As Introduced
133rd General Assembly
Regular Session H. B. No. 492
2019-2020
Representatives Wiggam, Miller, J.
Cosponsors: Representatives Manning, D., Lepore-Hagan, Lang, Crossman, Baldridge, Galonski
A BILL
To amend sections 1.64, 2108.61, 2133.211, 3701.351, 3727.06, 4730.02, 4730.03, 4730.04, 4730.05, 4730.06, 4730.07, 4730.08, 4730.11, 4730.14, 4730.19, 4730.20, 4730.201, 4730.203, 4730.21, 4730.22, 4730.25, 4730.26, 4730.32, 4730.41, 4730.411, 4730.42, 4731.22, 4761.17, 4773.02, 5122.01, and 5122.10; to enact section 4730.204; and to repeal sections 4730.111 and 4730.44 of the Revised Code to modify the laws regarding physician assistants.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1.64, 2108.61, 2133.211, 3701.351, 3727.06, 4730.02, 4730.03, 4730.04, 4730.05, 4730.06, 4730.07, 4730.08, 4730.11, 4730.14, 4730.19, 4730.20, 4730.201, 4730.203, 4730.21, 4730.22, 4730.25, 4730.26, 4730.32, 4730.41, 4730.411, 4730.42, 4731.22, 4761.17, 4773.02, 5122.01, and 5122.10 be amended and section 4730.204 of the Revised Code be enacted to read as follows:
Sec. 1.64. As used in the Revised Code:
(A) "Certified nurse-midwife" means an advanced practice registered nurse who holds a current, valid license issued under Chapter 4723. of the Revised Code and is designated as a certified nurse-midwife in accordance with section 4723.42 of the Revised Code and rules adopted by the board of nursing.
(B) "Certified nurse practitioner" means an advanced practice registered nurse who holds a current, valid license issued under Chapter 4723. of the Revised Code and is designated as a certified nurse practitioner in accordance with section 4723.42 of the Revised Code and rules adopted by the board of nursing.
(C) "Clinical nurse specialist" means an advanced practice registered nurse who holds a current, valid license issued under Chapter 4723. of the Revised Code and is designated as a clinical nurse specialist in accordance with section 4723.42 of the Revised Code and rules adopted by the board of nursing.
(D)
"Physician assistant" means an individual who is licensed
under Chapter 4730. of the Revised Code to provide services as a
physician assistant to patients under
with
the supervision,
control,
collaboration
and direction of one or more physicians.
Sec. 2108.61. (A) As used in this section and sections 2108.62 and 2108.63 of the Revised Code:
(1) "Health care institution" means a hospital registered as such under section 3701.07 of the Revised Code or a freestanding birthing center.
(2)
"Health care professional" means a physician authorized
under Chapter 4731. of the Revised Code to practice medicine and
surgery or osteopathic medicine and surgery; a registered nurse,
including a certified nurse-midwife, authorized to practice under
Chapter 4723. of the Revised Code; or a physician assistant
authorized to practice under Chapter 4130.
4730.
of the Revised Code.
(3) "Umbilical cord blood" means the blood that remains in the umbilical cord and placenta after the birth of a newborn child.
(B) The department of health shall encourage health care professionals who provide health care services that are directly related to a woman's pregnancy to provide a woman before her third trimester of pregnancy with the publications described in section 2108.62 of the Revised Code.
Sec. 2133.211. A person who holds a current, valid license issued under Chapter 4723. of the Revised Code to practice as an advanced practice registered nurse may take any action that may be taken by an attending physician under sections 2133.21 to 2133.26 of the Revised Code and has the immunity provided by section 2133.22 of the Revised Code if the action is taken pursuant to a standard care arrangement with a collaborating physician.
A
person who holds a license to practice as a physician assistant
issued under Chapter 4730. of the Revised Code may take any action
that may be taken by an attending physician under sections 2133.21 to
2133.26 of the Revised Code and has the immunity provided by section
2133.22 of the Revised Code if the action is taken pursuant to a
supervision
collaboration
agreement entered into under section 4730.19
of the Revised Code, including, if applicable, the policies of a
health care facility in which the physician assistant is practicing.
Sec. 3701.351. (A) The governing body of every hospital shall set standards and procedures to be applied by the hospital and its medical staff in considering and acting upon applications for staff membership or professional privileges. These standards and procedures shall be available for public inspection.
(B) The governing body of any hospital, in considering and acting upon applications for staff membership or professional privileges within the scope of the applicants' respective licensures, shall not discriminate against a qualified person solely on the basis of whether that person is licensed to practice medicine, osteopathic medicine, or podiatry, is licensed to practice as a physician assistant, is licensed to practice dentistry or psychology, or is licensed to practice nursing as an advanced practice registered nurse. Staff membership or professional privileges shall be considered and acted on in accordance with standards and procedures established under division (A) of this section. This section does not permit a psychologist to admit a patient to a hospital in violation of section 3727.06 of the Revised Code.
(C) The governing body of any hospital that is licensed to provide maternity services, in considering and acting upon applications for clinical privileges, shall not discriminate against a qualified person solely on the basis that the person is authorized to practice nurse-midwifery. An application from a certified nurse-midwife who is not employed by the hospital shall contain the name of a physician member of the hospital's medical staff who holds clinical privileges in obstetrics at that hospital and who has agreed to be the collaborating physician for the applicant in accordance with section 4723.43 of the Revised Code.
(D) Any person may apply to the court of common pleas for temporary or permanent injunctions restraining a violation of division (A), (B), or (C) of this section. This action is an additional remedy not dependent on the adequacy of the remedy at law.
(E)(1) If a hospital does not provide or permit the provision of any diagnostic or treatment service for mental or emotional disorders or any other service that may be legally performed by a psychologist licensed under Chapter 4732. of the Revised Code, this section does not require the hospital to provide or permit the provision of any such service and the hospital shall be exempt from requirements of this section pertaining to psychologists.
(2) This section does not impair the right of a hospital to enter into an employment, personal service, or any other kind of contract with a licensed psychologist, upon any such terms as the parties may mutually agree, for the provision of any service that may be legally performed by a licensed psychologist.
Sec. 3727.06. (A) As used in this section:
(1) "Doctor" means an individual authorized to practice medicine and surgery or osteopathic medicine and surgery.
(2) "Podiatrist" means an individual authorized to practice podiatric medicine and surgery.
(B)(1) Only the following may admit a patient to a hospital:
(a) A doctor who is a member of the hospital's medical staff;
(b) A dentist who is a member of the hospital's medical staff;
(c) A podiatrist who is a member of the hospital's medical staff;
(d) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner if all of the following conditions are met:
(i) The clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner has a standard care arrangement entered into pursuant to section 4723.431 of the Revised Code with a collaborating doctor or podiatrist who is a member of the medical staff;
(ii) The patient will be under the medical supervision of the collaborating doctor or podiatrist;
(iii) The hospital has granted the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner admitting privileges and appropriate credentials.
(e) A physician assistant if all of the following conditions are met:
(i)
The physician assistant is listed on a supervision
collaboration
agreement entered into under section 4730.19
of the Revised Code for a doctor or podiatrist who is a member of the
hospital's medical staff.
(ii)
The patient will be under the medical supervision of the supervising
collaborating
doctor or podiatrist.
(iii) The hospital has granted the physician assistant admitting privileges and appropriate credentials.
(2)
Prior to admitting a patient, a clinical nurse specialist, certified
nurse-midwife, certified nurse practitioner, or physician assistant
shall notify the collaborating or
supervising
doctor or podiatrist of the planned
admission.
(C) All hospital patients shall be under the medical supervision of a doctor, except that services that may be rendered by a licensed dentist pursuant to Chapter 4715. of the Revised Code provided to patients admitted solely for the purpose of receiving such services shall be under the supervision of the admitting dentist and that services that may be rendered by a podiatrist pursuant to section 4731.51 of the Revised Code provided to patients admitted solely for the purpose of receiving such services shall be under the supervision of the admitting podiatrist. If treatment not within the scope of Chapter 4715. or section 4731.51 of the Revised Code is required at the time of admission by a dentist or podiatrist, or becomes necessary during the course of hospital treatment by a dentist or podiatrist, such treatment shall be under the supervision of a doctor who is a member of the medical staff. It shall be the responsibility of the admitting dentist or podiatrist to make arrangements with a doctor who is a member of the medical staff to be responsible for the patient's treatment outside the scope of Chapter 4715. or section 4731.51 of the Revised Code when necessary during the patient's stay in the hospital.
Sec. 4730.02. (A) No person shall hold that person out as being able to function as a physician assistant, or use any words or letters indicating or implying that the person is a physician assistant, without a current, valid license to practice as a physician assistant issued pursuant to this chapter.
(B)
No person shall practice as a physician assistant without the
supervision,
control,
collaboration
and direction of a physician.
(C)
No person shall practice as a physician assistant without having
entered into a supervision
collaboration
agreement with a supervising
collaborating
physician under section 4730.19 of the
Revised Code.
(D)
No person acting as the supervising
collaborating
physician of a physician assistant shall
authorize the physician assistant to perform services if either of
the following is the case:
(1) The services are not within the physician's normal course of practice and expertise;
(2)
The services are inconsistent with the supervision
collaboration
agreement under which the physician
assistant is being
supervisedpracticing,
including, if applicable, the policies of the health care facility in
which the physician and physician assistant are practicing.
(E) No person practicing as a physician assistant shall prescribe any drug or device to perform or induce an abortion, or otherwise perform or induce an abortion.
(F)
No
person
shall
advertise
to
provide
services
as
a
physician
assistant,
except
for
the
purpose
of
seeking
employment.
(G)
No person practicing as a physician
assistant shall fail to wear at all times when on duty a placard,
plate, or other device identifying that person as a "physician
assistant."
(H)
(G)
Division (A) of this section does not apply
to a person who meets all of the following conditions:
(1) The person holds in good standing a valid license or other form of authority to practice as a physician assistant issued by another state.
(2) The person is practicing as a volunteer without remuneration during a charitable event that lasts not more than seven days.
(3) The medical care provided by the person will be supervised by the medical director of the charitable event or by another physician.
When a person meets the conditions of this division, the person shall be deemed to hold, during the course of the charitable event, a license to practice as a physician assistant from the state medical board and shall be subject to the provisions of this chapter authorizing the board to take disciplinary action against a license holder. Not less than seven calendar days before the first day of the charitable event, the person or the event's organizer shall notify the board of the person's intent to practice as a physician assistant at the event. During the course of the charitable event, the person's scope of practice is limited to the procedures that a physician assistant licensed under this chapter is authorized to perform unless the person's scope of practice in the other state is more restrictive than in this state. If the latter is the case, the person's scope of practice is limited to the procedures that a physician assistant in the other state may perform.
Sec. 4730.03. Nothing in this chapter shall:
(A) Be construed to affect or interfere with the performance of duties of any medical personnel who are either of the following:
(1) In active service in the army, navy, coast guard, marine corps, air force, public health service, or marine hospital service of the United States while so serving;
(2) Employed by the veterans administration of the United States while so employed.
(B) Prevent any person from performing any of the services a physician assistant may be authorized to perform, if the person's professional scope of practice established under any other chapter of the Revised Code authorizes the person to perform the services;
(C) Prohibit a physician from delegating responsibilities to any nurse or other qualified person who does not hold a license to practice as a physician assistant, provided that the individual does not hold the individual out to be a physician assistant;
(D)
Be construed as authorizing a physician assistant independently to
order or direct the execution of procedures or techniques by a
registered nurse or licensed practical nurse in the care and
treatment of a person in any setting, except to the extent that the
physician assistant is authorized to do so by a physician who is
responsible for supervising
collaborating
with
the physician assistant and, if applicable,
the policies of the health care facility in which the physician
assistant is practicing;
(E)
Authorize a physician assistant to engage in the practice of
optometry, except to the extent that the physician assistant
is
authorized
by
a
supervising
assistant's
collaborating
physician,
acting in accordance with this chapter,
has
authorized
the
physician
assistant
to perform routine visual screening, provide medical care prior to or
following eye surgery, or assist in the care of diseases of the eye;
(F) Be construed as authorizing a physician assistant to prescribe any drug or device to perform or induce an abortion, or as otherwise authorizing a physician assistant to perform or induce an abortion.
Sec. 4730.04. (A) As used in this section:
(1) "Disaster" means any imminent threat or actual occurrence of widespread or severe damage to or loss of property, personal hardship or injury, or loss of life that results from any natural phenomenon or act of a human.
(2) "Emergency" means an occurrence or event that poses an imminent threat to the health or life of a human.
(B) Nothing in this chapter prohibits any of the following individuals from providing medical care, to the extent the individual is able, in response to a need for medical care precipitated by a disaster or emergency:
(1) An individual who holds a license to practice as a physician assistant issued under this chapter;
(2) An individual licensed or authorized to practice as a physician assistant in another state;
(3) An individual credentialed or employed as a physician assistant by an agency, office, or other instrumentality of the federal government.
(C)
For purposes of the medical care provided by a physician assistant
pursuant to division (B)(1) of this section, both of the following
apply notwithstanding any supervision
collaboration
requirement of this chapter to the contrary:
(1)
The physician who supervises
collaborates
with
the physician assistant pursuant to a
supervision
collaboration
agreement entered into under section 4730.19
of the Revised Code is not required to meet the supervision
collaboration
requirements established under this chapter.
(2)
The physician designated as the medical director of the disaster or
emergency may supervise
collaborate
with
the medical
care
provided
by
the
physician assistant
when
the
physician
assistant
is
providing
the
medical
care.
Sec. 4730.05. (A) There is hereby created the physician assistant policy committee of the state medical board. The president of the board shall appoint the members of the committee. The committee shall consist of the seven members specified in divisions (A)(1) to (3) of this section. When the committee is developing or revising policy and procedures for physician-delegated prescriptive authority for physician assistants, the committee shall include the additional member specified in division (A)(4) of this section.
(1)
Three members of the committee shall be physicians. Of the physician
members, one shall be a member of the state medical board, one shall
be appointed from a list of five physicians recommended by the Ohio
state medical association, and one shall be appointed from a list of
five physicians recommended by the Ohio osteopathic association. At
all times, the physician membership of the committee shall include at
least one physician who is a supervising
collaborating
physician of a physician assistant,.
Beginning
two
years
after
the
effective
date
of
this
amendment,
each
collaborating
physician
member
preferably with
shall
have
at least two years' experience as a
supervising
collaborating
physician.
(2) Three members shall be physician assistants appointed from a list of five individuals recommended by the Ohio association of physician assistants.
(3) One member, who is not affiliated with any health care profession, shall be appointed to represent the interests of consumers.
(4) One additional member, appointed to serve only when the committee is developing or revising policy and procedures for physician-delegated prescriptive authority for physician assistants, shall be a pharmacist. The member shall be appointed from a list of five clinical pharmacists recommended by the Ohio pharmacists association or appointed from the pharmacist members of the state board of pharmacy, preferably from among the members who are clinical pharmacists.
The pharmacist member shall have voting privileges only for purposes of developing or revising policy and procedures for physician-delegated prescriptive authority for physician assistants. Presence of the pharmacist member shall not be required for the transaction of any other business.
(B) Terms of office shall be for two years, with each term ending on the same day of the same month as did the term that it succeeds. Each member shall hold office from the date of being appointed until the end of the term for which the member was appointed. Members may be reappointed, except that a member may not be appointed to serve more than three consecutive terms. As vacancies occur, a successor shall be appointed who has the qualifications the vacancy requires. A member appointed to fill a vacancy occurring prior to the expiration of the term for which a predecessor was appointed shall hold office as a member for the remainder of that term. A member shall continue in office subsequent to the expiration date of the member's term until a successor takes office or until a period of sixty days has elapsed, whichever occurs first.
(C) Each member of the committee shall receive the member's necessary and actual expenses incurred in the performance of official duties as a member.
(D) The committee members specified in divisions (A)(1) to (3) of this section by a majority vote shall elect a chairperson from among those members. The members may elect a new chairperson at any time.
(E) The state medical board may appoint assistants, clerical staff, or other employees as necessary for the committee to perform its duties adequately.
(F) The committee shall meet as necessary to carry out its responsibilities.
(G) The board may permit meetings of the physician assistant policy committee to include the use of interactive videoconferencing, teleconferencing, or both if all of the following requirements are met:
(1) The meeting location is open and accessible to the public.
(2) Each committee member is permitted to choose whether the member attends in person or through the use of the meeting's videoconferencing or teleconferencing;
(3) Any meeting-related materials available before the meeting are sent to each committee member by electronic mail, facsimile, or United States mail, or are hand delivered.
(4) If interactive videoconferencing is used, there is a clear video and audio connection that enables all participants at the meeting location to see and hear each committee member.
(5) If teleconferencing is used, there is a clear audio connection that enables all participants at the meeting location to hear each committee member.
(6) A roll call vote is recorded for each vote taken.
(7) The meeting minutes specify for each member whether the member attended by videoconference, teleconference, or in person.
Sec. 4730.06. (A) The physician assistant policy committee of the state medical board shall review, and shall submit to the board recommendations concerning, all of the following:
(1) Requirements for issuing a license to practice as a physician assistant, including the educational requirements that must be met to receive the license;
(2)
Existing and proposed rules pertaining to the practice of physician
assistants, the supervisory
collaborative
relationship between physician assistants
and supervising
collaborating
physicians, and the administration and
enforcement of this chapter;
(3) In accordance with section 4730.38 of the Revised Code, physician-delegated prescriptive authority for physician assistants;
(4) Application procedures and forms for a license to practice as a physician assistant;
(5) Fees required by this chapter for issuance and renewal of a license to practice as a physician assistant;
(6) Any issue the board asks the committee to consider.
(B)
In addition to the matters that are required to be reviewed under
division (A) of this section, the committee may review, and may
submit to the board recommendations concerning quality assurance
activities to be performed by a supervising
collaborating
physician and physician assistant under a
quality assurance system established pursuant to division (F) of
section 4730.21 of the Revised Code.
(C) The board shall take into consideration all recommendations submitted by the committee. Not later than ninety days after receiving a recommendation from the committee, the board shall approve or disapprove the recommendation and notify the committee of its decision. If a recommendation is disapproved, the board shall inform the committee of its reasons for making that decision. The committee may resubmit the recommendation after addressing the concerns expressed by the board and modifying the disapproved recommendation accordingly. Not later than ninety days after receiving a resubmitted recommendation, the board shall approve or disapprove the recommendation. There is no limit on the number of times the committee may resubmit a recommendation for consideration by the board.
(D)(1) Except as provided in division (D)(2) of this section, the board may not take action regarding a matter that is subject to the committee's review under division (A) or (B) of this section unless the committee has made a recommendation to the board concerning the matter.
(2) If the board submits to the committee a request for a recommendation regarding a matter that is subject to the committee's review under division (A) or (B) of this section, and the committee does not provide a recommendation before the sixty-first day after the request is submitted, the board may take action regarding the matter without a recommendation.
Sec.
4730.07.
In addition to rules that are specifically
required or authorized by this chapter to be adopted, the state
medical board may, subject to division (D) of section 4730.06 of the
Revised Code, adopt any other rules necessary to govern the practice
of physician assistants, the supervisory
collaborative
relationship between physician assistants
and supervising
collaborating
physicians, and the administration and
enforcement of this chapter. Rules adopted under this section shall
be adopted in accordance with Chapter 119. of the Revised Code.
Sec. 4730.08. (A) A license to practice as a physician assistant issued under this chapter authorizes the holder to practice as a physician assistant as follows:
(1)
The physician assistant shall practice only under
with
the supervision,
control,
collaboration
and direction of a physician with whom the
physician assistant has entered into a supervision
collaboration
agreement under section 4730.19 of the
Revised Code.
(2)
The physician assistant shall practice in accordance with the
supervision
collaboration
agreement entered into with the physician
who is responsible for supervising
collaborating
with
the physician assistant, including, if
applicable, the policies of the health care facility in which the
physician assistant is practicing.
(B) The state medical board may, subject to division (D) of section 4730.06 of the Revised Code, adopt rules designating facilities to be included as health care facilities that are in addition to the facilities specified in divisions (B)(1) and (2) of section 4730.01 of the Revised Code. Any rules adopted shall be adopted in accordance with Chapter 119. of the Revised Code.
Sec. 4730.11. (A) To be eligible to receive a license to practice as a physician assistant, all of the following apply to an applicant:
(1) The applicant shall be at least eighteen years of age.
(2) The applicant shall be of good moral character.
(3)
The
On
the
date
of
application,
the
applicant shall hold current certification
by the national commission on certification of physician assistants
or a successor organization that is recognized by the state medical
board.
(4) The applicant shall meet either of the following requirements:
(a) The educational requirements specified in division (B)(1) or (2) of this section;
(b) The educational or other applicable requirements specified in division (C)(1), (2), or (3) of this section.
(B) For purposes of division (A)(4)(a) of this section, an applicant shall meet either of the following educational requirements:
(1) The applicant shall hold a master's or higher degree obtained from a program accredited by the accreditation review commission on education for the physician assistant or a predecessor or successor organization recognized by the board.
(2) The applicant shall hold both of the following degrees:
(a) A degree other than a master's or higher degree obtained from a program accredited by the accreditation review commission on education for the physician assistant or a predecessor or successor organization recognized by the board;
(b) A master's or higher degree in a course of study with clinical relevance to the practice of physician assistants and obtained from a program accredited by a regional or specialized and professional accrediting agency recognized by the council for higher education accreditation.
(C) For purposes of division (A)(4)(b) of this section, an applicant shall present evidence satisfactory to the board of meeting one of the following requirements in lieu of meeting the educational requirements specified in division (B)(1) or (2) of this section:
(1) The applicant shall hold a current, valid license or other form of authority to practice as a physician assistant issued by another jurisdiction and either have been in active practice in any jurisdiction throughout the two-year period immediately preceding the date of application or have met one or more of the following requirements as specified by the board:
(a) Passed an oral or written examination or assessment, or both types of examination or assessment, that determined the applicant's present fitness to resume practice;
(b) Obtained additional training and passed an examination or assessment on completion of the training;
(c) Agreed to limitations on the applicant's extent, scope, or type of practice.
(2) The applicant shall hold a degree obtained as a result of being enrolled on January 1, 2008, in a program in this state that was accredited by the accreditation review commission on education for the physician assistant but did not grant a master's or higher degree to individuals enrolled in the program on that date, and completing the program on or before December 31, 2009.
(3) The applicant shall hold a degree obtained from a program accredited by the accreditation review commission on education for the physician assistant and meet either of the following experience requirements:
(a) Either have experience practicing as a physician assistant for at least two consecutive years immediately preceding the date of application while on active duty, with evidence of service under honorable conditions, in any of the armed forces of the United States or the national guard of any state, including any experience attained while practicing as a physician assistant at a health care facility or clinic operated by the United States department of veterans affairs or have met one or more of the following requirements as specified by the board:
(i) Passed an oral or written examination or assessment, or both types of examination or assessment, that determined the applicant's present fitness to resume practice;
(ii) Obtained additional training and passed an examination or assessment on completion of the training;
(iii) Agreed to limitations on the applicant's extent, scope, or type of practice;
(b) Either have experience practicing as a physician assistant for at least two consecutive years immediately preceding the date of application while on active duty in the United States public health service commissioned corps or have met one or more of the following requirements as specified by the board:
(i) Passed an oral or written examination or assessment, or both types of examination or assessment, that determined the applicant's present fitness to resume practice;
(ii) Obtained additional training and passed an examination or assessment on completion of the training;
(iii) Agreed to limitations on the applicant's extent, scope, or type of practice.
(D) This section does not require an individual to obtain a master's or higher degree as a condition of retaining or renewing a license to practice as a physician assistant if the individual received the license without holding a master's or higher degree as provided in either of the following:
(1) Before the educational requirements specified in division (B)(1) or (2) of this section became effective January 1, 2008;
(2) By meeting the educational or other applicable requirements specified in division (C)(1), (2), or (3) of this section.
Sec. 4730.14. (A) A license to practice as a physician assistant shall be valid for a two-year period unless revoked or suspended, shall expire on the date that is two years after the date of issuance, and may be renewed for additional two-year periods in accordance with this section. A person seeking to renew a license shall apply to the state medical board for renewal prior to the license's expiration date. The board shall provide renewal notices to license holders at least one month prior to the expiration date.
Applications shall be submitted to the board in a manner prescribed by the board. Each application shall be accompanied by a biennial renewal fee of two hundred dollars. The board shall deposit the fees in accordance with section 4731.24 of the Revised Code.
The applicant shall report any criminal offense that constitutes grounds for refusing to issue a license to practice under section 4730.25 of the Revised Code to which the applicant has pleaded guilty, of which the applicant has been found guilty, or for which the applicant has been found eligible for intervention in lieu of conviction, since last signing an application for a license to practice as a physician assistant.
(B) To be eligible for renewal of a license, an applicant is subject to all of the following:
(1)
The
applicant
must
certify
to
the
board
that
the
applicant
has
maintained
certification
by
the
national
commission
on
certification
of
physician
assistants
or
a
successor
organization
that
is
recognized
by
the
board
by
meeting
the
standards
to
hold
current
certification
from
the
commission
or
its
successor,
including
passing
periodic
recertification
examinations;
(2)
Except as provided in section 5903.12
of the Revised Code, the applicant must certify to the board that the
applicant is in compliance with the board's
continuing medical education requirements
necessary
to
hold
current
certification
from
the
commission
or
its
successorfor
physician
assistants.
(3)
(2)
The applicant must comply with the renewal
eligibility requirements established under section 4730.49 of the
Revised Code that pertain to the applicant.
(C) If an applicant submits a complete renewal application and qualifies for renewal pursuant to division (B) of this section, the board shall issue to the applicant a renewed license to practice as a physician assistant.
(D)
The board may require a random sample of physician assistants to
submit materials documenting both
of
the
following:
(1)
Certification
by
the
national
commission
on
certification
of
physician
assistants
or
a
successor
organization
that
is
recognized
by
the
board;
(2)
Completion
completion
of the continuing medical education required
to
hold
current
certification
from
the
commission
or
its
successorby
the
board
for
physician
assistants.
Division
(D)
of
this
section
This
division
does not limit the board's authority to
conduct investigations pursuant to section 4730.25 of the Revised
Code.
(E) A license to practice that is not renewed on or before its expiration date is automatically suspended on its expiration date. Continued practice after suspension of the license shall be considered as practicing in violation of division (A) of section 4730.02 of the Revised Code.
(F) If a license has been suspended pursuant to division (E) of this section for two years or less, it may be reinstated. The board shall reinstate a license suspended for failure to renew upon an applicant's submission of a renewal application, the biennial renewal fee, and any applicable monetary penalty.
If a license has been suspended pursuant to division (E) of this section for more than two years, it may be restored. In accordance with section 4730.28 of the Revised Code, the board may restore a license suspended for failure to renew upon an applicant's submission of a restoration application, the biennial renewal fee, and any applicable monetary penalty and compliance with sections 4776.01 to 4776.04 of the Revised Code. The board shall not restore to an applicant a license to practice as a physician assistant unless the board, in its discretion, decides that the results of the criminal records check do not make the applicant ineligible for a license issued pursuant to section 4730.12 of the Revised Code.
The penalty for reinstatement shall be fifty dollars and the penalty for restoration shall be one hundred dollars. The board shall deposit penalties in accordance with section 4731.24 of the Revised Code.
(G)(1) If, through a random sample conducted under division (D) of this section or any other means, the board finds that an individual who certified completion of the continuing medical education required to renew, reinstate, or restore a license to practice did not complete the requisite continuing medical education, the board may do either of the following:
(a) Take disciplinary action against the individual under section 4730.25 of the Revised Code, impose a civil penalty, or both;
(b) Permit the individual to agree in writing to complete the continuing medical education and pay a civil penalty.
(2) The board's finding in any disciplinary action taken under division (G)(1)(a) of this section shall be made pursuant to an adjudication under Chapter 119. of the Revised Code and by an affirmative vote of not fewer than six of its members.
(3) A civil penalty imposed under division (G)(1)(a) of this section or paid under division (G)(1)(b) of this section shall be in an amount specified by the board of not more than five thousand dollars. The board shall deposit civil penalties in accordance with section 4731.24 of the Revised Code.
Sec.
4730.19.
(A) Before initiating supervision
of
collaboration
with
one or more physician assistants licensed
under this chapter, a physician shall enter into a supervision
collaboration
agreement with each physician assistant who
will
be
supervisedwith
whom
the
physician
will
collaborate.
A supervision
collaboration
agreement may apply to one or more physician
assistants, but, except as provided in division (B)(2)(e) of this
section, may apply to not more than one physician. The
supervision
The
collaboration
agreement shall specify that the physician
agrees to supervise
collaborate
with
the physician assistant and the physician
assistant agrees to practice under
with
that physician's supervisioncollaboration.
The
agreement
shall
clearly
state
that
the
supervising
physician
is
legally
responsible
and
assumes
legal
liability
for
the
services
provided
by
the
physician
assistant.
The collaboration
agreement shall be signed by the physician
and the physician assistant.
(B)
A supervision
collaboration
agreement shall include either or both of
the following:
(1) If a physician assistant will practice within a health care facility, the agreement shall include terms that require the physician assistant to practice in accordance with the policies of the health care facility.
(2) If a physician assistant will practice outside a health care facility, the agreement shall include terms that specify all of the following:
(a)
The responsibilities to be fulfilled by the physician in supervising
collaborating
with
the physician assistant;
(b)
The responsibilities to be fulfilled by the physician assistant when
performing services under
with
the physician's supervisioncollaboration;
(c) Any limitations on the responsibilities to be fulfilled by the physician assistant;
(d)
The circumstances under which the physician assistant is required to
refer a patient to the supervising
collaborating
physician;
(e)
If the supervising
collaborating
physician chooses to designate physicians to
act as alternate supervising
collaborating
physicians, the names, business addresses,
and business telephone numbers of the physicians who have agreed to
act in that capacity.
(C)
A supervision
collaboration
agreement may be amended to modify the
responsibilities of one or more physician assistants or to include
one or more additional physician assistants.
(D)
The supervising
collaborating
physician who entered into a supervision
collaboration
agreement shall retain a copy of the
agreement in the records maintained by the supervising
collaborating
physician. Each physician assistant who
entered into the supervision
collaboration
agreement shall retain a copy of the
agreement in the records maintained by the physician assistant.
(E)(1) If the state medical board finds, through a review conducted under this section or through any other means, any of the following, the board may take disciplinary action against the individual under section 4730.25 or 4731.22 of the Revised Code, impose a civil penalty, or both:
(a)
That a physician assistant has practiced in a manner that departs
from, or fails to conform to, the terms of a supervision
collaboration
agreement entered into under this section;
(b)
That a physician has supervised
collaborated
with
a physician assistant in a manner that
departs from, or fails to conform to, the terms of a supervision
collaboration
agreement entered into under this section;
(c) That a physician or physician assistant failed to comply with division (A) or (B) of this section.
(2) If the board finds, through a review conducted under this section or through any other means, that a physician or physician assistant failed to comply with division (D) of this section, the board may do either of the following:
(a) Take disciplinary action against the individual under section 4730.25 or 4731.22 of the Revised Code, impose a civil penalty, or both;
(b) Permit the individual to agree in writing to update the records to comply with division (D) of this section and pay a civil penalty.
(3) The board's finding in any disciplinary action taken under division (E)(1) or (2) of this section shall be made pursuant to an adjudication conducted under Chapter 119. of the Revised Code.
(4) A civil penalty imposed under division (E)(1) or (2)(a) of this section or paid under division (E)(2)(b) of this section shall be in an amount specified by the board of not more than five thousand dollars and shall be deposited in accordance with section 4731.24 of the Revised Code.
Sec.
4730.20.
(A) A physician assistant licensed under
this chapter may perform
provide
any of the following services authorized by
the supervising
physician
assistant's
collaborating
physician that are part of the supervising
collaborating
physician's normal course of practice and
expertise:
(1) Ordering diagnostic, therapeutic, and other medical services;
(2) Prescribing physical therapy or referring a patient to a physical therapist for physical therapy;
(3) Ordering occupational therapy or referring a patient to an occupational therapist for occupational therapy;
(4) Taking any action that may be taken by an attending physician under sections 2133.21 to 2133.26 of the Revised Code, as specified in section 2133.211 of the Revised Code;
(5) Determining and pronouncing death in accordance with section 4730.202 of the Revised Code;
(6) Assisting in surgery;
(7) If the physician assistant holds a valid prescriber number issued by the state medical board and has been granted physician-delegated prescriptive authority, ordering, prescribing, personally furnishing, and administering drugs and medical devices;
(8)
Any
Performing
fluoroscopic
procedures
to
the
extent
authorized
by
section
4730.204
of
the
Revised
Code;
(9) Serving as a qualified health professional, as defined in section 5119.90 of the Revised Code, by conducting examinations for purposes of drug and alcohol addiction assessments and diagnoses and by issuing certifications that the criteria specified in section 5119.92 of the Revised Code have been met;
(10) Taking the actions described in section 5122.10 of the Revised Code when there is reason to believe that a person is a mentally ill person subject to court order and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination;
(11)
Performing
any
other services that are part of the
supervising
collaborating
physician's normal course of practice and
expertise.
(B)
The services a physician assistant may provide under the policies of
a health care facility are limited to the services the facility
authorizes the physician assistant to provide for the facility. A
facility shall not authorize a physician assistant to perform a
service that is prohibited under this chapter. A physician who is
supervising
collaborating
with
a physician assistant within a health care
facility may impose limitations on the physician assistant's practice
that are in addition to any limitations applicable under the policies
of the facility.
Sec.
4730.201.
(A)
As
used
in
this
section,
"local
anesthesia"
means
the
injection
of
a
drug
or
combination
of
drugs
to
stop
or
prevent
a
painful
sensation
in
a
circumscribed
area
of
the
body
where
a
painful
procedure
is
to
be
performed.
"Local
anesthesia"
includes
only
local
infiltration
anesthesia,
digital
blocks,
and
pudendal
blocks.
(B)
A physician assistant may administer,
monitor, or maintain local
anesthesia,
with
the
exception
of
general
anesthesia,
as a component of a procedure the physician assistant is performing
or as a separate service when the procedure requiring local
anesthesia is to be performed by the
physician assistant's supervising
collaborating
physician or another person.
A
physician
assistant
shall
not
administer,
monitor,
or
maintain
any
other
form
of
anesthesia,
including
regional
anesthesia
or
any
systemic
sedation.
Sec.
4730.203.
(A) Acting pursuant to a supervision
collaboration
agreement, a physician assistant may
delegate performance of a task to implement a patient's plan of care
or, if the conditions in division (C) of this section are met, may
delegate administration of a drug. Subject to division (D) of section
4730.03 of the Revised Code, delegation may be to any person. The
physician assistant must be physically present at the location where
the task is performed or the drug administered.
(B) Prior to delegating a task or administration of a drug, a physician assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.
(C) A physician assistant may delegate administration of a drug only if all of the following conditions are met:
(1) The physician assistant has been granted physician-delegated prescriptive authority and is authorized to prescribe the drug.
(2) The drug is not a controlled substance.
(3) The drug will not be administered intravenously.
(4) The drug will not be administered in a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department; a freestanding emergency department; or an ambulatory surgical facility licensed under section 3702.30 of the Revised Code.
(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a physician assistant's delegation under this section.
Sec. 4730.204. (A) A physician assistant may perform fluoroscopic procedures for imaging guidance during diagnostic and therapeutic procedures, but only if the physician assistant has successfully completed a fluoroscopy course approved under division (B) of this section.
(B) The state medical board shall approve fluoroscopy courses for purposes of division (A) of this section. To be eligible for approval, a course must consist of all of the following:
(1) Forty hours of training in the following topics as they relate to fluoroscopy: radiation physics, radiation biology, radiation safety, radiation management, and any other topics the board considers appropriate;
(2) Forty hours of clinical practice in the performance of fluoroscopic procedures, to be completed in collaboration with a collaborating physician;
(3) Any other requirements the board considers necessary to receive its approval.
Sec.
4730.21.
(A) The supervising
collaborating
physician of a physician assistant exercises
supervision,
control,
and
direction of the physician assistant. A
physician assistant may practice in any setting within which the
supervising
collaborating
physician practices
and
has supervision,
control,
and
direction of the physician assistant.
In
supervising
collaborating
with
a physician assistant, all of the following
apply:
(1)
The supervising
collaborating
physician shall be continuously available
for direct communication with the physician assistant by either of
the following means:
(a) Being physically present at the location where the physician assistant is practicing;
(b) Being readily available to the physician assistant through some means of telecommunication and being in a location that is a distance from the location where the physician assistant is practicing that reasonably allows the physician to assure proper care of patients.
(2)
The supervising
collaborating
physician shall personally and actively
review the physician assistant's professional activities.
(3)
The supervising
collaborating
physician shall ensure that the quality
assurance system established pursuant to division (F) of this section
is implemented and maintained.
(4)
The supervising
collaborating
physician shall regularly perform any other
reviews of the physician assistant that the supervising
collaborating
physician considers necessary.
(B)
A physician may enter into supervision
collaboration
agreements with any number of physician
assistants, but the physician may not supervise
collaborate
with
more than five physician assistants at any
one time. A physician assistant may enter into supervision
collaboration
agreements with any number of supervising
collaborating
physicians.
(C)
A supervising
collaborating
physician may authorize a physician
assistant to perform a service only if the physician is satisfied
that the physician assistant is capable of competently performing the
service. A supervising
collaborating
physician shall not authorize a physician
assistant to perform any service that is beyond the physician's or
the physician assistant's normal course of practice and expertise.
(D)
In the case of a health care facility with an emergency department,
if the supervising
collaborating
physician routinely practices in the
facility's emergency department, the supervising
collaborating
physician shall provide on-site supervision
of
collaboration
with
the physician assistant when the physician
assistant practices in the emergency department. If the supervising
collaborating
physician does not routinely practice in the
facility's emergency department, the supervising
collaborating
physician may, on occasion, send the
physician assistant to the facility's emergency department to assess
and manage a patient. In
supervising
During
the physician assistant's assessment and
management of the patient, the supervising
collaborating
physician shall determine the appropriate
level of supervision
collaboration
in compliance with the requirements of
divisions (A) to (C) of this section, except that the supervising
collaborating
physician must be available to go to the
emergency department to personally evaluate the patient and, at the
request of an emergency department physician, the supervising
collaborating
physician shall go to the emergency
department to personally evaluate the patient.
(E) Each time a physician assistant writes a medical order, including prescriptions written in the exercise of physician-delegated prescriptive authority, the physician assistant shall sign the form on which the order is written and record on the form the time and date that the order is written.
(F)(1)
The supervising
collaborating
physician of a physician assistant shall
establish a quality assurance system to be used in supervising
collaborating
with
the physician assistant. All or part of the
system may be applied to other physician assistants who
are
supervised
by
with
whom
the supervising
collaborating
physician
is
collaborating.
The system shall be developed in consultation with each physician
assistant to
be
supervised
by
who
collaborates
with
the physician.
(2)
In establishing the quality assurance system, the supervising
collaborating
physician shall describe a process to be
used for all of the following:
(a) Routine review by the physician of selected patient record entries made by the physician assistant and selected medical orders issued by the physician assistant;
(b) Discussion of complex cases;
(c) Discussion of new medical developments relevant to the practice of the physician and physician assistant;
(d) Performance of any quality assurance activities required in rules adopted by state medical board pursuant to any recommendations made by the physician assistant policy committee under section 4730.06 of the Revised Code;
(e)
Performance of any other quality assurance activities that the
supervising
collaborating
physician considers to be appropriate.
(3)
The supervising
collaborating
physician and physician assistant shall keep
records of their quality assurance activities. On request, the
records shall be made available to the board.
Sec.
4730.22.
(A)
When
performing
authorized
services,
a
physician
assistant
acts
as
the
agent
of
the
physician
assistant's
supervising
physician.
The
supervising
physician
is
legally
responsible
and
assumes
legal
liability
for
the
services
provided
by
the
physician
assistant.
The
physician
is
not
responsible
or
liable
for
any
services
provided
by
the
physician
assistant
after
their
supervision
agreement
expires
or
is
terminated.
(B)
When a health care facility permits
physician assistants to practice within that facility or any other
health care facility under its control, the health care facility
shall make reasonable efforts to explain to each individual who may
work with a particular physician assistant the scope of that
physician assistant's practice within the facility. The appropriate
credentialing body within the health care facility shall provide, on
request of an individual practicing in the facility with a physician
assistant, a copy of the facility's policies on the practice of
physician assistants within the facility and a copy of each
supervision
collaboration
agreement applicable to the physician
assistant.
An
individual who follows the orders of a physician assistant practicing
in a health care facility is not subject to disciplinary action by
any administrative agency that governs that individual's conduct and
is not liable in damages in a civil action for injury, death, or loss
to person or property resulting from the individual's acts or
omissions in the performance of any procedure, treatment, or other
health care service if the individual reasonably believed that the
physician assistant was acting within the proper scope of practice or
was relaying medical orders from a supervising
collaborating
physician, unless the act or omission
constitutes willful or wanton misconduct.
Sec. 4730.25. (A) The state medical board, by an affirmative vote of not fewer than six members, may revoke or may refuse to grant a license to practice as a physician assistant to a person found by the board to have committed fraud, misrepresentation, or deception in applying for or securing the license.
(B) The board, by an affirmative vote of not fewer than six members, shall, to the extent permitted by law, limit, revoke, or suspend an individual's license to practice as a physician assistant or prescriber number, refuse to issue a license to an applicant, refuse to renew a license, refuse to reinstate a license, or reprimand or place on probation the holder of a license for any of the following reasons:
(1)
Failure to practice in accordance with the supervising
collaborating
physician's supervision
collaboration
agreement with the physician assistant,
including, if applicable, the policies of the health care facility in
which the supervising
collaborating
physician and physician assistant are
practicing;
(2) Failure to comply with the requirements of this chapter, Chapter 4731. of the Revised Code, or any rules adopted by the board;
(3) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this chapter, Chapter 4731. of the Revised Code, or the rules adopted by the board;
(4) Inability to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness, including physical deterioration that adversely affects cognitive, motor, or perceptive skills;
(5) Impairment of ability to practice according to acceptable and prevailing standards of care because of habitual or excessive use or abuse of drugs, alcohol, or other substances that impair ability to practice;
(6) Administering drugs for purposes other than those authorized under this chapter;
(7) Willfully betraying a professional confidence;
(8) Making a false, fraudulent, deceptive, or misleading statement in soliciting or advertising for employment as a physician assistant; in connection with any solicitation or advertisement for patients; in relation to the practice of medicine as it pertains to physician assistants; or in securing or attempting to secure a license to practice as a physician assistant.
As used in this division, "false, fraudulent, deceptive, or misleading statement" means a statement that includes a misrepresentation of fact, is likely to mislead or deceive because of a failure to disclose material facts, is intended or is likely to create false or unjustified expectations of favorable results, or includes representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived.
(9) Representing, with the purpose of obtaining compensation or other advantage personally or for any other person, that an incurable disease or injury, or other incurable condition, can be permanently cured;
(10) The obtaining of, or attempting to obtain, money or anything of value by fraudulent misrepresentations in the course of practice;
(11) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a felony;
(12) Commission of an act that constitutes a felony in this state, regardless of the jurisdiction in which the act was committed;
(13) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a misdemeanor committed in the course of practice;
(14) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a misdemeanor involving moral turpitude;
(15) Commission of an act in the course of practice that constitutes a misdemeanor in this state, regardless of the jurisdiction in which the act was committed;
(16) Commission of an act involving moral turpitude that constitutes a misdemeanor in this state, regardless of the jurisdiction in which the act was committed;
(17) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for violating any state or federal law regulating the possession, distribution, or use of any drug, including trafficking in drugs;
(18) Any of the following actions taken by the state agency responsible for regulating the practice of physician assistants in another state, for any reason other than the nonpayment of fees: the limitation, revocation, or suspension of an individual's license to practice; acceptance of an individual's license surrender; denial of a license; refusal to renew or reinstate a license; imposition of probation; or issuance of an order of censure or other reprimand;
(19) A departure from, or failure to conform to, minimal standards of care of similar physician assistants under the same or similar circumstances, regardless of whether actual injury to a patient is established;
(20) Violation of the conditions placed by the board on a license to practice as a physician assistant;
(21) Failure to use universal blood and body fluid precautions established by rules adopted under section 4731.051 of the Revised Code;
(22) Failure to cooperate in an investigation conducted by the board under section 4730.26 of the Revised Code, including failure to comply with a subpoena or order issued by the board or failure to answer truthfully a question presented by the board at a deposition or in written interrogatories, except that failure to cooperate with an investigation shall not constitute grounds for discipline under this section if a court of competent jurisdiction has issued an order that either quashes a subpoena or permits the individual to withhold the testimony or evidence in issue;
(23) Assisting suicide, as defined in section 3795.01 of the Revised Code;
(24) Prescribing any drug or device to perform or induce an abortion, or otherwise performing or inducing an abortion;
(25) Failure to comply with section 4730.53 of the Revised Code, unless the board no longer maintains a drug database pursuant to section 4729.75 of the Revised Code;
(26) Failure to comply with the requirements in section 3719.061 of the Revised Code before issuing for a minor a prescription for an opioid analgesic, as defined in section 3719.01 of the Revised Code;
(27)
Having
certification
by
the
national
commission
on
certification
of
physician
assistants
or
a
successor
organization
expire,
lapse,
or
be
suspended
or
revoked;
(28)
The revocation, suspension,
restriction, reduction, or termination of clinical privileges by the
United States department of defense or department of veterans affairs
or the termination or suspension of a certificate of registration to
prescribe drugs by the drug enforcement administration of the United
States department of justice.
(C) Disciplinary actions taken by the board under divisions (A) and (B) of this section shall be taken pursuant to an adjudication under Chapter 119. of the Revised Code, except that in lieu of an adjudication, the board may enter into a consent agreement with a physician assistant or applicant to resolve an allegation of a violation of this chapter or any rule adopted under it. A consent agreement, when ratified by an affirmative vote of not fewer than six members of the board, shall constitute the findings and order of the board with respect to the matter addressed in the agreement. If the board refuses to ratify a consent agreement, the admissions and findings contained in the consent agreement shall be of no force or effect.
(D) For purposes of divisions (B)(12), (15), and (16) of this section, the commission of the act may be established by a finding by the board, pursuant to an adjudication under Chapter 119. of the Revised Code, that the applicant or license holder committed the act in question. The board shall have no jurisdiction under these divisions in cases where the trial court renders a final judgment in the license holder's favor and that judgment is based upon an adjudication on the merits. The board shall have jurisdiction under these divisions in cases where the trial court issues an order of dismissal upon technical or procedural grounds.
(E) The sealing of conviction records by any court shall have no effect upon a prior board order entered under the provisions of this section or upon the board's jurisdiction to take action under the provisions of this section if, based upon a plea of guilty, a judicial finding of guilt, or a judicial finding of eligibility for intervention in lieu of conviction, the board issued a notice of opportunity for a hearing prior to the court's order to seal the records. The board shall not be required to seal, destroy, redact, or otherwise modify its records to reflect the court's sealing of conviction records.
(F) For purposes of this division, any individual who holds a license issued under this chapter, or applies for a license issued under this chapter, shall be deemed to have given consent to submit to a mental or physical examination when directed to do so in writing by the board and to have waived all objections to the admissibility of testimony or examination reports that constitute a privileged communication.
(1) In enforcing division (B)(4) of this section, the board, upon a showing of a possible violation, may compel any individual who holds a license issued under this chapter or who has applied for a license pursuant to this chapter to submit to a mental examination, physical examination, including an HIV test, or both a mental and physical examination. The expense of the examination is the responsibility of the individual compelled to be examined. Failure to submit to a mental or physical examination or consent to an HIV test ordered by the board constitutes an admission of the allegations against the individual unless the failure is due to circumstances beyond the individual's control, and a default and final order may be entered without the taking of testimony or presentation of evidence. If the board finds a physician assistant unable to practice because of the reasons set forth in division (B)(4) of this section, the board shall require the physician assistant to submit to care, counseling, or treatment by physicians approved or designated by the board, as a condition for an initial, continued, reinstated, or renewed license. An individual affected under this division shall be afforded an opportunity to demonstrate to the board the ability to resume practicing in compliance with acceptable and prevailing standards of care.
(2) For purposes of division (B)(5) of this section, if the board has reason to believe that any individual who holds a license issued under this chapter or any applicant for a license suffers such impairment, the board may compel the individual to submit to a mental or physical examination, or both. The expense of the examination is the responsibility of the individual compelled to be examined. Any mental or physical examination required under this division shall be undertaken by a treatment provider or physician qualified to conduct such examination and chosen by the board.
Failure to submit to a mental or physical examination ordered by the board constitutes an admission of the allegations against the individual unless the failure is due to circumstances beyond the individual's control, and a default and final order may be entered without the taking of testimony or presentation of evidence. If the board determines that the individual's ability to practice is impaired, the board shall suspend the individual's license or deny the individual's application and shall require the individual, as a condition for initial, continued, reinstated, or renewed licensure, to submit to treatment.
Before being eligible to apply for reinstatement of a license suspended under this division, the physician assistant shall demonstrate to the board the ability to resume practice or prescribing in compliance with acceptable and prevailing standards of care. The demonstration shall include the following:
(a) Certification from a treatment provider approved under section 4731.25 of the Revised Code that the individual has successfully completed any required inpatient treatment;
(b) Evidence of continuing full compliance with an aftercare contract or consent agreement;
(c) Two written reports indicating that the individual's ability to practice has been assessed and that the individual has been found capable of practicing according to acceptable and prevailing standards of care. The reports shall be made by individuals or providers approved by the board for making such assessments and shall describe the basis for their determination.
The board may reinstate a license suspended under this division after such demonstration and after the individual has entered into a written consent agreement.
When the impaired physician assistant resumes practice or prescribing, the board shall require continued monitoring of the physician assistant. The monitoring shall include compliance with the written consent agreement entered into before reinstatement or with conditions imposed by board order after a hearing, and, upon termination of the consent agreement, submission to the board for at least two years of annual written progress reports made under penalty of falsification stating whether the physician assistant has maintained sobriety.
(G) If the secretary and the supervising member elected by the board under section 4731.02 of the Revised Code determine that there is clear and convincing evidence that a physician assistant has violated division (B) of this section and that the individual's continued practice or prescribing presents a danger of immediate and serious harm to the public, they may recommend that the board suspend the individual's license without a prior hearing. Written allegations shall be prepared for consideration by the board.
The board, upon review of those allegations and by an affirmative vote of not fewer than six of its members, excluding the secretary and supervising member, may suspend a license without a prior hearing. A telephone conference call may be utilized for reviewing the allegations and taking the vote on the summary suspension.
The board shall issue a written order of suspension by certified mail or in person in accordance with section 119.07 of the Revised Code. The order shall not be subject to suspension by the court during pendency of any appeal filed under section 119.12 of the Revised Code. If the physician assistant requests an adjudicatory hearing by the board, the date set for the hearing shall be within fifteen days, but not earlier than seven days, after the physician assistant requests the hearing, unless otherwise agreed to by both the board and the license holder.
A summary suspension imposed under this division shall remain in effect, unless reversed on appeal, until a final adjudicative order issued by the board pursuant to this section and Chapter 119. of the Revised Code becomes effective. The board shall issue its final adjudicative order within sixty days after completion of its hearing. Failure to issue the order within sixty days shall result in dissolution of the summary suspension order, but shall not invalidate any subsequent, final adjudicative order.
(H) If the board takes action under division (B)(11), (13), or (14) of this section, and the judicial finding of guilt, guilty plea, or judicial finding of eligibility for intervention in lieu of conviction is overturned on appeal, upon exhaustion of the criminal appeal, a petition for reconsideration of the order may be filed with the board along with appropriate court documents. Upon receipt of a petition and supporting court documents, the board shall reinstate the individual's license. The board may then hold an adjudication under Chapter 119. of the Revised Code to determine whether the individual committed the act in question. Notice of opportunity for hearing shall be given in accordance with Chapter 119. of the Revised Code. If the board finds, pursuant to an adjudication held under this division, that the individual committed the act, or if no hearing is requested, it may order any of the sanctions identified under division (B) of this section.
(I) The license to practice issued to a physician assistant and the physician assistant's practice in this state are automatically suspended as of the date the physician assistant pleads guilty to, is found by a judge or jury to be guilty of, or is subject to a judicial finding of eligibility for intervention in lieu of conviction in this state or treatment or intervention in lieu of conviction in another state for any of the following criminal offenses in this state or a substantially equivalent criminal offense in another jurisdiction: aggravated murder, murder, voluntary manslaughter, felonious assault, kidnapping, rape, sexual battery, gross sexual imposition, aggravated arson, aggravated robbery, or aggravated burglary. Continued practice after the suspension shall be considered practicing without a license.
The board shall notify the individual subject to the suspension by certified mail or in person in accordance with section 119.07 of the Revised Code. If an individual whose license is suspended under this division fails to make a timely request for an adjudication under Chapter 119. of the Revised Code, the board shall enter a final order permanently revoking the individual's license to practice.
(J) In any instance in which the board is required by Chapter 119. of the Revised Code to give notice of opportunity for hearing and the individual subject to the notice does not timely request a hearing in accordance with section 119.07 of the Revised Code, the board is not required to hold a hearing, but may adopt, by an affirmative vote of not fewer than six of its members, a final order that contains the board's findings. In that final order, the board may order any of the sanctions identified under division (A) or (B) of this section.
(K) Any action taken by the board under division (B) of this section resulting in a suspension shall be accompanied by a written statement of the conditions under which the physician assistant's license may be reinstated. The board shall adopt rules in accordance with Chapter 119. of the Revised Code governing conditions to be imposed for reinstatement. Reinstatement of a license suspended pursuant to division (B) of this section requires an affirmative vote of not fewer than six members of the board.
(L) When the board refuses to grant or issue to an applicant a license to practice as a physician assistant, revokes an individual's license, refuses to renew an individual's license, or refuses to reinstate an individual's license, the board may specify that its action is permanent. An individual subject to a permanent action taken by the board is forever thereafter ineligible to hold the license and the board shall not accept an application for reinstatement of the license or for issuance of a new license.
(M) Notwithstanding any other provision of the Revised Code, all of the following apply:
(1) The surrender of a license issued under this chapter is not effective unless or until accepted by the board. Reinstatement of a license surrendered to the board requires an affirmative vote of not fewer than six members of the board.
(2) An application made under this chapter for a license may not be withdrawn without approval of the board.
(3) Failure by an individual to renew a license in accordance with section 4730.14 of the Revised Code shall not remove or limit the board's jurisdiction to take disciplinary action under this section against the individual.
Sec.
4730.26.
(A) The state medical board shall
investigate evidence that appears to show that any person has
violated this chapter or a rule adopted under it. In an investigation
involving the practice of
or supervision
of
collaboration
with
a physician assistant pursuant to the
policies of a health care facility, the board may require that the
health care facility provide any information the board considers
necessary to identify either or both of the following:
(1) The facility's policies for the practice of physician assistants within the facility;
(2) The services that the facility has authorized a particular physician assistant to provide for the facility.
(B) Any person may report to the board in a signed writing any information the person has that appears to show a violation of any provision of this chapter or rule adopted under it. In the absence of bad faith, a person who reports such information or testifies before the board in an adjudication conducted under Chapter 119. of the Revised Code shall not be liable for civil damages as a result of reporting the information or providing testimony. Each complaint or allegation of a violation received by the board shall be assigned a case number and be recorded by the board.
(C) Investigations of alleged violations of this chapter or rules adopted under it shall be supervised by the supervising member elected by the board in accordance with section 4731.02 of the Revised Code and by the secretary as provided in section 4730.33 of the Revised Code. The president may designate another member of the board to supervise the investigation in place of the supervising member. A member of the board who supervises the investigation of a case shall not participate in further adjudication of the case.
(D) In investigating a possible violation of this chapter or a rule adopted under it, the board may administer oaths, order the taking of depositions, issue subpoenas, and compel the attendance of witnesses and production of books, accounts, papers, records, documents, and testimony, except that a subpoena for patient record information shall not be issued without consultation with the attorney general's office and approval of the secretary and supervising member of the board. Before issuance of a subpoena for patient record information, the secretary and supervising member shall determine whether there is probable cause to believe that the complaint filed alleges a violation of this chapter or a rule adopted under it and that the records sought are relevant to the alleged violation and material to the investigation. The subpoena may apply only to records that cover a reasonable period of time surrounding the alleged violation.
On failure to comply with any subpoena issued by the board and after reasonable notice to the person being subpoenaed, the board may move for an order compelling the production of persons or records pursuant to the Rules of Civil Procedure.
A subpoena issued by the board may be served by a sheriff, the sheriff's deputy, or a board employee designated by the board. Service of a subpoena issued by the board may be made by delivering a copy of the subpoena to the person named therein, reading it to the person, or leaving it at the person's usual place of residence. When the person being served is a physician assistant, service of the subpoena may be made by certified mail, restricted delivery, return receipt requested, and the subpoena shall be deemed served on the date delivery is made or the date the person refuses to accept delivery.
A sheriff's deputy who serves a subpoena shall receive the same fees as a sheriff. Each witness who appears before the board in obedience to a subpoena shall receive the fees and mileage provided for under section 119.094 of the Revised Code.
(E) All hearings and investigations of the board shall be considered civil actions for the purposes of section 2305.252 of the Revised Code.
(F) Information received by the board pursuant to an investigation is confidential and not subject to discovery in any civil action.
The board shall conduct all investigations and proceedings in a manner that protects the confidentiality of patients and persons who file complaints with the board. The board shall not make public the names or any other identifying information about patients or complainants unless proper consent is given or, in the case of a patient, a waiver of the patient privilege exists under division (B) of section 2317.02 of the Revised Code, except that consent or a waiver is not required if the board possesses reliable and substantial evidence that no bona fide physician-patient relationship exists.
The board may share any information it receives pursuant to an investigation, including patient records and patient record information, with law enforcement agencies, other licensing boards, and other governmental agencies that are prosecuting, adjudicating, or investigating alleged violations of statutes or administrative rules. An agency or board that receives the information shall comply with the same requirements regarding confidentiality as those with which the state medical board must comply, notwithstanding any conflicting provision of the Revised Code or procedure of the agency or board that applies when it is dealing with other information in its possession. In a judicial proceeding, the information may be admitted into evidence only in accordance with the Rules of Evidence, but the court shall require that appropriate measures are taken to ensure that confidentiality is maintained with respect to any part of the information that contains names or other identifying information about patients or complainants whose confidentiality was protected by the state medical board when the information was in the board's possession. Measures to ensure confidentiality that may be taken by the court include sealing its records or deleting specific information from its records.
(G) The state medical board shall develop requirements for and provide appropriate initial and continuing training for investigators employed by the board to carry out its duties under this chapter. The training and continuing education may include enrollment in courses operated or approved by the Ohio peace officer training commission that the board considers appropriate under conditions set forth in section 109.79 of the Revised Code.
(H) On a quarterly basis, the board shall prepare a report that documents the disposition of all cases during the preceding three months. The report shall contain the following information for each case with which the board has completed its activities:
(1) The case number assigned to the complaint or alleged violation;
(2) The type of license, if any, held by the individual against whom the complaint is directed;
(3) A description of the allegations contained in the complaint;
(4) The disposition of the case.
The report shall state how many cases are still pending, and shall be prepared in a manner that protects the identity of each person involved in each case. The report shall be submitted to the physician assistant policy committee of the board and is a public record for purposes of section 149.43 of the Revised Code.
Sec. 4730.32. (A) Within sixty days after the imposition of any formal disciplinary action taken by a health care facility against any individual holding a valid license to practice as a physician assistant issued under this chapter, the chief administrator or executive officer of the facility shall report to the state medical board the name of the individual, the action taken by the facility, and a summary of the underlying facts leading to the action taken. Upon request, the board shall be provided certified copies of the patient records that were the basis for the facility's action. Prior to release to the board, the summary shall be approved by the peer review committee that reviewed the case or by the governing board of the facility.
The filing of a report with the board or decision not to file a report, investigation by the board, or any disciplinary action taken by the board, does not preclude a health care facility from taking disciplinary action against a physician assistant.
In the absence of fraud or bad faith, no individual or entity that provides patient records to the board shall be liable in damages to any person as a result of providing the records.
(B)(1) Except as provided in division (B)(2) of this section, a physician assistant, professional association or society of physician assistants, physician, or professional association or society of physicians that believes a violation of any provision of this chapter, Chapter 4731. of the Revised Code, or rule of the board has occurred shall report to the board the information upon which the belief is based.
(2) A physician assistant, professional association or society of physician assistants, physician, or professional association or society of physicians that believes that a violation of division (B)(5) of section 4730.25 of the Revised Code has occurred shall report the information upon which the belief is based to the monitoring organization conducting the program established by the board under section 4731.251 of the Revised Code. If any such report is made to the board, it shall be referred to the monitoring organization unless the board is aware that the individual who is the subject of the report does not meet the program eligibility requirements of section 4731.252 of the Revised Code.
(C) Any professional association or society composed primarily of physician assistants that suspends or revokes an individual's membership for violations of professional ethics, or for reasons of professional incompetence or professional malpractice, within sixty days after a final decision, shall report to the board, on forms prescribed and provided by the board, the name of the individual, the action taken by the professional organization, and a summary of the underlying facts leading to the action taken.
The filing or nonfiling of a report with the board, investigation by the board, or any disciplinary action taken by the board, shall not preclude a professional organization from taking disciplinary action against a physician assistant.
(D) Any insurer providing professional liability insurance to any person holding a valid license to practice as a physician assistant issued under this chapter or any other entity that seeks to indemnify the professional liability of a physician assistant shall notify the board within thirty days after the final disposition of any written claim for damages where such disposition results in a payment exceeding twenty-five thousand dollars. The notice shall contain the following information:
(1) The name and address of the person submitting the notification;
(2) The name and address of the insured who is the subject of the claim;
(3) The name of the person filing the written claim;
(4) The date of final disposition;
(5) If applicable, the identity of the court in which the final disposition of the claim took place.
(E) The board may investigate possible violations of this chapter or the rules adopted under it that are brought to its attention as a result of the reporting requirements of this section, except that the board shall conduct an investigation if a possible violation involves repeated malpractice. As used in this division, "repeated malpractice" means three or more claims for malpractice within the previous five-year period, each resulting in a judgment or settlement in excess of twenty-five thousand dollars in favor of the claimant, and each involving negligent conduct by the physician assistant.
(F)
All summaries, reports, and records received and maintained by the
board pursuant to this section shall be held in confidence and shall
not be subject to discovery or introduction in evidence in any
federal or state civil action involving a physician assistant,
supervising
collaborating
physician, or health care facility arising
out of matters that are the subject of the reporting required by this
section. The board may use the information obtained only as the basis
for an investigation, as evidence in a disciplinary hearing against a
physician assistant or supervising
collaborating
physician, or in any subsequent trial or
appeal of a board action or order.
The
board may disclose the summaries and reports it receives under this
section only to health care facility committees within or outside
this state that are involved in credentialing or recredentialing a
physician assistant or supervising
collaborating
physician or reviewing their privilege to
practice within a particular facility. The board shall indicate
whether or not the information has been verified. Information
transmitted by the board shall be subject to the same confidentiality
provisions as when maintained by the board.
(G) Except for reports filed by an individual pursuant to division (B) of this section, the board shall send a copy of any reports or summaries it receives pursuant to this section to the physician assistant. The physician assistant shall have the right to file a statement with the board concerning the correctness or relevance of the information. The statement shall at all times accompany that part of the record in contention.
(H) An individual or entity that reports to the board, reports to the monitoring organization described in section 4731.251 of the Revised Code, or refers an impaired physician assistant to a treatment provider approved by the board under section 4731.25 of the Revised Code shall not be subject to suit for civil damages as a result of the report, referral, or provision of the information.
(I) In the absence of fraud or bad faith, a professional association or society of physician assistants that sponsors a committee or program to provide peer assistance to a physician assistant with substance abuse problems, a representative or agent of such a committee or program, a representative or agent of the monitoring organization described in section 4731.251 of the Revised Code, and a member of the state medical board shall not be held liable in damages to any person by reason of actions taken to refer a physician assistant to a treatment provider approved under section 4731.25 of the Revised Code for examination or treatment.
Sec. 4730.41. (A) A physician assistant who holds a valid prescriber number issued by the state medical board is authorized to prescribe and personally furnish drugs and therapeutic devices in the exercise of physician-delegated prescriptive authority.
(B) In exercising physician-delegated prescriptive authority, a physician assistant is subject to all of the following:
(1)
The physician assistant shall exercise physician-delegated
prescriptive authority only to the extent that the physician
supervising
collaborating
with
the physician assistant has granted that
authority.
(2)
The physician assistant shall comply with all conditions placed on
the physician-delegated prescriptive authority, as specified by the
supervising
collaborating
physician who is supervising
collaborating
with
the physician assistant in the exercise of
physician-delegated prescriptive authority.
(3) If the physician assistant possesses physician-delegated prescriptive authority for controlled substances, the physician assistant shall register with the federal drug enforcement administration.
(4) If the physician assistant possesses physician-delegated prescriptive authority for schedule II controlled substances, the physician assistant shall comply with section 4730.411 of the Revised Code.
(5) If the physician assistant possesses physician-delegated prescriptive authority to prescribe for a minor an opioid analgesic, as those terms are defined in sections 3719.061 and 3719.01 of the Revised Code, respectively, the physician assistant shall comply with section 3719.061 of the Revised Code.
(6)
The
physician
assistant
shall
comply
with
the
requirements
of
section
4730.44
of
the
Revised
Code.
(C) A physician assistant shall not prescribe any drug in violation of state or federal law.
Sec. 4730.411. (A) Except as provided in division (B) or (C) of this section, a physician assistant may prescribe to a patient a schedule II controlled substance only if all of the following are the case:
(1) The patient is in a terminal condition, as defined in section 2133.01 of the Revised Code.
(2)
The physician assistant's supervising
collaborating
physician initially prescribed the substance
for the patient.
(3)
The prescription is for an amount that does not exceed the amount
necessary for the patient's use in a single, twenty-four-hour
seventy-two-hour
period.
(B) The restrictions on prescriptive authority in division (A) of this section do not apply if a physician assistant issues the prescription to the patient from any of the following locations:
(1) A hospital registered under section 3701.07 of the Revised Code;
(2) An entity owned or controlled, in whole or in part, by a hospital or by an entity that owns or controls, in whole or in part, one or more hospitals;
(3) A health care facility operated by the department of mental health and addiction services or the department of developmental disabilities;
(4) A nursing home licensed under section 3721.02 of the Revised Code or by a political subdivision certified under section 3721.09 of the Revised Code;
(5) A county home or district home operated under Chapter 5155. of the Revised Code that is certified under the medicare or medicaid program;
(6) A hospice care program, as defined in section 3712.01 of the Revised Code;
(7) A community mental health services provider, as defined in section 5122.01 of the Revised Code;
(8) An ambulatory surgical facility, as defined in section 3702.30 of the Revised Code;
(9) A freestanding birthing center, as defined in section 3702.141 of the Revised Code;
(10) A federally qualified health center, as defined in section 3701.047 of the Revised Code;
(11) A federally qualified health center look-alike, as defined in section 3701.047 of the Revised Code;
(12) A health care office or facility operated by the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code;
(13)
A site where a medical practice is operated, but only if the practice
is comprised of one or more physicians who also are owners of the
practice; the practice is organized to provide direct patient care;
and the physician assistant has entered into a supervisory
collaboration
agreement with at least one of the physician
owners who practices primarily at that site.
(C) A physician assistant shall not issue to a patient a prescription for a schedule II controlled substance from a convenience care clinic even if the convenience care clinic is owned or operated by an entity specified in division (B) of this section.
(D) A pharmacist who acts in good faith reliance on a prescription issued by a physician assistant under division (B) of this section is not liable for or subject to any of the following for relying on the prescription: damages in any civil action, prosecution in any criminal proceeding, or professional disciplinary action by the state board of pharmacy under Chapter 4729. of the Revised Code.
Sec.
4730.42.
(A) In granting physician-delegated
prescriptive authority to a particular physician assistant who holds
a valid prescriber number issued by the state medical board, the
supervising
collaborating
physician is subject to all of the
following:
(1)
The supervising
collaborating
physician shall not grant
physician-delegated prescriptive authority for any drug or device
that may be used to perform or induce an abortion.
(2)
The supervising
collaborating
physician shall not grant
physician-delegated prescriptive authority in a manner that exceeds
the supervising
collaborating
physician's prescriptive authority,
including the physician's authority to treat chronic pain with
controlled substances and products containing tramadol as described
in section 4731.052 of the Revised Code.
(3)
The supervising
collaborating
physician shall supervise
collaborate
with
the physician assistant in accordance with
both of the following:
(a)
The supervision
collaboration
requirements specified in section 4730.21 of
the Revised Code;
(b)
The supervision
collaboration
agreement entered into with the physician
assistant under section 4730.19 of the Revised Code, including, if
applicable, the policies of the health care facility in which the
physician and physician assistant are practicing.
(B)(1)
The supervising
collaborating
physician of a physician assistant may place
conditions on the physician-delegated prescriptive authority granted
to the physician assistant. If conditions are placed on that
authority, the supervising
collaborating
physician shall maintain a written record of
the conditions and make the record available to the state medical
board on request.
(2)
The conditions that a supervising
collaborating
physician may place on the
physician-delegated prescriptive authority granted to a physician
assistant include the following:
(a) Identification by class and specific generic nomenclature of drugs and therapeutic devices that the physician chooses not to permit the physician assistant to prescribe;
(b) Limitations on the dosage units or refills that the physician assistant is authorized to prescribe;
(c)
Specification of circumstances under which the physician assistant is
required to refer patients to the supervising
collaborating
physician or another physician when
exercising physician-delegated prescriptive authority;
(d)
Responsibilities to be fulfilled by the physician in supervising
collaborating
with
the physician assistant that are not
otherwise specified in the supervision
collaboration
agreement or otherwise required by this
chapter.
Sec. 4731.22. (A) The state medical board, by an affirmative vote of not fewer than six of its members, may limit, revoke, or suspend a license or certificate to practice or certificate to recommend, refuse to grant a license or certificate, refuse to renew a license or certificate, refuse to reinstate a license or certificate, or reprimand or place on probation the holder of a license or certificate if the individual applying for or holding the license or certificate is found by the board to have committed fraud during the administration of the examination for a license or certificate to practice or to have committed fraud, misrepresentation, or deception in applying for, renewing, or securing any license or certificate to practice or certificate to recommend issued by the board.
(B) The board, by an affirmative vote of not fewer than six members, shall, to the extent permitted by law, limit, revoke, or suspend a license or certificate to practice or certificate to recommend, refuse to issue a license or certificate, refuse to renew a license or certificate, refuse to reinstate a license or certificate, or reprimand or place on probation the holder of a license or certificate for one or more of the following reasons:
(1) Permitting one's name or one's license or certificate to practice to be used by a person, group, or corporation when the individual concerned is not actually directing the treatment given;
(2) Failure to maintain minimal standards applicable to the selection or administration of drugs, or failure to employ acceptable scientific methods in the selection of drugs or other modalities for treatment of disease;
(3) Except as provided in section 4731.97 of the Revised Code, selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes or a plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction of, a violation of any federal or state law regulating the possession, distribution, or use of any drug;
(4) Willfully betraying a professional confidence.
For purposes of this division, "willfully betraying a professional confidence" does not include providing any information, documents, or reports under sections 307.621 to 307.629 of the Revised Code to a child fatality review board; does not include providing any information, documents, or reports to the director of health pursuant to guidelines established under section 3701.70 of the Revised Code; does not include written notice to a mental health professional under section 4731.62 of the Revised Code; and does not include the making of a report of an employee's use of a drug of abuse, or a report of a condition of an employee other than one involving the use of a drug of abuse, to the employer of the employee as described in division (B) of section 2305.33 of the Revised Code. Nothing in this division affects the immunity from civil liability conferred by section 2305.33 or 4731.62 of the Revised Code upon a physician who makes a report in accordance with section 2305.33 or notifies a mental health professional in accordance with section 4731.62 of the Revised Code. As used in this division, "employee," "employer," and "physician" have the same meanings as in section 2305.33 of the Revised Code.
(5) Making a false, fraudulent, deceptive, or misleading statement in the solicitation of or advertising for patients; in relation to the practice of medicine and surgery, osteopathic medicine and surgery, podiatric medicine and surgery, or a limited branch of medicine; or in securing or attempting to secure any license or certificate to practice issued by the board.
As used in this division, "false, fraudulent, deceptive, or misleading statement" means a statement that includes a misrepresentation of fact, is likely to mislead or deceive because of a failure to disclose material facts, is intended or is likely to create false or unjustified expectations of favorable results, or includes representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived.
(6) A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established;
(7) Representing, with the purpose of obtaining compensation or other advantage as personal gain or for any other person, that an incurable disease or injury, or other incurable condition, can be permanently cured;
(8) The obtaining of, or attempting to obtain, money or anything of value by fraudulent misrepresentations in the course of practice;
(9) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a felony;
(10) Commission of an act that constitutes a felony in this state, regardless of the jurisdiction in which the act was committed;
(11) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a misdemeanor committed in the course of practice;
(12) Commission of an act in the course of practice that constitutes a misdemeanor in this state, regardless of the jurisdiction in which the act was committed;
(13) A plea of guilty to, a judicial finding of guilt of, or a judicial finding of eligibility for intervention in lieu of conviction for, a misdemeanor involving moral turpitude;
(14) Commission of an act involving moral turpitude that constitutes a misdemeanor in this state, regardless of the jurisdiction in which the act was committed;
(15) Violation of the conditions of limitation placed by the board upon a license or certificate to practice;
(16) Failure to pay license renewal fees specified in this chapter;
(17) Except as authorized in section 4731.31 of the Revised Code, engaging in the division of fees for referral of patients, or the receiving of a thing of value in return for a specific referral of a patient to utilize a particular service or business;
(18) Subject to section 4731.226 of the Revised Code, violation of any provision of a code of ethics of the American medical association, the American osteopathic association, the American podiatric medical association, or any other national professional organizations that the board specifies by rule. The state medical board shall obtain and keep on file current copies of the codes of ethics of the various national professional organizations. The individual whose license or certificate is being suspended or revoked shall not be found to have violated any provision of a code of ethics of an organization not appropriate to the individual's profession.
For purposes of this division, a "provision of a code of ethics of a national professional organization" does not include any provision that would preclude the making of a report by a physician of an employee's use of a drug of abuse, or of a condition of an employee other than one involving the use of a drug of abuse, to the employer of the employee as described in division (B) of section 2305.33 of the Revised Code. Nothing in this division affects the immunity from civil liability conferred by that section upon a physician who makes either type of report in accordance with division (B) of that section. As used in this division, "employee," "employer," and "physician" have the same meanings as in section 2305.33 of the Revised Code.
(19) Inability to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness, including, but not limited to, physical deterioration that adversely affects cognitive, motor, or perceptive skills.
In enforcing this division, the board, upon a showing of a possible violation, may compel any individual authorized to practice by this chapter or who has submitted an application pursuant to this chapter to submit to a mental examination, physical examination, including an HIV test, or both a mental and a physical examination. The expense of the examination is the responsibility of the individual compelled to be examined. Failure to submit to a mental or physical examination or consent to an HIV test ordered by the board constitutes an admission of the allegations against the individual unless the failure is due to circumstances beyond the individual's control, and a default and final order may be entered without the taking of testimony or presentation of evidence. If the board finds an individual unable to practice because of the reasons set forth in this division, the board shall require the individual to submit to care, counseling, or treatment by physicians approved or designated by the board, as a condition for initial, continued, reinstated, or renewed authority to practice. An individual affected under this division shall be afforded an opportunity to demonstrate to the board the ability to resume practice in compliance with acceptable and prevailing standards under the provisions of the individual's license or certificate. For the purpose of this division, any individual who applies for or receives a license or certificate to practice under this chapter accepts the privilege of practicing in this state and, by so doing, shall be deemed to have given consent to submit to a mental or physical examination when directed to do so in writing by the board, and to have waived all objections to the admissibility of testimony or examination reports that constitute a privileged communication.
(20) Except as provided in division (F)(1)(b) of section 4731.282 of the Revised Code or when civil penalties are imposed under section 4731.225 of the Revised Code, and subject to section 4731.226 of the Revised Code, violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provisions of this chapter or any rule promulgated by the board.
This division does not apply to a violation or attempted violation of, assisting in or abetting the violation of, or a conspiracy to violate, any provision of this chapter or any rule adopted by the board that would preclude the making of a report by a physician of an employee's use of a drug of abuse, or of a condition of an employee other than one involving the use of a drug of abuse, to the employer of the employee as described in division (B) of section 2305.33 of the Revised Code. Nothing in this division affects the immunity from civil liability conferred by that section upon a physician who makes either type of report in accordance with division (B) of that section. As used in this division, "employee," "employer," and "physician" have the same meanings as in section 2305.33 of the Revised Code.
(21) The violation of section 3701.79 of the Revised Code or of any abortion rule adopted by the director of health pursuant to section 3701.341 of the Revised Code;
(22) Any of the following actions taken by an agency responsible for authorizing, certifying, or regulating an individual to practice a health care occupation or provide health care services in this state or another jurisdiction, for any reason other than the nonpayment of fees: the limitation, revocation, or suspension of an individual's license to practice; acceptance of an individual's license surrender; denial of a license; refusal to renew or reinstate a license; imposition of probation; or issuance of an order of censure or other reprimand;
(23) The violation of section 2919.12 of the Revised Code or the performance or inducement of an abortion upon a pregnant woman with actual knowledge that the conditions specified in division (B) of section 2317.56 of the Revised Code have not been satisfied or with a heedless indifference as to whether those conditions have been satisfied, unless an affirmative defense as specified in division (H)(2) of that section would apply in a civil action authorized by division (H)(1) of that section;
(24) The revocation, suspension, restriction, reduction, or termination of clinical privileges by the United States department of defense or department of veterans affairs or the termination or suspension of a certificate of registration to prescribe drugs by the drug enforcement administration of the United States department of justice;
(25) Termination or suspension from participation in the medicare or medicaid programs by the department of health and human services or other responsible agency;
(26) Impairment of ability to practice according to acceptable and prevailing standards of care because of habitual or excessive use or abuse of drugs, alcohol, or other substances that impair ability to practice.
For the purposes of this division, any individual authorized to practice by this chapter accepts the privilege of practicing in this state subject to supervision by the board. By filing an application for or holding a license or certificate to practice under this chapter, an individual shall be deemed to have given consent to submit to a mental or physical examination when ordered to do so by the board in writing, and to have waived all objections to the admissibility of testimony or examination reports that constitute privileged communications.
If it has reason to believe that any individual authorized to practice by this chapter or any applicant for licensure or certification to practice suffers such impairment, the board may compel the individual to submit to a mental or physical examination, or both. The expense of the examination is the responsibility of the individual compelled to be examined. Any mental or physical examination required under this division shall be undertaken by a treatment provider or physician who is qualified to conduct the examination and who is chosen by the board.
Failure to submit to a mental or physical examination ordered by the board constitutes an admission of the allegations against the individual unless the failure is due to circumstances beyond the individual's control, and a default and final order may be entered without the taking of testimony or presentation of evidence. If the board determines that the individual's ability to practice is impaired, the board shall suspend the individual's license or certificate or deny the individual's application and shall require the individual, as a condition for initial, continued, reinstated, or renewed licensure or certification to practice, to submit to treatment.
Before being eligible to apply for reinstatement of a license or certificate suspended under this division, the impaired practitioner shall demonstrate to the board the ability to resume practice in compliance with acceptable and prevailing standards of care under the provisions of the practitioner's license or certificate. The demonstration shall include, but shall not be limited to, the following:
(a) Certification from a treatment provider approved under section 4731.25 of the Revised Code that the individual has successfully completed any required inpatient treatment;
(b) Evidence of continuing full compliance with an aftercare contract or consent agreement;
(c) Two written reports indicating that the individual's ability to practice has been assessed and that the individual has been found capable of practicing according to acceptable and prevailing standards of care. The reports shall be made by individuals or providers approved by the board for making the assessments and shall describe the basis for their determination.
The board may reinstate a license or certificate suspended under this division after that demonstration and after the individual has entered into a written consent agreement.
When the impaired practitioner resumes practice, the board shall require continued monitoring of the individual. The monitoring shall include, but not be limited to, compliance with the written consent agreement entered into before reinstatement or with conditions imposed by board order after a hearing, and, upon termination of the consent agreement, submission to the board for at least two years of annual written progress reports made under penalty of perjury stating whether the individual has maintained sobriety.
(27) A second or subsequent violation of section 4731.66 or 4731.69 of the Revised Code;
(28) Except as provided in division (N) of this section:
(a) Waiving the payment of all or any part of a deductible or copayment that a patient, pursuant to a health insurance or health care policy, contract, or plan that covers the individual's services, otherwise would be required to pay if the waiver is used as an enticement to a patient or group of patients to receive health care services from that individual;
(b) Advertising that the individual will waive the payment of all or any part of a deductible or copayment that a patient, pursuant to a health insurance or health care policy, contract, or plan that covers the individual's services, otherwise would be required to pay.
(29) Failure to use universal blood and body fluid precautions established by rules adopted under section 4731.051 of the Revised Code;
(30) Failure to provide notice to, and receive acknowledgment of the notice from, a patient when required by section 4731.143 of the Revised Code prior to providing nonemergency professional services, or failure to maintain that notice in the patient's medical record;
(31)
Failure of a physician supervising
collaborating
with
a physician assistant to maintain
supervision
collaboration
in accordance with the requirements of
Chapter 4730. of the Revised Code and the rules adopted under that
chapter;
(32) Failure of a physician or podiatrist to enter into a standard care arrangement with a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner with whom the physician or podiatrist is in collaboration pursuant to section 4731.27 of the Revised Code or failure to fulfill the responsibilities of collaboration after entering into a standard care arrangement;
(33) Failure to comply with the terms of a consult agreement entered into with a pharmacist pursuant to section 4729.39 of the Revised Code;
(34) Failure to cooperate in an investigation conducted by the board under division (F) of this section, including failure to comply with a subpoena or order issued by the board or failure to answer truthfully a question presented by the board in an investigative interview, an investigative office conference, at a deposition, or in written interrogatories, except that failure to cooperate with an investigation shall not constitute grounds for discipline under this section if a court of competent jurisdiction has issued an order that either quashes a subpoena or permits the individual to withhold the testimony or evidence in issue;
(35) Failure to supervise an oriental medicine practitioner or acupuncturist in accordance with Chapter 4762. of the Revised Code and the board's rules for providing that supervision;
(36) Failure to supervise an anesthesiologist assistant in accordance with Chapter 4760. of the Revised Code and the board's rules for supervision of an anesthesiologist assistant;
(37) Assisting suicide, as defined in section 3795.01 of the Revised Code;
(38) Failure to comply with the requirements of section 2317.561 of the Revised Code;
(39) Failure to supervise a radiologist assistant in accordance with Chapter 4774. of the Revised Code and the board's rules for supervision of radiologist assistants;
(40) Performing or inducing an abortion at an office or facility with knowledge that the office or facility fails to post the notice required under section 3701.791 of the Revised Code;
(41) Failure to comply with the standards and procedures established in rules under section 4731.054 of the Revised Code for the operation of or the provision of care at a pain management clinic;
(42) Failure to comply with the standards and procedures established in rules under section 4731.054 of the Revised Code for providing supervision, direction, and control of individuals at a pain management clinic;
(43) Failure to comply with the requirements of section 4729.79 or 4731.055 of the Revised Code, unless the state board of pharmacy no longer maintains a drug database pursuant to section 4729.75 of the Revised Code;
(44) Failure to comply with the requirements of section 2919.171, 2919.202, or 2919.203 of the Revised Code or failure to submit to the department of health in accordance with a court order a complete report as described in section 2919.171 or 2919.202 of the Revised Code;
(45) Practicing at a facility that is subject to licensure as a category III terminal distributor of dangerous drugs with a pain management clinic classification unless the person operating the facility has obtained and maintains the license with the classification;
(46) Owning a facility that is subject to licensure as a category III terminal distributor of dangerous drugs with a pain management clinic classification unless the facility is licensed with the classification;
(47) Failure to comply with any of the requirements regarding making or maintaining medical records or documents described in division (A) of section 2919.192, division (C) of section 2919.193, division (B) of section 2919.195, or division (A) of section 2919.196 of the Revised Code;
(48) Failure to comply with the requirements in section 3719.061 of the Revised Code before issuing for a minor a prescription for an opioid analgesic, as defined in section 3719.01 of the Revised Code;
(49) Failure to comply with the requirements of section 4731.30 of the Revised Code or rules adopted under section 4731.301 of the Revised Code when recommending treatment with medical marijuana;
(50) Practicing at a facility, clinic, or other location that is subject to licensure as a category III terminal distributor of dangerous drugs with an office-based opioid treatment classification unless the person operating that place has obtained and maintains the license with the classification;
(51) Owning a facility, clinic, or other location that is subject to licensure as a category III terminal distributor of dangerous drugs with an office-based opioid treatment classification unless that place is licensed with the classification;
(52) A pattern of continuous or repeated violations of division (E)(2) or (3) of section 3963.02 of the Revised Code.
(C) Disciplinary actions taken by the board under divisions (A) and (B) of this section shall be taken pursuant to an adjudication under Chapter 119. of the Revised Code, except that in lieu of an adjudication, the board may enter into a consent agreement with an individual to resolve an allegation of a violation of this chapter or any rule adopted under it. A consent agreement, when ratified by an affirmative vote of not fewer than six members of the board, shall constitute the findings and order of the board with respect to the matter addressed in the agreement. If the board refuses to ratify a consent agreement, the admissions and findings contained in the consent agreement shall be of no force or effect.
A telephone conference call may be utilized for ratification of a consent agreement that revokes or suspends an individual's license or certificate to practice or certificate to recommend. The telephone conference call shall be considered a special meeting under division (F) of section 121.22 of the Revised Code.
If the board takes disciplinary action against an individual under division (B) of this section for a second or subsequent plea of guilty to, or judicial finding of guilt of, a violation of section 2919.123 of the Revised Code, the disciplinary action shall consist of a suspension of the individual's license or certificate to practice for a period of at least one year or, if determined appropriate by the board, a more serious sanction involving the individual's license or certificate to practice. Any consent agreement entered into under this division with an individual that pertains to a second or subsequent plea of guilty to, or judicial finding of guilt of, a violation of that section shall provide for a suspension of the individual's license or certificate to practice for a period of at least one year or, if determined appropriate by the board, a more serious sanction involving the individual's license or certificate to practice.
(D) For purposes of divisions (B)(10), (12), and (14) of this section, the commission of the act may be established by a finding by the board, pursuant to an adjudication under Chapter 119. of the Revised Code, that the individual committed the act. The board does not have jurisdiction under those divisions if the trial court renders a final judgment in the individual's favor and that judgment is based upon an adjudication on the merits. The board has jurisdiction under those divisions if the trial court issues an order of dismissal upon technical or procedural grounds.
(E) The sealing of conviction records by any court shall have no effect upon a prior board order entered under this section or upon the board's jurisdiction to take action under this section if, based upon a plea of guilty, a judicial finding of guilt, or a judicial finding of eligibility for intervention in lieu of conviction, the board issued a notice of opportunity for a hearing prior to the court's order to seal the records. The board shall not be required to seal, destroy, redact, or otherwise modify its records to reflect the court's sealing of conviction records.
(F)(1) The board shall investigate evidence that appears to show that a person has violated any provision of this chapter or any rule adopted under it. Any person may report to the board in a signed writing any information that the person may have that appears to show a violation of any provision of this chapter or any rule adopted under it. In the absence of bad faith, any person who reports information of that nature or who testifies before the board in any adjudication conducted under Chapter 119. of the Revised Code shall not be liable in damages in a civil action as a result of the report or testimony. Each complaint or allegation of a violation received by the board shall be assigned a case number and shall be recorded by the board.
(2) Investigations of alleged violations of this chapter or any rule adopted under it shall be supervised by the supervising member elected by the board in accordance with section 4731.02 of the Revised Code and by the secretary as provided in section 4731.39 of the Revised Code. The president may designate another member of the board to supervise the investigation in place of the supervising member. No member of the board who supervises the investigation of a case shall participate in further adjudication of the case.
(3) In investigating a possible violation of this chapter or any rule adopted under this chapter, or in conducting an inspection under division (E) of section 4731.054 of the Revised Code, the board may question witnesses, conduct interviews, administer oaths, order the taking of depositions, inspect and copy any books, accounts, papers, records, or documents, issue subpoenas, and compel the attendance of witnesses and production of books, accounts, papers, records, documents, and testimony, except that a subpoena for patient record information shall not be issued without consultation with the attorney general's office and approval of the secretary and supervising member of the board.
(a) Before issuance of a subpoena for patient record information, the secretary and supervising member shall determine whether there is probable cause to believe that the complaint filed alleges a violation of this chapter or any rule adopted under it and that the records sought are relevant to the alleged violation and material to the investigation. The subpoena may apply only to records that cover a reasonable period of time surrounding the alleged violation.
(b) On failure to comply with any subpoena issued by the board and after reasonable notice to the person being subpoenaed, the board may move for an order compelling the production of persons or records pursuant to the Rules of Civil Procedure.
(c) A subpoena issued by the board may be served by a sheriff, the sheriff's deputy, or a board employee or agent designated by the board. Service of a subpoena issued by the board may be made by delivering a copy of the subpoena to the person named therein, reading it to the person, or leaving it at the person's usual place of residence, usual place of business, or address on file with the board. When serving a subpoena to an applicant for or the holder of a license or certificate issued under this chapter, service of the subpoena may be made by certified mail, return receipt requested, and the subpoena shall be deemed served on the date delivery is made or the date the person refuses to accept delivery. If the person being served refuses to accept the subpoena or is not located, service may be made to an attorney who notifies the board that the attorney is representing the person.
(d) A sheriff's deputy who serves a subpoena shall receive the same fees as a sheriff. Each witness who appears before the board in obedience to a subpoena shall receive the fees and mileage provided for under section 119.094 of the Revised Code.
(4) All hearings, investigations, and inspections of the board shall be considered civil actions for the purposes of section 2305.252 of the Revised Code.
(5) A report required to be submitted to the board under this chapter, a complaint, or information received by the board pursuant to an investigation or pursuant to an inspection under division (E) of section 4731.054 of the Revised Code is confidential and not subject to discovery in any civil action.
The board shall conduct all investigations or inspections and proceedings in a manner that protects the confidentiality of patients and persons who file complaints with the board. The board shall not make public the names or any other identifying information about patients or complainants unless proper consent is given or, in the case of a patient, a waiver of the patient privilege exists under division (B) of section 2317.02 of the Revised Code, except that consent or a waiver of that nature is not required if the board possesses reliable and substantial evidence that no bona fide physician-patient relationship exists.
The board may share any information it receives pursuant to an investigation or inspection, including patient records and patient record information, with law enforcement agencies, other licensing boards, and other governmental agencies that are prosecuting, adjudicating, or investigating alleged violations of statutes or administrative rules. An agency or board that receives the information shall comply with the same requirements regarding confidentiality as those with which the state medical board must comply, notwithstanding any conflicting provision of the Revised Code or procedure of the agency or board that applies when it is dealing with other information in its possession. In a judicial proceeding, the information may be admitted into evidence only in accordance with the Rules of Evidence, but the court shall require that appropriate measures are taken to ensure that confidentiality is maintained with respect to any part of the information that contains names or other identifying information about patients or complainants whose confidentiality was protected by the state medical board when the information was in the board's possession. Measures to ensure confidentiality that may be taken by the court include sealing its records or deleting specific information from its records.
(6) On a quarterly basis, the board shall prepare a report that documents the disposition of all cases during the preceding three months. The report shall contain the following information for each case with which the board has completed its activities:
(a) The case number assigned to the complaint or alleged violation;
(b) The type of license or certificate to practice, if any, held by the individual against whom the complaint is directed;
(c) A description of the allegations contained in the complaint;
(d) The disposition of the case.
The report shall state how many cases are still pending and shall be prepared in a manner that protects the identity of each person involved in each case. The report shall be a public record under section 149.43 of the Revised Code.
(G) If the secretary and supervising member determine both of the following, they may recommend that the board suspend an individual's license or certificate to practice or certificate to recommend without a prior hearing:
(1) That there is clear and convincing evidence that an individual has violated division (B) of this section;
(2) That the individual's continued practice presents a danger of immediate and serious harm to the public.
Written allegations shall be prepared for consideration by the board. The board, upon review of those allegations and by an affirmative vote of not fewer than six of its members, excluding the secretary and supervising member, may suspend a license or certificate without a prior hearing. A telephone conference call may be utilized for reviewing the allegations and taking the vote on the summary suspension.
The board shall issue a written order of suspension by certified mail or in person in accordance with section 119.07 of the Revised Code. The order shall not be subject to suspension by the court during pendency of any appeal filed under section 119.12 of the Revised Code. If the individual subject to the summary suspension requests an adjudicatory hearing by the board, the date set for the hearing shall be within fifteen days, but not earlier than seven days, after the individual requests the hearing, unless otherwise agreed to by both the board and the individual.
Any summary suspension imposed under this division shall remain in effect, unless reversed on appeal, until a final adjudicative order issued by the board pursuant to this section and Chapter 119. of the Revised Code becomes effective. The board shall issue its final adjudicative order within seventy-five days after completion of its hearing. A failure to issue the order within seventy-five days shall result in dissolution of the summary suspension order but shall not invalidate any subsequent, final adjudicative order.
(H) If the board takes action under division (B)(9), (11), or (13) of this section and the judicial finding of guilt, guilty plea, or judicial finding of eligibility for intervention in lieu of conviction is overturned on appeal, upon exhaustion of the criminal appeal, a petition for reconsideration of the order may be filed with the board along with appropriate court documents. Upon receipt of a petition of that nature and supporting court documents, the board shall reinstate the individual's license or certificate to practice. The board may then hold an adjudication under Chapter 119. of the Revised Code to determine whether the individual committed the act in question. Notice of an opportunity for a hearing shall be given in accordance with Chapter 119. of the Revised Code. If the board finds, pursuant to an adjudication held under this division, that the individual committed the act or if no hearing is requested, the board may order any of the sanctions identified under division (B) of this section.
(I) The license or certificate to practice issued to an individual under this chapter and the individual's practice in this state are automatically suspended as of the date of the individual's second or subsequent plea of guilty to, or judicial finding of guilt of, a violation of section 2919.123 of the Revised Code. In addition, the license or certificate to practice or certificate to recommend issued to an individual under this chapter and the individual's practice in this state are automatically suspended as of the date the individual pleads guilty to, is found by a judge or jury to be guilty of, or is subject to a judicial finding of eligibility for intervention in lieu of conviction in this state or treatment or intervention in lieu of conviction in another jurisdiction for any of the following criminal offenses in this state or a substantially equivalent criminal offense in another jurisdiction: aggravated murder, murder, voluntary manslaughter, felonious assault, kidnapping, rape, sexual battery, gross sexual imposition, aggravated arson, aggravated robbery, or aggravated burglary. Continued practice after suspension shall be considered practicing without a license or certificate.
The board shall notify the individual subject to the suspension by certified mail or in person in accordance with section 119.07 of the Revised Code. If an individual whose license or certificate is automatically suspended under this division fails to make a timely request for an adjudication under Chapter 119. of the Revised Code, the board shall do whichever of the following is applicable:
(1) If the automatic suspension under this division is for a second or subsequent plea of guilty to, or judicial finding of guilt of, a violation of section 2919.123 of the Revised Code, the board shall enter an order suspending the individual's license or certificate to practice for a period of at least one year or, if determined appropriate by the board, imposing a more serious sanction involving the individual's license or certificate to practice.
(2) In all circumstances in which division (I)(1) of this section does not apply, enter a final order permanently revoking the individual's license or certificate to practice.
(J) If the board is required by Chapter 119. of the Revised Code to give notice of an opportunity for a hearing and if the individual subject to the notice does not timely request a hearing in accordance with section 119.07 of the Revised Code, the board is not required to hold a hearing, but may adopt, by an affirmative vote of not fewer than six of its members, a final order that contains the board's findings. In that final order, the board may order any of the sanctions identified under division (A) or (B) of this section.
(K) Any action taken by the board under division (B) of this section resulting in a suspension from practice shall be accompanied by a written statement of the conditions under which the individual's license or certificate to practice may be reinstated. The board shall adopt rules governing conditions to be imposed for reinstatement. Reinstatement of a license or certificate suspended pursuant to division (B) of this section requires an affirmative vote of not fewer than six members of the board.
(L) When the board refuses to grant or issue a license or certificate to practice to an applicant, revokes an individual's license or certificate to practice, refuses to renew an individual's license or certificate to practice, or refuses to reinstate an individual's license or certificate to practice, the board may specify that its action is permanent. An individual subject to a permanent action taken by the board is forever thereafter ineligible to hold a license or certificate to practice and the board shall not accept an application for reinstatement of the license or certificate or for issuance of a new license or certificate.
(M) Notwithstanding any other provision of the Revised Code, all of the following apply:
(1) The surrender of a license or certificate issued under this chapter shall not be effective unless or until accepted by the board. A telephone conference call may be utilized for acceptance of the surrender of an individual's license or certificate to practice. The telephone conference call shall be considered a special meeting under division (F) of section 121.22 of the Revised Code. Reinstatement of a license or certificate surrendered to the board requires an affirmative vote of not fewer than six members of the board.
(2) An application for a license or certificate made under the provisions of this chapter may not be withdrawn without approval of the board.
(3) Failure by an individual to renew a license or certificate to practice in accordance with this chapter or a certificate to recommend in accordance with rules adopted under section 4731.301 of the Revised Code shall not remove or limit the board's jurisdiction to take any disciplinary action under this section against the individual.
(4) At the request of the board, a license or certificate holder shall immediately surrender to the board a license or certificate that the board has suspended, revoked, or permanently revoked.
(N) Sanctions shall not be imposed under division (B)(28) of this section against any person who waives deductibles and copayments as follows:
(1) In compliance with the health benefit plan that expressly allows such a practice. Waiver of the deductibles or copayments shall be made only with the full knowledge and consent of the plan purchaser, payer, and third-party administrator. Documentation of the consent shall be made available to the board upon request.
(2) For professional services rendered to any other person authorized to practice pursuant to this chapter, to the extent allowed by this chapter and rules adopted by the board.
(O) Under the board's investigative duties described in this section and subject to division (F) of this section, the board shall develop and implement a quality intervention program designed to improve through remedial education the clinical and communication skills of individuals authorized under this chapter to practice medicine and surgery, osteopathic medicine and surgery, and podiatric medicine and surgery. In developing and implementing the quality intervention program, the board may do all of the following:
(1) Offer in appropriate cases as determined by the board an educational and assessment program pursuant to an investigation the board conducts under this section;
(2) Select providers of educational and assessment services, including a quality intervention program panel of case reviewers;
(3) Make referrals to educational and assessment service providers and approve individual educational programs recommended by those providers. The board shall monitor the progress of each individual undertaking a recommended individual educational program.
(4) Determine what constitutes successful completion of an individual educational program and require further monitoring of the individual who completed the program or other action that the board determines to be appropriate;
(5) Adopt rules in accordance with Chapter 119. of the Revised Code to further implement the quality intervention program.
An individual who participates in an individual educational program pursuant to this division shall pay the financial obligations arising from that educational program.
Sec. 4761.17. All of the following apply to the practice of respiratory care by a person who holds a license or limited permit issued under this chapter:
(A) The person shall practice only pursuant to a prescription or other order for respiratory care issued by any of the following:
(1) A physician;
(2) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner who holds a current, valid license issued under Chapter 4723. of the Revised Code to practice nursing as an advanced practice registered nurse and has entered into a standard care arrangement with a physician;
(3)
A physician assistant who holds a valid prescriber number issued by
the state medical board, has been granted physician-delegated
prescriptive authority, and has entered into a supervision
collaboration
agreement that allows the physician
assistant to prescribe or order respiratory care services.
(B) The person shall practice only under the supervision of any of the following:
(1) A physician;
(2) A certified nurse practitioner, certified nurse-midwife, or clinical nurse specialist;
(3) A physician assistant who is authorized to prescribe or order respiratory care services as provided in division (A)(3) of this section.
(C)(1) When practicing under the prescription or order of a certified nurse practitioner, certified nurse midwife, or clinical nurse specialist or under the supervision of such a nurse, the person's administration of medication that requires a prescription is limited to the drugs that the nurse is authorized to prescribe pursuant to section 4723.481 of the Revised Code.
(2) When practicing under the prescription or order of a physician assistant or under the supervision of a physician assistant, the person's administration of medication that requires a prescription is limited to the drugs that the physician assistant is authorized to prescribe pursuant to the physician assistant's physician-delegated prescriptive authority.
Sec. 4773.02. (A) Except as provided in division (B) of this section, no person shall practice or hold self out as a general x-ray machine operator, radiographer, radiation therapy technologist, or nuclear medicine technologist without a valid license issued under this chapter for the person's area of practice.
(B) Division (A) of this section does not apply to any of the following when acting in accordance with the person's area of practice:
(1) A physician, podiatrist, mechanotherapist, or chiropractor;
(2) A physician assistant performing fluoroscopic procedures to the extent authorized by section 4730.204 of the Revised Code;
(3) An individual licensed under Chapter 4715. of the Revised Code to practice dentistry, to practice as a dental hygienist, or to practice as a dental x-ray machine operator;
(3)
(4)
As specified in 42 C.F.R. 75, radiologic
personnel employed by the federal government or serving in a branch
of the armed forces of the United States;
(4)
(5)
Students engaging in any of the activities
performed by basic x-ray machine operators, radiographers, radiation
therapy technologists, and nuclear medicine technologists as an
integral part of a program of study leading to receipt of a license
issued under this chapter or Chapter 4715., 4730.,
4731., or 4734. of the Revised Code.
Sec. 5122.01. As used in this chapter and Chapter 5119. of the Revised Code:
(A) "Mental illness" means a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life.
(B) "Mentally ill person subject to court order" means a mentally ill person who, because of the person's illness:
(1) Represents a substantial risk of physical harm to self as manifested by evidence of threats of, or attempts at, suicide or serious self-inflicted bodily harm;
(2) Represents a substantial risk of physical harm to others as manifested by evidence of recent homicidal or other violent behavior, evidence of recent threats that place another in reasonable fear of violent behavior and serious physical harm, or other evidence of present dangerousness;
(3) Represents a substantial and immediate risk of serious physical impairment or injury to self as manifested by evidence that the person is unable to provide for and is not providing for the person's basic physical needs because of the person's mental illness and that appropriate provision for those needs cannot be made immediately available in the community;
(4) Would benefit from treatment for the person's mental illness and is in need of such treatment as manifested by evidence of behavior that creates a grave and imminent risk to substantial rights of others or the person;
(5)(a) Would benefit from treatment as manifested by evidence of behavior that indicates all of the following:
(i) The person is unlikely to survive safely in the community without supervision, based on a clinical determination.
(ii) The person has a history of lack of compliance with treatment for mental illness and one of the following applies:
(I) At least twice within the thirty-six months prior to the filing of an affidavit seeking court-ordered treatment of the person under section 5122.111 of the Revised Code, the lack of compliance has been a significant factor in necessitating hospitalization in a hospital or receipt of services in a forensic or other mental health unit of a correctional facility, provided that the thirty-six-month period shall be extended by the length of any hospitalization or incarceration of the person that occurred within the thirty-six-month period.
(II) Within the forty-eight months prior to the filing of an affidavit seeking court-ordered treatment of the person under section 5122.111 of the Revised Code, the lack of compliance resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others, provided that the forty-eight-month period shall be extended by the length of any hospitalization or incarceration of the person that occurred within the forty-eight-month period.
(iii) The person, as a result of the person's mental illness, is unlikely to voluntarily participate in necessary treatment.
(iv) In view of the person's treatment history and current behavior, the person is in need of treatment in order to prevent a relapse or deterioration that would be likely to result in substantial risk of serious harm to the person or others.
(b) An individual who meets only the criteria described in division (B)(5)(a) of this section is not subject to hospitalization.
(C)(1) "Patient" means, subject to division (C)(2) of this section, a person who is admitted either voluntarily or involuntarily to a hospital or other place under section 2945.39, 2945.40, 2945.401, or 2945.402 of the Revised Code subsequent to a finding of not guilty by reason of insanity or incompetence to stand trial or under this chapter, who is under observation or receiving treatment in such place.
(2) "Patient" does not include a person admitted to a hospital or other place under section 2945.39, 2945.40, 2945.401, or 2945.402 of the Revised Code to the extent that the reference in this chapter to patient, or the context in which the reference occurs, is in conflict with any provision of sections 2945.37 to 2945.402 of the Revised Code.
(D) "Licensed physician" means a person licensed under the laws of this state to practice medicine or a medical officer of the government of the United States while in this state in the performance of the person's official duties.
(E) "Psychiatrist" means a licensed physician who has satisfactorily completed a residency training program in psychiatry, as approved by the residency review committee of the American medical association, the committee on post-graduate education of the American osteopathic association, or the American osteopathic board of neurology and psychiatry, or who on July 1, 1989, has been recognized as a psychiatrist by the Ohio state medical association or the Ohio osteopathic association on the basis of formal training and five or more years of medical practice limited to psychiatry.
(F) "Hospital" means a hospital or inpatient unit licensed by the department of mental health and addiction services under section 5119.33 of the Revised Code, and any institution, hospital, or other place established, controlled, or supervised by the department under Chapter 5119. of the Revised Code.
(G) "Public hospital" means a facility that is tax-supported and under the jurisdiction of the department of mental health and addiction services.
(H) "Community mental health services provider" means an agency, association, corporation, individual, or program that provides community mental health services that are certified by the director of mental health and addiction services under section 5119.36 of the Revised Code.
(I) "Licensed clinical psychologist" means a person who holds a current, valid psychologist license issued under section 4732.12 of the Revised Code, and in addition, meets the educational requirements set forth in division (B) of section 4732.10 of the Revised Code and has a minimum of two years' full-time professional experience, or the equivalent as determined by rule of the state board of psychology, at least one year of which shall be a predoctoral internship, in clinical psychological work in a public or private hospital or clinic or in private practice, diagnosing and treating problems of mental illness or intellectual disability under the supervision of a psychologist who is licensed or who holds a diploma issued by the American board of professional psychology, or whose qualifications are substantially similar to those required for licensure by the state board of psychology when the supervision has occurred prior to enactment of laws governing the practice of psychology.
(J) "Health officer" means any public health physician; public health nurse; or other person authorized or designated by a city or general health district or a board of alcohol, drug addiction, and mental health services to perform the duties of a health officer under this chapter.
(K) "Chief clinical officer" means the medical director of a hospital, community mental health services provider, or board of alcohol, drug addiction, and mental health services, or, if there is no medical director, the licensed physician responsible for the treatment provided by a hospital or community mental health services provider. The chief clinical officer may delegate to the attending physician responsible for a patient's care the duties imposed on the chief clinical officer by this chapter. In the case of a community mental health services provider, the chief clinical officer shall be designated by the governing body of the services provider and shall be a licensed physician or licensed clinical psychologist who supervises diagnostic and treatment services. A licensed physician or licensed clinical psychologist designated by the chief clinical officer may perform the duties and accept the responsibilities of the chief clinical officer in the chief clinical officer's absence.
(L) "Working day" or "court day" means Monday, Tuesday, Wednesday, Thursday, and Friday, except when such day is a holiday.
(M) "Indigent" means unable without deprivation of satisfaction of basic needs to provide for the payment of an attorney and other necessary expenses of legal representation, including expert testimony.
(N) "Respondent" means the person whose detention, commitment, hospitalization, continued hospitalization or commitment, or discharge is being sought in any proceeding under this chapter.
(O) "Ohio protection and advocacy system" has the same meaning as in section 5123.60 of the Revised Code.
(P) "Independent expert evaluation" means an evaluation conducted by a licensed clinical psychologist, psychiatrist, or licensed physician who has been selected by the respondent or the respondent's counsel and who consents to conducting the evaluation.
(Q) "Court" means the probate division of the court of common pleas.
(R) "Expunge" means:
(1) The removal and destruction of court files and records, originals and copies, and the deletion of all index references;
(2) The reporting to the person of the nature and extent of any information about the person transmitted to any other person by the court;
(3) Otherwise insuring that any examination of court files and records in question shall show no record whatever with respect to the person;
(4) That all rights and privileges are restored, and that the person, the court, and any other person may properly reply that no such record exists, as to any matter expunged.
(S) "Residence" means a person's physical presence in a county with intent to remain there, except that:
(1) If a person is receiving a mental health service at a facility that includes nighttime sleeping accommodations, residence means that county in which the person maintained the person's primary place of residence at the time the person entered the facility;
(2) If a person is committed pursuant to section 2945.38, 2945.39, 2945.40, 2945.401, or 2945.402 of the Revised Code, residence means the county where the criminal charges were filed.
When the residence of a person is disputed, the matter of residence shall be referred to the department of mental health and addiction services for investigation and determination. Residence shall not be a basis for a board of alcohol, drug addiction, and mental health services to deny services to any person present in the board's service district, and the board shall provide services for a person whose residence is in dispute while residence is being determined and for a person in an emergency situation.
(T) "Admission" to a hospital or other place means that a patient is accepted for and stays at least one night at the hospital or other place.
(U) "Prosecutor" means the prosecuting attorney, village solicitor, city director of law, or similar chief legal officer who prosecuted a criminal case in which a person was found not guilty by reason of insanity, who would have had the authority to prosecute a criminal case against a person if the person had not been found incompetent to stand trial, or who prosecuted a case in which a person was found guilty.
(V)(1) "Treatment plan" means a written statement of reasonable objectives and goals for an individual established by the treatment team, with specific criteria to evaluate progress towards achieving those objectives.
(2) The active participation of the patient in establishing the objectives and goals shall be documented. The treatment plan shall be based on patient needs and include services to be provided to the patient while the patient is hospitalized, after the patient is discharged, or in an outpatient setting. The treatment plan shall address services to be provided. In the establishment of the treatment plan, consideration should be given to the availability of services, which may include but are not limited to all of the following:
(a) Community psychiatric supportive treatment;
(b) Assertive community treatment;
(c) Medications;
(d) Individual or group therapy;
(e) Peer support services;
(f) Financial services;
(g) Housing or supervised living services;
(h) Alcohol or substance abuse treatment;
(i) Any other services prescribed to treat the patient's mental illness and to either assist the patient in living and functioning in the community or to help prevent a relapse or a deterioration of the patient's current condition.
(3) If the person subject to the treatment plan has executed an advance directive for mental health treatment, the treatment team shall consider any directions included in such advance directive in developing the treatment plan.
(W) "Community control sanction" has the same meaning as in section 2929.01 of the Revised Code.
(X) "Post-release control sanction" has the same meaning as in section 2967.01 of the Revised Code.
(Y) "Local correctional facility" has the same meaning as in section 2903.13 of the Revised Code.
(Z) "Clinical nurse specialist" and "certified nurse practitioner" have the same meanings as in section 4723.01 of the Revised Code.
(AA) "Licensed physician assistant" means an individual who holds a valid license to practice as a physician assistant issued under Chapter 4730. of the Revised Code.
Sec. 5122.10. (A)(1) Any of the following who has reason to believe that a person is a mentally ill person subject to court order and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination may take the person into custody and may immediately transport the person to a hospital or, notwithstanding section 5119.33 of the Revised Code, to a general hospital not licensed by the department of mental health and addiction services where the person may be held for the period prescribed in this section:
(a) A psychiatrist;
(b) A licensed physician;
(c) A licensed clinical psychologist;
(d) A clinical nurse specialist who is certified as a psychiatric-mental health CNS by the American nurses credentialing center;
(e) A certified nurse practitioner who is certified as a psychiatric-mental health NP by the American nurses credentialing center;
(f) A health officer;
(g) A parole officer;
(h) A police officer;
(i) A sheriff;
(j) A physician assistant.
(2) If the chief of the adult parole authority or a parole or probation officer with the approval of the chief of the authority has reason to believe that a parolee, an offender under a community control sanction or post-release control sanction, or an offender under transitional control is a mentally ill person subject to court order and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination, the chief or officer may take the parolee or offender into custody and may immediately transport the parolee or offender to a hospital or, notwithstanding section 5119.33 of the Revised Code, to a general hospital not licensed by the department of mental health and addiction services where the parolee or offender may be held for the period prescribed in this section.
(B) A written statement shall be given to the hospital by the individual authorized under division (A)(1) or (2) of this section to transport the person. The statement shall specify the circumstances under which such person was taken into custody and the reasons for the belief that the person is a mentally ill person subject to court order and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination. This statement shall be made available to the respondent or the respondent's attorney upon request of either.
(C) Every reasonable and appropriate effort shall be made to take persons into custody in the least conspicuous manner possible. A person taking the respondent into custody pursuant to this section shall explain to the respondent: the name and professional designation and affiliation of the person taking the respondent into custody; that the custody-taking is not a criminal arrest; and that the person is being taken for examination by mental health professionals at a specified mental health facility identified by name.
(D) If a person taken into custody under this section is transported to a general hospital, the general hospital may admit the person, or provide care and treatment for the person, or both, notwithstanding section 5119.33 of the Revised Code, but by the end of twenty-four hours after arrival at the general hospital, the person shall be transferred to a hospital as defined in section 5122.01 of the Revised Code.
(E) A person transported or transferred to a hospital or community mental health services provider under this section shall be examined by the staff of the hospital or services provider within twenty-four hours after arrival at the hospital or services provider. If to conduct the examination requires that the person remain overnight, the hospital or services provider shall admit the person in an unclassified status until making a disposition under this section. After the examination, if the chief clinical officer of the hospital or services provider believes that the person is not a mentally ill person subject to court order, the chief clinical officer shall release or discharge the person immediately unless a court has issued a temporary order of detention applicable to the person under section 5122.11 of the Revised Code. After the examination, if the chief clinical officer believes that the person is a mentally ill person subject to court order, the chief clinical officer may detain the person for not more than three court days following the day of the examination and during such period admit the person as a voluntary patient under section 5122.02 of the Revised Code or file an affidavit under section 5122.11 of the Revised Code. If neither action is taken and a court has not otherwise issued a temporary order of detention applicable to the person under section 5122.11 of the Revised Code, the chief clinical officer shall discharge the person at the end of the three-day period unless the person has been sentenced to the department of rehabilitation and correction and has not been released from the person's sentence, in which case the person shall be returned to that department.
Section 2. That existing sections 1.64, 2108.61, 2133.211, 3701.351, 3727.06, 4730.02, 4730.03, 4730.04, 4730.05, 4730.06, 4730.07, 4730.08, 4730.11, 4730.14, 4730.19, 4730.20, 4730.201, 4730.203, 4730.21, 4730.22, 4730.25, 4730.26, 4730.32, 4730.41, 4730.411, 4730.42, 4731.22, 4761.17, 4773.02, 5122.01, and 5122.10 of the Revised Code are hereby repealed.
Section 3. That sections 4730.111 and 4730.44 of the Revised Code are hereby repealed.