Bill Text: HI SB1610 | 2010 | Regular Session | Amended
Bill Title: Physician Assistant; Registered Nurse; Medical Orders
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB1610 Detail]
Download: Hawaii-2010-SB1610-Amended.html
Report Title:
Physician Assistant; Registered Nurse; Medical Orders
Description:
Clarifies that a physician assistant acts as agent of the supervising physician when issuing a medical order and the order is deemed to be issued by the supervising physician. Clarifies that when following a medical order issued by a physician assistant, a registered nurse follows a medical order issued by the supervising physician for whom the physician assistant acts as agent. Does not relieve physician assistants or registered nurses from exercising due care in performing within their respective scope of practice. (SD2)
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THE SENATE |
S.B. NO. |
1610 |
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TWENTY-FIFTH LEGISLATURE, 2009 |
S.D. 2 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO MEDICAL ORDERS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that both physician assistants and registered nurses provide valuable medical care to patients under the orders of licensed physicians.
Physician assistants are licensed under section 453‑5.3, Hawaii Revised Statutes, and practice under the supervision of a physician or osteopathic physician. The Hawaii medical board implemented administrative rules to delineate the scope of practice of a physician assistant and the complementary responsibilities of the physician assistant and the supervising physician.
Specifically, under section 16‑85‑44.5, Hawaii Administrative Rules, "[a] physician assistant may perform those duties and responsibilities delegated by the physician assistant's supervising physician." In turn, a supervising physician is defined to mean "a physician or group of physicians or an osteopathic physician and surgeon licensed to practice medicine and surgery in this State who accepts the responsibility for the supervision of services rendered by physician assistants. The supervising physician shall direct and exercise supervision at all times." Supervision means "overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant. Supervision shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place the services are rendered." In providing this supervision, the supervising physician is required under section 16‑85‑49(a)(4), Hawaii Administrative Rules, to provide "adequate means for direct communication between the physician assistant and the supervising physician; provided that where the physical presence of the supervising physician is not required, the direct communication may occur through the use of technology which may include but is not limited to, two-way radio, telephone, fax machine, modem, or other telecommunication device." In addition, a supervising physician is required under section 16‑85‑49(a)(5), Hawaii Administrative Rules, to "personally review the records of each patient seen by the physician assistant within seven working days."
Furthermore, under section 16‑85‑46(a)(10), Hawaii Administrative Rules, a physician assistant is required to provide a "statement signed by the licensed physician or group of physicians, as the case may be, stating that the physician or group of physicians will direct and supervise the physician assistant and that the physician assistant will be considered the agent of the physician or group of physicians."
The legislature also finds that registered nurses are licensed under chapter 457, Hawaii Revised Statutes, and are regulated by the board of nursing. Among other actions, in performing the practice of nursing as a registered nurse, a registered nurse uses reasonable judgment in carrying out prescribed medical orders of a licensed dentist, medical doctor, osteopathic physician, or podiatrist, or the orders of an advanced practice registered nurse.
Because the historical process of licensing and regulating the scopes of practice of physician assistants and of registered nurses has developed independently for the two health care disciplines, the relevant regulatory language pertaining to their respective responsibilities with respect to following physician orders is neither compatible nor clear. This situation has led to conflict between the two groups when registered nurses decline to accept orders from physician assistants.
The legislature finds that clarifying the relevant statutory language is necessary to resolve the situation to clearly state that, under certain conditions, orders from a physician assistant do not originate from the physician assistant but from the supervising physician for whom the physician assistant acts as an agent.
SECTION 2. Chapter 453, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§453‑ Order given by physician assistant; agent. (a) Any medical order issued by a licensed physician assistant who is properly performing within the physician assistant's scope of practice under this chapter shall not be deemed a medical order of the physician assistant but shall be deemed a medical order of the physician assistant's supervising physician; provided that:
(1) The physician assistant is acting under the required supervision of a supervising physician; and
(2) The supervising physician:
(A) Accepts full responsibility for the issuing of the medical order by the physician assistant;
(B) Provides adequate means for direct communication between the physician assistant and the supervising physician; provided that where the physical presence of the supervising physician is not required, the direct communication may occur through the use of technology that may include but is not limited to two-way radio, telephone, fax machine, modem, or other telecommunication device; and
(C) Personally reviews the records of each patient seen by the physician assistant with seven working days.
(b) In issuing any medical order under subsection (a), a physician assistant shall be deemed an agent of the supervising physician.
(c) Nothing in this section shall be construed to relieve any physician assistant from an obligation to exercise due care in the performance of the physician assistant's scope of practice."
SECTION 3. Chapter 457, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§457‑ Order given by physician assistant; agent. (a) Any medical order issued by a physician assistant properly licensed under section 453‑5.3 and who is properly performing within the physician assistant's scope of practice shall not be deemed a medical order of the physician assistant but shall be deemed a medical order of the physician assistant's supervising physician; provided that:
(1) The physician assistant is acting under the required supervision of a supervising physician; and
(2) The supervising physician:
(A) Accepts full responsibility for the issuing of the medical order by the physician assistant;
(B) Provides adequate means for direct communication between the physician assistant and the supervising physician; provided that where the physical presence of the supervising physician is not required, the direct communication may occur through the use of technology that may include but is not limited to two-way radio, telephone, fax machine, modem, or other telecommunication device; and
(C) Personally reviews the records of each patient seen by the physician assistant within seven working days.
(b) In following any medical order issued by a physician assistant under subsection (a) and section 453‑ , a registered nurse shall be deemed to be following a medical order issued by the supervising physician of the physician assistant, who shall be deemed as acting as an agent of the supervising physician.
(c) Nothing in this section shall be construed to relieve any registered nurse from an obligation to exercise due care in the performance of the registered nurse's scope of practice."
SECTION 4. New statutory material is underscored. SECTION 5. This Act shall take effect upon its approval.
