Honolulu, Hawaii


RE: S.B. No. 1406

S.D. 1




Honorable Ronald D. Kouchi

President of the Senate

Thirtieth State Legislature

Regular Session of 2019

State of Hawaii




Your Committees on Commerce, Consumer Protection, and Health and Judiciary, to which was referred S.B. No. 1406 entitled:




beg leave to report as follows:


The purpose and intent of this measure is to:


(1) Clarify the scope and practice of physician assistants in the State;


(2) Amend the composition of the Hawaii Medical Board to include two physician assistants; and


(3) Expand the grounds for revocation or suspension of a physician or surgeon's license.


Your Committees received testimony in support of this measure from Hawaii Pacific Health, American Academy of PAs, Society of Physician Assistants in Rheumatology, Minit Medical, and twenty-three individuals. Your Committees received testimony in opposition to this measure from the Hawaii Medical Association. Your Committees received comments on this measure from the Department of Commerce and Consumer Affairs, Regulated Industries Complaints Office of the Department of Commerce and Consumer Affairs, Hawaii Medical Board, and Kaiser Permanente Hawaii.


Your Committees find that Hawaii is facing a critical physician shortage, especially in rural areas, which is expected to worsen with the increased demand for health care from an aging population. The latest physician workforce survey by the University of Hawaii shows that nearly eight hundred doctors are needed across all specialties in the State. Physician assistants are skilled health care providers trained to take medical histories, perform physical examinations, order and interpret laboratory tests, diagnose illnesses, develop and manage treatment plans, prescribe medications, and assist in surgery. Further, since the federal Affordable Care Act was passed in 2010, physician assistants have been one of the three health care professionals (along with physicians and nurse practitioners) who are authorized to provide primary care. Existing state law, however, requires physicians to review one hundred percent of physician assistants' charts, one of the most restrictive standards in the country, which creates a significant administrative burden on physicians.


Your Committees further find that a number of stakeholders, including the Hawaii Academy of Physician Assistants, Hawaii Medical Board, and Kaiser Permanente, have collaborated to suggest certain amendments and provisions that modernize the scope of practice for physician assistants. The consensus language is narrower in scope than this measure, but still provides physician assistants greater latitude to meet the urgent need for reform.


Accordingly, your Committees have amended this measure by deleting its contents and adopting consensus language agreed upon by stakeholders that:


(1) Clarifies that the existing supervisory requirements for licensure as a physician assistant, including the degree of supervision required, also include supervision by a group of physicians;


(2) Specifies requirements for the supervisory review of physician assistant medical records, including a percentage of supervision based on duration of licensure;


(3) Establishes biennial requirements of forty credit hours of continuing medical education for physician assistant license renewal;


(4) Authorizes the Hawaii Medical Board to conduct random audits to enforce compliance; and


(5) Specifies conditions for forfeiture and reinstatement of a physician assistant license.


As affirmed by the records of votes of the members of your Committees on Commerce, Consumer Protection, and Health and Judiciary that are attached to this report, your Committees are in accord with the intent and purpose of S.B. No. 1406, as amended herein, and recommend that it pass Second Reading in the form attached hereto as S.B. No. 1406, S.D. 1, and be placed on the calendar for Third Reading.


Respectfully submitted on behalf of the members of the Committees on Commerce, Consumer Protection, and Health and Judiciary,