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SSHB 268: "An Act relating to the prescription of opioids; relating to the Department of Health and Social Services; relating to the practice of dentistry; relating to the practice of medicine; relating to the practice of podiatry; relating to the practice of osteopathy; relating to the practice of nursing; and relating to the practice of optometry."

00                  SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 268                                                              
01 "An Act relating to the prescription of opioids; relating to the Department of Health and                               
02 Social Services; relating to the practice of dentistry; relating to the practice of medicine;                           
03 relating to the practice of podiatry; relating to the practice of osteopathy; relating to the                           
04 practice of nursing; and relating to the practice of optometry."                                                        
05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
06    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
07 to read:                                                                                                                
08       SHORT TITLE. This Act may be known as the Consumer Advisory on Potential                                          
09 Heroin Addiction from Opioid Use Act.                                                                                   
10    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
11 read:                                                                                                                   
12       OPIOID ADDICTION: LEGISLATIVE FINDINGS. The legislature finds that                                                
13            (1)  the state has a considerable moral, public health, and financial interest in                            
14 reducing opioid and heroin addiction in the state;                                                                      
01            (2)  it is medically documented that opioid prescription drugs are addictive and                             
02 that opioid addiction is harmful and expensive to address;                                                              
03            (3)  as of 2017, accepted evidence shows that a significant percentage of                                    
04 people who become addicted to heroin were initially addicted to opioid prescription drugs;                              
05            (4)  opioid prescription drug and heroin addiction interferes with an addict's                               
06 ability to work and provide for a stable and healthy family;                                                            
07            (5)  the state's opioid epidemic damages the health of families and children and                             
08 affects the chances that a child will receive a healthy upbringing;                                                     
09            (6)  the opioid epidemic increases crime in the state, and the presence of heroin                            
10 dealers in the state poses a public safety threat;                                                                      
11 (7)  the opioid epidemic costs the state and other entities excessive amounts of                                        
12 money, which is especially problematic in lean budget times;                                                            
13 (8)  policies that reduce the number of people who become addicted to opioids                                           
14 and heroin will better serve citizens of the state and foster healthier families;                                       
15 (9)  patients are not always advised of the addictive effects of opioid                                                 
16 prescription drug use or that opioid prescription drug use may lead to opioid prescription drug                         
17 and heroin addiction; and                                                                                               
18 (10)  requiring medical providers to inform patients of the risks associated with                                       
19 opioid prescription drug use can help to reduce opioid prescription drug and heroin addictions                          
20 in the state.                                                                                                           
21    * Sec. 3. AS 08.36.315 is amended to read:                                                                         
22 Sec. 08.36.315. Grounds for discipline, suspension, or revocation of license.                                         
23 The board may revoke or suspend the license of a dentist, or may reprimand, censure,                                    
24       or discipline a dentist, or both, if the board finds, after a hearing, that the dentist                           
25 (1)  used or knowingly cooperated in deceit, fraud, or intentional                                                      
26       misrepresentation to obtain a license;                                                                            
27 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                                  
28 course of providing or billing for professional dental services or engaging in                                          
29       professional activities;                                                                                          
30 (3)  advertised professional dental services in a false or misleading                                                   
31       manner;                                                                                                           
01                 (4)  received compensation for referring a person to another dentist or                                 
02       dental practice;                                                                                                  
03                 (5)  has been convicted of a felony or other crime that affects the                                     
04       dentist's ability to continue to practice dentistry competently and safely;                                       
05                 (6)  engaged in the performance of patient care, or permitted the                                       
06       performance of patient care by persons under the dentist's supervision, regardless of                             
07       whether actual injury to the patient occurred,                                                                    
08                      (A)  that did not conform to minimum professional standards of                                     
09            dentistry; or                                                                                                
10 (B)  when the dentist, or a person under the supervision of the                                                         
11 dentist, did not have the permit, registration, or certificate required under                                           
12            AS 08.32 or this chapter;                                                                                    
13 (7)  failed to comply with this chapter, with a regulation adopted under                                                
14       this chapter, or with an order of the board;                                                                      
15                 (8)  continued to practice after becoming unfit due to                                                  
16                      (A)  professional incompetence;                                                                    
17 (B)  addiction or dependence on alcohol or other drugs that                                                             
18            impair the dentist's ability to practice safely;                                                             
19                      (C)  physical or mental disability;                                                                
20 (9)  engaged in lewd or immoral conduct in connection with the                                                          
21       delivery of professional service to patients;                                                                     
22 (10)  permitted a dental hygienist or dental assistant who is employed                                                  
23 by the dentist or working under the dentist's supervision to perform a dental procedure                                 
24       in violation of AS 08.32.110 or AS 08.36.346;                                                                     
25 (11)  failed to report to the board a death that occurred on the premises                                               
26       used for the practice of dentistry within 48 hours;                                                               
27 (12)  falsified or destroyed patient or facility records or failed to                                                   
28 maintain a patient or facility record for at least seven years after the date the record                                
29       was created;                                                                                                      
30 (13)  prescribed or dispensed an opioid in excess of the maximum                                                        
31       dosage authorized under AS 08.36.355; [OR]                                                                        
01                 (14)  procured, sold, prescribed, or dispensed drugs in violation of a                                  
02       law, regardless of whether there has been a criminal action or harm to the patient; or                        
03                 (15)  habitually and without good cause failed to provide oral and                                  
04       written information on opioids under AS 08.36.357 before prescribing an opioid                                
05       to a patient.                                                                                                 
06    * Sec. 4. AS 08.36 is amended by adding a new section to read:                                                     
07 Sec. 08.36.357. Opioid prescription information; relationship to causes of                                            
08 action. (a) Before a licensee prescribes an opioid to a patient, the licensee or an agent                             
09 of the licensee shall provide to the patient or the person authorized to make health care                               
10       decisions for the patient                                                                                         
11 (1)  an oral statement which, in the licensee's or agent's own words,                                                   
12       includes                                                                                                          
13                      (A)  the licensee's reasons for prescribing the opioid;                                            
14                      (B)  any reasonable non-opioid alternatives to the prescription;                                   
15                      (C)  information that                                                                              
16 (i)  the prescription could potentially lead to opioid                                                                  
17                 addiction;                                                                                              
18 (ii)  the danger of opioid addiction can begin to increase                                                              
19                 if a prescription is extended over longer periods of time; and                                          
20 (iii)  heroin and opioid addiction pose a potentially                                                                   
21 lifelong health danger, and many heroin users begin their use after                                                     
22                 becoming addicted to opioid prescription drugs; and                                                     
23 (2)  a written statement, which may include graphics, prepared by the                                                   
24 Department of Health and Social Services that provides appropriate information                                          
25       conveying the potential addictive and health dangers of opioids.                                                  
26 (b)  The requirements under (a) of this section do not apply to a patient                                               
27       receiving                                                                                                         
28                 (1)  hospice care from a licensed provider or facility; and                                             
29                 (2)  substance abuse or opioid dependence treatment.                                                    
30 (c)  The Department of Health and Social Services shall provide access on the                                           
31 department's Internet website to a printable version of the written statement a licensee                                
01       is required to distribute under (a)(2) of this section.                                                           
02            (d)  Nothing in this section creates a new cause of action or affects an existing                            
03       cause of action.                                                                                                  
04    * Sec. 5. AS 08.64.326(a) is amended to read:                                                                      
05            (a)  The board may impose a sanction if the board finds after a hearing that a                               
06       licensee                                                                                                          
07                 (1)  secured a license through deceit, fraud, or intentional                                            
08       misrepresentation;                                                                                                
09                 (2)  engaged in deceit, fraud, or intentional misrepresentation while                                   
10       providing professional services or engaging in professional activities;                                           
11                 (3)  advertised professional services in a false or misleading manner;                                  
12 (4)  has been convicted, including conviction based on a guilty plea or                                                 
13       plea of nolo contendere, of                                                                                       
14 (A)  a class A or unclassified felony or a crime in another                                                             
15 jurisdiction with elements similar to a class A or unclassified felony in this                                          
16            jurisdiction;                                                                                                
17 (B)  a class B or class C felony or a crime in another jurisdiction                                                     
18 with elements similar to a class B or class C felony in this jurisdiction if the                                        
19 felony or other crime is substantially related to the qualifications, functions, or                                     
20            duties of the licensee; or                                                                                   
21 (C)  a crime involving the unlawful procurement, sale,                                                                  
22            prescription, or dispensing of drugs;                                                                        
23 (5)  has procured, sold, prescribed, or dispensed drugs in violation of a                                               
24       law regardless of whether there has been a criminal action or harm to the patient;                                
25 (6)  intentionally or negligently permitted the performance of patient                                                  
26 care by persons under the licensee's supervision that does not conform to minimum                                       
27       professional standards even if the patient was not injured;                                                       
28 (7)  failed to comply with this chapter, a regulation adopted under this                                                
29       chapter, or an order of the board;                                                                                
30                 (8)  has demonstrated                                                                                   
31 (A)  professional incompetence, gross negligence, or repeated                                                           
01            negligent conduct; the board may not base a finding of professional                                          
02            incompetence solely on the basis that a licensee's practice is unconventional or                             
03            experimental in the absence of demonstrable physical harm to a patient;                                      
04                      (B)  addiction to, severe dependency on, or habitual overuse of                                    
05            alcohol or other drugs that impairs the licensee's ability to practice safely;                               
06                      (C)  unfitness because of physical or mental disability;                                           
07 (9)  engaged in unprofessional conduct, in sexual misconduct, or in                                                     
08 lewd or immoral conduct in connection with the delivery of professional services to                                     
09 patients; in this paragraph, "sexual misconduct" includes sexual contact, as defined by                                 
10 the board in regulations adopted under this chapter, or attempted sexual contact with a                                 
11 patient outside the scope of generally accepted methods of examination or treatment of                                  
12 the patient, regardless of the patient's consent or lack of consent, during the term of the                             
13 physician-patient relationship, as defined by the board in regulations adopted under                                    
14 this chapter, unless the patient was the licensee's spouse at the time of the contact or,                               
15 immediately preceding the physician-patient relationship, was in a dating, courtship,                                   
16       or engagement relationship with the licensee;                                                                     
17                 (10)  has violated AS 18.16.010;                                                                        
18 (11)  has violated any code of ethics adopted by regulation by the                                                      
19       board;                                                                                                            
20 (12)  has denied care or treatment to a patient or person seeking                                                       
21 assistance from the physician if the only reason for the denial is the failure or refusal                               
22       of the patient to agree to arbitrate as provided in AS 09.55.535(a);                                              
23 (13)  has had a license or certificate to practice medicine in another                                                  
24 state or territory of the United States, or a province or territory of Canada, denied,                                  
25 suspended, revoked, surrendered while under investigation for an alleged violation,                                     
26 restricted, limited, conditioned, or placed on probation unless the denial, suspension,                                 
27 revocation, or other action was caused by the failure of the licensee to pay fees to that                               
28       state, territory, or province; [OR]                                                                               
29 (14)  prescribed or dispensed an opioid in excess of the maximum                                                        
30       dosage authorized under AS 08.64.363; or                                                                      
31 (15)  habitually and without good cause failed to provide oral and                                                  
01       written information on opioids under AS 08.64.371 before prescribing an opioid                                
02       to a patient.                                                                                                 
03    * Sec. 6. AS 08.64 is amended by adding a new section to read:                                                     
04 Sec. 08.64.371. Opioid prescription information; relationship to causes of                                            
05 action. (a) Before a licensee prescribes an opioid to a patient, the licensee or an agent                             
06 of the licensee shall provide to the patient or the person authorized to make health care                               
07       decisions for the patient                                                                                         
08                 (1)  an oral statement which, in the licensee's or agent's own words,                                   
09       includes                                                                                                          
10                      (A)  the licensee's reasons for prescribing the opioid;                                            
11 (B)  any reasonable non-opioid alternatives to the prescription;                                                        
12            and                                                                                                          
13                      (C)  information that                                                                              
14 (i)  the prescription could potentially lead to opioid                                                                  
15                 addiction;                                                                                              
16 (ii)  the danger of opioid addiction can begin to increase                                                              
17                 if a prescription is extended over longer periods of time;                                              
18 (iii)  heroin and opioid addiction pose a potentially                                                                   
19 lifelong health danger, and many heroin users begin their use after                                                     
20                 becoming addicted to opioid prescription drugs; and                                                     
21 (2)  a written statement, which may include graphics, prepared by the                                                   
22 Department of Health and Social Services that provides appropriate information                                          
23       conveying the potential addictive and health dangers of opioids.                                                  
24 (b)  The requirements under (a) of this section do not apply to a patient                                               
25       receiving                                                                                                         
26                 (1)  hospice care from a licensed provider or facility; and                                             
27                 (2)  substance abuse or opioid dependence treatment.                                                    
28 (c)  The Department of Health and Social Services shall provide access on the                                           
29 department's Internet website to a printable version of the written statement a licensee                                
30       is required to distribute under (a)(2) of this section.                                                           
31 (d)  Nothing in this section creates a new cause of action or affects an existing                                       
01       cause of action.                                                                                                  
02    * Sec. 7. AS 08.68.270 is amended to read:                                                                         
03            Sec. 08.68.270. Grounds for denial, suspension, or revocation. The board                                   
04       may deny, suspend, or revoke the license of a person who                                                          
05                 (1)  has obtained or attempted to obtain a license to practice nursing by                               
06       fraud or deceit;                                                                                                  
07                 (2)  has been convicted of a felony or other crime if the felony or other                               
08 crime is substantially related to the qualifications, functions, or duties of the licensee;                             
09 (3)  habitually abuses alcoholic beverages, or illegally uses controlled                                                
10       substances;                                                                                                       
11 (4)  has impersonated a registered, advanced practice registered, or                                                    
12       practical nurse;                                                                                                  
13 (5)  has intentionally or negligently engaged in conduct that has                                                       
14       resulted in a significant risk to the health or safety of a client or in injury to a client;                      
15 (6)  practices or attempts to practice nursing while afflicted with                                                     
16 physical or mental illness, deterioration, or disability that interferes with the                                       
17       individual's performance of nursing functions;                                                                    
18 (7)  is guilty of unprofessional conduct as defined by regulations                                                      
19       adopted by the board;                                                                                             
20 (8)  has wilfully or repeatedly violated a provision of this chapter or                                                 
21       regulations adopted under this chapter or AS 08.01;                                                               
22                 (9)  is professionally incompetent;                                                                     
23 (10)  denies care or treatment to a patient or person seeking assistance                                                
24 if the sole reason for the denial is the failure or refusal of the patient or person seeking                            
25       assistance to agree to arbitrate as provided in AS 09.55.535(a);                                                  
26 (11)  has prescribed or dispensed an opioid in excess of the maximum                                                    
27       dosage authorized under AS 08.68.705; [OR]                                                                        
28 (12)  has procured, sold, prescribed, or dispensed drugs in violation of a                                              
29       law, regardless of whether there has been a criminal action or harm to the patient; or                        
30 (13)  has habitually and without good cause failed to provide oral                                                  
31 and written information on opioids under AS 08.68.710 before prescribing an                                         
01       opioid to a patient.                                                                                          
02    * Sec. 8. AS 08.68 is amended by adding a new section to article 6 to read:                                        
03 Sec. 08.68.710. Opioid prescription information; relationship to causes of                                            
04 action. (a) Before an advanced practice registered nurse prescribes an opioid to a                                    
05 patient, the advanced practice registered nurse or an agent of the advanced practice                                    
06 registered nurse shall provide to the patient or the person authorized to make health                                   
07       care decisions for the patient                                                                                    
08                 (1)  an oral statement which, in the advanced practice registered nurse's                               
09       or agent's own words, includes                                                                                    
10 (A)  the advanced practice registered nurse's reasons for                                                               
11            prescribing the opioid;                                                                                      
12 (B)  any reasonable non-opioid alternatives to the prescription;                                                        
13            and                                                                                                          
14                      (C)  information that                                                                              
15 (i)  the prescription could potentially lead to opioid                                                                  
16                 addiction;                                                                                              
17 (ii)  the danger of opioid addiction can begin to increase                                                              
18                 if a prescription is extended over longer periods of time;                                              
19 (iii)  heroin and opioid addiction pose a potentially                                                                   
20 lifelong health danger, and many heroin users begin their use after                                                     
21                 becoming addicted to opioid prescription drugs; and                                                     
22 (2)  a written statement, which may include graphics, prepared by the                                                   
23 Department of Health and Social Services that provides appropriate information                                          
24       conveying the potential addictive and health dangers of opioids.                                                  
25 (b)  The requirements under (a) of this section do not apply to a patient                                               
26       receiving                                                                                                         
27                 (1)  hospice care from a licensed provider or facility; and                                             
28                 (2)  substance abuse or opioid dependence treatment.                                                    
29 (c)  The Department of Health and Social Services shall provide access on the                                           
30 department's Internet website to a printable version of the written statement an                                        
31       advanced practice registered nurse is required to distribute under (a)(2) of this section.                        
01            (d)  Nothing in this section creates a new cause of action or affects an existing                            
02       cause of action.                                                                                                  
03    * Sec. 9. AS 08.72.240 is amended to read:                                                                         
04            Sec. 08.72.240. Grounds for imposition of disciplinary sanctions. The board                                
05 may impose disciplinary sanctions when the board finds after a hearing that a licensee                                  
06 (1)  secured a license through deceit, fraud, or intentional                                                            
07       misrepresentation;                                                                                                
08                 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                  
09       course of providing professional services or engaging in professional activities;                                 
10                 (3)  advertised professional services in a false or misleading manner;                                  
11 (4)  has been convicted of a felony or other crime that affects the                                                     
12       licensee's ability to continue to practice competently and safely;                                                
13 (5)  intentionally or negligently engaged in or permitted the                                                           
14 performance of patient care by persons under the licensee's supervision that does not                                   
15 conform to minimum professional standards regardless of whether actual injury to the                                    
16       patient occurred;                                                                                                 
17 (6)  failed to comply with this chapter, with a regulation adopted under                                                
18       this chapter, or with an order of the board;                                                                      
19                 (7)  continued to practice after becoming unfit due to                                                  
20                      (A)  professional incompetence;                                                                    
21 (B)  failure to keep informed of or use current professional                                                            
22            theories or practices;                                                                                       
23 (C)  addiction or severe dependency on alcohol or other drugs                                                           
24            that impairs the licensee's ability to practice safely;                                                      
25                      (D)  physical or mental disability;                                                                
26 (8)  engaged in lewd or immoral conduct in connection with the                                                          
27       delivery of professional service to patients;                                                                     
28 (9)  failed to refer a patient to a physician after ascertaining the                                                    
29       presence of ocular or systemic conditions requiring management by a physician;                                    
30 (10)  prescribed or dispensed an opioid in excess of the maximum                                                        
31       dosage authorized under AS 08.72.276;                                                                             
01                 (11)  procured, sold, prescribed, or dispensed drugs in violation of a                                  
02       law, regardless of whether there has been a criminal action or harm to the patient; or                        
03                 (12)  habitually and without good cause failed to provide oral and                                  
04       written information on opioids under AS 08.72.277 before prescribing an opioid                                
05       to a patient.                                                                                                 
06    * Sec. 10. AS 08.72 is amended by adding a new section to read:                                                    
07 Sec. 08.72.277. Opioid prescription information; relationship to causes of                                            
08 action. (a) Before a licensee prescribes an opioid to a patient, the licensee or an agent                             
09 of the licensee shall provide to the patient or the person authorized to make health care                               
10       decisions for the patient                                                                                         
11 (1)  an oral statement which, in the licensee's or agent's own words,                                                   
12       includes                                                                                                          
13                      (A)  the licensee's reasons for prescribing the opioid;                                            
14 (B)  any reasonable non-opioid alternatives to the prescription;                                                        
15            and                                                                                                          
16                      (C)  information that                                                                              
17 (i)  the prescription could potentially lead to opioid                                                                  
18                 addiction;                                                                                              
19 (ii)  the danger of opioid addiction can begin to increase                                                              
20                 if a prescription is extended over longer periods of time;                                              
21 (iii)  heroin and opioid addiction pose a potentially                                                                   
22 lifelong health danger, and many heroin users begin their use after                                                     
23                 becoming addicted to opioid prescription drugs; and                                                     
24 (2)  a written statement, which may include graphics, prepared by the                                                   
25 Department of Health and Social Services that provides appropriate information                                          
26       conveying the potential addictive and health dangers of opioids.                                                  
27 (b)  The requirements under (a) of this section do not apply to a patient                                               
28       receiving                                                                                                         
29                 (1)  hospice care from a licensed provider or facility; and                                             
30                 (2)  substance abuse or opioid dependence treatment.                                                    
31 (c)  The Department of Health and Social Services shall provide access on the                                           
01       department's Internet website to a printable version of the written statement a licensee                          
02       is required to distribute under (a)(2) of this section.                                                           
03            (d)  Nothing in this section creates a new cause of action or affects an existing                            
04       cause of action.                                                                                                  
05    * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to                         
06 read:                                                                                                                   
07 TRANSITION: REGULATIONS. The Department of Health and Social Services may                                               
08 adopt regulations necessary to implement the changes made by secs. 4, 6, 8, and 10 of this                              
09 Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not                                 
10 before the effective date of the relevant provision of this Act implemented by the regulation.