It is enacted by the General Assembly as follows:

SECTION 1. Sections 5-54-2, 5-54-3, 5-54-4, 5-54-5, 5-54-6, 5-54-7, 5-54-8, 5-54-9, 5-54-9.1, 5-54-11, 5-54-12, and 5-54-16 of the General Laws in Chapter 5-54 entitled "Physician Assistants" are hereby amended to read as follows:

{ADD 5-54-2. Definitions. -- ADD} As used in this chapter, the following words shall have the following meanings:

"Board" means the {ADD board ADD} of {DEL registration DEL} {ADD licensure ADD} of physician assistants.

"Formulary committee" means a committee empowered to develop a list of medications that physician assistants may prescribe.

"Approved program" means a program for the education and training of physician assistants that has been formally approved by the American medical association's (A.M.A.'s) committee on allied health, education and accreditation {DEL . DEL} {ADD , its successor, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or its successor. ADD}

"Physician assistant" means a person not a physician nor person holding an M.D. or equivalent degree who is qualified by academic and practical training to provide those certain patient services under the supervision, control, responsibility and direction of a licensed physician.

"Administrator" means the administrator, division of professional regulation.

"Division" means the division of professional regulation, department of health.

"Director" means the director of the department of health.

"Physician" means a person licensed under the provisions of chapters 29, 36 [repealed] or 37 of this title.

"Supervision" means {DEL the provision or exercise of control and direction over the services of DEL} {ADD overseeing the activities of, and accepting the responsibility for the medical services rendered by ADD} the physician assistants. Supervision shall be continuous, and under the direct control of a licensed physician expert in the field of medicine in which the physician assistants practice. {ADD The constant physical presence of the supervising physician or physician designee is not required. It is the responsibility of the supervising physician and physician assistant to assure an appropriate level of supervision depending on the services being rendered. Each physician or group of physicians, or other health care delivery organization excluding licensed hospital or licensed health care facilities controlled or operated by a licensed hospital employing physician assistant(s) must have on file at the primary practice site a copy of a policy in the form of an agreement between the supervising physician(s) and physician assistant(s) delineating:

(1) the level of supervision provided by the supervising physician(s) or designee(s) with particular reference to differing levels of supervision depending on the type of patient services provided and requirements for communication between the supervising physician(s) or designee(s) and the physician assistant.

(2) a job description for the physician assistant listing patient care responsibilities and procedures to be performed by the physician assistant.

(3) a program for quality assurance for physician assistant services including requirements for periodic review of the physician assistant services.

Requirements for supervision of physician assistants employed or extended medical staff privileges by licensed hospitals or other licensed health care facilities or employed by other health care delivery agencies shall be delineated by the medical staff bylaws and/or applicable governing authority of the facility.

The supervising physician or physician designee must be available for easy communication and referral at all times. ADD}

{DEL "Physician Assistants" may not be the sole medical personnel in charge of emergency or outpatient services or any other clinical service where the supervising physician or his or her physician designee is not regularly available.

Supervision need not be in the actual presence of the physician, or their designee provided that the supervising physician or physician designee is regularly available.

"Regularly available" means that the physical presence of the supervising physician or physician designee is required except in the following situations:

(1) So long as the physician assistant functions at the primary practice site of the supervising physician.

(2) In a licensed hospital, nursing home or other inpatient health care facility with the approval of the governing board of the hospital, nursing home or other inpatient health care facility in which the supervising physician is a medical staff member.

(3) On calls outside the hospital or supervising physician's office provided that the supervising physician assigns specific services on a daily basis.

In those instances when the physical presence of the supervising physician is not required, the supervising physician or physician designee must be available for easy communication, for consultation and direction.

Further, the supervising physician or physician designee shall be within reasonable travel distance so he or she can personally assure proper care to the patient. The supervising physician or physician designee shall, on a daily basis, personally communicate with the physician assistant to review the services rendered by the physician assistant. DEL}

{ADD 5-54-3. Exemptions. -- ADD} The provisions of this chapter shall not apply to services performed in any of the following areas:

(a) The practice of dentistry or dental hygiene as defined in chapter 31.1 of this title.

(b) The practice of chiropractic.

(c) The practice of optometry as defined in chapter 35 of this title.

{ADD (d) A physician assistant student enrolled in a physician assistant or surgeon assistant educational program while performing duties in conjunction with a formal training program clinical rotation under the auspices of a recognized degree granting institution.

(e) Technicians, or other assistants or employees of physicians who perform delegated tasks in the office of a physician but who are not rendering services as a physician assistant or identifying themselves as a physician assistant. ADD}

{DEL 5-54-4.Board of registration -- Creation. DEL} {ADD 5-54-4. Board of licensure -- Creation. -- ADD} Within the division of professional regulation established in the department of health pursuant to chapter 26 of this title there shall be a board of registration for physician assistants as provided by sections 5-54-5 to 5-54-7, inclusive.

{DEL 5-54-5. Board of registration -- Composition -- Appointment, terms, removal of members. DEL} {ADD 5-54-5. Board of licensure -- Composition -- Appointment, terms, removal of members. -- ADD} The director of health, with the approval of the governor, shall appoint a board consisting of seven (7) persons, residents of the state, to constitute a board of {DEL registration DEL} {ADD licensure ADD} for physician assistants with the duties, powers and authority as set forth in this chapter, and that board shall be composed of the following:

Two (2) members shall be licensed physicians under the provisions of chapter 36 [repealed] or 37 of this title who shall have been actively engaged in the practice of medicine;

Two (2) members shall be chief executive officers of a health care facility located and licensed in the state or their designees who shall not be licensed in any health care profession;

One (1) member shall be a representative of the general public not employed in any health-related field; and

Two (2) members shall be physician assistants.

Members shall be appointed for terms of three (3) years each with no member serving more than two (2) consecutive terms.

In his or her initial appointment, the director shall designate the members of the board of {DEL registration DEL} {ADD licensure ADD} for physician assistants as follows: two (2) members to serve for terms of three (3) years; two (2) members to serve for a term of two (2) years; and three (3) members to serve for a term of one (1) year. Any additional appointments shall serve for one (1) year.

The director of health may remove any member of the board for cause.

{DEL 5-54-6. Board of registration -- Organization and meetings -- Compensation of members. DEL} {ADD 5-54-6. Board of licensure -- Organization and meetings -- Compensation of members. -- ADD} The board shall elect its own chairman annually and shall meet at the call of the administrator, the chairman or upon the request of two (2) or more members of the board. A quorum shall consist of at least three (3) members present. Board members shall serve without compensation.

{DEL 5-54-7. Board of registration -- Powers and duties. DEL} {ADD 5-54-7. Board of licensure -- Powers and duties. -- ADD} (a) The board shall administer, coordinate, and enforce the provisions of this chapter, approve programs for the training of physician assistants, evaluate the qualifications of applicants, supervise any examination of applicants deemed necessary, recommend to the director the commencement of disciplinary hearings in accordance with chapter 35 of title 42 and the provisions of this chapter and shall investigate persons engaging in practices which violate the provisions of this chapter. This authority shall specifically encompass practicing physician assistants, supervisory physicians, and those health care agencies employing physician assistants. The board shall investigate all such persons and agencies engaging in practices which violate the provisions in this chapter.

(b) The board shall conduct such hearings of a non-disciplinary nature and keep such records and minutes as shall be necessary to an orderly dispatch of business.

(c) The board shall, with the approval of the director of health, adopt rules and regulations necessary to carry into effect the provisions of this chapter and may amend or repeal the same.

(d) Regular meetings of the board shall be held at such time and places as it prescribes and special meetings may be held upon the call of the chairman provided that at least one regular meeting be held each year.

(e) The conferral or enumeration of specific powers elsewhere in this chapter shall not be construed as a limitation of the general powers conferred by this section.

(f) The board shall recommend to the director for registration those persons meeting the criteria set forth by this chapter;

(g) The board shall recommend to the director the revocation or suspension of the registration of any physician assistant who does not conform to the requirements of this chapter or regulations adopted thereunder.

In accordance with its authority under subsection (a) of this section, the board shall also make recommendations to the director for discipline of supervising physicians and employing health care agencies found wanting in their use of physician assistants.

{ADD 5-54-8. Permitted health care practices by physician assistants. -- ADD} {ADD Physician assistants practice with physician supervision. Physician assistants may perform those duties and responsibilities consistent with the limitations of this section, including prescribing of drugs and medical devices, that are delegated by their supervising physician(s). Physician assistants may request, receive, sign for and distribute professional samples of drugs and medical devices to patients only within the limitations of this section. ADD} Notwithstanding any other provisions of law, a physician assistant may perform health care services when those services are rendered under the supervision of a licensed physician. A licensed physician shall supervise no more than two (2) physician assistants at any one (1) time in practicing settings other than licensed hospitals {ADD , nursing homes ADD} or other inpatient health care facilities.

Physician assistants, depending upon their level of professional training and experience, as determined by a supervising physician, may perform health care services consistent with their expertise and that of the supervising physician, who is a licensed physician in solo practice, in group practice, or in health care facilities.

Physician assistants may write prescriptions and medical orders to the extent provided in this paragraph. When employed by or extended medical staff privileges by a licensed hospital or other licensed health care facility a physician assistant may write medical orders for inpatients as governing delineated by the medical staff bylaws of the facility as well as its credentialling process and applicable governing authority. Physician assistants employed directly by physicians, health maintenance organizations or other health care delivery organizations may prescribe legend medications, including schedule V medications under title 21 chapter 28 of the Rhode Island Uniform Controlled Substances Act, medical therapies, medical devices and medical diagnostics according to guidelines established by the employing physician, health maintenance organization or other health care delivery organization.

When supervised by a physician licensed under chapter 29 of this title, the services rendered by the physician assistant shall be limited to the foot. The "foot" is defined as the pedal extremity of the human body and its articulations and shall include the tendons and muscles of the lower leg only as they be involved in the conditions of the foot.

Hospitals and other licensed health care facilities shall have discretion to grant privileges to a physician assistant and to define the scope of privileges or services which a physician assistant may deliver in a facility. In no event shall those privileges, if granted, exceed the privileges granted to the supervising physician.

{DEL 5-54-9. Criteria for Registration as a Physician Assistant. -- DEL} {ADD 5-54-9. Criteria for licensure as a physician assistant. -- ADD} {ADD (a) ADD} The board will recommend to the director for {DEL registration DEL} {ADD licensure ADD} as a physician assistant an applicant who:

(1) is of good character and reputation;

(2) has been graduated from a physician assistant training program certified by the AMA's committee on allied health, education and accreditation {DEL . DEL} {ADD , its successor, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or its successor. ADD}

(3) has passed a certifying examination approved by the national commission on certification of physician assistants, or any other national certifying exam approved by the board.

(4) has submitted a completed application together with the required fee of fifty dollars ($50.00).

{ADD 5-54-9.1. Graduate practice. -- ADD} Any graduate of an approved physician assistant training program who has filed a completed application for {DEL registration DEL} {ADD licensure ADD} may, upon receiving a receipt from the division of professional regulation, perform as a graduate physician assistant subject to the board promulgating rules and regulations delineating the appropriate level of supervision for the graduate physician assistant practice. During this period, the applicant shall identify himself or herself only as a "graduate physician assistant".

If such an applicant shall fail to take the next succeeding examination without due cause, or fail to pass the examination and be {DEL registered DEL} {ADD licensed ADD} , all privileges, granted pursuant to this section shall automatically cease.

{DEL 5-54-11. Issuance and annual renewal of certificates of registration. DEL} {ADD 5-54-11. Issuance and annual renewal of certificates of licensure. ADD} The board shall recommend to the director for registration those individuals who meet the criteria for {DEL registration DEL} {ADD licensure ADD} as set forth in this chapter. Upon that recommendation, the director shall issue a certificate of {DEL registration DEL} {ADD licensure ADD} as a physician assistant.

The certificate of {DEL registration DEL} {ADD licensure ADD} shall expire annually on the thirtieth day of September. On or before the first day of August in each year, the administrator shall mail an application for renewal certificate to every person {DEL registered DEL} {ADD licensed ADD} under the provisions of this chapter, and every person who desires his or her certificate to be renewed shall file with the division the renewal application together with a renewal fee of fifty dollars ($50.00) on or before the first day of September in each year. Upon receipt of the renewal application and payment of fee, the accuracy of the application shall be verified and the administrator shall grant a renewal certificate effective October 1st and expiring the following September 30th unless the certificate shall sooner be suspended for cause as provided in 5-54-12.

{ADD 5-54-12. Grounds for refusal to renew, suspension or revocation of certificates. -- ADD} The director may, after due notice and hearing, as hereinafter provided, refuse to grant, refuse to renew, suspend or revoke any certificate of {DEL registration DEL} {ADD licensure ADD} or otherwise discipline any registrant upon proof that the person:

(1) is guilty of fraud or deceit in procuring or attempting to procure a {DEL registration DEL} {ADD licensure ADD} ;

(2) is guilty of a crime of gross immorality;

(3) is unfit or incompetent by reason of negligence, habits or other cause;

(4) is habitually intemperate or is addicted to the use of habit forming drugs;

(5) is mentally incompetent;

(6) is guilty of unprofessional conduct; and

(7) has violated any of the provisions of this chapter.

{ADD 5-54-16. Penalty for misrepresentation. -- ADD} No person who is not {DEL registered DEL} {ADD licensed ADD} as a physician assistant shall use the title of "Physician Assistant" or hold himself out as a Physician Assistant. Any person who violates the provisions of this section shall be punished by a fine of not less than two hundred dollars ($200) nor more than five hundred dollars ($500) nor more than one (1) year imprisonment or by both the fine and imprisonment.

SECTION 2. Chapter 5-54 of the General Laws entitled "Physician Assistants" is hereby amended by adding thereto the following section:

{ADD 5-54-20.1. Immunity from liability for gratuitous emergency assistance. -- ADD} {ADD No person licensed under the provisions of this chapter or members of the same profession duly licensed to practice in other states of the United States who voluntarily and gratuitously, and other than in the ordinary course of his or her employment or practice, renders emergency medical assistance to a person in need thereof shall be liable for civil damages for any personal injuries which result from acts or omissions by those persons in rendering the emergency care which may constitute ordinary negligence. The immunity granted by this section shall not apply to acts or omissions constituting gross, willful, or wanton negligence or when the medical assistance is rendered at any hospital, physician's office or other health care delivery entity where those services are normally rendered. ADD}

SECTION 3. This act shall take effect upon passage.