Introduced By: Representatives Ginaitt and Dennigan
Date Introduced : February 3, 1998
It is enacted by the General Assembly as follows:
SECTION 1. Sections 5-54-2, 5-54-12 and 5-54-14 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 shall 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 that has been 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) "Board" means the board of licensure of physician assistants.
(4) "Director" means the director of the department of health.
(5) "Division" means the division of professional regulation, department of health.
(6) "Formulary committee" means a committee empowered to develop a list of medications that physician assistants may prescribe.
(7) "Physician" means a person licensed under the provisions of chapters 29 or 37 of this title.
(8) "Physician assistant" means a person not a physician nor person holding a medical doctor or equivalent degree who is qualified by academic and practical training to provide those certain patient services under the supervision, control, responsibility and direction of a licensed physician.
(9) "Supervision" means overseeing the activities of, and accepting the responsibility for the medical services rendered by the physician assistants. Supervision shall be 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 assistant(s) must have on file at the primary practice site a copy of a policy in the form of an agreement between the supervising physician(s) and physician assistant(s) delineating:
(A) the level of supervision provided by the supervising physician(s) or designee(s) with particular reference to differing levels of supervision depending on the type of patient services provided and requirements for communication between the supervising physician(s) or designee(s) and the physician assistant.
(B) a job description for the physician assistant listing patient care responsibilities and procedures to be performed by the physician assistant.
(C) a program for quality assurance for physician assistant services including requirements for periodic review of the physician assistant services.
Requirements for supervision of physician assistant 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 bylaws and/or applicable governing authority of the facility.
The supervising physician or physician designee must be available for easy communication and referral at all times.
(10) "Approved program for continuing medical education" shall mean 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.
{ADD (11) "Unprofessional conduct" shall include but not be limited to the following items or any combination thereof and may be further defined by regulations established by the board with prior approval of the director: ADD}
{ADD (1) Fraudulent or deceptive procuring or use of a license; ADD}
{ADD (2) Representation of himself or herself as a physician; ADD}
{ADD (3) 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; ADD}
{ADD (4) Abandonment of a patient; ADD}
{ADD (5) Dependence upon a controlled substance, habitual drunkenness, or rendering professional services to a patient while intoxicated or incapacitated by the use of drugs; ADD}
{ADD (6) Promotion of the sale of drugs, devices appliances, or goods or services provided for a patient in such a manner as to exploit the patient for the financial gain of the physician assistant; ADD}
{ADD (7) Immoral conduct of a physician assistant in the practice of medicine; ADD}
{ADD (8) Willfully making and filing false reports or records; ADD}
{ADD (9) 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; ADD}
{ADD (10) Agreeing with clinical or bioanalytical laboratories to accept payments from such laboratories for individual tests or test series for patients; ADD}
{ADD (11) Practicing with an unlicensed physician or physician assistant or aiding or abetting such unlicensed persons in the practice of medicine; ADD}
{ADD (12) Offering, undertaking or agreeing to cure or treat a disease by a secret method, procedure, treatment or medicine; ADD}
{ADD (13) Professional or mental incompetence; ADD}
{ADD (14) 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 set forth in this chapter; ADD}
{ADD (15) Any adverse judgement, settlement, or award arising from a medical liability claim related to acts or conduct which would constitute grounds for action as set forth in this chapter; ADD}
{ADD (16) Failure to furnish the board, the administrator, investigator or representatives, information legally requested by the board; ADD}
{ADD (17) Violation of any provision(s) of this chapter or the rules and regulations promulgated by the director or an action, stipulation, or agreement of the board; ADD}
{ADD (18) Cheating or attempting to subvert the certifying examination; ADD}
{ADD (19) Violating any state or federal law or regulation relating to controlled substances; ADD}
{ADD (20) Medical malpractice; ADD}
{ADD (21) Sexual contact between a physician assistant and patient during the existence of the physician assistant/patient relationship. ADD}
5-54-12. Grounds for refusal to renew, suspension or revocation
of certificates. -- The director may, after due
notice and hearing, as hereinafter provided, refuse to grant,
refuse to renew, suspend, or revoke any certificate of licensure
or otherwise discipline any registrant upon proof that the person {DEL : DEL}
{DEL (1) Is guilty of fraud or deceit in procuring or attempting
to procure a licensure; DEL}
{DEL (2) Is guilty of a crime of gross immorality; DEL}
{DEL (3) Is unfit or incompetent by reason of negligence, habits
or other cause; DEL}
{DEL (4) Is habitually intemperate or is addicted to the use
of habit-forming drugs; DEL}
{DEL (5) Is mentally incompetent; DEL}
{DEL (6) Is guilty of unprofessional conduct; and DEL}
{DEL (7) Has violated any of the provisions of this chapter.
DEL}
{ADD is guilty of unprofessional conduct as defined in section 5-54-2. ADD}
5-54-14. Grounds for discipline without hearing. --
{DEL In the event a person shall be hospitalized for mental
illness or as an alcoholic as defined in chapter 4 of title 40.1,
the director may without the necessity of the proceedings provided
for in section 5-54-13 above, suspend or refuse to renew the certificate
of that person for the duration of the confinement or until that
person shall be medically discharged from that hospitalization. DEL}
{ADD The director may, temporarily suspend the license of a physician
assistant without a hearing if the director finds that the evidence
in his or her possession indicates that a physician assistant's
continuation in practice would constitute a danger to the public.
In the event that the director suspends, temporarily, the license
of a physician assistant without a hearing, a hearing by the board
must be held within ten (10) days after such suspension has occurred. ADD}
SECTION 2. Chapter 5-54 of the General Laws entitled "Physician Assistants" is hereby amended by adding thereto the following section:
{ADD 5-54-11.1. Inactive list. -- ADD} {ADD A physician assistant licensed to practice who does not intend to engage in the practice of his or her profession during any year, upon written request to the board may have his or her name transferred to an inactive list, and shall not be required to register annually or pay any renewal as long as he or she remains inactive. Any physician assistant included in the inactive list as provided for in this section shall be restored to active status by the administrator upon filing of a written request accompanied by the renewal fee. ADD}
{ADD 5-54-13.1. Non-disciplinary alternative. ADD}-- {ADD The board may provide for a non-disciplinary alternative in situations involving alcohol and drug abuse, provided the physician assistant agrees voluntarily to participate in a program of treatment and rehabilitation. All records pertaining to the physician assistant's participation in the non-disciplinary program shall be confidential and not subject to discovery, subpoena, or public disclosure. Provided, however, that information related to the non-disciplinary program shall be provided to the physician assistant's employer to ensure adequate worksite monitoring and compliance. ADD}
{ADD (1) A physician assistant may be considered for a non-disciplinary program in the following ways: ADD}
{ADD (2) By self referral; ADD}
{ADD (3) By employer referral; ADD}
{ADD (4) By identification of chemical dependency in conjunction with a sworn complaint filed against the physician assistant; or ADD}
{ADD (5) By referral from a family member, friend, physician, physician assistant, or other health care professional, or physician assistant/medical professional association. ADD}
{ADD If the physician assistant does not agree to voluntarily participate in a treatment protocol approved by the board, or fails to satisfactorily complete a treatment program, the board shall be informed and shall institute disciplinary proceedings. ADD}
{ADD The following criteria shall disqualify a physician assistant from participation in a non-disciplinary substance abuse program; ADD}
{ADD (1) Diversion of drugs; ADD}
{ADD (2) Conviction of the sale, distribution or manufacture of illegal substances; ADD}
{ADD (3) Severity of a chemical dependency problem that could represent a clear and present danger to patient health and safety; ADD}
{ADD (4) Any other criteria established by the board by regulation. ADD}
{ADD 5-54-22. Continuing medical education. ADD}-- {ADD Every physician assistant licensed to practice within the state shall be required to have satisfactorily completed ten (10) hours of approved continuing medical education annually. The annual period for accumulation of continuing education hours shall commence on the first day of October and run through the last day of September beginning in 1996. Beginning with annual renewal period commencing the first day of October 1997 the administrator shall not renew the certificate of licensure until satisfactory evidence of the completion of the required continuing medical education has been provided to the division. ADD}
{ADD 5-54-23. Reports relating to professional conduct and capacity -- Regulations -- Confidentiality -- Immunity.ADD}-- {ADD In addition to the requirements of section 42-14-2.1: ADD}
{ADD (1) The board with the approval of the director may adopt regulations requiring any person, including, but not limited to, corporations, health care facilities, health maintenance organization, organizations and federal, state, or local governmental agencies, or peer review boards to report to the board any: Conviction, determination, or finding that a licensed physician assistant has committed unprofessional conduct as defined in section 5-54-2 as now or hereafter amended, or to report information which indicates that a licensed physician assistant may not be able to practice with reasonable skill and safety to patients as the result of any mental or physical condition. The regulations shall include the reporting requirements on subdivision (2)(i), (ii), (iii). ADD}
{ADD (2) The following reports in writing shall be filed with the board: ADD}
{ADD (i) Every insurer providing professional liability insurance to a physician assistant licensed under the provisions of this chapter shall send a complete report to the board setting forth any formal notice of any claim, settlement of any claim or cause of action, or final judgement rendered in any cause of action for damages for death or personal injury caused by such a physician assistant's negligence, error or omission in practice or his or her rendering of unauthorized professional services. Such a report shall be sent within thirty (30) days after service of such complaint or notice, settlement, judgement, or arbitration award on the parties. All such reports shall set forth an in depth factual summary of the claim in question. ADD}
{ADD (ii) All hospital and licensed health care facilities including, but not limited to, nursing homes and health maintenance organizations and the division of drug control must report within thirty (30) days of such action, any action, disciplinary or otherwise, taken for any reason, which limits, suspends, or revokes a physician assistant's privilege to practice, either through formal action by the institution or facility or through any voluntary agreement with the physician assistant. ADD}
{ADD (iii) Within ten (10) days after a judgement by a court of this state that a physician assistant licensed under the provisions of this chapter has been convicted of a crime or is civilly liable for any death or personal injury caused by his or her negligence, error or omission in his or her practice or his or her rendering unauthorized professional services, the clerk of the court which rendered such judgement shall report the judgement to the board. ADD}
{ADD (3) The board shall publicly report any change of privileges, of which it is aware, to the board of trustees or other appropriate body of all licensed hospitals, licensed health care facilities, health maintenance organizations and such other parties as the board shall deem appropriate, within thirty (30) days, provided, however that notwithstanding the provisions of this subdivision, the board may, in instances where the change of privilege is not related to quality of patient care, elect not to disseminate the report of changed privileges. Such an election may be made in executive session and no decision not to disseminate shall be made except by the majority vote of the members present at the meeting and only upon a finding of fact by the board after inquiry that the change was not related to quality of patient care. ADD}
{ADD (4) The contents of any report file shall be confidential and exempt from public disclosure, except that it may be reviewed: ADD}
{ADD (i) By the licensee involved or his or her counsel or authorized representative who may submit any additional exculpatory or explanatory statements or other information, which statements or other information shall be included in the file, or ADD}
{ADD (ii) By the chief administrative officer, a representative of the board or investigator thereof, who has been assigned to review the activities of a licensed physician assistant. ADD}
{ADD (5) Upon determination that a report is without merit, the board's records may be purged of information relating to the report. ADD}
{ADD (6) If any person refuses to furnish a required report, the board may petition the superior court of any county in which the person resides or is found, and the court shall issue to such person an order to furnish the required report. Any failure to obey such an order shall be punished by the court as a civil contempt may be punished. ADD}
{ADD (7) Every individual medical association, medical society, physician assistant professional organization, health care facility, health maintenance organization, peer review board, medical service bureau, health insurance carrier or agent, professional standards review organization, and agency of the federal, state, or local government shall be immune from civil liability, whether direct or derivative, for providing information in good faith to the board pursuant to this statute or the regulations outlined in subdivision (1) or requirements of subdivision (2). ADD}
{ADD (8) Nondisclosure agreements are prohibited in so far as they forbid parties from making reports regarding competency and/or unprofessional conduct to the board. ADD}
{ADD 5-54-24. Requirements relating to professional conduct. ADD}-- {ADD The board shall receive and maintain a confidential file which will be available to the board to precipitate or aid in their investigations. The information shall also be available to licensed health care facilities including health maintenance organizations in connection with the granting of staff privileges and to the individual physician assistants themselves. The file shall contain the following information: ADD}
{ADD (1) Cases of malpractice suits against physician assistants as reported to the board by insurers and self insurers; ADD}
{ADD (2) Cases of malpractice suits that result in allegations being dropped, a dismissal, a settlement, or court judgement or arbitration award adverse to the physician assistant; ADD}
{ADD (3) Reports by any hospital or state or local professional medical association/society of disciplinary action taken against any physician assistant. This should also include any resignation of a physician assistant if related to unprofessional conduct as defined in law or any withdrawal of an application for hospital privileges relating to unprofessional conduct; ADD}
{ADD (4) Reports by state and federal courts of physician assistants found guilty of a felony; ADD}
{ADD (5) Reports by professional review organizations and third party health insurers of sanctions imposed on a physician assistant; ADD}
{ADD (6) The file may contain such other data as the board by reasonable rule or regulation deems appropriate. ADD}
{ADD 5-54-25. Communication of information among health care facilities.ADD}-- {ADD Any licensed health care facility, acting by and through it's chief executive officer or his or her designee, may upon the request of any other licensed health care facility, communicate to the chief executive officer of such requesting facility or his or her designee any and all information available thereto regarding circumstances under which the privileges of any physician assistant were changed as described in section 5-54-22(3). No health care facility, chief executive officer, or his or her designee, communicating information under this section, shall have liability arising out of such communication, unless the person making such communication is not acting in good faith. ADD}
{ADD 5-54-26. Hospital responsibility to take action based upon adverse information received. ADD}-- {ADD (a) Whenever a hospital received information from the board pursuant to section 5-54-23(3), that indicate that the privileges of a physician assistant or other health care professional have been suspended, revoked, or limited at another hospital, such receiving hospital shall within thirty (30) days initiate a preliminary inquiry into whether the privileges of the affected physician assistant or other health care professional at said receiving hospital should be similarly suspended, revoked, or limited, based upon review of the exercise of privileges at said receiving hospital, unless such information indicates that any adverse action with respect to privileges was administrative in character. ADD}
{ADD (b) Any hospital receiving information described in subsection (a) may take any one or more of the following courses of action in addition to such action required in subsection (a), any one of which shall discharge its responsibility under this chapter to monitor the qualification and fitness of physician assistants and other health care professionals on its medical staff: ADD}
{ADD (1) In any case that has been referred to the board, to await final disposition of the board, and to take such further action as is consistent with sanctions, if any, imposed thereby; ADD}
{ADD (2) In any case in which the matter has resulted in the suspension, revocation, or restriction of privileges at any other hospital, to adopt the factual findings of such other hospital, and to impose such suspension, revocation, or restriction in privileges as such receiving hospital deems appropriate, if any, in light of such factors; or ADD}
{ADD (3) In any case, to conduct a formal inquiry, in accordance with applicable procedural requirements, to determine what action, if any, should be taken with respect to the privileges of such physician assistant or other health care professional. ADD}
{ADD (c) No hospital, or officer, employee, physician assistant or other health care professional associated therewith shall be liable to any physician assistant or other health care professional for any action taken in accordance with subsections (a) or (b) when such action was made in good faith. ADD}
SECTION 3. This act shall take effect upon passage.
