130th Ohio General Assembly
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Sub. S. B. No. 279  As Reported by the Senate Health, Human Services and Aging Committee
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 



A BILL
To amend sections 4730.03, 4730.09, 4731.19, 4731.281, 4731.293, and 4760.131 of the Revised Code regarding certain State Medical Board procedures, restrictions on physician assistants, and admission to the massage or cosmetic therapist examination.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 4730.03, 4730.09, 4731.19, 4731.281, 4731.293, and 4760.131 of the Revised Code be amended to read as follows:
Sec. 4730.03.  Nothing in this chapter shall:
(A) Be construed to affect or interfere with the performance of duties of any medical personnel in who are either of the following:
(1) In active service in the army, navy, coast guard, marine corps, air force, public health service, or marine hospital service of the United States while so serving;
(2) Employed by the veterans administration of the United States while so employed;
(B) Prevent any person from performing any of the services a physician assistant may be authorized to perform, if the person's professional scope of practice established under any other chapter of the Revised Code authorizes the person to perform the services;
(C) Prohibit a physician from delegating responsibilities to any nurse or other qualified person who does not hold a certificate to practice as a physician assistant, provided that the individual does not hold the individual out to be a physician assistant;
(D) Be construed as authorizing a physician assistant independently to order or direct the execution of procedures or techniques by a registered nurse or licensed practical nurse in the care and treatment of a person in any setting, except to the extent that the physician assistant is authorized to do so by the physician supervisory plan approved under section 4730.17 of the Revised Code for the physician who is responsible for supervising the physician assistant or the policies of the health care facility in which the physician assistant is practicing;
(E) Authorize a physician assistant to engage in the practice of optometry, except to the extent that the physician assistant is authorized by a supervising physician acting in accordance with this chapter to perform routine visual screening, provide medical care prior to or following eye surgery, or assist in the care of diseases of the eye;
(F) Be construed as authorizing a physician assistant to prescribe any drug or device to perform or induce an abortion, or as otherwise authorizing a physician assistant to perform or induce an abortion.
Sec. 4730.09. (A) Under a physician supervisory plan approved under section 4730.17 of the Revised Code, a physician assistant may provide any or all of the following services without approval by the state medical board as special services:
(1) Obtaining comprehensive patient histories;
(2) Performing physical examinations, including audiometry screening, routine visual screening, and pelvic, rectal, and genital-urinary examinations, when indicated;
(3) Ordering, performing, or ordering and performing routine diagnostic procedures, as indicated;
(4) Identifying normal and abnormal findings on histories, physical examinations, and commonly performed diagnostic studies;
(5) Assessing patients and developing and implementing treatment plans for patients;
(6) Monitoring the effectiveness of therapeutic interventions;
(7) Exercising physician-delegated prescriptive authority pursuant to a certificate to prescribe issued under this chapter;
(8) Carrying out or relaying the supervising physician's orders for the administration of medication, to the extent permitted by law;
(9) Providing patient education;
(10) Instituting and changing orders on patient charts;
(11) Performing developmental screening examinations on children with regard to neurological, motor, and mental functions;
(12) Performing wound care management, suturing minor lacerations and removing the sutures, and incision and drainage of uncomplicated superficial abscesses;
(13) Removing superficial foreign bodies;
(14) Administering intravenous fluids;
(15) Inserting a foley or cudae catheter into the urinary bladder and removing the catheter;
(16) Removing intrauterine devices;
(17) Performing biopsies of superficial lesions;
(18) Making appropriate referrals as directed by the supervising physician;
(19) Removing norplant capsules;
(20) Performing penile duplex ultrasound;
(21) Changing of a tracheostomy;
(22) Performing bone marrow aspirations from the posterior iliac crest;
(23) Performing bone marrow biopsies from the posterior iliac crest;
(24) Performing cystograms;
(25) Performing nephrostograms after physician placement of nephrostomy tubes;
(26) Fitting or inserting family planning devices, including intrauterine devices, diaphragms, and cervical caps;
(27) Removing cervical polyps;
(28) Performing nerve conduction testing;
(29) Performing endometrial biopsies;
(30) Inserting filiform and follower catheters;
(31) Performing arthrocentesis of the knee;
(32) Performing knee joint injections;
(33) Performing endotracheal intubation with successful completion of an advanced cardiac life support course;
(34) Performing lumbar punctures;
(35) In accordance with rules adopted by the board, using light-based medical devices for the purpose of hair removal;
(36) Administering, monitoring, or maintaining local anesthesia, as defined in section 4730.091 of the Revised Code;
(37) Applying or removing a cast or splint;
(38) Performing other services that are within the supervising physician's normal course of practice and expertise, if the services are included in any model physician supervisory plan approved under section 4730.06 of the Revised Code or the services are designated by the board by rule or other means as services that are not subject to approval as special services.
(B) Under the policies of a health care facility, the services a physician assistant may provide are limited to the services the facility has authorized the physician assistant to provide for the facility. The services a health care facility may authorize a physician assistant to provide for the facility include the following:
(1) Any or all of the services specified in division (A) of this section;
(2) Assisting in surgery in the health care facility;
(3) Any other services permitted by the policies of the health care facility, except that the facility may not authorize a physician assistant to perform a service that is prohibited by this chapter.
Sec. 4731.19. (A) The state medical board shall determine the standing of the schools, colleges, or institutions giving instruction in the limited branches of medicine of massage therapy and cosmetic therapy. If there shall at any time be such schools, colleges, or institutions giving instruction in such limited branches, the
(B) An applicant for a certificate to practice a limited branch of medicine shall, as a condition of admission to the examination, produce a have one of the following:
(1) A diploma or certificate from a school, college, or institution in good standing as determined by the board, showing the completion of the required courses of instruction;
(2) A current license, registration, or certificate that is in good standing in another state for massage therapy or cosmetic therapy, as applicable;
(3) Certification from a national certification body and a diploma or certificate from a school, college, or institution showing completion of a course of instruction that meets course requirements determined by the board through rules adopted under section 4731.05 of the Revised Code.
The entrance examiner of the board shall determine the sufficiency of the preliminary education of applicants for a certificate to practice massage therapy or cosmetic therapy in the same manner that sufficiency of preliminary education is determined under section 4731.09 of the Revised Code, except that the board may adopt rules defining and establishing for the limited branch of medicine preliminary educational requirements that are less exacting than those prescribed by such section, as the nature of the case may require.
Sec. 4731.281.  (A) On or before the deadline established under division (B) of this section for applying for renewal of a certificate of registration, each person holding a certificate under this chapter to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery shall certify to the state medical board that in the preceding two years the person has completed one hundred hours of continuing medical education. The certification shall be made upon the application for biennial registration submitted pursuant to division (B) of this section. The board shall adopt rules providing for pro rata reductions by month of the number of hours of continuing education required for persons who are in their first registration period, who have a registration period of less than two years due to initial implementation of the staggered renewal schedule established under division (B) of this section, who have been disabled due to illness or accident, or who have been absent from the country.
In determining whether a course, program, or activity qualifies for credit as continuing medical education, the board shall approve all continuing medical education taken by persons holding a certificate to practice medicine and surgery that is certified by the Ohio state medical association, all continuing medical education taken by persons holding a certificate to practice osteopathic medicine and surgery that is certified by the Ohio osteopathic association, and all continuing medical education taken by persons holding a certificate to practice podiatry podiatric medicine and surgery that is certified by the Ohio podiatric medical association. Each person holding a certificate to practice under this chapter shall be given sufficient choice of continuing education programs to ensure that the person has had a reasonable opportunity to participate in continuing education programs that are relevant to the person's medical practice in terms of subject matter and level.
The board may require a random sample of persons holding a certificate to practice under this chapter to submit materials documenting completion of the continuing medical education requirement during the preceding registration period, but this provision shall not limit the board's authority to investigate pursuant to section 4731.22 of the Revised Code.
(B)(1) Every person holding a certificate under this chapter to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery wishing to renew that certificate shall apply to the board for a certificate of registration upon an application furnished by the board, and pay to the board at the time of application a fee of three hundred five dollars, according to the following schedule:
(a) Persons whose last name begins with the letters "A" through "B," on or before April 1, 2001, and the first day of April of every odd-numbered year thereafter;
(b) Persons whose last name begins with the letters "C" through "D," on or before January 1, 2001, and the first day of January of every odd-numbered year thereafter;
(c) Persons whose last name begins with the letters "E" through "G," on or before October 1, 2000, and the first day of October of every even-numbered year thereafter;
(d) Persons whose last name begins with the letters "H" through "K," on or before July 1, 2000, and the first day of July of every even-numbered year thereafter;
(e) Persons whose last name begins with the letters "L" through "M," on or before April 1, 2000, and the first day of April of every even-numbered year thereafter;
(f) Persons whose last name begins with the letters "N" through "R," on or before January 1, 2000, and the first day of January of every even-numbered year thereafter;
(g) Persons whose last name begins with the letter "S," on or before October 1, 1999, and the first day of October of every odd-numbered year thereafter;
(h) Persons whose last name begins with the letters "T" through "Z," on or before July 1, 1999, and the first day of July of every odd-numbered year thereafter.
The board shall deposit the fee in accordance with section 4731.24 of the Revised Code, except that the board shall deposit twenty dollars of the fee into the state treasury to the credit of the physician loan repayment fund created by section 3702.78 of the Revised Code.
(2) The board shall mail or cause to be mailed to every person registered to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery, an application for a notice of registration renewal addressed to the person's last known post-office address or may cause the application notice to be sent to the person through the secretary of any recognized medical, osteopathic, or podiatric society, according to the following schedule:
(a) To persons whose last name begins with the letters "A" through "B," on or before January 1, 2001, and the first day of January of every odd-numbered year thereafter;
(b) To persons whose last name begins with the letters "C" through "D," on or before October 1, 2000, and the first day of October of every even-numbered year thereafter;
(c) To persons whose last name begins with the letters "E" through "G," on or before July 1, 2000, and the first day of July of every even-numbered year thereafter;
(d) To persons whose last name begins with the letters "H" through "K," on or before April 1, 2000, and the first day of April of every even-numbered year thereafter;
(e) To persons whose last name begins with the letters "L" through "M," on or before January 1, 2000, and the first day of January of every even-numbered year thereafter;
(f) To persons whose last name begins with the letters "N" through "R," on or before October 1, 1999, and the first day of October of every odd-numbered year thereafter;
(g) To persons whose last name begins with the letter "S," on or before July 1, 1999, and the first day of July of every odd-numbered year thereafter;
(h) To persons whose last name begins with the letters "T" through "Z," on or before April 1, 1999, and the first day of April of every odd-numbered year thereafter.
Failure of any person to receive an application a notice of renewal from the board shall not excuse the person from the requirements contained in this section. The application shall contain proper spaces for the applicant's signature and the insertion of the required information, including a statement that the person has fulfilled the continuing education requirements imposed by this section.
The notice shall inform the applicant of the renewal procedure. The board shall provide the application for registration renewal in a form determined by the board. The applicant shall write or cause to be written upon provide in the application so furnished the applicant's full name, principal practice address and residence address, the number of the applicant's certificate to practice, and any other facts for the identification of the applicant as a person holding a certificate to practice under this chapter as information required by the board considers necessary. The applicant shall include with the application a list of the names and addresses of any clinical nurse specialists, certified nurse-midwives, or certified nurse practitioners with whom the applicant is currently collaborating, as defined in section 4723.01 of the Revised Code. The applicant shall execute and deliver the application to the board by mail or in person in a manner prescribed by the board. Every person registered under this section shall give written notice to the board of any change of principal practice address or residence address or in the list within thirty days of the change.
The applicant shall report any criminal offense that constitutes grounds for refusal of registration under section 4731.22 of the Revised Code to which the applicant has pleaded guilty, of which the applicant has been found guilty, or for which the applicant has been found eligible for intervention in lieu of conviction, since last signing filing an application for a certificate of registration.
(C) The board shall issue to any person holding a certificate under this chapter to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery, upon application and qualification therefor in accordance with this section, a certificate of registration under the seal of the board. A certificate of registration shall be valid for a two-year period, commencing on the first day of the third month after the registration fee is due and expiring on the last day of the month two years thereafter.
The board shall publish and cause to be mailed to each person registered under this section, upon request, a printed list of the persons so registered.
(D) Failure of any certificate holder to register and comply with this section shall operate automatically to suspend the holder's certificate to practice. Continued practice after the suspension of the certificate to practice shall be considered as practicing in violation of section 4731.41, 4731.43, or 4731.60 of the Revised Code. If the certificate has been suspended pursuant to this division for two years or less, it may be reinstated. The board shall reinstate a certificate to practice for failure to register upon an applicant's submission of a renewal application, the biennial registration fee, and the applicable monetary penalty. The penalty for reinstatement shall be fifty dollars. If the certificate has been suspended pursuant to this division for more than two years, it may be restored. In accordance with section 4731.222 of the Revised Code, the board may restore a certificate to practice for failure to register upon an applicant's submission of a restoration application, the biennial registration fee, and the applicable monetary penalty and compliance with sections 4776.01 to 4776.04 of the Revised Code. The board shall not restore to an applicant a certificate to practice unless the board, in its discretion, decides that the results of the criminal records check do not make the applicant ineligible for a certificate issued pursuant to section 4731.14, 4731.56, or 4731.57 of the Revised Code. The penalty for restoration shall be one hundred dollars. The board shall deposit the penalties in accordance with section 4731.24 of the Revised Code.
(E) If an individual certifies completion of the number of hours and type of continuing medical education required to receive a certificate of registration or reinstatement of a certificate to practice, and the board finds through the random samples it conducts under this section or through any other means that the individual did not complete the requisite continuing medical education, the board may impose a civil penalty of not more than five thousand dollars. The board's finding shall be made pursuant to an adjudication under Chapter 119. of the Revised Code and by an affirmative vote of not fewer than six members.
A civil penalty imposed under this division may be in addition to or in lieu of any other action the board may take under section 4731.22 of the Revised Code. The board shall deposit civil penalties in accordance with section 4731.24 of the Revised Code.
(F) The state medical board may obtain information not protected by statutory or common law privilege from courts and other sources concerning malpractice claims against any person holding a certificate to practice under this chapter or practicing as provided in section 4731.36 of the Revised Code.
(G) Each mailing sent by the board under division (B)(2) of this section to a person registered to practice medicine and surgery or osteopathic medicine and surgery shall inform the applicant of the reporting requirement established by division (H) of section 3701.79 of the Revised Code. At the discretion of the board, the information may be included on the application for registration or on an accompanying page.
Sec. 4731.293.  (A) The state medical board may issue, without examination, a visiting medical faculty certificate to any person who holds a current, unrestricted license to practice medicine and surgery or osteopathic medicine and surgery issued by another state or country and has been appointed to serve in this state on the academic staff of a medical school accredited by the liaison committee on medical education or an osteopathic medical school accredited by the American osteopathic association.
(B) An applicant for a visiting medical faculty certificate shall submit evidence satisfactory to the board that he the applicant meets the requirements of division (A) of this section. The applicant shall pay a fee of one hundred twenty-five three hundred seventy-five dollars. The board shall maintain a register of all persons who hold a visiting medical faculty certificate.
(C) The holder of a visiting medical faculty certificate may practice medicine and surgery or osteopathic medicine and surgery only as is incidental to his certificate holder's teaching duties at the school or the teaching hospitals affiliated with the school. The board may revoke a certificate on receiving proof satisfactory to the board that the holder of the certificate has engaged in practice in this state outside the scope of the certificate or that there are grounds for action against him the certificate holder under section 4731.22 of the Revised Code.
(D) A visiting medical faculty certificate is valid for the shorter of one year three years or the duration of the holder's appointment to the academic staff of the school. The certificate may not be renewed.
(E) The board may adopt any rules it considers necessary to implement this section. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
Sec. 4760.131.  On receipt of a notice pursuant to section 2301.373 3123.43 of the Revised Code, the state medical board shall comply with that section sections 3123.41 to 3123.50 of the Revised Code and any applicable rules adopted under section 3123.63 of the Revised Code with respect to a certificate of registration as an anesthesiologist assistant issued pursuant to this chapter.
Section 2. That existing sections 4730.03, 4730.09, 4731.19, 4731.281, 4731.293, and 4760.131 of the Revised Code are hereby repealed.
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