Yesterday, the Georgia Composite Medical Board’s rules committee voted to propose an amendment to its rule regarding prescriptions of controlled substances by electronic means. The amendment will now undergo review by the Georgia Attorney General and be posted for public comment.
The proposed rule is a clarification of GCMB Rule 360-3-.02(5), which makes it “Unprofessional Conduct” for a Board licensee to prescribe controlled substances and/or dangerous drugs “based solely on a consultation via electronic means.”
The amended rule would clarify that it does not prohibit the prescription-via-telemedicine of Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder, where the patient is in the presence of a licensed nurse, to the extent allowable under the federal Ryan Haight Act, 21 U.S.C. § 829(e).
The Ryan Haight Act governs the prescription of controlled substances by means of the Internet, and contains several exceptions for the practice of telemedicine as defined under federal law. For example, hospitals and clinics registered with the DEA may present patients for telemedicine encounters where controlled substances are prescribed.
The Georgia Council for Child & Adolescent Psychiatry and the National Association of Rural Mental Health supported the proposed amendment through written letters to the Board.
The proposal represents a small step forward for certain telemedicine providers, especially tele-psychiatry practices serving child and adolescent populations. But, should the rule be enacted as proposed by the Board, many telemedicine practitioners in Georgia will still face a lack of clarity regarding Georgia’s “Unprofessional Conduct” rule. The rules committee expressed caution over the potential adoption of a rule that would go beyond what is permitted under federal law.
The full text of the proposed rule is below (changes in bold).
Rule 360-3-.02 (“Unprofessional Conduct Defined”)
(5) Prescribing controlled substances (O.C.G.A. T. 16, Ch. 13, Art. 2) and/or dangerous drugs (O.C.G.A. T. 16, Ch. 13, Art. 3) for a patient based solely on a consultation via electronic means with the patient, patient's guardian or patient's agent. This shall not prohibit a licensee who is on-call or covering for another licensee from prescribing up to a 72-hour supply of medications for a patient of such other licensee nor shall it prohibit a licensee from prescribing medications when documented emergency circumstances exist.
This shall also not prevent a licensed physician from prescribing Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder to a patient in the physical presence of a licensed nurse, provided the initial diagnosis was made and an initial prescription was issued in accordance with 21 U.S.C. § 829(e), including but not limited to the following:
(a) The physician has conducted at least one in-person medical evaluation of the patient; or
(b) The physician is covering for a licensee who is temporarily unavailable and has conducted at least one in-person medical evaluation of the patient; or
(c) The physician is engaged in the practice of telemedicine in accordance with Board Rule 360-3-.07 and with 21 U.S.C. §§ 802(54) and 829(e)(3)(A), including, but not limited to:
1. Where the patient is being treated by, and physically located in, a hospital or clinic registered with the U.S. Drug Enforcement Agency (“DEA”), the physician is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(A) are met; or
2. Where the patient is being treated by, and physically in the presence of, a licensee who is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(B) are met; or
3. Where the physician has obtained from the U.S. Attorney General a special registration for telemedicine in accordance with 21 U.S.C. §§ 802(54)(E) and 831(h).
Disclaimer: The foregoing materials are provided for informational purposes only, and are not to be construed as legal advice. Please consult an attorney before applying this guidance to any particular facts or circumstances.