4731-11-09 Prescribing to persons not seen by the physician.

(A) Except in institutional settings, on call situations, cross coverage situations, situations involving new patients, protocol situations, situations involving nurses practicing in accordance with standard care arrangements, and hospice settings, as described in paragraphs (D) and (E) of this rule, a physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any controlled substance to a person who the physician has never personally physically examined and diagnosed.

(B) Except in institutional settings, on call situations, cross coverage situations, situations involving new patients, protocol situations, situations involving nurses practicing in accordance with standard care arrangements, and hospice settings, as described in paragraphs (D) and (E) of this rule, a physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any dangerous drug which is not a controlled substance to a person who the physician has never personally physically examined and diagnosed, except in accordance with one of the following requirements:

(1) The physician is providing care in compliance with both of the following:

(a) The care provided is in consultation with another physician who:

(i) Has an ongoing professional relationship with the patient; and

(ii) Has agreed to supervise the patient's use of the drug or drugs to be provided.

(b) The care provided meets all applicable standards of care and all applicable statutory and regulatory requirements.

(2) The psychiatrist is providing telepsychiatry to one patient per session who is located at the Ohio office of an Ohio licensed physician or a community mental health clinic certified by the Ohio department of mental health, and all of the following requirements are met:

(a) The psychiatrist has reviewed records from a physical examination of the patient that was conducted by a physician licensed under Chapter 4731. of the Revised Code within a reasonable period of time prior to the telepsychiatry visit;

(b) A licensed healthcare professional is available during the telepsychiatry visit to provide various physical findings in accordance with the licensed healthcare professional's scope of practice that the psychiatrist may need to complete an adequate assessment;

(c) The psychiatrist agrees to do both of the following:

(i) Be available to consult with another physician who has an ongoing professional relationship with the patient; and

(ii) Supervise the patient's use of the drug or drugs prvided;

(d) The psychiatrist's care of the patient meets all applicable standards of care and all applicable statutory and regulatory requirements.

(C) A physician shall not advertise or offer, or permit the physician's name or certificate to be used in an advertisement or offer, to provide any dangerous drug in a manner that would violate paragraph (A) or paragraph (B) of this rule.

(D) Paragraphs (A) and (B) of this rule do not apply to or prohibit the provision of drugs to a person who is admitted as an inpatient to or is a resident of an institutional facility. For purposes of this rule, "institutional facility" has the same meaning as in rule 4729-17-01 of the Administrative Code. This paragraph does not authorize or legitimize practices that would violate other applicable standards or legal requirements.

(E) Paragraphs (A) and (B) of this rule do not apply to or prohibit:

(1) The provision of controlled substances or dangerous drugs by a physician to a person who is a patient of a colleague of the physician, if the drugs are provided pursuant to an on call or cross coverage arrangement between the physicians;

(2) The provision of controlled substances or dangerous drugs by a physician to a person who the physician has accepted as a patient, if the physician has scheduled or is in the process of scheduling an appointment to examine the patient and the drugs are intended to be used pending that appointment;

(3) The provision of controlled substances or dangerous drugs by emergency medical squad personnel, nurses, or other appropriately trained and licensed individuals, in accordance with protocols approved by the state board of pharmacy pursuant to rule 4729-5-01 of the Administrative Code; or

(4) The provision of controlled substances or dangerous drugs by a nurse practicing in accordance with a standard care arrangement that meets the requirements of Chapter 4723. of the Revised Code and rules promulgated by the board of nursing pursuant thereto.

(5) The provision of controlled substances or dangerous drugs by a physician who is a medical director or hospice physician of a hospice program licensed pursuant to Chapter 3712. of the Revised Code, to a patient who is enrolled in that hospice program.

This paragragh does not authorize or legitimize practices that would violate other applicable standards or legal requirements.

(F) For purposes of this rule, "controlled substance" has the same meaning as in section 3719.01 of the Revised Code.

(G) For purposes of this rule, "dangerous drug" has the same meaning as in section 4729.01 of the Revised Code.

(H) A violation of any provision of this rule, as determined by the board, shall constitute "failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code; "selling, prescribing, giving away, or administering drugs for other than legal and legitimate therapeutic purposes," as that clause is used in division (B)(3) of section 4731.22 of the Revised Code; and "a departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

(I) For purposes of this rule:

(1) "Licensed healthcare professional" means any of the following:

(a) An individual licensed under Chapter 4731. of the Revised Code to practice allopathic medicine and surgery or osteopathic medicine and surgery;

(b) A physician assistant licensed under Chapter 4730. of the Revised Code who is practicing in compliance with all applicable statutory and rule requirements; and

(c) A nurse licensed under Chapter 4723. of the Revised Code who is practicing in compliance with all applicable statutory and rule requirements.

(2) "Psychiatrist" means an individual licensed under Chapter 4731. of the Revised Code to practice allopathic medicine and surgery or osteopathic medicine and surgery who has successfully completed an approved psychiatry training program, as specified in the accreditation requirements that must be met to qualify as graduate medical education under section 4731.091 of the Revised Code.

(3) "Telepsychiatry" means the provision of psychiatric care via real-time, adequate resolution audio and video telecommunications when all of the following requirements are met:

(a) Videoconferencing picture resolution, at a minimum, shall have a data rate of 30 frames per second (fps), with each frame containing 288 lines and 352 pixels per line.

(b) Systems shall have a minimum of 384 kilobytes per second (Kbps) of bandwidth, and the provider site shall have the capacity to zoom and to follow the patient at the remote site.

Effective: 11/30/2010
R.C. 119.032 review dates: 08/31/2001
Promulgated Under: 119.03
Statutory Authority: 4731.05
Rule Amplifies: 4731.22
Prior Effective Dates: 10/1/99, 8/31/06