Bill Text: NY S02254 | 2013-2014 | General Assembly | Amended
Bill Title: Authorizes physician assistants under the supervision of a physician to perform most medical services that a physician can perform, including the signing of death certificates.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2014-01-29 - PRINT NUMBER 2254A [S02254 Detail]
Download: New_York-2013-S02254-Amended.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 2254--A 2013-2014 Regular Sessions I N S E N A T E January 15, 2013 ___________ Introduced by Sen. YOUNG -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- recommitted to the Committee on Health in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, the education law, the social services law, the workers' compensation law, the mental hygiene law and the general business law, in relation to clarifying the scope of practice of licensed physician assistants THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Subdivision 1 of section 3700 of the public health law, as 2 amended by chapter 48 of the laws of 2012, is amended to read as 3 follows: 4 1. Physician assistant. The term "physician assistant" means a 5 [person] DEPENDENT PRACTITIONER WORKING UNDER THE SUPERVISION OF A 6 LICENSED PHYSICIAN RESPONSIBLE FOR THE ACTIONS OF THE PHYSICIAN ASSIST- 7 ANT AND who is licensed as a physician assistant pursuant to section 8 sixty-five hundred forty-one of the education law. 9 S 2. The public health law is amended by adding a new section 3704 to 10 read as follows: 11 S 3704. PERFORMANCE OF MEDICAL SERVICES. 1. A PHYSICIAN ASSISTANT MAY 12 PERFORM MEDICAL SERVICES, BUT ONLY WHEN UNDER THE SUPERVISION OF A 13 PHYSICIAN AND ONLY WHEN SUCH ACTS ASSIGNED TO HIM OR HER ARE WITHIN THE 14 SCOPE OF PRACTICE OF SUCH SUPERVISING PHYSICIAN. THE SUPERVISING PHYSI- 15 CIAN MAY DELEGATE TO THE PHYSICIAN ASSISTANT ANY MEDICAL PROCEDURES OR 16 TASKS FOR WHICH THE PHYSICIAN ASSISTANT IS APPROPRIATELY TRAINED AND 17 QUALIFIED TO PERFORM AND THAT ARE PERFORMED WITHIN THE NORMAL SCOPE OF 18 THE PHYSICIAN'S PRACTICE. 19 2. NOTHING IN THIS ARTICLE OR IN ARTICLE ONE HUNDRED THIRTY-ONE-B OF 20 THE EDUCATION LAW SHALL BE CONSTRUED TO AUTHORIZE PHYSICIAN ASSISTANTS EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD06422-02-4 S. 2254--A 2 1 TO PERFORM THOSE SPECIFIC FUNCTIONS AND DUTIES SPECIFICALLY DELEGATED BY 2 LAW TO THOSE PERSONS LICENSED AS ALLIED HEALTH PROFESSIONALS UNDER THIS 3 CHAPTER OR THE EDUCATION LAW. SPECIFICALLY, PHYSICIAN ASSISTANTS SHALL 4 NOT PERFORM THE PRACTICE OF RADIOLOGIC TECHNOLOGY OR THE PRACTICE OF 5 OPTOMETRY AS THOSE PRACTICES ARE DEFINED UNDER THIS CHAPTER AND THE 6 EDUCATION LAW. 7 S 3. Subdivisions 1 and 2 of section 2305 of the public health law, as 8 amended by section 35 of part E of chapter 56 of the laws of 2013, are 9 amended to read as follows: 10 1. No person, other than a licensed physician OR A PHYSICIAN ASSISTANT 11 UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, or, in a hospital, a 12 staff physician, shall diagnose, treat or prescribe for a person who is 13 infected with a sexually transmitted disease, or who has been exposed to 14 infection with a sexually transmitted disease, or dispense or sell a 15 drug, medicine or remedy for the treatment of such person except on 16 prescription of a duly licensed physician OR A PHYSICIAN ASSISTANT UNDER 17 THE SUPERVISION OF A LICENSED PHYSICIAN. 18 2. A licensed physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION 19 OF A LICENSED PHYSICIAN, or in a hospital, a staff physician, may diag- 20 nose, treat or prescribe for a person under the age of twenty-one years 21 without the consent or knowledge of the parents or guardian of said 22 person, where such person is infected with a sexually transmitted 23 disease, or has been exposed to infection with a sexually transmitted 24 disease. 25 S 4. Subdivisions 1 and 2 of section 2308 of the public health law are 26 amended to read as follows: 27 1. Every physician OR PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF 28 SUCH PHYSICIAN attending pregnant women in the state shall in the case 29 of every woman so attended take or cause to be taken a sample of blood 30 of such woman at the time of first examination, and submit such sample 31 to an approved laboratory for a standard serological test for syphilis. 32 2. Every other person permitted by law to attend upon pregnant women 33 in the state but not permitted by law to take blood tests, shall cause a 34 sample of the blood of such pregnant woman to be taken promptly by a 35 duly licensed physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION 36 OF SUCH PHYSICIAN and submitted to an approved laboratory for a standard 37 serological test for syphilis. 38 S 5. Section 2498 of the public health law, as added by chapter 237 of 39 the laws of 1990, is amended to read as follows: 40 S 2498. Provision of summary by physician. The summary shall be 41 provided by a physician, OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION 42 OF SUCH PHYSICIAN, to each person under such physician's OR PHYSICIAN 43 ASSISTANT'S care, when a hysterectomy is under consideration for that 44 person. 45 S 6. Subdivision 10 of section 2500-e of the public health law, as 46 added by chapter 4 of the laws of 1990, is amended to read as follows: 47 10. If any licensed physician, PHYSICIAN ASSISTANT UNDER THE SUPER- 48 VISION OF A LICENSED PHYSICIAN or nurse practitioner certifies that a 49 follow-up dose of hepatitis B vaccine may be detrimental to a child's 50 health, the requirements of this section shall be inapplicable until 51 such immunization is found no longer to be detrimental to such child's 52 health. 53 S 7. Section 2502 of the public health law, as amended by chapter 884 54 of the laws of 1972, is amended to read as follows: 55 S 2502. Report of certain conditions. Any nurse-midwife, nurse or 56 other person having the care of an infant within the age of two weeks S. 2254--A 3 1 who neglects or omits to report immediately to the health officer or to 2 a legally qualified practitioner of medicine of the city, town or place 3 where such child is being cared for, the fact that one or both eyes of 4 such infant are [inflammed] INFLAMED or reddened whenever such shall be 5 the case, or who applies any remedy therefor without the advice, or 6 except by the direction of such officer or physician OR A PHYSICIAN 7 ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN is guilty of a misdemea- 8 nor. 9 S 8. Section 2503 of the public health law, as amended by chapter 485 10 of the laws of 1978, is amended to read as follows: 11 S 2503. Drug information to be furnished expectant mothers. The physi- 12 cian, A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN or 13 nurse-midwife to be in attendance at the birth of a child shall inform 14 the expectant mother, in advance of the birth, of the drugs that such 15 physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN or 16 nurse-midwife expects to employ during pregnancy and of the obstetrical 17 and other drugs that such physician, PHYSICIAN ASSISTANT UNDER THE 18 SUPERVISION OF A PHYSICIAN or nurse-midwife expects to employ at birth 19 and of the possible effects of such drugs on the child and mother. 20 S 9. Subdivision 4 of section 2504 of the public health law, as added 21 by chapter 769 of the laws of 1972 and as renumbered by chapter 976 of 22 the laws of 1984, is amended to read as follows: 23 4. Medical, dental, health and hospital services may be rendered to 24 persons of any age without the consent of a parent or legal guardian 25 when, in the physician's OR PHYSICIAN ASSISTANT'S UNDER THE SUPERVISION 26 OF SUCH PHYSICIAN judgment an emergency exists and the person is in 27 immediate need of medical attention and an attempt to secure consent 28 would result in delay of treatment which would increase the risk to the 29 person's life or health. 30 S 10. Subdivision 1 of section 2570 of the public health law, as 31 amended by chapter 495 of the laws of 1955, is amended to read as 32 follows: 33 1. Every institution in this state, operated for the express purpose 34 of receiving or caring for dependent, neglected or destitute children or 35 juvenile delinquents, except hospitals, shall have attached thereto a 36 regular physician OR PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A 37 REGULAR PHYSICIAN of its selection duly licensed under the laws of the 38 state and in good professional standing, whose name and address shall be 39 kept posted conspicuously within such institution. 40 S 11. Subdivision 1 of section 2573 of the public health law, as added 41 by chapter 495 of the laws of 1955, is amended to read as follows: 42 1. The administrative officer or person in charge and the regular 43 physician OR PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A REGULAR 44 PHYSICIAN of every institution caring for children referred to in this 45 article shall make such reports concerning the physical condition and 46 health of the children and the environmental sanitation of the institu- 47 tion as may be required by the state health commissioner, local health 48 officer or health commissioner having jurisdiction. 49 S 12. Subdivision 14 of section 3001 of the public health law, as 50 amended by chapter 804 of the laws of 1992, is amended to read as 51 follows: 52 14. "Qualified medical and health personnel" means physicians, PHYSI- 53 CIAN ASSISTANTS, registered professional nurses and advanced emergency 54 medical technicians competent in the management of patients requiring 55 advanced life support care. S. 2254--A 4 1 S 13. Subdivisions 4 and 5 of section 3602 of the public health law, 2 as amended by chapter 600 of the laws of 2002, are amended to read as 3 follows: 4 4. "Home health aide services" means simple health care tasks, 5 personal hygiene services, housekeeping tasks essential to the patient's 6 health and other related supportive services. Such services shall be 7 prescribed by a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION 8 OF A PHYSICIAN in accordance with a plan of treatment for the patient 9 and shall be under the supervision of a registered professional nurse 10 from a certified home health agency or, when appropriate, from a provid- 11 er of a long term home health care program and of the appropriate 12 professional therapist from such agency or provider when the aide 13 carries out simple procedures as an extension of physical, speech or 14 occupational therapy. Such services may also be prescribed or ordered by 15 a nurse practitioner to the extent authorized by law and consistent with 16 the written practice agreement pursuant to subdivision three of section 17 six thousand nine hundred two of the education law and not prohibited by 18 federal law or regulation. 19 5. "Personal care services" means services to assist with personal 20 hygiene, dressing, feeding and household tasks essential to the 21 patient's health. Such services shall be prescribed by a physician OR A 22 PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN in accordance 23 with a plan of home care supervised by a registered professional nurse. 24 Such services may also be prescribed or ordered by a nurse practitioner 25 to the extent authorized by law and consistent with the written practice 26 agreement pursuant to subdivision three of section six thousand nine 27 hundred two of the education law and not prohibited by federal law or 28 regulations. 29 S 14. Subdivision 4 of section 4141 of the public health law, as 30 amended by chapter 153 of the laws of 2011, is amended to read as 31 follows: 32 4. (a) The medical certificate shall be made, dated, and signed by the 33 physician, THE PHYSICIAN ASSISTANT ACTING UNDER THE SUPERVISION OF A 34 PHYSICIAN, or nurse practitioner, if any, last in attendance on the 35 deceased. 36 (b) Indefinite terms, denoting only symptoms of disease or conditions 37 resulting from disease, shall not be held sufficient. 38 (c) Any certificate stating the cause of death in terms which the 39 commissioner declares indefinite shall be returned to the physician, THE 40 PHYSICIAN ASSISTANT ACTING UNDER THE SUPERVISION OF A PHYSICIAN, nurse 41 practitioner, or person making the medical certificate for correction 42 and more definite statement. A CERTIFICATE CERTIFIED TO AND SIGNED BY A 43 PHYSICIAN ASSISTANT IN ACCORDANCE WITH THIS SECTION SHALL HAVE THE SAME 44 FORCE AND EFFECT IN THE LAW AS A CERTIFICATE SIGNED BY A PHYSICIAN. 45 (d) Where a death is caused by an opioid overdose, such information 46 shall be indicated, including any related information as the commission- 47 er may require. 48 S 15. Section 4141-a of the public health law, as amended by chapter 49 352 of the laws of 2013, is amended to read as follows: 50 S 4141-a. Death certificate; duties of hospital administrator. When a 51 death occurs in a hospital, except in those cases where certificates are 52 issued by coroners or medical examiners, the person in charge of such 53 hospital or his or her designated representative shall promptly present 54 the certificate to the physician, THE PHYSICIAN ASSISTANT ACTING UNDER 55 THE SUPERVISION OF A PHYSICIAN, or nurse practitioner in attendance, or 56 a physician, PHYSICIAN ASSISTANT ACTING UNDER THE SUPERVISION OF A S. 2254--A 5 1 PHYSICIAN, or nurse practitioner acting in his or her behalf, who shall 2 promptly certify to the facts of death, provide the medical information 3 required by the certificate, sign the medical certificate of death, and 4 thereupon return such certificate to such person, so that the seventy- 5 two hour registration time limit prescribed in section four thousand one 6 hundred forty of this title can be met; provided, however that commenc- 7 ing on or after the implementation date under section forty-one hundred 8 forty-eight of this title, information and signatures required by this 9 section shall be obtained and made in accordance with section forty-one 10 hundred forty-eight of this title. A CERTIFICATE CERTIFIED TO AND 11 SIGNED BY A PHYSICIAN ASSISTANT IN ACCORDANCE WITH THIS SECTION SHALL 12 HAVE THE SAME FORCE AND EFFECT IN LAW AS A CERTIFICATE SIGNED BY A 13 PHYSICIAN. 14 S 16. Subdivision (b) of section 4142 of the public health law, as 15 amended by chapter 153 of the laws of 2011, is amended to read as 16 follows: 17 (b) present the certificate promptly to the attending physician, 18 PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse prac- 19 titioner, who shall forthwith certify to the facts of death, provide the 20 medical information required by the certificate and sign the medical 21 certificate of death, or to the coroner or medical examiner in those 22 cases where so required by this article or, when a death occurs in a 23 hospital, except in those cases where certificates are issued by coron- 24 ers or medical examiners, to the person in charge of such hospital or 25 his or her designated representative, who shall obtain the medical 26 certificate of death as prescribed in section four thousand one hundred 27 forty-one-a of this title; 28 S 17. Paragraph (b) of subdivision 2 of section 4144 of the public 29 health law, as amended by chapter 352 of the laws of 2013, is amended to 30 read as follows: 31 (b) [Verbal] SPOKEN permission to remove a body of a deceased person 32 from the county in which death occurred or the body was found to a non- 33 adjacent county within the state of New York, as provided in subdivision 34 one of this section, shall be issued by the said registrar of vital 35 statistics, upon request by telephone of a licensed funeral director or 36 undertaker who holds a certificate of death signed by the attending 37 physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or 38 nurse practitioner, or for deaths occurring on or after the implementa- 39 tion date under section forty-one hundred forty-eight of this title, 40 such certificate of death signed by the attending physician, PHYSICIAN 41 ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse practitioner is 42 available electronically in accordance with section forty-one hundred 43 forty-eight of this title, showing that the death resulted from natural 44 causes and was not a result of accidental, suicidal, homicidal or other 45 external causes. 46 S 18. The section heading and subdivisions 2, 3 and 4 of section 4161 47 of the public health law, the section heading and subdivisions 2 and 3 48 as amended by chapter 153 of the laws of 2011 and subdivision 4 as 49 amended by chapter 352 of the laws of 2013, are amended to read as 50 follows: 51 Fetal death certificates; form and content; physicians, PHYSICIAN 52 ASSISTANTS, nurse practitioners, midwives, and hospital administrators. 53 2. In each case where a physician, PHYSICIAN ASSISTANT UNDER THE 54 SUPERVISION OF A PHYSICIAN, or nurse practitioner was in attendance at 55 or after a fetal death, it is the duty of such physician, PHYSICIAN 56 ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse practitioner to S. 2254--A 6 1 certify to the birth and to the cause of death on the fetal death 2 certificate. Where a nurse-midwife was in attendance at a fetal death it 3 is the duty of such nurse-midwife to certify to the birth but, he or she 4 shall not certify to the cause of death on the fetal death certificate. 5 3. Fetal deaths occurring without the attendance of a physician, 6 PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse prac- 7 titioner as provided in subdivision two of this section shall be treated 8 as deaths without medical attendance, as provided in this article. 9 4. When a fetal death occurs in a hospital, except in those cases 10 where certificates are issued by coroners or medical examiners, the 11 person in charge of such hospital or his or her designated represen- 12 tative shall promptly present the certificate to the physician, PHYSI- 13 CIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse practi- 14 tioner in attendance, or a physician, PHYSICIAN ASSISTANT UNDER THE 15 SUPERVISION OF A PHYSICIAN, or nurse practitioner acting in his or her 16 behalf, who shall promptly certify to the facts of birth and of fetal 17 death, provide the medical information required by the certificate, sign 18 the medical certificate of birth and death, and thereupon return such 19 certificate to such person, so that the seventy-two hour registration 20 time limit prescribed in section four thousand one hundred sixty of this 21 title can be met; provided, however that commencing on or after the 22 implementation date under section forty-one hundred forty-eight of this 23 article, information and signatures required by this subdivision shall 24 be obtained and made in accordance with section forty-one hundred 25 forty-eight of this article. 26 S 19. The section heading and subdivision 1 of section 4171 of the 27 public health law, as amended by chapter 153 of the laws of 2011, are 28 amended to read as follows: 29 Records; duties of physicians, PHYSICIAN ASSISTANTS, nurse practition- 30 ers, and others to furnish information. 31 1. Physicians, PHYSICIAN ASSISTANTS UNDER THE SUPERVISION OF A PHYSI- 32 CIAN, nurse practitioners, nurse-midwives, funeral directors, undertak- 33 ers and informants, and all other persons having knowledge of the facts, 34 are hereby required to supply, upon a form provided by the commissioner 35 or upon the original certificate, such information as they may possess 36 regarding any birth or death upon demand of the commissioner, in person, 37 by mail, or through the registrar. 38 S 20. Subdivisions 1, 3 and 5 of section 4175 of the public health 39 law, as amended by chapter 153 of the laws of 2011, are amended to read 40 as follows: 41 1. If, at any time after the birth, or within one year of the death, 42 of any person within the state, a certified copy of the official record 43 of said birth or death, with the information required to be registered 44 by this article, is necessary for legal, judicial, or other proper 45 purposes, and, after search by the commissioner or his or her represen- 46 tatives, it appears that no such certificate of birth or death was made 47 and filed as provided by this article, then the commissioner shall imme- 48 diately require the physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION 49 OF A PHYSICIAN, nurse practitioner, or nurse-midwife who, being in 50 attendance upon a birth, failed or neglected to file a certificate ther- 51 eof, or the funeral director, undertaker, or other person who, having 52 charge of the interment or removal of the body of a deceased person, 53 failed or neglected to file the certificate of death, if he or she is 54 living, to obtain and file at once with the local registrar such certif- 55 icate in as complete form as the lapse of time will permit. S. 2254--A 7 1 3. If the physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A 2 PHYSICIAN, nurse practitioner, nurse-midwife, funeral director, or 3 undertaker responsible for the report is deceased or cannot be located, 4 then the person making application for the certified copy of the record 5 may file such certificate of birth or death together with such state- 6 ments subscribed and affirmed by the persons making them as true under 7 the penalties of perjury and other evidence as the commissioner may 8 require. 9 5. The delinquent physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION 10 OF A PHYSICIAN, nurse practitioner, nurse-midwife, funeral director, 11 undertaker, or other person may, in the discretion of the commissioner, 12 be prosecuted as required by this article, without bar from the statute 13 of limitations, if he or she neglects or fails to file promptly the 14 certificate required by this section. 15 S 21. Subdivision 1 of section 6540 of the education law, as amended 16 by chapter 48 of the laws of 2012, is amended to read as follows: 17 1. Physician assistant. The term "physician assistant" means a 18 [person] DEPENDENT PRACTITIONER WORKING UNDER THE SUPERVISION OF A 19 LICENSED PHYSICIAN RESPONSIBLE FOR THE ACTIONS OF THE PHYSICIAN ASSIST- 20 ANT AND who is licensed as a physician assistant pursuant to this arti- 21 cle. 22 S 22. Subdivisions 1 and 7 of section 6542 of the education law, as 23 amended by chapter 48 of the laws of 2012, are amended to read as 24 follows: 25 1. Notwithstanding any other provision of law, a physician assistant 26 may perform medical services, but only when under the supervision of a 27 physician and only when such acts and duties as are assigned to him or 28 her are within the scope of practice of such supervising physician. THE 29 SUPERVISING PHYSICIAN MAY DELEGATE TO THE PHYSICIAN ASSISTANT ANY 30 MEDICAL PROCEDURES OR TASKS FOR WHICH THE PHYSICIAN ASSISTANT IS APPRO- 31 PRIATELY TRAINED AND QUALIFIED TO PERFORM AND THAT ARE PERFORMED WITHIN 32 THE NORMAL SCOPE OF THE PHYSICIAN'S PRACTICE. 33 7. Nothing in this article, or in article thirty-seven of the public 34 health law, shall be construed to authorize physician assistants to 35 perform those specific functions and duties specifically delegated by 36 law to those persons licensed as allied health professionals under the 37 public health law or this [chapter] TITLE. SPECIFICALLY, PHYSICIAN 38 ASSISTANTS SHALL NOT PERFORM THE PRACTICE OF RADIOLOGIC TECHNOLOGY OR 39 THE PRACTICE OF OPTOMETRY AS THOSE PRACTICES ARE DEFINED UNDER THE 40 PUBLIC HEALTH LAW AND THIS TITLE. 41 S 23. The education law is amended by adding a new section 6545-a to 42 read as follows: 43 S 6545-A. STATUTORY CONSTRUCTION. A PHYSICIAN ASSISTANT MAY PERFORM 44 ANY FUNCTION, WITH APPROPRIATE PHYSICIAN SUPERVISION, IN ANY HEALTH CARE 45 SETTING, THAT A STATUTE AUTHORIZES OR DIRECTS A PHYSICIAN TO PERFORM AND 46 THAT IS WITHIN THE NORMAL PRACTICE OF THAT PHYSICIAN, EXCEPT THOSE FUNC- 47 TIONS AUTHORIZED OR DIRECTED BY AND IN ARTICLE THIRTY-THREE OF THE 48 PUBLIC HEALTH LAW, UNLESS THE STATUTE AUTHORIZING OR DIRECTING THE 49 PHYSICIAN TO PERFORM SUCH FUNCTION OR FUNCTIONS EXPRESSLY STATES OTHER- 50 WISE. 51 S 24. Subdivision c of section 6731 of the education law, as amended 52 by chapter 389 of the laws of 2007, is amended to read as follows: 53 c. Such treatment shall be rendered pursuant to a referral which may 54 be directive as to treatment by a licensed physician, A PHYSICIAN 55 ASSISTANT UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, dentist, podia- 56 trist, nurse practitioner or licensed midwife, each acting within his or S. 2254--A 8 1 her lawful scope of practice, and in accordance with their diagnosis, 2 except as provided in subdivision d of this section. 3 S 25. Subdivision c of section 6741 of the education law, as added by 4 chapter 618 of the laws of 1980, is amended to read as follows: 5 c. Nothing in this article is intended to affect the overall medical 6 direction by a licensed physician OR A PHYSICIAN ASSISTANT UNDER THE 7 SUPERVISION OF A LICENSED PHYSICIAN, of a physical therapist assistant. 8 S 26. Subdivision 3 of section 6807 of the education law, as added by 9 chapter 573 of the laws of 1999, is amended to read as follows: 10 3. A pharmacist may dispense drugs and devices to a registered profes- 11 sional nurse, and a registered professional nurse may possess and admin- 12 ister, drugs and devices, pursuant to a non-patient specific regimen 13 prescribed or ordered by a licensed physician, A PHYSICIAN ASSISTANT 14 UNDER THE SUPERVISION OF A LICENSED PHYSICIAN or certified nurse practi- 15 tioner, pursuant to regulations promulgated by the commissioner and the 16 public health law. 17 S 27. Subdivision 5 of section 6909 of the education law, as added by 18 chapter 573 of the laws of 1999, is amended to read as follows: 19 5. A registered professional nurse may execute a non-patient specific 20 regimen prescribed or ordered by a licensed physician, A PHYSICIAN 21 ASSISTANT UNDER THE SUPERVISION OF A LICENSED PHYSICIAN or certified 22 nurse practitioner, pursuant to regulations promulgated by the commis- 23 sioner. 24 S 28. Section 6957 of the education law, as amended by chapter 328 of 25 the laws of 1992, is amended to read as follows: 26 S 6957. Exempt persons. Nothing in this article shall be construed to 27 affect, prevent or in any manner expand or limit any duty or responsi- 28 bility of a licensed physician OR A PHYSICIAN ASSISTANT UNDER THE SUPER- 29 VISION OF A LICENSED PHYSICIAN, from practicing midwifery or affect or 30 prevent a medical student, PHYSICIAN ASSISTANT STUDENT or midwifery 31 student in clinical practice under the supervision of a licensed physi- 32 cian or board certified obstetrician/gynecologist or licensed midwife 33 practicing [pursuant to the provisions of section twenty-five hundred 34 sixty of the public health law] in pursuance of an educational program 35 registered by the department from engaging in such practice. 36 S 29. Section 7901 of the education law, as amended by chapter 460 of 37 the laws of 2011, is amended to read as follows: 38 S 7901. Definition. The practice of the profession of occupational 39 therapy is defined as the functional evaluation of the client, the plan- 40 ning and utilization of a program of purposeful activities, the develop- 41 ment and utilization of a treatment program, and/or consultation with 42 the client, family, caregiver or organization in order to restore, 43 develop or maintain adaptive skills, and/or performance abilities 44 designed to achieve maximal physical, cognitive and mental functioning 45 of the client associated with his or her activities of daily living and 46 daily life tasks. A treatment program designed to restore function, 47 shall be rendered on the prescription or referral of a physician, PHYSI- 48 CIAN ASSISTANT UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, nurse 49 practitioner or other health care provider acting within his or her 50 scope of practice pursuant to this title. However, nothing contained in 51 this article shall be construed to permit any licensee hereunder to 52 practice medicine or psychology, including psychotherapy or to otherwise 53 expand such licensee's scope of practice beyond what is authorized by 54 this chapter. S. 2254--A 9 1 S 30. Subdivision 7 of section 461-c of the social services law, as 2 amended by chapter 168 of the laws of 2011, is amended to read as 3 follows: 4 7. (a) At the time of the admission to an adult care facility, other 5 than a shelter for adults, a resident shall submit to the facility a 6 written report from a physician, a physician assistant UNDER THE SUPER- 7 VISION OF A LICENSED PHYSICIAN, or a nurse practitioner, which report 8 shall state: 9 (i) that the physician, physician assistant UNDER THE SUPERVISION OF A 10 LICENSED PHYSICIAN, or nurse practitioner has physically examined the 11 resident within one month and the date of such examination; 12 (ii) that the resident is not in need of acute or long term medical or 13 nursing care which would require placement in a hospital or residential 14 health care facility; and 15 (iii) that the resident is not otherwise medically or mentally 16 unsuited for care in the facility. 17 (b) For the purpose of creating an accessible and available record and 18 assuring that a resident is properly placed in such a facility, the 19 report shall also contain the resident's significant medical history and 20 current conditions, the prescribed medication regimen, and recommenda- 21 tions for diet, the assistance needed in the activities of daily living 22 and where appropriate, recommendations for exercise, recreation and 23 frequency of medical examinations. 24 (c) Such resident shall thereafter be examined by a physician, a 25 physician assistant UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, or a 26 nurse practitioner, at least annually and shall submit an annual written 27 report in conformity with the provisions of this subdivision. 28 (d) Following a resident's stay in a hospital or residential health 29 care facility, upon return to the adult care facility, the adult care 30 facility shall not be required to obtain the report in paragraph (a) of 31 this subdivision, and instead shall obtain a statement from the 32 discharging facility which shall: 33 (i) state that the resident is appropriate to return to the facility; 34 and 35 (ii) include the reason for the resident's stay, the treatment plan to 36 be followed, and any new or changed orders, including medications. 37 The statement shall be completed by a physician, a physician assistant 38 UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, or a nurse practitioner. 39 (e) Nothing required in this section shall require the use of an iden- 40 tical form in adult care facilities and assisted living residences, 41 either upon admission or return. 42 S 31. Paragraphs (a), (b) and (c) of subdivision 1 of section 13-b of 43 the workers' compensation law, as amended by chapter 473 of the laws of 44 2000, are amended to read as follows: 45 (a) Any physician licensed to practice medicine in the state of New 46 York OR A PHYSICIAN ASSISTANT UNDER THE DIRECT SUPERVISION OF SUCH A 47 LICENSED PHYSICIAN may render emergency medical care under this chapter 48 without authorization by the chair under this section; and 49 (b) A licensed physician who is a member of a constituted medical 50 staff of any hospital OR A PHYSICIAN ASSISTANT UNDER THE DIRECT SUPER- 51 VISION OF SUCH A LICENSED PHYSICIAN, may render medical care under this 52 chapter while an injured employee remains a patient in such hospital; 53 and 54 (c) CONSISTENT WITH ARTICLE THIRTY-SEVEN OF THE PUBLIC HEALTH LAW AND 55 ARTICLE ONE HUNDRED THIRTY-ONE-B OF THE EDUCATION LAW, MEDICAL CARE MAY 56 BE RENDERED BY A PHYSICIAN ASSISTANT UNDER THE DIRECT SUPERVISION OF A S. 2254--A 10 1 LICENSED AUTHORIZED PHYSICIAN. Under the active and personal supervision 2 of an authorized physician medical care may be rendered by a registered 3 nurse or other person trained in laboratory or diagnostic techniques 4 within the scope of such person's specialized training and qualifica- 5 tions. This supervision shall be evidenced by signed records of 6 instructions for treatment and signed records of the patient's condition 7 and progress. Reports of such treatment and supervision shall be made by 8 such physician to the chair on such forms and at such times as the chair 9 may require. 10 S 32. Paragraph (d) of subdivision 3 of section 13-c of the workers' 11 compensation law, as added by chapter 828 of the laws of 1975, subpara- 12 graph (ii) as amended and subparagraph (iii) as added by chapter 803 of 13 the laws of 1983, and subparagraph (iv) as added and subparagraph (v) as 14 renumbered by chapter 649 of the laws of 1985, is amended to read as 15 follows: 16 (d) (i) A physician rendering medical care at a medical center author- 17 ized, OR A PHYSICIAN ASSISTANT UNDER THE DIRECT SUPERVISION OF SUCH A 18 PHYSICIAN, hereunder must be authorized to render such care pursuant to 19 this chapter and he OR SHE shall limit his OR HER professional activ- 20 ities hereunder to such medical care as his OR HER experience and train- 21 ing qualify him OR HER to render. 22 (ii) When para-medical, laboratory or X-ray services or other medical 23 care is required it shall be rendered, under the active and personal 24 supervision of an authorized physician, by a registered nurse or other 25 person trained in laboratory or diagnostic techniques within the scope 26 of such person's specialized training and qualifications. This super- 27 vision shall be evidenced by signed records of instructions for treat- 28 ment and signed records of the patient's condition and progress. Reports 29 of such treatment and supervision shall be made by such physician to the 30 chairman on such forms and at such times as the chairman may require. 31 (iii) When physical therapy care is required it shall be rendered by a 32 duly licensed physical therapist upon the referral which may be direc- 33 tive as to treatment of an authorized physician, PHYSICIAN ASSISTANT 34 UNDER THE DIRECT SUPERVISION OF SUCH PHYSICIAN or podiatrist within the 35 scope of such physical therapist's specialized training and qualifica- 36 tions as defined in article one hundred thirty-six of the education law. 37 Reports of such treatment and records of instruction for treatment, if 38 any, shall be maintained by the physical therapist and referring profes- 39 sional and submitted to the chairman on such forms and at such times as 40 the chairman may require. 41 (iv) When occupational therapy care is required it shall be rendered 42 by a duly licensed and registered occupational therapist upon the 43 prescription or referral of an authorized physician OR PHYSICIAN ASSIST- 44 ANT UNDER THE DIRECT SUPERVISION OF SUCH PHYSICIAN within the scope of 45 such occupational therapist's specialized training and qualifications as 46 defined in article one hundred fifty-six of the education law. Reports 47 of such treatment and records of instruction for treatment, if any, 48 shall be maintained by the occupational therapist and referring profes- 49 sional and submitted to the chairman on such forms and at such times as 50 the chairman may require. 51 (v) The physician rendering the medical care hereunder shall be in 52 charge of the care unless, in his OR HER judgment, it is necessary to 53 refer the case to a specially trained and qualified physician, which 54 physician shall then assume complete responsibility for and supervision 55 of any further medical care rendered. S. 2254--A 11 1 S 33. Subdivisions (d), (e) and (f) of section 33.04 of the mental 2 hygiene law, subdivisions (d) and (f) as added by chapter 779 of the 3 laws of 1977, such section as renumbered and subdivision (e) as amended 4 by chapter 334 of the laws of 1980, are amended to read as follows: 5 (d) Restraint shall be effected only by written order of a physician 6 OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN after a 7 personal examination of the patient except in an emergency situation, as 8 provided by subdivision (e) of this section. The order shall set forth 9 the facts justifying the restraint and shall specify the nature of the 10 restraint and any conditions for maintaining the restraint. The order 11 shall also set forth the time of expiration of the authorization, with 12 such order to apply for a period of no more than four hours, provided, 13 however, that any such order imposing restraint after nine o'clock p.m. 14 may extend until nine o'clock a.m. of the next day. A full record of 15 restraint, including all signed orders of physicians, shall be kept in 16 the patient's file and shall be subject to inspection by authorized 17 persons. 18 (e) If an emergency situation exists in which the patient is engaging 19 in activity that presents an immediate danger to himself, HERSELF or 20 others and a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF 21 SUCH PHYSICIAN is not immediately available, restraint may be effected 22 only to the extent necessary to prevent the patient from injuring 23 himself or others at the direction of the senior member of the staff who 24 is present. The senior staff member shall cause a physician OR A PHYSI- 25 CIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN to be immediately 26 summoned and shall record the time of the call and the person contacted. 27 Pending the arrival of a physician OR A PHYSICIAN ASSISTANT UNDER THE 28 SUPERVISION OF SUCH PHYSICIAN, the patient shall be kept under constant 29 supervision. If a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPER- 30 VISION OF SUCH PHYSICIAN does not arrive within thirty minutes of being 31 summoned, the senior staff member shall record any such delay in the 32 patient's clinical record and also place into the patient's clinical 33 record a written description of the facts justifying the emergency 34 restraint which shall specify the nature of the restraint and any condi- 35 tions for maintaining the restraint until the arrival of a physician OR 36 A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN, the 37 reasons why less restrictive forms of restraint were not used, and a 38 description of the steps taken to assure that the patient's needs, 39 comfort and safety were properly cared for. Such physician OR A PHYSI- 40 CIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN shall place in 41 the clinical record an explanation for any such delay. 42 (f) During the time that a patient is in restraint, he OR SHE shall be 43 monitored to see that his OR HER physical needs, comfort, and safety are 44 properly cared for. An assessment of the patient's condition shall be 45 made at least once every thirty minutes or at more frequent intervals as 46 directed by a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION 47 OF SUCH PHYSICIAN. The assessment shall be recorded and placed in the 48 patient's file. A patient in restraint shall be released from restraint 49 at least every two hours, except when asleep. If at any time a patient 50 upon being released from restraint makes no overt gestures that would 51 threaten serious harm or injury to himself, HERSELF or others, restraint 52 shall not be reimposed and a physician shall be immediately notified. 53 Restraint shall not be reimposed in such situation unless in the physi- 54 cian's OR A PHYSICIAN ASSISTANT'S UNDER THE SUPERVISION OF SUCH PHYSI- 55 CIAN professional judgment release would be harmful to the patient or 56 others. S. 2254--A 12 1 S 34. Paragraph e of subdivision 1 of section 406 of the general busi- 2 ness law, as amended by chapter 600 of the laws of 2002, is amended to 3 read as follows: 4 e. Each application shall be accompanied by a certificate of a duly 5 licensed physician, A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF SUCH 6 A PHYSICIAN or nurse practitioner to the extent authorized by law and 7 consistent with the written practice agreement pursuant to subdivision 8 three of section six thousand nine hundred two of the education law on a 9 form prescribed by the secretary, showing freedom from any infectious or 10 communicable disease which certificate shall have been issued within 11 thirty days prior to the date of the filing of the application. 12 S 35. This act shall take effect immediately.