanent public records of the school district 23

as required by law. Notwithstanding section 39-101, the standards adopted by 24 the Arizona state library, archives and public records for the maintenance 25 and storage of school district public records shall allow school districts to 26 elect to satisfy the requirements of this paragraph by maintaining and 27 storing these records either on paper or in an electronic format, or a 28 combination of a paper and electronic format. 29

42. Adopt in a public meeting and implement by school year 2013-2014 30 policies for principal evaluations. Before the adoption of principal 31 evaluation policies, the school district governing board shall provide 32 opportunities for public discussion on the proposed policies. The policies 33 shall describe: 34

(a) The principal evaluation instrument, including the four 35 performance classifications adopted by the governing board pursuant to 36 section 15-203, subsection A, paragraph 38. 37

(b) Alignment of professional development opportunities to the 38 principal evaluations. 39

(c) Incentives for principals in one of the two highest performance 40 classifications pursuant to section 15-203, subsection A, paragraph 38, which 41 may include: 42

(i) Multiyear contracts pursuant to section 15-503. 43 (ii) Incentives to work at schools that are assigned a letter grade of 44

D or F pursuant to section 15-241. 45

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(d) Transfer and contract processes for principals designated in the 1 lowest performance classification pursuant to section 15-203, subsection A, 2 paragraph 38. 3

43. PRESCRIBE AND ENFORCE POLICIES AND PROCEDURES FOR THE EMERGENCY 4 ADMINISTRATION OF NALOXONE HYDROCHLORIDE OR ANY OTHER OPIOID ANTAGONIST 5 APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION BY AN EMPLOYEE OF 6 A SCHOOL DISTRICT PURSUANT TO SECTION 36-2267. 7

B. Notwithstanding subsection A, paragraphs 7, 9 and 11 of this 8 section, the county school superintendent may construct, improve and furnish 9 school buildings or purchase or sell school sites in the conduct of an 10 accommodation school. 11

C. If any school district acquires real or personal property, whether 12 by purchase, exchange, condemnation, gift or otherwise, the governing board 13 shall pay to the county treasurer any taxes on the property that were unpaid 14 as of the date of acquisition, including penalties and interest. The lien 15 for unpaid delinquent taxes, penalties and interest on property acquired by a 16 school district: 17

1. Is not abated, extinguished, discharged or merged in the title to 18 the property. 19

2. Is enforceable in the same manner as other delinquent tax liens. 20 D. The governing board may not locate a school on property that is 21

less than one-fourth mile from agricultural land regulated pursuant to 22 section 3-365, except that the owner of the agricultural land may agree to 23 comply with the buffer zone requirements of section 3-365. If the owner 24 agrees in writing to comply with the buffer zone requirements and records the 25 agreement in the office of the county recorder as a restrictive covenant 26 running with the title to the land, the school district may locate a school 27 within the affected buffer zone. The agreement may include any stipulations 28 regarding the school, including conditions for future expansion of the school 29 and changes in the operational status of the school that will result in a 30 breach of the agreement. 31

E. A school district, its governing board members, its school council 32 members and its employees are immune from civil liability for the 33 consequences of adoption and implementation of policies and procedures 34 pursuant to subsection A of this section and section 15-342. This waiver 35 does not apply if the school district, its governing board members, its 36 school council members or its employees are guilty of gross negligence or 37 intentional misconduct. 38

F. A governing board may delegate in writing to a superintendent, 39 principal or head teacher the authority to prescribe procedures that are 40 consistent with the governing board's policies. 41

G. Notwithstanding any other provision of this title, a school 42 district governing board shall not take any action that would result in a 43 reduction of pupil square footage unless the governing board notifies the 44 school facilities board established by section 15-2001 of the proposed action 45

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and receives written approval from the school facilities board to take the 1 action. A reduction includes an increase in administrative space that 2 results in a reduction of pupil square footage or sale of school sites or 3 buildings, or both. A reduction includes a reconfiguration of grades that 4 results in a reduction of pupil square footage of any grade level. This 5 subsection does not apply to temporary reconfiguration of grades to 6 accommodate new school construction if the temporary reconfiguration does not 7 exceed one year. The sale of equipment that results in a reduction that 8 falls below the equipment requirements prescribed in section 15-2011, 9 subsection B is subject to commensurate withholding of school district 10 district additional assistance monies pursuant to the direction of the school 11 facilities board. Except as provided in section 15-342, paragraph 10, 12 proceeds from the sale of school sites, buildings or other equipment shall be 13 deposited in the school plant fund as provided in section 15-1102. 14

H. Subsections C through G of this section apply to a county board of 15 supervisors and a county school superintendent when operating and 16 administering an accommodation school. 17

Sec. 2. Section 32-1401, Arizona Revised Statutes, is amended to read: 18 32-1401. Definitions 19 In this chapter, unless the context otherwise requires: 20 1. "Active license" means a valid and existing license to practice 21

medicine. 22 2. "Adequate records" means legible medical records, produced by hand 23

or electronically, containing, at a minimum, sufficient information to 24 identify the patient, support the diagnosis, justify the treatment, 25 accurately document the results, indicate advice and cautionary warnings 26 provided to the patient and provide sufficient information for another 27 practitioner to assume continuity of the patient's care at any point in the 28 course of treatment. 29

3. "Advisory letter" means a nondisciplinary letter to notify a 30 licensee that either: 31

(a) While there is insufficient evidence to support disciplinary 32 action, the board believes that continuation of the activities that led to 33 the investigation may result in further board action against the licensee. 34

(b) The violation is a minor or technical violation that is not of 35 sufficient merit to warrant disciplinary action. 36

(c) While the licensee has demonstrated substantial compliance through 37 rehabilitation or remediation that has mitigated the need for disciplinary 38 action, the board believes that repetition of the activities that led to the 39 investigation may result in further board action against the licensee. 40

4. "Approved hospital internship, residency or clinical fellowship 41 program" means a program at a hospital that at the time the training occurred 42 was legally incorporated and that had a program that was approved for 43 internship, fellowship or residency training by the accreditation council for 44 graduate medical education, the association of American medical colleges, the 45

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royal college of physicians and surgeons of Canada or any similar body in the 1 United States or Canada approved by the board whose function is that of 2 approving hospitals for internship, fellowship or residency training. 3

5. "Approved school of medicine" means any school or college offering 4 a course of study that, on successful completion, results in the degree of 5 doctor of medicine and whose course of study has been approved or accredited 6 by an educational or professional association, recognized by the board, 7 including the association of American medical colleges, the association of 8 Canadian medical colleges or the American medical association. 9

6. "Board" means the Arizona medical board. 10 7. "Completed application" means that the applicant has supplied all 11

required fees, information and correspondence requested by the board on forms 12 and in a manner acceptable to the board. 13

8. "Direct supervision" means that a physician, physician assistant 14 licensed pursuant to chapter 25 of this title or nurse practitioner certified 15 pursuant to chapter 15 of this title is within the same room or office suite 16 as the medical assistant in order to be available for consultation regarding 17 those tasks the medical assistant performs pursuant to section 32-1456. 18

9. "Dispense" means the delivery by a doctor of medicine of a 19 prescription drug or device to a patient, except for samples packaged for 20 individual use by licensed manufacturers or repackagers of drugs, and 21 includes the prescribing, administering, packaging, labeling and security 22 necessary to prepare and safeguard the drug or device for delivery. 23

10. "Doctor of medicine" means a natural person holding a license, 24 registration or permit to practice medicine pursuant to this chapter. 25

11. "Full-time faculty member" means a physician WHO IS employed full 26 time as a faculty member while holding the academic position of assistant 27 professor or a higher position at an approved school of medicine. 28

12. "Health care institution" means any facility as defined in section 29 36-401, any person authorized to transact disability insurance, as defined in 30 title 20, chapter 6, article 4 or 5, any person who is issued a certificate 31 of authority pursuant to title 20, chapter 4, article 9 or any other 32 partnership, association or corporation that provides health care to 33 consumers. 34

13. "Immediate family" means the spouse, natural or adopted children, 35 father, mother, brothers and sisters of the doctor and the natural or adopted 36 children, father, mother, brothers and sisters of the doctor's spouse. 37

14. "Letter of reprimand" means a disciplinary letter that is issued by 38 the board and that informs the physician that the physician's conduct 39 violates state or federal law and may require the board to monitor the 40 physician. 41

15. "Limit" means taking a nondisciplinary action that alters the 42 physician's practice or professional activities if the board determines that 43 there is evidence that the physician is or may be mentally or physically 44 unable to safely engage in the practice of medicine. 45

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16. "Medical assistant" means an unlicensed person who meets the 1 requirements of section 32-1456, has completed an education program approved 2 by the board, assists in a medical practice under the supervision of a doctor 3 of medicine, physician assistant or nurse practitioner and performs delegated 4 procedures commensurate with the assistant's education and training but does 5 not diagnose, interpret, design or modify established treatment programs or 6 perform any functions that would violate any statute applicable to the 7 practice of medicine. 8

17. "Medical peer review" means: 9 (a) The participation by a doctor of medicine in the review and 10

evaluation of the medical management of a patient and the use of resources 11 for patient care. 12

(b) Activities relating to a health care institution's decision to 13 grant or continue privileges to practice at that institution. 14

18. "Medically incompetent" means a person who the board determines is 15 incompetent based on a variety of factors, including: 16

(a) A lack of sufficient medical knowledge or skills, or both, to a 17 degree likely to endanger the health of patients. 18

(b) When considered with other indications of medical incompetence, 19 failing to obtain a scaled score of at least seventy-five percent on the 20 written special purpose licensing examination. 21

19. "Medicine" means allopathic medicine as practiced by the recipient 22 of a degree of doctor of medicine. 23

20. "Office based surgery" means a medical procedure conducted in a 24 physician's office or other outpatient setting that is not part of a licensed 25 hospital or licensed ambulatory surgical center. 26

21. "Physician" means a doctor of medicine WHO IS licensed pursuant to 27 this chapter. 28

22. "Practice of medicine" means the diagnosis, the treatment or the 29 correction of or the attempt or the claim to be able to diagnose, treat or 30 correct any and all human diseases, injuries, ailments, infirmities, OR 31 deformities, physical or mental, real or imaginary, by any means, methods, 32 devices or instrumentalities, except as the same may be among the acts or 33 persons not affected by this chapter. The practice of medicine includes the 34 practice of medicine alone or the practice of surgery alone, or both. 35

23. "Restrict" means taking a disciplinary action that alters the 36 physician's practice or professional activities if the board determines that 37 there is evidence that the physician is or may be medically incompetent or 38 guilty of unprofessional conduct. 39

24. "Special purpose licensing examination" means an examination THAT 40 IS developed by the national board of medical examiners on behalf of the 41 federation of state medical boards for use by state licensing boards to test 42 the basic medical competence of physicians who are applying for licensure and 43 who have been in practice for a considerable period of time in another 44

H.B. 2355

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jurisdiction and to determine the competence of a physician WHO IS under 1 investigation by a state licensing board. 2

25. "Teaching hospital's accredited graduate medical education program" 3 means that the hospital is incorporated and has an internship, fellowship or 4 residency training program that is accredited by the accreditation council 5 for graduate medical education, the American medical association, the 6 association of American medical colleges, the royal college of physicians and 7 surgeons of Canada or a similar body in the United States or Canada THAT IS 8 approved by the board AND whose function is that of approving hospitals for 9 internship, fellowship or residency training. 10

26. "Teaching license" means a valid license to practice medicine as a 11 full-time faculty member of an approved school of medicine or a teaching 12 hospital's accredited graduate medical education program. 13

27. "Unprofessional conduct" includes the following, whether occurring 14 in this state or elsewhere: 15

(a) Violating any federal or state laws, rules or regulations 16 applicable to the practice of medicine. 17

(b) Intentionally disclosing a professional secret or intentionally 18 disclosing a privileged communication except as either act may otherwise be 19 required by law. 20

(c) False, fraudulent, deceptive or misleading advertising by a doctor 21 of medicine or the doctor's staff, employer or representative. 22

(d) Committing a felony, whether or not involving moral turpitude, or 23 a misdemeanor involving moral turpitude. In either case, conviction by any 24 court of competent jurisdiction or a plea of no contest is conclusive 25 evidence of the commission. 26

(e) Failing or refusing to maintain adequate records on a patient. 27 (f) Habitual intemperance in the use of alcohol or habitual substance 28

abuse. 29 (g) Using controlled substances except if prescribed by another 30

physician for use during a prescribed course of treatment. 31 (h) Prescribing or dispensing controlled substances to members of the 32

physician's immediate family. 33 (i) Prescribing, dispensing or administering schedule II controlled 34

substances as defined in section 36-2513 including amphetamines and similar 35 schedule II sympathomimetic drugs in the treatment of exogenous obesity for a 36 period in excess of thirty days in any one year, or the nontherapeutic use of 37 injectable amphetamines. 38

(j) Prescribing, dispensing or administering any controlled substance 39 or prescription-only drug for other than accepted therapeutic purposes. 40

(k) Signing a blank, undated or predated prescription form. 41 (l) Conduct that the board determines is gross malpractice, repeated 42

malpractice or any malpractice resulting in the death of a patient. 43 (m) Representing that a manifestly incurable disease or infirmity can 44

be permanently cured, or that any disease, ailment or infirmity can be cured 45

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by a secret method, procedure, treatment, medicine or device, if this is not 1 true. 2

(n) Refusing to divulge to the board on demand the means, method, 3 procedure, modality of treatment or medicine used in the treatment of a 4 disease, injury, ailment or infirmity. 5

(o) Action that is taken against a doctor of medicine by another 6 licensing or regulatory jurisdiction due to that doctor's mental or physical 7 inability to engage safely in the practice of medicine or the doctor's 8 medical incompetence or for unprofessional conduct as defined by that 9 jurisdiction and that corresponds directly or indirectly to an act of 10 unprofessional conduct prescribed by this paragraph. The action taken may 11 include refusing, denying, revoking or suspending a license by that 12 jurisdiction or a surrendering of a license to that jurisdiction, otherwise 13 limiting, restricting or monitoring a licensee by that jurisdiction or 14 placing a licensee on probation by that jurisdiction. 15

(p) Sanctions imposed by an agency of the federal government, 16 including restricting, suspending, limiting or removing a person from the 17 practice of medicine or restricting that person's ability to obtain financial 18 remuneration. 19

(q) Any conduct or practice that is or might be harmful or dangerous 20 to the health of the patient or the public. 21

(r) Violating a formal order, probation, consent agreement or 22 stipulation issued or entered into by the board or its executive director 23 under this chapter. 24

(s) Violating or attempting to violate, directly or indirectly, or 25 assisting in or abetting the violation of or conspiring to violate any 26 provision of this chapter. 27

(t) Knowingly making any false or fraudulent statement, written or 28 oral, in connection with the practice of medicine or if applying for 29 privileges or renewing an application for privileges at a health care 30 institution. 31

(u) Charging a fee for services not rendered or dividing a 32 professional fee for patient referrals among health care providers or health 33 care institutions or between these providers and institutions or a 34 contractual arrangement that has the same effect. This subdivision does not 35 apply to payments from a medical researcher to a physician in connection with 36 identifying and monitoring patients for a clinical trial regulated by the 37 United States food and drug administration. 38

(v) Obtaining a fee by fraud, deceit or misrepresentation. 39 (w) Charging or collecting a clearly excessive fee. In determining if 40

WHETHER a fee is clearly excessive, the board shall consider the fee or range 41 of fees customarily charged in the THIS state for similar services in light 42 of modifying factors such as the time required, the complexity of the service 43 and the skill requisite to perform the service properly. This subdivision 44 does not apply if there is a clear written contract for a fixed fee between 45

H.B. 2355

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the physician and the patient that has been entered into before the provision 1 of THE service. 2

(x) Fetal experiments conducted in violation of section 36-2302. 3 (y) The use of experimental forms of diagnosis and treatment without 4

adequate informed patient consent, and without conforming to generally 5 accepted experimental criteria, including protocols, detailed records, 6 periodic analysis of results and periodic review by a medical peer review 7 committee as approved by the federal UNITED STATES food and drug 8 administration or its successor agency. 9

(z) Engaging in sexual conduct with a current patient or with a former 10 patient within six months after the last medical consultation unless the 11 patient was the licensee's spouse at the time of the contact or, immediately 12 preceding the physician-patient relationship, was in a dating or engagement 13 relationship with the licensee. For the purposes of this subdivision, 14 "sexual conduct" includes: 15

(i) Engaging in or soliciting sexual relationships, whether consensual 16 or nonconsensual. 17

(ii) Making sexual advances, requesting sexual favors or engaging in 18 any other verbal conduct or physical contact of a sexual nature. 19

(iii) Intentionally viewing a completely or partially disrobed patient 20 in the course of treatment if the viewing is not related to patient diagnosis 21 or treatment under current practice standards. 22

(aa) Procuring or attempting to procure a license to practice medicine 23 or a license renewal by fraud, by misrepresentation or by knowingly taking 24 advantage of the mistake of another person or an agency. 25

(bb) Representing or claiming to be a medical specialist if this is 26 not true. 27

(cc) Maintaining a professional connection with or lending one's name 28 to enhance or continue the activities of an illegal practitioner of medicine. 29

(dd) Failing to furnish information in a timely manner to the board or 30 the board's investigators or representatives if legally requested by the 31 board. 32

(ee) Failing to allow properly authorized board personnel on demand to 33 examine and have access to documents, reports and records maintained by the 34 physician that relate to the physician's medical practice or medically 35 related activities. 36

(ff) Knowingly failing to disclose to a patient on a form that is 37 prescribed by the board and that is dated and signed by the patient or 38 guardian acknowledging that the patient or guardian has read and understands 39 that the doctor has a direct financial interest in a separate diagnostic or 40 treatment agency or in nonroutine goods or services that the patient is being 41 prescribed and if the prescribed treatment, goods or services are available 42 on a competitive basis. This subdivision does not apply to a referral by one 43 doctor of medicine to another doctor of medicine within a group of doctors of 44 medicine practicing together. 45

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(gg) Using chelation therapy in the treatment of arteriosclerosis or 1 as any other form of therapy, with the exception of treatment of heavy metal 2 poisoning, without: 3

(i) Adequate informed patient consent. 4 (ii) Conforming to generally accepted experimental criteria, including 5

protocols, detailed records, periodic analysis of results and periodic review 6 by a medical peer review committee. 7

(iii) Approval by the federal UNITED STATES food and drug 8 administration or its successor agency. 9

(hh) Prescribing, dispensing or administering anabolic-androgenic 10 steroids to a person for other than therapeutic purposes. 11

(ii) Lack of or inappropriate direction, collaboration or direct 12 supervision of a medical assistant or a licensed, certified or registered 13 health care provider employed by, supervised by or assigned to the physician. 14

(jj) Knowingly making a false or misleading statement to the board or 15 on a form required by the board or in a written correspondence, including 16 attachments, with the board. 17

(kk) Failing to dispense drugs and devices in compliance with article 18 6 of this chapter. 19

(ll) Conduct that the board determines is gross negligence, repeated 20 negligence or negligence resulting in harm to or the death of a patient. 21

(mm) The representation by a doctor of medicine or the doctor's staff, 22 employer or representative that the doctor is boarded or board certified if 23 this is not true or the standing is not current or without supplying the full 24 name of the specific agency, organization or entity granting this standing. 25

(nn) Refusing to submit to a body fluid examination or any other 26 examination known to detect the presence of alcohol or other drugs as 27 required by the board pursuant to section 32-1452 or pursuant to a board 28 investigation into a doctor of medicine's alleged substance abuse. 29

(oo) Failing to report in writing to the Arizona medical board or the 30 Arizona regulatory board of physician assistants any evidence that a doctor 31 of medicine or a physician assistant is or may be medically incompetent, 32 guilty of unprofessional conduct or mentally or physically unable to safely 33 practice medicine or to perform as a physician assistant. 34

(pp) The failure of a physician who is the chief executive officer, 35 the medical director or the medical chief of staff of a health care 36 institution to report in writing to the board that the hospital privileges of 37 a doctor of medicine have been denied, revoked, suspended, supervised or 38 limited because of actions by the doctor that appear to show that the doctor 39 is or may be medically incompetent, is or may be guilty of unprofessional 40 conduct or is or may be unable to engage safely in the practice of medicine. 41

(qq) Claiming to be a current member of the board, OR its staff or a 42 board medical consultant if this is not true. 43

(rr) Failing to make patient medical records in the physician's 44 possession promptly available to a physician assistant, a nurse practitioner, 45

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a person licensed pursuant to this chapter or a podiatrist, chiropractor, 1 naturopathic physician, osteopathic physician or homeopathic physician 2 licensed under chapter 7, 8, 14, 17 or 29 of this title on receipt of proper 3 authorization to do so from the patient, a minor patient's parent, the 4 patient's legal guardian or the patient's authorized representative or 5 failing to comply with title 12, chapter 13, article 7.1. 6

(ss) Prescribing, dispensing or furnishing a prescription medication 7 or a prescription-only device as defined in section 32-1901 to a person 8 unless the licensee first conducts a physical or mental health status 9 examination of that person or has previously established a doctor-patient 10 relationship. The physical or mental health status examination may be 11 conducted during a real-time telemedicine encounter with audio and video 12 capability if the telemedicine audio and video capability meets the elements 13 required by the centers for medicare and medicaid services, unless the 14 examination is for the purpose of obtaining a written certification from the 15 physician for the purposes of title 36, chapter 28.1. This subdivision does 16 not apply to: 17

(i) A physician who provides temporary patient supervision on behalf 18 of the patient's regular treating licensed health care professional or 19 provides a consultation requested by the patient's regular treating licensed 20 health care professional. 21

(ii) Emergency medical situations as defined in section 41-1831. 22 (iii) Prescriptions written to prepare a patient for a medical 23

examination. 24 (iv) Prescriptions written or prescription medications issued for use 25

by a county or tribal public health department for immunization programs or 26 emergency treatment or in response to an infectious disease investigation, 27 public health emergency, infectious disease outbreak or act of bioterrorism. 28 For the purposes of this item, "bioterrorism" has the same meaning prescribed 29 in section 36-781. 30

(v) Prescriptions written or antimicrobials dispensed to a contact as 31 defined in section 36-661 who is believed to have had significant exposure 32 risk as defined in section 36-661 with another person who has been diagnosed 33 with a communicable disease as defined in section 36-661 by the prescribing 34 or dispensing physician. 35

(vi) Prescriptions written or prescription medications issued for 36 administration of immunizations or vaccines listed in the United States 37 centers for disease control and prevention's recommended immunization 38 schedule to a household member of a patient. 39

(vii) Prescriptions for epinephrine auto-injectors written or 40 dispensed for a school district or charter school to be stocked for emergency 41 use pursuant to section 15-157. 42

(viii) Prescriptions written by a licensee through a telemedicine 43 program that is covered by the policies and procedures adopted by the 44 administrator of a hospital or outpatient treatment center. 45

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(ix) Prescriptions for naloxone hydrochloride or any other opiate 1 OPIOID antagonist approved by the United States food and drug administration 2 that are written or dispensed for use pursuant to section 36-2228 OR 36-2266. 3

(tt) Performing office based surgery using sedation in violation of 4 board rules. 5

(uu) Practicing medicine under a false or assumed name in this state. 6 Sec. 3. Section 32-1854, Arizona Revised Statutes, is amended to read: 7 32-1854. Definition of unprofessional conduct 8 For the purposes of this chapter, "unprofessional conduct" includes the 9

following acts, whether occurring in this state or elsewhere: 10 1. Knowingly betraying a professional secret or wilfully violating a 11

privileged communication except as either of these may otherwise be required 12 by law. This paragraph does not prevent members of the board from exchanging 13 information with the licensing and disciplinary boards of other states, 14 territories or districts of the United States or with foreign countries or 15 with osteopathic medical organizations located in this state or in any state, 16 district or territory of this country or in any foreign country. 17

2. Committing a felony or a misdemeanor involving moral turpitude. In 18 either case conviction by any court of competent jurisdiction is conclusive 19 evidence of the commission of the offense. 20

3. Practicing medicine while under the influence of alcohol, a 21 dangerous drug as defined in section 13-3401, narcotic or hypnotic drugs or 22 any substance that impairs or may impair the licensee's ability to safely and 23 skillfully practice medicine. 24

4. Being diagnosed by a physician licensed under this chapter or 25 chapter 13 of this title or a psychologist licensed under chapter 19.1 of 26 this title as excessively or illegally using alcohol or a controlled 27 substance. 28

5. Prescribing, dispensing or administering controlled substances or 29 prescription-only drugs for other than accepted therapeutic purposes. 30

6. Engaging in the practice of medicine in a manner that harms or may 31 harm a patient or that the board determines falls below the community 32 standard. 33

7. Impersonating another physician. 34 8. Acting or assuming to act as a member of the board if this is not 35

true. 36 9. Procuring, renewing or attempting to procure or renew a license to 37

practice osteopathic medicine by fraud or misrepresentation. 38 10. Having professional connection with or lending one's name to an 39

illegal practitioner of osteopathic medicine or any of the other healing 40 arts. 41

11. Representing that a manifestly incurable disease, injury, ailment 42 or infirmity can be permanently cured or that a curable disease, injury, 43 ailment or infirmity can be cured within a stated time, if this is not true. 44

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12. Failing to reasonably disclose and inform the patient or the 1 patient's representative of the method, device or instrumentality the 2 licensee uses to treat the patient's disease, injury, ailment or infirmity. 3

13. Refusing to divulge to the board on demand the means, method, 4 device or instrumentality used in the treatment of a disease, injury, ailment 5 or infirmity. 6

14. Charging a fee for services not rendered or dividing a 7 professional fee for patient referrals. This paragraph does not apply to 8 payments from a medical researcher to a physician in connection with 9 identifying and monitoring patients for clinical trial regulated by the 10 United States food and drug administration. 11

15. Knowingly making any false or fraudulent statement, written or 12 oral, in connection with the practice of medicine or when applying for or 13 renewing privileges at a health care institution or a health care program. 14

16. Advertising in a false, deceptive or misleading manner. 15 17. Representing or claiming to be an osteopathic medical specialist 16

if the physician has not satisfied the applicable requirements of this 17 chapter or board rules. 18

18. The denial of or disciplinary action against a license by any 19 other state, territory, district or country, unless it can be shown that this 20 occurred for reasons that did not relate to the person's ability to safely 21 and skillfully practice osteopathic medicine or to any act of unprofessional 22 conduct as provided in this section. 23

19. Any conduct or practice contrary to recognized standards of ethics 24 of the osteopathic medical profession. 25

20. Violating or attempting to violate, directly or indirectly, or 26 assisting in or abetting the violation of or conspiring to violate any of the 27 provisions of this chapter. 28

21. Failing or refusing to establish and maintain adequate records on 29 a patient as follows: 30

(a) If the patient is an adult, for at least six years after the last 31 date the licensee provided the patient with medical or health care services. 32

(b) If the patient is a child, either for at least three years after 33 the child's eighteenth birthday or for at least six years after the last date 34 the licensee provided that patient with medical or health care services, 35 whichever date occurs later. 36

22. Using controlled substances or prescription-only drugs unless they 37 are provided by a medical practitioner, as defined in section 32-1901, as 38 part of a lawful course of treatment. 39

23. Prescribing controlled substances to members of one's immediate 40 family unless there is no other physician available within fifty miles to 41 treat a member of the family and an emergency exists. 42

24. Nontherapeutic use of injectable amphetamines. 43 25. Violating a formal order, probation or a stipulation issued by the 44

board under this chapter. 45

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26. Charging or collecting an inappropriate fee. This paragraph does 1 not apply to a fee that is fixed in a written contract between the physician 2 and the patient and entered into before treatment begins. 3

27. Using experimental forms of therapy without adequate informed 4 patient consent or without conforming to generally accepted criteria and 5 complying with federal and state statutes and regulations governing 6 experimental therapies. 7

28. Failing to make patient medical records in the physician's 8 possession promptly available to a physician assistant, a nurse practitioner, 9 a person licensed pursuant to this chapter or a podiatrist, chiropractor, 10 naturopathic physician, physician or homeopathic physician licensed under 11 chapter 7, 8, 13, 14 or 29 of this title on receipt of proper authorization 12 to do so from the patient, a minor patient's parent, the patient's legal 13 guardian or the patient's authorized representative or failing to comply with 14 title 12, chapter 13, article 7.1. 15

29. Failing to allow properly authorized board personnel to have, on 16 presentation of a subpoena, access to any documents, reports or records that 17 are maintained by the physician and that relate to the physician's medical 18 practice or medically related activities pursuant to section 32-1855.01. 19

30. Signing a blank, undated or predated prescription form. 20 31. Obtaining a fee by fraud, deceit or misrepresentation. 21 32. Failing to report to the board an osteopathic physician and 22

surgeon who is or may be guilty of unprofessional conduct or is or may be 23 mentally or physically unable safely to engage in the practice of medicine. 24

33. Referring a patient to a diagnostic or treatment facility or 25 prescribing goods and services without disclosing that the physician has a 26 direct pecuniary interest in the facility, goods or services to which the 27 patient has been referred or prescribed. This paragraph does not apply to a 28 referral by one physician to another physician within a group of physicians 29 practicing together. 30

34. Lack of or inappropriate direction, collaboration or supervision 31 of a licensed, certified or registered health care provider or office 32 personnel employed by or assigned to the physician in the medical care of 33 patients. 34

35. Violating a federal law, a state law or a rule applicable to the 35 practice of medicine. 36

36. Prescribing or dispensing controlled substances or 37 prescription-only medications without establishing and maintaining adequate 38 patient records. 39

37. Failing to dispense drugs and devices in compliance with article 4 40 of this chapter. 41

38. Any conduct or practice that endangers a patient's or the public's 42 health or may reasonably be expected to do so. 43

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39. Any conduct or practice that impairs the licensee's ability to 1 safely and skillfully practice medicine or that may reasonably be expected to 2 do so. 3

40. With the exception of heavy metal poisoning, using chelation 4 therapy in the treatment of arteriosclerosis or as any other form of therapy 5 without adequate informed patient consent and without conforming to generally 6 accepted experimental criteria, including protocols, detailed records, 7 periodic analysis of results and periodic review by a medical peer review 8 committee. 9

41. Prescribing, dispensing or administering anabolic-androgenic 10 steroids to a person for other than therapeutic purposes. 11

42. Engaging in sexual conduct with a current patient or with a former 12 patient within six months after the last medical consultation unless the 13 patient was the licensee's spouse at the time of the contact or, immediately 14 preceding the physician-patient relationship, was in a dating or engagement 15 relationship with the licensee. For the purposes of this paragraph, "sexual 16 conduct" includes: 17

(a) Engaging in or soliciting sexual relationships, whether consensual 18 or nonconsensual. 19

(b) Making sexual advances, requesting sexual favors or engaging in 20 any other verbal conduct or physical conduct of a sexual nature. 21

43. Fetal experiments conducted in violation of section 36-2302. 22 44. Conduct that the board determines constitutes gross negligence, 23

repeated negligence or negligence that results in harm or death of a patient. 24 45. Conduct in the practice of medicine that evidences moral unfitness 25

to practice medicine. 26 46. Engaging in disruptive or abusive behavior in a professional 27

setting. 28 47. Failing to disclose to a patient that the licensee has a direct 29

financial interest in a prescribed treatment, good or service if the 30 treatment, good or service is available on a competitive basis. This 31 paragraph does not apply to a referral by one licensee to another licensee 32 within a group of licensees who practice together. A licensee meets the 33 disclosure requirements of this paragraph if all BOTH of the following are 34 true: 35

(a) The licensee makes the disclosure on a form prescribed by the 36 board. 37

(b) The patient or the patient's guardian or parent acknowledges by 38 signing the form that the licensee has disclosed the licensee's direct 39 financial interest. 40

48. Prescribing, dispensing or furnishing a prescription medication or 41 a prescription-only device to a person if the licensee has not conducted a 42 physical or mental health status examination of that person or has not 43 previously established a physician-patient relationship. The physical or 44 mental health status examination may be conducted during a real-time 45

H.B. 2355

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telemedicine encounter with audio and video capability if the telemedicine 1 audio and video capability meets the elements required by the centers for 2 medicare and medicaid services, unless the examination is for the purpose of 3 obtaining a written certification from the physician for the purposes of 4 title 36, chapter 28.1. This paragraph does not apply to: 5

(a) Emergencies. 6 (b) A licensee who provides patient care on behalf of the patient's 7

regular treating licensed health care professional or provides a consultation 8 requested by the patient's regular treating licensed health care 9 professional. 10

(c) Prescriptions written or antimicrobials dispensed to a contact as 11 defined in section 36-661 who is believed to have had significant exposure 12 risk as defined in section 36-661 with another person who has been diagnosed 13 with a communicable disease as defined in section 36-661 by the prescribing 14 or dispensing physician. 15

(d) Prescriptions for epinephrine auto-injectors written or dispensed 16 for a school district or charter school to be stocked for emergency use 17 pursuant to section 15-157. 18

(e) Prescriptions written by a licensee through a telemedicine program 19 that is covered by the policies and procedures adopted by the administrator 20 of a hospital or outpatient treatment center. 21

(f) Prescriptions for naloxone hydrochloride or any other opiate 22 OPIOID antagonist approved by the United States food and drug administration 23 that are written or dispensed for use pursuant to section 36-2228 OR 36-2266. 24

49. If a licensee provides medical care by computer, failing to 25 disclose the licensee's license number and the board's address and telephone 26 number. 27

Sec. 4. Section 32-1901.01, Arizona Revised Statutes, is amended to 28 read: 29

32-1901.01. Definition of unethical and unprofessional conduct; 30 permittees; licensees 31

A. In this chapter, unless the context otherwise requires, for the 32 purposes of disciplining a permittee, "unethical conduct" means the 33 following, whether occurring in this state or elsewhere: 34

1. Committing a felony, whether or not involving moral turpitude, or a 35 misdemeanor involving moral turpitude or any drug-related offense. In either 36 case, conviction by a court of competent jurisdiction or a plea of no contest 37 is conclusive evidence of the commission. 38

2. Committing an act that is substantially related to the 39 qualifications, functions or duties of a permittee and that demonstrates 40 either a lack of good moral character or an actual or potential unfitness to 41 hold a permit in light of the public's safety. 42

3. Working under the influence of alcohol or other drugs. 43 4. Addiction to the use of alcohol or other drugs to such a degree as 44

to render the permittee unfit to perform the permittee's employment duties. 45

H.B. 2355

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5. Violating a federal or state law or administrative rule relating to 1 the manufacture, sale or distribution of drugs, devices, poisons, hazardous 2 substances or precursor chemicals. 3

6. Violating a federal or state law or administrative rule relating to 4 marijuana, prescription-only drugs, narcotics, dangerous drugs, controlled 5 substances or precursor chemicals. 6

7. Violating state or federal reporting or recordkeeping requirements 7 on transactions relating to precursor chemicals. 8

8. Failing to report in writing to the board any evidence that a 9 pharmacist, pharmacy intern or graduate intern is or may be professionally 10 incompetent, is or may be guilty of unprofessional conduct or is or may be 11 mentally or physically unable safely to engage in the practice of pharmacy. 12

9. Failing to report in writing to the board any evidence that a 13 pharmacy technician or pharmacy technician trainee is or may be 14 professionally incompetent, is or may be guilty of unprofessional conduct or 15 is or may be mentally or physically unable safely to engage in the 16 permissible activities of a pharmacy technician or pharmacy technician 17 trainee. 18

10. Failing to report in writing to the board any evidence that appears 19 to show that a permittee or permittee's employee is or may be guilty of 20 unethical conduct, is or may be mentally or physically unable safely to 21 engage in employment duties related to manufacturing, selling, distributing 22 or dispensing of drugs, devices, poisons, hazardous substances, controlled 23 substances or precursor chemicals or is or may be in violation of this 24 chapter or a rule adopted under this chapter. 25

11. Intending to sell, transfer or distribute, or to offer for sale, 26 transfer or distribution, or selling, transferring, distributing or 27 dispensing or offering for sale, transfer or distribution an imitation 28 controlled substance, imitation over-the-counter drug or imitation 29 prescription-only drug as defined in section 13-3451. 30

12. Denial or discipline of a permittee's permit to manufacture, sell, 31 distribute or dispense drugs, devices, poisons, hazardous substances or 32 precursor chemicals in another jurisdiction and the permit was not 33 reinstated. 34

13. Committing an offense in another jurisdiction that if committed in 35 this state would be grounds for discipline. 36

14. Obtaining or attempting to obtain a permit or a permit renewal by 37 fraud, by misrepresentation or by knowingly taking advantage of the mistake 38 of another person or an agency. 39

15. Wilfully making a false report or record required by this chapter, 40 required by federal or state laws pertaining to drugs, devices, poisons, 41 hazardous substances or precursor chemicals or required for the payment for 42 drugs, devices, poisons or hazardous substances or precursor chemicals or for 43 services pertaining to such drugs or substances. 44

H.B. 2355

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16. Knowingly filing with the board any application, renewal or other 1 document that contains false or misleading information. 2

17. Providing false or misleading information or omitting material 3 information in any communication to the board or the board's employees or 4 agents. 5

18. Violating or attempting to violate, directly or indirectly, or 6 assisting in or abetting the violation of, or conspiring to violate, this 7 chapter. 8

19. Violating a formal order, terms of probation, a consent agreement 9 or a stipulation issued or entered into by the board or its executive 10 director pursuant to this chapter. 11

20. Failing to comply with a board subpoena or failing to comply in a 12 timely manner with a board subpoena without providing any explanation to the 13 board for not complying with the subpoena. 14

21. Failing to provide the board, OR its employees or agents or an 15 authorized federal or state official conducting a site investigation, 16 inspection or audit with access to any place for which a permit has been 17 issued or for which an application for a permit has been submitted. 18

22. Failing to notify the board of a change of ownership, management or 19 pharmacist in charge. 20

23. Failing to promptly produce on the request of the official 21 conducting a site investigation, inspection or audit any book, record or 22 document. 23

24. Overruling or attempting to overrule a pharmacist in matters of 24 pharmacy ethics or interpreting laws pertaining to the practice of pharmacy 25 or the distribution of drugs or devices. 26

25. Distributing premiums or rebates of any kind in connection with the 27 sale of prescription medication, other than to the prescription medication 28 recipient. 29

26. Failing to maintain effective controls against the diversion of 30 precursor chemicals to unauthorized persons or entities. 31

27. Fraudulently claiming to have performed a service. 32 28. Fraudulently charging a fee for a service. 33 29. Advertising drugs or devices, or services pertaining to drugs or 34

devices, in a manner that is untrue or misleading in any particular, and that 35 is known, or that by the exercise of reasonable care should be known, to be 36 untrue or misleading. 37

B. In this chapter, unless the context otherwise requires, for the 38 purposes of disciplining a pharmacist, pharmacy intern or graduate intern, 39 "unprofessional conduct" means the following, whether occurring in this state 40 or elsewhere: 41

1. Addiction to the use of alcohol or other drugs to such a degree as 42 to render the licensee unfit to practice the profession of pharmacy. 43

H.B. 2355

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2. Violating any federal or state law, rule or regulation relating to 1 the manufacture or distribution of drugs and devices or the practice of 2 pharmacy. 3

3. Dispensing a different drug or brand of drug in place of the drug 4 or brand of drug ordered or prescribed without the express permission in each 5 case of the orderer, or in the case of a prescription order, the medical 6 practitioner. The conduct prohibited by this paragraph does not apply to 7 substitutions authorized pursuant to section 32-1963.01. 8

4. Obtaining or attempting to obtain a license to practice pharmacy or 9 a license renewal by fraud, by misrepresentation or by knowingly taking 10 advantage of the mistake of another person or an agency. 11

5. Denial or discipline of a licensee's license to practice pharmacy 12 in another jurisdiction and the license was not reinstated. 13

6. Claiming professional superiority in compounding or dispensing 14 prescription orders. 15

7. Failing to comply with the mandatory continuing professional 16 pharmacy education requirements of sections 32-1936 and 32-1937 and rules 17 adopted by the board. 18

8. Committing a felony, whether or not involving moral turpitude, or a 19 misdemeanor involving moral turpitude or any drug-related offense. In either 20 case, conviction by a court of competent jurisdiction or a plea of no contest 21 is conclusive evidence of the commission. 22

9. Working under the influence of alcohol or other drugs. 23 10. Violating a federal or state law or administrative rule relating to 24

marijuana, prescription-only drugs, narcotics, dangerous drugs, controlled 25 substances or precursor chemicals when determined by the board or by 26 conviction in a federal or state court. 27

11. Knowingly dispensing a drug without a valid prescription order as 28 required pursuant to section 32-1968, subsection A. 29

12. Knowingly dispensing a drug on a prescription order that was issued 30 in the course of the conduct of business of dispensing drugs pursuant to 31 diagnosis by mail or the internet, unless the order was any of the following: 32

(a) Made by a physician who provides temporary patient supervision on 33 behalf of the patient's regular treating licensed health care professional or 34 provides a consultation requested by the patient's regular treating licensed 35 health care professional. 36

(b) Made in an emergency medical situation as defined in section 37 41-1831. 38

(c) Written to prepare a patient for a medical examination. 39 (d) Written or the prescription medications were issued for use by a 40

county or tribal public health department for immunization programs or 41 emergency treatment or in response to an infectious disease investigation, a 42 public health emergency, an infectious disease outbreak or an act of 43 bioterrorism. For the purposes of this subdivision, "bioterrorism" has the 44 same meaning prescribed in section 36-781. 45

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(e) Written or antimicrobials were dispensed by the prescribing or 1 dispensing physician to a contact as defined in section 36-661 who is 2 believed to have had significant exposure risk as defined in section 36-661 3 with another person who has been diagnosed with a communicable disease as 4 defined in section 36-661. 5

(f) Written or the prescription medications were issued for 6 administration of immunizations or vaccines listed in the United States 7 centers for disease control and prevention's recommended immunization 8 schedule to a household member of a patient. 9

(g) For epinephrine auto-injectors that are written or dispensed for a 10 school district or charter school and that are to be stocked for emergency 11 use pursuant to section 15-157. 12

(h) Written by a licensee through a telemedicine program that is 13 covered by the policies and procedures adopted by the administrator of a 14 hospital or outpatient treatment center. 15

(i) Written pursuant to a physical or mental health status examination 16 that was conducted during a real-time telemedicine encounter with audio and 17 video capability that meets the elements required by the centers for medicare 18 and medicaid services. 19

(j) For naloxone hydrochloride or any other opiate OPIOID antagonist 20 approved by the United States food and drug administration and written or 21 dispensed for use pursuant to section 36-2228 OR 36-2266. 22

13. Failing to report in writing to the board any evidence that a 23 pharmacist, pharmacy intern or graduate intern is or may be professionally 24 incompetent, is or may be guilty of unprofessional conduct or is or may be 25 mentally or physically unable to safely engage in the practice of pharmacy. 26

14. Failing to report in writing to the board any evidence that a 27 pharmacy technician or pharmacy technician trainee is or may be 28 professionally incompetent, is or may be guilty of unprofessional conduct or 29 is or may be mentally or physically unable to safely engage in the 30 permissible activities of a pharmacy technician or pharmacy technician 31 trainee. 32

15. Failing to report in writing to the board any evidence that a 33 permittee or a permittee's employee is or may be guilty of unethical conduct 34 or is or may be in violation of this chapter or a rule adopted under this 35 chapter. 36

16. Committing an offense in another jurisdiction that if committed in 37 this state would be grounds for discipline. 38

17. Knowingly filing with the board any application, renewal or other 39 document that contains false or misleading information. 40

18. Providing false or misleading information or omitting material 41 information in any communication to the board or the board's employees or 42 agents. 43

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19. Violating or attempting to violate, directly or indirectly, or 1 assisting in or abetting in the violation of, or conspiring to violate, this 2 chapter. 3

20. Violating a formal order, terms of probation, a consent agreement 4 or a stipulation issued or entered into by the board or its executive 5 director pursuant to this chapter. 6

21. Failing to comply with a board subpoena or failing to comply in a 7 timely manner with a board subpoena without providing any explanation to the 8 board for not complying with the subpoena. 9

22. Refusing without just cause to allow authorized agents of the board 10 to examine documents that are required to be kept pursuant to this chapter or 11 title 36. 12

23. Participating in an arrangement or agreement to allow a 13 prescription order or a prescription medication to be left at, picked up 14 from, accepted by or delivered to a place that is not licensed as a pharmacy. 15 This paragraph does not prohibit a pharmacist or a pharmacy from using an 16 employee or a common carrier to pick up prescription orders at or deliver 17 prescription medications to the office or home of a medical practitioner, the 18 residence of a patient or a patient's hospital. 19

24. Paying rebates or entering into an agreement for the payment of 20 rebates to a medical practitioner or any other person in the health care 21 field. 22

25. Providing or causing to be provided to a medical practitioner 23 prescription order blanks or forms bearing the pharmacist's or pharmacy's 24 name, address or other means of identification. 25

26. Fraudulently claiming to have performed a professional service. 26 27. Fraudulently charging a fee for a professional service. 27 28. Failing to report a change of the licensee's home address or 28

employer as required pursuant to section 32-1926. 29 29. Failing to report a change in the licensee's residency status as 30

required pursuant to section 32-1926.01. 31 C. In this chapter, unless the context otherwise requires, for the 32

purposes of disciplining a pharmacy technician or pharmacy technician 33 trainee, "unprofessional conduct" means the following, whether occurring in 34 this state or elsewhere: 35

1. Addiction to the use of alcohol or other drugs to such a degree as 36 to render the licensee unfit to perform the licensee's employment duties. 37

2. Violating a federal or state law or administrative rule relating to 38 the manufacture or distribution of drugs or devices. 39

3. Obtaining or attempting to obtain a pharmacy technician or pharmacy 40 technician trainee license or a pharmacy technician license renewal by fraud, 41 by misrepresentation or by knowingly taking advantage of the mistake of 42 another person or an agency. 43

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4. Denial or discipline of a licensee's license to practice as a 1 pharmacy technician in another jurisdiction and the license was not 2 reinstated. 3

5. Failing to comply with the mandatory continuing professional 4 education requirements of section 32-1925, subsection I and rules adopted by 5 the board. 6

6. Committing a felony, whether or not involving moral turpitude, or a 7 misdemeanor involving moral turpitude or any drug-related offense. In either 8 case, conviction by a court of competent jurisdiction or a plea of no contest 9 is conclusive evidence of the commission. 10

7. Working under the influence of alcohol or other drugs. 11 8. Violating a federal or state law or administrative rule relating to 12

marijuana, prescription-only drugs, narcotics, dangerous drugs, controlled 13 substances or precursor chemicals when determined by the board or by 14 conviction in a federal or state court. 15

9. Failing to report in writing to the board any evidence that a 16 pharmacist, pharmacy intern or graduate intern is or may be professionally 17 incompetent, is or may be guilty of unprofessional conduct or is or may be 18 mentally or physically unable to safely engage in the practice of pharmacy. 19

10. Failing to report in writing to the board any evidence that a 20 pharmacy technician or pharmacy technician trainee is or may be 21 professionally incompetent, is or may be guilty of unprofessional conduct or 22 is or may be mentally or physically unable to safely engage in the 23 permissible activities of a pharmacy technician or pharmacy technician 24 trainee. 25

11. Failing to report in writing to the board any evidence that a 26 permittee or a permittee's employee is or may be guilty of unethical conduct 27 or is or may be in violation of this chapter or a rule adopted under this 28 chapter. 29

12. Committing an offense in another jurisdiction that if committed in 30 this state would be grounds for discipline. 31

13. Knowingly filing with the board any application, renewal or other 32 document that contains false or misleading information. 33

14. Providing false or misleading information or omitting material 34 information in any communication to the board or the board's employees or 35 agents. 36

15. Violating or attempting to violate, directly or indirectly, or 37 assisting in or abetting in the violation of, or conspiring to violate, this 38 chapter. 39

16. Violating a formal order, terms of probation, a consent agreement 40 or a stipulation issued or entered into by the board or its executive 41 director pursuant to this chapter. 42

17. Failing to comply with a board subpoena or failing to comply in a 43 timely manner with a board subpoena without providing any explanation to the 44 board for not complying with the subpoena. 45

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18. Failing to report a change of the licensee's home address or 1 employer as required pursuant to section 32-1926. 2

19. Failing to report a change in the licensee's residency status as 3 required pursuant to section 32-1926.01. 4

Sec. 5. Title 32, chapter 18, article 3, Arizona Revised Statutes, is 5 amended by adding section 32-1979, to read: 6

32-1979. Pharmacists; dispensing opioid antagonists without a 7 prescription; board protocols; immunity 8

A. A PHARMACIST MAY DISPENSE WITHOUT A PRESCRIPTION, ACCORDING TO 9 PROTOCOLS ADOPTED BY THE BOARD, NALOXONE HYDROCHLORIDE OR ANY OTHER OPIOID 10 ANTAGONIST THAT IS APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION 11 FOR USE ACCORDING TO THE PROTOCOLS SPECIFIED BY BOARD RULE TO A PERSON WHO IS 12 AT RISK OF EXPERIENCING AN OPIOID-RELATED OVERDOSE OR TO A FAMILY MEMBER OR 13 COMMUNITY MEMBER WHO IS IN A POSITION TO ASSIST THAT PERSON. 14

B. A PHARMACIST WHO DISPENSES NALOXONE HYDROCHLORIDE OR ANY OTHER 15 OPIOID ANTAGONIST PURSUANT TO SUBSECTION A OF THIS SECTION SHALL: 16

1. DOCUMENT THE DISPENSING CONSISTENT WITH BOARD RULES. 17 2. INSTRUCT THE INDIVIDUAL TO WHOM THE OPIOID ANTAGONIST IS DISPENSED 18

TO SUMMON EMERGENCY SERVICES AS SOON AS PRACTICABLE EITHER BEFORE OR AFTER 19 ADMINISTERING THE OPIOID ANTAGONIST. 20

C. THIS SECTION DOES NOT AFFECT THE AUTHORITY OF A PHARMACIST TO FILL 21 OR REFILL A PRESCRIPTION FOR NALOXONE HYDROCHLORIDE OR ANY OTHER OPIOID 22 ANTAGONIST THAT IS APPROVED BY THE UNITED STATES FOOD AND DRUG 23 ADMINISTRATION. 24

D. A PHARMACIST WHO DISPENSES AN OPIOID ANTAGONIST PURSUANT TO THIS 25 SECTION IS IMMUNE FROM PROFESSIONAL LIABILITY AND CRIMINAL PROSECUTION FOR 26 ANY DECISION MADE, ACT OR OMISSION OR INJURY THAT RESULTS FROM THAT ACT IF 27 THE PHARMACIST ACTS WITH REASONABLE CARE AND IN GOOD FAITH, EXCEPT IN CASES 28 OF WANTON OR WILFUL NEGLECT. 29

Sec. 6. Section 36-2228, Arizona Revised Statutes, is amended to read: 30 36-2228. Administration of opioid antagonists; training; 31

immunity; designation by director 32 A. Pursuant to a standing order issued by a physician licensed 33

pursuant to title 32, chapter 13 or 17 or a nurse practitioner licensed 34 pursuant to title 32, chapter 15 and authorized by law to prescribe drugs, an 35 emergency medical care technician or a peace officer who is trained in the 36 administration of naloxone hydrochloride or any other opiate OPIOID 37 antagonist that is approved by the United States food and drug administration 38 and designated by the director may administer naloxone hydrochloride or 39 another opiate OPIOID antagonist to a person who the emergency medical care 40 technician or peace officer believes is suffering from an opiate-related 41 OPIOID-RELATED drug overdose. 42

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B. The department, in coordination with the Arizona peace officer 1 standards and training board, shall develop a training module for emergency 2 medical care technicians and peace officers that provides training regarding 3 the identification of a person suffering from an opiate-related 4 OPIOID-RELATED drug overdose and the use of naloxone hydrochloride or other 5 opiate OPIOID antagonists. 6

C. Physicians who are licensed pursuant to title 32, chapter 13 or 17 7 and who issue a standing order, nurse practitioners who are licensed pursuant 8 to title 32, chapter 15 and authorized by law to prescribe drugs and who 9 issue a standing order and emergency medical care technicians and peace 10 officers who administer naloxone hydrochloride or any other opiate OPIOID 11 antagonist pursuant to this section are immune from professional liability 12 and criminal prosecution for any decision made, act or omission or injury 13 that results from that act if those persons act with reasonable care and in 14 good faith, except in cases of wanton or wilful neglect. This section does 15 not create a duty to act or standard of care for peace officers to administer 16 an opiate OPIOID antagonist. 17

D. The director shall designate opiate OPIOID antagonists that may be 18 used pursuant to this section based on an evaluation of the opiate OPIOID 19 antagonist's safety and efficacy. 20

Sec. 7. Title 36, chapter 21.1, Arizona Revised Statutes, is amended 21 by adding article 4, to read: 22

ARTICLE 4. OPIOID ANTAGONISTS 23 36-2266. Prescribing and dispensing; immunity; good faith 24

statement; definition 25 A. A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17, 26

A NURSE PRACTITIONER LICENSED PURSUANT TO TITLE 32, CHAPTER 15 AND AUTHORIZED 27 BY LAW TO PRESCRIBE DRUGS OR ANY OTHER HEALTH PROFESSIONAL WHO HAS 28 PRESCRIBING AUTHORITY AND WHO IS ACTING WITHIN THE HEALTH PROFESSIONAL'S 29 SCOPE OF PRACTICE MAY, DIRECTLY OR BY A STANDING ORDER, PRESCRIBE OR DISPENSE 30 NALOXONE HYDROCHLORIDE OR ANY OTHER OPIOID ANTAGONIST THAT IS APPROVED BY THE 31 UNITED STATES FOOD AND DRUG ADMINISTRATION FOR USE ACCORDING TO THE PROTOCOL 32 SPECIFIED BY THE PHYSICIAN, NURSE PRACTITIONER OR OTHER HEALTH PROFESSIONAL 33 TO A PERSON WHO IS AT RISK OF EXPERIENCING AN OPIOID-RELATED OVERDOSE, TO A 34 FAMILY MEMBER OF THAT PERSON, TO A COMMUNITY ORGANIZATION THAT PROVIDES 35 SERVICES TO PERSONS WHO ARE AT RISK OF AN OPIOID-RELATED OVERDOSE OR TO ANY 36 OTHER PERSON WHO IS IN A POSITION TO ASSIST A PERSON WHO IS AT RISK OF 37 EXPERIENCING AN OPIOID-RELATED OVERDOSE. 38

B. A PHYSICIAN, NURSE PRACTITIONER OR OTHER HEALTH PROFESSIONAL WHO 39 PRESCRIBES OR DISPENSES NALOXONE HYDROCHLORIDE OR ANY OTHER OPIOID ANTAGONIST 40 PURSUANT TO SUBSECTION A OF THIS SECTION, SHALL INSTRUCT THE INDIVIDUAL TO 41 WHOM THE OPIOID ANTAGONIST IS DISPENSED TO SUMMON EMERGENCY SERVICES AS SOON 42 AS PRACTICABLE EITHER BEFORE OR AFTER ADMINISTERING THE OPIOID ANTAGONIST. 43

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C. EXCEPT IN CASES OF GROSS NEGLIGENCE, WILFUL MISCONDUCT OR 1 INTENTIONAL WRONGDOING, A PHYSICIAN, NURSE PRACTITIONER OR OTHER HEALTH 2 PROFESSIONAL WHO IN GOOD FAITH PRESCRIBES OR DISPENSES AN OPIOID ANTAGONIST 3 PURSUANT TO SUBSECTION A OF THIS SECTION IS IMMUNE FROM PROFESSIONAL 4 LIABILITY AND CRIMINAL PROSECUTION FOR ANY DECISION MADE, ACT OR OMISSION OR 5 INJURY THAT RESULTS FROM THAT ACT IF THE PHYSICIAN, NURSE PRACTITIONER OR 6 OTHER HEALTH PROFESSIONAL ACTS WITH REASONABLE CARE AND IN GOOD FAITH. 7

D. BEFORE PRESCRIBING AN OPIOID ANTAGONIST PURSUANT TO SUBSECTION A OF 8 THIS SECTION, A PHYSICIAN, NURSE PRACTITIONER OR OTHER HEALTH PROFESSIONAL 9 MAY REQUIRE THE PERSON RECEIVING THE PRESCRIPTION, AS AN INDICATOR OF GOOD 10 FAITH, TO PROVIDE IN WRITING A FACTUAL BASIS FOR A REASONABLE CONCLUSION THAT 11 THE PERSON OR ENTITY MEETS THE DESCRIPTION IN SUBSECTION A OF THIS SECTION OF 12 A PERSON OR ENTITY WHO IS ABLE TO RECEIVE AN OPIOID ANTAGONIST UNDER THIS 13 SECTION. 14

E. FOR THE PURPOSES OF THIS SECTION, "PERSON" INCLUDES AN EMPLOYEE OF 15 A SCHOOL DISTRICT OR CHARTER SCHOOL WHO IS ACTING IN THE PERSON'S OFFICIAL 16 CAPACITY. 17

36-2267. Administration of opioid antagonist; exemption from 18 civil liability; definition 19

A. A PERSON MAY ADMINISTER AN OPIOID ANTAGONIST THAT IS PRESCRIBED OR 20 DISPENSED PURSUANT TO SECTION 32-1979 OR 36-2266 IN ACCORDANCE WITH THE 21 PROTOCOL SPECIFIED BY THE PHYSICIAN, NURSE PRACTITIONER, PHARMACIST OR OTHER 22 HEALTH PROFESSIONAL TO A PERSON WHO IS EXPERIENCING AN OPIOID-RELATED 23 OVERDOSE. 24

B. A PERSON WHO IN GOOD FAITH AND WITHOUT COMPENSATION ADMINISTERS AN 25 OPIOID ANTAGONIST TO A PERSON WHO IS EXPERIENCING AN OPIOID-RELATED OVERDOSE 26 IS NOT LIABLE FOR ANY CIVIL OR OTHER DAMAGES AS THE RESULT OF ANY ACT OR 27 OMISSION BY THE PERSON RENDERING THE CARE OR AS THE RESULT OF ANY ACT OR 28 FAILURE TO ACT TO ARRANGE FOR FURTHER MEDICAL TREATMENT OR CARE FOR THE 29 PERSON EXPERIENCING THE OVERDOSE, UNLESS THE PERSON WHILE RENDERING THE CARE 30 ACTS WITH GROSS NEGLIGENCE, WILFUL MISCONDUCT OR INTENTIONAL WRONGDOING. 31

C. FOR THE PURPOSES OF THIS SECTION, "PERSON" INCLUDES AN EMPLOYEE OF 32 A SCHOOL DISTRICT OR CHARTER SCHOOL WHO IS ACTING IN THE PERSON'S OFFICIAL 33 CAPACITY. 34