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.