senate Bill S2254

Amended

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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actions

  • 15 / Jan / 2013
    • REFERRED TO HEALTH
  • 08 / Jan / 2014
    • REFERRED TO HEALTH
  • 29 / Jan / 2014
    • AMEND AND RECOMMIT TO HEALTH
  • 29 / Jan / 2014
    • PRINT NUMBER 2254A

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:
S2254
S2254A
Legislative Cycle:
2013-2014
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 §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 Previous Legislative Cycles:
2011-2012: S766
2009-2010: S7357A

Sponsor Memo

BILL NUMBER:S2254

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 licensed physician assistants

PURPOSE: 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 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, 3704
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 2498 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-S of the education law.

Section 32 amends section 13-c of the clarify that physician
assistants are and be authorized to render such care clarify that
physician assistants are therapy care and occupational therapy
workers' compensation law to authorized to render medical care
pursuant to this chapter and to authorized to order physical 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 physician 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: 2011,2012: S.766 Referred to
Transportation 2009,2010: S.7357A Referred to Health 2003,2004: S.7057
Advanced to 2nd Calendar

EFFECTIVE DATE: Immediately.

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

                                  2254

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 15, 2013
                               ___________

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 licensed 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 48 of the  laws  of  2012,  is  amended  to  read  as
follows:
  1.  Physician  assistant.  The  term  "physician  assistant"  means  a
[person] DEPENDENT PRACTITIONER  WORKING  UNDER  THE  SUPERVISION  OF  A
LICENSED  PHYSICIAN RESPONSIBLE FOR THE ACTIONS OF THE PHYSICIAN ASSIST-
ANT AND who is licensed as a physician  assistant  pursuant  to  section
sixty-five hundred forty-one of the education law.
  S  2. The public health law is amended by adding a new section 3704 to
read as follows:
  S 3704. PERFORMANCE OF MEDICAL SERVICES. 1.  A PHYSICIAN 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 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.
  2. NOTHING IN THIS ARTICLE OR IN ARTICLE ONE HUNDRED  THIRTY-ONE-B  OF
THE  EDUCATION  LAW SHALL BE CONSTRUED TO AUTHORIZE PHYSICIAN ASSISTANTS
TO PERFORM THOSE SPECIFIC FUNCTIONS AND DUTIES SPECIFICALLY DELEGATED BY
LAW TO THOSE PERSONS LICENSED AS ALLIED HEALTH PROFESSIONALS UNDER  THIS
CHAPTER  OR  THE EDUCATION LAW. SPECIFICALLY, PHYSICIAN ASSISTANTS SHALL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06422-01-3

S. 2254                             2

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
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

S. 2254                             3

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  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:

S. 2254                             4

  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, as
amended by chapter 153 of the laws  of  2011,  is  amended  to  read  as
follows:
  4. (a) The medical certificate shall be made, dated, and signed by the
physician,  THE  PHYSICIAN  ASSISTANT  ACTING UNDER THE SUPERVISION OF A
PHYSICIAN, or nurse practitioner, 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 declares indefinite shall be returned to the physician, THE
PHYSICIAN  ASSISTANT  ACTING UNDER THE SUPERVISION OF A PHYSICIAN, nurse
practitioner, 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 THE 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 amended by chapter
153 of the laws of 2011, 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, THE PHYSICIAN ASSISTANT ACTING UNDER
THE SUPERVISION OF A PHYSICIAN, or nurse practitioner in attendance,  or
a  physician,  PHYSICIAN  ASSISTANT  ACTING  UNDER  THE SUPERVISION OF A
PHYSICIAN, or nurse practitioner acting in his 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

S. 2254                             5

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 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 153 of the laws  of  2011,  is  amended  to  read  as
follows:
  (b)  present  the  certificate  promptly  to  the attending physician,
PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse prac-
titioner, 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 coron-
ers or medical examiners, to the person in charge of  such  hospital  or
his  or  her  designated  representative,  who  shall obtain the medical
certificate of death as prescribed in section four thousand one  hundred
forty-one-a of this title;
  S  17.  Paragraph  (b)  of subdivision 2 of section 4144 of the public
health law, as amended by chapter 153 of the laws of 2011, 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 of this section, shall be issued by  the  said  registrar  of  vital
statistics,  upon request by telephone of a licensed funeral director or
undertaker who holds a certificate of  death  signed  by  the  attending
physician,  PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or
nurse practitioner, 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, as amended by chapter 153 of the laws of 2011,
are amended to read as follows:
  Fetal  death  certificates;  form  and  content; physicians, PHYSICIAN
ASSISTANTS, nurse practitioners, midwives, and hospital administrators.
  2. In each case where  a  physician,  PHYSICIAN  ASSISTANT  UNDER  THE
SUPERVISION  OF  A PHYSICIAN, or nurse practitioner was in attendance at
or after a fetal death, it is the  duty  of  such  physician,  PHYSICIAN
ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse practitioner to
certify  to  the  birth  and  to  the  cause of death on the fetal death
certificate. Where a nurse-midwife was in attendance at a fetal death it
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,
PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A PHYSICIAN, or nurse prac-
titioner as 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-
tative shall promptly present the certificate to the  physician,  PHYSI-
CIAN  ASSISTANT  UNDER  THE SUPERVISION OF A PHYSICIAN, or nurse practi-
tioner in attendance, or a  physician,  PHYSICIAN  ASSISTANT  UNDER  THE

S. 2254                             6

SUPERVISION  OF  A PHYSICIAN, or nurse practitioner 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
title can be met.
  S  19.  The  section  heading and subdivision 1 of section 4171 of the
public health law, as amended by chapter 153 of the laws  of  2011,  are
amended to read as follows:
  Records; duties of physicians, PHYSICIAN ASSISTANTS, nurse practition-
ers, and others to furnish information.
  1.  Physicians, PHYSICIAN ASSISTANTS UNDER THE SUPERVISION OF A PHYSI-
CIAN, nurse practitioners, 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 153 of the laws of 2011, 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, is necessary  for  legal,  judicial,  or  other  proper
purposes,  and, after search by the commissioner or his or her represen-
tatives, it appears that no such certificate of birth or death was  made
and filed as provided by this article, then the commissioner shall imme-
diately require the physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION
OF  A  PHYSICIAN,  nurse  practitioner,  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  is
living, to obtain and file at once with the local registrar such certif-
icate in as complete form as the lapse of time will permit.
  3.  If  the  physician, PHYSICIAN ASSISTANT UNDER THE SUPERVISION OF A
PHYSICIAN,  nurse  practitioner,  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 state-
ments 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  practitioner,  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 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 48 of the laws of 2012, is amended to read as follows:
  1.  Physician  assistant.    The  term  "physician  assistant" means a
[person] DEPENDENT PRACTITIONER  WORKING  UNDER  THE  SUPERVISION  OF  A
LICENSED  PHYSICIAN RESPONSIBLE FOR THE ACTIONS OF THE PHYSICIAN ASSIST-

S. 2254                             7

ANT AND who is licensed as a physician assistant pursuant to this  arti-
cle.
  S  22.  Subdivisions  1 and 7 of section 6542 of the education law, as
amended by chapter 48 of the laws  of  2012,  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.
  7.  Nothing  in this article, or in article thirty-seven of the public
health law, shall be construed  to  authorize  physician  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  this [chapter] TITLE.   SPECIFICALLY, PHYSICIAN
ASSISTANTS SHALL NOT PERFORM THE PRACTICE 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. 2254                             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 460 of
the laws of 2011, 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, the plan-
ning and utilization of a program of purposeful activities, the develop-
ment  and  utilization  of a treatment program, and/or consultation with
the client, family, caregiver  or  organization  in  order  to  restore,
develop  or  maintain  adaptive  skills,  and/or  performance  abilities
designed to achieve maximal physical, cognitive and  mental  functioning
of  the client associated with his or her activities of daily living and
daily life tasks. A treatment  program  designed  to  restore  function,
shall be rendered on the prescription or referral of a physician, PHYSI-
CIAN  ASSISTANT  UNDER  THE  SUPERVISION  OF A LICENSED PHYSICIAN, nurse
practitioner or other health care provider  acting  within  his  or  her
scope  of practice pursuant to this title. However, nothing contained in
this article shall be construed to  permit  any  licensee  hereunder  to
practice medicine or psychology, including psychotherapy or to otherwise
expand  such  licensee's  scope of practice beyond what is authorized by
this chapter.
  S 30. Subdivision 7 of section 461-c of the social  services  law,  as
amended  by  chapter  168  of  the  laws  of 2011, 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, a physician assistant UNDER THE  SUPER-
VISION  OF  A  LICENSED PHYSICIAN, or a nurse practitioner, which report
shall state:
  (i) that the physician, physician assistant UNDER THE SUPERVISION OF A
LICENSED PHYSICIAN, or nurse practitioner 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
report shall also contain the resident's significant medical history and
current conditions, the prescribed medication regimen,  and  recommenda-

S. 2254                             9

tions  for diet, the assistance needed in the activities of daily living
and where appropriate,  recommendations  for  exercise,  recreation  and
frequency of medical examinations.
  (c)  Such  resident  shall  thereafter  be  examined by a physician, a
physician assistant UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, or  a
nurse practitioner, at least annually and shall submit an annual written
report in conformity with the provisions of this subdivision.
  (d)  Following  a  resident's stay in a hospital or residential health
care facility, upon return to the adult care facility,  the  adult  care
facility  shall not be required to obtain the report in paragraph (a) of
this  subdivision,  and  instead  shall  obtain  a  statement  from  the
discharging facility which shall:
  (i)  state that the resident is appropriate to return to the facility;
and
  (ii) include the reason for the resident's stay, the treatment plan to
be followed, and any new or changed orders, including medications.
  The statement shall be completed by a physician, a physician assistant
UNDER THE SUPERVISION OF A LICENSED PHYSICIAN, or a nurse practitioner.
  (e) Nothing required in this section shall require the use of an iden-
tical form in adult care  facilities  and  assisted  living  residences,
either upon admission or return.
  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-

S. 2254                            10

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.
  (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

S. 2254                            11

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.
  (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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