Honolulu, Hawaii
                                                   , 1999

                                 RE: H.B. No. 47
                                     H.D. 1

Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Consumer Protection and Commerce, to which
was referred H.B. No. 47 entitled: 


begs leave to report as follows:

     The purpose of this bill is to allow full implementation of
the Board of Medical Examiners' (BME) rules governing physician
assistants (PAs), by changing the statutory nomenclature
applicable to PA regulation from "certification" to "licensing,"
thus allowing PAs to, among other things, be recognized by the
Department of Public Safety as licensed individuals who may be
registered to write prescriptions for schedule III to V
controlled substances.

     Your Committee received testimony supporting this measure
from the BME, the Legislative Auditor (Auditor), Hawai'i State
Primary Care Association, Hawaii Academy of Physician Assistants,
and three PAs.  Kaiser Permanente and a number of organizations
providing medical care on Kauai and the Big Island also submitted
testimony in support.  The Hawaii Government Employees
Association testified in opposition to the measure.  The Hawai'i
Nurses' Association took no position on the licensing of PAs but
requested that the Legislature treat PAs and advanced practice
registered nurses equally with regard to prescriptive authority.

     Your Committee finds that this bill provides the basis upon
which to fully implement the BME's 1997 PA rules, and is
consistent with the Auditor's recommendations in Report 98-19,

                                 STAND. COM. REP. NO. 958
                                 Page 2

"Analysis of a Proposal to Modify the Regulation of Physician
Assistants," that was written in response to the 1998 House
Concurrent Resolution No. 14, H.D.1, S.D.1 (HCR No. 14, 1998).

     HCR No. 14, 1998, found that in 1984 the Auditor had
recommended revision of the rules applicable to PAs because the
rules were overly restrictive to the detriment of optimal PA
practice and utilization.  In December 1997, the BME revised its
PA administrative rules consistent with the American Medical
Association Model Guidelines for Physician/Physician Assistant
Practice as well as the American Academy of Physician Assistants
Model Regulations.

     HCR No. 14, 1998, stated that to fully implement the new PA
rules the regulatory terminology used in the PA statutes should
be amended from "certification" to "licensure," because laws and
rules concerning medical practice assume that medical
practitioners such as PAs are licensed.  HCR No. 14, 1998,
requested that the Auditor analyze the probable effects of the
language change.

     The Auditor's Report 98-19 found that in adopting the 1997
rules, the BME knew that the Narcotics Enforcement Division did
not, at that time, register PAs to prescribe controlled
substances because PAs were certified and not licensed.  Knowing
this, the BME recognized PA competence, and authorized physician
delegation of authority to PAs to prescribe schedule III to V
controlled substances.

     The report further found that a change in statutory
terminology from certified to licensed would more accurately
reflect the regulatory intent and practice, and would have:

     (1)  Minimal fiscal and operational impact on the DCCA;

     (2)  Little to no effect on the public's health, safety, or
          welfare because safeguards currently in place in
          statutes or administrative rules are sufficient to
          ensure consumer protection; and

     (3)  No effect on insurance coverage because physician
          assistant services are generally billed through the
          supervising physician.

                                 STAND. COM. REP. NO. 958
                                 Page 3

     Examining safeguards for public health and safety under
statute and rules, Report 98-19 found that physician supervision
mandated by law ensures public health and safety.  Under the law,
physicians retain full professional and legal responsibility for
the performance of PAs, and patient care and treatment.  Although
the physical presence of the physician is not required,
supervision must be continuous and there must be a means of
direct communication between the physician and PA.

     Report 98-19 also found that as of August 1998, PAs had
prescribing privileges in 43 states, including Hawaii.  Only 13
of these states imposed restrictions such as the use of a
formulary.  Thirty-four states allow PAs to prescribe controlled
substances, and of these, 18 allow PAs to prescribe schedule II
through V substances, with another 14 allowing only schedule III
to V substances.  Only two states restrict controlled substance
prescription to schedule V substances.

     Your Committee heard concerns that allowing physicians to
delegate authority to PAs to prescribe controlled substances
would compromise public health and safety.  Although your
Committee believes that the legally required supervisory
relationship between physician and PA ensures public safety and
is an essential prerequisite to the prescriptive authority
allowed under the BME rules, your Committee feels that continued
examination of the Auditor's findings and discussion of the issue
of public safety would be beneficial. 

     Your Committee has therefore amended the bill by leaving the
effective date of this measure blank.

     As affirmed by the record of votes of the members of your
Committee on Consumer Protection and Commerce that is attached to
this report, your Committee is in accord with the intent and
purpose of H.B. No. 47, as amended herein, and recommends that it
pass Third Reading in the form attached hereto as H.B. No. 47,
H.D. 1.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Consumer
                                   Protection and Commerce,

                                   RON MENOR, Chair