Bill Text: OH HB284 | 2011-2012 | 129th General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: To modify the laws governing physician assistants, to authorize certain nurses to determine and pronounce death under specified circumstances, and to revise the laws governing the professions of chemical dependency counseling and alcohol and other drug prevention.

Spectrum: Bipartisan Bill

Status: (Passed) 2013-03-22 - Effective Date [HB284 Detail]

Download: Ohio-2011-HB284-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

H. B. No. 284

Representatives Gonzales, Letson 

Cosponsors: Representatives Stebelton, Wachtmann, Boyd, Slesnick, Gerberry, O'Brien, Murray, Reece, Mallory 

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A BILL

To amend sections 185.01, 185.03, 185.05, 2105.35,

1

2108.40, 2133.211, 3719.06, 4730.06, 4730.09,

2

4730.38, 4730.39, 4730.40, 4730.41, 4730.42,

3

4730.44, 4730.45, 4755.48, 4755.481, 4765.01,

4

4765.35, 4765.36, 4765.37, 4765.38, 4765.39,

5

4765.49, and 4765.51, to enact sections 4730.411,

6

5111.0212, and 5111.051, and to repeal section

7

4730.401 of the Revised Code to modify the laws

8

governing physician assistants.

9

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1.  That sections 185.01, 185.03, 185.05, 2105.35,	10
2108.40, 2133.211, 3719.06, 4730.06, 4730.09, 4730.38, 4730.39,	11
4730.40, 4730.41, 4730.42, 4730.44, 4730.45, 4755.48, 4755.481,	12
4765.01, 4765.35, 4765.36, 4765.37, 4765.38, 4765.39, 4765.49, and	13
4765.51 be amended and sections 4730.411, 5111.0212, and 5111.051	14
of the Revised Code be enacted to read as follows:	15

Sec. 185.01.  As used in this chapter:

16

(A) "Advanced practice nurse" has the same meaning as in	17
section 4723.01 of the Revised Code.	18

(B) "Collaboration" has the same meaning as in section	19
4723.01 of the Revised Code.	20

(C) "Health care coverage and quality council" means the	21
entity established under section 3923.90 of the Revised Code.	22

(D) "Patient centered medical home education advisory group"	23
means the entity established under section 185.03 of the Revised	24
Code to implement and administer the patient centered medical home	25
education pilot project.	26

(E) "Patient centered medical home education pilot project"	27
means the pilot project established under section 185.02 of the	28
Revised Code.	29

(F) "Physician assistant" means an individual who holds a	30
valid certificate to practice as a physician assistant issued	31
under Chapter 4730. of the Revised Code.	32

Sec. 185.03. (A) The patient centered medical home education	33
advisory group is hereby created for the purpose of implementing	34
and administering the patient centered medical home pilot project.	35
The advisory group shall develop a set of expected outcomes for	36
the pilot project.	37

(B) The advisory group shall consist of the following voting	38
members:	39

(1) One individual with expertise in the training and	40
education of primary care physicians who is appointed by the dean	41
of the university of Toledo college of medicine;	42

(2) One individual with expertise in the training and	43
education of primary care physicians who is appointed by the dean	44
of the Boonshoft school of medicine at Wright state university;	45

(3) One individual with expertise in the training and	46
education of primary care physicians who is appointed by the	47
president and dean of the northeast Ohio medical university;	48

(4) One individual with expertise in the training and	49
education of primary care physicians who is appointed by the dean	50
of the Ohio university college of osteopathic medicine;	51

(5) Two individuals appointed by the governing board of the	52
Ohio academy of family physicians;	53

(6) One individual appointed by the governing board of the	54
Ohio chapter of the American college of physicians;	55

(7) One individual appointed by the governing board of the	56
American academy of pediatrics;	57

(8) One individual appointed by the governing board of the	58
Ohio osteopathic association;	59

(9) One individual with expertise in the training and	60
education of advanced practice nurses who is appointed by the	61
governing board of the Ohio council of deans and directors of	62
baccalaureate and higher degree programs in nursing;	63

(10) One individual appointed by the governing board of the	64
Ohio nurses association;	65

(11) One individual appointed by the governing board of the	66
Ohio association of advanced practice nurses;	67

(12) One individual appointed by the governing board of the	68
Ohio association of physician assistants;	69

(13) A member of the health care coverage and quality	70
council, other than the advisory group member specified in	71
division (C)(2) of this section, appointed by the superintendent	72
of insurance.	73

(C) The advisory group shall consist of the following	74
nonvoting, ex officio members:	75

(1) The executive director of the state medical board, or the	76
director's designee;	77

(2) The executive director of the board of nursing or the	78
director's designee;	79

(3) The chancellor of the Ohio board of regents, or the	80
chancellor's designee;	81

(4) The individual within the department of job and family	82
services who serves as the director of medicaid, or the director's	83
designee;	84

(5) The director of health or the director's designee.

85

(D) Advisory group members who are appointed shall serve at	86
the pleasure of their appointing authorities. Terms of office of	87
appointed members shall be three years, except that a member's	88
term ends if the pilot project ceases operation during the	89
member's term.	90

Vacancies shall be filled in the manner provided for original	91
appointments.	92

Members shall serve without compensation, except to the	93
extent that serving on the advisory group is considered part of	94
their regular employment duties.	95

(E) The advisory group shall select from among its members a	96
chairperson and vice-chairperson. The advisory group may select	97
any other officers it considers necessary to conduct its business.	98

A majority of the members of the advisory group constitutes a	99
quorum for the transaction of official business. A majority of a	100
quorum is necessary for the advisory group to take any action,	101
except that when one or more members of a quorum are required to	102
abstain from voting as provided in division (C)(1)(d) or (C)(2)(c)	103
of section 185.05 of the Revised Code, the number of members	104
necessary for a majority of a quorum shall be reduced accordingly.	105

The advisory group shall meet as necessary to fulfill its	106
duties. The times and places for the meetings shall be selected by	107
the chairperson.	108

(F) Sections 101.82 to 101.87 of the Revised Code do not	109
apply to the advisory group.	110

Sec. 185.05. (A) The patient centered medical home education	111
advisory group shall accept applications for inclusion in the	112
patient centered medical home education pilot project from primary	113
care practices with educational affiliations, as determined by the	114
advisory group, with one or more of the following:	115

(1) The Boonshoft school of medicine at Wright state	116
university;	117

(2) The university of Toledo college of medicine;

118

(3) The northeastern Ohio universities colleges of medicine	119
and pharmacy;	120

(4) The Ohio university college of osteopathic medicine;

121

(5) The college of nursing at the university of Toledo;

122

(6) The Wright state university college of nursing and	123
health;	124

(7) The college of nursing at Kent state university;

125

(8) The university of Akron college of nursing;

126

(9) The school of nursing at Ohio university.

127

(B)(1) Subject to division (C)(1) of this section, the	128
advisory group shall select for inclusion in the pilot project not	129
more than the following number of physician practices:	130

(a) Ten practices affiliated with the Boonshoft school of	131
medicine at Wright state university;	132

(b) Ten practices affiliated with the university of Toledo	133
college of medicine;	134

(c) Ten practices affiliated with the northeastern Ohio	135
universities colleges of medicine and pharmacy;	136

(d) Ten practices affiliated with the centers for osteopathic	137
research and education of the Ohio university college of	138
osteopathic medicine.	139

(2) Subject to division (C)(2) of this section, the advisory	140
group shall select for inclusion in the pilot project not less	141
than the following number of advanced practice nurse primary care	142
practices:	143

(a) One practice affiliated with the college of nursing at	144
the university of Toledo;	145

(b) One practice affiliated with the Wright state university	146
college of nursing and health;	147

(c) One practice affiliated with the college of nursing at	148
Kent state university or the university of Akron college of	149
nursing;	150

(d) One practice affiliated with the school of nursing at	151
Ohio university.	152

(C)(1) All of the following apply with respect to the	153
selection of physician practices under division (B) of this	154
section:	155

(a) The advisory group shall strive to select physician	156
practices in such a manner that the pilot project includes aboth	157
of the following:	158

(i) A diverse range of primary care specialties, including	159
practices specializing in pediatrics, geriatrics, general internal	160
medicine, or family medicine;	161

(ii) Practices that utilize physician assistants as part of	162
the health care delivery system.	163

(b) When evaluating an application, the advisory group shall	164
consider the percentage of patients in the physician practice who	165
are part of a medically underserved population, including medicaid	166
recipients and individuals without health insurance.	167

(c) The advisory group shall select not fewer than six	168
practices that serve rural areas of this state, as those areas are	169
determined by the advisory group.	170

(d) A member of the advisory group shall abstain from	171
participating in any vote taken regarding the selection of a	172
physician practice if the member would receive any financial	173
benefit from having the practice included in the pilot project.	174

(2) All of the following apply with respect to the selection	175
of advanced practice nurse primary care practices under division	176
(B) of this section:	177

(a) When evaluating an application, the advisory group shall	178
consider the percentage of patients in the advanced practice nurse	179
primary care practice who are part of a medically underserved	180
population, including medicaid recipients and individuals without	181
health insurance.	182

(b) If the advisory group determines that it has not received	183
an application from a sufficiently qualified advanced practice	184
nurse primary care practice affiliated with a particular	185
institution specified in division (B)(2) of this section, the	186
advisory group shall make the selections required under that	187
division in such a manner that the greatest possible number of	188
those institutions are represented in the pilot project. To be	189
selected in this manner, a practice remains subject to the	190
eligibility requirements specified in division (B) of section	191
185.06 of the Revised Code. As specified in division (B)(2) of	192
this section, the number of practices selected for inclusion in	193
the pilot project shall be at least four.	194

(c) A member of the advisory group shall abstain from	195
participating in any vote taken regarding the selection of an	196
advanced practice nurse primary care practice if the member would	197
receive any financial benefit from having the practice included in	198
the pilot project.	199

Sec. 2105.35. (A)(1) A person is dead if the person has been	200
determined to be and pronounced dead pursuant to standards	201
established under section 2108.40 of the Revised Code.	202

(2) A physician or physician assistant who makes a	203
determination and pronouncement of death in accordance with	204
section 2108.40 of the Revised Code and any person who acts in	205
good faith in reliance on a determination and pronouncement of	206
death made by a physician in accordance with that section is	207
2108.40 of the Revised Code by a physician or physician assistant	208
are each entitled to the immunity conveyed by that section	209
2108.40 of the Revised Code.	210

(B) A certified or authenticated copy of a death certificate	211
purporting to be issued by an official or agency of the place	212
where the death of a person purportedly occurred is prima-facie	213
evidence of the fact, place, date, and time of the person's death	214
and the identity of the decedent.	215

(C) A certified or authenticated copy of any record or report	216
of a domestic or foreign governmental agency that a person is	217
missing, detained, dead, or alive is prima-facie evidence of the	218
status and of the dates, circumstances, and places disclosed by	219
the record or report.	220

(D) In the absence of prima-facie evidence of death under	221
division (B) or (C) of this section, the fact of death may be	222
established by clear and convincing evidence, including	223
circumstantial evidence.	224

(E) Except as provided in division (F) of this section, a	225
presumption of the death of a person arises:	226

(1) When the person has disappeared and been continuously	227
absent from the person's place of last domicile for a five-year	228
period without being heard from during the period;	229

(2) When the person has disappeared and been continuously	230
absent from the person's place of last domicile without being	231
heard from and was at the beginning of the person's absence	232
exposed to a specific peril of death, even though the absence has	233
continued for less than a five-year period.	234

(F) When a person who is on active duty in the armed services	235
of the United States has been officially determined to be absent	236
in a status of "missing" or "missing in action," a presumption of	237
death arises when the head of the federal department concerned has	238
made a finding of death pursuant to the "Federal Missing Persons	239
Act," 80 Stat. 625 (1966), 37 U.S.C.A. 551, as amended.	240

(G) In the absence of evidence disputing the time of death	241
stipulated on a document described in division (B) or (C) of this	242
section, a document described in either of those divisions that	243
stipulates a time of death one hundred twenty hours or more after	244
the time of death of another person, however the time of death of	245
the other person is determined, establishes by clear and	246
convincing evidence that the person survived the other person by	247
one hundred twenty hours.	248

(H) The provisions of divisions (A) to (G) of this section	249
are in addition to any other provisions of the Revised Code, the	250
Rules of Criminal Procedure, or the Rules of Evidence that pertain	251
to the determination of death and status of a person.	252

Sec. 2108.40. (A) An individual is dead if the individual has	253
sustained either irreversible cessation of circulatory and	254
respiratory functions or irreversible cessation of all functions	255
of the brain, including the brain stem, as determined in	256
accordance with accepted medical standards. If the respiratory and	257
circulatory functions of a person are being artificially	258
sustained, under accepted medical standards a determination that	259
death has occurred is made by a physician by observing and	260
conducting a test to determine that the irreversible cessation of	261
all functions of the brain has occurred.	262

(B) The determination and pronouncement of an individual's	263
death may be made by a physician or, subject to divisions (C) and	264
(D) of this section, a physician assistant.	265

(C) A physician assistant may determine and pronounce an	266
individual's death only if the individual's respiratory and	267
circulatory functions are not being artificially sustained and, at	268
the time the determination and pronouncement of death is made,	269
either or both of the following conditions are met:	270

(1) The individual was receiving care in one of the	271
following:	272

(a) A nursing home, residential care facility, or home for	273
the aging licensed under Chapter 3721. of the Revised Code;	274

(b) A county home or district home operated pursuant to	275
Chapter 5155. of the Revised Code;	276

(c) A residential facility licensed under section 5123.19 of	277
the Revised Code.	278

(2) The physician assistant is providing or supervising the	279
individual's care through a hospice care program licensed under	280
Chapter 3712. of the Revised Code or any other entity that	281
provides palliative care.	282

(D) If a physician assistant determines and pronounces an	283
individual's death, both of the following conditions apply:	284

(1) The physician assistant shall not complete any portion of	285
the individual's death certificate.	286

(2) The physician assistant shall notify the individual's	287
attending physician of the determination and pronouncement in	288
order for the physician to fulfill the physician's duties under	289
section 3705.16 of the Revised Code. The physician assistant shall	290
provide the notification within a reasonable period of time	291
following the determination and pronouncement of the individual's	292
death.	293

(E)(1) A physician who makes a determination and	294
pronouncement of death in accordance with this section and	295
accepted medical standards is not liable for damages, or subject	296
to, any of the following for the physician's acts, the acts of a	297
physician assistant who makes a determination and pronouncement of	298
death in accordance with this section and accepted medical	299
standards, or the acts of others based on a determination and	300
pronouncement of death in accordance with this section and	301
accepted medical standards:	302

(a) Damages in any civil action or subject to prosecution;

303

(b) Prosecution in any criminal proceeding for the	304
physician's acts or the acts of others based on that	305
determination;	306

(c) Professional disciplinary action pursuant to Chapter	307
4731. of the Revised Code.	308

(2) A physician assistant who makes a determination and	309
pronouncement of death in accordance with this section and	310
accepted medical standards is not liable for, or subject to, any	311
of the following for the physician assistant's acts or the acts of	312
others based on that determination and pronouncement:	313

(a) Damages in any civil action;

314

(b) Prosecution in any criminal proceeding;

315

(c) Professional disciplinary action pursuant to Chapter	316
4730. of the Revised Code.	317

(3) Any person who acts in good faith in reliance on a	318
determination and pronouncement of death made by a physician or	319
physician assistant in accordance with this section and accepted	320
medical standards is not liable for damages in any civil action or	321
subject to prosecution in any criminal proceeding for the person's	322
actions.	323

Sec. 2133.211.  A person who holds a certificate of authority	324
to practice as a certified nurse practitioner or clinical nurse	325
specialist issued under section 4723.42 of the Revised Code may	326
take any action that may be taken by an attending physician under	327
sections 2133.21 to 2133.26 of the Revised Code and has the	328
immunity provided by section 2133.22 of the Revised Code if the	329
action is taken pursuant to a standard care arrangement with a	330
collaborating physician.	331

A person who holds a certificate to practice as a physician	332
assistant issued under Chapter 4730. of the Revised Code may take	333
any action that may be taken by an attending physician under	334
sections 2133.21 to 2133.26 of the Revised Code and has the	335
immunity provided by section 2133.22 of the Revised Code if the	336
action is taken pursuant to a physician supervisory plan approved	337
pursuant to section 4730.17 of the Revised Code or the policies of	338
a health care facility in which the physician assistant is	339
practicing.	340

Sec. 3719.06.  (A)(1) A licensed health professional	341
authorized to prescribe drugs, if acting in the course of	342
professional practice, in accordance with the laws regulating the	343
professional's practice, and in accordance with rules adopted by	344
the state board of pharmacy, may, except as provided in division	345
(A)(2) or (3) of this section, do the following:	346

(a) Prescribe schedule II, III, IV, and V controlled	347
substances;	348

(b) Administer or personally furnish to patients schedule II,	349
III, IV, and V controlled substances;	350

(c) Cause schedule II, III, IV, and V controlled substances	351
to be administered under the prescriber's direction and	352
supervision.	353

(2) A licensed health professional authorized to prescribe	354
drugs who is a clinical nurse specialist, certified nurse-midwife,	355
or certified nurse practitioner is subject to both of the	356
following:	357

(a) A schedule II controlled substance may be prescribed only	358
for a patient with a terminal condition, as defined in section	359
2133.01 of the Revised Code, only if the nurse's collaborating	360
physician initially prescribed the substance for the patient, and	361
only in an amount that does not exceed the amount necessary for	362
the patient's use in a single, twenty-four-hour period.	363

(b) No schedule II controlled substance shall be personally	364
furnished to any patient.	365

(3) A licensed health professional authorized to prescribe	366
drugs who is a physician assistant shall not prescribe or	367
personally furnish to patients anyis subject to all of the	368
following:	369

(a) A controlled substance that is notmay be prescribed or	370
personally furnished only if it is included in the	371
physician-delegated prescriptive authority granted to the	372
physician assistant in accordance with Chapter 4730. of the	373
Revised Code.	374

(b) A schedule II controlled substance may be prescribed only	375
in accordance with division (B)(4) of section 4730.41 and section	376
4730.411 of the Revised Code.	377

(c) No schedule II controlled substance shall be personally	378
furnished to any patient.	379

(B) No licensed health professional authorized to prescribe	380
drugs shall prescribe, administer, or personally furnish a	381
schedule III anabolic steroid for the purpose of human muscle	382
building or enhancing human athletic performance and no pharmacist	383
shall dispense a schedule III anabolic steroid for either purpose,	384
unless it has been approved for that purpose under the "Federal	385
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.	386
301, as amended.	387

(C) Each written prescription shall be properly executed,	388
dated, and signed by the prescriber on the day when issued and	389
shall bear the full name and address of the person for whom, or	390
the owner of the animal for which, the controlled substance is	391
prescribed and the full name, address, and registry number under	392
the federal drug abuse control laws of the prescriber. If the	393
prescription is for an animal, it shall state the species of the	394
animal for which the controlled substance is prescribed.	395

Sec. 4730.06.  (A) The physician assistant policy committee	396
of the state medical board shall review, and shall submit to the	397
board recommendations concerning, all of the following:	398

(1) Requirements for issuance of certificates to practice as	399
a physician assistant, including the educational requirements that	400
must be met to receive a certificate to practice;	401

(2) Existing and proposed rules pertaining to the practice of	402
physician assistants, the supervisory relationship between	403
physician assistants and supervising physicians, and the	404
administration and enforcement of this chapter;	405

(3) Physician-delegatedIn accordance with section 4730.38 of	406
the Revised Code, physician-delegated prescriptive authority for	407
physician assistants, in accordance withand proposed changes to	408
the physician assistant formulary the board adopts pursuant to	409
division (A)(1) of section 4730.384730.39 of the Revised Code;	410

(4) Application procedures and forms for certificates to	411
practice as a physician assistant, physician supervisory plans,	412
and supervision agreements;	413

(5) Fees required by this chapter for issuance and renewal of	414
certificates to practice as a physician assistant;	415

(6) Criteria to be included in applications submitted to the	416
board for approval of physician supervisory plans, including	417
criteria to be included in applications for approval to delegate	418
to physician assistants the performance of special services;	419

(7) Criteria to be included in supervision agreements	420
submitted to the board for approval and renewal of the board's	421
approval;	422

(8) Any issue the board asks the committee to consider.

423

(B) In addition to the matters that are required to be	424
reviewed under division (A) of this section, the committee may	425
review, and may submit to the board recommendations concerning,	426
either or both of the following:	427

(1) Quality assurance activities to be performed by a	428
supervising physician and physician assistant under a quality	429
assurance system established pursuant to division (F) of section	430
4730.21 of the Revised Code;	431

(2) The development and approval of one or more model	432
physician supervisory plans and one or more models for a special	433
services portion of the one or more model physician supervisory	434
plans. The committee may submit recommendations for model plans	435
that reflect various medical specialties.	436

(C) The board shall take into consideration all	437
recommendations submitted by the committee. Not later than ninety	438
days after receiving a recommendation from the committee, the	439
board shall approve or disapprove the recommendation and notify	440
the committee of its decision. If a recommendation is disapproved,	441
the board shall inform the committee of its reasons for making	442
that decision. The committee may resubmit the recommendation after	443
addressing the concerns expressed by the board and modifying the	444
disapproved recommendation accordingly. Not later than ninety days	445
after receiving a resubmitted recommendation, the board shall	446
approve or disapprove the recommendation. There is no limit on the	447
number of times the committee may resubmit a recommendation for	448
consideration by the board.	449

(D)(1) Except as provided in division (D)(2) of this section,	450
the board may not take action regarding a matter that is subject	451
to the committee's review under division (A) or (B) of this	452
section unless the committee has made a recommendation to the	453
board concerning the matter.	454

(2) If the board submits to the committee a request for a	455
recommendation regarding a matter that is subject to the	456
committee's review under division (A) or (B) of this section, and	457
the committee does not provide a recommendation before the	458
sixty-first day after the request is submitted, the board may take	459
action regarding the matter without a recommendation.	460

Sec. 4730.09. (A) Under a physician supervisory plan approved	461
under section 4730.17 of the Revised Code, a physician assistant	462
may provide any or all of the following services without approval	463
by the state medical board as special services:	464

(1) Obtaining comprehensive patient histories;

465

(2) Performing physical examinations, including audiometry	466
screening, routine visual screening, and pelvic, rectal, and	467
genital-urinary examinations, when indicated;	468

(3) Ordering, performing, or ordering and performing routine	469
diagnostic procedures, as indicated;	470

(4) Identifying normal and abnormal findings on histories,	471
physical examinations, and commonly performed diagnostic studies;	472

(5) Assessing patients and developing and implementing	473
treatment plans for patients;	474

(6) Monitoring the effectiveness of therapeutic	475
interventions;	476

(7) Exercising physician-delegated prescriptive authority	477
pursuant to a certificate to prescribe issued under this chapter;	478

(8) Carrying out or relaying the supervising physician's	479
orders for the administration of medication, to the extent	480
permitted by law;	481

(9) Providing patient education;

482

(10) Instituting and changing orders on patient charts;

483

(11) Performing developmental screening examinations on	484
children with regard to neurological, motor, and mental functions;	485

(12) Performing wound care management, suturing minor	486
lacerations and removing the sutures, and incision and drainage of	487
uncomplicated superficial abscesses;	488

(13) Removing superficial foreign bodies;

489

(14) Administering intravenous fluids;

490

(15) Inserting a foley or cudae catheter into the urinary	491
bladder and removing the catheter;	492

(16) Removing intrauterine devices;

493

(17) Performing biopsies of superficial lesions;

494

(18)(17) Making appropriate referrals as directed by the	495
supervising physician;	496

(19) Removing norplant capsules

497

(18) Removing birth control devices;

498

(20)(19) Performing penile duplex ultrasound;

499

(21)(20) Changing of a tracheostomy;

500

(22)(21) Performing bone marrow aspirations from the	501
posterior iliac crest;	502

(23)(22) Performing bone marrow biopsies from the posterior	503
iliac crest;	504

(24)(23) Performing cystograms;

505

(25)(24) Performing nephrostograms after physician placement	506
of nephrostomy tubes;	507

(26)(25) Fitting or inserting family planning devices,	508
including intrauterine devices, diaphragms, and cervical caps;	509

(27)(26) Removing cervical polyps;

510

(28)(27) Performing nerve conduction testing;

511

(29)(28) Performing endometrial biopsies;

512

(30)(29) Inserting filiform and follower catheters;

513

(31)(30) Performing arthrocentesis of the knee;

514

(32)(31) Performing knee joint injections;

515

(33)(32) Performing endotracheal intubation with successful	516
completion of an advanced cardiac life support course;	517

(34)(33) Performing lumbar punctures;

518

(35)(34) In accordance with rules adopted by the board, using	519
light-based medical devices for the purpose of hair removal;	520

(36)(35) Administering, monitoring, or maintaining local	521
anesthesia, as defined in section 4730.091 of the Revised Code;	522

(37)(36) Applying or removing a cast or splint;

523

(38)(37) Inserting or removing chest tubes;

524

(38) Prescribing physical therapy or referring a patient to a	525
physical therapist for the purpose of receiving physical therapy;	526

(39) Ordering occupational therapy or referring a patient to	527
an occupational therapist for the purpose of receiving	528
occupational therapy;	529

(40) Taking any action that may be taken by an attending	530
physician under sections 2133.21 to 2133.26 of the Revised Code,	531
as specified in section 2133.211 of the Revised Code;	532

(41) Performing other services that are within the	533
supervising physician's normal course of practice and expertise,	534
if the services are included in any model physician supervisory	535
plan approved under section 4730.06 of the Revised Code or the	536
services are designated by the board by rule or other means as	537
services that are not subject to approval as special services.	538

(B) Under the policies of a health care facility, the	539
services a physician assistant may provide are limited to the	540
services the facility has authorized the physician assistant to	541
provide for the facility. The services a health care facility may	542
authorize a physician assistant to provide for the facility	543
include the following:	544

(1) Any or all of the services specified in division (A) of	545
this section;	546

(2) Assisting in surgery in the health care facility;

547

(3) Any other services permitted by the policies of the	548
health care facility, except that the facility may not authorize a	549
physician assistant to perform a service that is prohibited by	550
this chapter.	551

Sec. 4730.38.  (A) Not later than six months after the	552
effective dateExcept as provided in division (B) of this section,	553
the physician assistant policy committee of the state medical	554
board shall, at such times the committee determines to be	555
necessary, submit to the board its initial recommendations	556
regarding physician-delegated prescriptive authority for physician	557
assistants. The committee's recommendations shall address allboth	558
of the following:	559

(1) Policy and procedures regarding physician-delegated	560
prescriptive authority, including the issuance of certificates to	561
prescribe under this chapter;	562

(2) Subject to the limitations specified in section 4730.40	563
of the Revised Code, a formulary listing the drugs and therapeutic	564
devices by class and specific nomenclature that a supervising	565
physician may include in the physician-delegated prescriptive	566
authority granted to a physician assistant who holds a certificate	567
to prescribe issued under this chapter;	568

(3) Any issue the committee considers necessary to assist the	569
board in fulfilling its duty to adopt rules governing	570
physician-delegated prescriptive authority, including the issuance	571
of certificates to prescribe.	572

(B) After the board's adoption of initial rules under section	573
4730.39 of the Revised Code, the committee shall conduct an annual	574
review of its recommendations regarding physician-delegated	575
prescriptive authority. Based on its review, the committee shall	576
submit recommendations to the board as the committee considers	577
necessaryNot less than every six months beginning on the first	578
day of June following the effective date of this amendment, the	579
committee shall review the physician assistant formulary the board	580
adopts pursuant to division (A)(1) of section 4730.39 of the	581
Revised Code and, to the extent it determines to be necessary,	582
submit recommendations proposing changes to the formulary.	583

(C) Recommendations submitted under this section are subject	584
to the procedures and time frames specified in division (C) of	585
section 4730.06 of the Revised Code.	586

Sec. 4730.39.  (A) Not later than six months after receiving	587
the initial recommendations of the physician assistant policy	588
committee submitted pursuant to division (A) of section 4730.38 of	589
the Revised Code, theThe state medical board shall adoptdo both	590
of the following:	591

(1) Adopt a formulary listing the drugs and therapeutic	592
devices by class and specific generic nomenclature that a	593
physician may include in the physician-delegated prescriptive	594
authority granted to a physician assistant who holds a certificate	595
to prescribe under this chapter;	596

(2) Adopt rules governing physician-delegated prescriptive	597
authority for physician assistants, including the issuance of	598
certificates to prescribe under this chapter. The	599

(B) The board's rules governing physician-delegated	600
prescriptive authority adopted pursuant to division (A)(2) of this	601
section shall be adopted in accordance with Chapter 119. of the	602
Revised Code and shall establish all of the following:	603

(1) Subject to the limitations specified in section 4730.40	604
of the Revised Code, a formulary listing the drugs and therapeutic	605
devices by class and specific generic nomenclature that a	606
physician may include in the physician-delegated prescriptive	607
authority granted to a physician assistant who holds a certificate	608
to prescribe under this chapter;	609

(2) Requirements regarding the pharmacology courses that a	610
physician assistant is required to complete to receive a	611
certificate to prescribe;	612

(3)(2) Standards and procedures for the issuance and renewal	613
of certificates to prescribe to physician assistants;	614

(4)(3) Standards and procedures for the appropriate conduct	615
of the provisional period that a physician assistant is required	616
to complete pursuant to section 4730.45 of the Revised Code and	617
for determining whether a physician assistant has successfully	618
completed the provisional period;	619

(5)(4) A specific prohibition against prescribing any drug or	620
device to perform or induce an abortion;	621

(6)(5) Standards and procedures to be followed by a physician	622
assistant in personally furnishing samples of drugs or complete or	623
partial supplies of drugs to patients under section 4730.43 of the	624
Revised Code;	625

(7)(6) Any other requirements the board considers necessary	626
to implement the provisions of this chapter regarding	627
physician-delegated prescriptive authority and the issuance of	628
certificates to prescribe.	629

(B)(C)(1) After adopting the initial rulesconsidering	630
recommendations submitted by the physician assistant policy	631
committee pursuant to sections 4730.06 and 4730.38 of the Revised	632
Code, the board shall conduct an annual review either or both of	633
the rules. Basedfollowing, as appropriate according to the	634
submitted recommendations:	635

(a) The formulary the board adopts under division (A)(1) of	636
this section;	637

(b) The rules the board adopts under division (A)(2) of this	638
section regarding physician-delegated prescriptive authority.	639

(2) Based on its review, the board shall make any necessary	640
modifications to the formulary or rules.	641

(C) All rules adopted under this section shall be adopted in	642
accordance with Chapter 119. of the Revised Code. When adopting	643
the initial rules, the board shall consider the recommendations of	644
the physician assistant policy committee submitted pursuant to	645
division (A) of section 4730.38 of the Revised Code. When making	646
any modifications to the rules subsequent to its annual review of	647
the rules, the board shall consider the committee's	648
recommendations submitted pursuant to division (B) of section	649
4730.38 of the Revised Code.	650

Sec. 4730.40.  (A) Subject to divisionsdivision (B) and (C)	651
of this section, the physician assistant formulary established	652
adopted by the state medical board in rules adopted under section	653
4730.39 of the Revised Code listing the drugs and therapeutic	654
devices by class and specific nomenclature that a supervising	655
physician may include in the physician-delegated prescriptive	656
authority granted to a physician assistant who holds a certificate	657
to prescribe issued under this chapter may include any or all of	658
the following drugs:	659

(1) Schedule II, III, IV, and V controlled substances;

660

(2) Drugs that under state or federal law may be dispensed	661
only pursuant to a prescription by a licensed health professional	662
authorized to prescribe drugs, as defined in section 4729.01 of	663
the Revised Code;	664

(3) Any drug that is not a dangerous drug, as defined in	665
section 4729.01 of the Revised Code.	666

(B) The formulary established in the board's rulesadopted by	667
the board shall not include, and shall specify that it does not	668
include, the following:	669

(1) Any schedule II controlled substance;

670

(2) Anyany drug or device used to perform or induce an	671
abortion.	672

(C) When adopting rules establishing the initial formulary,	673
the board shall include provisions ensuring that a physician	674
assistant who holds a certificate to prescribe issued under this	675
chapter may be granted physician-delegated prescriptive authority	676
for all drugs and therapeutic devices that may be prescribed on	677
the effective date of the rules by a holder of a certificate to	678
prescribe issued by the board of nursing under Chapter 4723. of	679
the Revised Code, with the exception of schedule II controlled	680
substances. To the extent permitted by division (A) of this	681
section, the initial formulary may include additional drugs or	682
therapeutic devices.	683

Sec. 4730.41.  (A) A certificate to prescribe issued under	684
this chapter authorizes a physician assistant to prescribe and	685
personally furnish drugs and therapeutic devices in the exercise	686
of physician-delegated prescriptive authority.	687

(B) In exercising physician-delegated prescriptive authority,	688
a physician assistant is subject to all of the following:	689

(1) The physician assistant shall exercise	690
physician-delegated prescriptive authority only to the extent that	691
the physician supervising the physician assistant has granted that	692
authority.	693

(2) The physician assistant shall comply with all conditions	694
placed on the physician-delegated prescriptive authority, as	695
specified by the supervising physician who is supervising the	696
physician assistant in the exercise of physician-delegated	697
prescriptive authority.	698

(3) If the physician assistant possesses physician-delegated	699
prescriptive authority for controlled substances, the physician	700
assistant shall register with the federal drug enforcement	701
administration.	702

(4) If the physician assistant possesses physician-delegated	703
prescriptive authority for schedule II controlled substances, the	704
physician assistant shall comply with section 4730.411 of the	705
Revised Code.	706

Sec. 4730.411. (A) Except as provided in division (B) or (C)	707
of this section, the physician assistant may prescribe to a	708
patient a schedule II controlled substance only if all of the	709
following are the case:	710

(1) The patient is in a terminal condition, as defined in	711
section 2133.01 of the Revised Code.	712

(2) The physician assistant's supervising physician initially	713
prescribed the substance for the patient.	714

(3) The prescription is for an amount that does not exceed	715
the amount necessary for the patient's use in a single,	716
twenty-four-hour period.	717

(B) The restrictions on prescriptive authority in division	718
(A) of this section do not apply if a physician assistant issues	719
the prescription to the patient from any of the following	720
locations:	721

(1) A hospital registered under section 3701.07 of the	722
Revised Code;	723

(2) A health care facility operated by the department of	724
mental health or the department of developmental disabilities;	725

(3) A nursing home licensed under section 3721.02 of the	726
Revised Code or by a political subdivision certified under section	727
3721.09 of the Revised Code;	728

(4) A county home or district home operated under Chapter	729
5155. of the Revised Code that is certified under Title XVIII or	730
XIX of the Social Security Act of 1935;	731

(5) A hospice care program, as defined in section 3712.01 of	732
the Revised Code;	733

(6) A community mental health facility, as defined in section	734
5122.01 of the Revised Code;	735

(7) An ambulatory surgical facility, as defined in section	736
3702.30 of the Revised Code;	737

(8) A freestanding birthing center, as defined in section	738
3702.51 of the Revised Code;	739

(9) A federally qualified health center, as defined in	740
section 1905(l)(2)(B) of the "Social Security Act," 103 Stat. 2264	741
(1989), 42 U.S.C. 1396d(l)(2)(B);	742

(10) A health care office or facility operated by the board	743
of health of a city or general health district or the authority	744
having the duties of a board of health under section 3709.05 of	745
the Revised Code.	746

(C) A physician assistant shall not issue to a patient a	747
prescription for a schedule II controlled substance from a	748
convenience care clinic even if the convenience care clinic is	749
owned or operated by an entity specified in division (B) of this	750
section.	751

Sec. 4730.42.  (A) In granting physician-delegated	752
prescriptive authority to a particular physician assistant who	753
holds a certificate to prescribe issued under this chapter, the	754
supervising physician is subject to all of the following:	755

(1) The supervising physician shall not grant	756
physician-delegated prescriptive authority for any drug or	757
therapeutic device that is not listed on the physician assistant	758
formulary established in rules adopted under section 4730.39 of	759
the Revised Code as a drug or therapeutic device that may be	760
included in the physician-delegated prescriptive authority granted	761
to a physician assistant.	762

(2) The supervising physician shall not grant	763
physician-delegated prescriptive authority for any drug or device	764
that may be used to perform or induce an abortion.	765

(3) The supervising physician shall not grant	766
physician-delegated prescriptive authority in a manner that	767
exceeds the supervising physician's prescriptive authority.	768

(4) The supervising physician shall supervise the physician	769
assistant in accordance with all of the following:	770

(a) The supervision requirements specified in section 4730.21	771
of the Revised Code and, in the case of supervision provided	772
during a provisional period of physician-delegated prescriptive	773
authority, the supervision requirements specified in section	774
4730.45 of the Revised Code;	775

(b) The physician supervisory plan approved for the	776
supervising physician or the policies of the health care facility	777
in which the physician and physician assistant are practicing;	778

(c) The supervision agreement approved under section 4730.19	779
of the Revised Code that applies to the supervising physician and	780
the physician assistant.	781

(B)(1) The supervising physician of a physician assistant may	782
place conditions on the physician-delegated prescriptive authority	783
granted to the physician assistant. If conditions are placed on	784
that authority, the supervising physician shall maintain a written	785
record of the conditions and make the record available to the	786
state medical board on request.	787

(2) The conditions that a supervising physician may place on	788
the physician-delegated prescriptive authority granted to a	789
physician assistant include the following:	790

(a) Identification by class and specific generic nomenclature	791
of drugs and therapeutic devices that the physician chooses not to	792
permit the physician assistant to prescribe;	793

(b) Limitations on the dosage units or refills that the	794
physician assistant is authorized to prescribe;	795

(c) Specification of circumstances under which the physician	796
assistant is required to refer patients to the supervising	797
physician or another physician when exercising physician-delegated	798
prescriptive authority;	799

(d) Responsibilities to be fulfilled by the physician in	800
supervising the physician assistant that are not otherwise	801
specified in the physician supervisory plan or otherwise required	802
by this chapter.	803

Sec. 4730.44. (A) A physician assistant seeking a certificate	804
to prescribe shall submit to the state medical board a written	805
application on a form prescribed and supplied by the board. The	806
application shall include all of the following information:	807

(1) The applicant's name, residential address, business	808
address, if any, and social security number;	809

(2) Evidence of holding a valid certificate to practice as a	810
physician assistant issued under this chapter;	811

(3) One of the following:

812

(a) Satisfactory proof that the applicant meets the	813
requirements specified in section 4730.46 of the Revised Code to	814
participate in a provisional period of physician-delegated	815
prescriptive authority or satisfactory;	816

(b) Satisfactory proof of successful completion of the	817
provisional period, evidenced by a letter or copy of a letter	818
attesting to the successful completion written by a supervising	819
physician of the physician assistant at the time of completion;	820

(c) Satisfactory proof that the applicant has practiced as a	821
physician assistant in another state or was credentialed or	822
employed as a physician assistant by the United States government,	823
holds a master's or higher degree that was obtained from a program	824
accredited by the accreditation review commission on education for	825
the physician assistant or a predecessor or successor organization	826
recognized by the board, and held valid authority issued by the	827
other state or the United States government to prescribe	828
therapeutic devices and drugs, including at least some controlled	829
substances, evidenced by an affidavit issued by an appropriate	830
agency or office of the other state or the United States	831
government attesting to the prescriptive authority described in	832
division (A)(3)(c) of this section.	833

(4) Any other information the board requires.

834

(B) At the time of making application for a certificate to	835
prescribe, the applicant shall pay the board a fee of one hundred	836
dollars, no part of which shall be returned. The fees shall be	837
deposited in accordance with section 4731.24 of the Revised Code.	838

(C)(1) The board shall review all applications received. If	839
an application is complete and the board determines that the	840
applicant meets the requirements for a certificate to prescribe,	841
the board shall, subject to division (C)(2) of this section, issue	842
the certificate to the applicant. The	843

(2) The initial certificate to prescribe issued to an	844
applicant who meets the requirements of division (A)(3)(a) of this	845
section shall be issued as a provisional certificate to prescribe.	846

Sec. 4730.45.  (A) A provisional certificate to prescribe	847
issued under division (C)(2) of section 4730.44 of the Revised	848
Code authorizes the physician assistant holding the certificate to	849
participate in a provisional period of physician-delegated	850
prescriptive authority. The physician assistant shall successfully	851
complete the provisional period as a condition of receiving a new	852
certificate to prescribe.	853

(B) The provisional period shall be conducted by one or more	854
supervising physicians in accordance with rules adopted under	855
section 4730.39 of the Revised Code. When supervising a physician	856
assistant who is completing the first five hundred hours of a	857
provisional period, the supervising physician shall provide	858
on-site supervision of the physician assistant's exercise of	859
physician-delegated prescriptive authority.	860

The provisional period shall last not longer than one year,	861
unless it is extended for not longer than one additional year at	862
the direction of a supervising physician. The physician assistant	863
shall not be required to participate in the provisional period for	864
more than one-thousand-eight-hundredone thousand eight hundred	865
hours, except when a supervising physician has extended the	866
physician assistant's provisional period.	867

(C) If a physician assistant does not successfully complete	868
the provisional period, each supervising physician shall cease	869
granting physician-delegated prescriptive authority to the	870
physician assistant. The supervising physician with primary	871
responsibility for conducting the provisional period shall	872
promptly notify the state medical board that the physician	873
assistant did not successfully complete the provisional period and	874
the board shall revoke the certificate.	875

(D) A physician assistant who successfully completes a	876
provisional period shall not be required to complete another	877
provisional period as a condition of being eligible to be granted	878
physician-delegated prescriptive authority by a supervising	879
physician who was not involved in the conduct of the provisional	880
period.	881

Sec. 4755.48.  (A) No person shall employ fraud or deception	882
in applying for or securing a license to practice physical therapy	883
or to be a physical therapist assistant.	884

(B) No person shall practice or in any way imply or claim to	885
the public by words, actions, or the use of letters as described	886
in division (C) of this section to be able to practice physical	887
therapy or to provide physical therapy services, including	888
practice as a physical therapist assistant, unless the person	889
holds a valid license under sections 4755.40 to 4755.56 of the	890
Revised Code or except for submission of claims as provided in	891
section 4755.56 of the Revised Code.	892

(C) No person shall use the words or letters, physical	893
therapist, physical therapy, physical therapy services,	894
physiotherapist, physiotherapy, physiotherapy services, licensed	895
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T.,	896
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical	897
therapist assistant, physical therapy technician, licensed	898
physical therapist assistant, L.P.T.A., R.P.T.A., or any other	899
letters, words, abbreviations, or insignia, indicating or implying	900
that the person is a physical therapist or physical therapist	901
assistant without a valid license under sections 4755.40 to	902
4755.56 of the Revised Code.	903

(D) No person who practices physical therapy or assists in	904
the provision of physical therapy treatments under the supervision	905
of a physical therapist shall fail to display the person's current	906
license granted under sections 4755.40 to 4755.56 of the Revised	907
Code in a conspicuous location in the place where the person	908
spends the major part of the person's time so engaged.	909

(E) Nothing in sections 4755.40 to 4755.56 of the Revised	910
Code shall affect or interfere with the performance of the duties	911
of any physical therapist or physical therapist assistant in	912
active service in the army, navy, coast guard, marine corps, air	913
force, public health service, or marine hospital service of the	914
United States, while so serving.	915

(F) Nothing in sections 4755.40 to 4755.56 of the Revised	916
Code shall prevent or restrict the activities or services of a	917
person pursingpursuing a course of study leading to a degree in	918
physical therapy in an accredited or approved educational program	919
if the activities or services constitute a part of a supervised	920
course of study and the person is designated by a title that	921
clearly indicates the person's status as a student.	922

(G) No(1) Except as provided in division (G)(2) of this	923
section and subject to division (H) of this section, no person	924
shall practice physical therapy other than on the prescription of,	925
or the referral of a patient by, a person who is licensed in this	926
or another state to practicedo at least one of the following:	927

(a) Practice medicine and surgery, chiropractic, dentistry,	928
osteopathic medicine and surgery, podiatric medicine and surgery,	929
or to practice;	930

(b) Practice as a physician assistant;

931

(c) Practice nursing as a certified registered nurse	932
anesthetist, clinical nurse specialist, certified nurse-midwife,	933
or certified nurse practitioner, within the scope of such	934
practices, and whose license is in good standing, unless either of	935
the following conditions is met:.	936

(1)(2) The prohibition in division (G)(1) of this section on	937
practicing physical therapy other than on the prescription of, or	938
the referral of a patient by, any of the persons described in that	939
division does not apply if either of the following applies to the	940
person:	941

(a) The person holds a master's or doctorate degree from a	942
professional physical therapy program that is accredited by a	943
national physical therapy accreditation agency recognized by the	944
United States department of education.	945

(2)(b) On or before December 31, 2004, the person has	946
completed at least two years of practical experience as a licensed	947
physical therapist.	948

(H) To be authorized to prescribe physical therapy or refer	949
a patient to a physical therapist for physical therapy, a person	950
described in division (G)(1) of this section must be in good	951
standing with the relevant licensing board in this state or the	952
state in which the person is licensed and must act only within the	953
person's scope of practice.	954

(I) In the prosecution of any person for violation of	955
division (B) or (C) of this section, it is not necessary to allege	956
or prove want of a valid license to practice physical therapy or	957
to practice as a physical therapist assistant, but such matters	958
shall be a matter of defense to be established by the accused.	959

Sec. 4755.481. (A) If a physical therapist evaluates and	960
treats a patient without the prescription of, or the referral of	961
the patient by, a person who is licensed to practice medicine and	962
surgery, chiropractic, dentistry, osteopathic medicine and	963
surgery, podiatric medicine and surgery, or nursing as a certified	964
registered nurse anesthetist, clinical nurse specialist, certified	965
nurse-midwife, or certified nurse practitionerdescribed in	966
division (G)(1) of section 4755.48 of the Revised Code, all of the	967
following apply:	968

(1) The physical therapist shall, upon consent of the	969
patient, inform the patient's physician, chiropractor, dentist,	970
podiatrist, certified registered nurse anesthetist, clinical nurse	971
specialist, certified nurse-midwife, or certified nurse	972
practitionerrelevant person described in division (G)(1) of	973
section 4755.48 of the Revised Code of the evaluation not later	974
than five business days after the evaluation is made.	975

(2) If the physical therapist determines, based on reasonable	976
evidence, that no substantial progress has been made with respect	977
to that patient during the thirty-day period immediately following	978
the date of the patient's initial visit with the physical	979
therapist, the physical therapist shall consult with or refer the	980
patient to a licensed physician, chiropractor, dentist,	981
podiatrist, certified registered nurse anesthetist, clinical nurse	982
specialist, certified nurse-midwife, or certified nurse	983
practitionerperson described in division (G)(1) of section	984
4755.48 of the Revised Code, unless either of the following	985
applies:	986

(a) The evaluation, treatment, or services are being provided	987
for fitness, wellness, or prevention purposes.	988

(b) The patient previously was diagnosed with chronic,	989
neuromuscular, or developmental conditions and the evaluation,	990
treatment, or services are being provided for problems or symptoms	991
associated with one or more of those previously diagnosed	992
conditions.	993

(3) If the physical therapist determines that orthotic	994
devices are necessary to treat the patient, the physical therapist	995
shall be limited to the application of the following orthotic	996
devices:	997

(a) Upper extremity adaptive equipment used to facilitate the	998
activities of daily living;	999

(b) Finger splints;

1000

(c) Wrist splints;

1001

(d) Prefabricated elastic or fabric abdominal supports with	1002
or without metal or plastic reinforcing stays and other	1003
prefabricated soft goods requiring minimal fitting;	1004

(e) Nontherapeutic accommodative inlays;

1005

(f) Shoes that are not manufactured or modified for a	1006
particular individual;	1007

(g) Prefabricated foot care products;

1008

(h) Custom foot orthotics;

1009

(i) Durable medical equipment.

1010

(4) If, at any time, the physical therapist has reason to	1011
believe that the patient has symptoms or conditions that require	1012
treatment or services beyond the scope of practice of a physical	1013
therapist, the physical therapist shall refer the patient to a	1014
licensed health care practitioner acting within the practitioner's	1015
scope of practice.	1016

(B) Nothing in sections 4755.40 to 4755.56 of the Revised	1017
Code shall be construed to require reimbursement under any health	1018
insuring corporation policy, contract, or agreement, any sickness	1019
and accident insurance policy, the medical assistance program as	1020
defined in section 5111.01 of the Revised Code, or the health	1021
partnership program or qualified health plans established pursuant	1022
to sections 4121.44 to 4121.442 of the Revised Code, for any	1023
physical therapy service rendered without the prescription of, or	1024
the referral of the patient by, a licensed physician,	1025
chiropractor, dentist, podiatrist, certified registered nurse	1026
anesthetist, clinical nurse specialist, certified nurse-midwife,	1027
or certified nurse practitionerperson described in division	1028
(G)(1) of section 4755.48 of the Revised Code.	1029

(C) For purposes of this section, "business day" means any	1030
calendar day that is not a Saturday, Sunday, or legal holiday.	1031
"Legal holiday" has the same meaning as in section 1.14 of the	1032
Revised Code.	1033

Sec. 4765.01.  As used in this chapter:

1034

(A) "First responder" means an individual who holds a	1035
current, valid certificate issued under section 4765.30 of the	1036
Revised Code to practice as a first responder.	1037

(B) "Emergency medical technician-basic" or "EMT-basic" means	1038
an individual who holds a current, valid certificate issued under	1039
section 4765.30 of the Revised Code to practice as an emergency	1040
medical technician-basic.	1041

(C) "Emergency medical technician-intermediate" or "EMT-I"	1042
means an individual who holds a current, valid certificate issued	1043
under section 4765.30 of the Revised Code to practice as an	1044
emergency medical technician-intermediate.	1045

(D) "Emergency medical technician-paramedic" or "paramedic"	1046
means an individual who holds a current, valid certificate issued	1047
under section 4765.30 of the Revised Code to practice as an	1048
emergency medical technician-paramedic.	1049

(E) "Ambulance" means any motor vehicle that is used, or is	1050
intended to be used, for the purpose of responding to emergency	1051
medical situations, transporting emergency patients, and	1052
administering emergency medical service to patients before,	1053
during, or after transportation.	1054

(F) "Cardiac monitoring" means a procedure used for the	1055
purpose of observing and documenting the rate and rhythm of a	1056
patient's heart by attaching electrical leads from an	1057
electrocardiograph monitor to certain points on the patient's body	1058
surface.	1059

(G) "Emergency medical service" means any of the services	1060
described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of	1061
the Revised Code that are performed by first responders, emergency	1062
medical technicians-basic, emergency medical	1063
technicians-intermediate, and paramedics. "Emergency medical	1064
service" includes such services performed before or during any	1065
transport of a patient, including transports between hospitals and	1066
transports to and from helicopters.	1067

(H) "Emergency medical service organization" means a public	1068
or private organization using first responders, EMTs-basic,	1069
EMTs-I, or paramedics, or a combination of first responders,	1070
EMTs-basic, EMTs-I, and paramedics, to provide emergency medical	1071
services.	1072

(I) "Physician" means an individual who holds a current,	1073
valid certificate issued under Chapter 4731. of the Revised Code	1074
authorizing the practice of medicine and surgery or osteopathic	1075
medicine and surgery.	1076

(J) "Registered nurse" means an individual who holds a	1077
current, valid license issued under Chapter 4723. of the Revised	1078
Code authorizing the practice of nursing as a registered nurse.	1079

(K) "Volunteer" means a person who provides services either	1080
for no compensation or for compensation that does not exceed the	1081
actual expenses incurred in providing the services or in training	1082
to provide the services.	1083

(L) "Emergency medical service personnel" means first	1084
responders, emergency medical service technicians-basic, emergency	1085
medical service technicians-intermediate, emergency medical	1086
service technicians-paramedic, and persons who provide medical	1087
direction to such persons.	1088

(M) "Hospital" has the same meaning as in section 3727.01 of	1089
the Revised Code.	1090

(N) "Trauma" or "traumatic injury" means severe damage to or	1091
destruction of tissue that satisfies both of the following	1092
conditions:	1093

(1) It creates a significant risk of any of the following:

1094

(a) Loss of life;

1095

(b) Loss of a limb;

1096

(c) Significant, permanent disfigurement;

1097

(d) Significant, permanent disability.

1098

(2) It is caused by any of the following:

1099

(a) Blunt or penetrating injury;

1100

(b) Exposure to electromagnetic, chemical, or radioactive	1101
energy;	1102

(c) Drowning, suffocation, or strangulation;

1103

(d) A deficit or excess of heat.

1104

(O) "Trauma victim" or "trauma patient" means a person who	1105
has sustained a traumatic injury.	1106

(P) "Trauma care" means the assessment, diagnosis,	1107
transportation, treatment, or rehabilitation of a trauma victim by	1108
emergency medical service personnel or by a physician, nurse,	1109
physician assistant, respiratory therapist, physical therapist,	1110
chiropractor, occupational therapist, speech-language pathologist,	1111
audiologist, or psychologist licensed to practice as such in this	1112
state or another jurisdiction.	1113

(Q) "Trauma center" means all of the following:

1114

(1) Any hospital that is verified by the American college of	1115
surgeons as an adult or pediatric trauma center;	1116

(2) Any hospital that is operating as an adult or pediatric	1117
trauma center under provisional status pursuant to section	1118
3727.101 of the Revised Code;	1119

(3) Until December 31, 2004, any hospital in this state that	1120
is designated by the director of health as a level II pediatric	1121
trauma center under section 3727.081 of the Revised Code;	1122

(4) Any hospital in another state that is licensed or	1123
designated under the laws of that state as capable of providing	1124
specialized trauma care appropriate to the medical needs of the	1125
trauma patient.	1126

(R) "Pediatric" means involving a patient who is less than	1127
sixteen years of age.	1128

(S) "Adult" means involving a patient who is not a pediatric	1129
patient.	1130

(T) "Geriatric" means involving a patient who is at least	1131
seventy years old or exhibits significant anatomical or	1132
physiological characteristics associated with advanced aging.	1133

(U) "Air medical organization" means an organization that	1134
provides emergency medical services, or transports emergency	1135
victims, by means of fixed or rotary wing aircraft.	1136

(V) "Emergency care" and "emergency facility" have the same	1137
meanings as in section 3727.01 of the Revised Code.	1138

(W) "Stabilize," except as it is used in division (B) of	1139
section 4765.35 of the Revised Code with respect to the manual	1140
stabilization of fractures, has the same meaning as in section	1141
1753.28 of the Revised Code.	1142

(X) "Transfer" has the same meaning as in section 1753.28 of	1143
the Revised Code.	1144

(Y) "Firefighter" means any member of a fire department as	1145
defined in section 742.01 of the Revised Code.	1146

(Z) "Volunteer firefighter" has the same meaning as in	1147
section 146.01 of the Revised Code.	1148

(AA) "Part-time paid firefighter" means a person who provides	1149
firefighting services on less than a full-time basis, is routinely	1150
scheduled to be present on site at a fire station or other	1151
designated location for purposes of responding to a fire or other	1152
emergency, and receives more than nominal compensation for the	1153
provision of firefighting services.	1154

(BB) "Physician assistant" means an individual who holds a	1155
valid certificate to practice as a physician assistant issued	1156
under Chapter 4730. of the Revised Code.	1157

Sec. 4765.35.  (A) A first responder shall perform the	1158
emergency medical services described in this section in accordance	1159
with this chapter and any rules adopted under it.	1160

(B) A first responder may provide limited emergency medical	1161
services to patients until the arrival of an emergency medical	1162
technician-basic, emergency medical technician-intermediate, or	1163
emergency medical technician-paramedic. In an emergency, a first	1164
responder may render emergency medical services such as opening	1165
and maintaining an airway, giving mouth to barrier ventilation,	1166
chest compressions, electrical interventions with automated	1167
defibrillators to support or correct the cardiac function and	1168
other methods determined by the board, controlling of hemorrhage,	1169
manual stabilization of fractures, bandaging, assisting in	1170
childbirth, and determining triage of trauma victims.	1171

(C) A first responder may perform any other emergency medical	1172
services approved pursuant to rules adopted under section 4765.11	1173
of the Revised Code. The board shall determine whether the nature	1174
of any such service requires that a first responder receive	1175
authorization prior to performing the service.	1176

(D)(1) Except as provided in division (D)(2) of this section,	1177
if the board determines under division (C) of this section that a	1178
service requires prior authorization, the service shall be	1179
performed only pursuant to the written or verbal authorization of	1180
a physician or of the cooperating physician advisory board, or	1181
pursuant to an authorization transmitted through a direct	1182
communication device by a physician, physician assistant	1183
designated by a physician, or registered nurse designated by a	1184
physician.	1185

(2) If communications fail during an emergency situation or	1186
the required response time prohibits communication, a first	1187
responder may perform services subject to this division, if, in	1188
the judgment of the first responder, the life of the patient is in	1189
immediate danger. Services performed under these circumstances	1190
shall be performed in accordance with the written protocols for	1191
triage of adult and pediatric trauma victims established in rules	1192
adopted under sections 4765.11 and 4765.40 of the Revised Code and	1193
any applicable protocols adopted by the emergency medical service	1194
organization with which the first responder is affiliated.	1195

Sec. 4765.36.  In a hospital, an emergency medical	1196
technician-basic, emergency medical technician-intermediate, or	1197
emergency medical technician-paramedic may perform emergency	1198
medical services only under the direction and supervision of a	1199
physician or registered nurse designated by a physician and only	1200
if the services are performed in accordance with both of the	1201
following conditions:	1202

(A) Only in the hospital's emergency department or while	1203
moving a patient between the emergency department and another part	1204
of the hospital;	1205

(B) Only under the direction and supervision of one of the	1206
following:	1207

(1) A physician;

1208

(2) A physician assistant designated by a physician;

1209

(3) A registered nurse designated by a physician.

1210

Sec. 4765.37.  (A) An emergency medical technician-basic	1211
shall perform the emergency medical services described in this	1212
section in accordance with this chapter and any rules adopted	1213
under it by the state board of emergency medical services.	1214

(B) An emergency medical technician-basic may operate, or be	1215
responsible for operation of, an ambulance and may provide	1216
emergency medical services to patients. In an emergency, an	1217
EMT-basic may determine the nature and extent of illness or injury	1218
and establish priority for required emergency medical services. An	1219
EMT-basic may render emergency medical services such as opening	1220
and maintaining an airway, giving positive pressure ventilation,	1221
cardiac resuscitation, electrical interventions with automated	1222
defibrillators to support or correct the cardiac function and	1223
other methods determined by the board, controlling of hemorrhage,	1224
treatment of shock, immobilization of fractures, bandaging,	1225
assisting in childbirth, management of mentally disturbed	1226
patients, initial care of poison and burn patients, and	1227
determining triage of adult and pediatric trauma victims. Where	1228
patients must in an emergency be extricated from entrapment, an	1229
EMT-basic may assess the extent of injury and render all possible	1230
emergency medical services and protection to the entrapped	1231
patient; provide light rescue services if an ambulance has not	1232
been accompanied by a specialized unit; and after extrication,	1233
provide additional care in sorting of the injured in accordance	1234
with standard emergency procedures.	1235

(C) An EMT-basic may perform any other emergency medical	1236
services approved pursuant to rules adopted under section 4765.11	1237
of the Revised Code. The board shall determine whether the nature	1238
of any such service requires that an EMT-basic receive	1239
authorization prior to performing the service.	1240

(D)(1) Except as provided in division (D)(2) of this section,	1241
if the board determines under division (C) of this section that a	1242
service requires prior authorization, the service shall be	1243
performed only pursuant to the written or verbal authorization of	1244
a physician or of the cooperating physician advisory board, or	1245
pursuant to an authorization transmitted through a direct	1246
communication device by a physician, physician assistant	1247
designated by a physician, or registered nurse designated by a	1248
physician.	1249

(2) If communications fail during an emergency situation or	1250
the required response time prohibits communication, an EMT-basic	1251
may perform services subject to this division, if, in the judgment	1252
of the EMT-basic, the life of the patient is in immediate danger.	1253
Services performed under these circumstances shall be performed in	1254
accordance with the protocols for triage of adult and pediatric	1255
trauma victims established in rules adopted under sections 4765.11	1256
and 4765.40 of the Revised Code and any applicable protocols	1257
adopted by the emergency medical service organization with which	1258
the EMT-basic is affiliated.	1259

Sec. 4765.38.  (A) An emergency medical	1260
technician-intermediate shall perform the emergency medical	1261
services described in this section in accordance with this chapter	1262
and any rules adopted under it.	1263

(B) An EMT-I may do any of the following:

1264

(1) Establish and maintain an intravenous lifeline that has	1265
been approved by a cooperating physician or physician advisory	1266
board;	1267

(2) Perform cardiac monitoring;

1268

(3) Perform electrical interventions to support or correct	1269
the cardiac function;	1270

(4) Administer epinephrine;

1271

(5) Determine triage of adult and pediatric trauma victims;

1272

(6) Perform any other emergency medical services approved	1273
pursuant to rules adopted under section 4765.11 of the Revised	1274
Code.	1275

(C)(1) Except as provided in division (C)(2) of this section,	1276
the services described in division (B) of this section shall be	1277
performed by an EMT-I only pursuant to the written or verbal	1278
authorization of a physician or of the cooperating physician	1279
advisory board, or pursuant to an authorization transmitted	1280
through a direct communication device by a physician, physician	1281
assistant designated by a physician, or registered nurse	1282
designated by a physician.	1283

(2) If communications fail during an emergency situation or	1284
the required response time prohibits communication, an EMT-I may	1285
perform any of the services described in division (B) of this	1286
section, if, in the judgment of the EMT-I, the life of the patient	1287
is in immediate danger. Services performed under these	1288
circumstances shall be performed in accordance with the protocols	1289
for triage of adult and pediatric trauma victims established in	1290
rules adopted under sections 4765.11 and 4765.40 of the Revised	1291
Code and any applicable protocols adopted by the emergency medical	1292
service organization with which the EMT-I is affiliated.	1293

(D) In addition to, and in the course of, providing emergency	1294
medical treatment, an emergency medical technician-intermediate	1295
may withdraw blood as provided under sections 1547.11, 4506.17,	1296
and 4511.19 of the Revised Code. An emergency medical	1297
technician-intermediate shall withdraw blood in accordance with	1298
this chapter and any rules adopted under it by the state board of	1299
emergency medical services.	1300

Sec. 4765.39.  (A) An emergency medical technician-paramedic	1301
shall perform the emergency medical services described in this	1302
section in accordance with this chapter and any rules adopted	1303
under it.	1304

(B) A paramedic may do any of the following:

1305

(1) Perform cardiac monitoring;

1306

(2) Perform electrical interventions to support or correct	1307
the cardiac function;	1308

(3) Perform airway procedures;

1309

(4) Perform relief of pneumothorax;

1310

(5) Administer appropriate drugs and intravenous fluids;

1311

(6) Determine triage of adult and pediatric trauma victims;

1312

(7) Perform any other emergency medical services, including	1313
life support or intensive care techniques, approved pursuant to	1314
rules adopted under section 4765.11 of the Revised Code.	1315

(C)(1) Except as provided in division (C)(2) of this section,	1316
the services described in division (B) of this section shall be	1317
performed by a paramedic only pursuant to the written or verbal	1318
authorization of a physician or of the cooperating physician	1319
advisory board, or pursuant to an authorization transmitted	1320
through a direct communication device by a physician, physician	1321
assistant designated by a physician, or registered nurse	1322
designated by a physician.	1323

(2) If communications fail during an emergency situation or	1324
the required response time prohibits communication, a paramedic	1325
may perform any of the services described in division (B) of this	1326
section, if, in the paramedic's judgment, the life of the patient	1327
is in immediate danger. Services performed under these	1328
circumstances shall be performed in accordance with the protocols	1329
for triage of adult and pediatric trauma victims established in	1330
rules adopted under sections 4765.11 and 4765.40 of the Revised	1331
Code and any applicable protocols adopted by the emergency medical	1332
service organization with which the paramedic is affiliated.	1333

(D) In addition to, and in the course of, providing emergency	1334
medical treatment, an emergency medical technician-paramedic may	1335
withdraw blood as provided under sections 1547.11, 4506.17, and	1336
4511.19 of the Revised Code. An emergency medical	1337
technician-paramedic shall withdraw blood in accordance with this	1338
chapter and any rules adopted under it by the state board of	1339
emergency medical services.	1340

Sec. 4765.49.  (A) A first responder, emergency medical	1341
technician-basic, emergency medical technician-intermediate, or	1342
emergency medical technician-paramedic is not liable in damages in	1343
a civil action for injury, death, or loss to person or property	1344
resulting from the individual's administration of emergency	1345
medical services, unless the services are administered in a manner	1346
that constitutes willful or wanton misconduct. A physician,	1347
physician assistant designated by a physician, or registered nurse	1348
designated by a physician, whoany of whom is advising or	1349
assisting in the emergency medical services by means of any	1350
communication device or telemetering system, is not liable in	1351
damages in a civil action for injury, death, or loss to person or	1352
property resulting from the individual's advisory communication or	1353
assistance, unless the advisory communication or assistance is	1354
provided in a manner that constitutes willful or wanton	1355
misconduct. Medical directors and members of cooperating physician	1356
advisory boards of emergency medical service organizations are not	1357
liable in damages in a civil action for injury, death, or loss to	1358
person or property resulting from their acts or omissions in the	1359
performance of their duties, unless the act or omission	1360
constitutes willful or wanton misconduct.	1361

(B) A political subdivision, joint ambulance district, joint	1362
emergency medical services district, or other public agency, and	1363
any officer or employee of a public agency or of a private	1364
organization operating under contract or in joint agreement with	1365
one or more political subdivisions, that provides emergency	1366
medical services, or that enters into a joint agreement or a	1367
contract with the state, any political subdivision, joint	1368
ambulance district, or joint emergency medical services district	1369
for the provision of emergency medical services, is not liable in	1370
damages in a civil action for injury, death, or loss to person or	1371
property arising out of any actions taken by a first responder,	1372
EMT-basic, EMT-I, or paramedic working under the officer's or	1373
employee's jurisdiction, or for injury, death, or loss to person	1374
or property arising out of any actions of licensed medical	1375
personnel advising or assisting the first responder, EMT-basic,	1376
EMT-I, or paramedic, unless the services are provided in a manner	1377
that constitutes willful or wanton misconduct.	1378

(C) A student who is enrolled in an emergency medical	1379
services training program accredited under section 4765.17 of the	1380
Revised Code or an emergency medical services continuing education	1381
program approved under that section is not liable in damages in a	1382
civil action for injury, death, or loss to person or property	1383
resulting from either of the following:	1384

(1) The student's administration of emergency medical	1385
services or patient care or treatment, if the services, care, or	1386
treatment is administered while the student is under the direct	1387
supervision and in the immediate presence of an EMT-basic, EMT-I,	1388
paramedic, registered nurse, physician assistant, or physician and	1389
while the student is receiving clinical training that is required	1390
by the program, unless the services, care, or treatment is	1391
provided in a manner that constitutes willful or wanton	1392
misconduct;	1393

(2) The student's training as an ambulance driver, unless the	1394
driving is done in a manner that constitutes willful or wanton	1395
misconduct.	1396

(D) An EMT-basic, EMT-I, paramedic, or other operator, who	1397
holds a valid commercial driver's license issued pursuant to	1398
Chapter 4506. of the Revised Code or driver's license issued	1399
pursuant to Chapter 4507. of the Revised Code and who is employed	1400
by an emergency medical service organization that is not owned or	1401
operated by a political subdivision as defined in section 2744.01	1402
of the Revised Code, is not liable in damages in a civil action	1403
for injury, death, or loss to person or property that is caused by	1404
the operation of an ambulance by the EMT-basic, EMT-I, paramedic,	1405
or other operator while responding to or completing a call for	1406
emergency medical services, unless the operation constitutes	1407
willful or wanton misconduct or does not comply with the	1408
precautions of section 4511.03 of the Revised Code. An emergency	1409
medical service organization is not liable in damages in a civil	1410
action for any injury, death, or loss to person or property that	1411
is caused by the operation of an ambulance by its employee or	1412
agent, if this division grants the employee or agent immunity from	1413
civil liability for the injury, death, or loss.	1414

(E) An employee or agent of an emergency medical service	1415
organization who receives requests for emergency medical services	1416
that are directed to the organization, dispatches first	1417
responders, EMTs-basic, EMTs-I, or paramedics in response to those	1418
requests, communicates those requests to those employees or agents	1419
of the organization who are authorized to dispatch first	1420
responders, EMTs-basic, EMTs-I, or paramedics, or performs any	1421
combination of these functions for the organization, is not liable	1422
in damages in a civil action for injury, death, or loss to person	1423
or property resulting from the individual's acts or omissions in	1424
the performance of those duties for the organization, unless an	1425
act or omission constitutes willful or wanton misconduct.	1426

(F) A person who is performing the functions of a first	1427
responder, EMT-basic, EMT-I, or paramedic under the authority of	1428
the laws of a state that borders this state and who provides	1429
emergency medical services to or transportation of a patient in	1430
this state is not liable in damages in a civil action for injury,	1431
death, or loss to person or property resulting from the person's	1432
administration of emergency medical services, unless the services	1433
are administered in a manner that constitutes willful or wanton	1434
misconduct. A physician, physician assistant designated by a	1435
physician, or registered nurse designated by a physician, whoany	1436
of whom is licensed to practice in the adjoining state and who is	1437
advising or assisting in the emergency medical services by means	1438
of any communication device or telemetering system, is not liable	1439
in damages in a civil action for injury, death, or loss to person	1440
or property resulting from the person's advisory communication or	1441
assistance, unless the advisory communication or assistance is	1442
provided in a manner that constitutes willful or wanton	1443
misconduct.	1444

(G) A person certified under section 4765.23 of the Revised	1445
Code to teach in an emergency medical services training program or	1446
emergency medical services continuing education program, and a	1447
person who teaches at the Ohio fire academy established under	1448
section 3737.33 of the Revised Code or in a fire service training	1449
program described in division (A) of section 4765.55 of the	1450
Revised Code, is not liable in damages in a civil action for	1451
injury, death, or loss to person or property resulting from the	1452
person's acts or omissions in the performance of the person's	1453
duties, unless an act or omission constitutes willful or wanton	1454
misconduct.	1455

(H) In the accreditation of emergency medical services	1456
training programs or approval of emergency medical services	1457
continuing education programs, the state board of emergency	1458
medical services and any person or entity authorized by the board	1459
to evaluate applications for accreditation or approval are not	1460
liable in damages in a civil action for injury, death, or loss to	1461
person or property resulting from their acts or omissions in the	1462
performance of their duties, unless an act or omission constitutes	1463
willful or wanton misconduct.	1464

(I) A person authorized by an emergency medical service	1465
organization to review the performance of first responders,	1466
EMTs-basic, EMTs-I, and paramedics or to administer quality	1467
assurance programs is not liable in damages in a civil action for	1468
injury, death, or loss to person or property resulting from the	1469
person's acts or omissions in the performance of the person's	1470
duties, unless an act or omission constitutes willful or wanton	1471
misconduct.	1472

Sec. 4765.51.  Nothing in this chapter prevents or restricts	1473
the practice, services, or activities of any registered nurse	1474
practicing within the scope of histhe registered nurse's	1475
practice.	1476

Nothing in this chapter prevents or restricts the practice,	1477
services, or activities of any physician assistant practicing in	1478
accordance with a physician supervisory plan approved pursuant to	1479
section 4730.17 of the Revised Code or the policies of the health	1480
care facility in which the physician assistant is practicing.	1481

Sec. 5111.0212. For any service a physician assistant	1482
provides to a medicaid recipient in accordance with Chapter 4730.	1483
of the Revised Code, the medicaid program shall reimburse the	1484
physician assistant an amount that is one hundred per cent of the	1485
amount, as contained in the medicaid fee schedule determined	1486
pursuant to rules adopted under section 5111.02 of the Revised	1487
Code, established as the medicaid maximum for the service.	1488

Sec. 5111.051. (A) As used in this section, "group practice"	1489
has the same meaning as in section 4731.65 of the Revised Code.	1490

(B) The department of job and family services shall establish	1491
a process by which a physician assistant may enter into a medicaid	1492
provider agreement.	1493

(C) Subject to division (D) of this section, a claim for	1494
reimbursement for a service provided by a physician assistant to a	1495
medicaid recipient may be submitted by either of the following:	1496

(1) The physician assistant who provided the service or	1497
another person the physician assistant designates to submit the	1498
claim on the physician assistant's behalf;	1499

(2) The physician, group practice, clinic, or other health	1500
care facility that employs or contracts with the physician	1501
assistant.	1502

(D) A claim for reimbursement may be submitted as described	1503
in division (C)(1) of this section only if the physician assistant	1504
has a valid medicaid provider agreement. When submitting the	1505
claim, the physician assistant or designated person shall use only	1506
the medicaid provider number the department has assigned to the	1507
physician assistant.	1508

Section 2.  That existing sections 185.01, 185.03, 185.05,	1509
2105.35, 2108.40, 2133.211, 3719.06, 4730.06, 4730.09, 4730.38,	1510
4730.39, 4730.40, 4730.41, 4730.42, 4730.44, 4730.45, 4755.48,	1511
4755.481, 4765.01, 4765.35, 4765.36, 4765.37, 4765.38, 4765.39,	1512
4765.49, and 4765.51 and section 4730.401 of the Revised Code are	1513
hereby repealed.	1514