HB1335

SECTION 1. Chapter 460, Hawaii Revised Statutes, is amended by adding five new sections to be appropriately designated and to read as follows:

"§460- Educational teaching license. (a) The board may issue an educational teaching license to an osteopathic physician who is not licensed in this State and who is invited by the chief of service of a clinical department of a hospital to provide and promote professional education for students, interns, residents, fellows, and doctors of medicine in this State. In no case shall an educational teaching license issued hereunder be valid for more than a period of twelve months from the date of issuance of the license.

(b) To receive an educational teaching license, the applicant shall:

(1) Complete an application as prescribed by the board which shall include a summary of the applicant's osteopathic medical, educational, and professional background;

(2) Provide proof that the applicant is licensed as an osteopathic physician in another state or country and the license is current and in good standing;

(3) Submit a letter with the application signed by the chief of service of a clinical department of a hospital attesting that the chief of service is a licensed osteopathic physician of this State and is requesting to sponsor and monitor the applicant while the person is engaged in educational or teaching activities for the hospital under an educational teaching license; and

(4) Pay all applicable fees.

(c) The holder of an educational teaching license shall not open or appoint a place to meet patients, or receive calls from patients relating to the practice of osteopathic medicine, beyond the parameters of the hospital that is sponsoring and monitoring the licensee's activities.

(d) The holder of an educational teaching license shall obey all laws and rules of this State.

§460- Training replacement temporary license. (a) The board may issue a limited and temporary license to an osteopathic physician to maintain patient services for the purpose of substituting for another physician licensed in this State who is participating in specialized training at an out-of-state fully accredited medical teaching institution; provided that the out-of-state osteopathic physician seeking the limited and temporary license:

(1) Is board certified by the American Board of Medical Specialties or the Bureau of Osteopathic Specialties in the subspecialty in which the Hawaii physician is seeking training;

(2) Is a member of the teaching faculty of the accredited medical teaching institution;

(3) Has an unrestricted license in another state;

(4) Has been invited by the chief of a clinical department of a hospital; and

(5) Has been examined and approved by the hospital's credential process.

(b) The chief of the clinical department in which the out-of-state osteopathic physician will practice shall submit a letter to the board which shall include, without limitation, the following:

(1) Identification and documentation of unrestricted license for the applicant for the specialty training license;

(2) A statement that the hospital is sponsoring the applicant, and shall be responsible for monitoring the individual osteopathic physician during the period of the temporary license;

(3) Verification of the start and end dates for the requested temporary license;

and

(4) Verification that the chief of the clinical department is a licensed physician of this State.

(c) The limited and temporary license issued under this section shall expire upon notification to the board by the Hawaii-licensed physician that physician has resumed the physician's practice in this State. Licenses and extensions of licenses issued under this section to an individual shall not be valid for more than nine months during any consecutive twenty-four month period.

(d) The holder of a specialty training license shall obey and be subject to all laws and rules of this State.

§460- Duty of osteopathic physician, hospital, clinic, etc., to report wounds. (a) Every osteopathic physician attending or treating a case of knife wound, bullet wound, gunshot wound, powder burn, or any injury that would seriously maim, produce death, or has rendered the injured person unconscious, caused by the use of violence or sustained in a suspicious or unusual manner or in a motor vehicle collision resulting in serious injury or death, or, whenever the case is treated in a hospital, clinic, or other institution, the manager, superintendent, or person in charge thereof, shall report the case or provide requested information to the chief of police of the county within which the person was attended or treated, giving the name of the injured person, description of the nature, type, and extent of the injury, together with other pertinent information that may be of use to the chief of police. As used herein, the term "chief of police" means the chief of police of each county and any of the chief's authorized subordinates.

(b) This section shall not apply to wounds, burns, or injuries received by a member of the armed forces of the United States or of the State while engaged in the actual performance of duty.

(c) Any person who fails to make the report called for in this section within twenty‑four hours after the attendance or treatment shall be fined not less than $50 nor more than $500.

§460- Who shall give consent to a postmortem examination. A pathologist or any licensed osteopathic physician may conduct a postmortem examination when written consent thereto is given by whoever of the following assumes custody of the body for purposes of burial: father, mother, husband, wife, reciprocal beneficiary, child, guardian, next of kin, or, in the absence of any of the foregoing, a friend or person, including a governmental agency, charged by law with the responsibility for the burial. If two or more such persons assume custody of the body, the consent of one of them is sufficient. The consent shall include the consent to the retention by the licensed osteopathic physician who conducts the postmortem examination of tissues, including fetal material, of the body removed at the time of the postmortem examination to be used for necessary or advisable scientific investigation, including research, teaching, and therapeutic purposes.

§460- Intentional termination of pregnancy; penalties; refusal to perform. (a) No abortion shall be performed in this State unless:

(1) The abortion is performed by a licensed physician or surgeon, or by a licensed osteopathic physician; and

(2) The abortion is performed in a hospital licensed by the department of health or operated by the federal government or an agency thereof, or in a clinic, physician's office, or osteopathic physician's office.

(b) Abortion shall mean an operation to intentionally terminate the pregnancy of a nonviable fetus. The termination of a pregnancy of a viable fetus is not included in this section.

(c) The State shall not deny or interfere with a female's right to choose or obtain an abortion of a nonviable fetus or an abortion that is necessary to protect the life or health of the female.

(d) Any person who knowingly violates subsection (a) shall be fined not more than $1,000 or imprisoned not more than five years, or both.

(e) Nothing in this section shall require any hospital or any person to participate in an abortion nor shall any hospital or any person be liable for a refusal."

SECTION 2. Section 460-1, Hawaii Revised Statutes, is amended to read as follows:

"§460‑1 License to practice. (a) No person shall practice as an osteopathic physician either gratuitously or for pay, or shall offer to so practice, or shall advertise or announce, either publicly or privately, that the person is prepared or qualified to so practice, or shall append the letters "Dr." or the letters "D.O." to the person's name, with the intent thereby to imply that the person is a practitioner as an osteopathic physician, without having a valid unrevoked license, obtained from the board of medical examiners, in form and manner substantially as hereinafter set forth.

(b) Nothing herein shall:

(1) Apply to any osteopathic physician from another state who is in actual consultation, including but not limited to, in-person, mail, electronic, telephonic, fiber optic, or other telemedicine consultation, with a licensed physician of this State if the physician from another state is licensed to practice in the state in which the physician resides, provided that [~~the~~]:

(A) The physician from another state shall not open an office, or administer treatment to any patient except in [an] actual temporary consultation with a resident licensed physician of this State; or

(B) The licensed physician of this State retains control and remains responsible for the provision of care for the patient; and provided further that the laws and rules relating to contagious diseases are not violated;

(2) [~~Prohibit~~] Except for final refraction resulting in a prescription for spectacles, contact lenses, or visual training as performed by an oculist or optometrist duly licensed by the State, prohibit services rendered by any osteopathic physician's assistant when the services are rendered under the supervision, direction, and control of an osteopathic physician licensed in this State, as may be specified by rule or statute. The board of medical examiners shall adopt rules to define the type of supervision, direction, and control that must be maintained and the extent that the personal presence of the osteopathic physician will be required. Any osteopathic physician who employs or directs an osteopathic physician's assistant shall retain full professional and personal responsibility for any act which constitutes the practice of osteopathic medicine [~~and surgery~~] when performed by an osteopathic physician's assistant[.];

(3) Prohibit services rendered by any person certified under chapter 453 to provide emergency medical services when the services are rendered under the direction and control of an osteopathic physician licensed in this State, as may be specified by rule or statute. Any osteopathic physician who employs or directs a person certified under chapter 453 shall retain full professional and personal responsibility for any act which constitutes the practice of osteopathic medicine and surgery when performed by that person;

(4) Apply to any commissioned medical officer in the United States armed forces or public health service engaged in the discharge of one's official duty;

(5) Apply to so-called Christian Scientists so long as they merely practice the religious tenets of their church without pretending a knowledge of osteopathic medicine;

(6) Prohibit service in the case of emergency or the domestic administration of family remedies;

(7) Prohibit automatic external defibrillation by:

(A) Any first responder personnel certified by the department of health to provide automatic external defibrillation when it is rendered under the medical oversight of an osteopathic physician licensed in this State; or

(B) Any person who successfully completes training under an automatic external defibrillator program administered by an osteopathic physician. An "automatic external defibrillator program" means an appropriate training course that includes cardiopulmonary resuscitation and proficiency in the use of an automatic external defibrillator.

(c) Nothing in this chapter shall prohibit healing practices by traditional Hawaiian healers engaged in traditional Native Hawaiian healing practices, both as recognized and certified as such by any kupuna council convened by Papa Ola Lokahi. No person or organization involved with the selection of kupuna council members, the convening of a kupuna council, or the certification process of healers under this subsection shall be sued or held liable for any cause of action that may arise out of their participation in the selection, convening, or certification process. Nothing in this chapter shall limit, alter, or otherwise adversely affect any rights of practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii."

SECTION 3. Section 460-1.6, Hawaii Revised Statutes, is amended to read as follows:

"[[]§460-1.6[]] Limited and temporary licenses. The board may issue a limited and temporary license to an applicant [~~who~~] against whom no disciplinary actions or proceedings are pending in any state or territory, if the applicant is otherwise qualified to be examined, and upon determination that [~~the~~]:

(1) The applicant has been appointed to an internship that meets the requirements of section 460‑6(2)[~~; provided that no disciplinary actions or proceedings are pending against the applicant in any state or territory.~~] or accepted for specialty training in a health care facility or organized ambulatory health care facility as defined in section 323D-2 or a hospital approved by the board. The applicant's practice shall be limited to duties as a resident or as directed by the program of training while at the health care facility, organized ambulatory health care facility, or hospital. The license shall be valid for one year and may be renewed from year to year during the period of residency[.];

(2) There is an absence or shortage of licensed physicians and osteopathic physicians in a particular locality and that the applicant has been duly licensed as an osteopathic physician by written examination under the laws of another state or territory of the United States. A limited and temporary license issued under this paragraph shall permit the practice of osteopathic medicine by the applicant only in the particular locality, and no other, as shall be set forth in the license issued to the applicant. The license shall be valid only for a period of eighteen months from the date of issuance. The board shall establish guidelines to determine a locality with an absence or shortage of physicians and osteopathic physicians. For this purpose, the board may consider a locality to have an absence or shortage of physicians and osteopathic physicians if the absence or shortage results from the temporary loss of a physician or osteopathic physician. In designating a locality with an absence or shortage of physicians and osteopathic physicians, the board shall not delegate its authority to a private organization;

(3) The applicant is to be employed by an agency or department of the state or county government, and that the applicant has been duly licensed as an osteopathic physician by written examination under the laws of another state or territory of the United States. A limited and temporary license issued under this paragraph shall only be valid for the practice of osteopathic medicine while the applicant is in the employ of such governmental agency or department and in no case shall be used to provide private patient care for a fee. A license issued under this paragraph may be renewed from year to year;

(4) The applicant would practice osteopathic medicine only while under the direction of a physician or osteopathic physician regularly licensed in the State other than as permitted by this section, and that the applicant intends to take the regular licensing examination within the next eighteen months. A limited and temporary license issued under this paragraph shall be valid for no more than eighteen months from the date of issuance, unless otherwise extended at the discretion of the board; provided that this discretionary extension shall not exceed a period of six months beyond the original expiration date of the limited and temporary license; or

(5) A public emergency exists, and that the applicant has been duly licensed as an osteopathic physician by written examination under the laws of another state or territory of the United States. A limited and temporary license issued under this paragraph shall only be valid for the period of such public emergency."

SECTION 4. Section 460-5, Hawaii Revised Statutes, is amended to read as follows:

"§460‑5 Fees[.]; continuing education. (a) No applicant for a license to practice as an osteopathic physician [~~and surgeon~~] shall be examined until the applicant has paid to the board application and examination fees.

(b) Section 460‑2 and any other provisions of this chapter to the contrary notwithstanding, [~~there shall be paid to the board by~~] every person licensed to practice as an osteopathic physician [~~and surgeon,~~] shall renew the license with the board biennially in each even‑numbered year on or before June 30, pay a renewal fee[.], and comply with the continuing medical education requirements provided in rules adopted by the board.

(c) At the start of the June 2010 license renewal period, an osteopathic physician shall meet the continuing medical education requirements by obtaining credit hours in a category 1A continuing medical education program approved by the American Osteopathic Association, in a continuing medical education activity designated for category 1 by an American Medical Association accredited provider, or in other approved continuing medical education as provided in the board's rules. To determine compliance, the board may conduct a random audit. An osteopathic physician selected for audit shall be notified by the board. Within sixty days of notification, the osteopathic physician shall provide to the board documentation to verify compliance with the category 1 continuing medical education requirements.

(d) Failure of any licensee to pay [~~any~~] the renewal fee, and in the case of audited osteopathic physicians, provide documentation of compliance, shall [~~work~~] constitute a forfeiture of the license[~~. Licenses forfeited by this section shall be restored upon payment of a penalty fee and all fees which the licensee would have paid if the licensee had continuously renewed the license.~~] , which may be restored only upon the submission of written application, payment to the board of a restoration fee, and, in the case of audited osteopathic physicians, providing documentation of compliance with continuing medical education requirements.

(e) A license that has been forfeited for one renewal term shall be automatically terminated and cannot be restored, and a new application for licensure shall be required."

SECTION 5. Section 460-6, Hawaii Revised Statutes, is amended to read as follows:

"§460‑6 Application and licensure. Before any applicant shall be eligible for licensure, the applicant shall be found to possess the necessary qualifications and submit evidence satisfactory to the board that:

(1) The applicant is a graduate of a school or college of osteopathy which is approved by the American Osteopathic Association;

(2) The applicant has served an internship of at least one year in a [~~hospital~~] training program approved by the American Osteopathic Association and the American College of Osteopathic Surgeons, or in a [~~hospital approved by the American Medical Association,~~] program that has been accredited for the training of resident physicians by the Accreditation Council for Graduate Medical Education, or the equivalent of the requirement as determined by the board if the applicant graduated prior to 1943; and

(3) The applicant has passed the:

(A) National Board of Osteopathic Medical Examiners examination (NBOME), or the Federation Licensing Examination (FLEX), or the United States Medical Licensing Examination (USMLE), or a combination of parts of the [~~Federation Licensing Examination~~] FLEX and [~~United States Medical Licensing Examination~~] USMLE as approved by the board, with scores deemed satisfactory by the board[.];

(B) The Comprehensive Osteopathic Medical Variable-Purpose Examination – USA (COMVEX – USA), provided that the applicant is or was licensed in another state by virtue of having passed a state-produced examination with scores deemed satisfactory by the board; or

the applicant is or was licensed in another state by virtue of having passed a state-produced examination with scores deemed satisfactory by the board."

SECTION 6. Section 460-12, Hawaii Revised Statutes, is amended to read as follows:

"§460‑12 Refusal, suspension, and revocation of license. (a) In addition to any other grounds for denial of license or disciplinary action authorized by law, the board may refuse to issue a license, or may suspend or revoke any license at any time in a proceeding before the board for any cause authorized by law, including but not limited to the following:

(1) Procuring or aiding or abetting in procuring a criminal abortion;

(2) Employing any person to solicit patients for one's self;

(3) Engaging in false, fraudulent, or deceptive advertising, including, but not limited to:

(A) Making excessive claims of expertise in one or more medical specialty fields;

(B) Assuring a permanent cure for an incurable disease; or

(4) Being habituated to the excessive use of drugs or alcohol; or being addicted to, dependent on, or [an] a habitual user of a narcotic, barbiturate, amphetamine, hallucinogen, or other drug having similar effects;

(5) Practicing medicine while the ability to practice is impaired by alcohol, drugs, physical disability, or mental instability;

(6) Procuring a license through fraud, misrepresentation, or deceit or knowingly permitting an unlicensed person to perform activities requiring a license;

(7) Professional misconduct, gross carelessness, or manifest incapacity in the practice of osteopathy;

(8) Negligence or incompetence, including, but not limited to, the consistent use of medical service in osteopathy which is inappropriate or unnecessary;

(9) Conduct or practice contrary to recognized standards of ethics of the osteopathic profession as adopted by the American Osteopathic Association;

(10) Revocation, suspension, or other disciplinary action by another state of a license or certificate for reasons as provided in this section;

(11) Conviction, whether by nolo contendere or otherwise, of a penal offense substantially related to the qualifications, functions, or duties of an osteopathic physician [~~and surgeon~~], notwithstanding any statutory provision to the contrary;

(12) Violation of chapter 329, the uniform controlled substances law, or any rule adopted thereunder; [or]

(13) Failure to report to the board by a licensee, in writing, any disciplinary decision issued in another jurisdiction against the licensee within thirty days after the disciplinary decision is issued, or failure to report to the board by an applicant, in writing, any disciplinary decision issued in another jurisdiction against the applicant prior to the application or during the pendency of the application[.];

(14) Violation of the conditions or limitations upon which a limited and temporary license is issued; or

(15) Submitting to or filing with the board any notice, statement, or other document, required under this chapter, that is false or untrue or contains any material misstatement or omission of fact.

(b) If disciplinary action related to the practice of osteopathic medicine has been taken against the applicant in any jurisdiction that would constitute a violation under this section, or if the applicant reveals a physical or mental condition that would constitute a violation under this section, then the board may impose one or more of the actions set forth in section 460-14.5 as a condition for licensure and:

(1) Physical and mental evaluation of the applicant by a licensed physician or osteopathic physician approved by the board;

(2) Probation, including such conditions of probation as requiring observation of the licensee by an appropriate group of society of licensed physicians, surgeons, or osteopathic physicians and surgeons;

(3) Limitation of the license by restricting the fields of practice in which the licensee may engage;

(4) Further education or training or proof of performance competency; and

(5) Limitation of the osteopathic medical practice of the licensee in any reasonable manner to assure the safety and welfare of the consuming public."

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect upon its approval; provided that the continuing medical education requirements in section 4 shall take effect at the start of the June 2010 license renewal period.

INTRODUCED BY:

_____________________________

BY REQUEST

HOUSE OF REPRESENTATIVES	H.B. NO.	1335
TWENTY-FOURTH LEGISLATURE, 2007
STATE OF HAWAII