2016 -- S 2580

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

____________

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- LASER AND ENERGY-BASED

PROCEDURES

     Introduced By: Senators Kettle, Miller, and Satchell

     Date Introduced: February 25, 2016

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 5 of the General Laws entitled "BUSINESSES AND PROFESSIONS"

is hereby amended by adding thereto the following chapter:

CHAPTER 37.8

LASER AND ENERGY-BASED PROCEDURES

     5-37.8-1. Definitions. -- As used in this chapter:

     (1) "Board" means the board of medical licensure and discipline.

     (2) "Delegate" means a non-physician tasked with performing a laser or energy-based

procedure.

     (3) "Energy-based procedure" means a medical procedure using an ultrasound,

cryolipolysis, microwave or radio frequency device that is not expected or intended to remove,

burn, or vaporize the live epidermal surface of the skin, but may damage underlying tissue, if

used inappropriately.

     (4) "Laser procedure" means a medical procedure using a laser or intense pulsed light

device that is not expected or intended to remove, burn, or vaporize the live epidermal surface of

the skin, but may damage underlying tissue, if used inappropriately. This definition includes

procedures related to laser hair removal.

     (5) "Physician" means a person with a license to practice allopathic or osteopathic

medicine in this state under the provisions of this chapter and chapter 37 of this title.

     (6) "Supervision" means the overseeing of the delegated laser or energy-based procedures

performed by a delegate. Supervision shall only be provided by a physician.

     (7) "Surgery" means a procedure performed for the purpose of structurally altering the

human body by the incision or destruction of tissues and is part of the practice of medicine. This

definition includes the diagnostic or therapeutic treatment of conditions or disease processes by

any instruments causing localized alteration or transposition of human tissue which include

lasers, ultrasound, ionizing radiation, scalpels, probes, and needles. The tissue can be cut, burned,

vaporized, frozen, sutured, probed, or manipulated by closed reductions for major dislocations or

fractures, or otherwise altered by mechanical, thermal, light-based, electromagnetic, or chemical

means. All of these surgical procedures are invasive, including those that are performed with

lasers, and the risks of any surgical procedure are not eliminated by using a light knife or laser in

place of a metal knife, or scalpel.

     5-37.8-2. General restrictions. -- (a) The use of a laser or energy-based device that is

expected or intended to remove, burn, or vaporize the live epidermal surface of the skin is surgery

and may only be performed by a physician.

     (b) A laser or energy-based procedure, including laser-assisted hair removal, may be

performed by a delegate if the procedure has been delegated, the delegating physician provides

the appropriate on-site supervision, and the delegate has met the necessary training requirements.

     5-37.8-3. Delegation of laser or energy-based procedures. -- (a) Prior to delegating the

performance of a laser or energy-based procedure, the delegating physician shall perform the

initial assessment of the patient to determine which procedure is appropriate for the patient and

determine the settings on the chosen device.

     (b) Prior to delegating the performance of a laser or energy-based procedure, the

delegating physician shall ensure that the delegate has satisfactorily met the training requirements

and that the procedure is within the scope of practice for the delegate's profession. The delegating

physician is responsible for ensuring that the delegate performing the procedure has demonstrated

sufficient proficiency for each laser and energy-based procedure performed.

     (c) Prior to the performance of a delegated laser or energy-based procedure, the

delegating physician shall inform the patient about the training and qualifications of who will be

performing the procedure.

     (d) A physician may delegate the performance of a laser and energy-based procedure

through the use of a written protocol. The written protocol shall provide, at a minimum:

     (1) The identification of the devices and settings to be used;

     (2) A description of appropriate care and follow-up for common complications, injuries,

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or adverse reactions that may result from the laser procedure, including a plan to manage medical

emergencies;

     (3) A description of the treatment plan to be followed for each procedure delegated under

the written protocol, including the method to be used for documenting decisions, communicating

with the delegating physician, and recording all treatment provided in the patient's record; and

     (4) A quality assurance plan for monitoring care provided by the delegate, including

patient care review and any necessary follow-up.

     (e) The written protocol shall be annually reviewed by the delegating physician and the

delegate and updated as necessary. The written protocol shall be provided to the board or to any

patient, upon request.

     5-37.8-4. Supervision. -- A delegate may only perform a delegated laser or energy-based

procedure under the on-site supervision of a physician. On-site supervision requires:

     (1) A physician to be physically present in the facility where the procedure is to be

performed for at least the entire duration of the procedure; and

     (2) A physician shall be immediately available and able to respond promptly to any

question or problem that may occur while the procedure is being performed.

     5-37.8-5. Training. -- (a) A physician who delegates the performance of a laser or

energy-based procedure shall be able to document to the board the completion of appropriate

training in the physics, safety, and surgical techniques involved in the use of laser and energy-

based devices capable of damaging living tissues. This training should include an extensive

understanding of cutaneous medicine and surgery, the indications and contraindications for such

procedures, the pre- and post-operative care involved in treatment, as well as the treatment of

complications associated with these devices.

     (b) For each laser and energy-based procedure to be performed, it is the responsibility of

the delegating physician to ensure that the delegate is appropriately trained in the indications and

contraindications and the pre- and post-operative care involved in treatment.

     5-37.8-6. Violations and enforcement. -- Failure to comply with any provision under

this chapter or knowingly delegating a laser or energy-based procedure other than as authorized

under this chapter shall constitute unprofessional conduct, as defined in §5-37-5.1.

     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 -- LASER AND ENERGY-BASED

PROCEDURES

***

     This act would provide guidelines for the delegation by physicians of laser or energy-

based procedures to a properly trained and qualified individual.

     This act would take effect upon passage.

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