2015 -- S 0328 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS

     Introduced By: Senators Ottiano, Pichardo, Crowley, Miller, and Cote

     Date Introduced: February 12, 2015

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 5-54-2, 5-54-3, 5-54-5 and 5-54-8 of the General Laws in Chapter

5-54 entitled "Physician Assistants" are hereby amended to read as follows:

     5-54-2. Definitions. -- As used in this chapter, the following words have the following

meanings:

      (1) "Administrator" means the administrator, division of professional regulation.

      (2) "Approved program" means a program for the education and training of physician

assistants formally approved by the American Medical Association's (A.M.A.'s) Committee on

Allied Health, Education and Accreditation, its successor, the Commission on Accreditation of

Allied Health Education Programs (CAAHEP) or its successor.

      (3) "Approved program for continuing medical education" means a program for

continuing education approved by the American Academy of Physician Assistants (AAPA) or the

Accreditation Council for Continuing Medical Education of the American Medical Association

(AMA), or the American Academy of Family Physicians (AAPFP) or the American Osteopathic

Association Committee on Continuing Medical Education (AOACCME) or any other board

approved program.

      (4) "Board" means the board of licensure of physician assistants.

      (5) "Director" means the director of the department of health.

      (6) "Division" means the division of professional regulation, department of health.

      (7) [Deleted by P.L. 2013, ch. 320, § 1 and P.L. 2013, ch. 420, § 1].

      (8) "Physician" means a person licensed under the provisions of chapter 29 or 37 of this

title.

      (9) "Physician assistant" means a person who is qualified by academic and practical

training to provide those certain patient services under practice medicine with the supervision,

control, responsibility and direction of a licensed physician expert in the field of medicine in

which the physician assistant practices.

      (10) "Supervision" means overseeing the activities of, and accepting the responsibility

for the medical services rendered by the physician assistants. Supervision is continuous, and

under the direct control of a licensed physician expert in the field of medicine in which the

physician assistants practice. The constant physical presence of the supervising physician or

physician designee is not required. It is the responsibility of the supervising physician and

physician assistant to assure an appropriate level of supervision depending on the services being

rendered. Each physician or group of physicians, or other health care delivery organization

excluding licensed hospital or licensed health care facilities controlled or operated by a licensed

hospital employing physician assistants must have on file at the primary practice site a copy of a

policy in the form of an agreement between the supervising physicians and physician assistants

delineating:

      (i) The level of supervision provided by the supervising physician or designee with

particular reference to differing levels of supervision depending on the type of patient services

provided and requirements for communication between the supervising physician or designee and

the physician assistant.

      (ii)(i) A job description for the physician assistant listing patient care responsibilities and

procedures to be performed by the physician assistant.

      (iii)(ii) A program for quality assurance for physician assistant services including

requirements for periodic review of the physician assistant services.

      (iv)(iii) Requirements for supervision of physician assistants employed or extended

medical staff privileges by licensed hospitals or other licensed health care facilities or employed

by other health care delivery agencies shall be delineated by the medical staff by laws and/or

applicable governing authority of the facility.

      (v)(iv) The supervising physician or physician designee must be available for easy

communication and referral at all times.

      (11) "Unprofessional conduct" includes, but is not limited to, the following items or any

combination and may be defined by regulations established by the board with prior approval of

the director:

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      (i) Fraudulent or deceptive procuring or use of a license;

      (ii) Representation of himself or herself as a physician;

      (iii) Conviction of a crime involving moral turpitude; conviction of a felony; conviction

of a crime arising out of the practice of medicine. All advertising of medical business, which is

intended or has a tendency to deceive the public;

      (iv) Abandonment of a patient;

      (v) Dependence upon a controlled substance, habitual drunkenness, or rendering

professional services to a patient while intoxicated or incapacitated by the use of drugs;

      (vi) Promotion of the sale of drugs, devices appliances, or goods or services provided for

a patient in a manner that exploits the patient for the financial gain of the physician assistant;

      (vii) Immoral conduct of a physician assistant in the practice of medicine;

      (viii) Willfully making and filing false reports or records;

      (ix) Willful omission to file or record or willfully impeding or obstructing a filing or

recording, or inducing another person to omit to file or record medical or other reports as required

by law;

      (x) Agreeing with clinical or bioanalytical laboratories to accept payments from these

laboratories for individual tests or test series for patients;

      (xi) Practicing with an unlicensed physician or physician assistant or aiding or abetting

these unlicensed persons in the practice of medicine;

      (xii) Offering, undertaking or agreeing to cure or treat a disease by a secret method,

procedure, treatment or medicine;

      (xiii) Professional or mental incompetence;

      (xiv) Surrender, revocation, suspension, limitation of privilege based on quality of care

provided, or any other disciplinary action against a license or authorization to practice in another

state or jurisdiction; or surrender, revocation, suspension, or any other disciplinary action relating

to membership on any medical staff or in any medical professional association, or society while

under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to

acts or conduct which would constitute grounds for action as stated in this chapter;

      (xv) Any adverse judgment, settlement, or award arising from a medical liability claim

related to acts or conduct, which would constitute grounds for action as stated in this chapter;

      (xvi) Failure to furnish the board, the administrator, investigator or representatives,

information legally requested by the board;

      (xvii) Violation of any provisions of this chapter or the rules and regulations

promulgated by the director or an action, stipulation, or agreement of the board;

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      (xviii) Cheating or attempting to subvert the certifying examination;

      (xix) Violating any state or federal law or regulation relating to controlled substances;

      (xx) Medical malpractice;

      (xxi) Sexual contact between a physician assistant and patient during the existence of the

physician assistant/patient relationship;

      (xxii) Providing services to a person who is making a claim as a result of a personal

injury, who charges or collects from the person any amount in excess of the reimbursement to the

physician assistant by the insurer as a condition of providing or continuing to provide services or

treatment.

     5-54-3. Exemptions. -- The provisions of this chapter do not apply to services performed

in any of the following areas:

      (1) The practice of dentistry or dental hygiene as defined in chapter 31.1 of this title.

      (2) The practice of chiropractic medicine.

      (3) The practice of optometry as defined in chapter 35 of this title.

      (4) A physician assistant student enrolled in a physician assistant or surgeon assistant an

approved educational program while performing duties in conjunction with a formal training

program clinical rotation under the auspices of a recognized degree granting institution.

      (5) Technicians, or other assistants or employees of physicians who perform delegated

tasks in the office of a physician but who are not rendering services as physician assistant or

identifying themselves as a physician assistant.

     5-54-5. Board of licensure. -- (a) The director of the department of health, with the

approval of the governor, shall appoint a board consisting of seven (7) nine (9) persons, residents

of the state, to constitute a board of licensure for physician assistants with the duties, powers, and

authority as stated in this chapter, and that board shall be composed of the following:

      (1) Two (2) members shall be licensed physicians under the provisions of chapter 37 of

this title who have been actively engaged in the practice of medicine;

      (2) One member is a chief executive officer of a health care facility located and licensed

in the state or his or her designee who is not licensed in any health care profession;

      (3) Two (2) members who are representatives of the general public not employed in any

health-related field; and

      (4) Two (2) Four (4) members shall be licensed physician assistants.

      (b) Members shall be appointed for terms of three (3) years each with no member

serving more than two (2) consecutive terms.

      (c) In his or her initial appointment, the director shall designate the members of the

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board of licensure for physician assistants as follows: two (2) members to serve for terms of three

(3) years; two (2) members to serve for a term of two (2) years; and three (3) members to serve

for a term of one year. Any additional appointments shall serve for one year.

      (d) The director of the department of health may remove any member of the board for

cause.

      (e) Vacancies shall be filled for the unexpired portion of any term in the same manner as

the original appointment.

     5-54-8. Permitted health care practices by physician assistants. -- Permitted medical

practices by physician assistants. -- (a) Physician assistants shall practice with physician

supervision and shall be considered the agents of their supervising physicians in the performance

of all practice-related activities. Whenever any provision of general or public law, or regulation,

requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, it

shall be deemed to include a signature, certification, stamp, verification, affidavit or endorsement

by a physician assistant; provided, however, that nothing in this section shall be construed to

expand the scope of practice of physician assistants. Physician assistants may perform those

duties and responsibilities consistent with the limitations of this section, including prescribing of

drugs and medical devices, which are delegated by their supervising physician(s). Physician

assistants may request, receive, sign for and distribute professional samples of drugs and medical

devices to patients only within the limitations of this section. Notwithstanding any other

provisions of law, a physician assistant may perform health care medical services when those

services are rendered under the supervision of a licensed physician.

      (b) Physician assistants, depending upon their level of professional training and

experience, as determined by a supervising physician, may perform health care medical services

consistent with their expertise and that of the supervising physician, who is a licensed physician

in solo practice, in group practice, or in health care facilities.

      (c) Physician assistants may write prescriptions and medical orders to the extent

provided in this paragraph. When employed by or extended medical staff privileges by a licensed

hospital or other licensed health care facility a physician assistant may write medical orders for

inpatients as delineated by the medical staff bylaws of the facility as well as its credentialing

process and applicable governing authority. Physician assistants employed directly by physicians,

health maintenance organizations or other health care delivery organizations may prescribe

legend medications including schedule II, III, IV and V medications under chapter 28 of title 21

of the Rhode Island Uniform Controlled Substances Act, medical therapies, medical devices and

medical diagnostics according to guidelines established by the employing physician, health

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maintenance organization or other health care delivery organization.

      (d) When supervised by a physician licensed under chapter 29 of this title, the service

rendered by the physician assistant shall be limited to the foot. The "foot" is defined as the pedal

extremity of the human body and its articulations, and includes the tendons and muscles of the

lower leg only as they are involved in conditions of the foot.

      (e) Hospitals and other licensed health care facilities have discretion to grant privileges

to a physician assistant and to define the scope of privileges or services which a physician

assistant may deliver in a facility. In no event shall those privileges, if granted, exceed the

privileges granted to the supervising physician.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS

***

     This act would revise the definition and supervision standards of physician assistants,

amend the number and composition of the board of licensure of physician assistants, by adding

two additional licensed physician assistants as members, and more precisely identify the scope of

practice of physician assistants by providing that physician assistants may perform medical

services.

     This act would take effect upon passage.

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