EMergency medicine @
The 2024 Virginia General Assembly

Every year, VACEP is active in the Virginia General Assembly, advocating for legislation that supports the practice of emergency medicine and protects the patients under our care. Here’s a look at our efforts for 2024. Questions or comments? Email Andrew Mann, VACEP’s Association Executive.

Nurse Practitioners

HB 971 (Tran) and HB 983 (Walker): Nurse practitioners; patient care team provider; autonomous practice. These identical bills would allow certain nurse practitioners to oversee patient care teams by changing "patient care team physician" to "patient care team provider." The bill defines "patient care team provider" as a patient care team physician, as defined in relevant law, or a nurse practitioner who meets certain requirements.

The bill also lowers from five years (9,000 hours) to three years (5,400 hours) the amount of full-time clinical experience required before an advanced practice registered nurse may practice without a practice agreement.

• VACEP has fought this battle every year to keep clinical training for NPs at five years/9,000 supervised hours before gaining independent practice. We are fighting for that again this year.

• Physicians are not allowed to practice without supervision after they graduate from medical school. They need to complete at least a three-year, 10,000 to 15,000 hour residency. We believe the standard should be the same for our NP colleagues before they are allowed to practice alone.

HB 87 (Green): Board of Health; hospital regulations; patient drug testing. Requires the Board of Health to amend its regulations to require hospitals to test patients who are presenting with overdose symptoms for fentanyl and to test for fentanyl, marijuana, amphetamines, opioids, and phencyclidine as a part of any routine drug screening administered to a patient.

HB 267 (Watts): Assault or assault and battery against a law-enforcement officer; arrest and prosecution of individual experiencing a mental health emergency. Provides that no individual shall be subject to arrest or prosecution for an assault or assault and battery against a law-enforcement officer if at the time of the assault or assault and battery (i) the individual (a) is experiencing a mental health emergency or (b) meets the criteria for issuance of an emergency custody order and (ii) the law-enforcement officer subject to the assault or assault and battery was responding to a call for service requesting assistance for such individual. The bill provides that no law-enforcement officer acting in good faith shall be found liable for false arrest if it is later determined that the person arrested was immune from prosecution. 

HB 371 (Martinez): Physicians; informed consent; procedure observation by students or trainees for teaching purposes. Requires physicians to notify patients that students or trainees may observe a procedure and requires physicians to obtain informed consent before such observation may occur.

 HB 480 (Scott, P.A.): Simon's Law; health care; life-sustaining treatment for minors; exceptions. Requires a physician to obtain the written permission from at least one parent or legal guardian of a minor, defined in the bill as an unemancipated individual who is younger than 18 years of age and not under juvenile court supervision or on active duty with the Armed Forces of the United States, before instituting a Do Not Resuscitate order or similar physician's order. The bill creates an exception for when a physician is unable to contact a parent or legal guardian of such minor within 72 hours of the initial contact attempt. The bill also prevents a physician from interfering with such parent's or legal guardian's efforts to obtain other medical opinions, hindering or delaying the necessary measures to facilitate a transfer of such minor to another medical facility, or refusing to continue providing life-sustaining treatment to such minor when such a transfer is imminent. Under the bill, such parent or legal guardian maintains all rights to determine whether life-sustaining treatment and cardiopulmonary resuscitation are used on such minor unless a court of law or equity determines that there is destruction of the circulatory system, respiratory system, and the entire brain. A parent or legal guardian may also request disclosure of the physician's policies involving cardiopulmonary resuscitation and life-sustaining treatment.

HB 484 (Garrett): Statewide Fire Prevention Code; State Fire Marshal; consumer fireworks; penalties. Authorizes the use of consumer fireworks in the Commonwealth and distinguishes by definition consumer fireworks from display fireworks and permissible fireworks. The bill defines "consumer fireworks" as small fireworks devices (i) containing restricted amounts of pyrotechnic composition designed primarily to produce visible or audible effects by combustion and (ii) complying with certain federal regulations regarding composition and labeling. The bill also provides that the storage and transportation of consumer fireworks are to be considered the same hazard class as the storage and transportation of 1.4G explosives under the Statewide Fire Prevention Code (SFPC) and Uniform Statewide Building Code. The bill excludes from the provisions of the SFPC, unless prohibited by a local ordinance, (a) the sale of permissible or consumer fireworks; (b) any person using, igniting, or exploding permissible or consumer fireworks on residential or agricultural property with the consent of the owner of such property; or (c) such permissible or consumer fireworks when they are being transported from a locality where they were legally obtained to a locality where they are legally permitted. Current law only excludes sale of permissible fireworks or the use of such fireworks on private property. The bill also directs 10 percent of the sales and use tax revenue generated by the local sales and tax use on the sale of consumer or permissible fireworks to be allocated to a special fund used solely for providing funding for first responders, as defined in the bill. The bill contains technical amendments.

HB 699 (Maldonado): Board of Medicine; Board of Dentistry; patient counseling; treatment with opioids. Directs the Board of Medicine and the Board of Dentistry to amend their regulations to require the provision of certain information to patients being prescribed an opioid for the treatment of acute or chronic pain. The bill requires that the regulations include an exception to the required provision of such information for patients who are (i) in active treatment for cancer, (ii) receiving hospice care from a licensed hospice or palliative care, (iii) residents of a long-term care facility, or (iv) being prescribed an opioid in the course of treatment for substance abuse or opioid dependence. 

HB 808 (Rasoul): State psychiatric hospitals; temporary detention orders; delayed admission to determine medical needs. Allows state psychiatric hospitals to delay admission of an individual under a temporary detention order until the state psychiatric hospital has determined that the individual does not have potentially life-threatening medical needs that require immediate evaluation and treatment that the state psychiatric hospital is incapable of providing. This bill is a recommendation of the Joint Legislative Audit and Review Commission and the Behavioral Health Commission.

HB 822 (Cherry): Emergency custody; transportation; transfer of custody. Provides that, in cases in which transportation of a person subject to an emergency custody order is ordered to be provided by an alternative transportation provider, the primary law-enforcement agency that executes the order may transfer custody of the person to the alternative transportation provider immediately upon execution of the order, and that the alternative transportation provider shall maintain custody of the person from the time custody is transferred to the alternative transportation provider by the primary law-enforcement agency until such time as custody of the person is transferred to the community services board or its designee that is responsible for conducting the evaluation or the temporary detention facility, as is appropriate. The bill adds employees of and persons providing services pursuant to a contract with the Department of Behavioral Health and Developmental Services to the list of individuals who may serve as alternative transportation providers for emergency custody orders. Additionally, the bill allows for the transfer of custody to the temporary detention facility if the magistrate issuing the emergency custody order determines that the person subject to the order is not at risk to seriously harm others in the near future without any additional conditions being met.

 HB 964 (Willett): Board of Medicine; executive director; qualifications. Allows attorneys to serve as the executive director for the Board of Medicine. Under current law, the executive director for the Board of Medicine must be a physician.

HB 1242 (Willett): Emergency custody and temporary detention orders; evaluations; presence of others. Requires (i) the facility at which an individual who is the subject of an emergency custody order is being evaluated to determine whether the individual meets the criteria for temporary detention or (ii) the hospital emergency department and treating physician, when providing services to an individual who is being evaluated to determine whether the individual meets the criteria for temporary detention, to allow the individual's family member or legal guardian to be present unless the individual objects or their presence would create a medical or safety risk. 

SB 279 (Sturtevant): Virginia Commonwealth University Health System Authority; board of directors membership; powers and duties; capital projects; issuance of bonds. Provides for a number of reforms related to the Virginia Commonwealth University Health System Authority. The bill reduces the number of members serving on the Authority's board of directors and the number of physician-faculty members that are required to serve on the board, requires persons who are appointed by the Speaker of the House of Delegates and the Senate Committee on Rules to be nonlegislative citizen members, and changes the term of office for board members. Additionally, the bill amends the Authority's powers and duties to provide outside oversight of certain actions taken or contemplated by the Authority. The Authority is required to notify the Governor, the Secretary of Finance, and the House Appropriations and Senate Finance and Appropriations Committees prior to seeking financing or incurring debt or entering into a contract related to hospital facilities and other projects. Further, the Authority is required to conduct a comprehensive financial and risk analysis for every proposed capital project and, for capital projects exceeding $15 million, to consult with the Secretary of Finance and the Department of Planning and Budget on various details, in addition to notifying the House Appropriations and Senate Finance and Appropriations Committees and providing specific information related to the capital project.

SB 493 (Stanley): Medical malpractice; limitations on recovery; certain actions. Eliminates the cap on the recovery in actions against health care providers for medical malpractice where the act or acts of malpractice occurred on or after July 1, 2024, and occurred against a patient age 10 or younger. 

SB 546 (Bagby): Emergency custody and temporary detention orders; evaluations; presence of others. Requires (i) the facility at which an individual who is the subject of an emergency custody order is being evaluated to determine whether the individual meets the criteria for temporary detention or (ii) the hospital emergency department and treating physician, when providing services to an individual who is being evaluated to determine whether the individual meets the criteria for temporary detention, to allow the individual's family member or legal guardian to be present unless the individual objects or their presence would create a medical or safety risk. 

SB 639 (Sturtevant): Firearms; removal from persons posing substantial risk; penalties. Repeals the procedure by which any attorney for the Commonwealth or law-enforcement officer may apply to a general district court, circuit court, or juvenile and domestic relations district court judge or magistrate for an emergency substantial risk order to prohibit a person who poses a substantial risk of injury to himself or others from purchasing, possessing, or transporting a firearm. The bill also removes the substantial risk order registry for the entry of orders issued.

HB 519 (Mundon King): Board of Medicine; unprofessional conduct. Prohibits the Board of Medicine from taking disciplinary action against a doctor based on the alleged provision or receipt of abortion care that is not prohibited under the laws of the Commonwealth, regardless of where such abortion care was provided or received. The bill also specifies that grounds for refusal to issue a certificate or license to any applicant or to take disciplinary action for procuring or performing an abortion apply to such action only as it is prohibited by the laws of the Commonwealth. Under current law, such grounds for refusal or disciplinary action apply for procuring or performing a criminal abortion.

HB 637 (Sullivan): Substantial risk orders; training program. Directs the Department of Criminal Justice Services to establish a Substantial Risk Order Training Program for the purposes of training law-enforcement agencies, judiciary staff, and other public institutions throughout the Commonwealth to use and implement the substantial risk order law. The bill states that the programming shall provide training regarding proper procedures to follow, the circumstances under which the law can be used, the benefits to public safety from proper use of the law, and the harm that may ensue from the law not being used when lawfully available. The Program shall also include efforts to educate the public on and increase awareness of the substantial risk order law. Under the bill, $2 million of funds allocated to the Commonwealth pursuant to the federal Byrne State Crisis Intervention Program shall be used for Program purposes.

HB 732 (Sewell) and SB 387 (Pekarsky): Public elementary and secondary schools; policies and requirements relating to naloxone. Requires each local school board to develop, in accordance with the guidelines developed by the Department of Health in collaboration with the Department of Education, plans and policies for each public elementary and secondary school relating to opioid overdose prevention and reversal, including (i) the procurement, storage, and maintenance of at least two unexpired doses of naloxone at each such school; (ii) the possession and administration of naloxone by school board employees; and (iii) providing, pursuant to the provisions of the bill, immunity from any disciplinary action or civil or criminal liability to any employee of a public elementary or secondary school who, regardless of whether such employee was trained and certified in the administration of naloxone, in good faith administers naloxone for opioid overdose reversal to any individual who is believed to be experiencing or about to experience a life-threatening opioid overdose, except in the case of gross negligence or willful misconduct. 

The bill modifies the list of individuals who are authorized to administer naloxone or other opioid antagonists to include any school board employee who has completed training and is certified in the administration of naloxone by an organization authorized by the Department of Behavioral Health and Developmental Services to provide such training and certification. Current law limits such authorization to school nurses or school board employees contracted by a school board to provide school health services.

Finally, the bill directs the Department of Health and the Department of Education to collaborate to develop guidelines and policies for the implementation of the provisions of the bill and directs the Department of Education to submit such guidelines to relevant committees of the General Assembly by January 1, 2025. The bill requires such guidelines and policies to be implemented by each school board by the beginning of the 2026–2027 school year.

HB 813 (Mundon King): Parental access to minor's medical records; consent by certain minors to treatment of mental or emotional disorder. Adds an exception to the right of parental access to a minor child's health records if the furnishing to or review by the requesting parent of such health records would be reasonably likely to deter the minor from seeking care. Under the bill, a minor 16 years of age or older who is determined by a health care provider to be mature and capable of giving informed consent shall be deemed an adult for the purpose of giving consent to treatment of a mental or emotional disorder. The bill provides that the capacity of a minor to consent to treatment of a mental or emotional disorder does not include the capacity to refuse treatment for a mental or emotional disorder for which a parent, guardian, or custodian of the minor has given consent and that a parent, legal guardian, or custodian of a minor shall be notified by a health care provider of the minor's drug abuse, substance abuse, or potential of self-harm. 

HB 1065 (Hodges): Department of Behavioral Health and Developmental Services; community services boards. Provides that every community services board shall conduct stakeholder meetings at least four time per year to discuss challenges, identify opportunities for improvement, and collaboratively work towards effective solutions. The bill requires each community services board to submit an annual report of such meetings to the Department of Behavioral Health and Developmental Services and authorizes the Director of the Department to provide guidance and recommendations to such boards and to revise funding in response to such reports. 

HB 1130 (Hayes): Board of Medicine; Board of Nursing; continuing education; continuing competency; unconscious bias and cultural competency. Directs the Board of Medicine and the Board of Nursing to require unconscious bias and cultural competency training as part of the continuing education and continuing competency requirements for renewal of licensure. The bill specifies requirements for the training and requires the Board of Medicine and Board of Nursing to report on the training to the Department of Health and the Neonatal Perinatal Collaborative. 

SB 33 (Locke): Supervision of certified registered nurse anesthetists; work group; report. Clarifies that supervision of a certified registered nurse anesthetist requires that a licensed doctor of medicine, osteopathy, podiatry, or dentistry is present during an operation or procedure or is immediately available to respond and provide patient care as needed. The bill directs the Secretary of Health and Human Resources, in collaboration with the Board of Medicine, Board of Nursing, and Department of Health Professions, to convene a work group of relevant stakeholders to evaluate and make recommendations to increase the anesthesia provider workforce in the Commonwealth. The bill requires the work group to report its recommendations to the Chairmen of the Senate Committee on Education and Health and the House Committee on Health, Welfare and Institutions by November 1, 2024. 

SB 35 (Locke): Board of Medicine; Board of Nursing; continuing education; continuing competency; unconscious bias and cultural competency. Directs the Board of Medicine and the Board of Nursing to require unconscious bias and cultural competency training as part of the continuing education and continuing competency requirements for renewal of licensure. The bill specifies requirements for the training and requires the Board of Medicine and Board of Nursing to report on the training to the Department of Health and the Neonatal Perinatal Collaborative.

SB 181 (Rouse): Public elementary and secondary schools; cardiac emergency response plans required; grant program established. Requires each public elementary or secondary school to develop a cardiac emergency response plan (CERP) that addresses the appropriate use of school personnel to respond to incidents involving an individual who is experiencing sudden cardiac arrest or a similar life-threatening emergency while on school grounds and, in the event that such school has an athletic department or organized athletic program, while attending or participating in an athletic practice or event. The bill requires each such CERP to integrate nationally recognized evidence-based core elements such as those recommended by the American Heart Association guidelines and to integrate certain provisions and guidelines, including those relating to establishing a cardiac emergency response team, activating such team in response to a sudden cardiac event, and integrating the CERP into the local community's emergency medical services response protocols. The bill also requires, with such funds as may be appropriated for such purpose pursuant to the general appropriation act, the Department to establish and administer the CERP Grant Program for the purpose of awarding grants, on a competitive basis, to any public elementary or secondary school to assist such school in the development or implementation of its CERP or in the purchase or funding of activities or equipment that further promotes CERP preparedness, giving priority to certain high-need schools. 

SB 360 (VanValkenburg): Covenants not to compete; health care professionals; civil penalty. Adds health care professionals as a category of employee with whom no employer shall enter into, enforce, or threaten to enforce a covenant not to compete. The bill defines "health care professional" as any physician, nurse, nurse practitioner, physician's assistant, pharmacist, social worker, dietitian, physical and occupational therapist, professional counselor, behavior analyst, assistant behavior analyst, or medical technologist authorized to provide health care services in the Commonwealth. The bill provides that any employer that violates the prohibition against covenants not to compete with a health care professional is subject to the civil penalty in current law of $10,000 for each violation. 

SB 515 (Williams Graves): Weapons; possession or transportation; facility that provides mental health services or developmental services; penalty. Makes it a Class 1 misdemeanor for any person to possess in or transport into any facility that provides mental health services or developmental services in the Commonwealth, including a hospital or an emergency department or other facility rendering emergency medical care, any (i) firearm or other weapon designed or intended to propel a missile or projectile of any kind; (ii) knife, except a pocket knife having a folding metal blade of less than three inches; or (iii) other dangerous weapon, including explosives and stun weapons. The bill provides that any such firearm, knife, explosive, or weapon is subject to seizure by a law-enforcement officer and specifies exceptions to the prohibition.

HB 23 (Laufer): Weapons; possession or transportation; facility that provides mental health services or developmental services; penalty. Makes it a Class 1 misdemeanor for any person to possess in or transport into any facility that provides mental health services or developmental services in the Commonwealth, including a hospital or an emergency department or other facility rendering emergency medical care, any (i) firearm or other weapon designed or intended to propel a missile or projectile of any kind; (ii) knife, except a pocket knife having a folding metal blade of less than three inches; or (iii) other dangerous weapon, including explosives and stun weapons. The bill provides that any such firearm, knife, explosive, or weapon is subject to seizure by a law-enforcement officer and specifies exceptions to the prohibition.

HB 32 (Clark): Medicine, Board of; continuing ed. related to implicit bias and cultural competency in health care. Requires the Board of Medicine to adopt and implement policies that require each practitioner licensed by the Board who has direct contact with persons who are or may become pregnant to complete two hours of continuing education related to implicit bias, defined in the bill, and cultural competency in health care at least once every other license renewal cycle.

HB 289 (Wiley): Carrying a concealed handgun with a permit; public parking lots. Provides that a concealed handgun permit holder may store his firearms or other weapons in a motor vehicle in a publicly or privately owned parking lot, traffic circle, or other means of vehicular ingress or egress to property that is open to the public regardless if such firearms or weapons are prohibited by the owner of such area.

HB 481 (Garrett): First responders; proof of immunization not required to attend trainings at medical care facilities. Provides that first responders shall not be required to show proof of immunization to attend trainings at medical care facilities, regardless of whether the administration of immunizing agents conflicts with their religious tenets or practices.

HB 601 (Kilgore): Health insurance; emergency services; mobile crisis response services. Provides that emergency services, with respect to an emergency medical condition, include (i) a screening examination, including ancillary services, that is within the capability of a provider licensed by the Department of Behavioral Health and Developmental Services as a behavioral health crisis service provider and (ii) such further examination and treatment as is required to stabilize the patient. The bill also adds crisis receiving centers to locations where mobile crisis response services and support may be provided and thereby be covered by health insurance.

HB 772 (Delaney): Parental admission of minors for inpatient treatment. Parental admission of minors for inpatient treatment. Clarifies that for the purposes of admission of a minor to a willing mental health facility for inpatient treatment, the finding required to be made by a qualified evaluator that the minor appears to have a mental illness serious enough to warrant inpatient treatment may include a finding of substance abuse and such inpatient treatment may be related to such mental illness or substance abuse. The bill also specifies that a temporary detention order shall not be required for a minor 14 years of age or older who objects to admission to be admitted to a willing facility upon the application of a parent. This bill is a recommendation of the Virginia Commission on Youth.

HB 861 (Hernandez): Weapons; possession or transportation; facility that provides mental health services or developmental services; penalty.  Makes it a Class 1 misdemeanor for any person to knowingly possess in or transport into any facility that provides mental health services or developmental services in the Commonwealth, including a hospital or an emergency room or other facility rendering emergency medical care, any (i) gun or other weapon designed or intended to propel a missile or projectile of any kind; (ii) knife, except a pocket knife having a folding metal blade of less than three inches; or (iii) other dangerous weapon, including explosives and stun weapons. The bill provides that any such firearm, knife, explosive, or weapon is subject to seizure by a law-enforcement officer and specifies exceptions to the prohibition.

HB 1185 (Willett): Board of Health; Department of Health Professions; Prescription Monitoring Program; overdose information. Directs the Board of Health to report patient level data information on patients who overdose on opioids to the Department of Health Professions for use in the Prescription Monitoring Program. The bill requires practitioners to obtain such data when prescribing opioids.

HB 1242 (Willett): Emergency custody and temporary detention orders; evaluations; presence of others. Requires (i) the facility at which an individual who is the subject of an emergency custody order is being evaluated to determine whether the individual meets the criteria for temporary detention or (ii) the hospital emergency department and treating physician, when providing services to an individual who is being evaluated to determine whether the individual meets the criteria for temporary detention, to allow the individual's family member or legal guardian to be present unless the individual objects or their presence would create a medical or safety risk.

SB 460 (Marsden): Parental admission of minors for inpatient treatment. Clarifies that for the purposes of admission of a minor to a willing mental health facility for inpatient treatment, the finding required to be made by a qualified evaluator that the minor appears to have a mental illness serious enough to warrant inpatient treatment may include a finding of substance abuse and such inpatient treatment may be related to such mental illness or substance abuse. The bill also specifies that a temporary detention order shall not be required for a minor 14 years of age or older who objects to admission to be admitted to a willing facility upon the application of a parent. This bill is a recommendation of the Virginia Commission on Youth.