2016 -- H 7743

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LC004948

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

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

PROCEDURES

     

     Introduced By: Representative Kathleen A. Fogarty

     Date Introduced: February 25, 2016

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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

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is hereby amended by adding thereto the following chapter:

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CHAPTER 37.8

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LASER AND ENERGY-BASED PROCEDURES

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

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

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

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procedure.

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

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

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

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used inappropriately.

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

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

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

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procedures related to laser hair removal.

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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place of a metal knife, or scalpel.

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

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

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and may only be performed by a physician.

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

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

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

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

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

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

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determine the settings on the chosen device.

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

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

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

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

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

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

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

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performing the procedure.

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

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

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

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     (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

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emergencies;

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

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

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

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

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patient care review and any necessary follow-up.

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

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

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patient, upon request.

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

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

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

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

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

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

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

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

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

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

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

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

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complications associated with these devices.

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

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

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

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

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

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under this chapter shall constitute unprofessional conduct, as defined in ยง5-37-5.1.

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     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

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

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based procedures to a properly trained and qualified individual.

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     This act would take effect upon passage.

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