As Reported by the Senate Health, Human Services and Aging Committee

127th General Assembly Regular Session 2007-2008

Sub. S. B. No. 279

Senator Schuring 

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A BILL

To amend sections 4730.03, 4730.09, 4731.19,

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4731.281, 4731.293, and 4760.131 of the Revised

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Code regarding certain State Medical Board

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procedures, restrictions on physician

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assistants, and admission to the massage or

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cosmetic therapist examination.

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

Section 1. That sections 4730.03, 4730.09, 4731.19, 4731.281,	7
4731.293, and 4760.131 of the Revised Code be amended to read as	8
follows:	9

Sec. 4730.03.  Nothing in this chapter shall:

10

(A) Be construed to affect or interfere with the performance	11
of duties of any medical personnel inwho are either of the	12
following:	13

(1) In active service in the army, navy, coast guard, marine	14
corps, air force, public health service, or marine hospital	15
service of the United States while so serving;	16

(2) Employed by the veterans administration of the United	17
States while so employed;	18

(B) Prevent any person from performing any of the services a	19
physician assistant may be authorized to perform, if the person's	20
professional scope of practice established under any other chapter	21
of the Revised Code authorizes the person to perform the services;	22

(C) Prohibit a physician from delegating responsibilities to	23
any nurse or other qualified person who does not hold a	24
certificate to practice as a physician assistant, provided that	25
the individual does not hold the individual out to be a physician	26
assistant;	27

(D) Be construed as authorizing a physician assistant	28
independently to order or direct the execution of procedures or	29
techniques by a registered nurse or licensed practical nurse in	30
the care and treatment of a person in any setting, except to the	31
extent that the physician assistant is authorized to do so by the	32
physician supervisory plan approved under section 4730.17 of the	33
Revised Code for the physician who is responsible for supervising	34
the physician assistant or the policies of the health care	35
facility in which the physician assistant is practicing;	36

(E) Authorize a physician assistant to engage in the practice	37
of optometry, except to the extent that the physician assistant is	38
authorized by a supervising physician acting in accordance with	39
this chapter to perform routine visual screening, provide medical	40
care prior to or following eye surgery, or assist in the care of	41
diseases of the eye;	42

(F) Be construed as authorizing a physician assistant to	43
prescribe any drug or device to perform or induce an abortion, or	44
as otherwise authorizing a physician assistant to perform or	45
induce an abortion.	46

Sec. 4730.09. (A) Under a physician supervisory plan approved	47
under section 4730.17 of the Revised Code, a physician assistant	48
may provide any or all of the following services without approval	49
by the state medical board as special services:	50

(1) Obtaining comprehensive patient histories;

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(2) Performing physical examinations, including audiometry	52
screening, routine visual screening, and pelvic, rectal, and	53
genital-urinary examinations, when indicated;	54

(3) Ordering, performing, or ordering and performing routine	55
diagnostic procedures, as indicated;	56

(4) Identifying normal and abnormal findings on histories,	57
physical examinations, and commonly performed diagnostic studies;	58

(5) Assessing patients and developing and implementing	59
treatment plans for patients;	60

(6) Monitoring the effectiveness of therapeutic	61
interventions;	62

(7) Exercising physician-delegated prescriptive authority	63
pursuant to a certificate to prescribe issued under this chapter;	64

(8) Carrying out or relaying the supervising physician's	65
orders for the administration of medication, to the extent	66
permitted by law;	67

(9) Providing patient education;

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(10) Instituting and changing orders on patient charts;

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(11) Performing developmental screening examinations on	70
children with regard to neurological, motor, and mental functions;	71

(12) Performing wound care management, suturing minor	72
lacerations and removing the sutures, and incision and drainage of	73
uncomplicated superficial abscesses;	74

(13) Removing superficial foreign bodies;

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(14) Administering intravenous fluids;

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(15) Inserting a foley or cudae catheter into the urinary	77
bladder and removing the catheter;	78

(16) Removing intrauterine devices;

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(17) Performing biopsies of superficial lesions;

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(18) Making appropriate referrals as directed by the	81
supervising physician;	82

(19) Removing norplant capsules;

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(20) Performing penile duplex ultrasound;

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(21) Changing of a tracheostomy;

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(22) Performing bone marrow aspirations from the posterior	86
iliac crest;	87

(23) Performing bone marrow biopsies from the posterior iliac	88
crest;	89

(24) Performing cystograms;

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(25) Performing nephrostograms after physician placement of	91
nephrostomy tubes;	92

(26) Fitting or inserting family planning devices, including	93
intrauterine devices, diaphragms, and cervical caps;	94

(27) Removing cervical polyps;

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(28) Performing nerve conduction testing;

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(29) Performing endometrial biopsies;

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(30) Inserting filiform and follower catheters;

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(31) Performing arthrocentesis of the knee;

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(32) Performing knee joint injections;

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(33) Performing endotracheal intubation with successful	101
completion of an advanced cardiac life support course;	102

(34) Performing lumbar punctures;

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(35) In accordance with rules adopted by the board, using	104
light-based medical devices for the purpose of hair removal;	105

(36) Administering, monitoring, or maintaining local	106
anesthesia, as defined in section 4730.091 of the Revised Code;	107

(37) Applying or removing a cast or splint;

108

(38) Performing other services that are within the	109
supervising physician's normal course of practice and expertise,	110
if the services are included in any model physician supervisory	111
plan approved under section 4730.06 of the Revised Code or the	112
services are designated by the board by rule or other means as	113
services that are not subject to approval as special services.	114

(B) Under the policies of a health care facility, the	115
services a physician assistant may provide are limited to the	116
services the facility has authorized the physician assistant to	117
provide for the facility. The services a health care facility may	118
authorize a physician assistant to provide for the facility	119
include the following:	120

(1) Any or all of the services specified in division (A) of	121
this section;	122

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

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(3) Any other services permitted by the policies of the	124
health care facility, except that the facility may not authorize a	125
physician assistant to perform a service that is prohibited by	126
this chapter.	127

Sec. 4731.19. (A) The state medical board shall determine the	128
standing of the schools, colleges, or institutions giving	129
instruction in the limited branches of medicine of massage therapy	130
and cosmetic therapy. If there shall at any time be such schools,	131
colleges, or institutions giving instruction in such limited	132
branches, the	133

(B) An applicant for a certificate to practice a limited	134
branch of medicine shall, as a condition of admission to the	135
examination, produce ahave one of the following:	136

(1) A diploma or certificate from a school, college, or	137
institution in good standing as determined by the board, showing	138
the completion of the required courses of instruction;	139

(2) A current license, registration, or certificate that is	140
in good standing in another state for massage therapy or cosmetic	141
therapy, as applicable;	142

(3) Certification from a national certification body and a	143
diploma or certificate from a school, college, or institution	144
showing completion of a course of instruction that meets course	145
requirements determined by the board through rules adopted under	146
section 4731.05 of the Revised Code.	147

The entrance examiner of the board shall determine the	148
sufficiency of the preliminary education of applicants for a	149
certificate to practice massage therapy or cosmetic therapy in the	150
same manner that sufficiency of preliminary education is	151
determined under section 4731.09 of the Revised Code, except that	152
the board may adopt rules defining and establishing for the	153
limited branch of medicine preliminary educational requirements	154
that are less exacting than those prescribed by such section, as	155
the nature of the case may require.	156

Sec. 4731.281.  (A) On or before the deadline established	157
under division (B) of this section for applying for renewal of a	158
certificate of registration, each person holding a certificate	159
under this chapter to practice medicine and surgery, osteopathic	160
medicine and surgery, or podiatric medicine and surgery shall	161
certify to the state medical board that in the preceding two years	162
the person has completed one hundred hours of continuing medical	163
education. The certification shall be made upon the application	164
for biennial registration submitted pursuant to division (B) of	165
this section. The board shall adopt rules providing for pro rata	166
reductions by month of the number of hours of continuing education	167
required for persons who are in their first registration period,	168
who have a registration period of less than two years due to	169
initial implementation of the staggered renewal schedule	170
established under division (B) of this section, who have been	171
disabled due to illness or accident, or who have been absent from	172
the country.	173

In determining whether a course, program, or activity	174
qualifies for credit as continuing medical education, the board	175
shall approve all continuing medical education taken by persons	176
holding a certificate to practice medicine and surgery that is	177
certified by the Ohio state medical association, all continuing	178
medical education taken by persons holding a certificate to	179
practice osteopathic medicine and surgery that is certified by the	180
Ohio osteopathic association, and all continuing medical education	181
taken by persons holding a certificate to practice podiatry	182
podiatric medicine and surgery that is certified by the Ohio	183
podiatric medical association. Each person holding a certificate	184
to practice under this chapter shall be given sufficient choice of	185
continuing education programs to ensure that the person has had a	186
reasonable opportunity to participate in continuing education	187
programs that are relevant to the person's medical practice in	188
terms of subject matter and level.	189

The board may require a random sample of persons holding a	190
certificate to practice under this chapter to submit materials	191
documenting completion of the continuing medical education	192
requirement during the preceding registration period, but this	193
provision shall not limit the board's authority to investigate	194
pursuant to section 4731.22 of the Revised Code.	195

(B)(1) Every person holding a certificate under this chapter	196
to practice medicine and surgery, osteopathic medicine and	197
surgery, or podiatric medicine and surgery wishing to renew that	198
certificate shall apply to the board for a certificate of	199
registration upon an application furnished by the board, and pay	200
to the board at the time of application a fee of three hundred	201
five dollars, according to the following schedule:	202

(a) Persons whose last name begins with the letters "A"	203
through "B," on or before April 1, 2001, and the first day of	204
April of every odd-numbered year thereafter;	205

(b) Persons whose last name begins with the letters "C"	206
through "D," on or before January 1, 2001, and the first day of	207
January of every odd-numbered year thereafter;	208

(c) Persons whose last name begins with the letters "E"	209
through "G," on or before October 1, 2000, and the first day of	210
October of every even-numbered year thereafter;	211

(d) Persons whose last name begins with the letters "H"	212
through "K," on or before July 1, 2000, and the first day of July	213
of every even-numbered year thereafter;	214

(e) Persons whose last name begins with the letters "L"	215
through "M," on or before April 1, 2000, and the first day of	216
April of every even-numbered year thereafter;	217

(f) Persons whose last name begins with the letters "N"	218
through "R," on or before January 1, 2000, and the first day of	219
January of every even-numbered year thereafter;	220

(g) Persons whose last name begins with the letter "S," on	221
or before October 1, 1999, and the first day of October of every	222
odd-numbered year thereafter;	223

(h) Persons whose last name begins with the letters "T"	224
through "Z," on or before July 1, 1999, and the first day of July	225
of every odd-numbered year thereafter.	226

The board shall deposit the fee in accordance with section	227
4731.24 of the Revised Code, except that the board shall deposit	228
twenty dollars of the fee into the state treasury to the credit of	229
the physician loan repayment fund created by section 3702.78 of	230
the Revised Code.	231

(2) The board shall mail or cause to be mailed to every	232
person registered to practice medicine and surgery, osteopathic	233
medicine and surgery, or podiatric medicine and surgery, an	234
application fora notice of registration renewal addressed to the	235
person's last known post-office address or may cause the	236
applicationnotice to be sent to the person through the secretary	237
of any recognized medical, osteopathic, or podiatric society,	238
according to the following schedule:	239

(a) To persons whose last name begins with the letters "A"	240
through "B," on or before January 1, 2001, and the first day of	241
January of every odd-numbered year thereafter;	242

(b) To persons whose last name begins with the letters "C"	243
through "D," on or before October 1, 2000, and the first day of	244
October of every even-numbered year thereafter;	245

(c) To persons whose last name begins with the letters "E"	246
through "G," on or before July 1, 2000, and the first day of July	247
of every even-numbered year thereafter;	248

(d) To persons whose last name begins with the letters "H"	249
through "K," on or before April 1, 2000, and the first day of	250
April of every even-numbered year thereafter;	251

(e) To persons whose last name begins with the letters "L"	252
through "M," on or before January 1, 2000, and the first day of	253
January of every even-numbered year thereafter;	254

(f) To persons whose last name begins with the letters "N"	255
through "R," on or before October 1, 1999, and the first day of	256
October of every odd-numbered year thereafter;	257

(g) To persons whose last name begins with the letter "S,"	258
on or before July 1, 1999, and the first day of July of every	259
odd-numbered year thereafter;	260

(h) To persons whose last name begins with the letters "T"	261
through "Z," on or before April 1, 1999, and the first day of	262
April of every odd-numbered year thereafter.	263

Failure of any person to receive an applicationa notice of	264
renewal from the board shall not excuse the person from the	265
requirements contained in this section. The application shall	266
contain proper spaces for the applicant's signature and the	267
insertion of the required information, including a statement that	268
the person has fulfilled the continuing education requirements	269
imposed by this section.	270

The notice shall inform the applicant of the renewal	271
procedure. The board shall provide the application for	272
registration renewal in a form determined by the board. The	273
applicant shall write or cause to be written uponprovide in the	274
application so furnished the applicant's full name, principal	275
practice address and residence address, the number of the	276
applicant's certificate to practice, and any other facts for the	277
identification of the applicant as a person holding a certificate	278
to practice under this chapter asinformation required by the	279
board considers necessary. The applicant shall include with the	280
application a list of the names and addresses of any clinical	281
nurse specialists, certified nurse-midwives, or certified nurse	282
practitioners with whom the applicant is currently collaborating,	283
as defined in section 4723.01 of the Revised Code. The applicant	284
shall execute and deliver the application to the board by mail or	285
in personin a manner prescribed by the board. Every person	286
registered under this section shall give written notice to the	287
board of any change of principal practice address or residence	288
address or in the list within thirty days of the change.	289

The applicant shall report any criminal offense that	290
constitutes grounds for refusal of registration under section	291
4731.22 of the Revised Code to which the applicant has pleaded	292
guilty, of which the applicant has been found guilty, or for which	293
the applicant has been found eligible for intervention in lieu of	294
conviction, since last signingfiling an application for a	295
certificate of registration.	296

(C) The board shall issue to any person holding a certificate	297
under this chapter to practice medicine and surgery, osteopathic	298
medicine and surgery, or podiatric medicine and surgery, upon	299
application and qualification therefor in accordance with this	300
section, a certificate of registration under the seal of the	301
board. A certificate of registration shall be valid for a two-year	302
period, commencing on the first day of the third month after the	303
registration fee is due and expiring on the last day of the month	304
two years thereafter.	305

The board shall publish and cause to be mailed to each person	306
registered under this section, upon request, a printed list of the	307
persons so registered.	308

(D) Failure of any certificate holder to register and comply	309
with this section shall operate automatically to suspend the	310
holder's certificate to practice. Continued practice after the	311
suspension of the certificate to practice shall be considered as	312
practicing in violation of section 4731.41, 4731.43, or 4731.60 of	313
the Revised Code. If the certificate has been suspended pursuant	314
to this division for two years or less, it may be reinstated. The	315
board shall reinstate a certificate to practice for failure to	316
register upon an applicant's submission of a renewal application,	317
the biennial registration fee, and the applicable monetary	318
penalty. The penalty for reinstatement shall be fifty dollars. If	319
the certificate has been suspended pursuant to this division for	320
more than two years, it may be restored. In accordance with	321
section 4731.222 of the Revised Code, the board may restore a	322
certificate to practice for failure to register upon an	323
applicant's submission of a restoration application, the biennial	324
registration fee, and the applicable monetary penalty and	325
compliance with sections 4776.01 to 4776.04 of the Revised Code.	326
The board shall not restore to an applicant a certificate to	327
practice unless the board, in its discretion, decides that the	328
results of the criminal records check do not make the applicant	329
ineligible for a certificate issued pursuant to section 4731.14,	330
4731.56, or 4731.57 of the Revised Code. The penalty for	331
restoration shall be one hundred dollars. The board shall deposit	332
the penalties in accordance with section 4731.24 of the Revised	333
Code.	334

(E) If an individual certifies completion of the number of	335
hours and type of continuing medical education required to receive	336
a certificate of registration or reinstatement of a certificate to	337
practice, and the board finds through the random samples it	338
conducts under this section or through any other means that the	339
individual did not complete the requisite continuing medical	340
education, the board may impose a civil penalty of not more than	341
five thousand dollars. The board's finding shall be made pursuant	342
to an adjudication under Chapter 119. of the Revised Code and by	343
an affirmative vote of not fewer than six members.	344

A civil penalty imposed under this division may be in	345
addition to or in lieu of any other action the board may take	346
under section 4731.22 of the Revised Code. The board shall deposit	347
civil penalties in accordance with section 4731.24 of the Revised	348
Code.	349

(F) The state medical board may obtain information not	350
protected by statutory or common law privilege from courts and	351
other sources concerning malpractice claims against any person	352
holding a certificate to practice under this chapter or practicing	353
as provided in section 4731.36 of the Revised Code.	354

(G) Each mailing sent by the board under division (B)(2) of	355
this section to a person registered to practice medicine and	356
surgery or osteopathic medicine and surgery shall inform the	357
applicant of the reporting requirement established by division (H)	358
of section 3701.79 of the Revised Code. At the discretion of the	359
board, the information may be included on the application for	360
registration or on an accompanying page.	361

Sec. 4731.293.  (A) The state medical board may issue,	362
without examination, a visiting medical faculty certificate to any	363
person who holds a current, unrestricted license to practice	364
medicine and surgery or osteopathic medicine and surgery issued by	365
another state or country and has been appointed to serve in this	366
state on the academic staff of a medical school accredited by the	367
liaison committee on medical education or an osteopathic medical	368
school accredited by the American osteopathic association.	369

(B) An applicant for a visiting medical faculty certificate	370
shall submit evidence satisfactory to the board that hethe	371
applicant meets the requirements of division (A) of this section.	372
The applicant shall pay a fee of one hundred twenty-fivethree	373
hundred seventy-five dollars. The board shall maintain a register	374
of all persons who hold a visiting medical faculty certificate.	375

(C) The holder of a visiting medical faculty certificate may	376
practice medicine and surgery or osteopathic medicine and surgery	377
only as is incidental to hiscertificate holder's teaching duties	378
at the school or the teaching hospitals affiliated with the	379
school. The board may revoke a certificate on receiving proof	380
satisfactory to the board that the holder of the certificate has	381
engaged in practice in this state outside the scope of the	382
certificate or that there are grounds for action against himthe	383
certificate holder under section 4731.22 of the Revised Code.	384

(D) A visiting medical faculty certificate is valid for the	385
shorter of one yearthree years or the duration of the holder's	386
appointment to the academic staff of the school. The certificate	387
may not be renewed.	388

(E) The board may adopt any rules it considers necessary to	389
implement this section. The rules shall be adopted in accordance	390
with Chapter 119. of the Revised Code.	391

Sec. 4760.131.  On receipt of a notice pursuant to section	392
2301.3733123.43 of the Revised Code, the state medical board	393
shall comply with that sectionsections 3123.41 to 3123.50 of the	394
Revised Code and any applicable rules adopted under section	395
3123.63 of the Revised Code with respect to a certificate of	396
registration as an anesthesiologist assistant issued pursuant to	397
this chapter.	398

Section 2. That existing sections 4730.03, 4730.09, 4731.19,	399
4731.281, 4731.293, and 4760.131 of the Revised Code are hereby	400
repealed.	401