2019 -- S 0443

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LC001806

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - PHYSICIAN ASSISTANTS

     

     Introduced By: Senator Erin Lynch Prata

     Date Introduced: February 27, 2019

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 5-54-1, 5-54-2, 5-54-3, 5-54-5, 5-54-6, 5-54-7, 5-54-8, 5-54-9, 5-

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54-16, 5-54-22 and 5-54-27 of the General Laws in Chapter 5-54 entitled "Physician Assistants"

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are hereby amended to read as follows:

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     5-54-1. Declaration of policy.

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     (a) The general assembly intends to establish by this chapter a framework for the

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development of a new category of health personnel to be known as the physician assistant.

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     (b) The purpose of this chapter is to encourage the more effective utilization of the skills

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of physicians by enabling them to delegate health care tasks including the writing of prescriptions

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and medical orders to qualified physician assistants where that delegation is consistent with the

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patient's health and welfare provide for an adequate supply of qualified medical providers to meet

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the needs of the citizens of Rhode Island and protect the public safety by establishing criteria for

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licensure and regulation of physician assistants.

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     (c) Nothing in this chapter shall be construed to repeal or supersede existing laws relating

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to other paramedical professions or services.

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     5-54-2. Definitions.

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     As used in this chapter, the following words have the following meanings:

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

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

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

 

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

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Allied Health Education Programs (CAAHEP) or its successor.

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

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

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Accreditation Council for Continuing Medical Education of the American Medical Association

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

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

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approved program.

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

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     (5) "Collaboration" means the physician assistant shall, as indicated by the patient’s

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condition, the education, competencies and experience of the physician assistant and the

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standards of care, consult with or refer to an appropriate physician or other health care

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professional. The degree of collaboration shall be determined by the practice and includes

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decisions made by a physician employer, physician group practice, and the credentialing and

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privileging systems of a licensed hospital, health center or ambulatory care center. A physician

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must be accessible at all times for consultation by the physician assistant.

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

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

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

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

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this title.

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     (9)(10) "Physician assistant" or "PA" means a person who is qualified by academic and

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practical training to provide those certain patient medical and surgical services under the

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supervision, control, responsibility and direction of a licensed physician in collaboration with

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physicians.

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

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

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

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

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

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

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

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

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

 

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the form of an agreement between the supervising physicians and physician assistants delineating:

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

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

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

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the physician assistant.

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

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procedures to be performed by the physician assistant.

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

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requirements for periodic review of the physician assistant services.

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

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

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

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governing authority of the facility.

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

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communication and referral at all times.

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

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

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the director:

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

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

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

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

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intended or has a tendency to deceive the public;

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     (iv) Abandonment of a patient;

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

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

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

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

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

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

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

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

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by law;

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

 

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laboratories for individual tests or test series for patients;

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

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these unlicensed persons in the practice of medicine;

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

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procedure, treatment or medicine;

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     (xiii) Professional or mental incompetence;

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

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

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

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

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

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

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

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

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

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information legally requested by the board;

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

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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;

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

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     (xx) Medical malpractice;

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

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physician assistant/patient relationship;

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

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

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

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treatment.

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     5-54-3. Exemptions.

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     The provisions of this chapter do not apply to services performed in any of the following

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areas:

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

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     (2) The practice of chiropractic medicine.

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

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

 

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

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

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

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

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identifying themselves as a physician assistant.

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     5-54-5. Board of licensure.

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     (a) The director of the department of health, with the approval of the governor, shall

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appoint a board consisting of seven (7) persons, residents of the state, to constitute a board of

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licensure for physician assistants with the duties, powers, and authority as stated in this chapter,

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and that board shall be composed of the following:

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

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

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

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

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

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health-related field; and

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     (4) Two (2) Three (3) members shall be physician assistants.

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

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more than two (2) consecutive terms.

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

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of licensure for physician assistants as follows: two (2) members to serve for terms of three (3)

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

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

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

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cause.

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

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the original appointment.

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     5-54-6. Board of licensure -- Organization and meetings -- Compensation of

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members.

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     The board shall elect its own chairperson annually and shall meet at the call of the

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administrator, the chairperson or upon the request of two (2) or more members of the board. A

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quorum shall consist of at least three (3) four (4) members present. The board shall approve

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programs for continuing medical education. Board members shall serve without compensation.

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     5-54-7. Board of licensure -- Powers and duties.

 

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     (a) The board shall administer, coordinate, and enforce the provisions of this chapter,

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evaluate the qualifications of applicants, supervise any examination of applicants deemed

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necessary, recommend to the director the commencement of disciplinary hearings in accordance

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with chapter 35 of title 42 and the provisions of this chapter, and investigate persons engaging in

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practices which violate the provisions of this chapter. This authority shall specifically encompass

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practicing physician assistants, supervisory collaborating physicians, and those health care

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agencies employing physician assistants. The board shall investigate all persons and agencies

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engaging in practices which violate the provisions in this chapter.

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     (b) The board shall conduct hearings of a non-disciplinary nature and shall keep the

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records and minutes that are necessary to an orderly dispatch of business.

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     (c) The board, with the approval of the director of the department of health, shall adopt

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rules and regulations necessary to carry into effect the provisions of this chapter and may amend

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or repeal them.

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     (d) Regular meetings of the board shall be held at any time and places that the board

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prescribes and special meetings shall be held upon the call of the chairperson; provided, that at

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least one regular meeting is held each year.

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     (e) The conferral or enumeration of specific powers in this chapter shall not be construed

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as a limitation of the general powers conferred by this section.

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     (f) The board shall recommend to the director for registration those persons meeting the

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criteria stated by this chapter.

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     (g) The board shall recommend to the director the revocation or suspension of the

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registration license of any physician assistant who does not conform to the requirements of this

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chapter or regulations adopted under this chapter.

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     (h) In accordance with its authority under subsection (a) of this section the board shall

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make recommendations to the director for discipline of supervising physicians and employing

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health care agencies found wanting in their use of physician assistants.

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     (i) The board shall approve programs for continuing medical education.

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

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     (a) Physician assistants shall practice in collaboration with physician physicians

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

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of all practice-related activities. A physician assistant may provide any medical or surgical

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services that are within the physician assistant's skills, education and training. Whenever any

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provision of general or public law, or regulation, requires a signature, certification, stamp,

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verification, affidavit or endorsement by a physician, it shall be deemed to include a signature,

 

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certification, stamp, verification, affidavit or endorsement by a physician assistant; provided,

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however, that nothing in this section shall be construed to expand the scope of practice of

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physician assistants. Physician assistants may perform those duties and responsibilities consistent

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with the limitations of this section, including prescribing, administering, procuring and dispensing

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

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

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

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provisions of law, a physician assistant may perform health care provide medical and surgical

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services when those services are rendered under the supervision of in collaboration with a

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licensed physician.

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

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

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

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

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

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

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or other licensed health care facility in accordance with subsection (e) of this section, a physician

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assistant may write medical orders for inpatients as delineated by the medical staff bylaws of the

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facility as well as its credentialing process and applicable governing authority. Physician

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assistants employed directly by physicians, health maintenance organizations or other health care

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delivery organizations may prescribe legend medications including schedule II, III, IV and V

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medications under chapter 28 of title 21 of the Rhode Island Uniform Controlled Substances Act,

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medical therapies, medical devices and medical diagnostics according to guidelines established

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by the employing physician, health maintenance organization or other health care delivery

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organization.

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     (d) When supervised by a collaborating with a physician licensed under chapter 29 of this

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title, the service rendered by the physician assistant shall be limited to the foot. The "foot" is

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defined as the pedal extremity of the human body and its articulations, and includes the tendons

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

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

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

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

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granted to the supervising physician.

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     (f) A physician assistant shall not undertake or represent that he or she is qualified to

 

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provide a medical or surgical care service that he or she knows or reasonably should know to be

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outside his or her competence or is prohibited by law.

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     (g) Notwithstanding any other provision of law or regulation, a physician assistant shall

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be considered to be a primary care provider when the physician assistant is practicing in the

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medical specialties required for a physician to be a primary care provider.

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     5-54-9. Criteria for licensure as a physician assistant.

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     The board shall recommend to the director for licensure as a physician assistant an

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applicant who:

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     (1) Is of good character and reputation;

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     (2) Graduated from a physician assistant training program certified by the AMA's

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

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Accreditation of Allied Health Education Programs (CAAHEP), its successor or the Accreditation

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Review Commission on Education for the Physician Assistant (ARC-PA) or its successor.

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     (3) Passed a certifying examination approved by the National Commission on

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Certification of Physician Assistants physician assistant national certification examination or any

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other national certifying exam approved by the board.

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     (4) Submitted a completed application together with the required fee as set forth in § 23-

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1-54.

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     5-54-16. Penalty for misrepresentation.

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     No person who is not licensed as a physician assistant may use the title of "Physician

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Assistant" or "PA" or hold himself or herself out as a physician assistant. Any person who

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violates the provisions of this section shall be punished by a fine of not less than two hundred

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dollars ($200) nor more than five hundred dollars ($500), nor more than one year imprisonment,

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or by both the fine and imprisonment.

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     5-54-22. Continuing medical education.

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     Every physician assistant licensed to practice within the state shall be required to have

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satisfactorily completed ten (10) twenty-five (25) hours of approved continuing medical

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education annually. The annual period for accumulation of continuing education hours

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commences on the first day of October and runs through the last day of September beginning in

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1996. Beginning with the annual renewal period commencing the first day of October 1997 the

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administrator shall not renew the certificate of licensure until satisfactory evidence of the

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completion of the required continuing medical education is provided to the division.

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     5-54-27. Participation in disaster and emergency care.

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     A person licensed under the provisions of this chapter or members of the same profession

 

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licensed to practice in other states of the United States or members of the same profession

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credentialed by a federal employer who voluntarily and gratuitously, and other than in the

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ordinary course of his or her employment or practice, renders emergency medical assistance

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during an emergency or a state or local disaster may render such care without supervision

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collaboration as set forth in subdivision 5-54-2(10) § 5-54-2(5), or with such supervision as is

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available. Any physician who supervises a physician assistant providing medical care in response

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to such an emergency or state or local disaster shall not be required to meet the supervising

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physician requirements set forth in subdivision 5-54-2(10).

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     SECTION 2. Chapter 5-54 of the General Laws entitled "Physician Assistants" is hereby

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amended by adding thereto the following section:

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     5-54-28. Participation in charitable and voluntary care.

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     A physician assistant licensed in this state, or licensed or authorized to practice in any

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other U.S. jurisdiction, or who is credentialed by a federal employer or meets the licensure

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requirements of his or her requisite federal agency as a physician assistant may volunteer to

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render such care that he or she is able to provide at a children's summer camp or for a public or

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community event or in a licensed ambulatory health center providing free care. Such care must be

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rendered without compensation or remuneration. It is the obligation of the physician assistant to

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assure adequate and appropriate professional liability coverage.

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     SECTION 3. Section 5-54-12.1 of the General Laws in Chapter 5-54 entitled "Physician

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Assistants" is hereby repealed.

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     5-54-12.1. Continuing medical education.

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     Every physician assistant licensed to practice within the state shall be required to have

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satisfactorily completed ten (10) hours of approved continuing medical education annually. The

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annual period for accumulation of continuing medical education hours commences on the first

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day of September and runs through the thirty-first day of August beginning in 1996. Beginning

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with the annual renewal period commencing the first day of August 1997 the administrator shall

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not renew the certificate of licensure until satisfactory evidence of completion of the required

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continuing medical education is provided to the division.

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     SECTION 4. 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 - PHYSICIAN ASSISTANTS

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     This act would update the laws relating to physician assistants to reflect current standards

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and terminology.

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     This act would take effect upon passage.

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