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Groover v. Johnston11/10/2005
ected from a formulary of such drugs established by the Composite State Board of Medical Examiners and the authority to order dangerous drugs, medical treatments, and diagnostic studies.
OCGA § 43-34-26.1 (b) (1) (B). The statute defines the term " rder" as "to select a drug . . . in accordance with a nurse protocol." OCGA § 43- 34-26.1 (a) (8). "Nurse protocol" is defined as
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.
OCGA § 43-34-26.1 (a) (7).
(a) Groover argues that subsection (b) (1) (B) of the statute must be read to permit a physician such as Johnston to delegate his authority to order controlled drugs, such as narcotics, to registered nurses only if the nurses have specified advanced training and skills, and only if a written protocol is in place. In contrast, Johnston argues that the statute places no limit on the extent to which physicians may delegate their authority to nurses without the advanced skills or training specified in the statute. According to Johnston, the statute simply does not apply, because the nurses in the PACU were nurses without the advanced skills or training specified in the statute.
Johnston's reading fails both logically and historically. Logically, it makes no sense for the General Assembly to have placed stringent controls and limits on the extent to which physicians may delegate authority to nurses with advanced or specialized training, while at the same time giving physicians unlimited power to delegate their authority to nurses with less training, skills, and experience. And we must construe a statute so as to avoid an absurd result. Mansfield v. Pannell, 261 Ga. 243, 244 (404 SE2d 104) (1991).
No purpose is stated explicitly in the statute. The events and circumstances prevailing at the time it was enacted, however, shed light on its intended purpose. See Rowe, "Health: Registered Nurses and Physicians' Assistants May Order Drugs Under Protocol," 6 Ga. St. Univ. L. Rev. 304 (1989). Before the statute's enactment, registered nurses in Georgia had statutory authority to administer medications, but no authority to order medications. Id. at 304-305. Yet the practice of nurses ordering medication under a written protocol existed, primarily in the public health arena, but also in other settings. When the attorney general issued an opinion finding this practice illegal, difficulties ensued in public health and indigent medical care, prompting the enactment of the statute. Id.
The proposed legislation was originally introduced to meet the health care needs of indigent and rural Georgians, where an insufficient number of practicing physicians made expanded nurse care necessary. Rowe, supra at 311. The Act as passed, however, has a broader scope that protects the public in general. Id. The statute permits registered nurses without advanced training to "order" medications only if they are working in certain public health agencies or indigent outpatient clinics. OCGA § 43-34-26.1. It provides that nurses with advanced training may "order," but not "prescribe" or "dispense" controlled or dangerous drugs under "protocols" in all settings. Id. at 308. The statute therefore clearly applies in this case; it provides a standard of care governing situations in which doctors delegate their authority to "order," "prescribe," or "dispense" to nurses.
(b) Having concluded that the statute does apply here, w
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