Bill Text: OH SB276 | 2011-2012 | 129th General Assembly | Introduced

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Bill Title: To modify the laws governing physician assistants.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2012-01-03 - To Health, Human Services, & Aging [SB276 Detail]

Download: Ohio-2011-SB276-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

S. B. No. 276

Senator Hite 

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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

and 5111.0216, and to repeal section 4730.401 of

7

the Revised Code to modify the laws governing

8

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 and 5111.0216 of the	14
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) "Patient centered medical home education advisory group"	21
means the entity established under section 185.03 of the Revised	22
Code to implement and administer the patient centered medical home	23
education pilot project.	24

(D) "Patient centered medical home education pilot project"	25
means the pilot project established under section 185.02 of the	26
Revised Code.	27

(E) "Physician assistant" means an individual who holds a	28
valid certificate to practice as a physician assistant issued	29
under Chapter 4730. of the Revised Code.	30

Sec. 185.03. (A) The patient centered medical home education	31
advisory group is hereby created for the purpose of implementing	32
and administering the patient centered medical home pilot project.	33
The advisory group shall develop a set of expected outcomes for	34
the pilot project.	35

(B) The advisory group shall consist of the following voting	36
members:	37

(1) One individual with expertise in the training and	38
education of primary care physicians who is appointed by the dean	39
of the university of Toledo college of medicine;	40

(2) One individual with expertise in the training and	41
education of primary care physicians who is appointed by the dean	42
of the Boonshoft school of medicine at Wright state university;	43

(3) One individual with expertise in the training and	44
education of primary care physicians who is appointed by the	45
president and dean of the northeast Ohio medical university;	46

(4) One individual with expertise in the training and	47
education of primary care physicians who is appointed by the dean	48
of the Ohio university college of osteopathic medicine;	49

(5) Two individuals appointed by the governing board of the	50
Ohio academy of family physicians;	51

(6) One individual appointed by the governing board of the	52
Ohio chapter of the American college of physicians;	53

(7) One individual appointed by the governing board of the	54
American academy of pediatrics;	55

(8) One individual appointed by the governing board of the	56
Ohio osteopathic association;	57

(9) One individual with expertise in the training and	58
education of advanced practice nurses who is appointed by the	59
governing board of the Ohio council of deans and directors of	60
baccalaureate and higher degree programs in nursing;	61

(10) One individual appointed by the governing board of the	62
Ohio nurses association;	63

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

(12) One individual appointed by the governing board of the	66
Ohio council for home care and hospice;	67

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

(14) One individual appointed by the superintendent of	70
insurance.	71

(C) The advisory group shall consist of the following	72
nonvoting, ex officio members:	73

(1) The executive director of the state medical board, or the	74
director's designee;	75

(2) The executive director of the board of nursing or the	76
director's designee;	77

(3) The chancellor of the Ohio board of regents, or the	78
chancellor's designee;	79

(4) The individual within the department of job and family	80
services who serves as the director of medicaid, or the director's	81
designee;	82

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

83

(D) Advisory group members who are appointed shall serve at	84
the pleasure of their appointing authorities. Terms of office of	85
appointed members shall be three years, except that a member's	86
term ends if the pilot project ceases operation during the	87
member's term.	88

Vacancies shall be filled in the manner provided for original	89
appointments.	90

Members shall serve without compensation, except to the	91
extent that serving on the advisory group is considered part of	92
their regular employment duties.	93

(E) The advisory group shall select from among its members a	94
chairperson and vice-chairperson. The advisory group may select	95
any other officers it considers necessary to conduct its business.	96

A majority of the members of the advisory group constitutes a	97
quorum for the transaction of official business. A majority of a	98
quorum is necessary for the advisory group to take any action,	99
except that when one or more members of a quorum are required to	100
abstain from voting as provided in division (C)(1)(d) or (C)(2)(c)	101
of section 185.05 of the Revised Code, the number of members	102
necessary for a majority of a quorum shall be reduced accordingly.	103

The advisory group shall meet as necessary to fulfill its	104
duties. The times and places for the meetings shall be selected by	105
the chairperson.	106

(F) Sections 101.82 to 101.87 of the Revised Code do not	107
apply to the advisory group.	108

Sec. 185.05. (A) The patient centered medical home education	109
advisory group shall accept applications for inclusion in the	110
patient centered medical home education pilot project from primary	111
care practices with educational affiliations, as determined by the	112
advisory group, with one or more of the following:	113

(1) The Boonshoft school of medicine at Wright state	114
university;	115

(2) The university of Toledo college of medicine;

116

(3) The northeast Ohio medical university;

117

(4) The Ohio university college of osteopathic medicine;

118

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

119

(6) The Wright state university college of nursing and	120
health;	121

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

122

(8) The university of Akron college of nursing;

123

(9) The school of nursing at Ohio university.

124

(B)(1) Subject to division (C)(1) of this section, the	125
advisory group shall select for inclusion in the pilot project not	126
more than the following number of physician practices:	127

(a) Ten practices affiliated with the Boonshoft school of	128
medicine at Wright state university;	129

(b) Ten practices affiliated with the university of Toledo	130
college of medicine;	131

(c) Ten practices affiliated with the northeast Ohio medical	132
university;	133

(d) Ten practices affiliated with the centers for osteopathic	134
research and education of the Ohio university college of	135
osteopathic medicine.	136

(2) Subject to division (C)(2) of this section, the advisory	137
group shall select for inclusion in the pilot project not less	138
than the following number of advanced practice nurse primary care	139
practices:	140

(a) One practice affiliated with the college of nursing at	141
the university of Toledo;	142

(b) One practice affiliated with the Wright state university	143
college of nursing and health;	144

(c) One practice affiliated with the college of nursing at	145
Kent state university or the university of Akron college of	146
nursing;	147

(d) One practice affiliated with the school of nursing at	148
Ohio university.	149

(C)(1) All of the following apply with respect to the	150
selection of physician practices under division (B) of this	151
section:	152

(a) The advisory group shall strive to select physician	153
practices in such a manner that the pilot project includes aboth	154
of the following:	155

(i) A diverse range of primary care specialties, including	156
practices specializing in pediatrics, geriatrics, general internal	157
medicine, or family medicine;	158

(ii) Practices that utilize physician assistants as part of	159
the health care delivery system.	160

(b) When evaluating an application, the advisory group shall	161
consider the percentage of patients in the physician practice who	162
are part of a medically underserved population, including medicaid	163
recipients and individuals without health insurance.	164

(c) The advisory group shall select not fewer than six	165
practices that serve rural areas of this state, as those areas are	166
determined by the advisory group.	167

(d) A member of the advisory group shall abstain from	168
participating in any vote taken regarding the selection of a	169
physician practice if the member would receive any financial	170
benefit from having the practice included in the pilot project.	171

(2) All of the following apply with respect to the selection	172
of advanced practice nurse primary care practices under division	173
(B) of this section:	174

(a) When evaluating an application, the advisory group shall	175
consider the percentage of patients in the advanced practice nurse	176
primary care practice who are part of a medically underserved	177
population, including medicaid recipients and individuals without	178
health insurance.	179

(b) If the advisory group determines that it has not received	180
an application from a sufficiently qualified advanced practice	181
nurse primary care practice affiliated with a particular	182
institution specified in division (B)(2) of this section, the	183
advisory group shall make the selections required under that	184
division in such a manner that the greatest possible number of	185
those institutions are represented in the pilot project. To be	186
selected in this manner, a practice remains subject to the	187
eligibility requirements specified in division (B) of section	188
185.06 of the Revised Code. As specified in division (B)(2) of	189
this section, the number of practices selected for inclusion in	190
the pilot project shall be at least four.	191

(c) A member of the advisory group shall abstain from	192
participating in any vote taken regarding the selection of an	193
advanced practice nurse primary care practice if the member would	194
receive any financial benefit from having the practice included in	195
the pilot project.	196

Sec. 2105.35. (A)(1) A person is dead if the person has been	197
determined to be and pronounced dead pursuant to standards	198
established under section 2108.40 of the Revised Code.	199

(2) A physician or physician assistant who makes a	200
determination and pronouncement of death in accordance with	201
section 2108.40 of the Revised Code and any person who acts in	202
good faith in reliance on a determination and pronouncement of	203
death made by a physician in accordance with that section is	204
2108.40 of the Revised Code by a physician or physician assistant	205
are each entitled to the immunity conveyed by that section	206
2108.40 of the Revised Code.	207

(B) A certified or authenticated copy of a death certificate	208
purporting to be issued by an official or agency of the place	209
where the death of a person purportedly occurred is prima-facie	210
evidence of the fact, place, date, and time of the person's death	211
and the identity of the decedent.	212

(C) A certified or authenticated copy of any record or report	213
of a domestic or foreign governmental agency that a person is	214
missing, detained, dead, or alive is prima-facie evidence of the	215
status and of the dates, circumstances, and places disclosed by	216
the record or report.	217

(D) In the absence of prima-facie evidence of death under	218
division (B) or (C) of this section, the fact of death may be	219
established by clear and convincing evidence, including	220
circumstantial evidence.	221

(E) Except as provided in division (F) of this section, a	222
presumption of the death of a person arises:	223

(1) When the person has disappeared and been continuously	224
absent from the person's place of last domicile for a five-year	225
period without being heard from during the period;	226

(2) When the person has disappeared and been continuously	227
absent from the person's place of last domicile without being	228
heard from and was at the beginning of the person's absence	229
exposed to a specific peril of death, even though the absence has	230
continued for less than a five-year period.	231

(F) When a person who is on active duty in the armed services	232
of the United States has been officially determined to be absent	233
in a status of "missing" or "missing in action," a presumption of	234
death arises when the head of the federal department concerned has	235
made a finding of death pursuant to the "Federal Missing Persons	236
Act," 80 Stat. 625 (1966), 37 U.S.C.A. 551, as amended.	237

(G) In the absence of evidence disputing the time of death	238
stipulated on a document described in division (B) or (C) of this	239
section, a document described in either of those divisions that	240
stipulates a time of death one hundred twenty hours or more after	241
the time of death of another person, however the time of death of	242
the other person is determined, establishes by clear and	243
convincing evidence that the person survived the other person by	244
one hundred twenty hours.	245

(H) The provisions of divisions (A) to (G) of this section	246
are in addition to any other provisions of the Revised Code, the	247
Rules of Criminal Procedure, or the Rules of Evidence that pertain	248
to the determination of death and status of a person.	249

Sec. 2108.40. (A) An individual is dead if the individual has	250
sustained either irreversible cessation of circulatory and	251
respiratory functions or irreversible cessation of all functions	252
of the brain, including the brain stem, as determined in	253
accordance with accepted medical standards. If the respiratory and	254
circulatory functions of a person are being artificially	255
sustained, under accepted medical standards a determination that	256
death has occurred is made by a physician by observing and	257
conducting a test to determine that the irreversible cessation of	258
all functions of the brain has occurred.	259

(B) The determination and pronouncement of an individual's	260
death may be made by a physician or, subject to divisions (C) and	261
(D) of this section, a physician assistant.	262

(C) A physician assistant may determine and pronounce an	263
individual's death only if the individual's respiratory and	264
circulatory functions are not being artificially sustained and, at	265
the time the determination and pronouncement of death is made,	266
either or both of the following conditions are met:	267

(1) The individual was receiving care in one of the	268
following:	269

(a) A nursing home, residential care facility, or home for	270
the aging licensed under Chapter 3721. of the Revised Code;	271

(b) A county home or district home operated pursuant to	272
Chapter 5155. of the Revised Code;	273

(c) A residential facility licensed under section 5123.19 of	274
the Revised Code.	275

(2) The physician assistant is providing or supervising the	276
individual's care through a hospice care program licensed under	277
Chapter 3712. of the Revised Code or any other entity that	278
provides palliative care.	279

(D) If a physician assistant determines and pronounces an	280
individual's death, both of the following conditions apply:	281

(1) The physician assistant shall not complete any portion of	282
the individual's death certificate.	283

(2) The physician assistant shall notify the individual's	284
attending physician of the determination and pronouncement in	285
order for the physician to fulfill the physician's duties under	286
section 3705.16 of the Revised Code. The physician assistant shall	287
provide the notification within a reasonable period of time	288
following the determination and pronouncement of the individual's	289
death.	290

(E)(1) A physician who makes a determination and	291
pronouncement of death in accordance with this section and	292
accepted medical standards is not liable for damages, or subject	293
to, any of the following for the physician's acts, the acts of a	294
physician assistant who makes a determination and pronouncement of	295
death in accordance with this section and accepted medical	296
standards, or the acts of others based on a determination and	297
pronouncement of death in accordance with this section and	298
accepted medical standards:	299

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

300

(b) Prosecution in any criminal proceeding for the	301
physician's acts or the acts of others based on that	302
determination;	303

(c) Professional disciplinary action pursuant to Chapter	304
4731. of the Revised Code.	305

(2) A physician assistant who makes a determination and	306
pronouncement of death in accordance with this section and	307
accepted medical standards is not liable for, or subject to, any	308
of the following for the physician assistant's acts or the acts of	309
others based on that determination and pronouncement:	310

(a) Damages in any civil action;

311

(b) Prosecution in any criminal proceeding;

312

(c) Professional disciplinary action pursuant to Chapter	313
4730. of the Revised Code.	314

(3) Any person who acts in good faith in reliance on a	315
determination and pronouncement of death made by a physician or	316
physician assistant in accordance with this section and accepted	317
medical standards is not liable for damages in any civil action or	318
subject to prosecution in any criminal proceeding for the person's	319
actions.	320

Sec. 2133.211.  A person who holds a certificate of authority	321
to practice as a certified nurse practitioner or clinical nurse	322
specialist issued under section 4723.42 of the Revised Code may	323
take any action that may be taken by an attending physician under	324
sections 2133.21 to 2133.26 of the Revised Code and has the	325
immunity provided by section 2133.22 of the Revised Code if the	326
action is taken pursuant to a standard care arrangement with a	327
collaborating physician.	328

A person who holds a certificate to practice as a physician	329
assistant issued under Chapter 4730. of the Revised Code may take	330
any action that may be taken by an attending physician under	331
sections 2133.21 to 2133.26 of the Revised Code and has the	332
immunity provided by section 2133.22 of the Revised Code if the	333
action is taken pursuant to a physician supervisory plan approved	334
pursuant to section 4730.17 of the Revised Code or the policies of	335
a health care facility in which the physician assistant is	336
practicing.	337

Sec. 3719.06.  (A)(1) A licensed health professional	338
authorized to prescribe drugs, if acting in the course of	339
professional practice, in accordance with the laws regulating the	340
professional's practice, and in accordance with rules adopted by	341
the state board of pharmacy, may, except as provided in division	342
(A)(2) or (3) of this section, do the following:	343

(a) Prescribe schedule II, III, IV, and V controlled	344
substances;	345

(b) Administer or personally furnish to patients schedule II,	346
III, IV, and V controlled substances;	347

(c) Cause schedule II, III, IV, and V controlled substances	348
to be administered under the prescriber's direction and	349
supervision.	350

(2) A licensed health professional authorized to prescribe	351
drugs who is a clinical nurse specialist, certified nurse-midwife,	352
or certified nurse practitioner is subject to both of the	353
following:	354

(a) A schedule II controlled substance may be prescribed only	355
for a patient with a terminal condition, as defined in section	356
2133.01 of the Revised Code, only if the nurse's collaborating	357
physician initially prescribed the substance for the patient, and	358
only in an amount that does not exceed the amount necessary for	359
the patient's use in a single, twenty-four-hour period.	360

(b) No schedule II controlled substance shall be personally	361
furnished to any patient.	362

(3) A licensed health professional authorized to prescribe	363
drugs who is a physician assistant shall not prescribe or	364
personally furnish to patients anyis subject to all of the	365
following:	366

(a) A controlled substance that is notmay be prescribed or	367
personally furnished only if it is included in the	368
physician-delegated prescriptive authority granted to the	369
physician assistant in accordance with Chapter 4730. of the	370
Revised Code.	371

(b) A schedule II controlled substance may be prescribed only	372
in accordance with division (B)(4) of section 4730.41 and section	373
4730.411 of the Revised Code.	374

(c) No schedule II controlled substance shall be personally	375
furnished to any patient.	376

(B) No licensed health professional authorized to prescribe	377
drugs shall prescribe, administer, or personally furnish a	378
schedule III anabolic steroid for the purpose of human muscle	379
building or enhancing human athletic performance and no pharmacist	380
shall dispense a schedule III anabolic steroid for either purpose,	381
unless it has been approved for that purpose under the "Federal	382
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.	383
301, as amended.	384

(C) Each written prescription shall be properly executed,	385
dated, and signed by the prescriber on the day when issued and	386
shall bear the full name and address of the person for whom, or	387
the owner of the animal for which, the controlled substance is	388
prescribed and the full name, address, and registry number under	389
the federal drug abuse control laws of the prescriber. If the	390
prescription is for an animal, it shall state the species of the	391
animal for which the controlled substance is prescribed.	392

Sec. 4730.06.  (A) The physician assistant policy committee	393
of the state medical board shall review, and shall submit to the	394
board recommendations concerning, all of the following:	395

(1) Requirements for issuance of certificates to practice as	396
a physician assistant, including the educational requirements that	397
must be met to receive a certificate to practice;	398

(2) Existing and proposed rules pertaining to the practice of	399
physician assistants, the supervisory relationship between	400
physician assistants and supervising physicians, and the	401
administration and enforcement of this chapter;	402

(3) Physician-delegatedIn accordance with section 4730.38 of	403
the Revised Code, physician-delegated prescriptive authority for	404
physician assistants, in accordance withand proposed changes to	405
the physician assistant formulary the board adopts pursuant to	406
division (A)(1) of section 4730.384730.39 of the Revised Code;	407

(4) Application procedures and forms for certificates to	408
practice as a physician assistant, physician supervisory plans,	409
and supervision agreements;	410

(5) Fees required by this chapter for issuance and renewal of	411
certificates to practice as a physician assistant;	412

(6) Criteria to be included in applications submitted to the	413
board for approval of physician supervisory plans, including	414
criteria to be included in applications for approval to delegate	415
to physician assistants the performance of special services;	416

(7) Criteria to be included in supervision agreements	417
submitted to the board for approval and renewal of the board's	418
approval;	419

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

420

(B) In addition to the matters that are required to be	421
reviewed under division (A) of this section, the committee may	422
review, and may submit to the board recommendations concerning,	423
either or both of the following:	424

(1) Quality assurance activities to be performed by a	425
supervising physician and physician assistant under a quality	426
assurance system established pursuant to division (F) of section	427
4730.21 of the Revised Code;	428

(2) The development and approval of one or more model	429
physician supervisory plans and one or more models for a special	430
services portion of the one or more model physician supervisory	431
plans. The committee may submit recommendations for model plans	432
that reflect various medical specialties.	433

(C) The board shall take into consideration all	434
recommendations submitted by the committee. Not later than ninety	435
days after receiving a recommendation from the committee, the	436
board shall approve or disapprove the recommendation and notify	437
the committee of its decision. If a recommendation is disapproved,	438
the board shall inform the committee of its reasons for making	439
that decision. The committee may resubmit the recommendation after	440
addressing the concerns expressed by the board and modifying the	441
disapproved recommendation accordingly. Not later than ninety days	442
after receiving a resubmitted recommendation, the board shall	443
approve or disapprove the recommendation. There is no limit on the	444
number of times the committee may resubmit a recommendation for	445
consideration by the board.	446

(D)(1) Except as provided in division (D)(2) of this section,	447
the board may not take action regarding a matter that is subject	448
to the committee's review under division (A) or (B) of this	449
section unless the committee has made a recommendation to the	450
board concerning the matter.	451

(2) If the board submits to the committee a request for a	452
recommendation regarding a matter that is subject to the	453
committee's review under division (A) or (B) of this section, and	454
the committee does not provide a recommendation before the	455
sixty-first day after the request is submitted, the board may take	456
action regarding the matter without a recommendation.	457

Sec. 4730.09. (A) Under a physician supervisory plan approved	458
under section 4730.17 of the Revised Code, a physician assistant	459
may provide any or all of the following services without approval	460
by the state medical board as special services:	461

(1) Obtaining comprehensive patient histories;

462

(2) Performing physical examinations, including audiometry	463
screening, routine visual screening, and pelvic, rectal, and	464
genital-urinary examinations, when indicated;	465

(3) Ordering, performing, or ordering and performing routine	466
diagnostic procedures, as indicated;	467

(4) Identifying normal and abnormal findings on histories,	468
physical examinations, and commonly performed diagnostic studies;	469

(5) Assessing patients and developing and implementing	470
treatment plans for patients;	471

(6) Monitoring the effectiveness of therapeutic	472
interventions;	473

(7) Exercising physician-delegated prescriptive authority	474
pursuant to a certificate to prescribe issued under this chapter;	475

(8) Carrying out or relaying the supervising physician's	476
orders for the administration of medication, to the extent	477
permitted by law;	478

(9) Providing patient education;

479

(10) Instituting and changing orders on patient charts;

480

(11) Performing developmental screening examinations on	481
children with regard to neurological, motor, and mental functions;	482

(12) Performing wound care management, suturing minor	483
lacerations and removing the sutures, and incision and drainage of	484
uncomplicated superficial abscesses;	485

(13) Removing superficial foreign bodies;

486

(14) Administering intravenous fluids;

487

(15) Inserting a foley or cudae catheter into the urinary	488
bladder and removing the catheter;	489

(16) Removing intrauterine devices;

490

(17) Performing biopsies of superficial lesions;

491

(18)(17) Making appropriate referrals as directed by the	492
supervising physician;	493

(19) Removing norplant capsules

494

(18) Removing birth control devices;

495

(20)(19) Performing penile duplex ultrasound;

496

(21)(20) Changing of a tracheostomy;

497

(22)(21) Performing bone marrow aspirations from the	498
posterior iliac crest;	499

(23)(22) Performing bone marrow biopsies from the posterior	500
iliac crest;	501

(24)(23) Performing cystograms;

502

(25)(24) Performing nephrostograms after physician placement	503
of nephrostomy tubes;	504

(26)(25) Fitting or inserting family planning devices,	505
including intrauterine devices, diaphragms, and cervical caps;	506

(27)(26) Removing cervical polyps;

507

(28)(27) Performing nerve conduction testing;

508

(29)(28) Performing endometrial biopsies;

509

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

510

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

511

(32)(31) Performing knee joint injections;

512

(33)(32) Performing endotracheal intubation with successful	513
completion of an advanced cardiac life support course;	514

(34)(33) Performing lumbar punctures;

515

(35)(34) In accordance with rules adopted by the board, using	516
light-based medical devices for the purpose of hair removal;	517

(36)(35) Administering, monitoring, or maintaining local	518
anesthesia, as defined in section 4730.091 of the Revised Code;	519

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

520

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

521

(38) Prescribing physical therapy or referring a patient to a	522
physical therapist for the purpose of receiving physical therapy;	523

(39) Ordering occupational therapy or referring a patient to	524
an occupational therapist for the purpose of receiving	525
occupational therapy;	526

(40) Taking any action that may be taken by an attending	527
physician under sections 2133.21 to 2133.26 of the Revised Code,	528
as specified in section 2133.211 of the Revised Code;	529

(41) Performing other services that are within the	530
supervising physician's normal course of practice and expertise,	531
if the services are included in any model physician supervisory	532
plan approved under section 4730.06 of the Revised Code or the	533
services are designated by the board by rule or other means as	534
services that are not subject to approval as special services.	535

(B) Under the policies of a health care facility, the	536
services a physician assistant may provide are limited to the	537
services the facility has authorized the physician assistant to	538
provide for the facility. The services a health care facility may	539
authorize a physician assistant to provide for the facility	540
include the following:	541

(1) Any or all of the services specified in division (A) of	542
this section;	543

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

544

(3) Any other services permitted by the policies of the	545
health care facility, except that the facility may not authorize a	546
physician assistant to perform a service that is prohibited by	547
this chapter.	548

Sec. 4730.38.  (A) Not later than six months after the	549
effective dateExcept as provided in division (B) of this section,	550
the physician assistant policy committee of the state medical	551
board shall, at such times the committee determines to be	552
necessary, submit to the board its initial recommendations	553
regarding physician-delegated prescriptive authority for physician	554
assistants. The committee's recommendations shall address allboth	555
of the following:	556

(1) Policy and procedures regarding physician-delegated	557
prescriptive authority, including the issuance of certificates to	558
prescribe under this chapter;	559

(2) Subject to the limitations specified in section 4730.40	560
of the Revised Code, a formulary listing the drugs and therapeutic	561
devices by class and specific nomenclature that a supervising	562
physician may include in the physician-delegated prescriptive	563
authority granted to a physician assistant who holds a certificate	564
to prescribe issued under this chapter;	565

(3) Any issue the committee considers necessary to assist the	566
board in fulfilling its duty to adopt rules governing	567
physician-delegated prescriptive authority, including the issuance	568
of certificates to prescribe.	569

(B) After the board's adoption of initial rules under section	570
4730.39 of the Revised Code, the committee shall conduct an annual	571
review of its recommendations regarding physician-delegated	572
prescriptive authority. Based on its review, the committee shall	573
submit recommendations to the board as the committee considers	574
necessaryNot less than every six months beginning on the first	575
day of June following the effective date of this amendment, the	576
committee shall review the physician assistant formulary the board	577
adopts pursuant to division (A)(1) of section 4730.39 of the	578
Revised Code and, to the extent it determines to be necessary,	579
submit recommendations proposing changes to the formulary.	580

(C) Recommendations submitted under this section are subject	581
to the procedures and time frames specified in division (C) of	582
section 4730.06 of the Revised Code.	583

Sec. 4730.39.  (A) Not later than six months after receiving	584
the initial recommendations of the physician assistant policy	585
committee submitted pursuant to division (A) of section 4730.38 of	586
the Revised Code, theThe state medical board shall adoptdo both	587
of the following:	588

(1) Adopt a formulary listing the drugs and therapeutic	589
devices by class and specific generic nomenclature that a	590
physician may include in the physician-delegated prescriptive	591
authority granted to a physician assistant who holds a certificate	592
to prescribe under this chapter;	593

(2) Adopt rules governing physician-delegated prescriptive	594
authority for physician assistants, including the issuance of	595
certificates to prescribe under this chapter. The	596

(B) The board's rules governing physician-delegated	597
prescriptive authority adopted pursuant to division (A)(2) of this	598
section shall be adopted in accordance with Chapter 119. of the	599
Revised Code and shall establish all of the following:	600

(1) Subject to the limitations specified in section 4730.40	601
of the Revised Code, a formulary listing the drugs and therapeutic	602
devices by class and specific generic nomenclature that a	603
physician may include in the physician-delegated prescriptive	604
authority granted to a physician assistant who holds a certificate	605
to prescribe under this chapter;	606

(2) Requirements regarding the pharmacology courses that a	607
physician assistant is required to complete to receive a	608
certificate to prescribe;	609

(3)(2) Standards and procedures for the issuance and renewal	610
of certificates to prescribe to physician assistants;	611

(4)(3) Standards and procedures for the appropriate conduct	612
of the provisional period that a physician assistant is required	613
to complete pursuant to section 4730.45 of the Revised Code and	614
for determining whether a physician assistant has successfully	615
completed the provisional period;	616

(5)(4) A specific prohibition against prescribing any drug or	617
device to perform or induce an abortion;	618

(6)(5) Standards and procedures to be followed by a physician	619
assistant in personally furnishing samples of drugs or complete or	620
partial supplies of drugs to patients under section 4730.43 of the	621
Revised Code;	622

(7)(6) Any other requirements the board considers necessary	623
to implement the provisions of this chapter regarding	624
physician-delegated prescriptive authority and the issuance of	625
certificates to prescribe.	626

(B)(C)(1) After adopting the initial rulesconsidering	627
recommendations submitted by the physician assistant policy	628
committee pursuant to sections 4730.06 and 4730.38 of the Revised	629
Code, the board shall conduct an annual review either or both of	630
the rules. Basedfollowing, as appropriate according to the	631
submitted recommendations:	632

(a) The formulary the board adopts under division (A)(1) of	633
this section;	634

(b) The rules the board adopts under division (A)(2) of this	635
section regarding physician-delegated prescriptive authority.	636

(2) Based on its review, the board shall make any necessary	637
modifications to the formulary or rules.	638

(C) All rules adopted under this section shall be adopted in	639
accordance with Chapter 119. of the Revised Code. When adopting	640
the initial rules, the board shall consider the recommendations of	641
the physician assistant policy committee submitted pursuant to	642
division (A) of section 4730.38 of the Revised Code. When making	643
any modifications to the rules subsequent to its annual review of	644
the rules, the board shall consider the committee's	645
recommendations submitted pursuant to division (B) of section	646
4730.38 of the Revised Code.	647

Sec. 4730.40.  (A) Subject to divisionsdivision (B) and (C)	648
of this section, the physician assistant formulary established	649
adopted by the state medical board in rules adopted under section	650
4730.39 of the Revised Code listing the drugs and therapeutic	651
devices by class and specific nomenclature that a supervising	652
physician may include in the physician-delegated prescriptive	653
authority granted to a physician assistant who holds a certificate	654
to prescribe issued under this chapter may include any or all of	655
the following drugs:	656

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

657

(2) Drugs that under state or federal law may be dispensed	658
only pursuant to a prescription by a licensed health professional	659
authorized to prescribe drugs, as defined in section 4729.01 of	660
the Revised Code;	661

(3) Any drug that is not a dangerous drug, as defined in	662
section 4729.01 of the Revised Code.	663

(B) The formulary established in the board's rulesadopted by	664
the board shall not include, and shall specify that it does not	665
include, the following:	666

(1) Any schedule II controlled substance;

667

(2) Anyany drug or device used to perform or induce an	668
abortion.	669

(C) When adopting rules establishing the initial formulary,	670
the board shall include provisions ensuring that a physician	671
assistant who holds a certificate to prescribe issued under this	672
chapter may be granted physician-delegated prescriptive authority	673
for all drugs and therapeutic devices that may be prescribed on	674
the effective date of the rules by a holder of a certificate to	675
prescribe issued by the board of nursing under Chapter 4723. of	676
the Revised Code, with the exception of schedule II controlled	677
substances. To the extent permitted by division (A) of this	678
section, the initial formulary may include additional drugs or	679
therapeutic devices.	680

Sec. 4730.41.  (A) A certificate to prescribe issued under	681
this chapter authorizes a physician assistant to prescribe and	682
personally furnish drugs and therapeutic devices in the exercise	683
of physician-delegated prescriptive authority.	684

(B) In exercising physician-delegated prescriptive authority,	685
a physician assistant is subject to all of the following:	686

(1) The physician assistant shall exercise	687
physician-delegated prescriptive authority only to the extent that	688
the physician supervising the physician assistant has granted that	689
authority.	690

(2) The physician assistant shall comply with all conditions	691
placed on the physician-delegated prescriptive authority, as	692
specified by the supervising physician who is supervising the	693
physician assistant in the exercise of physician-delegated	694
prescriptive authority.	695

(3) If the physician assistant possesses physician-delegated	696
prescriptive authority for controlled substances, the physician	697
assistant shall register with the federal drug enforcement	698
administration.	699

(4) If the physician assistant possesses physician-delegated	700
prescriptive authority for schedule II controlled substances, the	701
physician assistant shall comply with section 4730.411 of the	702
Revised Code.	703

Sec. 4730.411. (A) Except as provided in division (B) or (C)	704
of this section, the physician assistant may prescribe to a	705
patient a schedule II controlled substance only if all of the	706
following are the case:	707

(1) The patient is in a terminal condition, as defined in	708
section 2133.01 of the Revised Code.	709

(2) The physician assistant's supervising physician initially	710
prescribed the substance for the patient.	711

(3) The prescription is for an amount that does not exceed	712
the amount necessary for the patient's use in a single,	713
twenty-four-hour period.	714

(B) The restrictions on prescriptive authority in division	715
(A) of this section do not apply if a physician assistant issues	716
the prescription to the patient from any of the following	717
locations:	718

(1) A hospital registered under section 3701.07 of the	719
Revised Code;	720

(2) A health care facility operated by the department of	721
mental health or the department of developmental disabilities;	722

(3) A nursing home licensed under section 3721.02 of the	723
Revised Code or by a political subdivision certified under section	724
3721.09 of the Revised Code;	725

(4) A county home or district home operated under Chapter	726
5155. of the Revised Code that is certified under Title XVIII or	727
XIX of the Social Security Act of 1935;	728

(5) A hospice care program, as defined in section 3712.01 of	729
the Revised Code;	730

(6) A community mental health facility, as defined in section	731
5122.01 of the Revised Code;	732

(7) An ambulatory surgical facility, as defined in section	733
3702.30 of the Revised Code;	734

(8) A freestanding birthing center, as defined in section	735
3702.51 of the Revised Code;	736

(9) A federally qualified health center, as defined in	737
section 1905(l)(2)(B) of the "Social Security Act," 103 Stat. 2264	738
(1989), 42 U.S.C. 1396d(l)(2)(B);	739

(10) A health care office or facility operated by the board	740
of health of a city or general health district or the authority	741
having the duties of a board of health under section 3709.05 of	742
the Revised Code.	743

(C) A physician assistant shall not issue to a patient a	744
prescription for a schedule II controlled substance from a	745
convenience care clinic even if the convenience care clinic is	746
owned or operated by an entity specified in division (B) of this	747
section.	748

Sec. 4730.42.  (A) In granting physician-delegated	749
prescriptive authority to a particular physician assistant who	750
holds a certificate to prescribe issued under this chapter, the	751
supervising physician is subject to all of the following:	752

(1) The supervising physician shall not grant	753
physician-delegated prescriptive authority for any drug or	754
therapeutic device that is not listed on the physician assistant	755
formulary established in rules adopted under section 4730.39 of	756
the Revised Code as a drug or therapeutic device that may be	757
included in the physician-delegated prescriptive authority granted	758
to a physician assistant.	759

(2) The supervising physician shall not grant	760
physician-delegated prescriptive authority for any drug or device	761
that may be used to perform or induce an abortion.	762

(3) The supervising physician shall not grant	763
physician-delegated prescriptive authority in a manner that	764
exceeds the supervising physician's prescriptive authority.	765

(4) The supervising physician shall supervise the physician	766
assistant in accordance with all of the following:	767

(a) The supervision requirements specified in section 4730.21	768
of the Revised Code and, in the case of supervision provided	769
during a provisional period of physician-delegated prescriptive	770
authority, the supervision requirements specified in section	771
4730.45 of the Revised Code;	772

(b) The physician supervisory plan approved for the	773
supervising physician or the policies of the health care facility	774
in which the physician and physician assistant are practicing;	775

(c) The supervision agreement approved under section 4730.19	776
of the Revised Code that applies to the supervising physician and	777
the physician assistant.	778

(B)(1) The supervising physician of a physician assistant may	779
place conditions on the physician-delegated prescriptive authority	780
granted to the physician assistant. If conditions are placed on	781
that authority, the supervising physician shall maintain a written	782
record of the conditions and make the record available to the	783
state medical board on request.	784

(2) The conditions that a supervising physician may place on	785
the physician-delegated prescriptive authority granted to a	786
physician assistant include the following:	787

(a) Identification by class and specific generic nomenclature	788
of drugs and therapeutic devices that the physician chooses not to	789
permit the physician assistant to prescribe;	790

(b) Limitations on the dosage units or refills that the	791
physician assistant is authorized to prescribe;	792

(c) Specification of circumstances under which the physician	793
assistant is required to refer patients to the supervising	794
physician or another physician when exercising physician-delegated	795
prescriptive authority;	796

(d) Responsibilities to be fulfilled by the physician in	797
supervising the physician assistant that are not otherwise	798
specified in the physician supervisory plan or otherwise required	799
by this chapter.	800

Sec. 4730.44. (A) A physician assistant seeking a certificate	801
to prescribe shall submit to the state medical board a written	802
application on a form prescribed and supplied by the board. The	803
application shall include all of the following information:	804

(1) The applicant's name, residential address, business	805
address, if any, and social security number;	806

(2) Evidence of holding a valid certificate to practice as a	807
physician assistant issued under this chapter;	808

(3) One of the following:

809

(a) Satisfactory proof that the applicant meets the	810
requirements specified in section 4730.46 of the Revised Code to	811
participate in a provisional period of physician-delegated	812
prescriptive authority or satisfactory;	813

(b) Satisfactory proof of successful completion of the	814
provisional period, evidenced by a letter or copy of a letter	815
attesting to the successful completion written by a supervising	816
physician of the physician assistant at the time of completion;	817

(c) Satisfactory proof that the applicant has practiced as a	818
physician assistant in another state or was credentialed or	819
employed as a physician assistant by the United States government,	820
holds a master's or higher degree that was obtained from a program	821
accredited by the accreditation review commission on education for	822
the physician assistant or a predecessor or successor organization	823
recognized by the board, and held valid authority issued by the	824
other state or the United States government to prescribe	825
therapeutic devices and drugs, including at least some controlled	826
substances, evidenced by an affidavit issued by an appropriate	827
agency or office of the other state or the United States	828
government attesting to the prescriptive authority described in	829
division (A)(3)(c) of this section.	830

(4) Any other information the board requires.

831

(B) At the time of making application for a certificate to	832
prescribe, the applicant shall pay the board a fee of one hundred	833
dollars, no part of which shall be returned. The fees shall be	834
deposited in accordance with section 4731.24 of the Revised Code.	835

(C)(1) The board shall review all applications received. If	836
an application is complete and the board determines that the	837
applicant meets the requirements for a certificate to prescribe,	838
the board shall, subject to division (C)(2) of this section, issue	839
the certificate to the applicant. The	840

(2) The initial certificate to prescribe issued to an	841
applicant who meets the requirements of division (A)(3)(a) of this	842
section shall be issued as a provisional certificate to prescribe.	843

Sec. 4730.45.  (A) A provisional certificate to prescribe	844
issued under division (C)(2) of section 4730.44 of the Revised	845
Code authorizes the physician assistant holding the certificate to	846
participate in a provisional period of physician-delegated	847
prescriptive authority. The physician assistant shall successfully	848
complete the provisional period as a condition of receiving a new	849
certificate to prescribe.	850

(B) The provisional period shall be conducted by one or more	851
supervising physicians in accordance with rules adopted under	852
section 4730.39 of the Revised Code. When supervising a physician	853
assistant who is completing the first five hundred hours of a	854
provisional period, the supervising physician shall provide	855
on-site supervision of the physician assistant's exercise of	856
physician-delegated prescriptive authority.	857

The provisional period shall last not longer than one year,	858
unless it is extended for not longer than one additional year at	859
the direction of a supervising physician. The physician assistant	860
shall not be required to participate in the provisional period for	861
more than one-thousand-eight-hundredone thousand eight hundred	862
hours, except when a supervising physician has extended the	863
physician assistant's provisional period.	864

(C) If a physician assistant does not successfully complete	865
the provisional period, each supervising physician shall cease	866
granting physician-delegated prescriptive authority to the	867
physician assistant. The supervising physician with primary	868
responsibility for conducting the provisional period shall	869
promptly notify the state medical board that the physician	870
assistant did not successfully complete the provisional period and	871
the board shall revoke the certificate.	872

(D) A physician assistant who successfully completes a	873
provisional period shall not be required to complete another	874
provisional period as a condition of being eligible to be granted	875
physician-delegated prescriptive authority by a supervising	876
physician who was not involved in the conduct of the provisional	877
period.	878

Sec. 4755.48.  (A) No person shall employ fraud or deception	879
in applying for or securing a license to practice physical therapy	880
or to be a physical therapist assistant.	881

(B) No person shall practice or in any way imply or claim to	882
the public by words, actions, or the use of letters as described	883
in division (C) of this section to be able to practice physical	884
therapy or to provide physical therapy services, including	885
practice as a physical therapist assistant, unless the person	886
holds a valid license under sections 4755.40 to 4755.56 of the	887
Revised Code or except for submission of claims as provided in	888
section 4755.56 of the Revised Code.	889

(C) No person shall use the words or letters, physical	890
therapist, physical therapy, physical therapy services,	891
physiotherapist, physiotherapy, physiotherapy services, licensed	892
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T.,	893
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical	894
therapist assistant, physical therapy technician, licensed	895
physical therapist assistant, L.P.T.A., R.P.T.A., or any other	896
letters, words, abbreviations, or insignia, indicating or implying	897
that the person is a physical therapist or physical therapist	898
assistant without a valid license under sections 4755.40 to	899
4755.56 of the Revised Code.	900

(D) No person who practices physical therapy or assists in	901
the provision of physical therapy treatments under the supervision	902
of a physical therapist shall fail to display the person's current	903
license granted under sections 4755.40 to 4755.56 of the Revised	904
Code in a conspicuous location in the place where the person	905
spends the major part of the person's time so engaged.	906

(E) Nothing in sections 4755.40 to 4755.56 of the Revised	907
Code shall affect or interfere with the performance of the duties	908
of any physical therapist or physical therapist assistant in	909
active service in the army, navy, coast guard, marine corps, air	910
force, public health service, or marine hospital service of the	911
United States, while so serving.	912

(F) Nothing in sections 4755.40 to 4755.56 of the Revised	913
Code shall prevent or restrict the activities or services of a	914
person pursingpursuing a course of study leading to a degree in	915
physical therapy in an accredited or approved educational program	916
if the activities or services constitute a part of a supervised	917
course of study and the person is designated by a title that	918
clearly indicates the person's status as a student.	919

(G) No(1) Except as provided in division (G)(2) of this	920
section and subject to division (H) of this section, no person	921
shall practice physical therapy other than on the prescription of,	922
or the referral of a patient by, a person who is licensed in this	923
or another state to practicedo at least one of the following:	924

(a) Practice medicine and surgery, chiropractic, dentistry,	925
osteopathic medicine and surgery, podiatric medicine and surgery,	926
or to practice;	927

(b) Practice as a physician assistant;

928

(c) Practice nursing as a certified registered nurse	929
anesthetist, clinical nurse specialist, certified nurse-midwife,	930
or certified nurse practitioner, within the scope of such	931
practices, and whose license is in good standing, unless either of	932
the following conditions is met:.	933

(1)(2) The prohibition in division (G)(1) of this section on	934
practicing physical therapy other than on the prescription of, or	935
the referral of a patient by, any of the persons described in that	936
division does not apply if either of the following applies to the	937
person:	938

(a) The person holds a master's or doctorate degree from a	939
professional physical therapy program that is accredited by a	940
national physical therapy accreditation agency recognized by the	941
United States department of education.	942

(2)(b) On or before December 31, 2004, the person has	943
completed at least two years of practical experience as a licensed	944
physical therapist.	945

(H) To be authorized to prescribe physical therapy or refer	946
a patient to a physical therapist for physical therapy, a person	947
described in division (G)(1) of this section must be in good	948
standing with the relevant licensing board in this state or the	949
state in which the person is licensed and must act only within the	950
person's scope of practice.	951

(I) In the prosecution of any person for violation of	952
division (B) or (C) of this section, it is not necessary to allege	953
or prove want of a valid license to practice physical therapy or	954
to practice as a physical therapist assistant, but such matters	955
shall be a matter of defense to be established by the accused.	956

Sec. 4755.481. (A) If a physical therapist evaluates and	957
treats a patient without the prescription of, or the referral of	958
the patient by, a person who is licensed to practice medicine and	959
surgery, chiropractic, dentistry, osteopathic medicine and	960
surgery, podiatric medicine and surgery, or nursing as a certified	961
registered nurse anesthetist, clinical nurse specialist, certified	962
nurse-midwife, or certified nurse practitionerdescribed in	963
division (G)(1) of section 4755.48 of the Revised Code, all of the	964
following apply:	965

(1) The physical therapist shall, upon consent of the	966
patient, inform the patient's physician, chiropractor, dentist,	967
podiatrist, certified registered nurse anesthetist, clinical nurse	968
specialist, certified nurse-midwife, or certified nurse	969
practitionerrelevant person described in division (G)(1) of	970
section 4755.48 of the Revised Code of the evaluation not later	971
than five business days after the evaluation is made.	972

(2) If the physical therapist determines, based on reasonable	973
evidence, that no substantial progress has been made with respect	974
to that patient during the thirty-day period immediately following	975
the date of the patient's initial visit with the physical	976
therapist, the physical therapist shall consult with or refer the	977
patient to a licensed physician, chiropractor, dentist,	978
podiatrist, certified registered nurse anesthetist, clinical nurse	979
specialist, certified nurse-midwife, or certified nurse	980
practitionerperson described in division (G)(1) of section	981
4755.48 of the Revised Code, unless either of the following	982
applies:	983

(a) The evaluation, treatment, or services are being provided	984
for fitness, wellness, or prevention purposes.	985

(b) The patient previously was diagnosed with chronic,	986
neuromuscular, or developmental conditions and the evaluation,	987
treatment, or services are being provided for problems or symptoms	988
associated with one or more of those previously diagnosed	989
conditions.	990

(3) If the physical therapist determines that orthotic	991
devices are necessary to treat the patient, the physical therapist	992
shall be limited to the application of the following orthotic	993
devices:	994

(a) Upper extremity adaptive equipment used to facilitate the	995
activities of daily living;	996

(b) Finger splints;

997

(c) Wrist splints;

998

(d) Prefabricated elastic or fabric abdominal supports with	999
or without metal or plastic reinforcing stays and other	1000
prefabricated soft goods requiring minimal fitting;	1001

(e) Nontherapeutic accommodative inlays;

1002

(f) Shoes that are not manufactured or modified for a	1003
particular individual;	1004

(g) Prefabricated foot care products;

1005

(h) Custom foot orthotics;

1006

(i) Durable medical equipment.

1007

(4) If, at any time, the physical therapist has reason to	1008
believe that the patient has symptoms or conditions that require	1009
treatment or services beyond the scope of practice of a physical	1010
therapist, the physical therapist shall refer the patient to a	1011
licensed health care practitioner acting within the practitioner's	1012
scope of practice.	1013

(B) Nothing in sections 4755.40 to 4755.56 of the Revised	1014
Code shall be construed to require reimbursement under any health	1015
insuring corporation policy, contract, or agreement, any sickness	1016
and accident insurance policy, the medical assistance program as	1017
defined in section 5111.01 of the Revised Code, or the health	1018
partnership program or qualified health plans established pursuant	1019
to sections 4121.44 to 4121.442 of the Revised Code, for any	1020
physical therapy service rendered without the prescription of, or	1021
the referral of the patient by, a licensed physician,	1022
chiropractor, dentist, podiatrist, certified registered nurse	1023
anesthetist, clinical nurse specialist, certified nurse-midwife,	1024
or certified nurse practitionerperson described in division	1025
(G)(1) of section 4755.48 of the Revised Code.	1026

(C) For purposes of this section, "business day" means any	1027
calendar day that is not a Saturday, Sunday, or legal holiday.	1028
"Legal holiday" has the same meaning as in section 1.14 of the	1029
Revised Code.	1030

Sec. 4765.01.  As used in this chapter:

1031

(A) "First responder" means an individual who holds a	1032
current, valid certificate issued under section 4765.30 of the	1033
Revised Code to practice as a first responder.	1034

(B) "Emergency medical technician-basic" or "EMT-basic" means	1035
an individual who holds a current, valid certificate issued under	1036
section 4765.30 of the Revised Code to practice as an emergency	1037
medical technician-basic.	1038

(C) "Emergency medical technician-intermediate" or "EMT-I"	1039
means an individual who holds a current, valid certificate issued	1040
under section 4765.30 of the Revised Code to practice as an	1041
emergency medical technician-intermediate.	1042

(D) "Emergency medical technician-paramedic" or "paramedic"	1043
means an individual who holds a current, valid certificate issued	1044
under section 4765.30 of the Revised Code to practice as an	1045
emergency medical technician-paramedic.	1046

(E) "Ambulance" means any motor vehicle that is used, or is	1047
intended to be used, for the purpose of responding to emergency	1048
medical situations, transporting emergency patients, and	1049
administering emergency medical service to patients before,	1050
during, or after transportation.	1051

(F) "Cardiac monitoring" means a procedure used for the	1052
purpose of observing and documenting the rate and rhythm of a	1053
patient's heart by attaching electrical leads from an	1054
electrocardiograph monitor to certain points on the patient's body	1055
surface.	1056

(G) "Emergency medical service" means any of the services	1057
described in sections 4765.35, 4765.37, 4765.38, and 4765.39 of	1058
the Revised Code that are performed by first responders, emergency	1059
medical technicians-basic, emergency medical	1060
technicians-intermediate, and paramedics. "Emergency medical	1061
service" includes such services performed before or during any	1062
transport of a patient, including transports between hospitals and	1063
transports to and from helicopters.	1064

(H) "Emergency medical service organization" means a public	1065
or private organization using first responders, EMTs-basic,	1066
EMTs-I, or paramedics, or a combination of first responders,	1067
EMTs-basic, EMTs-I, and paramedics, to provide emergency medical	1068
services.	1069

(I) "Physician" means an individual who holds a current,	1070
valid certificate issued under Chapter 4731. of the Revised Code	1071
authorizing the practice of medicine and surgery or osteopathic	1072
medicine and surgery.	1073

(J) "Registered nurse" means an individual who holds a	1074
current, valid license issued under Chapter 4723. of the Revised	1075
Code authorizing the practice of nursing as a registered nurse.	1076

(K) "Volunteer" means a person who provides services either	1077
for no compensation or for compensation that does not exceed the	1078
actual expenses incurred in providing the services or in training	1079
to provide the services.	1080

(L) "Emergency medical service personnel" means first	1081
responders, emergency medical service technicians-basic, emergency	1082
medical service technicians-intermediate, emergency medical	1083
service technicians-paramedic, and persons who provide medical	1084
direction to such persons.	1085

(M) "Hospital" has the same meaning as in section 3727.01 of	1086
the Revised Code.	1087

(N) "Trauma" or "traumatic injury" means severe damage to or	1088
destruction of tissue that satisfies both of the following	1089
conditions:	1090

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

1091

(a) Loss of life;

1092

(b) Loss of a limb;

1093

(c) Significant, permanent disfigurement;

1094

(d) Significant, permanent disability.

1095

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

1096

(a) Blunt or penetrating injury;

1097

(b) Exposure to electromagnetic, chemical, or radioactive	1098
energy;	1099

(c) Drowning, suffocation, or strangulation;

1100

(d) A deficit or excess of heat.

1101

(O) "Trauma victim" or "trauma patient" means a person who	1102
has sustained a traumatic injury.	1103

(P) "Trauma care" means the assessment, diagnosis,	1104
transportation, treatment, or rehabilitation of a trauma victim by	1105
emergency medical service personnel or by a physician, nurse,	1106
physician assistant, respiratory therapist, physical therapist,	1107
chiropractor, occupational therapist, speech-language pathologist,	1108
audiologist, or psychologist licensed to practice as such in this	1109
state or another jurisdiction.	1110

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

1111

(1) Any hospital that is verified by the American college of	1112
surgeons as an adult or pediatric trauma center;	1113

(2) Any hospital that is operating as an adult or pediatric	1114
trauma center under provisional status pursuant to section	1115
3727.101 of the Revised Code;	1116

(3) Until December 31, 2004, any hospital in this state that	1117
is designated by the director of health as a level II pediatric	1118
trauma center under section 3727.081 of the Revised Code;	1119

(4) Any hospital in another state that is licensed or	1120
designated under the laws of that state as capable of providing	1121
specialized trauma care appropriate to the medical needs of the	1122
trauma patient.	1123

(R) "Pediatric" means involving a patient who is less than	1124
sixteen years of age.	1125

(S) "Adult" means involving a patient who is not a pediatric	1126
patient.	1127

(T) "Geriatric" means involving a patient who is at least	1128
seventy years old or exhibits significant anatomical or	1129
physiological characteristics associated with advanced aging.	1130

(U) "Air medical organization" means an organization that	1131
provides emergency medical services, or transports emergency	1132
victims, by means of fixed or rotary wing aircraft.	1133

(V) "Emergency care" and "emergency facility" have the same	1134
meanings as in section 3727.01 of the Revised Code.	1135

(W) "Stabilize," except as it is used in division (B) of	1136
section 4765.35 of the Revised Code with respect to the manual	1137
stabilization of fractures, has the same meaning as in section	1138
1753.28 of the Revised Code.	1139

(X) "Transfer" has the same meaning as in section 1753.28 of	1140
the Revised Code.	1141

(Y) "Firefighter" means any member of a fire department as	1142
defined in section 742.01 of the Revised Code.	1143

(Z) "Volunteer firefighter" has the same meaning as in	1144
section 146.01 of the Revised Code.	1145

(AA) "Part-time paid firefighter" means a person who provides	1146
firefighting services on less than a full-time basis, is routinely	1147
scheduled to be present on site at a fire station or other	1148
designated location for purposes of responding to a fire or other	1149
emergency, and receives more than nominal compensation for the	1150
provision of firefighting services.	1151

(BB) "Physician assistant" means an individual who holds a	1152
valid certificate to practice as a physician assistant issued	1153
under Chapter 4730. of the Revised Code.	1154

Sec. 4765.35.  (A) A first responder shall perform the	1155
emergency medical services described in this section in accordance	1156
with this chapter and any rules adopted under it.	1157

(B) A first responder may provide limited emergency medical	1158
services to patients until the arrival of an emergency medical	1159
technician-basic, emergency medical technician-intermediate, or	1160
emergency medical technician-paramedic. In an emergency, a first	1161
responder may render emergency medical services such as opening	1162
and maintaining an airway, giving mouth to barrier ventilation,	1163
chest compressions, electrical interventions with automated	1164
defibrillators to support or correct the cardiac function and	1165
other methods determined by the board, controlling of hemorrhage,	1166
manual stabilization of fractures, bandaging, assisting in	1167
childbirth, and determining triage of trauma victims.	1168

(C) A first responder may perform any other emergency medical	1169
services approved pursuant to rules adopted under section 4765.11	1170
of the Revised Code. The board shall determine whether the nature	1171
of any such service requires that a first responder receive	1172
authorization prior to performing the service.	1173

(D)(1) Except as provided in division (D)(2) of this section,	1174
if the board determines under division (C) of this section that a	1175
service requires prior authorization, the service shall be	1176
performed only pursuant to the written or verbal authorization of	1177
a physician or of the cooperating physician advisory board, or	1178
pursuant to an authorization transmitted through a direct	1179
communication device by a physician, physician assistant	1180
designated by a physician, or registered nurse designated by a	1181
physician.	1182

(2) If communications fail during an emergency situation or	1183
the required response time prohibits communication, a first	1184
responder may perform services subject to this division, if, in	1185
the judgment of the first responder, the life of the patient is in	1186
immediate danger. Services performed under these circumstances	1187
shall be performed in accordance with the written protocols for	1188
triage of adult and pediatric trauma victims established in rules	1189
adopted under sections 4765.11 and 4765.40 of the Revised Code and	1190
any applicable protocols adopted by the emergency medical service	1191
organization with which the first responder is affiliated.	1192

Sec. 4765.36.  In a hospital, an emergency medical	1193
technician-basic, emergency medical technician-intermediate, or	1194
emergency medical technician-paramedic may perform emergency	1195
medical services only under the direction and supervision of a	1196
physician or registered nurse designated by a physician and only	1197
if the services are performed in accordance with both of the	1198
following conditions:	1199

(A) Only in the hospital's emergency department or while	1200
moving a patient between the emergency department and another part	1201
of the hospital;	1202

(B) Only under the direction and supervision of one of the	1203
following:	1204

(1) A physician;

1205

(2) A physician assistant designated by a physician;

1206

(3) A registered nurse designated by a physician.

1207

Sec. 4765.37.  (A) An emergency medical technician-basic	1208
shall perform the emergency medical services described in this	1209
section in accordance with this chapter and any rules adopted	1210
under it by the state board of emergency medical services.	1211

(B) An emergency medical technician-basic may operate, or be	1212
responsible for operation of, an ambulance and may provide	1213
emergency medical services to patients. In an emergency, an	1214
EMT-basic may determine the nature and extent of illness or injury	1215
and establish priority for required emergency medical services. An	1216
EMT-basic may render emergency medical services such as opening	1217
and maintaining an airway, giving positive pressure ventilation,	1218
cardiac resuscitation, electrical interventions with automated	1219
defibrillators to support or correct the cardiac function and	1220
other methods determined by the board, controlling of hemorrhage,	1221
treatment of shock, immobilization of fractures, bandaging,	1222
assisting in childbirth, management of mentally disturbed	1223
patients, initial care of poison and burn patients, and	1224
determining triage of adult and pediatric trauma victims. Where	1225
patients must in an emergency be extricated from entrapment, an	1226
EMT-basic may assess the extent of injury and render all possible	1227
emergency medical services and protection to the entrapped	1228
patient; provide light rescue services if an ambulance has not	1229
been accompanied by a specialized unit; and after extrication,	1230
provide additional care in sorting of the injured in accordance	1231
with standard emergency procedures.	1232

(C) An EMT-basic may perform any other emergency medical	1233
services approved pursuant to rules adopted under section 4765.11	1234
of the Revised Code. The board shall determine whether the nature	1235
of any such service requires that an EMT-basic receive	1236
authorization prior to performing the service.	1237

(D)(1) Except as provided in division (D)(2) of this section,	1238
if the board determines under division (C) of this section that a	1239
service requires prior authorization, the service shall be	1240
performed only pursuant to the written or verbal authorization of	1241
a physician or of the cooperating physician advisory board, or	1242
pursuant to an authorization transmitted through a direct	1243
communication device by a physician, physician assistant	1244
designated by a physician, or registered nurse designated by a	1245
physician.	1246

(2) If communications fail during an emergency situation or	1247
the required response time prohibits communication, an EMT-basic	1248
may perform services subject to this division, if, in the judgment	1249
of the EMT-basic, the life of the patient is in immediate danger.	1250
Services performed under these circumstances shall be performed in	1251
accordance with the protocols for triage of adult and pediatric	1252
trauma victims established in rules adopted under sections 4765.11	1253
and 4765.40 of the Revised Code and any applicable protocols	1254
adopted by the emergency medical service organization with which	1255
the EMT-basic is affiliated.	1256

Sec. 4765.38.  (A) An emergency medical	1257
technician-intermediate shall perform the emergency medical	1258
services described in this section in accordance with this chapter	1259
and any rules adopted under it.	1260

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

1261

(1) Establish and maintain an intravenous lifeline that has	1262
been approved by a cooperating physician or physician advisory	1263
board;	1264

(2) Perform cardiac monitoring;

1265

(3) Perform electrical interventions to support or correct	1266
the cardiac function;	1267

(4) Administer epinephrine;

1268

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

1269

(6) Perform any other emergency medical services approved	1270
pursuant to rules adopted under section 4765.11 of the Revised	1271
Code.	1272

(C)(1) Except as provided in division (C)(2) of this section,	1273
the services described in division (B) of this section shall be	1274
performed by an EMT-I only pursuant to the written or verbal	1275
authorization of a physician or of the cooperating physician	1276
advisory board, or pursuant to an authorization transmitted	1277
through a direct communication device by a physician, physician	1278
assistant designated by a physician, or registered nurse	1279
designated by a physician.	1280

(2) If communications fail during an emergency situation or	1281
the required response time prohibits communication, an EMT-I may	1282
perform any of the services described in division (B) of this	1283
section, if, in the judgment of the EMT-I, the life of the patient	1284
is in immediate danger. Services performed under these	1285
circumstances shall be performed in accordance with the protocols	1286
for triage of adult and pediatric trauma victims established in	1287
rules adopted under sections 4765.11 and 4765.40 of the Revised	1288
Code and any applicable protocols adopted by the emergency medical	1289
service organization with which the EMT-I is affiliated.	1290

(D) In addition to, and in the course of, providing emergency	1291
medical treatment, an emergency medical technician-intermediate	1292
may withdraw blood as provided under sections 1547.11, 4506.17,	1293
and 4511.19 of the Revised Code. An emergency medical	1294
technician-intermediate shall withdraw blood in accordance with	1295
this chapter and any rules adopted under it by the state board of	1296
emergency medical services.	1297

Sec. 4765.39.  (A) An emergency medical technician-paramedic	1298
shall perform the emergency medical services described in this	1299
section in accordance with this chapter and any rules adopted	1300
under it.	1301

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

1302

(1) Perform cardiac monitoring;

1303

(2) Perform electrical interventions to support or correct	1304
the cardiac function;	1305

(3) Perform airway procedures;

1306

(4) Perform relief of pneumothorax;

1307

(5) Administer appropriate drugs and intravenous fluids;

1308

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

1309

(7) Perform any other emergency medical services, including	1310
life support or intensive care techniques, approved pursuant to	1311
rules adopted under section 4765.11 of the Revised Code.	1312

(C)(1) Except as provided in division (C)(2) of this section,	1313
the services described in division (B) of this section shall be	1314
performed by a paramedic only pursuant to the written or verbal	1315
authorization of a physician or of the cooperating physician	1316
advisory board, or pursuant to an authorization transmitted	1317
through a direct communication device by a physician, physician	1318
assistant designated by a physician, or registered nurse	1319
designated by a physician.	1320

(2) If communications fail during an emergency situation or	1321
the required response time prohibits communication, a paramedic	1322
may perform any of the services described in division (B) of this	1323
section, if, in the paramedic's judgment, the life of the patient	1324
is in immediate danger. Services performed under these	1325
circumstances shall be performed in accordance with the protocols	1326
for triage of adult and pediatric trauma victims established in	1327
rules adopted under sections 4765.11 and 4765.40 of the Revised	1328
Code and any applicable protocols adopted by the emergency medical	1329
service organization with which the paramedic is affiliated.	1330

(D) In addition to, and in the course of, providing emergency	1331
medical treatment, an emergency medical technician-paramedic may	1332
withdraw blood as provided under sections 1547.11, 4506.17, and	1333
4511.19 of the Revised Code. An emergency medical	1334
technician-paramedic shall withdraw blood in accordance with this	1335
chapter and any rules adopted under it by the state board of	1336
emergency medical services.	1337

Sec. 4765.49.  (A) A first responder, emergency medical	1338
technician-basic, emergency medical technician-intermediate, or	1339
emergency medical technician-paramedic is not liable in damages in	1340
a civil action for injury, death, or loss to person or property	1341
resulting from the individual's administration of emergency	1342
medical services, unless the services are administered in a manner	1343
that constitutes willful or wanton misconduct. A physician,	1344
physician assistant designated by a physician, or registered nurse	1345
designated by a physician, whoany of whom is advising or	1346
assisting in the emergency medical services by means of any	1347
communication device or telemetering system, is not liable in	1348
damages in a civil action for injury, death, or loss to person or	1349
property resulting from the individual's advisory communication or	1350
assistance, unless the advisory communication or assistance is	1351
provided in a manner that constitutes willful or wanton	1352
misconduct. Medical directors and members of cooperating physician	1353
advisory boards of emergency medical service organizations are not	1354
liable in damages in a civil action for injury, death, or loss to	1355
person or property resulting from their acts or omissions in the	1356
performance of their duties, unless the act or omission	1357
constitutes willful or wanton misconduct.	1358

(B) A political subdivision, joint ambulance district, joint	1359
emergency medical services district, or other public agency, and	1360
any officer or employee of a public agency or of a private	1361
organization operating under contract or in joint agreement with	1362
one or more political subdivisions, that provides emergency	1363
medical services, or that enters into a joint agreement or a	1364
contract with the state, any political subdivision, joint	1365
ambulance district, or joint emergency medical services district	1366
for the provision of emergency medical services, is not liable in	1367
damages in a civil action for injury, death, or loss to person or	1368
property arising out of any actions taken by a first responder,	1369
EMT-basic, EMT-I, or paramedic working under the officer's or	1370
employee's jurisdiction, or for injury, death, or loss to person	1371
or property arising out of any actions of licensed medical	1372
personnel advising or assisting the first responder, EMT-basic,	1373
EMT-I, or paramedic, unless the services are provided in a manner	1374
that constitutes willful or wanton misconduct.	1375

(C) A student who is enrolled in an emergency medical	1376
services training program accredited under section 4765.17 of the	1377
Revised Code or an emergency medical services continuing education	1378
program approved under that section is not liable in damages in a	1379
civil action for injury, death, or loss to person or property	1380
resulting from either of the following:	1381

(1) The student's administration of emergency medical	1382
services or patient care or treatment, if the services, care, or	1383
treatment is administered while the student is under the direct	1384
supervision and in the immediate presence of an EMT-basic, EMT-I,	1385
paramedic, registered nurse, physician assistant, or physician and	1386
while the student is receiving clinical training that is required	1387
by the program, unless the services, care, or treatment is	1388
provided in a manner that constitutes willful or wanton	1389
misconduct;	1390

(2) The student's training as an ambulance driver, unless the	1391
driving is done in a manner that constitutes willful or wanton	1392
misconduct.	1393

(D) An EMT-basic, EMT-I, paramedic, or other operator, who	1394
holds a valid commercial driver's license issued pursuant to	1395
Chapter 4506. of the Revised Code or driver's license issued	1396
pursuant to Chapter 4507. of the Revised Code and who is employed	1397
by an emergency medical service organization that is not owned or	1398
operated by a political subdivision as defined in section 2744.01	1399
of the Revised Code, is not liable in damages in a civil action	1400
for injury, death, or loss to person or property that is caused by	1401
the operation of an ambulance by the EMT-basic, EMT-I, paramedic,	1402
or other operator while responding to or completing a call for	1403
emergency medical services, unless the operation constitutes	1404
willful or wanton misconduct or does not comply with the	1405
precautions of section 4511.03 of the Revised Code. An emergency	1406
medical service organization is not liable in damages in a civil	1407
action for any injury, death, or loss to person or property that	1408
is caused by the operation of an ambulance by its employee or	1409
agent, if this division grants the employee or agent immunity from	1410
civil liability for the injury, death, or loss.	1411

(E) An employee or agent of an emergency medical service	1412
organization who receives requests for emergency medical services	1413
that are directed to the organization, dispatches first	1414
responders, EMTs-basic, EMTs-I, or paramedics in response to those	1415
requests, communicates those requests to those employees or agents	1416
of the organization who are authorized to dispatch first	1417
responders, EMTs-basic, EMTs-I, or paramedics, or performs any	1418
combination of these functions for the organization, is not liable	1419
in damages in a civil action for injury, death, or loss to person	1420
or property resulting from the individual's acts or omissions in	1421
the performance of those duties for the organization, unless an	1422
act or omission constitutes willful or wanton misconduct.	1423

(F) A person who is performing the functions of a first	1424
responder, EMT-basic, EMT-I, or paramedic under the authority of	1425
the laws of a state that borders this state and who provides	1426
emergency medical services to or transportation of a patient in	1427
this state is not liable in damages in a civil action for injury,	1428
death, or loss to person or property resulting from the person's	1429
administration of emergency medical services, unless the services	1430
are administered in a manner that constitutes willful or wanton	1431
misconduct. A physician, physician assistant designated by a	1432
physician, or registered nurse designated by a physician, whoany	1433
of whom is licensed to practice in the adjoining state and who is	1434
advising or assisting in the emergency medical services by means	1435
of any communication device or telemetering system, is not liable	1436
in damages in a civil action for injury, death, or loss to person	1437
or property resulting from the person's advisory communication or	1438
assistance, unless the advisory communication or assistance is	1439
provided in a manner that constitutes willful or wanton	1440
misconduct.	1441

(G) A person certified under section 4765.23 of the Revised	1442
Code to teach in an emergency medical services training program or	1443
emergency medical services continuing education program, and a	1444
person who teaches at the Ohio fire academy established under	1445
section 3737.33 of the Revised Code or in a fire service training	1446
program described in division (A) of section 4765.55 of the	1447
Revised Code, is not liable in damages in a civil action for	1448
injury, death, or loss to person or property resulting from the	1449
person's acts or omissions in the performance of the person's	1450
duties, unless an act or omission constitutes willful or wanton	1451
misconduct.	1452

(H) In the accreditation of emergency medical services	1453
training programs or approval of emergency medical services	1454
continuing education programs, the state board of emergency	1455
medical services and any person or entity authorized by the board	1456
to evaluate applications for accreditation or approval are not	1457
liable in damages in a civil action for injury, death, or loss to	1458
person or property resulting from their acts or omissions in the	1459
performance of their duties, unless an act or omission constitutes	1460
willful or wanton misconduct.	1461

(I) A person authorized by an emergency medical service	1462
organization to review the performance of first responders,	1463
EMTs-basic, EMTs-I, and paramedics or to administer quality	1464
assurance programs is not liable in damages in a civil action for	1465
injury, death, or loss to person or property resulting from the	1466
person's acts or omissions in the performance of the person's	1467
duties, unless an act or omission constitutes willful or wanton	1468
misconduct.	1469

Sec. 4765.51.  Nothing in this chapter prevents or restricts	1470
the practice, services, or activities of any registered nurse	1471
practicing within the scope of histhe registered nurse's	1472
practice.	1473

Nothing in this chapter prevents or restricts the practice,	1474
services, or activities of any physician assistant practicing in	1475
accordance with a physician supervisory plan approved pursuant to	1476
section 4730.17 of the Revised Code or the policies of the health	1477
care facility in which the physician assistant is practicing.	1478

Sec. 5111.0216. For any service a physician assistant	1479
provides to a medicaid recipient in accordance with Chapter 4730.	1480
of the Revised Code, the medicaid program shall reimburse the	1481
physician assistant an amount that is one hundred per cent of the	1482
amount, as contained in the medicaid fee schedule determined	1483
pursuant to rules adopted under section 5111.02 of the Revised	1484
Code, established as the medicaid maximum for the service.	1485

Section 2.  That existing sections 185.01, 185.03, 185.05,	1486
2105.35, 2108.40, 2133.211, 3719.06, 4730.06, 4730.09, 4730.38,	1487
4730.39, 4730.40, 4730.41, 4730.42, 4730.44, 4730.45, 4755.48,	1488
4755.481, 4765.01, 4765.35, 4765.36, 4765.37, 4765.38, 4765.39,	1489
4765.49, and 4765.51 and section 4730.401 of the Revised Code are	1490
hereby repealed.	1491