08 LC 36
1094S
The
Senate Health and Human Services Committee offered the following substitute to
HB 492:
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating
to physicians, acupuncture, physician´s assistants, cancer and glaucoma
treatment, respiratory care, clinical perfusionists, and orthotics and
prosthetics practice, so as to provide for legislative findings; to increase the
membership of the Composite State Board of Medical Examiners; to provide for the
qualifications of such members; to provide for initial and subsequent terms of
office of the new members; to change the name of the Composite State Board of
Medical Examiners to the Georgia Composite Medical Board; to amend various
titles of the Official Code of Georgia Annotated so as to change provisions for
conformity purposes; to change certain provisions relating to the licensing of
cosmetic laser practitioners by the board; to revise certain definitions; to
require that each patient be examined prior to any cosmetic laser service being
performed; to require that each facility offering cosmetic laser services have a
supervisor; to provide certain qualifications and responsibilities for
supervisors; to require that certain information regarding cosmetic laser
practitioners, supervisors, and consulting physicians be disclosed by the
facilities; to provide for a licensed physician to be a member of the advisory
board; to provide for related matters; to provide for effective dates; to repeal
conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
PART
I
SECTION 1-1.
SECTION 1-1.
The
General Assembly finds and declares that access to high quality health care for
Georgia citizens is a top priority; that the practice of medicine is a privilege
granted by the people acting through their elected representatives and is not a
natural right of individuals; that it is in the interests of public health,
safety, and welfare to protect the public from the unprofessional, improper,
incompetent, unlawful, fraudulent, and/or deceptive practice of medicine; that
it is necessary to provide laws and regulations to govern the granting and
subsequent use of the privilege to practice medicine; and that the primary
responsibility of the Composite State Board of Medical Examiners is to protect
the public. Further, the General Assembly finds that expanded representation of
persons on the Composite State Board of Medical Examiners who are not engaged in
the practice of medicine or in the delivery of health care is in accord with the
recommendations of the Federation of State Medical Boards, and that such
expanded representation is intended to foster the public interest in improved
health care quality in this state.
SECTION
1-2.
Chapter
34 of Title 43 of the Official Code of Georgia Annotated, relating to
physicians, acupuncture, physician´s assistants, cancer and glaucoma
treatment, respiratory care, clinical perfusionists, and orthotics and
prosthetics practice, is amended by revising Code Section 43-34-21, relating to
the creation of the Composite State Board of Medical Examiners, as
follows:
"43-34-21.
(a)
A board is established to be known as the
Composite
State Board of Medical Examiners
Georgia
Composite Medical Board to be made up of 15
members. All members of the board shall
be citizens of the United States and residents of this state. All appointments
to the board shall be made by the Governor and confirmed by the
Senate.
(b)
Twelve
Thirteen
of the members shall be practicing physicians of integrity and ability and shall
be duly licensed to practice in this state.
Ten of the
12
Eleven of the
13 physician members shall be graduates of
reputable medical schools conferring the M.D. degree; the other two physician
members shall be graduates of reputable osteopathic schools conferring the D.O.
degree. All of the physician members shall have been engaged in the active
practice of their profession within this state for a period of at least five
years. Any vacancy occurring in a post held by a holder of the D.O. degree
shall be filled by a D.O. from the state at large.
(c)
The
thirteenth
member
fourteenth and
fifteenth members of the board shall be
appointed from the state at large and shall have no connection whatsoever with
the practice of medicine
or the
provision of health care services. Such public members of the board shall be
persons of recognized ability and integrity, but shall not be licensed
physicians or other health care providers, shall have no substantial personal or
financial interest in the practice of medicine, the provision of other health
care services, or affiliation with any organization regulated by the board, and
shall not be a spouse, parent, or child of any individual involved in the
practice of medicine, the provision of health care services, or affiliation with
any organization regulated by the board.
(d)
The board shall perform such duties and possess and exercise such powers
relative to the protection of the public health and the control of regulation of
the practice of medicine and osteopathy as this chapter prescribes and confers
upon it and shall have the power to carry out investigations, either through the
executive director or
independently;
provided, however, that the member of the board who is not a practicing
physician may vote only on matters relating to administration and policy which
do not directly relate to practical and scientific examination of physicians in
this state.
(e)(1)
The board shall appoint a Physician´s Assistants Advisory Committee
composed of four physicians, at least two of whom shall be members of the board,
and four licensed physician´s assistants, who shall each serve for terms of
office of two years and until their successors are appointed and qualified. The
committee shall review matters to come before the board which relate to
physician´s assistants, including but not limited to applicants for
physician´s assistant licensure and relicensure and education requirements
therefor, and proposed board regulations concerning physician´s assistants.
The committee shall periodically make recommendations to the board regarding
matters reviewed. Each member of the advisory committee shall be entitled to the
same expense allowances, mileage allowances, and reimbursement as members of the
board as provided for in subsection (f) of Code Section 43-1-2.
(2)
The committee shall appoint a physician´s assistant in an advisory capacity
to the board. The advisory person shall serve at the pleasure of the committee
as an ex officio adviser to the board in all matters relating to
physician´s assistants and shall share in the privileges and benefits of
the board without a vote.
(f)
The board shall examine applicants to test their qualifications to practice
medicine.
(g)
When funds are specifically appropriated for such purpose, the board shall
publish an informational booklet on breast cancer and the treatment of breast
cancer. The booklet shall contain a summary of the latest information on breast
cancer and, in brief form, shall discuss the generally accepted and widely
prevailing medical and surgical treatments for breast cancer. The booklet shall
include a valid assessment of the relative risks and benefits of the accepted
and widely prevailing methods of treatment. A copy of the booklet shall be made
available by the board to every appropriate physician in the state. A letter by
the board shall accompany this booklet stating that the board urges the
physician to distribute a copy of the booklet to each and every patient whose
suspected disease, disease, or course of treatment is covered by the material in
the booklet. Copies shall also be available to any person upon request at a fee
prescribed by the executive director sufficient to cover the cost of printing
and distribution. The booklet shall be updated and redistributed at such times
as the board shall deem necessary.
(h)
The board shall have the authority to contract with medical associations or
other professionally qualified organizations to conduct impaired physicians
programs."
SECTION
1-3.
Said
article is further amended by revising Code Section 43-34-22, relating to the
terms of office of members of the Composite State Board of Medical Examiners, as
follows:
"43-34-22.
(a)
The terms of office of members of the Composite State Board of Medical
Examiners, now
known as the Georgia Composite Medical
Board, in office on June 30, 1999, shall
expire July 1, 1999, except that the Governor by executive order may provide
that such terms expire after July 1, 1999, but no later than July 1, 2000, and
upon the appointment and qualification of their respective successors. Those
successors shall be appointed by the Governor for terms of office beginning on
the later of July 1, 1999, or the date immediately following the expiration of
the terms of office of those members in office on June 30, 1999, with four of
such successors to have initial terms of one year, four of such successors to
have initial terms of two years, and five of such successors to have initial
terms of three years. The Governor shall specify the initial terms of office
for each of those successors at the time of their appointment. Upon the
expiration of such initial terms, successors to members of the board whose terms
of office expire shall serve for terms of four years each.
(b)
Members of the board shall serve for the terms specified and until their
respective successors are appointed and qualified. All reappointments and new
appointments shall be made so that the various geographic regions of the state
shall be represented. Any vacancy that may occur in the board as a result of
death, resignation, removal from the state, or other cause shall be filled for
the unexpired term in the same manner as regular appointments are
made.
(c)
The terms of office of the new nonphysician member and the additional new
physician member, as of July 1, 2008, of the board appointed pursuant to
subsections (b) and (c) of Code Section 43-34-21 shall be made in accordance
with this Code section. Such new members shall be appointed by the Governor to
serve as members of the board for terms of office beginning on July 1, 2008, and
the physician member shall be appointed for an initial term of one year and the
additional new nonphysician member shall be appointed for an initial term of two
years. Upon the expiration of such initial terms, successors to such members of
the board whose terms of office expire shall serve for terms of four years
each."
SECTION
1-4.
Said
article is further amended by revising Code Section 43-34-29, relating to
reciprocity of physicians´ licenses, as follows:
"43-34-29.
The
board may grant a license without examination to licensees of boards of other
states requiring equal or higher qualifications, upon the same basis as such
states reciprocate with this state, all upon the following terms and
conditions:
(1)
If the date of the license from the board of such other state is on or before
January 1, 1967, no proof of interning in an approved hospital need be submitted
to obtain a license from the board giving the applicant absolute authority to
practice medicine in this state;
(2)
The applicant shall prove to the satisfaction of the board that the applicant
has graduated from a medical or osteopathic college approved by the board on the
date of application, for the purposes of this chapter, provided that the
applicant shall not be granted a license by reciprocity if the date of such
applicant´s graduation from such medical or osteopathic college shall have
occurred prior to July 1, 1963, unless such medical or osteopathic college was
approved for the purposes of this chapter by the Composite State Board of
Medical
Examiners, now
known as the Georgia Composite Medical
Board, or the State Board of Osteopathic
Examiners as of the date of such graduation;
and
(3)
If the date of the license from the board of such other state is after April 18,
1967, the applicant shall submit proof that he
or
she has had the same training as is
required for applicants for examination in paragraph (2) of subsection (a) of
Code Section 43-34-27, in which event the board shall grant the applicant a
license from the board giving the applicant absolute authority to practice
medicine in this state, provided that if the date of completion of such
internship program occurred prior to July 1, 1963, the board shall not grant
such license by reciprocity, except as allowed pursuant to the final proviso of
this paragraph, unless the internship program was approved by the board as of
the date of completion of such internship program by the applicant; and
provided, further, that the board may, in its discretion, waive the requirements
of this paragraph after determining that an applicant licensed to practice
medicine in another state which does not require an internship or residency has
been actively engaged in the practice of medicine in such other state for at
least two years."
SECTION
1-5.
Chapter
11 of Title 31 of the Official Code of Georgia Annotated, relating to emergency
medical services, is amended by revising paragraphs (5) and (6) of Code Section
31-11-2, relating to definitions, as follows:
"(5)
'Cardiac technician' means a person who, having been trained and certified as an
emergency medical technician and having completed additional training in
advanced cardiac life support techniques in a training course approved by the
department, is so certified by the Composite State Board of Medical
Examiners, now
known as the Georgia Composite Medical
Board, prior to January 1, 2002, or the
Department of Human Resources on and after January 1, 2002.
(6)
'Composite board' means the
Composite
State Board of Medical Examiners
Georgia
Composite Medical
Board."
SECTION
1-6.
The
following Code sections of the Official Code of Georgia Annotated are amended by
striking "Composite State Board of Medical Examiners" or "Composite State Board
of Medical Examiners of Georgia" wherever such terms occur and inserting in its
place "Georgia Composite Medical Board":
(1)
Code Section 20-3-476, relating to authorization and administration of loan
program for attendance at Colleges of Osteopathic Medicine;
(2)
Code Section 20-3-512, relating to powers of the State Medical Education Board
as to medical student loans and scholarships;
(3)
Code Section 20-3-513, relating to determination of amount of medical student
loans and scholarships;
(4)
Code Section 31-9-6.1, relating to the disclosure of information to persons
undergoing certain surgical or diagnostic procedures;
(5)
Code Section 31-11-81, relating to definitions relative to emergency
services;
(6)
Code Section 31-34-4, relating to loan applicant qualifications;
(7)
Code Section 31-38-2, relating to exemptions from applicability of chapter on
tanning facilities;
(8)
Code Section 33-3-27, relating to reports of awards under medical malpractice
insurance policies;
(9)
Code Section 33-20B-2, relating to definitions relative to essential rural
health care provider access;
(10)
Code Section 34-9-1, relating to definitions relative to workers´
compensation;
(11)
Code Section 43-5-13, relating to exceptions to operation of
chapter;
(12)
Code Section 43-34-20, relating to definitions relative to
physicians;
(13)
Code Section 43-34-24.1, relating to the board as an independent
agency;
(14)
Code Section 43-34-26.1, relating to delegation of authority to nurse or
physician´s assistant;
(15)
Code Section 43-34-62, relating to definitions relative to
acupuncture;
(16)
Code Section 43-34-102, relating to definitions relative to physician´s
assistants;
(17)
Code Section 43-34-122, relating to definitions relative to the use of marijuana
for treatment of cancer and glaucoma;
(18)
Code Section 43-34-123, relating to the Controlled Substances Therapeutic
Research Program;
(19)
Code Section 43-34-142, relating to definitions relative to respiratory
care;
(20)
Code Section 43-34-171, relating to definitions relative to clinical
perfusionist licensure;
(21)
Code Section 43-34A-2, relating to definitions relative to the "Patient Right to
Know Act of 2001";
(22)
Code Section 43-34A-3, relating to physician profiles and the dissemination of
such profiles to the public;
(23)
Code Section 43-34A-6, relating to a patient´s right to file a grievance
with the state board; and
(24)
Code Section 43-35-3, relating to definitions regarding the practice of
podiatry."
PART
II
SECTION 2-1.
SECTION 2-1.
Chapter
34 of Title 43 of the Official Code of Georgia Annotated, relating to
physicians, acupuncture, physician´s assistants, cancer and glaucoma
treatment, respiratory care, clinical perfusionists, and orthotics and
prosthetics practice, is amended by revising paragraphs (1) and (5) of Code
Section 43-34-242, relating to definitions relative to cosmetic laser services,
as follows:
"(1)
'Board' means the
Composite
State Board of Medical Examiners
Georgia
Composite Medical Board created by Code
Section 43-34-21."
"(5)
'Cosmetic laser services' means nonablative elective cosmetic light based skin
treatment,
photo rejuvenation, or hair removal using lasers and pulsed light devices
approved by the United States Food and Drug Administration for noninvasive
procedures. Such services and the provision thereof shall not be considered to
be the practice of medicine."
SECTION
2-2.
Said
chapter is further amended by revising Code Section 43-34-244, relating to two
levels of license and applications, as follows:
"43-34-244.
(a)
There shall be two levels of a license for a cosmetic laser practitioner:
assistant laser practitioner and senior laser practitioner.
(b)
Any person desiring to obtain a license as a cosmetic laser practitioner under
the terms of this article shall make application to the board as
follows:
(1)
An applicant for an 'assistant laser practitioner' license shall present proof
that he or she:
(A)
Holds a current valid license or certificate of registration as a
physician´s assistant, nurse, esthetician, or master cosmetologist, or has
previously held a license or certificate of registration as a medical
practitioner; and
(B)
Has received at least three laser certificates from attending laser/intense
pulsed light (IPL) courses as approved by the board, directly taught by a
licensed physician or certified continuing medical education or continuing
education educator.
If,
after review of the application, it is determined that the applicant is at least
21 years of age; has met the minimum educational requirements; is of good moral
character; and is possessed of the requisite skill to perform properly cosmetic
laser services, a license shall be issued to the applicant entitling the
applicant to practice the occupation of cosmetic laser practitioner at the
assistant laser practitioner level under the direct supervision of a senior
laser practitioner.
(2)
An applicant for a 'senior laser practitioner' license shall present proof that
he or she:
(A)
Holds a current valid license or certificate of registration as a
physician´s assistant or nurse or has previously held a license or
certificate of registration as a medical practitioner;
(B)
Has at least three years of clinical or technological medical experience, or
both;
(C)
Has been or was licensed or nationally board certified as a medical practitioner
for at least three years; and
(D)
Has received at least two laser certificates from attending laser/intense pulsed
light (IPL) continuing medical education courses as approved by the board,
directly taught by a licensed physician or certified continuing medical
education or continuing education educator.
If,
after review of the application, it is determined that the applicant is at least
21 years of age; has met the minimum educational and clinical training
requirements to perform cosmetic laser services with indirect supervision; is of
good moral character; and is possessed of the requisite skill to perform
properly these services, a license shall be issued to the applicant entitling
the applicant to practice the occupation of cosmetic laser practitioner at the
senior laser practitioner level pursuant to the protocols of a consulting
physician.
(c)
The board shall be authorized to waive any education requirements under this
Code section in cases of hardship, disability, or illness or under such other
circumstances as the board deems appropriate with respect to any applicant who
has practiced as a cosmetic laser practitioner prior to July 1,
2007.
(c)(1)
Any person desiring to obtain a license as an 'assistant laser practitioner' who
does not meet the requirements of paragraph (1) of subsection (b) of this Code
section shall also be eligible for a license as an 'assistant laser
practitioner' if he or she makes application to the board within six months of
the effective date of this article and presents proof that he or
she:
(A)
Prior to the effective date of this article, obtained a minimum of at least
2,000 hours of experience in administering cosmetic laser service;
and
(B)
Has received at least three laser certificates from attending laser/intense
pulsed light (IPL) courses, directly taught by a licensed physician or certified
continuing medical education or continuing education educator.
(2)
Any person licensed pursuant to paragraph (1) of this subsection shall not
perform any cosmetic laser services unless under the direct supervision of a
physician licensed under this chapter who is trained in laser
modalities.
(d)
Should an applicant have a current cosmetic laser practitioner license or
certificate of registration in force from another state, country, territory of
the United States, or the District of Columbia, where similar reciprocity is
extended to this state and licensure requirements are substantially equal to
those in this state, and have paid a fee and have submitted an application, the
applicant may be issued a license at the appropriate level entitling him or her
to practice the occupation of a cosmetic laser practitioner at that level,
unless the board, in its discretion, sees fit to require a written or a
practical examination subject to the terms and provisions of this article.
The board
shall be authorized to waive any education or experience requirements applicable
to any person who holds a current license or certificate to practice as a
cosmetic laser practitioner outside of this state and who desires to obtain a
license at a level authorized under this Code section to practice as a cosmetic
laser practitioner in this state in cases of hardship, disability, or illness or
under such other circumstances as the board deems
appropriate."
SECTION
2-3.
Said
chapter is further amended by revising Code Section 43-34-248, relating to
agreement with consulting physician, as follows:
"43-34-248.
(a)
Any facility providing cosmetic laser services shall have an agreement with a
consulting physician who shall:
(1)
Be trained in laser modalities;
(2)
Establish proper protocols for the cosmetic laser services provided at the
facility and file such protocols with the board;
and
(3)
Examine each patient prior to any cosmetic laser service being performed;
and
(3)(4)
Be available for emergency consultation with the cosmetic laser practitioner or
anyone employed by the facility.
(b)
Any facility providing cosmetic laser services shall have a supervisor present
at the facility at all times. The supervisor shall supervise the performance of
all cosmetic laser services performed by a person other than the consulting
physician. The supervisor shall be a physician licensed under this chapter who
is trained in laser modalities or a senior laser practitioner.
(c)(1)
Any facility providing cosmetic laser services shall post a sign listing the
consulting physician´s name, emergency contact number, his or her board
certification and specialty, and the address of his or her principal place of
practice, and indicating whether he or she is presently on site at the
facility.
(2)
If the consulting physician is not on site for any period of time during which
the facility is open, the facility shall post a sign indicating who is presently
acting as the supervisor for the facility and that person´s name, emergency
contact number, his or her degrees and qualifications, and the type of cosmetic
laser practitioner license
held."
SECTION
2-4.
Said
chapter is further amended by revising Code Section 43-34-249, relating to
informed consent, as follows:
"43-34-249.
(a)
Prior to receiving cosmetic laser services from a cosmetic laser practitioner, a
person must consent in writing to such services and shall be informed in writing
of the general terms of the following:
(1)
The nature and purpose of such proposed procedure;
(2)
Any material risks generally recognized and associated with the cosmetic laser
service to be performed which, if disclosed to a reasonably prudent person in
the customer´s position, could reasonably be expected to cause such prudent
person to decline such proposed cosmetic laser services on the basis of the
material risk of injury that could result from such proposed
services;
(3)
The name of,
the degrees and qualifications held by,
and type of
license
licenses
obtained by the individual who will be
performing the cosmetic laser service
has
obtained, the
supervisor, and the consulting physician;
and
(4)
The steps to be followed after the cosmetic laser service is performed in the
event of any
complications;
and
(5)
The emergency contact information for the consulting physician and the address
of his or her principal place of
practice.
(a.1)
After receiving each cosmetic laser service, a person shall be informed in
writing of the information required by paragraphs (4) and (5) of subsection (a)
of this Code section.
(b)
It shall be the responsibility of the cosmetic laser practitioner to ensure that
the information required by
subsection
(a)
subsections
(a) and (a.1) of this Code section is
disclosed and that the consent provided for in this Code section is
obtained.
(c)
Where the consumer is under 18 years of age, the consent of the consumer´s
parent or legal guardian shall be required.
(d)
The board shall be required to adopt and have the authority to promulgate rules
and regulations governing and establishing the standards necessary to implement
this Code section specifically including but not limited to the disciplining of
a cosmetic laser practitioner who fails to comply with this Code
section.
(e)
Nothing in this Code section shall prohibit the information provided for in this
Code section from being disclosed through the use of video tapes, audio tapes,
pamphlets, booklets, or other means of communication or through conversations
with the cosmetic laser practitioner; provided, however, that such information
is also provided in writing and attached to the consent form which the consumer
signs."
SECTION
2-5.
Said
chapter is further amended by revising Code Section 43-34-250, relating to the
advisory committee, as follows:
"43-34-250.
The
board shall appoint an advisory committee. The advisory committee shall be
representative of a cross section of the cultural backgrounds, to the extent
practical, of the licensed cosmetic laser practitioners licensed under this
article and such members as the board in its discretion may determine.
The advisory
committee shall include at least one person licensed to practice medicine under
this chapter. Members shall receive no
compensation for service on the committee. The committee shall have such
advisory duties and responsibilities as the board may determine, including but
not limited to consulting with the board on the issuance, denial, suspension,
and revocation of licenses and the promulgation of rules and regulations under
this article. The initial members of the advisory committee may include persons
eligible for licensing under this article. Subsequent advisory committee
members must be licensed pursuant to this article."
PART
III
SECTION 3-1.
SECTION 3-1.
(a)
Part 2 of this Act shall become effective only if and when the "Georgia Cosmetic
Laser Services Act," approved May 29, 2007 (Ga. L. 2007, p. 626), becomes
effective as provided in Section 2
therein.
(b) The remaining parts of this Act shall become effective on July 1, 2008.
(b) The remaining parts of this Act shall become effective on July 1, 2008.
SECTION
3-2.
All
laws and parts of laws in conflict with this Act are repealed.