SB191.DOC

SECTION 1. The legislature finds that there are a multitude of professional degrees using the term "doctor", including medical doctor or "M.D.", doctor of osteopathic medicine or "D.O.", doctor of dental surgery or "D.D.S.", doctor of podiatric medicine or "D.P.M.", doctor of optometry or "O.D.", doctor of chiropractic or "D.C.", and other designations that may be used by health care practitioners.

The legislature further finds that a 2014 study by the American Medical Association found that nearly twenty-two per cent of patients believe a chiropractor is a medical doctor; thirty-five per cent of patients believe a doctor of nursing practice is a medical doctor; thirty-six per cent of patients believe a psychologist is a medical doctor; forty-two per cent of patients believe an optometrist is a medical doctor; and seventy-four per cent of patients believe a podiatrist is a medical doctor.

The legislature additionally finds that there are widespread differences regarding the training and qualifications required to earn various health care practitioner degrees. These differences often concern the training and skills necessary to correctly detect, diagnose, prevent, and treat serious health care conditions.

The legislature also finds that there is a compelling state interest in patients being promptly and clearly informed of the training and qualifications of the health care practitioners who provide health care services to these patients. There is also a compelling state interest in the public being protected from potentially misleading and deceptive health care advertising that might cause patients to have undue expectations regarding the patients' treatment and outcome.

Accordingly, the purpose of this Act is to require:

(1) Advertisements for health care services that name a health care practitioner to identify the type of license held by the health care practitioner and be free of deceptive and misleading information; and

(2) Health care practitioners to conspicuously post and affirmatively communicate the practitioners' specific license and related information.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

health care praCTITIONER transparency act

§ -1 Title. This chapter shall be known and may be cited as the Health Care Practitioner Transparency Act.

§ -2 Definitions. As used in this chapter:

"Advertisement" means any communication or statement, whether printed, electronic, or oral, that names the health care practitioner in relation to the practitioner's practice, profession, or institution in which the practitioner is employed, volunteers, or otherwise provides health care services. "Advertisement" includes business cards, letterhead, patient brochures, electronic mail, Internet, audio and video, and any other communication or statement used in the course of business.

"Deceptive" or "misleading" includes but is not limited to any advertisement or affirmative communication or representation that misstates, falsely describes, holds out, or falsely details the health care practitioner's profession, skills, training, expertise, education, board certification, or licensure.

"Health care practitioner" or "practitioner" means:

(1) Practitioners of chiropractic licensed pursuant to chapter 442, and signified by the letters "D.C." or the words "chiropractor" or "doctor of chiropractic";

(2) Practitioners of dentistry licensed pursuant to chapter 448, and signified by the letters "D.D.S." or "D.M.D." or the words "dentist", "doctor of dental surgery", or "doctor of dental medicine";

(3) Practitioners of allopathic medicine or surgery licensed pursuant to chapter 453 and signified by the letters "Dr." or "M.D." or the words "surgeon", "physician", "medical doctor", or "doctor of medicine";

(4) Practitioners of osteopathic medicine or surgery licensed pursuant to chapter 453 and signified by the letters "Dr." or "D.O." or the words "surgeon", "osteopathic surgeon", "osteopathic physician", "osteopath", "doctor of osteopathy", or "doctor of osteopathic medicine";

(5) Physician assistants licensed pursuant to chapter 453 and signified by the letters "P.A." or the words "physician assistant";

(6) Practitioners of naturopathic medicine licensed pursuant to chapter 455 and signified by the letters "N.D." or the words "naturopathic physician", "naturopathic doctor", "naturopath", "doctor of naturopathy", or "doctor of naturopathic medicine";

(7) Practitioners of nursing licensed pursuant to chapter 457 and signified by the letters "A.P.R.N.", "L.P.N.", or "R.N."; the words "Advanced Practice Registered Nurse", "Licensed Practical Nurse", or "Registered Nurse"; or any other commonly used signifier to denote a doctorate of nursing practice, nurse practitioner, or certified registered nurse anesthetist, as appropriate, which signify the appropriate degree of licensure and degree earned from a regionally-accredited institution of higher education in the appropriatie field of learning;

(8) Certified nurse aides licensed pursuant to chapter 457A and signified by the letters "C.N.A." or "certified nurse aide";

(9) Practitioners of optometry licensed pursuant to chapter 459 and signified by the letters "O.D." or the words "optometrist" or "doctor of optometry";

(10) Practitioners of podiatric medicine licensed pursuant to chapter 463E and signified by the letters "D.P.M." or the words "podiatrist", "doctor of podiatric medicine", or "doctor of podiatry";

(11) Practitioners of speech pathology or audiology licensed pursuant to chapter 468E and signified by the letters "Au.D.", "Sc.D.", or "Ph.D."; the words "speech pathologist", "speech therapist", "audiologist", "doctor of audiology"; or other words that signify the appropriate degree of licensure and degree earned from a regionally-accredited institution of higher education in the appropriate field of learning; and

(12) Mental health counselors licensed pursuant to chapter 453D, pharmacists licensed pursuant to chapter 461, physical therapists licensed pursuant to chapter 461J, psychologists licensed pursuant to chapter 465, or any other health care practitioner not covered under this section, including but not limited to those signified by the letters "Ph.D.", "Ed.D.", "Pharm.D.", "P.T.", "M.P.T.", "Psy.D.", or "Sc.D.", as appropriate to signify the appropriate degree of licensure and degree earned from a regionally-accredited institution of higher education in the appropriate field of learning.

"Licensee" means a health care practitioner who holds an active license with the appropriate licensing authority.

"Licensing authority" shall have the same meaning as in section 436B-2.

§ -3 Requirements. (a) An advertisement for health care services that names a health care practitioner shall identify the type of license held by the health care practitioner and granted by the appropriate licensing authority. The advertisement shall be free from any and all deceptive or misleading information.

(b) A health care practitioner who provides health care services in the State shall conspicuously post and affirmatively communicate the practitioner's specific license as follows:

(1) The health care practitioner shall wear a photo identification name tag during all patient encounters that shall include:

(A) A recent photograph of the practitioner;

(B) The practitioner's name;

(C) The type of license (e.g., "medical doctor", "psychologist", "advanced practice registered nurse", "podiatrist"); and

(D) The expiration date of the license;

provided that the name tag shall be of sufficient size and worn in a conspicuous manner so as to be visible and apparent; and

(2) The health care practitioner shall display in the practitioner's office a writing that clearly identifies the type of license held by the practitioner; provided that the writing shall be of sufficient size so as to be visible and apparent to all current and prospective patients.

(c) A health care practitioner who practices in more than one office shall comply with the requirements of subsections (a) and (b) in each practice setting.

(d) A physician or osteopathic physician licensed pursuant to section 453 who supervises or participates in collaborative practice agreements with non-physician or non-osteopathic physician health care practitioners shall conspicuously post in each office a schedule of the regular hours when the physician or osteopathic physician will be present in that office.

§ -4 Violations and enforcement. (a) Failure to comply with this chapter shall constitute a violation. Each day of such failure shall constitute a separate violation.

(b) Any licensee knowingly aiding or abetting an unlicensed person to directly or indirectly evade this chapter or the applicable licensing laws, or combining or conspiring with an unlicensed person, or permitting one's license to be used by an unlicensed person, or acting as agent, partner, associate, or otherwise, of an unlicensed person with the intent to evade this chapter or the applicable licensing laws shall constitute a violation under this chapter.

(c) Any health care practitioner who violates this chapter shall be guilty of unprofessional conduct and shall be subject to disciplinary action by the appropriate licensing authority.

(d) The department of commerce and consumer affairs or the appropriate licensing authority may maintain a suit to enjoin the performance or the continuance of any act or acts by a person or entity violating this chapter.

(e) Notwithstanding any law to the contrary, any final order of discipline taken pursuant to this section shall be a matter of public record.

(f) Fees and other amounts billed to and paid by a patient to a health care practitioner who has been found to have violated this chapter, including amounts paid to third parties contracted to collect fees on behalf of the health care practitioner, health care practitioner's employer, or other entity contracting with the health care practitioner, shall be rescinded and refunded.

§ -5 Exemptions. This chapter shall not apply to health care practitioners working in non-patient care settings and who do not have any direct patient care interactions."

SECTION 3. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	191
TWENTY-NINTH LEGISLATURE, 2017
STATE OF HAWAII