Fatal drug overdose claims the lives of over 47,000 Americans every year. Nearly 19,000 of these deaths were related to opioid pain relievers, and over 10,500 related to heroin. Opioid overdoses are typically reversible through the timely administration of the drug naloxone and the provision of emergency care. Access to naloxone and emergency treatment, however, is often limited by laws that pre-date the overdose epidemic. To reverse this increase in preventable overdose deaths, many states have recently amended those laws to increase access to this life-saving medication.
The Network was recently contacted about whether Colorado law provides liability protection for a registered nurse (RN) to administer naloxone when “off the clock” – that is to say, when not administering naloxone as part of the RN’s job duties. The Network was also asked about legal liability when administering naloxone as part of an RN’s job duties. A brief review of the laws in Colorado that address these questions was provided.
Civil Immunity for nurses administering naloxone “off the clock” in an emergency
Existing law appears to provide this protection. Pursuant to C.R.S.A. § 13-21-108.7, "A person, other than a health care provider or a health care facility, who acts in good faith to furnish or administer an opiate antagonist to an individual the person believes to be suffering an opiate-related drug overdose event or to an individual who is in a position to assist the individual at risk of experiencing an opiate-related overdose event is not liable for any civil damages for acts or omissions made as a result of the act."
"Health care provider" is defined in C.R.S.A. §13-21-108.7 as a physician, physician assistant, advanced practice nurse with prescriptive authority, and pharmacist. Although advanced practice nurses are included in this definition, RNs are not; therefore, under this statute, a nurse (RN) is provided the same civil legal protection as a layperson when administering naloxone in an "off the clock" emergency. Further, Colorado's general Good Samaritan law (C.R.S.A. §13-21-108) provides that, "any… person, who in good faith renders emergency care or emergency assistance to a person not presently his patient without compensation at the place of an emergency or accident… shall not be liable for any civil damages for acts or omissions made in good faith as a result of the rendering of such emergency care or emergency assistance during the emergency, unless the acts or omissions were grossly negligent or willful and wanton." This law would also appear to apply to a nurse in an "off the clock" emergency situation.
Discipline from the Board of Nursing for administering naloxone “off the clock” in an emergency
The law does not explicitly provide that the administration of naloxone by a nurse "off the clock" may not be the basis of professional discipline. In fact, under existing law, no person or class of professional is provided disciplinary immunity for naloxone administration, although such immunity is provided to APRNs who prescribe or dispense naloxone via standing order (C.R.S.A. § 12-38-125.5) and pharmacists who dispense naloxone (C.R.S.A. § 12-42.5-120). It would seem to be highly unlikely that the Board of Nursing would discipline a nurse for administering naloxone in good faith in an overdose emergency. However, it does appear that such a sanction would be theoretically possible (as theoretically possible as, say, a nurse being sanctioned for administering an epi-pen “off the clock” in an anaphylaxis emergency).
Both civil immunity and professional discipline protection for RNs and Licensed Practical Nurses administering naloxone in the course of their professional duties
The liability risk for a nurse who administers naloxone while acting in his or her scope of practice and in the course of his or her employment is no greater than with any other medication. Further, a nurse who administers naloxone in a manner consistent with his or her scope of practice and course of employment is, by definition, acting appropriately and should not be subject to discipline from the Board of Nursing. Further, as noted above, nurses are provided with additional civil immunity for administering naloxone. This immunity does not apply to the health care facility in which the nurse practices, but should apply to the nurse regardless of whether the naloxone is administered “off the clock” or while on duty.
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