act-2008-0-46•Pennsylvania Act 2008-46 — OSTEOPATHIC MEDICAL PRACTICE ACT - STATE BOARD OF OSTEOPATHIC MEDICINE, PRACTICE WITHOUT LICENSE, PHYSICIAN ASSISTANTS, RESPIRATORY CARE PRACTITIONER CERTIFICATES AND PERMITS, REFUSAL, REVOCATION OR SUSPENSION OF LICENSE AND REGULATIONS
Pennsylvania Act 2008-46 — OSTEOPATHIC MEDICAL PRACTICE ACT - STATE BOARD OF OSTEOPATHIC MEDICINE, PRACTICE WITHOUT LICENSE, PHYSICIAN ASSISTANTS, RESPIRATORY CARE PRACTITIONER CERTIFICATES AND PERMITS, REFUSAL, REVOCATION OR SUSPENSION OF LICENSE AND REGULATIONS
act-2008-0-462008 Pa. Act 46Law
Act text
OSTEOPATHIC MEDICAL PRACTICE ACT - STATE BOARD OF OSTEOPATHIC MEDICINE,
PRACTICE WITHOUT LICENSE, PHYSICIAN ASSISTANTS, RESPIRATORY CARE
PRACTITIONER CERTIFICATES AND PERMITS, REFUSAL, REVOCATION OR SUSPENSION
OF LICENSE AND REGULATIONS
Act of Jul. 4, 2008, P.L. 589, No. 46 Cl. 63
Session of 2008
No. 2008-46
HB 2088
AN ACT
Amending the act of October 5, 1978 (P.L.1109, No.261), entitled
"An act requiring the licensing of practitioners of
osteopathic medicine and surgery; regulating their practice;
providing for certain funds and penalties for violations and
repeals," further providing for definitions, for the State
Board of Osteopathic Medicine, for prohibition on practice
without license, for physician assistants, for respiratory
care practitioners, for respiratory care practitioner
certificates and permits and for reasons for refusal,
revocation or suspension of license; and providing for
regulations.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The definitions of "board-regulated practitioner"
and "respiratory care practitioner" in section 2 of the act of
October 5, 1978 (P.L.1109, No.261), known as the Osteopathic
Medical Practice Act, amended or added July 2, 1993 (P.L.418,
No.59) and December 10, 2001 (P.L.863, No.93), are amended to
read:
Section 2. Definitions.
The following words and phrases when used in this act shall
have, unless the context clearly indicates otherwise, the
meanings given to them in this section:
* * *
"Board-regulated practitioner." An osteopathic physician,
physician assistant, respiratory [care practitioner] therapist
or certified athletic trainer or an applicant for a license or
certificate issued by the board.
* * *
"Respiratory [care practitioner] therapist." An individual
who is [certified] licensed to practice respiratory care by the
State Board of Osteopathic Medicine.
* * *
Section 2. Section 2.1(a) of the act, amended June 11, 2008
(P.L.161, No.20), is amended to read:
Section 2.1. State Board of Osteopathic Medicine.
(a) The State Board of Osteopathic Medicine shall consist of
the Commissioner of Professional and Occupational Affairs or his
designee; the Secretary of Health or his designee; two members
appointed by the Governor who shall be persons representing the
public at large; one member appointed by the Governor who shall
be a respiratory [care practitioner] therapist, A PERFUSIONIST,
a physician assistant or a certified athletic trainer; and six
members appointed by the Governor who shall be graduates of a
legally incorporated and reputable college of OSTEOPATHIC
MEDICINE and shall have been licensed to practice osteopathic
medicine under the laws of this Commonwealth and shall have been
engaged in the practice of osteopathy in this Commonwealth for a
period of at least five years. All professional and public
members of the board shall be appointed by the Governor with the
advice and consent of a majority of the members elected to the
Senate. The Governor shall assure that respiratory [care
practitioners] therapists, perfusionists, physician assistants
and certified athletic trainers are appointed to four-year terms
on a rotating basis.
* * *
Section 3. Section 3 of the act, amended July 2, 2004
(P.L.486, No.56), is amended to read:
Section 3. Practice of osteopathic medicine and surgery
without license prohibited.
(a) It shall be unlawful for any person to engage in the
practice of osteopathic medicine and surgery, or pretend to a
knowledge of any branch or branches of osteopathic medicine and
surgery, or to hold himself out as a practitioner in osteopathic
medicine and surgery, or to assume the title of Doctor of
Osteopathic Medicine and Surgery or doctor of any specific
disease, or to diagnose diseases or to treat diseases by the use
of osteopathic medicine and surgery or by any other means, or to
sign any birth or death certificate unless otherwise authorized
by law, or to hold himself out as able to do so, unless he has
received a certificate of licensure or permission from the board
which license shall be recorded in the office of the board.
(b) Nothing in this act shall be construed to prohibit
services and acts rendered by a qualified physician assistant,
technician or other allied medical person if such services and
acts are rendered under the supervision, direction or control of
a licensed physician. It shall be unlawful for any person to
practice as a physician assistant unless licensed and approved
by the board. It shall also be unlawful for any physician
assistant to render medical care and services except under the
supervision and direction of the supervising physician. A
physician assistant may use the title physician assistant or an
appropriate abbreviation for that title, such as "P.A.-C."
Section 4. Section 10(f) of the act, amended July 2, 2004
(P.L.486, No.56), is amended and the section is amended by
adding subsections to read:
Section 10. Licenses; exemptions; nonresident practitioners;
graduate students; biennial registration and
continuing medical education.
* * *
(f) The board shall grant licensure to physician assistants
which licensure shall be subject to biennial renewal by the
board. As part of biennial renewal, a physician assistant shall
complete continuing medical education as required by the
National Commission on Certification of Physician Assistants.
The board shall grant licensure to applicants who have fulfilled
the following criteria:
(1) Satisfactory performance on a proficiency
examination approved by the board.
(2) Satisfactory completion of a certified program for
the training and education of physician assistants approved
by the board.
(3) For candidates for initial licensure after January
1, 2005, obtainment of a baccalaureate or higher degree from
a college or university and completion of not fewer than 60
clock hours of didactic instruction in pharmacology or other
related courses as the board may approve by regulation.
In the event that completion of a formal training and
educational program is a prerequisite to taking the proficiency
examination, the board shall have the power, if it determines
that the experience of the applicant is of such magnitude and
scope so as to render further formal training and education
nonessential to the applicant in assisting a physician in the
provision of medical care and services, to waive the training
and education requirements under this section.
* * *
(g.2) (1) Except as limited by paragraph (2), and in
addition to existing authority, a physician assistant shall
have authority to do all of the following, provided that the
physician assistant is acting within the supervision and
direction of the supervising physician:
(i) Order durable medical equipment.
(ii) Issue oral orders to the extent permitted by a
health care facility's bylaws, rules, regulations or
administrative policies and guidelines.
(iii) Order physical therapy and dietitian
referrals.
(iv) Order respiratory and occupational therapy
referrals.
(v) Perform disability assessments for the program
providing Temporary Assistance to Needy Families (TANF).
(vi) Issue homebound schooling certifications.
(vii) Perform and sign the initial assessment of
methadone treatment evaluations in accordance with
Federal and State law, provided that any order for
methadone treatment shall be made only by a physician.
(2) Nothing in this subsection shall be construed to:
(i) Supersede the authority of the Department of
Health and the Department of Public Welfare to regulate
the types of health care professionals who are eligible
for medical staff membership or clinical privileges.
(ii) Restrict the authority of a health care
facility to determine the scope of practice and
supervision or other oversight requirements for health
care professionals practicing within the facility.
(g.3) Professional liability.--
(1) A licensed physician assistant in this Commonwealth
shall maintain a level of professional liability insurance
coverage in the minimum amount of $1,000,000 per occurrence
or claims made. Failure to maintain insurance coverage as
required shall subject the licensee to disciplinary
proceedings. The board shall accept from physician assistants
as satisfactory evidence of insurance coverage any of the
following:
(i) self-insurance;
(ii) personally purchased liability insurance; or
(iii) professional liability insurance coverage
provided by the physician assistant's employer or similar
insurance coverage acceptable to the board.
(2) A license applicant shall provide proof that the
applicant has obtained professional liability insurance in
accordance with paragraph (1). It is sufficient if the
applicant files with the application a copy of a letter from
the applicant's professional liability insurance carrier
indicating that the applicant will be covered against
professional liability in the required amounts effective upon
the issuance of the applicant's license to practice as a
physician assistant in this Commonwealth. Upon issuance of
the license, the licensee has 30 days to submit to the board
the certificate of insurance or a copy of the policy
declaration page.
* * *
Section 5. Section 10.1 of the act, added July 2, 1993
(P.L.418, No.59), is amended to read:
Section 10.1. Respiratory [care practitioners] therapists.
[(a) Eighteen months after the effective date of this
section, it shall be unlawful for any person to hold himself out
to the public as a respiratory care practitioner and to practice
or offer to practice respiratory care unless he holds a valid,
current temporary permit or certificate issued by the board.
(b) A respiratory care practitioner who holds a valid,
current temporary permit or certificate issued by the board may
use the title respiratory care practitioner or respiratory care
practitioner-certified or an appropriate abbreviation of that
title, such as "R.C.P." or "R.C.P.-C."]
(a) An individual shall be eligible to apply for licensure
as a respiratory therapist if that individual satisfies all of
the following:
(1) Submits evidence satisfactory to the board, on forms
approved by the board, that the applicant has met one or more
of the following criteria:
(i) Has graduated from a respiratory care program
approved by the Committee on Accreditation for
Respiratory Care and passed the entry level examination
as determined by the National Board for Respiratory Care.
(ii) Holds a valid license, certificate or
registration as a respiratory therapist in another state,
territory or the District of Columbia which has been
issued based on requirements substantially similar to
those required by this Commonwealth, including having
successfully passed an examination.
(2) Has paid the licensure fee as established by the
board by regulation.
(3) Has proved to the satisfaction of the board that the
individual is of good moral character and is not unfit or
unable to practice as a respiratory therapist by reason of
physical or mental impairment.
(a.1) It shall be unlawful for any individual to hold
himself out to the public as a respiratory therapist or to
practice or offer to practice respiratory care unless the
individual holds a valid, current license issued by the board or
the State Board of Medicine.
(a.2) It shall be unlawful for an individual to use the
title of "licensed respiratory therapist" or to use the letters
"L.R.T." or "R.T." or to hold oneself out as a licensed
respiratory therapist unless that individual is licensed to
practice respiratory care as provided under this act or the act
of December 20, 1985 (P.L.457, No.112), known as the Medical
Practice Act of 1985.
(b) For a period of two years following the effective date
of this subsection, an individual shall be eligible to apply for
licensure without examination if the individual meets the
qualifications for licensure under section 10.2 and holds valid
certification as a respiratory care practitioner as issued by
the board or the State Board of Medicine.
(c) The board is authorized to promulgate regulations to
implement this section.
(d) A respiratory [care practitioner certified] therapist
licensed by the board may implement direct respiratory care to
an individual being treated by either a licensed medical doctor
or a licensed doctor of osteopathic medicine upon physician
prescription or referral by a physician, certified registered
nurse practitioner or physician assistant, or under medical
direction and approval consistent with standing orders or
protocols of an institution or health care facility. This care
may constitute indirect services, such as consultation or
evaluation of an individual, and also includes, but is not
limited to, the following services:
(1) Administration of medical gases.
(2) Humidity and aerosol therapy.
(3) Administration of aerosolized medications.
(4) Intermittent positive pressure breathing.
(5) Incentive spirometry.
(6) Bronchopulmonary hygiene.
(7) Management and maintenance of natural airways.
(8) Maintenance and insertion of artificial airways.
(9) Cardiopulmonary rehabilitation.
(10) Management and maintenance of mechanical
ventilation.
(11) Measurement of ventilatory flows, volumes and
pressures.
(12) Analysis of ventilatory gases and blood gases.
(e) This section shall not prevent or restrict the
practices, services or activities of:
(1) A person licensed or certified in this Commonwealth
to provide another health care service, including, but not
limited to, physicians, physical therapists, chiropractors,
nurses, dentists, physician assistants and podiatrists.
(2) A person rendering respiratory care services
pursuant to employment by a Federal agency.
(3) A person pursuing a course of study leading to a
degree or certificate in respiratory care in an accredited
educational program if he is clearly designated as a student
and provides care under supervision implemented through that
program.
(4) A person executing or conveying medical orders
pursuant to lawful delegation by a physician.
(5) A person who, pursuant to lawful delegation by a
physician, delivers, installs, monitors or maintains a device
which enables an individual to self-administer respiratory
care.
(6) A person qualified by academic and clinical
education to operate extracorporeal circulation equipment in
a medical or surgical setting which requires support to or
the temporary replacement of a patient's circulatory or
respiratory functions.
(f) Information or allegations filed with the board against
a respiratory [care practitioner certified] therapist licensed
by the State Board of Medicine shall be referred to that board
for appropriate action.
Section 6. Section 10.2 of the act, amended or added July 2,
1993 (P.L.418, No.59) and July 2, 2004 (P.L.486, No.56), is
amended to read:
Section 10.2. Respiratory [care practitioner certificates]
therapist licenses and permits.
(a) A respiratory [care practitioner certificate] therapist
license issued by the board empowers the holder to practice
respiratory care under the supervision of a licensed medical
doctor or a licensed doctor of osteopathic medicine. In a health
care facility, that supervision may consist of standing orders
or protocols approved by the institution consistent with
acceptable and prevailing medical standards which may include
services rendered directly to the patient in his home or other
residence.
(b) The board shall issue temporary permits for the practice
of respiratory care to individuals who have applied for
[certification] licensure from the board and who meet any of the
following requirements:
(1) Graduation from an accredited respiratory care
training program recognized by the board.
(2) Enrollment in an accredited respiratory care
training program recognized by the board if the individual is
expected to graduate within 30 days from the date of
application.
(3) [Designation as a "Certified Respiratory Therapist"
or a "Registered Respiratory Therapist" by a nationally
recognized credentialing agency approved by the board.
(4) Continuous provision of respiratory care services
for a minimum of 12 months immediately preceding the
effective date of this section.
(5) Holding certification, licensure or registration as
a respiratory care practitioner issued by another state, the
District of Columbia or a territory of the United States
where the requirements for licensure, registration or
certification are substantially similar to those required by
the board.] Recognition as a credentialed respiratory
therapist as approved by the board.
(c) Temporary permits shall be valid for 12 months and for
such additional period as the board may, in each case, specially
determine, except that a temporary permit shall expire if the
holder fails the examination. An appropriate fee for a temporary
permit shall be established by the board by regulation. If [he]
the temporary permit holder is not in violation of any other
provision of this act, a holder of a temporary permit qualifies
for admission to the examination and shall apply for the next
regularly scheduled [certification] licensure examination
administered by the board. The board is authorized to promulgate
regulations to establish procedures for application, credentials
verification, examination and [certification] licensure,
together with appropriate fees.
(d) Pursuant to section 812.1 of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of 1929, the
board shall contract for the development and administration of
an examination for the [certification] licensure of respiratory
[care practitioners] therapists. [At least one administration of
this examination shall be given within 12 months of the
effective date of this section, and the] The examination shall
[thereafter] be given at least twice per year. [An individual
qualifying for a temporary permit under subsection (b)(5) shall
be issued a certificate by the board without examination. An
individual qualifying for a temporary permit under subsection
(b)(3) shall be issued a certificate by the board without
examination if the individual passed an examination in order to
obtain designation as a "Certified Respiratory Therapy
Technician" or a "Registered Respiratory Therapist" and that
examination was comparable to the examination developed and
administered pursuant to this subsection.]
(e) A respiratory [care practitioner certificate] therapist
license shall be renewed biennially upon application on a form
prescribed by the board and upon payment of a renewal fee
adopted by the board by regulation.
(f) (1) The board shall adopt, promulgate and enforce rules
and regulations consistent with the provisions of this act
establishing requirements of continuing education to be met
by individuals holding [certification] licensure as
respiratory [care practitioners] therapists under this act as
a condition for [certificate] biennial license renewal. The
regulations shall include any fees necessary for the board to
carry out its responsibilities under this section.
(2) Beginning with the first biennial license renewal
period [designated by regulation, certificate] following
promulgation of regulations, license holders shall be
required to attend and complete [20] 30 hours of mandatory
continuing education during each two-year [certificate]
licensure period. At least one credit hour shall be in
ethics, and one credit hour shall be in patient safety.
(3) An individual applying for the first time for
[certification] licensure in this Commonwealth shall be
exempted from the continuing education requirement for the
biennial renewal period [following initial certification] in
which licensure is obtained.
(4) [The board may waive all or a portion of the
continuing education requirement for biennial renewal for a
certificate holder who shows to the satisfaction of the board
that the individual was unable to complete the requirements
due to serious illness, military service or other
demonstrated hardship. The request shall be made in writing,
with appropriate documentation, and shall include a
description of circumstances sufficient to show why the
certificate holder is unable to comply with the continuing
education requirement. Waiver requests shall be evaluated by
the board on a case-by-case basis. The board shall send the
certificate holder written notification of its approval or
denial of a waiver request.] The board shall, by regulation,
provide for the waiver of continuing education requirements
in case of illness, hardship and armed service duties. A
request for waiver shall be evaluated on a case-by-case
basis.
(5) A [certificate holder] licensee seeking to reinstate
an inactive or lapsed [certificate] license shall show proof
of compliance with the continuing education requirement for
the preceding biennium.
(6) All courses, locations, instructors and providers
shall be approved by the board. No credit shall be given for
any course in office management or practice building.
[(7) The board shall initiate the promulgation of
regulations to carry out the provisions of this section
within one year of the effective date of this subsection.]
Section 7. Section 15(b) of the act, amended July 2, 2004
(P.L.486, No.56), is amended to read:
Section 15. Reasons for refusal, revocation or suspension of
license.
* * *
(b) The board shall have authority to refuse, revoke or
suspend the license of a physician assistant or respiratory
therapist, or the certification of a [respiratory care
practitioner or] certified athletic trainer for any or all of
the following reasons:
(1) Failing to demonstrate the qualification for
licensure or certification contained in this act or
regulations of the board.
(2) Making misleading, deceptive, untrue or fraudulent
representations in his serving as a physician assistant;
practicing fraud or deceit in obtaining a license to serve as
a physician assistant; or making a false or deceptive
biennial registration with the board.
(3) Conviction of a felony in this Commonwealth or any
other state, territory or country. Conviction as used in this
paragraph shall include a finding or verdict of guilt, an
admission of guilt or a plea of nolo contendere, or receiving
probation without verdict, disposition in lieu of trial, or
an Accelerated Rehabilitative Disposition in the disposition
of felony charges.
(4) Having his license to serve as a physician assistant
revoked or suspended or having other disciplinary action
taken, or his application for licensure refused, revoked or
suspended by the proper certifying authority of another
state, territory or country.
(5) Being unable to serve as a physician assistant with
reasonable skill and safety to the physician's patients by
reason of illness, drunkenness, excessive use of drugs,
narcotics, chemicals, or any other type of material, or as a
result of any mental or physical condition.
(6) In enforcing paragraph (5), the board shall, upon
probable cause, have authority to compel a physician
assistant to submit to a mental or physical examination by
physicians designated by it. Failure of a physician assistant
to submit to such examination shall constitute an admission
of the allegations against him unless the failure is due to
circumstances beyond his control, consequent upon which a
default and final order may be entered without the taking of
testimony or presentation of evidence. A physician assistant
affected under this paragraph shall at reasonable intervals
be afforded an opportunity to demonstrate that he can resume
the competent assistance of a physician in the physician's
practice of medicine, with reasonable skill and safety to the
physician's patients.
(7) Violating a lawful regulation promulgated by the
board or violating a lawful order of the board, previously
entered by the board in a disciplinary proceeding.
(8) Knowingly rendering medical care and services except
under the supervision and direction of the supervising
physician.
(9) Being guilty of immoral or unprofessional conduct
shall include any departure from, or the failure to conform
to, the standards of acceptable and prevailing practice for
physician assistants, in which proceeding actual injury to a
patient need not be established.
* * *
Section 8. (a) The State Board of Osteopathic Medicine and
the State Board of Medicine shall jointly promulgate regulations
to implement the amendment of sections 2, 2.1(a), 10.1, 10.2 and
15(b) of the act within 18 months of the effective date of this
section.
(b) The State Board of Osteopathic Medicine, the Department
of Public Welfare and the Department of Health shall promulgate
regulations to implement the addition of section 10(g.2) of the
act within 18 months of the effective date of this section.
Section 9. The following acts and parts of acts are
repealed insofar as they are inconsistent with the addition of
section 10(g.2) of the act:
(1) Section 9(a) of the act of October 10, 1975
(P.L.383, No.110), known as the Physical Therapy Practice
Act.
(2) Section 14 of the act of June 15, 1982 (P.L.502,
No.140), known as the Occupational Therapy Practice Act.
Section 10. This act shall take effect as follows:
(1) This section shall take effect immediately.
(2) Section 8 of this act shall take effect immediately.
(3) The remainder of this act shall take effect in 60
days.
APPROVED--The 4th day of July, A. D. 2008.
EDWARD G. RENDELL
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