130th Ohio General Assembly
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Sub. H. B. No. 284  As Reported by the House Health and Aging Committee
As Reported by the House Health and Aging Committee

129th General Assembly
Regular Session
2011-2012
Sub. H. B. No. 284


Representatives Gonzales, Letson 

Cosponsors: Representatives Stebelton, Wachtmann, Boyd, Slesnick, Gerberry, O'Brien, Murray, Reece, Mallory 



A BILL
To amend sections 185.01, 185.03, 185.05, 2133.211, 3719.06, 4730.06, 4730.09, 4730.38, 4730.39, 4730.40, 4730.41, 4730.42, 4730.44, 4730.45, 4755.48, 4755.481, 4765.01, 4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51, to enact sections 4730.04, 4730.092, 4730.093, and 4730.411, and to repeal section 4730.401 of the Revised Code to modify the laws governing physician assistants.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1.  That sections 185.01, 185.03, 185.05, 2133.211, 3719.06, 4730.06, 4730.09, 4730.38, 4730.39, 4730.40, 4730.41, 4730.42, 4730.44, 4730.45, 4755.48, 4755.481, 4765.01, 4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51 be amended and sections 4730.04, 4730.092, 4730.093, and 4730.411 of the Revised Code be enacted to read as follows:
Sec. 185.01.  As used in this chapter:
(A) "Advanced practice nurse" has the same meaning as in section 4723.01 of the Revised Code.
(B) "Collaboration" has the same meaning as in section 4723.01 of the Revised Code.
(C) "Patient centered medical home education advisory group" means the entity established under section 185.03 of the Revised Code to implement and administer the patient centered medical home education pilot project.
(D) "Patient centered medical home education pilot project" means the pilot project established under section 185.02 of the Revised Code.
(E) "Physician assistant" means an individual who holds a valid certificate to practice as a physician assistant issued under Chapter 4730. of the Revised Code.
Sec. 185.03. (A) The patient centered medical home education advisory group is hereby created for the purpose of implementing and administering the patient centered medical home pilot project. The advisory group shall develop a set of expected outcomes for the pilot project.
(B) The advisory group shall consist of the following voting members:
(1) One individual with expertise in the training and education of primary care physicians who is appointed by the dean of the university of Toledo college of medicine;
(2) One individual with expertise in the training and education of primary care physicians who is appointed by the dean of the Boonshoft school of medicine at Wright state university;
(3) One individual with expertise in the training and education of primary care physicians who is appointed by the president and dean of the northeast Ohio medical university;
(4) One individual with expertise in the training and education of primary care physicians who is appointed by the dean of the Ohio university college of osteopathic medicine;
(5) Two individuals appointed by the governing board of the Ohio academy of family physicians;
(6) One individual appointed by the governing board of the Ohio chapter of the American college of physicians;
(7) One individual appointed by the governing board of the American academy of pediatrics;
(8) One individual appointed by the governing board of the Ohio osteopathic association;
(9) One individual with expertise in the training and education of advanced practice nurses who is appointed by the governing board of the Ohio council of deans and directors of baccalaureate and higher degree programs in nursing;
(10) One individual appointed by the governing board of the Ohio nurses association;
(11) One individual appointed by the governing board of the Ohio association of advanced practice nurses;
(12) One individual appointed by the governing board of the Ohio association of physician assistants;
(13) One individual appointed by the governing board of the Ohio council for home care and hospice;
(13)(14) One individual appointed by the superintendent of insurance.
(C) The advisory group shall consist of the following nonvoting, ex officio members:
(1) The executive director of the state medical board, or the director's designee;
(2) The executive director of the board of nursing or the director's designee;
(3) The chancellor of the Ohio board of regents, or the chancellor's designee;
(4) The individual within the department of job and family services who serves as the director of medicaid, or the director's designee;
(5) The director of health or the director's designee.
(D) Advisory group members who are appointed shall serve at the pleasure of their appointing authorities. Terms of office of appointed members shall be three years, except that a member's term ends if the pilot project ceases operation during the member's term.
Vacancies shall be filled in the manner provided for original appointments.
Members shall serve without compensation, except to the extent that serving on the advisory group is considered part of their regular employment duties.
(E) The advisory group shall select from among its members a chairperson and vice-chairperson. The advisory group may select any other officers it considers necessary to conduct its business.
A majority of the members of the advisory group constitutes a quorum for the transaction of official business. A majority of a quorum is necessary for the advisory group to take any action, except that when one or more members of a quorum are required to abstain from voting as provided in division (C)(1)(d) or (C)(2)(c) of section 185.05 of the Revised Code, the number of members necessary for a majority of a quorum shall be reduced accordingly.
The advisory group shall meet as necessary to fulfill its duties. The times and places for the meetings shall be selected by the chairperson.
(F) Sections 101.82 to 101.87 of the Revised Code do not apply to the advisory group.
Sec. 185.05. (A) The patient centered medical home education advisory group shall accept applications for inclusion in the patient centered medical home education pilot project from primary care practices with educational affiliations, as determined by the advisory group, with one or more of the following:
(1) The Boonshoft school of medicine at Wright state university;
(2) The university of Toledo college of medicine;
(3) The northeast Ohio medical university;
(4) The Ohio university college of osteopathic medicine;
(5) The college of nursing at the university of Toledo;
(6) The Wright state university college of nursing and health;
(7) The college of nursing at Kent state university;
(8) The university of Akron college of nursing;
(9) The school of nursing at Ohio university.
(B)(1) Subject to division (C)(1) of this section, the advisory group shall select for inclusion in the pilot project not more than the following number of physician practices:
(a) Ten practices affiliated with the Boonshoft school of medicine at Wright state university;
(b) Ten practices affiliated with the university of Toledo college of medicine;
(c) Ten practices affiliated with the northeast Ohio medical university;
(d) Ten practices affiliated with the centers for osteopathic research and education of the Ohio university college of osteopathic medicine.
(2) Subject to division (C)(2) of this section, the advisory group shall select for inclusion in the pilot project not less than the following number of advanced practice nurse primary care practices:
(a) One practice affiliated with the college of nursing at the university of Toledo;
(b) One practice affiliated with the Wright state university college of nursing and health;
(c) One practice affiliated with the college of nursing at Kent state university or the university of Akron college of nursing;
(d) One practice affiliated with the school of nursing at Ohio university.
(C)(1) All of the following apply with respect to the selection of physician practices under division (B) of this section:
(a) The advisory group shall strive to select physician practices in such a manner that the pilot project includes a both of the following:
(i) A diverse range of primary care specialties, including practices specializing in pediatrics, geriatrics, general internal medicine, or family medicine;
(ii) Practices that utilize physician assistants as part of the health care delivery system.
(b) When evaluating an application, the advisory group shall consider the percentage of patients in the physician practice who are part of a medically underserved population, including medicaid recipients and individuals without health insurance.
(c) The advisory group shall select not fewer than six practices that serve rural areas of this state, as those areas are determined by the advisory group.
(d) A member of the advisory group shall abstain from participating in any vote taken regarding the selection of a physician practice if the member would receive any financial benefit from having the practice included in the pilot project.
(2) All of the following apply with respect to the selection of advanced practice nurse primary care practices under division (B) of this section:
(a) When evaluating an application, the advisory group shall consider the percentage of patients in the advanced practice nurse primary care practice who are part of a medically underserved population, including medicaid recipients and individuals without health insurance.
(b) If the advisory group determines that it has not received an application from a sufficiently qualified advanced practice nurse primary care practice affiliated with a particular institution specified in division (B)(2) of this section, the advisory group shall make the selections required under that division in such a manner that the greatest possible number of those institutions are represented in the pilot project. To be selected in this manner, a practice remains subject to the eligibility requirements specified in division (B) of section 185.06 of the Revised Code. As specified in division (B)(2) of this section, the number of practices selected for inclusion in the pilot project shall be at least four.
(c) A member of the advisory group shall abstain from participating in any vote taken regarding the selection of an advanced practice nurse primary care practice if the member would receive any financial benefit from having the practice included in the pilot project.
Sec. 2133.211.  A person who holds a certificate of authority to practice as a certified nurse practitioner or clinical nurse specialist issued under section 4723.42 of the Revised Code may take any action that may be taken by an attending physician under sections 2133.21 to 2133.26 of the Revised Code and has the immunity provided by section 2133.22 of the Revised Code if the action is taken pursuant to a standard care arrangement with a collaborating physician.
A person who holds a certificate to practice as a physician assistant issued under Chapter 4730. of the Revised Code may take any action that may be taken by an attending physician under sections 2133.21 to 2133.26 of the Revised Code and has the immunity provided by section 2133.22 of the Revised Code if the action is taken pursuant to a physician supervisory plan approved pursuant to section 4730.17 of the Revised Code or the policies of a health care facility in which the physician assistant is practicing.
Sec. 3719.06.  (A)(1) A licensed health professional authorized to prescribe drugs, if acting in the course of professional practice, in accordance with the laws regulating the professional's practice, and in accordance with rules adopted by the state board of pharmacy, may, except as provided in division (A)(2) or (3) of this section, do the following:
(a) Prescribe schedule II, III, IV, and V controlled substances;
(b) Administer or personally furnish to patients schedule II, III, IV, and V controlled substances;
(c) Cause schedule II, III, IV, and V controlled substances to be administered under the prescriber's direction and supervision.
(2) A licensed health professional authorized to prescribe drugs who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner is subject to both of the following:
(a) A schedule II controlled substance may be prescribed only for a patient with a terminal condition, as defined in section 2133.01 of the Revised Code, only if the nurse's collaborating physician initially prescribed the substance for the patient, and only in an amount that does not exceed the amount necessary for the patient's use in a single, twenty-four-hour period.
(b) No schedule II controlled substance shall be personally furnished to any patient.
(3) A licensed health professional authorized to prescribe drugs who is a physician assistant shall not prescribe or personally furnish to patients any is subject to all of the following:
(a) A controlled substance that is not may be prescribed or personally furnished only if it is included in the physician-delegated prescriptive authority granted to the physician assistant in accordance with Chapter 4730. of the Revised Code.
(b) A schedule II controlled substance may be prescribed only in accordance with division (B)(4) of section 4730.41 and section 4730.411 of the Revised Code.
(c) No schedule II controlled substance shall be personally furnished to any patient.
(B) No licensed health professional authorized to prescribe drugs shall prescribe, administer, or personally furnish a schedule III anabolic steroid for the purpose of human muscle building or enhancing human athletic performance and no pharmacist shall dispense a schedule III anabolic steroid for either purpose, unless it has been approved for that purpose under the "Federal Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A. 301, as amended.
(C) Each written prescription shall be properly executed, dated, and signed by the prescriber on the day when issued and shall bear the full name and address of the person for whom, or the owner of the animal for which, the controlled substance is prescribed and the full name, address, and registry number under the federal drug abuse control laws of the prescriber. If the prescription is for an animal, it shall state the species of the animal for which the controlled substance is prescribed.
Sec. 4730.04.  (A) As used in this section:
(1) "Disaster" means any imminent threat or actual occurrence of widespread or severe damage to or loss of property, personal hardship or injury, or loss of life that results from any natural phenomenon or act of a human.
(2) "Emergency" means an occurrence or event that poses an imminent threat to the health or life of a human.
(B) Nothing in this chapter prohibits any of the following individuals from providing medical care, to the extent the individual is able, in response to a need for medical care precipitated by a disaster or emergency:
(1) An individual who holds a certificate to practice as a physician assistant issued under this chapter;
(2) An individual licensed or authorized to practice as a physician assistant in another state;
(3) An individual credentialed or employed as a physician assistant by an agency, office, or other instrumentality of the federal government.
(C) For purposes of the medical care provided by a physician assistant pursuant to division (B)(1) of this section, both of the following apply notwithstanding any supervision requirement of this chapter to the contrary:
(1) The physician who supervises the physician assistant pursuant to a physician supervisory plan approved by the state medical board under section 4730.17 of the Revised Code is not required to meet the supervision requirements established under this chapter.
(2) The physician designated as the medical director of the disaster or emergency may supervise the medical care provided by the physician assistant.
Sec. 4730.06.  (A) The physician assistant policy committee of the state medical board shall review, and shall submit to the board recommendations concerning, all of the following:
(1) Requirements for issuance of certificates to practice as a physician assistant, including the educational requirements that must be met to receive a certificate to practice;
(2) Existing and proposed rules pertaining to the practice of physician assistants, the supervisory relationship between physician assistants and supervising physicians, and the administration and enforcement of this chapter;
(3) Physician-delegated In accordance with section 4730.38 of the Revised Code, physician-delegated prescriptive authority for physician assistants, in accordance with and proposed changes to the physician assistant formulary the board adopts pursuant to division (A)(1) of section 4730.38 4730.39 of the Revised Code;
(4) Application procedures and forms for certificates to practice as a physician assistant, physician supervisory plans, and supervision agreements;
(5) Fees required by this chapter for issuance and renewal of certificates to practice as a physician assistant;
(6) Criteria to be included in applications submitted to the board for approval of physician supervisory plans, including criteria to be included in applications for approval to delegate to physician assistants the performance of special services;
(7) Criteria to be included in supervision agreements submitted to the board for approval and renewal of the board's approval;
(8) Any issue the board asks the committee to consider.
(B) In addition to the matters that are required to be reviewed under division (A) of this section, the committee may review, and may submit to the board recommendations concerning, either or both of the following:
(1) Quality assurance activities to be performed by a supervising physician and physician assistant under a quality assurance system established pursuant to division (F) of section 4730.21 of the Revised Code;
(2) The development and approval of one or more model physician supervisory plans and one or more models for a special services portion of the one or more model physician supervisory plans. The committee may submit recommendations for model plans that reflect various medical specialties.
(C) The board shall take into consideration all recommendations submitted by the committee. Not later than ninety days after receiving a recommendation from the committee, the board shall approve or disapprove the recommendation and notify the committee of its decision. If a recommendation is disapproved, the board shall inform the committee of its reasons for making that decision. The committee may resubmit the recommendation after addressing the concerns expressed by the board and modifying the disapproved recommendation accordingly. Not later than ninety days after receiving a resubmitted recommendation, the board shall approve or disapprove the recommendation. There is no limit on the number of times the committee may resubmit a recommendation for consideration by the board.
(D)(1) Except as provided in division (D)(2) of this section, the board may not take action regarding a matter that is subject to the committee's review under division (A) or (B) of this section unless the committee has made a recommendation to the board concerning the matter.
(2) If the board submits to the committee a request for a recommendation regarding a matter that is subject to the committee's review under division (A) or (B) of this section, and the committee does not provide a recommendation before the sixty-first day after the request is submitted, the board may take action regarding the matter without a recommendation.
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)(17) Making appropriate referrals as directed by the supervising physician;
(19) Removing norplant capsules;
(20)(18) Performing penile duplex ultrasound;
(21)(19) Changing of a tracheostomy;
(22)(20) Performing bone marrow aspirations from the posterior iliac crest;
(23)(21) Performing bone marrow biopsies from the posterior iliac crest;
(24)(22) Performing cystograms;
(25)(23) Performing nephrostograms after physician placement of nephrostomy tubes;
(26)(24) Fitting or, inserting family planning, or removing birth control devices, including intrauterine devices, diaphragms, and cervical caps subject to section 4730.093 of the Revised Code;
(27)(25) Removing cervical polyps;
(28)(26) Performing nerve conduction testing;
(29)(27) Performing endometrial biopsies;
(30)(28) Inserting filiform and follower catheters;
(31)(29) Performing arthrocentesis of the knee;
(32)(30) Performing knee joint injections;
(33)(31) Performing endotracheal intubation with successful completion of an advanced cardiac life support course;
(34)(32) Performing lumbar punctures;
(35)(33) In accordance with rules adopted by the board, using light-based medical devices for the purpose of hair removal;
(36)(34) Administering, monitoring, or maintaining local anesthesia, as defined in section 4730.091 of the Revised Code;
(37)(35) Applying or removing a cast or splint;
(38)(36) Inserting or removing chest tubes;
(37) Prescribing physical therapy or referring a patient to a physical therapist for the purpose of receiving physical therapy;
(38) Ordering occupational therapy or referring a patient to an occupational therapist for the purpose of receiving occupational therapy;
(39) Taking any action that may be taken by an attending physician under sections 2133.21 to 2133.26 of the Revised Code, as specified in section 2133.211 of the Revised Code;
(40) Determining and pronouncing death in accordance with section 4730.092 of the Revised Code;
(41) 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. 4730.092.  (A) A physician assistant may determine and pronounce an individual's death, but only if the individual's respiratory and circulatory functions are not being artificially sustained and, at the time the determination and pronouncement of death is made, either or both of the following apply:
(1) The individual was receiving care in one of the following:
(a) A nursing home licensed under section 3721.02 of the Revised Code or by a political subdivision under section 3721.09 of the Revised Code;
(b) A residential care facility or home for the aging licensed under Chapter 3721. of the Revised Code;
(c) A county home or district home operated pursuant to Chapter 5155. of the Revised Code;
(d) A residential facility licensed under section 5123.19 of the Revised Code.
(2) The physician assistant is providing or supervising the individual's care through a hospice care program licensed under Chapter 3712. of the Revised Code or any other entity that provides palliative care.
(B) If a physician assistant determines and pronounces an individual's death, the physician assistant shall comply with both of the following:
(1) The physician assistant shall not complete any portion of the individual's death certificate.
(2) The physician assistant shall notify the individual's attending physician of the determination and pronouncement of death in order for the physician to fulfill the physician's duties under section 3705.16 of the Revised Code. The physician assistant shall provide the notification within a period of time that is reasonable but not later than twenty-four hours following the determination and pronouncement of the individual's death.
Sec. 4730.093.  Under either a physician supervisory plan or the policies of a health care facility, both of the following apply with respect to a physician assistant's authority to fit, insert, or remove a birth control device:
(A) A physician assistant may fit, insert, or remove a birth control device that is designed in such a manner that it functions solely by preventing fertilization, including such devices as diaphragms, cervical caps, and, except as provided in division (B) of this section, intrauterine devices.
(B) A physician assistant shall not fit, insert, or remove a birth control device, including an intrauterine device, that is designed in such a manner that it functions either solely or in combination with other functions by preventing or hindering an embryo from implanting within the uterus or from growing if implantation occurs.
Sec. 4730.38.  (A) Not later than six months after the effective date Except as provided in division (B) of this section, the physician assistant policy committee of the state medical board shall, at such times the committee determines to be necessary, submit to the board its initial recommendations regarding physician-delegated prescriptive authority for physician assistants. The committee's recommendations shall address all both of the following:
(1) Policy and procedures regarding physician-delegated prescriptive authority, including the issuance of certificates to prescribe under this chapter;
(2) Subject to the limitations specified in section 4730.40 of the Revised Code, a formulary listing the drugs and therapeutic devices by class and specific nomenclature that a supervising physician may include in the physician-delegated prescriptive authority granted to a physician assistant who holds a certificate to prescribe issued under this chapter;
(3) Any issue the committee considers necessary to assist the board in fulfilling its duty to adopt rules governing physician-delegated prescriptive authority, including the issuance of certificates to prescribe.
(B) After the board's adoption of initial rules under section 4730.39 of the Revised Code, the committee shall conduct an annual review of its recommendations regarding physician-delegated prescriptive authority. Based on its review, the committee shall submit recommendations to the board as the committee considers necessary Not less than every six months beginning on the first day of June following the effective date of this amendment, the committee shall review the physician assistant formulary the board adopts pursuant to division (A)(1) of section 4730.39 of the Revised Code and, to the extent it determines to be necessary, submit recommendations proposing changes to the formulary.
(C) Recommendations submitted under this section are subject to the procedures and time frames specified in division (C) of section 4730.06 of the Revised Code.
Sec. 4730.39.  (A) Not later than six months after receiving the initial recommendations of the physician assistant policy committee submitted pursuant to division (A) of section 4730.38 of the Revised Code, the The state medical board shall adopt do both of the following:
(1) Adopt a formulary listing the drugs and therapeutic devices by class and specific generic nomenclature that a physician may include in the physician-delegated prescriptive authority granted to a physician assistant who holds a certificate to prescribe under this chapter;
(2) Adopt rules governing physician-delegated prescriptive authority for physician assistants, including the issuance of certificates to prescribe under this chapter. The
(B) The board's rules governing physician-delegated prescriptive authority adopted pursuant to division (A)(2) of this section shall be adopted in accordance with Chapter 119. of the Revised Code and shall establish all of the following:
(1) Subject to the limitations specified in section 4730.40 of the Revised Code, a formulary listing the drugs and therapeutic devices by class and specific generic nomenclature that a physician may include in the physician-delegated prescriptive authority granted to a physician assistant who holds a certificate to prescribe under this chapter;
(2) Requirements regarding the pharmacology courses that a physician assistant is required to complete to receive a certificate to prescribe;
(3)(2) Standards and procedures for the issuance and renewal of certificates to prescribe to physician assistants;
(4)(3) Standards and procedures for the appropriate conduct of the provisional period that a physician assistant is required to complete pursuant to section 4730.45 of the Revised Code and for determining whether a physician assistant has successfully completed the provisional period;
(5)(4) A specific prohibition against prescribing any drug or device to perform or induce an abortion;
(6)(5) Standards and procedures to be followed by a physician assistant in personally furnishing samples of drugs or complete or partial supplies of drugs to patients under section 4730.43 of the Revised Code;
(7)(6) Any other requirements the board considers necessary to implement the provisions of this chapter regarding physician-delegated prescriptive authority and the issuance of certificates to prescribe.
(B)(C)(1) After adopting the initial rules considering recommendations submitted by the physician assistant policy committee pursuant to sections 4730.06 and 4730.38 of the Revised Code, the board shall conduct an annual review either or both of the rules. Based following, as appropriate according to the submitted recommendations:
(a) The formulary the board adopts under division (A)(1) of this section;
(b) The rules the board adopts under division (A)(2) of this section regarding physician-delegated prescriptive authority.
(2) Based on its review, the board shall make any necessary modifications to the formulary or rules.
(C) All rules adopted under this section shall be adopted in accordance with Chapter 119. of the Revised Code. When adopting the initial rules, the board shall consider the recommendations of the physician assistant policy committee submitted pursuant to division (A) of section 4730.38 of the Revised Code. When making any modifications to the rules subsequent to its annual review of the rules, the board shall consider the committee's recommendations submitted pursuant to division (B) of section 4730.38 of the Revised Code.
Sec. 4730.40.  (A) Subject to divisions division (B) and (C) of this section, the physician assistant formulary established adopted by the state medical board in rules adopted under section 4730.39 of the Revised Code listing the drugs and therapeutic devices by class and specific nomenclature that a supervising physician may include in the physician-delegated prescriptive authority granted to a physician assistant who holds a certificate to prescribe issued under this chapter may include any or all of the following drugs:
(1) Schedule II, III, IV, and V controlled substances;
(2) Drugs that under state or federal law may be dispensed only pursuant to a prescription by a licensed health professional authorized to prescribe drugs, as defined in section 4729.01 of the Revised Code;
(3) Any drug that is not a dangerous drug, as defined in section 4729.01 of the Revised Code.
(B) The formulary established in the board's rules adopted by the board shall not include, and shall specify that it does not include, the following:
(1) Any schedule II controlled substance;
(2) Any any drug or device used to perform or induce an abortion.
(C) When adopting rules establishing the initial formulary, the board shall include provisions ensuring that a physician assistant who holds a certificate to prescribe issued under this chapter may be granted physician-delegated prescriptive authority for all drugs and therapeutic devices that may be prescribed on the effective date of the rules by a holder of a certificate to prescribe issued by the board of nursing under Chapter 4723. of the Revised Code, with the exception of schedule II controlled substances. To the extent permitted by division (A) of this section, the initial formulary may include additional drugs or therapeutic devices.
Sec. 4730.41.  (A) A certificate to prescribe issued under this chapter authorizes a physician assistant to prescribe and personally furnish drugs and therapeutic devices in the exercise of physician-delegated prescriptive authority.
(B) In exercising physician-delegated prescriptive authority, a physician assistant is subject to all of the following:
(1) The physician assistant shall exercise physician-delegated prescriptive authority only to the extent that the physician supervising the physician assistant has granted that authority.
(2) The physician assistant shall comply with all conditions placed on the physician-delegated prescriptive authority, as specified by the supervising physician who is supervising the physician assistant in the exercise of physician-delegated prescriptive authority.
(3) If the physician assistant possesses physician-delegated prescriptive authority for controlled substances, the physician assistant shall register with the federal drug enforcement administration.
(4) If the physician assistant possesses physician-delegated prescriptive authority for schedule II controlled substances, the physician assistant shall comply with section 4730.411 of the Revised Code.
Sec. 4730.411. (A) Except as provided in division (B) or (C) of this section, a physician assistant may prescribe to a patient a schedule II controlled substance only if all of the following are the case:
(1) The patient is in a terminal condition, as defined in section 2133.01 of the Revised Code.
(2) The physician assistant's supervising physician initially prescribed the substance for the patient.
(3) The prescription is for an amount that does not exceed the amount necessary for the patient's use in a single, twenty-four-hour period.
(B) The restrictions on prescriptive authority in division (A) of this section do not apply if a physician assistant issues the prescription to the patient from any of the following locations:
(1) A hospital registered under section 3701.07 of the Revised Code;
(2) An entity owned or controlled, in whole or in part, by a hospital or by an entity that owns or controls, in whole or in part, one or more hospitals;
(3) A health care facility operated by the department of mental health or the department of developmental disabilities;
(4) A nursing home licensed under section 3721.02 of the Revised Code or by a political subdivision certified under section 3721.09 of the Revised Code;
(5) A county home or district home operated under Chapter 5155. of the Revised Code that is certified under the medicare or medicaid program;
(6) A hospice care program, as defined in section 3712.01 of the Revised Code;
(7) A community mental health agency, as defined in section 5122.01 of the Revised Code;
(8) An ambulatory surgical facility, as defined in section 3702.30 of the Revised Code;
(9) A freestanding birthing center, as defined in section 3702.51 of the Revised Code;
(10) A federally qualified health center, as defined in section 3701.047 of the Revised Code;
(11) A federally qualified health center look-alike, as defined in section 3701.047 of the Revised Code;
(12) A health care office or facility operated by the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code;
(13) A site where a medical practice is operated, but only if the practice is comprised of one or more physicians who also are owners of the practice; the practice is organized to provide direct patient care; and the physician assistant has entered into a supervisory agreement with at least one of the physician owners who practices primarily at that site.
(C) A physician assistant shall not issue to a patient a prescription for a schedule II controlled substance from a convenience care clinic even if the convenience care clinic is owned or operated by an entity specified in division (B) of this section.
(D) A pharmacist who acts in good faith reliance on a prescription issued by a physician assistant under division (B) of this section is not liable for or subject to any of the following for relying on the prescription: damages in any civil action, prosecution in any criminal proceeding, or professional disciplinary action by the state board of pharmacy under Chapter 4729. of the Revised Code.
Sec. 4730.42.  (A) In granting physician-delegated prescriptive authority to a particular physician assistant who holds a certificate to prescribe issued under this chapter, the supervising physician is subject to all of the following:
(1) The supervising physician shall not grant physician-delegated prescriptive authority for any drug or therapeutic device that is not listed on the physician assistant formulary established in rules adopted under section 4730.39 of the Revised Code as a drug or therapeutic device that may be included in the physician-delegated prescriptive authority granted to a physician assistant.
(2) The supervising physician shall not grant physician-delegated prescriptive authority for any drug or device that may be used to perform or induce an abortion.
(3) The supervising physician shall not grant physician-delegated prescriptive authority in a manner that exceeds the supervising physician's prescriptive authority.
(4) The supervising physician shall supervise the physician assistant in accordance with all of the following:
(a) The supervision requirements specified in section 4730.21 of the Revised Code and, in the case of supervision provided during a provisional period of physician-delegated prescriptive authority, the supervision requirements specified in section 4730.45 of the Revised Code;
(b) The physician supervisory plan approved for the supervising physician or the policies of the health care facility in which the physician and physician assistant are practicing;
(c) The supervision agreement approved under section 4730.19 of the Revised Code that applies to the supervising physician and the physician assistant.
(B)(1) The supervising physician of a physician assistant may place conditions on the physician-delegated prescriptive authority granted to the physician assistant. If conditions are placed on that authority, the supervising physician shall maintain a written record of the conditions and make the record available to the state medical board on request.
(2) The conditions that a supervising physician may place on the physician-delegated prescriptive authority granted to a physician assistant include the following:
(a) Identification by class and specific generic nomenclature of drugs and therapeutic devices that the physician chooses not to permit the physician assistant to prescribe;
(b) Limitations on the dosage units or refills that the physician assistant is authorized to prescribe;
(c) Specification of circumstances under which the physician assistant is required to refer patients to the supervising physician or another physician when exercising physician-delegated prescriptive authority;
(d) Responsibilities to be fulfilled by the physician in supervising the physician assistant that are not otherwise specified in the physician supervisory plan or otherwise required by this chapter.
Sec. 4730.44. (A) A physician assistant seeking a certificate to prescribe shall submit to the state medical board a written application on a form prescribed and supplied by the board. The application shall include all of the following information:
(1) The applicant's name, residential address, business address, if any, and social security number;
(2) Evidence of holding a valid certificate to practice as a physician assistant issued under this chapter;
(3) One of the following:
(a) Satisfactory proof that the applicant meets the requirements specified in section 4730.46 of the Revised Code to participate in a provisional period of physician-delegated prescriptive authority or satisfactory;
(b) Satisfactory proof of successful completion of the provisional period, evidenced by a letter or copy of a letter attesting to the successful completion written by a supervising physician of the physician assistant at the time of completion;
(c) Satisfactory proof that the applicant has practiced as a physician assistant in another state or was credentialed or employed as a physician assistant by the United States government, holds a master's or higher degree that was obtained from a program accredited by the accreditation review commission on education for the physician assistant or a predecessor or successor organization recognized by the board, and held valid authority issued by the other state or the United States government to prescribe therapeutic devices and drugs, including at least some controlled substances, evidenced by an affidavit issued by an appropriate agency or office of the other state or the United States government attesting to the prescriptive authority described in division (A)(3)(c) of this section.
(4) Any other information the board requires.
(B) At the time of making application for a certificate to prescribe, the applicant shall pay the board a fee of one hundred dollars, no part of which shall be returned. The fees shall be deposited in accordance with section 4731.24 of the Revised Code.
(C)(1) The board shall review all applications received. If an application is complete and the board determines that the applicant meets the requirements for a certificate to prescribe, the board shall, subject to division (C)(2) of this section, issue the certificate to the applicant. The
(2) The initial certificate to prescribe issued to an applicant who meets the requirements of division (A)(3)(a) of this section shall be issued as a provisional certificate to prescribe.
Sec. 4730.45.  (A) A provisional certificate to prescribe issued under division (C)(2) of section 4730.44 of the Revised Code authorizes the physician assistant holding the certificate to participate in a provisional period of physician-delegated prescriptive authority. The physician assistant shall successfully complete the provisional period as a condition of receiving a new certificate to prescribe.
(B) The provisional period shall be conducted by one or more supervising physicians in accordance with rules adopted under section 4730.39 of the Revised Code. When supervising a physician assistant who is completing the first five hundred hours of a provisional period, the supervising physician shall provide on-site supervision of the physician assistant's exercise of physician-delegated prescriptive authority.
The provisional period shall last not longer than one year, unless it is extended for not longer than one additional year at the direction of a supervising physician. The physician assistant shall not be required to participate in the provisional period for more than one-thousand-eight-hundred one thousand eight hundred hours, except when a supervising physician has extended the physician assistant's provisional period.
(C) If a physician assistant does not successfully complete the provisional period, each supervising physician shall cease granting physician-delegated prescriptive authority to the physician assistant. The supervising physician with primary responsibility for conducting the provisional period shall promptly notify the state medical board that the physician assistant did not successfully complete the provisional period and the board shall revoke the certificate.
(D) A physician assistant who successfully completes a provisional period shall not be required to complete another provisional period as a condition of being eligible to be granted physician-delegated prescriptive authority by a supervising physician who was not involved in the conduct of the provisional period.
Sec. 4755.48.  (A) No person shall employ fraud or deception in applying for or securing a license to practice physical therapy or to be a physical therapist assistant.
(B) No person shall practice or in any way imply or claim to the public by words, actions, or the use of letters as described in division (C) of this section to be able to practice physical therapy or to provide physical therapy services, including practice as a physical therapist assistant, unless the person holds a valid license under sections 4755.40 to 4755.56 of the Revised Code or except for submission of claims as provided in section 4755.56 of the Revised Code.
(C) No person shall use the words or letters, physical therapist, physical therapy, physical therapy services, physiotherapist, physiotherapy, physiotherapy services, licensed physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T., D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical therapist assistant, physical therapy technician, licensed physical therapist assistant, L.P.T.A., R.P.T.A., or any other letters, words, abbreviations, or insignia, indicating or implying that the person is a physical therapist or physical therapist assistant without a valid license under sections 4755.40 to 4755.56 of the Revised Code.
(D) No person who practices physical therapy or assists in the provision of physical therapy treatments under the supervision of a physical therapist shall fail to display the person's current license granted under sections 4755.40 to 4755.56 of the Revised Code in a conspicuous location in the place where the person spends the major part of the person's time so engaged.
(E) Nothing in sections 4755.40 to 4755.56 of the Revised Code shall affect or interfere with the performance of the duties of any physical therapist or physical therapist assistant 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.
(F) Nothing in sections 4755.40 to 4755.56 of the Revised Code shall prevent or restrict the activities or services of a person pursing pursuing a course of study leading to a degree in physical therapy in an accredited or approved educational program if the activities or services constitute a part of a supervised course of study and the person is designated by a title that clearly indicates the person's status as a student.
(G) No (1) Except as provided in division (G)(2) of this section and subject to division (H) of this section, no person shall practice physical therapy other than on the prescription of, or the referral of a patient by, a person who is licensed in this or another state to practice do at least one of the following:
(a) Practice medicine and surgery, chiropractic, dentistry, osteopathic medicine and surgery, podiatric medicine and surgery, or to practice;
(b) Practice as a physician assistant;
(c) Practice nursing as a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner, within the scope of such practices, and whose license is in good standing, unless either of the following conditions is met:.
(1)(2) The prohibition in division (G)(1) of this section on practicing physical therapy other than on the prescription of, or the referral of a patient by, any of the persons described in that division does not apply if either of the following applies to the person:
(a) The person holds a master's or doctorate degree from a professional physical therapy program that is accredited by a national physical therapy accreditation agency recognized by the United States department of education.
(2)(b) On or before December 31, 2004, the person has completed at least two years of practical experience as a licensed physical therapist.
(H) To be authorized to prescribe physical therapy or refer a patient to a physical therapist for physical therapy, a person described in division (G)(1) of this section must be in good standing with the relevant licensing board in this state or the state in which the person is licensed and must act only within the person's scope of practice.
(I) In the prosecution of any person for violation of division (B) or (C) of this section, it is not necessary to allege or prove want of a valid license to practice physical therapy or to practice as a physical therapist assistant, but such matters shall be a matter of defense to be established by the accused.
Sec. 4755.481. (A) If a physical therapist evaluates and treats a patient without the prescription of, or the referral of the patient by, a person who is licensed to practice medicine and surgery, chiropractic, dentistry, osteopathic medicine and surgery, podiatric medicine and surgery, or nursing as a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner described in division (G)(1) of section 4755.48 of the Revised Code, all of the following apply:
(1) The physical therapist shall, upon consent of the patient, inform the patient's physician, chiropractor, dentist, podiatrist, certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner relevant person described in division (G)(1) of section 4755.48 of the Revised Code of the evaluation not later than five business days after the evaluation is made.
(2) If the physical therapist determines, based on reasonable evidence, that no substantial progress has been made with respect to that patient during the thirty-day period immediately following the date of the patient's initial visit with the physical therapist, the physical therapist shall consult with or refer the patient to a licensed physician, chiropractor, dentist, podiatrist, certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner person described in division (G)(1) of section 4755.48 of the Revised Code, unless either of the following applies:
(a) The evaluation, treatment, or services are being provided for fitness, wellness, or prevention purposes.
(b) The patient previously was diagnosed with chronic, neuromuscular, or developmental conditions and the evaluation, treatment, or services are being provided for problems or symptoms associated with one or more of those previously diagnosed conditions.
(3) If the physical therapist determines that orthotic devices are necessary to treat the patient, the physical therapist shall be limited to the application of the following orthotic devices:
(a) Upper extremity adaptive equipment used to facilitate the activities of daily living;
(b) Finger splints;
(c) Wrist splints;
(d) Prefabricated elastic or fabric abdominal supports with or without metal or plastic reinforcing stays and other prefabricated soft goods requiring minimal fitting;
(e) Nontherapeutic accommodative inlays;
(f) Shoes that are not manufactured or modified for a particular individual;
(g) Prefabricated foot care products;
(h) Custom foot orthotics;
(i) Durable medical equipment.
(4) If, at any time, the physical therapist has reason to believe that the patient has symptoms or conditions that require treatment or services beyond the scope of practice of a physical therapist, the physical therapist shall refer the patient to a licensed health care practitioner acting within the practitioner's scope of practice.
(B) Nothing in sections 4755.40 to 4755.56 of the Revised Code shall be construed to require reimbursement under any health insuring corporation policy, contract, or agreement, any sickness and accident insurance policy, the medical assistance program as defined in section 5111.01 of the Revised Code, or the health partnership program or qualified health plans established pursuant to sections 4121.44 to 4121.442 of the Revised Code, for any physical therapy service rendered without the prescription of, or the referral of the patient by, a licensed physician, chiropractor, dentist, podiatrist, certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner person described in division (G)(1) of section 4755.48 of the Revised Code.
(C) For purposes of this section, "business day" means any calendar day that is not a Saturday, Sunday, or legal holiday. "Legal holiday" has the same meaning as in section 1.14 of the Revised Code.
Sec. 4765.01.  As used in this chapter:
(A) "First responder" means an individual who holds a current, valid certificate issued under section 4765.30 of the Revised Code to practice as a first responder.
(B) "Emergency medical technician-basic" or "EMT-basic" means an individual who holds a current, valid certificate issued under section 4765.30 of the Revised Code to practice as an emergency medical technician-basic.
(C) "Emergency medical technician-intermediate" or "EMT-I" means an individual who holds a current, valid certificate issued under section 4765.30 of the Revised Code to practice as an emergency medical technician-intermediate.
(D) "Emergency medical technician-paramedic" or "paramedic" means an individual who holds a current, valid certificate issued under section 4765.30 of the Revised Code to practice as an emergency medical technician-paramedic.
(E) "Ambulance" means any motor vehicle that is used, or is intended to be used, for the purpose of responding to emergency medical situations, transporting emergency patients, and administering emergency medical service to patients before, during, or after transportation.
(F) "Cardiac monitoring" means a procedure used for the purpose of observing and documenting the rate and rhythm of a patient's heart by attaching electrical leads from an electrocardiograph monitor to certain points on the patient's body surface.
(G) "Emergency medical service" means any of the services described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of the Revised Code that are performed by first responders, emergency medical technicians-basic, emergency medical technicians-intermediate, and paramedics. "Emergency medical service" includes such services performed before or during any transport of a patient, including transports between hospitals and transports to and from helicopters.
(H) "Emergency medical service organization" means a public or private organization using first responders, EMTs-basic, EMTs-I, or paramedics, or a combination of first responders, EMTs-basic, EMTs-I, and paramedics, to provide emergency medical services.
(I) "Physician" means an individual who holds a current, valid certificate issued under Chapter 4731. of the Revised Code authorizing the practice of medicine and surgery or osteopathic medicine and surgery.
(J) "Registered nurse" means an individual who holds a current, valid license issued under Chapter 4723. of the Revised Code authorizing the practice of nursing as a registered nurse.
(K) "Volunteer" means a person who provides services either for no compensation or for compensation that does not exceed the actual expenses incurred in providing the services or in training to provide the services.
(L) "Emergency medical service personnel" means first responders, emergency medical service technicians-basic, emergency medical service technicians-intermediate, emergency medical service technicians-paramedic, and persons who provide medical direction to such persons.
(M) "Hospital" has the same meaning as in section 3727.01 of the Revised Code.
(N) "Trauma" or "traumatic injury" means severe damage to or destruction of tissue that satisfies both of the following conditions:
(1) It creates a significant risk of any of the following:
(a) Loss of life;
(b) Loss of a limb;
(c) Significant, permanent disfigurement;
(d) Significant, permanent disability.
(2) It is caused by any of the following:
(a) Blunt or penetrating injury;
(b) Exposure to electromagnetic, chemical, or radioactive energy;
(c) Drowning, suffocation, or strangulation;
(d) A deficit or excess of heat.
(O) "Trauma victim" or "trauma patient" means a person who has sustained a traumatic injury.
(P) "Trauma care" means the assessment, diagnosis, transportation, treatment, or rehabilitation of a trauma victim by emergency medical service personnel or by a physician, nurse, physician assistant, respiratory therapist, physical therapist, chiropractor, occupational therapist, speech-language pathologist, audiologist, or psychologist licensed to practice as such in this state or another jurisdiction.
(Q) "Trauma center" means all of the following:
(1) Any hospital that is verified by the American college of surgeons as an adult or pediatric trauma center;
(2) Any hospital that is operating as an adult or pediatric trauma center under provisional status pursuant to section 3727.101 of the Revised Code;
(3) Until December 31, 2004, any hospital in this state that is designated by the director of health as a level II pediatric trauma center under section 3727.081 of the Revised Code;
(4) Any hospital in another state that is licensed or designated under the laws of that state as capable of providing specialized trauma care appropriate to the medical needs of the trauma patient.
(R) "Pediatric" means involving a patient who is less than sixteen years of age.
(S) "Adult" means involving a patient who is not a pediatric patient.
(T) "Geriatric" means involving a patient who is at least seventy years old or exhibits significant anatomical or physiological characteristics associated with advanced aging.
(U) "Air medical organization" means an organization that provides emergency medical services, or transports emergency victims, by means of fixed or rotary wing aircraft.
(V) "Emergency care" and "emergency facility" have the same meanings as in section 3727.01 of the Revised Code.
(W) "Stabilize," except as it is used in division (B) of section 4765.35 of the Revised Code with respect to the manual stabilization of fractures, has the same meaning as in section 1753.28 of the Revised Code.
(X) "Transfer" has the same meaning as in section 1753.28 of the Revised Code.
(Y) "Firefighter" means any member of a fire department as defined in section 742.01 of the Revised Code.
(Z) "Volunteer firefighter" has the same meaning as in section 146.01 of the Revised Code.
(AA) "Part-time paid firefighter" means a person who provides firefighting services on less than a full-time basis, is routinely scheduled to be present on site at a fire station or other designated location for purposes of responding to a fire or other emergency, and receives more than nominal compensation for the provision of firefighting services.
(BB) "Physician assistant" means an individual who holds a valid certificate to practice as a physician assistant issued under Chapter 4730. of the Revised Code.
Sec. 4765.35.  (A) A first responder shall perform the emergency medical services described in this section in accordance with this chapter and any rules adopted under it.
(B) A first responder may provide limited emergency medical services to patients until the arrival of an emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic. In an emergency, a first responder may render emergency medical services such as opening and maintaining an airway, giving mouth to barrier ventilation, chest compressions, electrical interventions with automated defibrillators to support or correct the cardiac function and other methods determined by the board, controlling of hemorrhage, manual stabilization of fractures, bandaging, assisting in childbirth, and determining triage of trauma victims.
(C) A first responder may perform any other emergency medical services approved pursuant to rules adopted under section 4765.11 of the Revised Code. The board shall determine whether the nature of any such service requires that a first responder receive authorization prior to performing the service.
(D)(1) Except as provided in division (D)(2) of this section, if the board determines under division (C) of this section that a service requires prior authorization, the service shall be performed only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or pursuant to an authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician.
(2) If communications fail during an emergency situation or the required response time prohibits communication, a first responder may perform services subject to this division, if, in the judgment of the first responder, the life of the patient is in immediate danger. Services performed under these circumstances shall be performed in accordance with the written protocols for triage of adult and pediatric trauma victims established in rules adopted under sections 4765.11 and 4765.40 of the Revised Code and any applicable protocols adopted by the emergency medical service organization with which the first responder is affiliated.
Sec. 4765.36.  In a hospital, an emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic may perform emergency medical services only under the direction and supervision of a physician or registered nurse designated by a physician and only if the services are performed in accordance with both of the following conditions:
(A) Only in the hospital's emergency department or while moving a patient between the emergency department and another part of the hospital;
(B) Only under the direction and supervision of one of the following:
(1) A physician;
(2) A physician assistant designated by a physician;
(3) A registered nurse designated by a physician.
Sec. 4765.37.  (A) An emergency medical technician-basic shall perform the emergency medical services described in this section in accordance with this chapter and any rules adopted under it by the state board of emergency medical services.
(B) An emergency medical technician-basic may operate, or be responsible for operation of, an ambulance and may provide emergency medical services to patients. In an emergency, an EMT-basic may determine the nature and extent of illness or injury and establish priority for required emergency medical services. An EMT-basic may render emergency medical services such as opening and maintaining an airway, giving positive pressure ventilation, cardiac resuscitation, electrical interventions with automated defibrillators to support or correct the cardiac function and other methods determined by the board, controlling of hemorrhage, treatment of shock, immobilization of fractures, bandaging, assisting in childbirth, management of mentally disturbed patients, initial care of poison and burn patients, and determining triage of adult and pediatric trauma victims. Where patients must in an emergency be extricated from entrapment, an EMT-basic may assess the extent of injury and render all possible emergency medical services and protection to the entrapped patient; provide light rescue services if an ambulance has not been accompanied by a specialized unit; and after extrication, provide additional care in sorting of the injured in accordance with standard emergency procedures.
(C) An EMT-basic may perform any other emergency medical services approved pursuant to rules adopted under section 4765.11 of the Revised Code. The board shall determine whether the nature of any such service requires that an EMT-basic receive authorization prior to performing the service.
(D)(1) Except as provided in division (D)(2) of this section, if the board determines under division (C) of this section that a service requires prior authorization, the service shall be performed only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or pursuant to an authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician.
(2) If communications fail during an emergency situation or the required response time prohibits communication, an EMT-basic may perform services subject to this division, if, in the judgment of the EMT-basic, the life of the patient is in immediate danger. Services performed under these circumstances shall be performed in accordance with the protocols for triage of adult and pediatric trauma victims established in rules adopted under sections 4765.11 and 4765.40 of the Revised Code and any applicable protocols adopted by the emergency medical service organization with which the EMT-basic is affiliated.
Sec. 4765.38.  (A) An emergency medical technician-intermediate shall perform the emergency medical services described in this section in accordance with this chapter and any rules adopted under it.
(B) An EMT-I may do any of the following:
(1) Establish and maintain an intravenous lifeline that has been approved by a cooperating physician or physician advisory board;
(2) Perform cardiac monitoring;
(3) Perform electrical interventions to support or correct the cardiac function;
(4) Administer epinephrine;
(5) Determine triage of adult and pediatric trauma victims;
(6) Perform any other emergency medical services approved pursuant to rules adopted under section 4765.11 of the Revised Code.
(C)(1) Except as provided in division (C)(2) of this section, the services described in division (B) of this section shall be performed by an EMT-I only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or pursuant to an authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician.
(2) If communications fail during an emergency situation or the required response time prohibits communication, an EMT-I may perform any of the services described in division (B) of this section, if, in the judgment of the EMT-I, the life of the patient is in immediate danger. Services performed under these circumstances shall be performed in accordance with the protocols for triage of adult and pediatric trauma victims established in rules adopted under sections 4765.11 and 4765.40 of the Revised Code and any applicable protocols adopted by the emergency medical service organization with which the EMT-I is affiliated.
(D) In addition to, and in the course of, providing emergency medical treatment, an emergency medical technician-intermediate may withdraw blood as provided under sections 1547.11, 4506.17, and 4511.19 of the Revised Code. An emergency medical technician-intermediate shall withdraw blood in accordance with this chapter and any rules adopted under it by the state board of emergency medical services.
Sec. 4765.39.  (A) An emergency medical technician-paramedic shall perform the emergency medical services described in this section in accordance with this chapter and any rules adopted under it.
(B) A paramedic may do any of the following:
(1) Perform cardiac monitoring;
(2) Perform electrical interventions to support or correct the cardiac function;
(3) Perform airway procedures;
(4) Perform relief of pneumothorax;
(5) Administer appropriate drugs and intravenous fluids;
(6) Determine triage of adult and pediatric trauma victims;
(7) Perform any other emergency medical services, including life support or intensive care techniques, approved pursuant to rules adopted under section 4765.11 of the Revised Code.
(C)(1) Except as provided in division (C)(2) of this section, the services described in division (B) of this section shall be performed by a paramedic only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or pursuant to an authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician.
(2) If communications fail during an emergency situation or the required response time prohibits communication, a paramedic may perform any of the services described in division (B) of this section, if, in the paramedic's judgment, the life of the patient is in immediate danger. Services performed under these circumstances shall be performed in accordance with the protocols for triage of adult and pediatric trauma victims established in rules adopted under sections 4765.11 and 4765.40 of the Revised Code and any applicable protocols adopted by the emergency medical service organization with which the paramedic is affiliated.
(D) In addition to, and in the course of, providing emergency medical treatment, an emergency medical technician-paramedic may withdraw blood as provided under sections 1547.11, 4506.17, and 4511.19 of the Revised Code. An emergency medical technician-paramedic shall withdraw blood in accordance with this chapter and any rules adopted under it by the state board of emergency medical services.
Sec. 4765.49.  (A) A first responder, emergency medical technician-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the individual's administration of emergency medical services, unless the services are administered in a manner that constitutes willful or wanton misconduct. A physician, physician assistant designated by a physician, or registered nurse designated by a physician, who any of whom is advising or assisting in the emergency medical services by means of any communication device or telemetering system, is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the individual's advisory communication or assistance, unless the advisory communication or assistance is provided in a manner that constitutes willful or wanton misconduct. Medical directors and members of cooperating physician advisory boards of emergency medical service organizations are not liable in damages in a civil action for injury, death, or loss to person or property resulting from their acts or omissions in the performance of their duties, unless the act or omission constitutes willful or wanton misconduct.
(B) A political subdivision, joint ambulance district, joint emergency medical services district, or other public agency, and any officer or employee of a public agency or of a private organization operating under contract or in joint agreement with one or more political subdivisions, that provides emergency medical services, or that enters into a joint agreement or a contract with the state, any political subdivision, joint ambulance district, or joint emergency medical services district for the provision of emergency medical services, is not liable in damages in a civil action for injury, death, or loss to person or property arising out of any actions taken by a first responder, EMT-basic, EMT-I, or paramedic working under the officer's or employee's jurisdiction, or for injury, death, or loss to person or property arising out of any actions of licensed medical personnel advising or assisting the first responder, EMT-basic, EMT-I, or paramedic, unless the services are provided in a manner that constitutes willful or wanton misconduct.
(C) A student who is enrolled in an emergency medical services training program accredited under section 4765.17 of the Revised Code or an emergency medical services continuing education program approved under that section is not liable in damages in a civil action for injury, death, or loss to person or property resulting from either of the following:
(1) The student's administration of emergency medical services or patient care or treatment, if the services, care, or treatment is administered while the student is under the direct supervision and in the immediate presence of an EMT-basic, EMT-I, paramedic, registered nurse, physician assistant, or physician and while the student is receiving clinical training that is required by the program, unless the services, care, or treatment is provided in a manner that constitutes willful or wanton misconduct;
(2) The student's training as an ambulance driver, unless the driving is done in a manner that constitutes willful or wanton misconduct.
(D) An EMT-basic, EMT-I, paramedic, or other operator, who holds a valid commercial driver's license issued pursuant to Chapter 4506. of the Revised Code or driver's license issued pursuant to Chapter 4507. of the Revised Code and who is employed by an emergency medical service organization that is not owned or operated by a political subdivision as defined in section 2744.01 of the Revised Code, is not liable in damages in a civil action for injury, death, or loss to person or property that is caused by the operation of an ambulance by the EMT-basic, EMT-I, paramedic, or other operator while responding to or completing a call for emergency medical services, unless the operation constitutes willful or wanton misconduct or does not comply with the precautions of section 4511.03 of the Revised Code. An emergency medical service organization is not liable in damages in a civil action for any injury, death, or loss to person or property that is caused by the operation of an ambulance by its employee or agent, if this division grants the employee or agent immunity from civil liability for the injury, death, or loss.
(E) An employee or agent of an emergency medical service organization who receives requests for emergency medical services that are directed to the organization, dispatches first responders, EMTs-basic, EMTs-I, or paramedics in response to those requests, communicates those requests to those employees or agents of the organization who are authorized to dispatch first responders, EMTs-basic, EMTs-I, or paramedics, or performs any combination of these functions for the organization, is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the individual's acts or omissions in the performance of those duties for the organization, unless an act or omission constitutes willful or wanton misconduct.
(F) A person who is performing the functions of a first responder, EMT-basic, EMT-I, or paramedic under the authority of the laws of a state that borders this state and who provides emergency medical services to or transportation of a patient in this state is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the person's administration of emergency medical services, unless the services are administered in a manner that constitutes willful or wanton misconduct. A physician, physician assistant designated by a physician, or registered nurse designated by a physician, who any of whom is licensed to practice in the adjoining state and who is advising or assisting in the emergency medical services by means of any communication device or telemetering system, is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the person's advisory communication or assistance, unless the advisory communication or assistance is provided in a manner that constitutes willful or wanton misconduct.
(G) A person certified under section 4765.23 of the Revised Code to teach in an emergency medical services training program or emergency medical services continuing education program, and a person who teaches at the Ohio fire academy established under section 3737.33 of the Revised Code or in a fire service training program described in division (A) of section 4765.55 of the Revised Code, is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the person's acts or omissions in the performance of the person's duties, unless an act or omission constitutes willful or wanton misconduct.
(H) In the accreditation of emergency medical services training programs or approval of emergency medical services continuing education programs, the state board of emergency medical services and any person or entity authorized by the board to evaluate applications for accreditation or approval are not liable in damages in a civil action for injury, death, or loss to person or property resulting from their acts or omissions in the performance of their duties, unless an act or omission constitutes willful or wanton misconduct.
(I) A person authorized by an emergency medical service organization to review the performance of first responders, EMTs-basic, EMTs-I, and paramedics or to administer quality assurance programs is not liable in damages in a civil action for injury, death, or loss to person or property resulting from the person's acts or omissions in the performance of the person's duties, unless an act or omission constitutes willful or wanton misconduct.
Sec. 4765.51.  Nothing in this chapter prevents or restricts the practice, services, or activities of any registered nurse practicing within the scope of his the registered nurse's practice.
Nothing in this chapter prevents or restricts the practice, services, or activities of any physician assistant practicing in accordance with a physician supervisory plan approved under section 4730.17 of the Revised Code or the policies of the health care facility in which the physician assistant is practicing.
Section 2.  That existing sections 185.01, 185.03, 185.05, 2133.211, 3719.06, 4730.06, 4730.09, 4730.38, 4730.39, 4730.40, 4730.41, 4730.42, 4730.44, 4730.45, 4755.48, 4755.481, 4765.01, 4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and 4765.51 and section 4730.401 of the Revised Code are hereby repealed.
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