Physician Assistants

Authorizes physician assistants registered with the Department of
Public Safety to administer, prescribe, and dispense controlled
substances under the supervision of a physician.  Provides for
the licensing, rather than certification, of physician assistants
who are nationally certified.  (CD1)

THE SENATE                              S.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                                C.D. 1
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Section 329-1, Hawaii Revised Statutes, is
 2 amended by adding two new definitions to be appropriately
 3 inserted and to read as follows:
 4      ""Physician assistant" means a person licensed under section
 5 453-5.3, who is registered under this chapter to administer,
 6 prescribe, or dispense a controlled substance under the authority
 7 and supervision of a physician registered under section 329-33,
 8 but who is not authorized to request, receive, or sign for
 9 professional controlled substance samples.
10      "Supervising physician" means a physician licensed to
11 practice medicine in the State and registered under section 329-
12 33, who supervises a physician assistant and retains full
13 professional and legal responsibility for the performance of the
14 supervised physician assistant and the care and treatment of the
15 patient."
16      SECTION 2.  Section 329-38, Hawaii Revised Statutes, is
17 amended by amending subsection (e) to read as follows:
18      "(e)  Prescriptions for controlled substances shall be
19 issued only as follows:

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1      (1)  All prescriptions for controlled substances shall be
 2           dated as of, and signed on, the day when the
 3           prescriptions were issued and shall bear: 
 4           (A)  The full name and address of the patient; and
 5           (B)  The name, address, and registration number of the
 6                practitioner.
 7           A practitioner may sign a prescription in the same
 8           manner as the practitioner would sign a check or legal
 9           document (e.g., J.H. Smith or John H. Smith) and shall
10           use both words and figures (e.g., alphabetically and
11           numerically as indications of quantity, such as five
12           (5)), to indicate the amount of controlled substance to
13           be dispensed.  Where an oral order is not permitted,
14           prescriptions shall be written with ink or indelible
15           pencil or by typewriter and shall be manually signed by
16           the practitioner.  The prescriptions may be prepared by
17           a secretary or agent for the signature of the
18           practitioner, but the prescribing practitioner shall be
19           responsible in case the prescription does not conform
20           in all essential respects to this chapter and any rules
21           adopted pursuant to this chapter.  A corresponding
22           liability shall rest upon a pharmacist who fills a
23           prescription not prepared in the form prescribed by

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1           this section;
 2      (2)  An intern, resident, or foreign-trained physician, or a
 3           physician on the staff of a Department of Veterans
 4           Affairs facility or other facility serving veterans,
 5           exempted from registration under this chapter, shall
 6           include on all prescriptions issued by the physician:
 7           (A)  The registration number of the hospital or other
 8                institution; and
 9           (B)  The special internal code number assigned to the
10                physician by the hospital or other institution in
11                lieu of the registration number of the
12                practitioner required by this section.
13           Each written prescription shall have the name of the
14           physician stamped, typed, or handprinted on it, as well
15           as the signature of the physician; [and]
16      (3)  An official exempted from registration shall include on
17           all prescriptions issued by the official:
18           (A)  The official's branch of service or agency (e.g.,
19                "U.S. Army" or "Public Health Service"); and
20           (B)  The official's service identification number, in
21                lieu of the registration number of the
22                practitioner required by this section.  The
23                service identification number for a Public Health

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1                Service employee shall be the employee's Social
 2                Security identification number.
 3           Each prescription shall have the name of the officer
 4           stamped, typed, or handprinted on it, as well as the
 5           signature of the officer[.]; and
 6      (4)  A physician assistant registered to prescribe
 7           controlled substances under the authorization of a
 8           supervising physician shall include on all
 9           prescriptions issued:
10           (A)  The DEA registration number of the supervising
11                physician; and
12           (B)  The special code number assigned to the physician
13                assistant by the department.
14           Each written prescription issued shall include the
15           printed, stamped, typed, or hand-printed name, address,
16           and phone number of both the supervising physician and
17           physician assistant, and shall be signed by the
18           physician assistant.  The medical record of each
19           written prescription issued by a physician assistant
20           shall be reviewed and initialed by the physician
21           assistant's supervising physician within seven working
22           days."
23      SECTION 3.  Section 453-5.3, Hawaii Revised Statutes, is
24 amended to read as follows:

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1      "453-5.3  Physician assistant; [certification] licensure
 2 required.(a)  The board of medical examiners shall require each
 3 person practicing medicine under the supervision of a physician,
 4 other than a person licensed under section 453-3, to be
 5 [certified] licensed as a physician assistant.  A person who is
 6 trained to do only a very limited number of diagnostic or
 7 therapeutic procedures under the direction of a physician shall
 8 not be deemed a practitioner of medicine and therefore does not
 9 require [certification] licensure under this section.
10      (b)  The board shall establish medical educational and
11 training standards with which a person applying for
12 [certification] licensure as a physician assistant shall comply.
13 The standards shall be at least equal to recognized national
14 education and training standards for physician assistants.
15      (c)  Upon satisfactory proof of compliance with the required
16 medical educational and training standards, the board may grant
17 state [certification] licensure to a person who has been granted
18 certification based upon passage of a national certifying
19 examination and who holds a current certificate from the national
20 certifying entity approved by the board.
21      (d)  The board shall approve temporary [certification]
22 licensure of an applicant under this section.  The applicant
23 shall have graduated from a board approved training program

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1 within twelve months of the date of application and never taken a
 2 national certifying examination approved by the board but
 3 otherwise meet the requirements of this section.  The applicant
 4 shall file a complete application with the board and pay all
 5 required fees.  If the applicant fails to apply for, or to take,
 6 the first examination scheduled by the board following the
 7 issuance of the temporary [certificate,] license, fails to pass
 8 the examination, or fails to receive [certification,] licensure,
 9 all privileges under this section shall automatically cease upon
10 written notification sent to the applicant by the board.  A
11 temporary [certificate] license shall be issued only once to each
12 person.
13      (e)  Prior to practicing under temporary [certification,]
14 licensure, holders of temporary [certificates] licenses shall
15 notify the board in writing of any and all supervising physicians
16 under whom they will be performing services.
17      (f)  The board shall establish the degree of supervision
18 required by the supervising physician when a physician assistant
19 performs a service within the practice of medicine.  A physician
20 who does not supervise a physician assistant's services at the
21 degree required by the board shall be deemed to have engaged in
22 professional misconduct.
23      (g)  Any [certification] license of a physician assistant

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1 may be denied, not [recertified,] renewed, revoked, limited, or
 2 suspended under section 453-8.
 3      (h)  The board shall establish the application procedure,
 4 medical educational and training standards, examination
 5 requirement, if any, and degrees of supervision by rule.
 6      (i)  Every person holding a [certificate] license under this
 7 section shall apply for [recertification] renewal with the board
 8 no later than January 31 of each even-numbered year and pay a
 9 renewal fee.  Failure to apply for [recertification] renewal
10 shall constitute a forfeiture of the [certificate which] license
11 that may only be restored upon written application for
12 [recertification] restoration and payment to the board of a
13 restoration fee.
14      (j)  A [certificate] license that has been forfeited for one
15 renewal term shall be automatically terminated and cannot be
16 restored.  A new application for [certification] licensure shall
17 be required."
18      SECTION 4.  Section 453-5.4, Hawaii Revised Statutes, is
19 amended to read as follows:
20      "[[]453-5.4[]]  Physician assistant advisory committee.
21 There shall be a physician assistant advisory committee under the
22 board of medical examiners consisting solely of persons
23 [certified] licensed under section 453-5.3.  The committee shall

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                                     S.B. NO.           H.D. 2
                                                        C.D. 1

 1 review all complaints and requests relating to physician
 2 assistants, and review and recommend revisions of the physician
 3 assistant regulations.
 4      The chairperson of the committee shall be the representative
 5 for the committee members to the board of medical examiners for
 6 the purpose of providing input to the board from the physician
 7 assistant's perspective on issues and concerns, including
 8 complaints and requests, regarding physician assistants.  The
 9 chairperson shall not be a member of the board of medical
10 examiners to avoid conflict of interests."
11      SECTION 5.  Statutory material to be repealed is bracketed.
12 New statutory material is underscored.
13      SECTION 6.  This Act shall take effect upon its approval.