1-1 By: Berlanga (Senate Sponsor - Zaffirini) H.B. No. 3075
1-2 (In the Senate - Received from the House May 15, 1997;
1-3 May 16, 1997, read first time and referred to Committee on Health
1-4 and Human Services; May 18, 1997, reported favorably by the
1-5 following vote: Yeas 11, Nays 0; May 18, 1997, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the possession of dangerous drugs by a home and
1-9 community support services agency.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Subchapter A, Chapter 142, Health and Safety
1-12 Code, is amended by amending Section 142.0061 and adding Sections
1-13 142.0062 and 142.0063 to read as follows:
1-14 Sec. 142.0061. POSSESSION OF STERILE WATER OR SALINE
1-15 [DANGEROUS DRUGS]. A home and community support services agency or
1-16 its employees who are registered nurses or licensed vocational
1-17 nurses may purchase, store, or transport for the purpose of
1-18 administering to their home health or hospice patients under
1-19 physician's orders [the following dangerous drugs]:
1-20 (1) sterile water for injection and irrigation; and
1-21 (2) sterile saline for injection and irrigation.
1-22 Sec. 142.0062. POSSESSION OF CERTAIN VACCINES OR TUBERCULIN.
1-23 (a) A home and community support services agency or its employees
1-24 who are registered nurses or licensed vocational nurses may
1-25 purchase, store, or transport for the purpose of administering to
1-26 the agency's employees, home health or hospice patients, or patient
1-27 family members under physician's standing orders the following
1-28 dangerous drugs:
1-29 (1) hepatitis B vaccine;
1-30 (2) influenza vaccine; and
1-31 (3) tuberculin purified protein derivative for
1-32 tuberculosis testing.
1-33 (b) A home and community support services agency that
1-34 purchases, stores, or transports a vaccine or tuberculin under this
1-35 section shall ensure that any standing order for the vaccine or
1-36 tuberculin:
1-37 (1) is signed and dated by the physician;
1-38 (2) identifies the vaccine or tuberculin covered by
1-39 the order;
1-40 (3) indicates that the recipient of the vaccine or
1-41 tuberculin has been assessed as an appropriate candidate to receive
1-42 the vaccine or tuberculin and has been assessed for the absence of
1-43 any contraindication;
1-44 (4) indicates that appropriate procedures are
1-45 established for responding to any negative reaction to the vaccine
1-46 or tuberculin; and
1-47 (5) orders that a specific medication or category of
1-48 medication be administered if the recipient has a negative reaction
1-49 to the vaccine or tuberculin.
1-50 Sec. 142.0063. POSSESSION OF CERTAIN DANGEROUS DRUGS.
1-51 (a) A home and community support services agency in compliance
1-52 with this section or its employees who are registered nurses or
1-53 licensed vocational nurses may purchase, store, or transport for
1-54 the purpose of administering to their home health or hospice
1-55 patients in accordance with Subsection (c) the following dangerous
1-56 drugs:
1-57 (1) any of the following items in a sealed portable
1-58 container of a size determined by the dispensing pharmacist:
1-59 (A) 1,000 milliliters of 0.9 percent sodium
1-60 chloride intravenous infusion;
1-61 (B) 1,000 milliliters of five percent dextrose
1-62 in water injection; or
1-63 (C) sterile saline; or
1-64 (2) not more than five dosage units of any of the
2-1 following items in an individually sealed, unused portable
2-2 container:
2-3 (A) heparin sodium lock flush in a concentration
2-4 of 10 units per milliliter or 100 units per milliliter;
2-5 (B) epinephrine HCl solution in a concentration
2-6 of 1 to 1,000;
2-7 (C) diphenhydramine HCl solution in a
2-8 concentration of 50 milligrams per milliliter;
2-9 (D) methylprednisolone in a concentration of 125
2-10 milligrams per two milliliters;
2-11 (E) naloxone in a concentration of one milligram
2-12 per milliliter in a two-milliliter vial;
2-13 (F) promethazine in a concentration of 25
2-14 milligrams per milliliter;
2-15 (G) glucagon in a concentration of one milligram
2-16 per milliliter;
2-17 (H) furosemide in a concentration of 10
2-18 milligrams per milliliter;
2-19 (I) lidocaine 2.5 percent and prilocaine 2.5
2-20 percent cream in a five-gram tube; or
2-21 (J) lidocaine HCl solution in a concentration of
2-22 one percent in a two-milliliter vial.
2-23 (b) A home and community support services agency or the
2-24 agency's authorized employees may purchase, store, or transport
2-25 dangerous drugs in a sealed portable container under this section
2-26 only if the agency has established policies and procedures to
2-27 ensure that:
2-28 (1) the container is handled properly with respect to
2-29 storage, transportation, and temperature stability;
2-30 (2) a drug is removed from the container only on a
2-31 physician's written or oral order;
2-32 (3) the administration of any drug in the container is
2-33 performed in accordance with a specific treatment protocol; and
2-34 (4) the agency maintains a written record of the dates
2-35 and times the container is in the possession of a registered nurse
2-36 or licensed vocational nurse.
2-37 (c) A home and community support services agency or the
2-38 agency's authorized employee who administers a drug listed in
2-39 Subsection (a) may administer the drug only in the patient's
2-40 residence under physician's orders in connection with the provision
2-41 of emergency treatment or the adjustment of:
2-42 (1) parenteral drug therapy; or
2-43 (2) vaccine or tuberculin administration.
2-44 (d) If a home and community support services agency or the
2-45 agency's authorized employee administers a drug listed in
2-46 Subsection (a) pursuant to a physician's oral order, the physician
2-47 shall promptly send a signed copy of the order to the agency, and
2-48 the agency shall:
2-49 (1) not later than 24 hours after receipt of the
2-50 order, reduce the order to written form and send a copy of the form
2-51 to the dispensing pharmacy by mail or facsimile transmission; and
2-52 (2) not later than 20 days after receipt of the order,
2-53 send a copy of the order as signed by and received from the
2-54 physician to the dispensing pharmacy.
2-55 (e) A pharmacist that dispenses a sealed portable container
2-56 under this section shall ensure that the container:
2-57 (1) is designed to allow access to the contents of the
2-58 container only if a tamper-proof seal is broken;
2-59 (2) bears a label that lists the drugs in the
2-60 container and provides notice of the container's expiration date,
2-61 which is the earlier of:
2-62 (A) the date that is six months after the date
2-63 on which the container is dispensed; or
2-64 (B) the earliest expiration date of any drug in
2-65 the container; and
2-66 (3) remains in the pharmacy or under the control of a
2-67 pharmacist, registered nurse, or licensed vocational nurse.
2-68 (f) If a home and community support services agency or the
2-69 agency's authorized employee purchases, stores, or transports a
3-1 sealed portable container under this section, the agency shall
3-2 deliver the container to the dispensing pharmacy for verification
3-3 of drug quality, quantity, integrity, and expiration dates not
3-4 later than the earlier of:
3-5 (1) the seventh day after the date on which the seal
3-6 on the container is broken; or
3-7 (2) the date for which notice is provided on the
3-8 container label.
3-9 (g) A pharmacy that dispenses a sealed portable container
3-10 under this section shall take reasonable precautionary measures to
3-11 ensure that the home and community support services agency
3-12 receiving the container complies with Subsection (f). On receipt
3-13 of a container under Subsection (f), the pharmacy shall perform an
3-14 inventory of the drugs used from the container and shall restock
3-15 and reseal the container before delivering the container to the
3-16 agency for reuse.
3-17 SECTION 2. Section 483.041(c), Health and Safety Code, is
3-18 amended to read as follows:
3-19 (c) Subsection (a) does not apply to the possession of a
3-20 dangerous drug in the usual course of business or practice or in
3-21 the performance of official duties by the following persons or an
3-22 agent or employee of the person:
3-23 (1) a pharmacy licensed by the board;
3-24 (2) a practitioner;
3-25 (3) a person who obtains a dangerous drug for lawful
3-26 research, teaching, or testing, but not for resale;
3-27 (4) a hospital that obtains a dangerous drug for
3-28 lawful administration by a practitioner;
3-29 (5) an officer or employee of the federal, state, or
3-30 local government;
3-31 (6) a manufacturer or wholesaler licensed by the
3-32 commissioner of health under Chapter 431 (Texas Food, Drug, and
3-33 Cosmetic Act);
3-34 (7) a carrier or warehouseman; or
3-35 (8) a home and community support services agency
3-36 licensed under and acting in accordance with Chapter 142[, which
3-37 may possess sterile water for injection and irrigation and sterile
3-38 saline for injection and irrigation as authorized by Section
3-39 142.0061].
3-40 SECTION 3. Section 19(f), Texas Pharmacy Act (Article
3-41 4542a-1, Vernon's Texas Civil Statutes), is amended to read as
3-42 follows:
3-43 (f) This Act does not apply to:
3-44 (1) a member of the faculty of a college of pharmacy
3-45 that is recognized by the board if the faculty member is a licensed
3-46 pharmacist and performs his services for the benefit of the college
3-47 only;
3-48 (2) a pharmacist-intern;
3-49 (3) a person who procures prescription drugs for
3-50 lawful research, teaching, or testing and not for resale; or
3-51 (4) a home and community support services agency that
3-52 possesses a dangerous drug as authorized by Section 142.0061,
3-53 142.0062, or 142.0063, Health and Safety Code.
3-54 SECTION 4. This Act takes effect September 1, 1997. The
3-55 change in law made by Section 2 of this Act applies only to an
3-56 offense committed on or after the effective date of this Act. An
3-57 offense committed before the effective date of this Act is covered
3-58 by the law in effect when the offense was committed, and the former
3-59 law is continued in effect for that purpose. For purposes of this
3-60 section, an offense was committed before the effective date of this
3-61 Act if any element of the offense occurred before that date.
3-62 SECTION 5. The importance of this legislation and the
3-63 crowded condition of the calendars in both houses create an
3-64 emergency and an imperative public necessity that the
3-65 constitutional rule requiring bills to be read on three several
3-66 days in each house be suspended, and this rule is hereby suspended.
3-67 * * * * *