2023 -- H 5284

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LC000921

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS

     

     Introduced By: Representatives Bennett, Baginski, Kislak, Noret, McNamara, Corvese,
Solomon, Casey, J. Lombardi, and Hull

     Date Introduced: February 01, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 5-54-2 and 5-54-28 of the General Laws in Chapter 5-54 entitled

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"Physician Assistants" are hereby amended to read as follows:

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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 continuing

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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 standards

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of care, consult with or refer to an appropriate physician or other healthcare professional. The

 

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degree of collaboration shall be determined by the practice and includes decisions made by a

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physician affiliated with the practice employer, or physician group practice as defined in § 5-37-1,

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and or the credentialing and privileging systems of a licensed hospital, health center, or ambulatory

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care center healthcare facility licensed pursuant to the provisions of chapter 17 of title 23, or health

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maintenance organization licensed pursuant to the provisions of chapter 17 of title 23 or chapter 41

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of title 27. A physician must be accessible at all times for consultation by the physician assistant.

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     (6) “Director” means the director of the department of health.

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     (7) “Division” means the division of professional regulation, department of health.

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

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     (9) “Physician” means a person licensed under the provisions of chapter 29 or 37 of this

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title.

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

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practical training to provide medical and surgical services in collaboration with physicians.

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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 the

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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 felony; conviction of a crime arising out of the practice of medicine.

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All advertising of medical business that is 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 that 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 that 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 injury,

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

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

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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 other

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

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of his or her requisite federal agency as a physician assistant may volunteer to render such care that

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he or she is able to provide at a children’s summer camp or for a public or community event or in

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a licensed ambulatory health center providing free care without a collaborating physician as it is

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defined in this section of law or with such collaborating physicians as may be available. Such care

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must be rendered without compensation or remuneration. It is the obligation of the physician

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assistant to assure adequate and appropriate professional liability coverage.

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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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     5-54-29. Restrictive covenants.

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     (a) Any contract or agreement that creates or establishes the terms of a partnership,

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employment, or any other form of professional relationship with a physician assistant licensed to

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practice pursuant to this section that includes any restriction of the right of such physician assistant

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to practice shall be void and unenforceable with respect to said restriction; provided, however, that

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nothing herein shall render void or unenforceable the remaining provisions of any such contract or

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agreement.

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     (b) Restrictions rendered void under subsection (a) of this section shall include, but shall

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not be limited to, the following:

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     (1) The right to practice in any geographic area for any period of time after the termination

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of such partnership, employment, or professional relationship;

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     (2) The right of such physician assistant to provide treatment, advise, consult with or

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establish a professional relationship with any current patient of the employer; and

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     (3) The right of such physician assistant to solicit or seek to establish a professional

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relationship with any current patient of the employer.

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     (c) Notwithstanding the foregoing, the prohibition on physician assistant covenants shall

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not apply in connection with the purchase and sale of a practice; provided, the restrictive covenant

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and non-compete covenant is for a period of a time of not more than five (5) years.

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     SECTION 3. Section 16-91-3 of the General Laws in Chapter 16-91 entitled "School and

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Youth Programs Concussion Act" is hereby amended to read as follows:

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     16-91-3. School district’s guidelines to be developed and implemented.

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     (a) The department of education and the department of health shall work in concert with

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the Rhode Island Interscholastic League to develop and promulgate guidelines to inform and

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educate coaches, teachers, school nurses, youth athletes, and their parents and/or guardians of the

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nature and risk of concussion and head injury, including continuing to play after concussion or head

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injury. A concussion and head injury information sheet shall be signed and returned by the youth

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athlete and the athlete’s parent and/or guardian prior to the youth athlete’s return to practice or

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competition.

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     (b) School districts are required to use training materials made available by the United

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States Center for Disease Control and Prevention entitled “Heads Up: Concussion in the High

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School Sports/Concussion in Youth Sports” and any updates or amendments thereto, or training

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materials substantively and substantially similar thereto. The department of education shall post

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training materials made available by the Center for Disease Control and Prevention and the Rhode

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Island Interscholastic League on its website. All coaches and volunteers involved in a youth sport

 

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or activity covered by this chapter must complete a training course and a refresher course annually

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thereafter in concussions and traumatic brain injuries. All school nurses must complete a training

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course and an annual refresher course in concussions and traumatic brain injuries. Teachers and

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teachers’ aides are strongly encouraged to complete the training course in concussions and

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traumatic brain injuries. Training may consist of videos, classes, and any other generally accepted

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mode and medium of providing information.

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     (c) School districts are encouraged to have all student athletes perform baseline

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neuropsychological testing, computerized or otherwise. Parents and/or guardians shall be provided

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with information as to the risk of concussion and/or traumatic brain injuries prior to the start of

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every sport season and they shall sign an acknowledgement as to their receipt of such information.

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     (d) A youth athlete, who is suspected of sustaining a concussion or head injury in a practice

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or game, shall be removed from competition at that time.

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     (e) A youth athlete, who has been removed from play, may not return to play until the

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athlete is evaluated by a licensed physician, physician assistant or certified nurse practitioner who

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may consult with an athletic trainer, all of whom shall be trained in the evaluation and management

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of concussions. The athlete must receive written clearance to return to play from that licensed

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physician, physician assistant or certified nurse practitioner.

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     (f) All school districts are encouraged to have an athletic trainer, or similarly trained

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person, at all recreational and athletic events addressed by this statute.

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     SECTION 4. Section 16-91.1-3 of the General Laws in Chapter 16-91.1 entitled "The

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Sudden Cardiac Arrest Prevention Act" is hereby amended to read as follows:

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     16-91.1-3. School districts’ guidelines to be developed and implemented.

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     (a) The department of education and the department of health shall promulgate guidelines

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to inform and educate coaches, teachers, school nurses, youth athletes, and their parents and/or

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guardians about the nature and warning signs of sudden cardiac arrest, including the risks associated

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with continuing to play or practice after experiencing the following symptoms: fainting or seizures

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during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate and

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extreme fatigue.

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     (b) School districts may use training materials made available at no cost to the school

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district by organizations such as Simon’s Fund, Parent Heart Watch, Sudden Arrhythmia Death

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Syndromes Foundation, or training materials substantively and substantially similar thereto. The

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department of education shall post links to training materials on its website. All coaches and

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volunteers involved in a youth sport program or activity covered by this chapter must complete a

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training course that may be completed online about the nature and warning signs of sudden cardiac

 

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arrest, including the risks associated with continuing to play or practice after experiencing

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symptoms including: fainting or seizures during exercise, unexplained shortness of breath, chest

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pains, dizziness, racing heart rate and extreme fatigue. Training may consist of videos, classes, and

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any other generally accepted mode and medium of providing information.

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     (c) Parents and/or guardians shall be provided with information as to the nature and

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warning signs of sudden cardiac arrest prior to the start of every sport season.

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     (d)(1) A student who, as determined by a game official, coach from the student’s team,

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certified athletic trainer, licensed physician, or other official designated by the student’s school

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entity, exhibits signs or symptoms of sudden cardiac arrest while participating in an athletic activity

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shall be removed by the coach from participation at that time, subject to subsection (d)(3) of this

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section.

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     (2) If a student is known to have exhibited signs or symptoms of sudden cardiac arrest at

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any time prior to or following an athletic activity, the student shall be prevented from participating

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in an athletic activity, subject to subsection (d)(3) of this section.

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     (3) A student removed or prevented from participating in an athletic activity under

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subsections (d)(1) or (d)(2) of this section shall not return to participation until the student is

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evaluated and cleared for return to participation in writing by a licensed physician, physician

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assistant, certified registered nurse practitioner, or cardiologist.

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     (e) All school districts are encouraged to have an athletic trainer, or similarly trained

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person, at all recreational and athletic events addressed by this statute.

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     SECTION 5. Section 23-1.7-5 of the General Laws in Chapter 23-1.7 entitled "Rhode

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Island Program to Address Alzheimer’s Disease" is hereby amended to read as follows:

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     23-1.7-5. Medical professional training.

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     (a) All physicians licensed pursuant to chapter 37 of title 5, physician assistants licensed

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pursuant to chapter 54 of title 5, and nurses licensed pursuant to chapter 34 of title 5, shall, no later

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than October 1, 2023, complete a one-time course of training consisting of a minimum of one hour

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of instruction on the diagnosis, treatment, and care of patients with cognitive impairments

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including, but not limited to, Alzheimer’s disease and related disorders.

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     (b) The department of health shall promulgate rules to implement the training requirement

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of subsection (a).

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     SECTION 6. 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 expand participation in charitable and voluntary care to allow a physician

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assistant licensed in this state to provide free care without a collaborating physician; prohibit any

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agreement whereby a physician assistant is restricted in his or her right to practice in a certain

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geographic area, assist or provide treatment or establish a professional relationship with any other

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employer; and establish the right of the physician assistant to solicit or seek to establish a

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professional relationship with any current patient of the employer. This restriction would not apply

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with the purchase and sale of a practice which includes a restriction or non-compete clause within

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five (5) years, and would allow physician assistants to clear students to participate in athletic

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activities at school and evaluate and clear a young student athlete who has been removed from play

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due to injury.

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     This act would take effect upon passage.

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