As Introduced

127th General Assembly Regular Session 2007-2008

S. B. No. 279

Senator Schuring 

---

A BILL

Top amend sections 4730.03, 4730.09, 4731.281,

1

4731.19, and 4731.293 of the Revised Code

2

regarding certain State Medical Board procedures,

3

restrictions on physician assistants, and

4

admission to the massage or cosmetic therapist

5

examination.

6

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 4730.03, 4730.09, 4731.281, 4731.19,	7
and 4731.293 of the Revised Code be amended to read as follows:	8

Sec. 4730.03.  Nothing in this chapter shall:

9

(A) Be construed to affect or interfere with the performance	10
of duties of any medical personnel inwho are either of the	11
following:	12

(1) In active service in the army, navy, coast guard, marine	13
corps, air force, public health service, or marine hospital	14
service of the United States while so serving;	15

(2) Employed by the veterans administration of the United	16
States while so employed;	17

(B) Prevent any person from performing any of the services a	18
physician assistant may be authorized to perform, if the person's	19
professional scope of practice established under any other chapter	20
of the Revised Code authorizes the person to perform the services;	21

(C) Prohibit a physician from delegating responsibilities to	22
any nurse or other qualified person who does not hold a	23
certificate to practice as a physician assistant, provided that	24
the individual does not hold the individual out to be a physician	25
assistant;	26

(D) Be construed as authorizing a physician assistant	27
independently to order or direct the execution of procedures or	28
techniques by a registered nurse or licensed practical nurse in	29
the care and treatment of a person in any setting, except to the	30
extent that the physician assistant is authorized to do so by the	31
physician supervisory plan approved under section 4730.17 of the	32
Revised Code for the physician who is responsible for supervising	33
the physician assistant or the policies of the health care	34
facility in which the physician assistant is practicing;	35

(E) Authorize a physician assistant to engage in the practice	36
of optometry, except to the extent that the physician assistant is	37
authorized by a supervising physician acting in accordance with	38
this chapter to perform routine visual screening, provide medical	39
care prior to or following eye surgery, or assist in the care of	40
diseases of the eye;	41

(F) Be construed as authorizing a physician assistant to	42
prescribe any drug or device to perform or induce an abortion, or	43
as otherwise authorizing a physician assistant to perform or	44
induce an abortion.	45

Sec. 4730.09. (A) Under a physician supervisory plan approved	46
under section 4730.17 of the Revised Code, a physician assistant	47
may provide any or all of the following services without approval	48
by the state medical board as special services:	49

(1) Obtaining comprehensive patient histories;

50

(2) Performing physical examinations, including audiometry	51
screening, routine visual screening, and pelvic, rectal, and	52
genital-urinary examinations, when indicated;	53

(3) Ordering, performing, or ordering and performing routine	54
diagnostic procedures, as indicated;	55

(4) Identifying normal and abnormal findings on histories,	56
physical examinations, and commonly performed diagnostic studies;	57

(5) Assessing patients and developing and implementing	58
treatment plans for patients;	59

(6) Monitoring the effectiveness of therapeutic	60
interventions;	61

(7) Exercising physician-delegated prescriptive authority	62
pursuant to a certificate to prescribe issued under this chapter;	63

(8) Carrying out or relaying the supervising physician's	64
orders for the administration of medication, to the extent	65
permitted by law;	66

(9) Providing patient education;

67

(10) Instituting and changing orders on patient charts;

68

(11) Performing developmental screening examinations on	69
children with regard to neurological, motor, and mental functions;	70

(12) Performing wound care management, suturing minor	71
lacerations and removing the sutures, and incision and drainage of	72
uncomplicated superficial abscesses;	73

(13) Removing superficial foreign bodies;

74

(14) Administering intravenous fluids;

75

(15) Inserting a foley or cudae catheter into the urinary	76
bladder and removing the catheter;	77

(16) Removing intrauterine devices;

78

(17) Performing biopsies of superficial lesions;

79

(18) Making appropriate referrals as directed by the	80
supervising physician;	81

(19) Removing norplant capsules;

82

(20) Performing penile duplex ultrasound;

83

(21) Changing of a tracheostomy;

84

(22) Performing bone marrow aspirations from the posterior	85
iliac crest;	86

(23) Performing bone marrow biopsies from the posterior iliac	87
crest;	88

(24) Performing cystograms;

89

(25) Performing nephrostograms after physician placement of	90
nephrostomy tubes;	91

(26) Fitting or inserting family planning devices, including	92
intrauterine devices, diaphragms, and cervical caps;	93

(27) Removing cervical polyps;

94

(28) Performing nerve conduction testing;

95

(29) Performing endometrial biopsies;

96

(30) Inserting filiform and follower catheters;

97

(31) Performing arthrocentesis of the knee;

98

(32) Performing knee joint injections;

99

(33) Performing endotracheal intubation with successful	100
completion of an advanced cardiac life support course;	101

(34) Performing lumbar punctures;

102

(35) In accordance with rules adopted by the board, using	103
light-based medical devices for the purpose of hair removal;	104

(36) Administering, monitoring, or maintaining local	105
anesthesia, as defined in section 4730.091 of the Revised Code;	106

(37) Applying or removing a cast or splint;

107

(38) Performing other services that are within the	108
supervising physician's normal course of practice and expertise,	109
if the services are included in any model physician supervisory	110
plan approved under section 4730.06 of the Revised Code or the	111
services are designated by the board by rule or other means as	112
services that are not subject to approval as special services.	113

(B) Under the policies of a health care facility, the	114
services a physician assistant may provide are limited to the	115
services the facility has authorized the physician assistant to	116
provide for the facility. The services a health care facility may	117
authorize a physician assistant to provide for the facility	118
include the following:	119

(1) Any or all of the services specified in division (A) of	120
this section;	121

(2) Assisting in surgery in the health care facility;

122

(3) Any other services permitted by the policies of the	123
health care facility, except that the facility may not authorize a	124
physician assistant to perform a service that is prohibited by	125
this chapter.	126

Sec. 4731.281.  (A) On or before the deadline established	127
under division (B) of this section for applying for renewal of a	128
certificate of registration, each person holding a certificate	129
under this chapter to practice medicine and surgery, osteopathic	130
medicine and surgery, or podiatric medicine and surgery shall	131
certify to the state medical board that in the preceding two years	132
the person has completed one hundred hours of continuing medical	133
education. The certification shall be made upon the application	134
for biennial registration submitted pursuant to division (B) of	135
this section. The board shall adopt rules providing for pro rata	136
reductions by month of the number of hours of continuing education	137
required for persons who are in their first registration period,	138
who have a registration period of less than two years due to	139
initial implementation of the staggered renewal schedule	140
established under division (B) of this section, who have been	141
disabled due to illness or accident, or who have been absent from	142
the country.	143

In determining whether a course, program, or activity	144
qualifies for credit as continuing medical education, the board	145
shall approve all continuing medical education taken by persons	146
holding a certificate to practice medicine and surgery that is	147
certified by the Ohio state medical association, all continuing	148
medical education taken by persons holding a certificate to	149
practice osteopathic medicine and surgery that is certified by the	150
Ohio osteopathic association, and all continuing medical education	151
taken by persons holding a certificate to practice podiatry that	152
is certified by the Ohio podiatric medical association. Each	153
person holding a certificate to practice under this chapter shall	154
be given sufficient choice of continuing education programs to	155
ensure that the person has had a reasonable opportunity to	156
participate in continuing education programs that are relevant to	157
the person's medical practice in terms of subject matter and	158
level.	159

The board may require a random sample of persons holding a	160
certificate to practice under this chapter to submit materials	161
documenting completion of the continuing medical education	162
requirement during the preceding registration period, but this	163
provision shall not limit the board's authority to investigate	164
pursuant to section 4731.22 of the Revised Code.	165

(B)(1) Every person holding a certificate under this chapter	166
to practice medicine and surgery, osteopathic medicine and	167
surgery, or podiatric medicine and surgery wishing to renew that	168
certificate shall apply to the board for a certificate of	169
registration upon an application furnished by the board, and pay	170
to the board at the time of application a fee of three hundred	171
five dollars, according to the following schedule:	172

(a) Persons whose last name begins with the letters "A"	173
through "B," on or before April 1, 2001, and the first day of	174
April of every odd-numbered year thereafter;	175

(b) Persons whose last name begins with the letters "C"	176
through "D," on or before January 1, 2001, and the first day of	177
January of every odd-numbered year thereafter;	178

(c) Persons whose last name begins with the letters "E"	179
through "G," on or before October 1, 2000, and the first day of	180
October of every even-numbered year thereafter;	181

(d) Persons whose last name begins with the letters "H"	182
through "K," on or before July 1, 2000, and the first day of July	183
of every even-numbered year thereafter;	184

(e) Persons whose last name begins with the letters "L"	185
through "M," on or before April 1, 2000, and the first day of	186
April of every even-numbered year thereafter;	187

(f) Persons whose last name begins with the letters "N"	188
through "R," on or before January 1, 2000, and the first day of	189
January of every even-numbered year thereafter;	190

(g) Persons whose last name begins with the lettersletter	191
"S," on or before October 1, 1999, and the first day of October of	192
every odd-numbered year thereafter;	193

(h) Persons whose last name begins with the letters "T"	194
through "Z," on or before July 1, 1999, and the first day of July	195
of every odd-numbered year thereafter.	196

The board shall deposit the fee in accordance with section	197
4731.24 of the Revised Code, except that the board shall deposit	198
twenty dollars of the fee into the state treasury to the credit of	199
the physician loan repayment fund created by section 3702.78 of	200
the Revised Code.	201

(2) The board shall mail or cause to be mailed to every	202
person registered to practice medicine and surgery, osteopathic	203
medicine and surgery, or podiatric medicine and surgery, an	204
application for registrationa notice of registration renewal	205
addressed to the person's last known post-office address or may	206
cause the applicationnotice to be sent to the person through the	207
secretary of any recognized medical, osteopathic, or podiatric	208
society, according to the following schedule:	209

(a) To persons whose last name begins with the letters "A"	210
through "B," on or before January 1, 2001, and the first day of	211
January of every odd-numbered year thereafter;	212

(b) To persons whose last name begins with the letters "C"	213
through "D," on or before October 1, 2000, and the first day of	214
October of every even-numbered year thereafter;	215

(c) To persons whose last name begins with the letters "E"	216
through "G," on or before July 1, 2000, and the first day of July	217
of every even-numbered year thereafter;	218

(d) To persons whose last name begins with the letters "H"	219
through "K," on or before April 1, 2000, and the first day of	220
April of every even-numbered year thereafter;	221

(e) To persons whose last name begins with the letters "L"	222
through "M," on or before January 1, 2000, and the first day of	223
January of every even-numbered year thereafter;	224

(f) To persons whose last name begins with the letters "N"	225
through "R," on or before October 1, 1999, and the first day of	226
October of every odd-numbered year thereafter;	227

(g) To persons whose last name begins with the lettersletter	228
"S," on or before July 1, 1999, and the first day of July of every	229
odd-numbered year thereafter;	230

(h) To persons whose last name begins with the letters "T"	231
through "Z," on or before April 1, 1999, and the first day of	232
April of every odd-numbered year thereafter;.	233

Failure of any person to receive an applicationa notice of	234
renewal from the board shall not excuse the person from the	235
requirements contained in this section. The application shall	236
contain proper spaces for the applicant's signature and the	237
insertion of the required information, including a statement that	238
the person has fulfilled the continuing education requirements	239
imposed by this section.	240

The notice shall inform the applicant of the renewal	241
procedure. The board shall provide the application for	242
registration renewal in a form determined by the board. The	243
applicant shall write or cause to be written uponprovide in the	244
application so furnished the applicant's full name, principal	245
practice address and residence address, the number of the	246
applicant's certificate to practice, and any other facts for the	247
identification of the applicant as a person holding a certificate	248
to practice under this chapter asinformation required by the	249
board considers necessary. The applicant shall include with the	250
application a list of the names and addresses of any clinical	251
nurse specialists, certified nurse-midwives, or certified nurse	252
practitioners with whom the applicant is currently collaborating,	253
as defined in section 4723.01 of the Revised Code. The applicant	254
shall execute and deliver the application to the board by mail or	255
in personin a manner prescribed by the board. Every person	256
registered under this section shall give written notice to the	257
board of any change of principal practice address or residence	258
address or in the list within thirty days of the change.	259

The applicant shall report any criminal offense that	260
constitutes grounds for refusal of registration under section	261
4731.22 of the Revised Code to which the applicant has pleaded	262
guilty, of which the applicant has been found guilty, or for which	263
the applicant has been found eligible for intervention in lieu of	264
conviction, since last signingfiling an application for a	265
certificate of registration.	266

(C) The board shall issue to any person holding a certificate	267
under this chapter to practice medicine and surgery, osteopathic	268
medicine and surgery, or podiatric medicine and surgery, upon	269
application and qualification therefor in accordance with this	270
section, a certificate of registration under the seal of the	271
board. A certificate of registration shall be valid for a two-year	272
period, commencing on the first day of the third month after the	273
registration fee is due and expiring on the last day of the month	274
two years thereafter.	275

The board shall publish and cause to be mailed to each person	276
registered under this section, upon request, a printed list of the	277
persons so registered.	278

(D) Failure of any certificate holder to register and comply	279
with this section shall operate automatically to suspend the	280
holder's certificate to practice. Continued practice after the	281
suspension of the certificate to practice shall be considered as	282
practicing in violation of section 4731.41, 4731.43, or 4731.60 of	283
the Revised Code. If the certificate has been suspended pursuant	284
to this division for two years or less, it may be reinstated. The	285
board shall reinstate a certificate to practice for failure to	286
register upon an applicant's submission of the biennial	287
registration fee, the applicable monetary penalty, and	288
certification by signature of the applicant that the applicant has	289
completed the requisite continuing medical educationcompletion of	290
an application for registration. The penalty for reinstatement	291
shall be fifty dollars. If the certificate has been suspended	292
pursuant to this division for more than two years, it may be	293
restored. In accordance with section 4731.222 of the Revised Code,	294
the board may restore a certificate to practice for failure to	295
register upon an applicant's submission of a restoration	296
application, the biennial registration fee, and the applicable	297
monetary penalty. The penalty for restoration shall be one hundred	298
dollars. The board shall deposit the penalties in accordance with	299
section 4731.24 of the Revised Code.	300

(E) If an individual certifies completion of the number of	301
hours and type of continuing medical education required to receive	302
a certificate of registration or reinstatement of a certificate to	303
practice, and the board finds through the random samples it	304
conducts under this section or through any other means that the	305
individual did not complete the requisite continuing medical	306
education, the board may impose a civil penalty of not more than	307
five thousand dollars. The board's finding shall be made pursuant	308
to an adjudication under Chapter 119. of the Revised Code and by	309
an affirmative vote of not fewer than six members.	310

A civil penalty imposed under this division may be in	311
addition to or in lieu of any other action the board may take	312
under section 4731.22 of the Revised Code. The board shall deposit	313
civil penalties in accordance with section 4731.24 of the Revised	314
Code.	315

(F) The state medical board may obtain information not	316
protected by statutory or common law privilege from courts and	317
other sources concerning malpractice claims against any person	318
holding a certificate to practice under this chapter or practicing	319
as provided in section 4731.36 of the Revised Code.	320

(G) Each mailing sent by the board under division (B)(2) of	321
this section to a person registered to practice medicine and	322
surgery or osteopathic medicine and surgery shall inform the	323
applicant of the reporting requirement established by division (H)	324
of section 3701.79 of the Revised Code. At the discretion of the	325
board, the information may be included on the application for	326
registration or on an accompanying page.	327

Sec. 4731.19. (A) The state medical board shall determine the	328
standing of the schools, colleges, or institutions giving	329
instruction in the limited branches of medicine of massage therapy	330
and cosmetic therapy. If there shall at any time be such schools,	331
colleges, or institutions giving instruction in such limited	332
branches, the	333

(B) An applicant for a certificate to practice a limited	334
branch of medicine shall, as a condition of admission to the	335
examination, produce ahave one of the following:	336

(1) A diploma or certificate from a school, college, or	337
institution in good standing as determined by the board, showing	338
the completion of the required courses of instruction;	339

(2) A current license, registration, or certificate that is	340
in good standing in another state for massage therapy or cosmetic	341
therapy, as applicable;	342

(3) Certification from a national certification body and a	343
diploma or certificate from a school, college, or institution	344
showing completion of a course of instruction that meets course	345
requirements determined by the board through rules adopted under	346
section 4731.05 of the Revised Code.	347

The entrance examiner of the board shall determine the	348
sufficiency of the preliminary education of applicants for a	349
certificate to practice massage therapy or cosmetic therapy in the	350
same manner that sufficiency of preliminary education is	351
determined under section 4731.09 of the Revised Code, except that	352
the board may adopt rules defining and establishing for the	353
limited branch of medicine preliminary educational requirements	354
that are less exacting than those prescribed by such section, as	355
the nature of the case may require.	356

Sec. 4731.293.  (A) The state medical board may issue,	357
without examination, a visiting medical faculty certificate to any	358
person who holds a current, unrestricted license to practice	359
medicine and surgery or osteopathic medicine and surgery issued by	360
another state or country and has been appointed to serve in this	361
state on the academic staff of a medical school accredited by the	362
liaison committee on medical education or an osteopathic medical	363
school accredited by the American osteopathic association.	364

(B) An applicant for a visiting medical faculty certificate	365
shall submit evidence satisfactory to the board that hethe	366
applicant meets the requirements of division (A) of this section.	367
The applicant shall pay a fee of one hundred twenty-fivethree	368
hundred seventy-five dollars. The board shall maintain a register	369
of all persons who hold a visiting medical faculty certificate.	370

(C) The holder of a visiting medical faculty certificate may	371
practice medicine and surgery or osteopathic medicine and surgery	372
only as is incidental to hiscertificate holder's teaching duties	373
at the school or the teaching hospitals affiliated with the	374
school. The board may revoke a certificate on receiving proof	375
satisfactory to the board that the holder of the certificate has	376
engaged in practice in this state outside the scope of the	377
certificate or that there are grounds for action against himthe	378
certificate holder under section 4731.22 of the Revised Code.	379

(D) A visiting medical faculty certificate is valid for the	380
shorter of one yearthree years or the duration of the holder's	381
appointment to the academic staff of the school. The certificate	382
may not be renewed.	383

(E) The board may adopt any rules it considers necessary to	384
implement this section. The rules shall be adopted in accordance	385
with Chapter 119. of the Revised Code.	386

Section 2. That existing sections 4730.03, 4730.09, 4731.281,	387
4731.19, and 4731.293 of the Revised Code are hereby repealed.	388