Bill Summary – FastDemocracy

8138.01000
     Sixty-eighth
     Legislative Assembly                    SENATE BILL NO. 2115
     of North Dakota
     Introduced by
       Workforce Development Committee
       (At the request of the North Dakota Board of Medicine)
  A BILL for an Act to create and enact section 43-17-02.5, two new subsections to section
  43-17-07.1, section 43-17-27.2, and a new subsection to section 43-17-41 of the North Dakota
  Century Code, relating to licensing and discipline of physicians and physician assistants; to
  amend and reenact sections 43-17-01, 43-17-02, 43-17-02.1, 43-17-02.2, 43-17-02.3, 43-17-03,
  43-17-04, 43-17-05, 43-17-06, 43-17-07, 43-17-11, 43-17-14, 43-17-18, 43-17-24, 43-17-25,
  43-17-26.1, 43-17-27.1, 43-17-31, 43-17-32.1, 43-17-37, 43-17-38, 43-17-43, 43-17-46,
  43-17.1-01, 43-17.1-02, 43-17.1-05, 43-17.1-05.1, 43-17.1-06, and 43-17.1-08 of the North
  Dakota Century Code, relating to licensing and discipline of physicians and physician
  assistants; and to repeal sections 43-17-21 and 43-17-30 of the North Dakota Century Code,
 relating to licensing and discipline of physicians and physician assistants.
 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
     SECTION 1. AMENDMENT. Section 43-17-01 of the North Dakota Century Code is
 amended and reenacted as follows:
     43-17-01. Definitions.
     As used in this chapter, unless the context or subject matter otherwise requires:
     1.   "Board" means the North Dakota board of medicine.
     2.   "Licensee" means a physician, resident physician, or physician assistant licensed to
          practice in North Dakota.
     3.   "Physician" includes physician and surgeon (M.D.) and osteopathic physician and
          surgeon (D.O.).
     4.   "Physician assistant" means an individual issued a physician assistant license under
          this chapter.
     5.   "Practice of medicine" includes the practice of medicine, surgery, and obstetrics. The
          following persons are regarded as practicing medicine:
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           a.   A person that holds out to the public as being engaged within this state in the
                diagnosis or treatment of diseases or injuries of human beings.
           b.   A person that suggests, recommends, or prescribes any form of treatment for the
                intended relief or cure of any physical or mental ailment of any individual, with the
                intention of receiving, directly or indirectly, any fee, gift, or compensation.
           c.   A person that maintains an office for the examination or treatment of individuals
                afflicted with disease or injury of the body or mind.
           d.   A person that attaches the title M.D., surgeon, doctor, D.O., osteopathic physician
                and surgeon, or any other similar word or words or abbreviation to the person's
               name, indicating that the person is engaged in the treatment or diagnosis of the
               diseases or injuries of human beings shall be held to be engaged in the practice
               of medicine.
     6.   "Resident physician" means an individual issued a postgraduate training license under
          this chapter.
     7.   "Telemedicine" means the practice of medicine using electronic communication,
          information technologies, or other means between a licensee in one location and a
          patient in another location, with or without an intervening health care provider.
          "Telemedicine" includes direct interactive patient encounters, asynchronous
          store-and-forward technologies, and remote monitoring.
    SECTION 2. AMENDMENT. Section 43-17-02 of the North Dakota Century Code is
 amended and reenacted as follows:
    43-17-02. Persons exempt from the provisions of chapter.
    The provisions of this chapter do not apply to the following:
     1.   Students of medicine or osteopathy who are continuing their training and performing
          the duties of a resident in any hospital or institution maintained and operated by the
          state, an agency of the federal government, or in any residency program accredited by
          the accreditation council on graduate medical education, provided that the North
          Dakota board of medicine may adopt rules relating to the licensure, fees,
          qualifications, activities, scope of practice, and discipline of such persons.
     2.   The domestic administration of family remedies.
   3.2.   Dentists practicing their profession when properly licensed.
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    4.3.   Optometrists practicing their profession when properly licensed.
    5.4.   The practice of christian science or other religious tenets or religious rules or
           ceremonies as a form of religious worship, devotion, or healing, if the person
           administering, making use of, assisting in, or prescribing, such religious worship,
           devotion, or healing does not prescribe or administer drugs or medicines and does not
           perform surgical or physical operations, and if the person does not hold out to be a
           physician or surgeon.
    6.5.   Commissioned medical officers of the armed forces of the United States, the United
           States public health service, and medical officers of the veterans administration of the
          United States, in the discharge of their official duties, and licensed physicians from
          other states or territories if called in consultation with a person licensed to practice
          medicine in this state.
   7.6.   Doctors of chiropractic duly licensed to practice in this state pursuant to the statutes
          regulating such profession.
   8.7.   Podiatrists practicing their profession when properly licensed.
     9.   An individual rendering services as a physician assistant. However, sections
          43-17-02.1 and 43-17-02.2 apply to physician assistants. The board shall adopt rules
          governing the conduct, licensure, fees, qualifications, and discipline of physician
          assistants. Physician assistants are not authorized to perform any services that must
          be performed by persons licensed pursuant to chapters 43-12.1, 43-13, 43-15, and
          43-28 or services otherwise regulated by licensing laws, notwithstanding medical
          doctors need not be licensed specifically to perform the services contemplated under
          such chapters or licensing laws.
  10.8.   A nurse practicing the nurse's profession when properly licensed by the North Dakota
          board of nursing.
  11.9.   A naturopath duly licensed to practice in this state pursuant to the statutes regulating
          such profession.
 12.10.   An individual duly licensed to practice medical imaging or radiation therapy in this
          state under chapter 43-62.
 13.11.   An acupuncturist duly licensed to practice in this state pursuant to the statutes
          regulating such profession.
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     SECTION 3. AMENDMENT. Section 43-17-02.1 of the North Dakota Century Code is
  amended and reenacted as follows:
     43-17-02.1. Physician assistant - Scope of practice.
      1.   An individual providing services of a physician assistant as outlined in this chapter to a
           patient located in the state shall possess an active North Dakota license for physician
           assistant practice. The board shall adopt rules governing the conduct, licensure, fees,
           qualifications, and discipline of physician assistants. Physician assistants are not
           authorized to perform any services that must be performed by individuals licensed
           pursuant to chapters 43-12.1, 43-13, 43-15, and 43-28 or services otherwise regulated
          by licensing laws, notwithstanding medical doctors need not be licensed specifically to
          perform the services contemplated under such chapters or licensing laws.
     2.   A physician assistant may:
          a.   Provide a legal medical service for which a physician assistant is prepared by
               education, training, and experience and is competent to perform, including:
               (1)   Obtaining and performing a comprehensive health history and physical
                     examination;
               (2)   Evaluating, diagnosing, managing, and providing medical treatment;
               (3)   Ordering and evaluating a diagnostic study and therapeutic procedure;
               (4)   Performing a diagnostic study or therapeutic procedure not involving the use
                     of medical imaging as defined in section 43-62-01 or radiation therapy as
                     defined in section 43-62-01;
               (5)   Performing limited sonography on a focused imaging target to assess
                     specific and limited information about a patient's medical condition or to
                     provide real-time visual guidance for another procedure;
               (6)   Educating a patient on health promotion and disease prevention;
               (7)   Providing consultation upon request; and
               (8)   Writing a medical order;
          b.   Obtain informed consent;
          c.   Supervise, delegate, and assign therapeutic and diagnostic measures not
               involving the use of medical imaging as defined in section 43-62-01 or radiation
               therapy as defined in section 43-62-01 to licensed or unlicensed personnel;
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           d.   Certify the health or disability of a patient as required by any local, state, or
                federal program;
           e.   Authenticate any document with the signature, certification, stamp, verification,
                affidavit, or endorsement of the physician assistant if the document may be
                authenticated by the signature, certification, stamp, verification, affidavit, or
                endorsement of a physician; and
           f.   Pronounce death.
    2.3.   A physician assistant shall collaborate with, consult with, or refer to the appropriate
           member of the health care team as indicated by the condition of the patient, the
          education, experience, and competence of the physician assistant, and the standard
          of care. The degree of collaboration must be determined at the practice which may
          include decisions made by the employer, group, hospital service, and the credentialing
          and privileging systems of a licensed facility. A physician assistant is responsible for
          the care provided by that physician assistant and a written agreement relating to the
          items in this chapter is not required.
   3.4.   A physician assistant:
          a.   May prescribe, dispense, administer, and procure drugs and medical devices;
          b.   May plan and initiate a therapeutic regimen that includes ordering and
               prescribing nonpharmacological interventions, including durable medical
               equipment, nutrition, blood and blood products, and diagnostic support services,
               including home health care, hospice, and physical and occupational therapy;
          c.   May prescribe and dispense schedule II through V substances as designated by
               the federal drug enforcement agency and all legend drugs;
          d.   May not dispense a drug, unless pharmacy services are not reasonably
               available, dispensing is in the best interest of the patient, or an emergency exists;
          e.   May request, receive, and sign for a professional sample, and may distribute a
               professional sample to a patient; and
          f.   If prescribing or dispensing a controlled substance, shall register with the federal
               drug enforcement administration and shall comply with appropriate state and
               federal laws.
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    4.5.   A physician assistant shall practice at a licensed health care facility, facility with a
           credentialing and privileging system, physician-owned facility or practice, or facility or
           practice approved by the board.
    5.6.   Notwithstanding subsections 2 and 4, a physician assistant with less than four
           thousand hours of practice approved by the board under subsection 4 shall execute a
           written collaborative agreement that:
           a.   Is between a physician and a physician assistant with less than four thousand
                hours practice;
           b.   Describes how collaboration required under subsection 2 must occur; and
          c.   Is available to the board on request.
   6.7.   A physician assistant shall comply with any privileging and credentialing systems at
          the facility at which the physician assistant practices.
    SECTION 4. AMENDMENT. Section 43-17-02.2 of the North Dakota Century Code is
 amended and reenacted as follows:
    43-17-02.2. Physician assistant - Use of certain words or initials prohibited.
     1.   A person that is not a physician assistant may not:
          a.   Represent oneself as a physician assistant or act as a physician assistant; or
          b.   Use any combination or abbreviation of the term or title "physician assistant" or
               "PA" to indicate or imply the person is a physician assistantAn individual not
               licensed as a physician or resident physician under this chapter is prohibited from
               using the title of "doctor of medicine", "medical doctor", "doctor of osteopathic
               medicine", "osteopathic physician", "physician", "M.D.", or "D.O.".
     2.   However, an individual who is not licensed as a physician assistant under this chapter
          but who meets the qualifications for licensure as a physician assistant under this
          chapter may use the title "physician assistant" or "PA" but may not act or practice as a
          physician assistant unless licensed under this chapterAn individual not licensed as a
          physician assistant under this chapter is prohibited from using the title of "physician
          assistant" or "P.A.".
     3.   This section may not be construed as to prohibit a licensed health care professional
          from using a title incorporating any of the words specified in subsection 1 or 2, or from
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           using a title or designation that is not specifically protected by subsections 1 or 2, if the
           title or designation used is permitted under the health care professional's practice act.
      4.   Notwithstanding subsections 1 and 2, an individual who does not hold an active
           physician, resident physician, or physician assistant license may still use the title
           conferred by a qualified educational degree recognized under this chapter, but may
           not practice unless licensed under this chapter.
      SECTION 5. AMENDMENT. Section 43-17-02.3 of the North Dakota Century Code is
  amended and reenacted as follows:
      43-17-02.3. Practice of medicine or osteopathy by holder of permanent, unrestricted
 license - Exceptions.
     The practice of medicine is deemed to occur in the state the patient is located. A practitioner
 providing medical care to a patient located in this state is subject to the licensing and
 disciplinary laws of this state and shall possess an active North Dakota license for the
 practitioner's profession. Notwithstanding anything in this chapter to the contrary, any physician
 who is the holder of a permanent, unrestricted license to practice medicine or osteopathy in any
 state or territory of the United States, the District of Columbia, or a province of Canada may
 practice medicine or osteopathy in this state without first obtaining a license from the North
 Dakota board of medicine under one or more of the following circumstances:
     1.   As a member of an organ harvest team;
     2.   On board an air ambulance and as a part of its treatment team;
     3.   To provide one-time consultation on a diagnosis for a patient to a physician licensed in
          the state, or teaching assistance for a period of not more than seven days; or
     4.   To provide consultation or teaching assistance previously approved by the board for
          charitable organizations; or
     5.   Under rules adopted by the board.
     SECTION 6. Section 43-17-02.5 of the North Dakota Century Code is created and enacted
 as follows:
     43-17-02.5. Licensure for resident physicians.
     Resident physicians of medicine or osteopathy who are continuing their training and
 performing the duties of a resident in a hospital or institution maintained and operated by the
 state, an agency of the federal government, or a residency program accredited by the
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  accreditation council on graduate medical education will be require