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Sub. H. B. No. 284 As Reported by the House Health and Aging CommitteeAs Reported by the House Health and Aging Committee
129th General Assembly | Regular Session | 2011-2012 |
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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;
(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:
(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:
(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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