Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0279 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- S 0279
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7	7	LC001289
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS
16	16	Introduced By: Senators Valverde, Lauria, Miller, Kallman, DiMario, and Lawson
17	17	Date Introduced: February 16, 2023
18	18	Referred To: Senate Health & Human Services
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21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Sections 5-54-2 and 5-54-28 of the General Laws in Chapter 5-54 entitled 1
23	23	"Physician Assistants" are hereby amended to read as follows: 2
24	24	5-54-2. Definitions. 3
25	25	As used in this chapter, the following words have the following meanings: 4
26	26	(1) “Administrator” means the administrator, division of professional regulation. 5
27	27	(2) “Approved program” means a program for the education and training of physician 6
28	28	assistants formally approved by the American Medical Association’s (A.M.A.’s) Committee on 7
29	29	Allied Health, Education and Accreditation, its successor, the Commission on Accreditation of 8
30	30	Allied Health Education Programs (CAAHEP) or its successor. 9
31	31	(3) “Approved program for continuing medical education” means a program for continuing 10
32	32	education approved by the American Academy of Physician Assistants (AAPA) or the 11
33	33	Accreditation Council for Continuing Medical Education of the American Medical Association 12
34	34	(AMA), or the American Academy of Family Physicians (AAPFP) or the American Osteopathic 13
35	35	Association Committee on Continuing Medical Education (AOACCME) or any other board-14
36	36	approved program. 15
37	37	(4) “Board” means the board of licensure of physician assistants. 16
38	38	(5) “Collaboration” means the physician assistant shall, as indicated by the patient’s 17
39	39	condition, the education, competencies, and experience of the physician assistant, and the standards 18
40	40	of care, consult with or refer to an appropriate physician or other healthcare professional. The 19
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44	44	degree of collaboration shall be determined by the practice and includes decisions made by a 1
45	45	physician affiliated with the practice employer, or physician group practice as defined in § 5-37-1, 2
46	46	and or the credentialing and privileging systems of a licensed hospital, health center, or ambulatory 3
47	47	care center healthcare facility licensed pursuant to the provisions of chapter 17 of title 23, or health 4
48	48	maintenance organization licensed pursuant to the provisions of chapter 17 of title 23 or chapter 41 5
49	49	of title 27. A physician must be accessible at all times for consultation by the physician assistant. 6
50	50	(6) “Director” means the director of the department of health. 7
51	51	(7) “Division” means the division of professional regulation, department of health. 8
52	52	(8) [Deleted by P.L. 2013, ch. 320, § 1 and P.L. 2013, ch. 420, § 1.] 9
53	53	(9) “Physician” means a person licensed under the provisions of chapter 29 or 37 of this 10
54	54	title. 11
55	55	(10) “Physician assistant” or “PA” means a person who is qualified by academic and 12
56	56	practical training to provide medical and surgical services in collaboration with physicians. 13
57	57	(11) “Unprofessional conduct” includes, but is not limited to, the following items or any 14
58	58	combination and may be defined by regulations established by the board with prior approval of the 15
59	59	director: 16
60	60	(i) Fraudulent or deceptive procuring or use of a license; 17
61	61	(ii) Representation of himself or herself as a physician; 18
62	62	(iii) Conviction of a felony; conviction of a crime arising out of the practice of medicine. 19
63	63	All advertising of medical business that is intended or has a tendency to deceive the public; 20
64	64	(iv) Abandonment of a patient; 21
65	65	(v) Dependence upon a controlled substance, habitual drunkenness, or rendering 22
66	66	professional services to a patient while intoxicated or incapacitated by the use of drugs; 23
67	67	(vi) Promotion of the sale of drugs, devices, appliances, or goods or services provided for 24
68	68	a patient in a manner that exploits the patient for the financial gain of the physician assistant; 25
69	69	(vii) Immoral conduct of a physician assistant in the practice of medicine; 26
70	70	(viii) Willfully making and filing false reports or records; 27
71	71	(ix) Willful omission to file or record or willfully impeding or obstructing a filing or 28
72	72	recording, or inducing another person to omit to file or record medical or other reports as required 29
73	73	by law; 30
74	74	(x) Agreeing with clinical or bioanalytical laboratories to accept payments from these 31
75	75	laboratories for individual tests or test series for patients; 32
76	76	(xi) Practicing with an unlicensed physician or physician assistant or aiding or abetting 33
77	77	these unlicensed persons in the practice of medicine; 34
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81	81	(xii) Offering, undertaking, or agreeing to cure or treat a disease by a secret method, 1
82	82	procedure, treatment, or medicine; 2
83	83	(xiii) Professional or mental incompetence; 3
84	84	(xiv) Surrender, revocation, suspension, limitation of privilege based on quality of care 4
85	85	provided, or any other disciplinary action against a license or authorization to practice in another 5
86	86	state or jurisdiction; or surrender, revocation, suspension, or any other disciplinary action relating 6
87	87	to membership on any medical staff or in any medical professional association, or society while 7
88	88	under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to 8
89	89	acts or conduct that would constitute grounds for action as stated in this chapter; 9
90	90	(xv) Any adverse judgment, settlement, or award arising from a medical liability claim 10
91	91	related to acts or conduct that would constitute grounds for action as stated in this chapter; 11
92	92	(xvi) Failure to furnish the board, the administrator, investigator, or representatives, 12
93	93	information legally requested by the board; 13
94	94	(xvii) Violation of any provisions of this chapter or the rules and regulations promulgated 14
95	95	by the director or an action, stipulation, or agreement of the board; 15
96	96	(xviii) Cheating or attempting to subvert the certifying examination; 16
97	97	(xix) Violating any state or federal law or regulation relating to controlled substances; 17
98	98	(xx) Medical malpractice; 18
99	99	(xxi) Sexual contact between a physician assistant and patient during the existence of the 19
100	100	physician assistant/patient relationship; 20
101	101	(xxii) Providing services to a person who is making a claim as a result of a personal injury, 21
102	102	who charges or collects from the person any amount in excess of the reimbursement to the physician 22
103	103	assistant by the insurer as a condition of providing or continuing to provide services or treatment. 23
104	104	5-54-28. Participation in charitable and voluntary care. 24
105	105	A physician assistant licensed in this state, or licensed or authorized to practice in any other 25
106	106	U.S. jurisdiction, or who is credentialed by a federal employer or meets the licensure requirements 26
107	107	of his or her requisite federal agency as a physician assistant may volunteer to render such care that 27
108	108	he or she is able to provide at a children’s summer camp or for a public or community event or in 28
109	109	a licensed ambulatory health center providing free care without a collaborating physician as it is 29
110	110	defined in this section of law or with such collaborating physicians as may be available. Such care 30
111	111	must be rendered without compensation or remuneration. It is the obligation of the physician 31
112	112	assistant to assure adequate and appropriate professional liability coverage. 32
113	113	SECTION 2. Chapter 5-54 of the General Laws entitled "Physician Assistants" is hereby 33
114	114	amended by adding thereto the following section: 34
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118	118	5-54-29. Restrictive covenants. 1
119	119	(a) Any contract or agreement that creates or establishes the terms of a partnership, 2
120	120	employment, or any other form of professional relationship with a physician assistant licensed to 3
121	121	practice pursuant to this section that includes any restriction of the right of such physician assistant 4
122	122	to practice shall be void and unenforceable with respect to said restriction; provided, however, that 5
123	123	nothing herein shall render void or unenforceable the remaining provisions of any such contract or 6
124	124	agreement. 7
125	125	(b) Restrictions rendered void under subsection (a) of this section shall include, but shall 8
126	126	not be limited to, the following: 9
127	127	(1) The right to practice in any geographic area for any period of time after the termination 10
128	128	of such partnership, employment, or professional relationship; 11
129	129	(2) The right of such physician assistant to provide treatment, advise, consult with or 12
130	130	establish a professional relationship with any current patient of the employer; and 13
131	131	(3) The right of such physician assistant to solicit or seek to establish a professional 14
132	132	relationship with any current patient of the employer. 15
133	133	(c) Notwithstanding the foregoing, the prohibition on physician assistant covenants shall 16
134	134	not apply in connection with the purchase and sale of a practice; provided, the restrictive covenant 17
135	135	and non-compete covenant is for a period of a time of not more than five (5) years. 18
136	136	SECTION 3. Section 16-91-3 of the General Laws in Chapter 16-91 entitled "School and 19
137	137	Youth Programs Concussion Act" is hereby amended to read as follows: 20
138	138	16-91-3. School district’s guidelines to be developed and implemented. 21
139	139	(a) The department of education and the department of health shall work in concert with 22
140	140	the Rhode Island Interscholastic League to develop and promulgate guidelines to inform and 23
141	141	educate coaches, teachers, school nurses, youth athletes, and their parents and/or guardians of the 24
142	142	nature and risk of concussion and head injury, including continuing to play after concussion or head 25
143	143	injury. A concussion and head injury information sheet shall be signed and returned by the youth 26
144	144	athlete and the athlete’s parent and/or guardian prior to the youth athlete’s return to practice or 27
145	145	competition. 28
146	146	(b) School districts are required to use training materials made available by the United 29
147	147	States Center for Disease Control and Prevention entitled “Heads Up: Concussion in the High 30
148	148	School Sports/Concussion in Youth Sports” and any updates or amendments thereto, or training 31
149	149	materials substantively and substantially similar thereto. The department of education shall post 32
150	150	training materials made available by the Center for Disease Control and Prevention and the Rhode 33
151	151	Island Interscholastic League on its website. All coaches and volunteers involved in a youth sport 34
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155	155	or activity covered by this chapter must complete a training course and a refresher course annually 1
156	156	thereafter in concussions and traumatic brain injuries. All school nurses must complete a training 2
157	157	course and an annual refresher course in concussions and traumatic brain injuries. Teachers and 3
158	158	teachers’ aides are strongly encouraged to complete the training course in concussions and 4
159	159	traumatic brain injuries. Training may consist of videos, classes, and any other generally accepted 5
160	160	mode and medium of providing information. 6
161	161	(c) School districts are encouraged to have all student athletes perform baseline 7
162	162	neuropsychological testing, computerized or otherwise. Parents and/or guardians shall be provided 8
163	163	with information as to the risk of concussion and/or traumatic brain injuries prior to the start of 9
164	164	every sport season and they shall sign an acknowledgement as to their receipt of such information. 10
165	165	(d) A youth athlete, who is suspected of sustaining a concussion or head injury in a practice 11
166	166	or game, shall be removed from competition at that time. 12
167	167	(e) A youth athlete, who has been removed from play, may not return to play until the 13
168	168	athlete is evaluated by a licensed physician, physician assistant or certified nurse practitioner who 14
169	169	may consult with an athletic trainer, all of whom shall be trained in the evaluation and management 15
170	170	of concussions. The athlete must receive written clearance to return to play from that licensed 16
171	171	physician, physician assistant or certified nurse practitioner. 17
172	172	(f) All school districts are encouraged to have an athletic trainer, or similarly trained 18
173	173	person, at all recreational and athletic events addressed by this statute. 19
174	174	SECTION 4. Section 16-91.1-3 of the General Laws in Chapter 16-91.1 entitled "The 20
175	175	Sudden Cardiac Arrest Prevention Act" is hereby amended to read as follows: 21
176	176	16-91.1-3. School districts’ guidelines to be developed and implemented. 22
177	177	(a) The department of education and the department of health shall promulgate guidelines 23
178	178	to inform and educate coaches, teachers, school nurses, youth athletes, and their parents and/or 24
179	179	guardians about the nature and warning signs of sudden cardiac arrest, including the risks associated 25
180	180	with continuing to play or practice after experiencing the following symptoms: fainting or seizures 26
181	181	during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate and 27
182	182	extreme fatigue. 28
183	183	(b) School districts may use training materials made available at no cost to the school 29
184	184	district by organizations such as Simon’s Fund, Parent Heart Watch, Sudden Arrhythmia Death 30
185	185	Syndromes Foundation, or training materials substantively and substantially similar thereto. The 31
186	186	department of education shall post links to training materials on its website. All coaches and 32
187	187	volunteers involved in a youth sport program or activity covered by this chapter must complete a 33
188	188	training course that may be completed online about the nature and warning signs of sudden cardiac 34
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192	192	arrest, including the risks associated with continuing to play or practice after experiencing 1
193	193	symptoms including: fainting or seizures during exercise, unexplained shortness of breath, chest 2
194	194	pains, dizziness, racing heart rate and extreme fatigue. Training may consist of videos, classes, and 3
195	195	any other generally accepted mode and medium of providing information. 4
196	196	(c) Parents and/or guardians shall be provided with information as to the nature and 5
197	197	warning signs of sudden cardiac arrest prior to the start of every sport season. 6
198	198	(d)(1) A student who, as determined by a game official, coach from the student’s team, 7
199	199	certified athletic trainer, licensed physician, or other official designated by the student’s school 8
200	200	entity, exhibits signs or symptoms of sudden cardiac arrest while participating in an athletic activity 9
201	201	shall be removed by the coach from participation at that time, subject to subsection (d)(3) of this 10
202	202	section. 11
203	203	(2) If a student is known to have exhibited signs or symptoms of sudden cardiac arrest at 12
204	204	any time prior to or following an athletic activity, the student shall be prevented from participating 13
205	205	in an athletic activity, subject to subsection (d)(3) of this section. 14
206	206	(3) A student removed or prevented from participating in an athletic activity under 15
207	207	subsections (d)(1) or (d)(2) of this section shall not return to participation until the student is 16
208	208	evaluated and cleared for return to participation in writing by a licensed physician, physician 17
209	209	assistant, certified registered nurse practitioner, or cardiologist. 18
210	210	(e) All school districts are encouraged to have an athletic trainer, or similarly trained 19
211	211	person, at all recreational and athletic events addressed by this statute. 20
212	212	SECTION 5. Section 23-1.7-5 of the General Laws in Chapter 23-1.7 entitled "Rhode 21
213	213	Island Program to Address Alzheimer’s Disease" is hereby amended to read as follows: 22
214	214	23-1.7-5. Medical professional training. 23
215	215	(a) All physicians licensed pursuant to chapter 37 of title 5, physician assistants licensed 24
216	216	pursuant to chapter 54 of title 5, and nurses licensed pursuant to chapter 34 of title 5, shall, no later 25
217	217	than October 1, 2023, complete a one-time course of training consisting of a minimum of one hour 26
218	218	of instruction on the diagnosis, treatment, and care of patients with cognitive impairments 27
219	219	including, but not limited to, Alzheimer’s disease and related disorders. 28
220	220	(b) The department of health shall promulgate rules to implement the training requirement 29
221	221	of subsection (a). 30
222	222	SECTION 6. This act shall take effect upon passage. 31
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229	229	EXPLANATION
230	230	BY THE LEGISLATIVE COUNCIL
231	231	OF
232	232	A N A C T
233	233	RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS
234	234	***
235	235	This act would expand participation in charitable and voluntary care to allow a physician 1
236	236	assistant licensed in this state to provide free care without a collaborating physician; prohibit any 2
237	237	agreement whereby a physician assistant is restricted in his or her right to practice in a certain 3
238	238	geographic area, assist or provide treatment or establish a professional relationship with any other 4
239	239	employer; and establish the right of the physician assistant to solicit or seek to establish a 5
240	240	professional relationship with any current patient of the employer. This restriction would not apply 6
241	241	with the purchase and sale of a practice which includes a restriction or non-compete clause within 7
242	242	five (5) years, and would allow physician assistants to clear students to participate in athletic 8
243	243	activities at school and evaluate and clear a young student athlete who has been removed from play 9
244	244	due to injury. 10
245	245	This act would take effect upon passage. 11
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