senate Bill S766

Authorizes physician assistants under the supervision of a physician to perform most medical services that a physician can perform

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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  • 05 / Jan / 2011
    • REFERRED TO HEALTH
  • 04 / Jan / 2012
    • REFERRED TO HEALTH

Summary

Authorizes physician assistants under the supervision of a physician to perform most medical services that a physician can perform, including the signing of death certificates.

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Bill Details

Versions:
S766
Legislative Cycle:
2011-2012
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally; amd §§6540, 6542, 6731, 6741, 6807, 6909, 6957 & 7901, add §6545-a, Ed L; amd §1194, V & T L; amd §461-c, Soc Serv L; amd §§13-b & 13-c, Work Comp L; amd §33.04, Ment Hyg L; amd §406, Gen Bus L
Versions Introduced in 2009-2010 Legislative Cycle:
S7357A

Sponsor Memo

BILL NUMBER:S766

TITLE OF BILL:
An act
to amend the public health law, the education law,
the social services law,
the workers'
compensation law, the mental hygiene law and the general business law,
in relation to clarifying the scope of practice of registered physician
assistants

PURPOSE OR GENERAL IDEA OF BILL:
To make conforming changes to current
laws to reflect the previously authorized scope of practice of
registered physician assistants. The bill authorizes physician
assistants under the supervision of a physician to perform most
medical services that a physician can perform.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends section 3700 of the
public health law to restate the definition of the term "physician
assistant".

Section 2 amends the public health law by adding a new section, 3705
to define the performance of medical services under the supervision
of a physician and only when such acts assigned are within the scope
of practice of such supervising physician, prohibit physician
assistants from performing specific functions and duties specifically
delegated by law to those persons licensed as allied health
professionals, and to define the statutory construction to clarify
that physician assistants are authorized to perform any function,
with supervision, in any health care setting, that a statute
authorizes or directs a physician to perform unless it expressly
states otherwise.

Section 3 amends section 2305 of the public health law to clarify
that physician assistants are authorized to diagnose or prescribe for
a person who is infected or has been infected with a sexually
transmissible disease including persons under the age of twenty-one
years without the consent or knowledge of the parents or guardian.

Section 4 amends section 2308 of the public health law to clarify
that physician assistants are authorized to attend pregnant women to
take or cause to be taken a sample of blood and submit it to an
approved laboratory for a test for syphilis.

Section 5 amends section 249B of the public health law to clarify
that physician assistants are authorized to provide a summary when a
hysterectomy is under consideration.

Section 6 amends section 2500-e of the public health law to clarify
that a physician assistant is authorized to certify that a follow-up
dose of hepatitis B vaccine may be detrimental to a child's health
making inapplicable the requirements of this section.


Section 7 amends section 2502 of the public health law to clarify
that physician assistants are authorized to direct or advise any
remedy for
the inflammation or reddening of one or both eyes of an infant within
the age of two weeks.

Section 8 amends section 2503 of the public health law to clarify that
physician assistants are authorized to inform the expectant mother of
the drugs expected to be employed during pregnancy and at birth and
of the possible side effects of such drugs.

Section 9 amends section 2504 of the public health law, to clarify
that physician assistants are authorized to render medical services
if the physician assistant judges an emergency exists and the person
is in immediate need of medical attention without the consent of a
parent or legal guardian.

Section 10 amends section 2570 of the public health law, to order
every institution, except hospitals, operated for the express purpose
or receiving or caring for dependent, neglected, or destitute
children to post the name and address within such institution of a
physician assistant of its selection.

Section 11 amends section 2573 of the public health law to clarify
that physician assistants are authorized to make reports concerning
the physical condition and health of the children and the
environmental sanitation of the institution as may be required by the
state health commissioner or local health officer.

Section 12 amends section 3001 of the public health law to define
"qualified medical and health personnel" to include physician
assistants.

Section 13 amends section 3602 of the public health law to clarify
that physician assistants are authorized to order or prescribe home
health aide and personal care services where not prohibited by
federal law or regulations.

Sections 14 through 20 amend sections 4141, 4141-a, 4142, 4144, 4161,
4171, and 4175 of the public health law to clarify that physician
assistants are authorized to sign and certify death certificates. It
also clarifies that physician assistants are required to record
information and file such certificates in the same manner as
physicians must do.

Section 21 amends section 6540 of the education law to define the term
"physician assistant".

Section 22 amends section 6542 of the education law to clarify that
physician assistants are authorized to perform medical services under
the supervision of a physician and within the supervising physician's
scope of practice and to clarify that physician assistants are
prohibited from performing any functions and duties delegated to
those persons licensed as allied health professionals such as
radiologic technology or the practice of optometry.


Section 23 amends the education law by adding a new section, 6545-a to
define statutory construction to clarify that physician assistants
are permitted to perform any function, with supervision, in any
health care setting, that a statute authorizes or directs a physician
to perform unless it expressly states otherwise.

Section 24 amends section 6731 of the education law to clarify that
physician assistants are authorized to order a referral for physical
therapy.

Section 25 amends subdivision 6741 of the education law to clarify
that nothing in this article is intended to affect the overall
medical direction by a licensed physician assistant of a physical
therapy assistant.

Section 26 amends section 6807 of the education law to clarify that
pharmacists are authorized to dispense drugs and devices pursuant to
a non-patient specific regimen as prescribed or ordered by a
physician assistant.

Section 27 amends section 6909 of the education law to clarify that a
registered professional nurse is authorized to execute a non-patient
specific regimen prescribed or ordered by a physician assistant.

Section 28 amends section 6957 of the education law to clarify that
nothing in this article shall be construed to affect or prevent or
expand or limit any duty of a licensed physician assistant or
physician assistant student from practicing midwifery.

Section 29 amends section 7901 of the education law to clarify that
physician assistants are authorized to order or prescribe
occupational therapy treatment.

Section 30 amends section 461-c of the social services law to clarify
that an adult care facility is authorized to accept a written report
from a physician assistant upon admission and allows for the resident
to be examined by a physician assistant at least annually thereafter
and submit an annual written report in conformity with the provisions
of this subdivision.

Section 31 amends subdivision 1 of section 13-b of the workers'
compensation law to clarify that physician assistants are authorized
to and may (a) render emergency medical care without authorization by
the chair, (b) render care while an injured employee remains in such
hospital and (c) render medical care consistent with article
thirty-seven of the public health law and article one hundred
thirty-one-B of the education law.

Section 32 amends section 13-c of the workers' compensation law to
clarify that physician assistants are authorized to render medical
care and be authorized to render such care pursuant to this chapter
and to clarify that physician assistants are authorized to order
physical therapy care and occupational therapy care.

Section 33 amends section 33.04 of the mental hygiene law to clarify
that physician assistants are authorized to order a restraint.


Section 34 amends section 406 of the general business law to clarify
that a physician assistant is authorized to certify freedom from any
infectious or communicable disease.

Section 35 states the enactment date.

JUSTIFICATION:
In 1971, the New York State Legislature recognized the
extreme shortage of physicians in many areas of the state and enacted
Articles 38 and 131 of the Education Law and Article 37 of the Public
Health Law permitting the licensure of physician assistants within
the State. The purpose of these Articles was "to provide for the
registration of physician's associates and specialist's assistants
who will be available for employment by physicians to permit medical
services to be given to persons not receiving them now and whose
qualifications will assure that the health of patients are met
properly."

Within these Articles, the legislature clearly and unambiguously
established that physician assistants are dependent practitioners
working under the supervision of a licensed physician responsible for
the actions of the physic~an assistant. Further, that the supervising
physician may delegate to the physician assistant any medical
procedures or tasks for which the physician assistant is
appropriately trained and qualified to perform and that are performed
within the normal scope of the physician's practice.

In the years since the enactment of these articles, physician
assistants have become an integral part of New York's health
caregiver team. Physician assistants practice in every health care
setting with physician supervision and have authority to diagnose and
treat patients with a range of medical conditions. From patient
education to surgical assisting and patients management, physician
assistants are versatile members of the medical team. with education
and skills that make them adaptable and flexible, physician
assistants complement the work of their supervising physicians.

However, regulatory and judicial interpretations of separate and
subsequent legislative acts have erroneously served to erode the
legislature's initial intent in enacting the above mentioned
articles. Some regulators and courts have begun to constrict the
original scope of practice mandate of physician assistants by
requiring subsequent legislative acts that authorize or direct
physicians to perform certain procedures to expressly authorize
physician assistants to perform such acts. In the absence of express
statutory authorization, they have reasoned, physician assistants are
not able to perform these functions under the supervision of a
physician.

Therefore, the legislature hereby finds and declares that a
clarification and restatement of the scope of practice of a physician
assistant is in order. Simply stated, the legislature finds and
declares that physician assistants may perform any function, with
appropriate physician supervision, in any health care setting, that a
statute authorizes a physician to perform and that is within the
normal practice of that physician, unless the statute expressly
states otherwise.


PRIOR LEGISLATIVE HISTORY:
2009-2010: S.7357-A Referred to Health
2003-2004: S.7057 Advanced to 2nd Calendar

EFFECTIVE DATE:
Immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   766

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced  by  Sen.  YOUNG  -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law, the  education  law,  the  social
  services  law,  the  workers' compensation law, the mental hygiene law
  and the general business law, in relation to clarifying the  scope  of
  practice of registered physician assistants

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  Subdivision 1 of section 3700 of the public health law, as
amended by chapter 210 of the laws  of  1975,  is  amended  to  read  as
follows:
  1.  Physician's  assistant.  The term "physician's assistant" means [a
person] A DEPENDENT PRACTITIONER WORKING  UNDER  THE  SUPERVISION  OF  A
LICENSED  PHYSICIAN RESPONSIBLE FOR THE ACTIONS OF THE PHYSICIAN ASSIST-
ANT AND who is registered as a [physician's] PHYSICIAN assistant  pursu-
ant  to  section  [sixty-five  hundred  thirty-one]  SIXTY-FIVE  HUNDRED
FORTY-ONE of the education law.
  S 2. The public health law is amended by adding a new section 3705  to
read as follows:
  S  3705.  PERFORMANCE OF MEDICAL SERVICES. 1.  A PHYSICIAN'S ASSISTANT
MAY PERFORM MEDICAL SERVICES, BUT ONLY WHEN UNDER THE SUPERVISION  OF  A
PHYSICIAN  AND ONLY WHEN SUCH ACTS ASSIGNED TO HIM OR HER ARE WITHIN THE
SCOPE OF PRACTICE OF SUCH SUPERVISING PHYSICIAN. THE SUPERVISING  PHYSI-
CIAN MAY DELEGATE TO THE PHYSICIAN'S ASSISTANT ANY MEDICAL PROCEDURES OR
TASKS  FOR  WHICH THE PHYSICIAN'S ASSISTANT IS APPROPRIATELY TRAINED AND
QUALIFIED TO PERFORM AND THAT ARE PERFORMED WITHIN THE NORMAL  SCOPE  OF
THE PHYSICIAN'S PRACTICE.
  2.  NOTHING  IN THIS ARTICLE OR IN ARTICLE ONE HUNDRED THIRTY-ONE-B OF
THE EDUCATION LAW SHALL BE CONSTRUED TO AUTHORIZE PHYSICIAN'S ASSISTANTS
TO PERFORM THOSE SPECIFIC FUNCTIONS AND DUTIES SPECIFICALLY DELEGATED BY

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02637-01-1

S. 766                              2

LAW TO THOSE PERSONS LICENSED AS ALLIED HEALTH PROFESSIONALS UNDER  THIS
CHAPTER OR THE EDUCATION LAW. SPECIFICALLY, PHYSICIAN'S ASSISTANTS SHALL
NOT  PERFORM  THE  PRACTICE  OF RADIOLOGIC TECHNOLOGY OR THE PRACTICE OF
OPTOMETRY  AS  THOSE  PRACTICES  ARE  DEFINED UNDER THIS CHAPTER AND THE
EDUCATION LAW.
  S 3. Subdivisions 1 and 2 of section 2305 of the public health law, as
amended by chapter 878 of the laws of  1980,  are  amended  to  read  as
follows:
  1. No person, other than a licensed physician OR A PHYSICIAN ASSISTANT
UNDER  THE  SUPERVISION  OF  A  LICENSED PHYSICIAN, or, in a hospital, a
staff physician, shall diagnose, treat or prescribe for a person who  is
infected  with a sexually transmissible disease, or who has been exposed
to infection with a sexually transmissible disease, or dispense or  sell
a  drug,  medicine  or remedy for the treatment of such person except on
prescription of a duly licensed physician OR A PHYSICIAN ASSISTANT UNDER
THE SUPERVISION OF A LICENSED PHYSICIAN.
  2. A licensed physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF A LICENSED PHYSICIAN, or in a hospital, a staff physician, may  diag-
nose,  treat or prescribe for a person under the age of twenty-one years
without the consent or knowledge of the  parents  or  guardian  of  said
person,  where  such  person  is  infected with a sexually transmissible
disease, or has been exposed to infection with a sexually  transmissible
disease.
  S 4. Subdivisions 1 and 2 of section 2308 of the public health law are
amended to read as follows:
  1.  Every  physician  OR  PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF
SUCH PHYSICIAN attending pregnant women in the state shall in  the  case
of  every  woman so attended take or cause to be taken a sample of blood
of such woman at the time of first examination, and submit  such  sample
to an approved laboratory for a standard serological test for syphilis.
  2.  Every  other person permitted by law to attend upon pregnant women
in the state but not permitted by law to take blood tests, shall cause a
sample of the blood of such pregnant woman to be  taken  promptly  by  a
duly  licensed  physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF SUCH PHYSICIAN and submitted to an approved laboratory for a standard
serological test for syphilis.
  S 5. Section 2498 of the public health law, as added by chapter 237 of
the laws of 1990, is amended to read as follows:
  S 2498. Provision of summary by  physician.    The  summary  shall  be
provided  by a physician, OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF SUCH PHYSICIAN, to each person under such  physician's  OR  PHYSICIAN
ASSISTANT'S  care,  when  a hysterectomy is under consideration for that
person.
  S 6. Subdivision 10 of section 2500-e of the  public  health  law,  as
added by chapter 4 of the laws of 1990, is amended to read as follows:
  10.  If  any  licensed physician, PHYSICIAN ASSISTANT UNDER THE SUPER-
VISION OF A LICENSED PHYSICIAN or nurse practitioner  certifies  that  a
follow-up  dose  of  hepatitis B vaccine may be detrimental to a child's
health, the requirements of this section  shall  be  inapplicable  until
such  immunization  is found no longer to be detrimental to such child's
health.
  S 7. Section 2502 of the public health law, as amended by chapter  884
of the laws of 1972, is amended to read as follows:
  S  2502.  Report  of  certain  conditions. Any nurse-midwife, nurse or
other person having the care of an infant within the age  of  two  weeks
who  neglects or omits to report immediately to the health officer or to

S. 766                              3

a legally qualified practitioner of medicine of the city, town or  place
where  such  child is being cared for, the fact that one or both eyes of
such infant are [inflammed] INFLAMED or reddened whenever such shall  be
the  case,  or  who  applies  any remedy therefor without the advice, or
except by the direction of such officer  or  physician  OR  A  PHYSICIAN
ASSISTANT  UNDER THE SUPERVISION OF A PHYSICIAN is guilty of a misdemea-
nor.
  S 8. Section 2503 of the public health law, as amended by chapter  485
of the laws of 1978, is amended to read as follows:
  S 2503. Drug information to be furnished expectant mothers. The physi-
cian,  A  PHYSICIAN  ASSISTANT  UNDER  THE SUPERVISION OF A PHYSICIAN or
nurse-midwife to be in attendance at the birth of a child  shall  inform
the  expectant  mother,  in advance of the birth, of the drugs that such
physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A  PHYSICIAN  or
nurse-midwife  expects to employ during pregnancy and of the obstetrical
and other drugs that  such  physician,  PHYSICIAN  ASSISTANT  UNDER  THE
SUPERVISION  OF  A PHYSICIAN or nurse-midwife expects to employ at birth
and of the possible effects of such drugs on the child and mother.
  S 9. Subdivision 4 of section 2504 of the public health law, as  added
by  chapter  769 of the laws of 1972 and as renumbered by chapter 976 of
the laws of 1984, is amended to read as follows:
  4. Medical, dental, health and hospital services may  be  rendered  to
persons  of  any  age  without the consent of a parent or legal guardian
when, in the physician's OR PHYSICIAN ASSISTANT'S UNDER THE  SUPERVISION
OF  SUCH  PHYSICIAN  judgment  an  emergency exists and the person is in
immediate need of medical attention and an  attempt  to  secure  consent
would  result in delay of treatment which would increase the risk to the
person's life or health.
  S 10. Subdivision 1 of section 2570  of  the  public  health  law,  as
amended  by  chapter  495  of  the  laws  of 1955, is amended to read as
follows:
  1. Every institution in this state, operated for the  express  purpose
of receiving or caring for dependent, neglected or destitute children or
juvenile  delinquents,  except  hospitals, shall have attached thereto a
regular physician OR PHYSICIAN ASSISTANT  UNDER  THE  SUPERVISION  OF  A
REGULAR  PHYSICIAN  of its selection duly licensed under the laws of the
state and in good professional standing, whose name and address shall be
kept posted conspicuously within such institution.
  S 11. Subdivision 1 of section 2573 of the public health law, as added
by chapter 495 of the laws of 1955, is amended to read as follows:
  1. The administrative officer or person  in  charge  and  the  regular
physician  OR  PHYSICIAN  ASSISTANT  UNDER  THE SUPERVISION OF A REGULAR
PHYSICIAN of every institution caring for children referred to  in  this
article  shall  make  such reports concerning the physical condition and
health of the children and the environmental sanitation of the  institu-
tion  as  may be required by the state health commissioner, local health
officer or health commissioner having jurisdiction.
  S 12. Subdivision 14 of section 3001 of  the  public  health  law,  as
amended  by  chapter  804  of  the  laws  of 1992, is amended to read as
follows:
  14. "Qualified medical and health personnel" means physicians,  PHYSI-
CIAN  ASSISTANTS,  registered professional nurses and advanced emergency
medical technicians competent in the management  of  patients  requiring
advanced life support care.

S. 766                              4

  S  13.  Subdivisions 4 and 5 of section 3602 of the public health law,
as amended by chapter 600 of the laws of 2002, are amended  to  read  as
follows:
  4.  "Home  health  aide  services"  means  simple  health  care tasks,
personal hygiene services, housekeeping tasks essential to the patient's
health and other related supportive services.  Such  services  shall  be
prescribed by a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF  A  PHYSICIAN  in accordance with a plan of treatment for the patient
and shall be under the supervision of a  registered  professional  nurse
from a certified home health agency or, when appropriate, from a provid-
er  of  a  long  term  home  health  care program and of the appropriate
professional therapist from  such  agency  or  provider  when  the  aide
carries  out  simple  procedures  as an extension of physical, speech or
occupational therapy. Such services may also be prescribed or ordered by
a nurse practitioner to the extent authorized by law and consistent with
the written practice agreement pursuant to subdivision three of  section
six thousand nine hundred two of the education law and not prohibited by
federal law or regulation.
  5.  "Personal  care  services"  means services to assist with personal
hygiene,  dressing,  feeding  and  household  tasks  essential  to   the
patient's  health. Such services shall be prescribed by a physician OR A
PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN  in  accordance
with  a plan of home care supervised by a registered professional nurse.
Such services may also be prescribed or ordered by a nurse  practitioner
to the extent authorized by law and consistent with the written practice
agreement  pursuant  to  subdivision  three of section six thousand nine
hundred two of the education law and not prohibited by  federal  law  or
regulations.
  S  14.  Subdivision  4 of section 4141 of the public health law, para-
graph (d) as added by chapter 413 of the laws of  2005,  is  amended  to
read as follows:
  4. (a) The medical certificate shall be made, dated, and signed by the
physician  OR  A  PHYSICIAN  ASSISTANT ACTING UNDER THE SUPERVISION OF A
PHYSICIAN, if any, last in attendance on the deceased.
  (b) Indefinite terms, denoting only symptoms of disease or  conditions
resulting from disease, shall not be held sufficient.
  (c)  Any  certificate  stating  the  cause of death in terms which the
commissioner [shall  have  declared]  DECLARES  indefinite[,]  shall  be
returned to the physician, A PHYSICIAN ASSISTANT ACTING UNDER THE SUPER-
VISION  OF  A PHYSICIAN, or person making the medical certificate[,] for
correction and more definite statement.  A CERTIFICATE CERTIFIED TO  AND
SIGNED  BY  A  PHYSICIAN ASSISTANT IN ACCORDANCE WITH THIS SECTION SHALL
HAVE THE SAME FORCE AND EFFECT IN LAW  AS  A  CERTIFICATE  SIGNED  BY  A
PHYSICIAN.
  (d)  Where  a  death is caused by an opioid overdose, such information
shall be indicated, including any related information as the commission-
er may require.
  S 15. Section 4141-a of the public health law, as added by chapter 402
of the laws of 1968, is amended to read as follows:
  S 4141-a. Death certificate; duties of hospital administrator.  When a
death occurs in a hospital, except in those cases where certificates are
issued by coroners or medical examiners, the person in  charge  of  such
hospital  or his OR HER designated representative shall promptly present
the certificate to the physician OR A PHYSICIAN ASSISTANT  ACTING  UNDER
THE SUPERVISION OF A PHYSICIAN in attendance, or a physician OR A PHYSI-
CIAN ASSISTANT ACTING UNDER THE SUPERVISION OF A PHYSICIAN acting in his

S. 766                              5

OR HER behalf, who shall promptly certify to the facts of death, provide
the  medical  information  required by the certificate, sign the medical
certificate of death, and thereupon  return  such  certificate  to  such
person,  so that the seventy-two hour registration time limit prescribed
in section four thousand one hundred forty of this [chapter]  TITLE  can
be  met.  A CERTIFICATE CERTIFIED TO AND SIGNED BY A PHYSICIAN ASSISTANT
IN ACCORDANCE WITH THIS SECTION SHALL HAVE THE SAME FORCE AND EFFECT  IN
LAW AS A CERTIFICATE SIGNED BY A PHYSICIAN.
  S  16.  Subdivision  (b)  of section 4142 of the public health law, as
amended by chapter 402 of the laws  of  1968,  is  amended  to  read  as
follows:
  (b)  present  the  certificate  promptly to the attending physician OR
PHYSICIAN ASSISTANT UNDER THE SUPERVISION  OF  A  PHYSICIAN,  who  shall
forthwith certify to the facts of death, provide the medical information
required  by  the certificate and sign the medical certificate of death,
or to the coroner or medical examiner in those cases where  so  required
by  this  article or, when a death occurs in a hospital, except in those
cases where certificates are issued by coroners or medical examiners, to
the person in charge of such hospital or his OR HER designated represen-
tative, who shall obtain the medical certificate of death as  prescribed
in  section  four  thousand  one  hundred  forty-one-a of this [chapter]
TITLE;
  S 17. Paragraph (b) of subdivision 2 of section  4144  of  the  public
health law, as amended by chapter 188 of the laws of 1997, is amended to
read as follows:
  (b)  [Verbal]  SPOKEN permission to remove a body of a deceased person
from the county in which death occurred or the body was found to a  non-
adjacent county within the state of New York, as provided in subdivision
one  [hereof]  OF THIS SECTION, shall be issued by the said registrar of
vital statistics, upon request by telephone of a licensed funeral direc-
tor or undertaker who holds a certificate of death signed by the attend-
ing physician OR PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF  A  PHYSI-
CIAN, showing THAT the death resulted from natural causes[,] and was not
a result of accidental, suicidal, homicidal or other external causes.
  S  18. The section heading and subdivisions 2, 3 and 4 of section 4161
of the public health law, the  section  heading  and  subdivision  4  as
amended  by chapter 402 of the laws of 1968, subdivision 2 as amended by
chapter 884 of the laws of 1972, and subdivision 3 as amended by chapter
388 of the laws of 1968, are amended to read as follows:
  Fetal death certificates;  form  and  content;  physicians,  PHYSICIAN
ASSISTANTS, midwives, and hospital administrators.
  2.  In  each  case  where a physician OR PHYSICIAN ASSISTANT UNDER THE
SUPERVISION OF A PHYSICIAN was in attendance at[,] or after[,]  a  fetal
death,  it [shall be] IS the duty of such physician OR PHYSICIAN ASSIST-
ANT UNDER THE SUPERVISION OF A PHYSICIAN to certify to the birth and  to
the  cause  of death on the fetal death certificate.  Where a nurse-mid-
wife was in attendance at a fetal death it [shall be]  IS  the  duty  of
such  nurse-midwife  to  certify  to  the birth but, HE OR she shall not
certify to the cause of death on the fetal death certificate.
  3. Fetal deaths occurring without the attendance  of  a  physician  OR
PHYSICIAN  ASSISTANT  UNDER  THE SUPERVISION OF A PHYSICIAN as [defined]
PROVIDED in subdivision two of this section shall be treated  as  deaths
without medical attendance, as provided in this article.
  4.  When  a  fetal  death  occurs in a hospital, except in those cases
where certificates are issued by  coroners  or  medical  examiners,  the
person  in  charge  of  such hospital or his OR HER designated represen-

S. 766                              6

tative shall promptly present the certificate to the physician OR PHYSI-
CIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN in attendance, or  a
physician  OR  PHYSICIAN  ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN
acting  in his OR HER behalf, who shall promptly certify to the facts of
birth and of fetal death, provide the medical  information  required  by
the  certificate,  sign  the medical certificate of birth and death, and
thereupon return such certificate to such person, so that  the  seventy-
two hour registration time limit prescribed in section four thousand one
hundred sixty of this [chapter] TITLE can be met.
  S  19.  The  section  heading and subdivision 1 of section 4171 of the
public health law, subdivision 1 as amended by chapter 884 of  the  laws
of 1972, is amended to read as follows:
  Records;  duties  of  physicians,  PHYSICIAN ASSISTANTS, and others to
furnish information.  1.  Physicians,  PHYSICIAN  ASSISTANTS  UNDER  THE
SUPERVISION OF A PHYSICIAN, nurse-midwives, funeral directors, undertak-
ers and informants, and all other persons having knowledge of the facts,
are  hereby required to supply, upon a form provided by the commissioner
or upon the original certificate, such information as they  may  possess
regarding any birth or death upon demand of the commissioner, in person,
by mail, or through the registrar.
  S  20.  Subdivisions  1,  3 and 5 of section 4175 of the public health
law, as amended by chapter 884 of the laws of 1972, are amended to  read
as follows:
  1.  If,  at any time after the birth, or within one year of the death,
of any person within the state, a certified copy of the official  record
of  said  birth or death, with the information required to be registered
by this article, [be] IS necessary for legal, judicial, or other  proper
purposes,  and, after search by the commissioner or his OR HER represen-
tatives, it [should appear] APPEARS that no such certificate of birth or
death was made and filed as provided by this article, then  the  commis-
sioner  shall  immediately  require  the  physician, PHYSICIAN ASSISTANT
UNDER THE SUPERVISION OF A PHYSICIAN, or nurse-midwife[,] who, being  in
attendance upon a birth, failed or neglected to file a certificate ther-
eof,  or  the  funeral director, undertaker, or other person who, having
charge of the interment or removal of the body  of  a  deceased  person,
failed  or neglected to file the certificate of death, if he or she [be]
IS living, to obtain and file at once  with  the  local  registrar  such
certificate in as complete form as the lapse of time will permit.
  3.  If  the  physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A
PHYSICIAN, nurse-midwife, funeral director,  or  undertaker  responsible
for  the  report[,]  is  deceased  or cannot be located, then the person
making application for the certified copy of the record  may  file  such
certificate  of  birth or death together with such statements subscribed
and affirmed by the persons making them as true under the  penalties  of
perjury and other evidence as the commissioner may require.
  5. The delinquent physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF  A  PHYSICIAN,  nurse-midwife, funeral director, undertaker, or other
person may, in the discretion of  the  commissioner,  be  prosecuted  as
required  by  this article, without bar from the statute of limitations,
if he or she [shall neglect or fail] NEGLECTS OR FAILS to file  promptly
the certificate required by this section.
  S  21.  Subdivision 1 of section 6540 of the education law, as amended
by chapter 179 of the laws of 1992, is amended to read as follows:
  1. Physician  assistant.  The  term  "physician  assistant"  means  [a
person]  A  DEPENDENT  PRACTITIONER  WORKING  UNDER THE SUPERVISION OF A
LICENSED PHYSICIAN RESPONSIBLE FOR THE ACTIONS OF THE PHYSICIAN  ASSIST-

S. 766                              7

ANT  AND  who  is  registered  as a physician assistant pursuant to this
article.
  S  22.  Subdivisions  1 and 8 of section 6542 of the education law, as
amended by chapter 179 of the laws of  1992,  are  amended  to  read  as
follows:
  1.  Notwithstanding  any other provision of law, a physician assistant
may perform medical services, but only when under the supervision  of  a
physician  and  only when such acts and duties as are assigned to him OR
HER are within the scope of practice of such supervising physician.  THE
SUPERVISING  PHYSICIAN  MAY  DELEGATE  TO  THE  PHYSICIAN  ASSISTANT ANY
MEDICAL PROCEDURES OR TASKS FOR WHICH THE PHYSICIAN ASSISTANT IS  APPRO-
PRIATELY  TRAINED AND QUALIFIED TO PERFORM AND THAT ARE PERFORMED WITHIN
THE NORMAL SCOPE OF THE PHYSICIAN'S PRACTICE.
  8. Nothing in this article, or in article thirty-seven of  the  public
health  law,  shall  be  construed  to authorize physician assistants or
specialist assistants to perform those  specific  functions  and  duties
specifically delegated by law to those persons licensed as allied health
professionals  under  the  public health law or [the education law] THIS
TITLE.  SPECIFICALLY, PHYSICIAN ASSISTANTS SHALL NOT PERFORM  THE  PRAC-
TICE  OF  RADIOLOGIC  TECHNOLOGY  OR  THE PRACTICE OF OPTOMETRY AS THOSE
PRACTICES ARE DEFINED UNDER THE PUBLIC HEALTH LAW AND THIS TITLE.
  S 23. The education law is amended by adding a new section  6545-a  to
read as follows:
  S  6545-A.  STATUTORY CONSTRUCTION.  A PHYSICIAN ASSISTANT MAY PERFORM
ANY FUNCTION, WITH APPROPRIATE PHYSICIAN SUPERVISION, IN ANY HEALTH CARE
SETTING, THAT A STATUTE AUTHORIZES OR DIRECTS A PHYSICIAN TO PERFORM AND
THAT IS WITHIN THE NORMAL PRACTICE OF THAT PHYSICIAN, EXCEPT THOSE FUNC-
TIONS AUTHORIZED OR DIRECTED BY  AND  IN  ARTICLE  THIRTY-THREE  OF  THE
PUBLIC  HEALTH  LAW,  UNLESS  THE  STATUTE  AUTHORIZING OR DIRECTING THE
PHYSICIAN TO PERFORM SUCH FUNCTION OR FUNCTIONS EXPRESSLY STATES  OTHER-
WISE.
  S  24.  Subdivision c of section 6731 of the education law, as amended
by chapter 389 of the laws of 2007, is amended to read as follows:
  c. Such treatment shall be rendered pursuant to a referral  which  may
be  directive  as  to  treatment  by  a  licensed physician, A PHYSICIAN
ASSISTANT UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, dentist, podia-
trist, nurse practitioner or licensed midwife, each acting within his or
her lawful scope of practice, and in accordance  with  their  diagnosis,
except as provided in subdivision d of this section.
  S  25. Subdivision c of section 6741 of the education law, as added by
chapter 618 of the laws of 1980, is amended to read as follows:
  c. Nothing in this article is intended to affect the  overall  medical
direction  by  a  licensed  physician OR A PHYSICIAN ASSISTANT UNDER THE
SUPERVISION OF A LICENSED PHYSICIAN, of a physical therapist assistant.
  S 26. Subdivision 3 of section 6807 of the education law, as added  by
chapter 573 of the laws of 1999, is amended to read as follows:
  3. A pharmacist may dispense drugs and devices to a registered profes-
sional nurse, and a registered professional nurse may possess and admin-
ister,  drugs  and  devices,  pursuant to a non-patient specific regimen
prescribed or ordered by a licensed  physician,  A  PHYSICIAN  ASSISTANT
UNDER THE SUPERVISION OF A LICENSED PHYSICIAN or certified nurse practi-
tioner,  pursuant to regulations promulgated by the commissioner and the
public health law.
  S 27. Subdivision 5 of section 6909 of the education law, as added  by
chapter 573 of the laws of 1999, is amended to read as follows:

S. 766                              8

  5.  A registered professional nurse may execute a non-patient specific
regimen prescribed or ordered  by  a  licensed  physician,  A  PHYSICIAN
ASSISTANT  UNDER  THE  SUPERVISION  OF A LICENSED PHYSICIAN or certified
nurse practitioner, pursuant to regulations promulgated by  the  commis-
sioner.
  S  28. Section 6957 of the education law, as amended by chapter 328 of
the laws of 1992, is amended to read as follows:
  S 6957. Exempt persons.  Nothing in this article shall be construed to
affect, prevent or in any manner expand or limit any duty  or  responsi-
bility of a licensed physician OR A PHYSICIAN ASSISTANT UNDER THE SUPER-
VISION  OF  A LICENSED PHYSICIAN, from practicing midwifery or affect or
prevent a medical student,  PHYSICIAN  ASSISTANT  STUDENT  or  midwifery
student  in clinical practice under the supervision of a licensed physi-
cian or board certified obstetrician/gynecologist  or  licensed  midwife
practicing  [pursuant  to  the provisions of section twenty-five hundred
sixty of the public health law] in pursuance of an  educational  program
registered by the department from engaging in such practice.
  S  29. Section 7901 of the education law, as amended by chapter 146 of
the laws of 1993, is amended to read as follows:
  S 7901. Definition.  The practice of the  profession  of  occupational
therapy  is  defined  as the functional evaluation of the client and the
planning and utilization of a program of purposeful activities to devel-
op or maintain adaptive skills, designed to achieve maximal physical and
mental functioning of the patient in his or her daily life  tasks.  Such
treatment program shall be rendered on the prescription or referral of a
physician,  A  PHYSICIAN  ASSISTANT  UNDER THE SUPERVISION OF A LICENSED
PHYSICIAN or nurse practitioner.  However,  nothing  contained  in  this
article  shall be construed to permit any licensee hereunder to practice
medicine or psychology, including psychotherapy.
  S 30. Subdivision 7 of section 461-c of the social  services  law,  as
added by chapter 601 of the laws of 1981, is amended to read as follows:
  7.  (a)  At the time of the admission to an adult care facility, other
than a shelter for adults, a resident shall submit  to  the  facility  a
written  report  from  a  physician  OR  A PHYSICIAN ASSISTANT UNDER THE
SUPERVISION OF A LICENSED PHYSICIAN, which report shall state:
  (i) that the physician OR PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF
A LICENSED PHYSICIAN has physically examined  the  resident  within  one
month and the date of such examination;
  (ii) that the resident is not in need of acute or long term medical or
nursing  care which would require placement in a hospital or residential
health care facility; and
  (iii) that  the  resident  is  not  otherwise  medically  or  mentally
unsuited for care in the facility.
  (b) For the purpose of creating an accessible and available record and
assuring  that  a  resident  is  properly placed in such a facility, the
physician's OR PHYSICIAN ASSISTANT'S report shall also contain the resi-
dent's  significant  medical  history  and   current   conditions,   the
prescribed medication regimen, and recommendations for diet, the assist-
ance  needed  in  the  activities of daily living and where appropriate,
recommendations for exercise, recreation and frequency of medical  exam-
inations.
  (c)  Such  resident  shall  thereafter be examined by a physician OR A
PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF  A  LICENSED  PHYSICIAN  at
least annually and shall submit an annual written report from his OR HER
physician  OR  PHYSICIAN  ASSISTANT in conformity with the provisions of
this subdivision.

S. 766                              9

  S 31. Paragraphs (a), (b) and (c) of subdivision 1 of section 13-b  of
the  workers' compensation law, as amended by chapter 473 of the laws of
2000, are amended to read as follows:
  (a)  Any  physician  licensed to practice medicine in the state of New
York OR A PHYSICIAN ASSISTANT UNDER THE DIRECT  SUPERVISION  OF  SUCH  A
LICENSED  PHYSICIAN may render emergency medical care under this chapter
without authorization by the chair under this section; and
  (b) A licensed physician who is a  member  of  a  constituted  medical
staff  of  any hospital OR A PHYSICIAN ASSISTANT UNDER THE DIRECT SUPER-
VISION OF SUCH A LICENSED PHYSICIAN, may render medical care under  this
chapter  while  an  injured employee remains a patient in such hospital;
and
  (c) CONSISTENT WITH ARTICLE THIRTY-SEVEN OF THE PUBLIC HEALTH LAW  AND
ARTICLE  ONE HUNDRED THIRTY-ONE-B OF THE EDUCATION LAW, MEDICAL CARE MAY
BE RENDERED BY A PHYSICIAN ASSISTANT UNDER THE DIRECT SUPERVISION  OF  A
LICENSED AUTHORIZED PHYSICIAN. Under the active and personal supervision
of  an authorized physician medical care may be rendered by a registered
nurse or other person trained in  laboratory  or  diagnostic  techniques
within  the  scope  of such person's specialized training and qualifica-
tions.  This  supervision  shall  be  evidenced  by  signed  records  of
instructions for treatment and signed records of the patient's condition
and progress. Reports of such treatment and supervision shall be made by
such physician to the chair on such forms and at such times as the chair
may require.
  S  32.  Paragraph (d) of subdivision 3 of section 13-c of the workers'
compensation law, as added by chapter 828 of the laws of 1975,  subpara-
graph  (ii) as amended and subparagraph (iii) as added by chapter 803 of
the laws of 1983, and subparagraph (iv) as added and subparagraph (v) as
renumbered by chapter 649 of the laws of 1985, is  amended  to  read  as
follows:
  (d) (i) A physician rendering medical care at a medical center author-
ized,  OR  A  PHYSICIAN ASSISTANT UNDER THE DIRECT SUPERVISION OF SUCH A
PHYSICIAN, hereunder must be authorized to render such care pursuant  to
this  chapter  and  he OR SHE shall limit his OR HER professional activ-
ities hereunder to such medical care as his OR HER experience and train-
ing qualify him OR HER to render.
  (ii) When para-medical, laboratory or X-ray services or other  medical
care  is  required  it  shall be rendered, under the active and personal
supervision of an authorized physician, by a registered nurse  or  other
person  trained  in laboratory or diagnostic techniques within the scope
of such person's specialized training and  qualifications.  This  super-
vision  shall  be evidenced by signed records of instructions for treat-
ment and signed records of the patient's condition and progress. Reports
of such treatment and supervision shall be made by such physician to the
chairman on such forms and at such times as the chairman may require.
  (iii) When physical therapy care is required it shall be rendered by a
duly licensed physical therapist upon the referral which may  be  direc-
tive  as  to  treatment  of an authorized physician, PHYSICIAN ASSISTANT
UNDER THE DIRECT SUPERVISION OF SUCH PHYSICIAN or podiatrist within  the
scope  of  such physical therapist's specialized training and qualifica-
tions as defined in article one hundred thirty-six of the education law.
Reports of such treatment and records of instruction for  treatment,  if
any, shall be maintained by the physical therapist and referring profes-
sional  and submitted to the chairman on such forms and at such times as
the chairman may require.

S. 766                             10

  (iv) When occupational therapy care is required it shall  be  rendered
by  a  duly  licensed  and  registered  occupational  therapist upon the
prescription or referral of an authorized physician OR PHYSICIAN ASSIST-
ANT UNDER THE DIRECT SUPERVISION OF SUCH PHYSICIAN within the  scope  of
such occupational therapist's specialized training and qualifications as
defined  in  article one hundred fifty-six of the education law. Reports
of such treatment and records of  instruction  for  treatment,  if  any,
shall  be maintained by the occupational therapist and referring profes-
sional and submitted to the chairman on such forms and at such times  as
the chairman may require.
  (v)  The  physician  rendering  the medical care hereunder shall be in
charge of the care unless, in his OR HER judgment, it  is  necessary  to
refer  the  case  to  a specially trained and qualified physician, which
physician shall then assume complete responsibility for and  supervision
of any further medical care rendered.
  S  33.  Subdivisions  (d),  (e) and (f) of section 33.04 of the mental
hygiene law, subdivisions (d) and (f) as added by  chapter  779  of  the
laws  of 1977, such section as renumbered and subdivision (e) as amended
by chapter 334 of the laws of 1980, are amended to read as follows:
  (d) Restraint shall be effected only by written order of  a  physician
OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN after a
personal examination of the patient except in an emergency situation, as
provided  by  subdivision (e) of this section. The order shall set forth
the facts justifying the restraint and shall specify the nature  of  the
restraint  and  any conditions for maintaining the restraint.  The order
shall also set forth the time of expiration of the  authorization,  with
such  order  to apply for a period of no more than four hours, provided,
however, that any such order imposing restraint after nine o'clock  p.m.
may  extend  until  nine o'clock a.m. of the next day.  A full record of
restraint, including all signed orders of physicians, shall be  kept  in
the  patient's  file  and  shall  be subject to inspection by authorized
persons.
  (e) If an emergency situation exists in which the patient is  engaging
in  activity  that  presents  an immediate danger to himself, HERSELF or
others and a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF
SUCH PHYSICIAN is not immediately available, restraint may  be  effected
only  to  the  extent  necessary  to  prevent  the patient from injuring
himself or others at the direction of the senior member of the staff who
is present.  The senior staff member shall cause a physician OR A PHYSI-
CIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN to be immediately
summoned and shall record the time of the call and the person contacted.
Pending the arrival of a physician OR A PHYSICIAN  ASSISTANT  UNDER  THE
SUPERVISION  OF SUCH PHYSICIAN, the patient shall be kept under constant
supervision. If a physician OR A PHYSICIAN ASSISTANT  UNDER  THE  SUPER-
VISION  OF SUCH PHYSICIAN does not arrive within thirty minutes of being
summoned, the senior staff member shall record any  such  delay  in  the
patient's  clinical  record  and  also place into the patient's clinical
record a written description  of  the  facts  justifying  the  emergency
restraint which shall specify the nature of the restraint and any condi-
tions  for maintaining the restraint until the arrival of a physician OR
A PHYSICIAN ASSISTANT UNDER  THE  SUPERVISION  OF  SUCH  PHYSICIAN,  the
reasons  why  less  restrictive  forms of restraint were not used, and a
description of the steps taken  to  assure  that  the  patient's  needs,
comfort  and  safety were properly cared for. Such physician OR A PHYSI-
CIAN ASSISTANT UNDER THE SUPERVISION OF SUCH PHYSICIAN  shall  place  in
the clinical record an explanation for any such delay.

S. 766                             11

  (f) During the time that a patient is in restraint, he OR SHE shall be
monitored to see that his OR HER physical needs, comfort, and safety are
properly  cared  for.  An assessment of the patient's condition shall be
made at least once every thirty minutes or at more frequent intervals as
directed  by  a physician OR A PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF SUCH PHYSICIAN. The assessment shall be recorded and  placed  in  the
patient's  file. A patient in restraint shall be released from restraint
at least every two hours, except when asleep. If at any time  a  patient
upon  being  released  from restraint makes no overt gestures that would
threaten serious harm or injury to himself, HERSELF or others, restraint
shall not be reimposed and a physician shall  be  immediately  notified.
Restraint  shall not be reimposed in such situation unless in the physi-
cian's OR A PHYSICIAN ASSISTANT'S UNDER THE SUPERVISION OF  SUCH  PHYSI-
CIAN  professional  judgment  release would be harmful to the patient or
others.
  S 34. Paragraph e of subdivision 1 of section 406 of the general busi-
ness law, as amended by chapter 600 of the laws of 2002, is  amended  to
read as follows:
  e.  Each  application  shall be accompanied by a certificate of a duly
licensed physician, A PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF  SUCH
A  PHYSICIAN  or  nurse practitioner to the extent authorized by law and
consistent with the written practice agreement pursuant  to  subdivision
three of section six thousand nine hundred two of the education law on a
form prescribed by the secretary, showing freedom from any infectious or
communicable  disease  which  certificate  shall have been issued within
thirty days prior to the date of the filing of the application.
  S 35. This act shall take effect immediately.

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