Delegation of Authority to Nurse or Physician Assistant

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  2. Georgia Code
  3. Professions and Businesses
  4. Physicians, Acupuncture, Physician Assistants, Cancer and Glaucoma Treatment, Respiratory Care, Clinical Perfusionists, and Orthotics and Prosthetics Practice
  5. Medical Practice
  6. Delegation of Authority to Nurse or Physician Assistant

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  1. As used in this Code section, the term:
    1. "Administer" means to give a unit dose of any drug or to perform any medical treatment or diagnostic study.
    2. "Controlled substance" means any controlled substance, as defined in Code Section 16-13-21, except any Schedule I controlled substance listed in Code Section 16-13-25.
    3. "Dangerous drug" means any dangerous drug, as defined in Code Section 16-13-71, but does not include any controlled substance or Schedule I controlled substance.

      (3.1) "Dispense" means to issue one or more doses of any drug in a suitable container with appropriate labeling for subsequent administration to, or use by, a patient.

    4. "Dispensing procedure" means a written document signed by a licensed pharmacist and a licensed physician which document establishes the appropriate manner under which drugs may be dispensed pursuant to this Code section.
    5. "Drug" means any dangerous drug or controlled substance.

      (5.1) "Job description" shall have the same meaning as in Code Section 43-34-102.

    6. "Nurse" means a person who is a registered professional nurse licensed as such under Article 1 of Chapter 26 of this title.
    7. "Nurse protocol" means a written document mutually agreed upon and signed by a nurse and a licensed physician, by which document the physician delegates to that nurse the authority to perform certain medical acts pursuant to subsection (b) of this Code section, and which acts shall include, without being limited to, the administering and ordering of any drug.
    8. "Order" means to select a drug, medical treatment, or diagnostic study through physician delegation in accordance with a nurse protocol or a physician assistant's job description. Ordering under such delegation shall not be construed to be prescribing nor shall ordering of a drug be construed to authorize the issuance of a written prescription.
    9. "Physician assistant" means a person licensed as a physician assistant pursuant to Article 4 of this chapter, the "Physician Assistant Act."
      1. A physician may delegate the authority contained in subparagraph (B) of this paragraph to:
        1. A physician assistant in accordance with a job description; or
        2. A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife, certified registered nurse anesthetist, certified nurse practitioner, or clinical nurse specialist, psychiatric/mental health in accordance with a nurse protocol.
      2. A physician may delegate to those health care professionals identified in subparagraph (A) of this paragraph:
        1. The authority to order controlled substances selected from a formulary of such drugs established by the board and the authority to order dangerous drugs, medical treatments, and diagnostic studies;
        2. The authority to request, receive, and sign for professional samples and to distribute professional samples to patients. The office or facility at which the health care professional identified in subparagraph (A) of this paragraph is working shall maintain a general list of the professional samples approved by the delegating physician for request, receipt, and distribution by the health care professional identified in subparagraph (A) of this paragraph as well as a complete list of the specific number and dosage of each professional sample and medication voucher received. Professional samples that are distributed by a health care professional identified in subparagraph (A) of this paragraph shall be so noted in the patient's medical record. In addition to the requirements of this Code section, all professional samples shall be maintained as required by applicable state and federal laws and regulations; and
        3. The authority to sign, certify, and endorse all documents relating to health care provided to a patient within his or her scope of authorized practice, including, but not limited to, documents relating to physical examination forms of all state agencies and verification and evaluation forms of the Department of Human Services, the State Board of Education, local boards of education, the Department of Community Health, and the Department of Corrections; provided, however, that a health care professional identified in subparagraph (A) of this paragraph shall not have the authority to sign death certificates or assign a percentage of a disability rating.
    2. A physician may delegate to a nurse or physician assistant the authority to order dangerous drugs, medical treatments, or diagnostic studies and a nurse or physician assistant is authorized to dispense dangerous drugs, in accordance with a dispensing procedure and under the authority of an order issued in conformity with a nurse protocol or job description, if that nurse or physician assistant orders or dispenses those dangerous drugs, medical treatments, or diagnostic studies:
      1. As an agent or employee of:
        1. The Department of Public Health;
        2. Any county board of health; or
        3. Any organization:
      2. Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal Revenue Code, as defined in Code Section 48-1-2, other than an organization which is a hospital, preferred provider organization, health maintenance organization, or similar organization; or
      3. Established under the authority of or receiving funds pursuant to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act,

        which organization provides that those medical services and dangerous drugs which are ordered or dispensed by its physician assistants and nurses will be provided at no cost to the patient or at a cost based solely upon the patient's ability to pay; and

      4. In conformity with subsection (b) of Code Section 26-4-130 and the rules and regulations established pursuant thereto by the State Board of Pharmacy.
    3. In addition, a physician may delegate to a nurse or physician assistant the authority to order dangerous drugs, medical treatments, or diagnostic studies and a nurse or physician assistant is authorized to dispense dangerous drugs, in accordance with a dispensing procedure and under the authority of an order issued in conformity with a nurse protocol or job description, if that nurse or physician assistant orders or dispenses such drugs, treatments, or studies to a patient of an outpatient clinic:
      1. Which is owned or operated by a licensed hospital;
      2. Which provides such drugs, treatments, or studies free or at a charge to the patient based solely upon the patient's ability to pay; provided, however, such charge shall not exceed the actual cost to the outpatient clinic; and
      3. Whose services are primarily provided to the medically disadvantaged

        and that nurse or physician assistant orders or dispenses such drugs in conformity with subsection (b) of Code Section 26-4-130 and the rules and regulations established pursuant thereto by the State Board of Pharmacy.

    4. Delegation of authority to a physician assistant pursuant to this subsection shall be authorized only if that delegation is contained in the job description approved for that physician assistant by the board.
    5. Delegation of authority to a nurse pursuant to this subsection shall be authorized only if that delegation is contained in a nurse protocol for that nurse.
  3. The board shall be empowered to promulgate rules and regulations governing physicians and physician assistants to carry out the intents and purposes of this Code section, including establishing criteria and standards governing physicians, physician assistants, job descriptions, and nurse protocols. The board shall be authorized to require that protocols not falling within such established criteria and standards be submitted to the board for review and approval or rejection.
  4. Notwithstanding any other provision of law to the contrary, a physician assistant or nurse may perform any act authorized to be performed by that person pursuant to and in conformity with this Code section without such act constituting the practice of medicine.
  5. Nothing in this Code section shall be construed to limit or repeal this article and Articles 4 and 6 of this chapter, relating to physicians, osteopathic physicians, physician assistants, and respiratory therapists, or Article 1 of Chapter 26 of this title, relating to registered nurses.
  6. Nothing in this Code section shall be construed to limit or repeal any existing authority of a licensed physician to delegate to a qualified person any acts, duties, or functions which are otherwise permitted by law or established by custom.
  7. Nothing in this Code section shall be construed to authorize or permit the issuance of a Drug Enforcement Administration license to a nurse who is not an advanced practice registered nurse.
  8. Nothing in this Code section shall be construed to limit or repeal the authority of any organization described in division (i) or (ii) of subparagraph (b)(2)(A) of this Code section or any organization established under the authority of or receiving funds pursuant to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act to supervise its agents or employees or interfere with the employer and employee relationship of any such agents or employees.
  9. Notwithstanding any other provision of law to the contrary, a physician assistant or nurse may perform any act deemed necessary to provide treatment to a hospital or nursing home patient in a life-threatening situation when such act is authorized by standing procedures established by the medical staff of the hospital or nursing home.

(Code 1981, §43-34-26.1, enacted by Ga. L. 1989, p. 261, § 3; Ga. L. 1990, p. 8, § 43; Ga. L. 1991, p. 94, § 43; Ga. L. 1993, p. 91, § 43; Ga. L. 1997, p. 935, § 2; Ga. L. 1999, p. 81, § 43; Ga. L. 2002, p. 415, § 43; Ga. L. 2006, p. 125, § 8/SB 480; Ga. L. 2009, p. 453, § 1-4/HB 228; Code 1981, §43-34-23, as redesignated by Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2011, p. 441, § 1/HB 303; Ga. L. 2011, p. 705, § 6-1/HB 214.)

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 1989, "this article and Articles 4 and 6" was substituted for "Articles 2, 4, and 6" in subsection (e).

Pursuant to Code Section 28-9-5, in 2009, "assistant" was inserted after "physician" in the undesignated language at the end of paragraph (b)(3).

Editor's notes.

- Ga. L. 2009, p. 859, § 1/HB 509, effective July 1, 2009, redesignated former Code Section 43-34-23 as present Code Section 43-34-4.

Law reviews.

- For article on 2006 amendment of this Code section, see 23 Georgia St. U.L. Rev. 209 (2006). For article on the 2011 amendment of this Code section, see 28 Georgia St. U.L. Rev. 147 (2011). For note on 1989 enactment of this Code section, see 6 Georgia St. U.L. Rev. 304 (1989).

JUDICIAL DECISIONS

Summary judgment properly denied in medical malpractice action.

- Anesthesiologist's standing verbal order to nurses in the post-anesthesia care unit that allowed the nurses to order and administer controlled substances to patients for purposes of pain management, after which the anesthesiologist would later sign the chart authorizing their prior decisions regarding the medication, was negligence per se in violation of former O.C.G.A. § 43-34-26.1 (see now O.C.G.A. § 43-34-23), as the written medical protocol was not followed; however, the trial court properly denied a motion by the spouse of the patient for partial summary judgment in a medical malpractice action as the spouse had not yet proved the issue of proximate causation. Groover v. Johnston, 277 Ga. App. 12, 625 S.E.2d 406 (2005).

Applicability in medical malpractice action.

- Former O.C.G.A. § 43-34-26.1 (see now O.C.G.A. § 43-34-23) was applicable to a medical malpractice action asserted by a patient's spouse against an anesthesiologist and the employer, alleging claims of negligence and negligence per se under the statute, because the issue was whether the anesthesiologist's standing verbal order to nurses, which allowed the nurses to order and administer controlled substances to patients, was negligence per se because there was no written protocol; as the purpose of the statute was to protect the public and to provide a standard of health care in situations in which doctors delegated their authority to order, prescribe, or dispense to nurses, § 43-34-26.1 (see now § 43-34-23) was applicable. Groover v. Johnston, 277 Ga. App. 12, 625 S.E.2d 406 (2005).

Cited in Gillis v. Cardio TVP Surgical Assocs., P.C., 239 Ga. App. 350, 520 S.E.2d 767 (1999).


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