2024 -- S 2182 | |
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LC003826 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
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A N A C T | |
RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS | |
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Introduced By: Senators Valverde, DiMario, Miller, Lauria, Lawson, Mack, and Murray | |
Date Introduced: January 24, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Sections 5-54-2 and 5-54-28 of the General Laws in Chapter 5-54 entitled |
2 | "Physician Assistants" are hereby amended to read as follows: |
3 | 5-54-2. Definitions. |
4 | As used in this chapter, the following words have the following meanings: |
5 | (1) “Administrator” means the administrator, division of professional regulation. |
6 | (2) “Approved program” means a program for the education and training of physician |
7 | assistants formally approved by the American Medical Association’s (A.M.A.’s) Committee on |
8 | Allied Health, Education and Accreditation, its successor, the Commission on Accreditation of |
9 | Allied Health Education Programs (CAAHEP) or its successor. |
10 | (3) “Approved program for continuing medical education” means a program for continuing |
11 | education approved by the American Academy of Physician Assistants (AAPA) or the |
12 | Accreditation Council for Continuing Medical Education of the American Medical Association |
13 | (AMA), or the American Academy of Family Physicians (AAPFP) or the American Osteopathic |
14 | Association Committee on Continuing Medical Education (AOACCME) or any other board- |
15 | approved program. |
16 | (4) “Board” means the board of licensure of physician assistants. |
17 | (5) “Collaboration” means the physician assistant shall, as indicated by the patient’s |
18 | condition, the education, competencies, and experience of the physician assistant, and the standards |
19 | of care, consult with or refer to an appropriate physician or other healthcare professional. The |
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1 | degree of collaboration shall be determined by the practice and includes decisions made by a |
2 | physician affiliated with the practice employer, or physician group practice as defined in § 5-37-1, |
3 | and or the credentialing and privileging systems of a licensed hospital, health center, or ambulatory |
4 | care center healthcare facility licensed pursuant to the provisions of chapter 17 of title 23, or health |
5 | maintenance organization licensed pursuant to the provisions of chapter 17 of title 23 or chapter 41 |
6 | of title 27. A physician must be accessible at all times for consultation by the physician assistant. |
7 | (6) “Director” means the director of the department of health. |
8 | (7) “Division” means the division of professional regulation, department of health. |
9 | (8) [Deleted by P.L. 2013, ch. 320, § 1 and P.L. 2013, ch. 420, § 1.] |
10 | (9) “Physician” means a person licensed under the provisions of chapter 29 or 37 of this |
11 | title. |
12 | (10) “Physician assistant” or “PA” means a person who is qualified by academic and |
13 | practical training to provide medical and surgical services in collaboration with physicians. |
14 | (11) “Unprofessional conduct” includes, but is not limited to, the following items or any |
15 | combination and may be defined by regulations established by the board with prior approval of the |
16 | director: |
17 | (i) Fraudulent or deceptive procuring or use of a license; |
18 | (ii) Representation of himself or herself as a physician; |
19 | (iii) Conviction of a felony; conviction of a crime arising out of the practice of medicine. |
20 | All advertising of medical business that is intended or has a tendency to deceive the public; |
21 | (iv) Abandonment of a patient; |
22 | (v) Dependence upon a controlled substance, habitual drunkenness, or rendering |
23 | professional services to a patient while intoxicated or incapacitated by the use of drugs; |
24 | (vi) Promotion of the sale of drugs, devices, appliances, or goods or services provided for |
25 | a patient in a manner that exploits the patient for the financial gain of the physician assistant; |
26 | (vii) Immoral conduct of a physician assistant in the practice of medicine; |
27 | (viii) Willfully making and filing false reports or records; |
28 | (ix) Willful omission to file or record or willfully impeding or obstructing a filing or |
29 | recording, or inducing another person to omit to file or record medical or other reports as required |
30 | by law; |
31 | (x) Agreeing with clinical or bioanalytical laboratories to accept payments from these |
32 | laboratories for individual tests or test series for patients; |
33 | (xi) Practicing with an unlicensed physician or physician assistant or aiding or abetting |
34 | these unlicensed persons in the practice of medicine; |
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1 | (xii) Offering, undertaking, or agreeing to cure or treat a disease by a secret method, |
2 | procedure, treatment, or medicine; |
3 | (xiii) Professional or mental incompetence; |
4 | (xiv) Surrender, revocation, suspension, limitation of privilege based on quality of care |
5 | provided, or any other disciplinary action against a license or authorization to practice in another |
6 | state or jurisdiction; or surrender, revocation, suspension, or any other disciplinary action relating |
7 | to membership on any medical staff or in any medical professional association, or society while |
8 | under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to |
9 | acts or conduct that would constitute grounds for action as stated in this chapter; |
10 | (xv) Any adverse judgment, settlement, or award arising from a medical liability claim |
11 | related to acts or conduct that would constitute grounds for action as stated in this chapter; |
12 | (xvi) Failure to furnish the board, the administrator, investigator, or representatives, |
13 | information legally requested by the board; |
14 | (xvii) Violation of any provisions of this chapter or the rules and regulations promulgated |
15 | by the director or an action, stipulation, or agreement of the board; |
16 | (xviii) Cheating or attempting to subvert the certifying examination; |
17 | (xix) Violating any state or federal law or regulation relating to controlled substances; |
18 | (xx) Medical malpractice; |
19 | (xxi) Sexual contact between a physician assistant and patient during the existence of the |
20 | physician assistant/patient relationship; |
21 | (xxii) Providing services to a person who is making a claim as a result of a personal injury, |
22 | who charges or collects from the person any amount in excess of the reimbursement to the physician |
23 | assistant by the insurer as a condition of providing or continuing to provide services or treatment. |
24 | 5-54-28. Participation in charitable and voluntary care. |
25 | A physician assistant licensed in this state, or licensed or authorized to practice in any other |
26 | U.S. jurisdiction, or who is credentialed by a federal employer or meets the licensure requirements |
27 | of his or her requisite federal agency as a physician assistant may volunteer to render such care that |
28 | he or she is able to provide at a children’s summer camp or for a public or community event or in |
29 | a licensed ambulatory health center providing free care without a collaborating physician as it is |
30 | defined in this chapter or with such collaborating physicians as may be available. Such care must |
31 | be rendered without compensation or remuneration. It is the obligation of the physician assistant to |
32 | assure adequate and appropriate professional liability coverage. |
33 | SECTION 2. Chapter 5-54 of the General Laws entitled "Physician Assistants" is hereby |
34 | amended by adding thereto the following section: |
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1 | 5-54-29. Restrictive covenants. |
2 | (a) Any contract or agreement that creates or establishes the terms of a partnership, |
3 | employment, or any other form of professional relationship with a physician assistant licensed to |
4 | practice pursuant to this chapter that includes any restriction of the right of such physician assistant |
5 | to practice shall be void and unenforceable with respect to said restriction; provided, however, that |
6 | nothing herein shall render void or unenforceable the remaining provisions of any such contract or |
7 | agreement. |
8 | (b) Restrictions rendered void under subsection (a) of this section shall include, but shall |
9 | not be limited to, the following: |
10 | (1) The right to practice in any geographic area for any period of time after the termination |
11 | of such partnership, employment, or professional relationship; |
12 | (2) The right of such physician assistant to provide treatment, advise, consult with or |
13 | establish a professional relationship with any current patient of the employer; and |
14 | (3) The right of such physician assistant to solicit or seek to establish a professional |
15 | relationship with any current patient of the employer. |
16 | (c) Notwithstanding the foregoing, the prohibition on physician assistant covenants shall |
17 | not apply in connection with the purchase and sale of a practice; provided, the restrictive covenant |
18 | and non-compete covenant is for a period of a time of not more than five (5) years. |
19 | SECTION 3. Section 16-91-3 of the General Laws in Chapter 16-91 entitled "School and |
20 | Youth Programs Concussion Act" is hereby amended to read as follows: |
21 | 16-91-3. School district’s guidelines to be developed and implemented. |
22 | (a) The department of education and the department of health shall work in concert with |
23 | the Rhode Island Interscholastic League to develop and promulgate guidelines to inform and |
24 | educate coaches, teachers, school nurses, youth athletes, and their parents and/or guardians of the |
25 | nature and risk of concussion and head injury, including continuing to play after concussion or head |
26 | injury. A concussion and head injury information sheet shall be signed and returned by the youth |
27 | athlete and the athlete’s parent and/or guardian prior to the youth athlete’s return to practice or |
28 | competition. |
29 | (b) School districts are required to use training materials made available by the United |
30 | States Center for Disease Control and Prevention entitled “Heads Up: Concussion in the High |
31 | School Sports/Concussion in Youth Sports” and any updates or amendments thereto, or training |
32 | materials substantively and substantially similar thereto. The department of education shall post |
33 | training materials made available by the Center for Disease Control and Prevention and the Rhode |
34 | Island Interscholastic League on its website. All coaches and volunteers involved in a youth sport |
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1 | or activity covered by this chapter must complete a training course and a refresher course annually |
2 | thereafter in concussions and traumatic brain injuries. All school nurses must complete a training |
3 | course and an annual refresher course in concussions and traumatic brain injuries. Teachers and |
4 | teachers’ aides are strongly encouraged to complete the training course in concussions and |
5 | traumatic brain injuries. Training may consist of videos, classes, and any other generally accepted |
6 | mode and medium of providing information. |
7 | (c) School districts are encouraged to have all student athletes perform baseline |
8 | neuropsychological testing, computerized or otherwise. Parents and/or guardians shall be provided |
9 | with information as to the risk of concussion and/or traumatic brain injuries prior to the start of |
10 | every sport season and they shall sign an acknowledgement as to their receipt of such information. |
11 | (d) A youth athlete, who is suspected of sustaining a concussion or head injury in a practice |
12 | or game, shall be removed from competition at that time. |
13 | (e) A youth athlete, who has been removed from play, may not return to play until the |
14 | athlete is evaluated by a licensed physician, physician assistant or certified nurse practitioner who |
15 | may consult with an athletic trainer, all of whom shall be trained in the evaluation and management |
16 | of concussions. The athlete must receive written clearance to return to play from that licensed |
17 | physician, physician assistant or certified nurse practitioner. |
18 | (f) All school districts are encouraged to have an athletic trainer, or similarly trained |
19 | person, at all recreational and athletic events addressed by this statute. |
20 | SECTION 4. Section 16-91.1-3 of the General Laws in Chapter 16-91.1 entitled "The |
21 | Sudden Cardiac Arrest Prevention Act" is hereby amended to read as follows: |
22 | 16-91.1-3. School districts’ guidelines to be developed and implemented. |
23 | (a) The department of education and the department of health shall promulgate guidelines |
24 | to inform and educate coaches, teachers, school nurses, youth athletes, and their parents and/or |
25 | guardians about the nature and warning signs of sudden cardiac arrest, including the risks associated |
26 | with continuing to play or practice after experiencing the following symptoms: fainting or seizures |
27 | during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate and |
28 | extreme fatigue. |
29 | (b) School districts may use training materials made available at no cost to the school |
30 | district by organizations such as Simon’s Fund, Parent Heart Watch, Sudden Arrhythmia Death |
31 | Syndromes Foundation, or training materials substantively and substantially similar thereto. The |
32 | department of education shall post links to training materials on its website. All coaches and |
33 | volunteers involved in a youth sport program or activity covered by this chapter must complete a |
34 | training course that may be completed online about the nature and warning signs of sudden cardiac |
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1 | arrest, including the risks associated with continuing to play or practice after experiencing |
2 | symptoms including: fainting or seizures during exercise, unexplained shortness of breath, chest |
3 | pains, dizziness, racing heart rate and extreme fatigue. Training may consist of videos, classes, and |
4 | any other generally accepted mode and medium of providing information. |
5 | (c) Parents and/or guardians shall be provided with information as to the nature and |
6 | warning signs of sudden cardiac arrest prior to the start of every sport season. |
7 | (d)(1) A student who, as determined by a game official, coach from the student’s team, |
8 | certified athletic trainer, licensed physician, or other official designated by the student’s school |
9 | entity, exhibits signs or symptoms of sudden cardiac arrest while participating in an athletic activity |
10 | shall be removed by the coach from participation at that time, subject to subsection (d)(3) of this |
11 | section. |
12 | (2) If a student is known to have exhibited signs or symptoms of sudden cardiac arrest at |
13 | any time prior to or following an athletic activity, the student shall be prevented from participating |
14 | in an athletic activity, subject to subsection (d)(3) of this section. |
15 | (3) A student removed or prevented from participating in an athletic activity under |
16 | subsections (d)(1) or (d)(2) of this section shall not return to participation until the student is |
17 | evaluated and cleared for return to participation in writing by a licensed physician, physician |
18 | assistant, certified registered nurse practitioner, or cardiologist. |
19 | (e) All school districts are encouraged to have an athletic trainer, or similarly trained |
20 | person, at all recreational and athletic events addressed by this statute. |
21 | SECTION 5. Section 23-1.7-5 of the General Laws in Chapter 23-1.7 entitled "Rhode |
22 | Island Program to Address Alzheimer’s Disease" is hereby amended to read as follows: |
23 | 23-1.7-5. Medical professional training. |
24 | (a) All physicians licensed pursuant to chapter 37 of title 5, physician assistants licensed |
25 | pursuant to chapter 54 of title 5, and nurses licensed pursuant to chapter 34 of title 5, shall, no later |
26 | than October 1, 2023, complete a one-time course of training consisting of a minimum of one hour |
27 | of instruction on the diagnosis, treatment, and care of patients with cognitive impairments |
28 | including, but not limited to, Alzheimer’s disease and related disorders. |
29 | (b) The department of health shall promulgate rules to implement the training requirement |
30 | of subsection (a). |
31 | SECTION 6. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS | |
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1 | This act would expand participation in charitable and voluntary care to allow a physician |
2 | assistant licensed in this state to provide free care without a collaborating physician; prohibit any |
3 | agreement whereby a physician assistant is restricted in his or her right to practice in a certain |
4 | geographic area, assist or provide treatment or establish a professional relationship with any other |
5 | employer; and establish the right of the physician assistant to solicit or seek to establish a |
6 | professional relationship with any current patient of the employer. This restriction would not apply |
7 | with the purchase and sale of a practice which includes a restriction or non-compete clause within |
8 | five (5) years, and would allow physician assistants to clear students to participate in athletic |
9 | activities at school and evaluate and clear a young student athlete who has been removed from play |
10 | due to injury. |
11 | This act would take effect upon passage. |
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