House Bill 9 — Medical Practice Act rewrite

House Bill 9 — Medical Practice Act rewrite

by
Phil Haunschild
January 25, 2019

Bill description: HB 9 is a substantial rewrite of the Medical Practice Act, which regulates the practice of physicians and physician assistants in the state.

Rating: +1

HB 9 is a substantial rewrite of the Medical Practice Act, reducing its length by 17 percent. While doing so, HB 9 would make regulations concerning physician assistants clearer, as references to PAs have been placed haphazardly throughout the act, making it unclear in places what regulations apply to these professionals.

Does it transfer a function of the private sector to the government? Examples include government ownership or control of any providers of goods or services such as the Land Board's purchase of a self-storage facility, mandatory emissions testing, or pre-kindergarten. Conversely, does it eliminate a function of government or return a function of government to the private sector?

Currently, the board has the authority to “determine and limit the scope of activities of each physician assistant” based upon their education (page 13, line 20). Not only would this be a substantial undertaking if the board were to complete this for every physician assistant licensed in the state, this is a role the supervising physician could perform more effectively. Each supervising physician has greater first-hand knowledge of the capabilities, training, and education of their assistants, and can allow them to practice within the full scope of their capacity.

HB 9 would take the board out of the supervisory role for physician assistants and return this role to the supervising physicians.

(+1)

Does it give government any new, additional, or expanded power to prohibit, restrict, or regulate activities in the free market? Conversely, does it eliminate or reduce government intervention in the market?

HB 9 would prohibit individuals from utilizing the title of “physician assistant,” or the abbreviated “P.A.” unless they are licensed under the terms of the Medical Practice Act (page 5, line 50). Any individual who uses those titles or otherwise tells the public they are licensed would be subject to a $3,000 fine and up to one year in prison.

(-1)

Does it increase barriers to entry into the market? Examples include occupational licensure, the minimum wage, and restrictions on home businesses. Conversely, does it remove barriers to entry into the market?

HB 9 would eliminate a barrier to entry into the medical profession for individuals who have applied but fail a portion of the medical examination required to receive their license (page 16, line 36). Currently, a person who fails any part of the three-part examination two times is required to wait at least one year before taking the examination again and complete an additional course of study in the interim.

HB 9 would specify that an applicant must fail the same step of the three-step examination twice, rather than any portion twice. An applicant who fails the same portion twice could be asked to meet with the board to provide further information.

(+1)

However, HB 9 would also specify that an applicant who has been disciplined by a medical licensing board, professional organization, medical school, hospital, or other group would not be eligible to receive “licensure by endorsement.” Licensure by endorsement is a fast-track approach to licensure. By prohibiting any individuals who have a disciplinary action filed against them, whether “past, pending, or confidential,” HB 9 could make it harder for them to obtain a license through this avenue.

(-1)

Currently, a person who is convicted of or pleads guilty to a felony or a crime of moral turpitude can face disciple by the state board. HB 9 would eliminate the reference to crimes of “moral turpitude” (page 18, line 47). Moral turpitude is a vague legal term, defined by a leading legal dictionary as “conduct that is contrary to justice, honesty, or morality.”

By pulling out this vague terminology, HB 9 would protect licensees from overbroad disciplinary procedures.

(+1)

HB 9 would add to the list of actions which can lead to disciplinary procedures “unprofessional or disruptive behavior or interaction in a health care setting” (page 20, lines 17-21). This vague term could be misused against a licensee.

(-1)

HB 9 would prohibit licensees from delegating professional responsibilities to either unlicensed individuals or individuals who are not fully trained. The licensee who does delegate these responsibilities could be disciplined by the state board for their actions. This possibility would obligate licensees to track the education and capabilities of employees and others.

The Board does already have the authority to discipline a licensee for “failing to supervise the activities of externs, interns, residents, nurse practitioners, certified nurse-midwives, clinical nurse specialists, or physician assistants” who are working under the physician’s supervision. The addition of the new language in HB 9 could expand upon this authority to include individuals who are not registered or licensed members of these professions.

(-1)

Licensees would be required to report if they have been convicted of a felony to the board within 30 days of conviction, regardless of whether the felony is related to the practice of medicine (page 20, lines 36-37). The licensee who does not report the conviction within the 30 day period could face discipline by the board.

(-1)

Does it directly or indirectly create or increase any taxes, fees, or other assessments? Conversely, does it eliminate or reduce any taxes, fees, or other assessments?

HB 9 would eliminate the registration requirement for medical students (externs). Presently, Idaho is the only state that requires medical students to register with the state licensing board. Each year, every medical student in Idaho must submit a registration fee to the board, along with a renewal application.

(+1)

HB 9 would allow medical residents and interns (the title used for residents while in their first year), to register biannually with the state board, rather than annually (page 13, line 5). Most residencies are for a period of three to five years. By extending the renewal period to every two years, HB 9 would reduce the burden on these medical professionals.

(+1)

HB 9 would change the examination procedures for licensed individuals who are deemed unfit to practice, for mental or medical reasons. As part of this rework of the examination procedures, this bill would add that a licensees would have to pay to conduct an examination of their physical or mental fitness to practice (page 22, lines 3-19). Licensees would be obligated to pay for this examination out of their own pocket. This examination would then be used by the board in determining whether a licensee is fit to practice. Under the current procedures, a licensee is not explicitly mandated to pay the committee convened by the board.

(-1)

Does it violate the principle of equal protection under the law? Examples include laws which discriminate or differentiate based on age, gender, or religion or which apply laws, regulations, rules, or penalties differently based on such characteristics. Conversely, does it restore or protect the principle of equal protection under the law?

HB 9 would pull out a reference to the  National Ski Patrol System, Inc. (page 4, Line 44) and the Outdoor Emergency Care Credential (page 4, line 45)  from the list of exceptions to the definition of unlicensed practice. Currently, the Medical Practice Act exempts members of this private organization or recipients of this credential from licensure as a physician. This is superfluous language, as the exception for “rendering aid in an emergency” is already in statute.

By pulling these private organizations out of the act, HB 9 would take away the preferential treatment these private organizations could receive.

(+1)

HB 9 would pull out references to two other private organizations, the Idaho Medical Association and the Idaho Osteopathic Association (page 6, line 44 and page 7, line 1). Currently, the statute reads when the Board of Medicine has an open seat, these private associations will provide the governor with a list of three candidates to consider for filling the empty seat on the board. If the boards needs a new osteopathic member, then the Osteopathic association provides a recommendation, if there is need for an MD, then the Medical Association submits the recommendations.

(+1)

HB 9 would add a reference to the National Commission on Certification of Physician Assistants, a private nonprofit organization (page 17, line 17).

(-1)

HB 9 would make it easier for out-of-state individuals to obtain licensure by endorsement in Idaho. This is particularly true for individuals who received a license to practice medicine in another country (page 17, line 34). This would be accomplished by pulling out the specific mention that individuals must have passed an examination issued by the National Board of Medical Examiners or the National Board of Examiners for Osteopathic Physicians and Surgeons. If an individual has proved their competency as a physician or surgeon, yet received their medical degree in another country, where they do not take the same examinations, or for some other reason has not taken the examination, they could still receive a license to practice in the state.

(+1)

Update: The language of this analysis was updated on 1/30 to better reflect the content of the legislation.

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