EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb0757*
HOUSE BILL 757
J2 EMERGENCY BILL 4lr2790
By: Delegate R. Lewis
Introduced and read first time: January 31, 2024
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
State Board of Physicians – Supervised Medical Graduates and Cardiovascular 2
Invasive Specialists 3
(Bridge to Medical Residency Act) 4
FOR the purpose of authorizing a supervised medical graduate to provide delegated duties 5
under direct supervision in accordance with regulations adopted by the State Board 6
of Physicians; repealing the termination of certain provisions of law relating to 7
delegation of duties by licensed physicians to cardiovascular invasive specialists; and 8
generally relating to the delegation of duties by licensed physicians. 9
BY repealing and reenacting, with amendments, 10
Article – Health Occupations 11
Section 14–306 12
Annotated Code of Maryland 13
(2021 Replacement Volume and 2023 Supplement) 14
BY repealing and reenacting, with amendments, 15
Chapter 445 of the Acts of the General Assembly of 2019 16
Section 4 17
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 18
That the Laws of Maryland read as follows: 19
Article – Health Occupations 20
14–306. 21
(a) To the extent permitted by the rules, regulations, and orders of the Board, an 22
individual to whom duties are delegated by a licensed physician may perform those duties 23
without a license as provided in this section. 24
2 HOUSE BILL 757
(b) The individuals to whom duties may be delegated under this section include 1
any individual authorized to practice any other health occupation regulated under this 2
article or § 13–516 of the Education Article. 3
(c) The Board shall adopt rules and regulations to delineate the scope of this 4
section. Before it adopts any rule or regulation under this section, the Board shall invite 5
and consider proposals from any individual or health group that could be affected by the 6
rule or regulation. 7
(d) (1) If a duty that is to be delegated under this section is a part of the 8
practice of a health occupation that is regulated under this article by another board, any 9
rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians 10
and the board that regulates the other health occupation. 11
(2) If the two boards cannot agree on a proposed rule or regulation, the 12
proposal shall be submitted to the Secretary for a final decision. 13
(e) Except as otherwise provided in this section, an individual may perform 14
X–ray duties without a license only if the duties: 15
(1) Do not include: 16
(i) Computerized or noncomputerized tomography; 17
(ii) Fluoroscopy; 18
(iii) Invasive radiology; 19
(iv) Mammography; 20
(v) Nuclear medicine; 21
(vi) Radiation therapy; or 22
(vii) Xerography; 23
(2) Are limited to X–ray procedures of the: 24
(i) Chest, anterior–posterior and lateral; 25
(ii) Spine, anterior–posterior and lateral; or 26
(iii) Extremities, anterior–posterior and lateral, not including the 27
head; and 28
(3) Are performed: 29
HOUSE BILL 757 3
(i) By an individual who is not employed primarily to perform 1
X–ray duties; 2
(ii) In the medical office of the physician who delegates the duties; 3
and 4
(iii) 1. By an individual who, before October 1, 2002, has: 5
A. Taken a course consisting of at least 30 hours of training 6
in performing X–ray procedures approved by the Maryland Radiological Society in 7
consultation with the Maryland Society of Radiologic Technologists; and 8
B. Successfully passed an examination based on that course 9
that has been approved by the Maryland Radiological Society in consultation with the 10
Maryland Society of Radiologic Technologists; or 11
2. By a licensed physician assistant who has completed a 12
course that includes anterior–posterior and lateral radiographic studies of extremities on 13
at least 20 separate patients under the direct supervision of the delegating physician or 14
radiologist using a mini C–arm or similar low–level radiation machine to perform 15
nonfluoroscopic X–ray procedures, if the duties: 16
A. Include only the X–ray procedures described in paragraph 17
(2)(iii) of this subsection; and 18
B. Are performed pursuant to a Board–approved delegation 19
agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this 20
article. 21
(f) (1) In accordance with regulations adopted by the Board, a licensed 22
physician may delegate duties to a registered cardiovascular invasive specialist assisting 23
in the physician’s performance of fluoroscopy if: 24
(i) The delegated duties are limited to a cardiac catheterization 25
procedure performed in a hospital cardiac catheterization laboratory; 26
(ii) The physician is physically present and personally directs each 27
act performed by the registered cardiovascular invasive specialist; 28
(iii) The registered cardiovascular invasive specialist has completed 29
the training and education and has the experience required by regulations adopted by the 30
Board; and 31
(iv) The hospital in which the cardiac catheterization laboratory is 32
located has verified and documented that the registered cardiovascular invasive specialist 33
has completed the training and education and has the experience required by regulations 34
adopted by the Board. 35 4 HOUSE BILL 757
(2) The hospital in which the cardiac catheterization laboratory is located 1
and the physician delegating duties to a registered cardiovascular invasive specialist under 2
this subsection are responsible for ensuring that all requirements of this subsection are 3
met for each procedure. 4
(3) A disciplinary panel may impose a civil penalty of up to $5,000 for each 5
instance of a hospital’s failure to comply with the requirements of this subsection. 6
(G) (1) (I) IN THIS SUBSECTION TH E FOLLOWING WORDS HAVE THE 7
MEANINGS INDICATED . 8
(II) “DIRECT SUPERVISION ” MEANS OVERSIGHT EXER CISED BY 9
A DELEGATING PHYSICI AN WHO IS: 10
1. PERSONALLY TREATING T HE PATIENT; AND 11
2. IN THE PRESENCE OF TH E PATIENT AND THE 12
SUPERVISED MEDICAL G RADUATE. 13
(III) “SUPERVISED MEDICAL GRADU ATE” MEANS AN INDIVIDUAL 14
WHO: 15
1. HAS A DEGREE OF: 16
A. DOCTOR OF MEDICINE FROM A M EDICAL SCHOOL 17
THAT IS ACCREDITED B Y AN ACCREDITING ORG ANIZATION THAT THE BOARD 18
RECOGNIZES IN ITS RE GULATIONS; OR 19
B. DOCTOR OF OSTEOPATHY FROM A SCHOOL OF 20
OSTEOPATHY IN THE UNITED STATES, ITS TERRITORIES OR P OSSESSIONS, PUERTO 21
RICO, OR CANADA THAT HAS STAND ARDS FOR GRADUATION EQUIVALENT TO THOSE 22
ESTABLISHED BY THE AMERICAN OSTEOPATHIC ASSOCIATION; AND 23
2. HAS PASSED PARTS 1 AND 2 OF THE UNITED STATES 24
MEDICAL LICENSING EXAMINATION. 25
(2) IN ACCORDANCE WITH RE GULATIONS ADOPTED BY THE BOARD, A 26
SUPERVISED MEDICAL G RADUATE MAY PERFORM DELEGATED DUTIES UND ER 27
DIRECT SUPERVISION . 28
Chapter 445 of the Acts of 2019 29
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 30
October 1, 2019. [It shall remain effective for a period of 5 years and, at the end of 31 HOUSE BILL 757 5
September 30, 2024, this Act, with no further action required by the General Assembly, 1
shall be abrogated and of no further force and effect.] 2
SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 3
measure, is necessary for the immediate preservation of the public health or safety, has 4
been passed by a yea and nay vote supported by three–fifths of all the members elected to 5
each of the two Houses of the General Assembly, and shall take effect from the date it is 6
enacted. 7