Reference Title: board of osteopathic examiners

AN ACT
AMENDING SECTIONS 32-1800, 32-1803, 32-1804, 32-1822, 32-1825 AND 32-1826, ARIZONA REVISED STATUTES; AMENDING TITLE 32, CHAPTER 17, ARTICLE 2, ARIZONA REVISED STATUTES, BY ADDING SECTIONS 32-1828, 32-1829 AND 32-1830; AMENDING SECTION 32-1854, ARIZONA REVISED STATUTES; RELATING TO THE BOARD OF OSTEOPATHIC EXAMINERS IN MEDICINE AND SURGERY.

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 32-1800, Arizona Revised Statutes, is amended to read:

32-1800 . Definitions

In this chapter, unless the context otherwise requires:

1. "Active license" means a valid license to practice medicine.

2. "Adequate records" means legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another licensed health care practitioner to assume continuity of the patient's care at any point in the course of treatment.

3. "Approved fellowship program" means that an applicant for licensure completed training when the hospital or other facility in which the training occurred was approved for fellowship by the American osteopathic association or by the accreditation council on graduate medical education.

4. "Approved hospital internship" means that an applicant for licensure completed training when the hospital or other facility in which the training occurred was approved for internship by the American osteopathic association or by the accreditation council on graduate medical education.

5. "Approved preceptorship" means that an applicant for licensure completed training when the hospital or other facility in which the training occurred was approved for preceptorship by the American osteopathic association or by the accreditation council on graduate medical education.

6. "Approved residency" means that an applicant for licensure completed training when the hospital or other facility in which the training occurred was approved for residency by the American osteopathic association or by the accreditation council on graduate medical education.

7. "Approved school of osteopathic medicine" means a school or college offering a course of study which, on successful completion, results in the awarding of the degree of doctor of osteopathy and whose course of study has been approved or accredited by the American osteopathic association.

8. "Board" means the Arizona board of osteopathic examiners in medicine and surgery.

9. "COMPLETED APPLICATION" MEANS AN APPLICATION FOR WHICH THE APPLICANT HAS SUPPLIED ALL REQUIRED FEES, INFORMATION AND CORRESPONDENCE REQUIRED BY THE BOARD ON FORMS AND IN A MANNER APPROVED BY THE BOARD.

9. 10. "Decree of censure" means a formal written reprimand by the board of a physician for a violation of this chapter that constitutes an official action against a physician's license.

11. "DIRECT SUPERVISION" MEANS THAT A PHYSICIAN IS WITHIN THE SAME ROOM OR OFFICE SUITE AS THE MEDICAL ASSISTANT IN ORDER TO BE AVAILABLE FOR CONSULTATION REGARDING THOSE TASKS THE MEDICAL ASSISTANT PERFORMS PURSUANT TO SECTION 32-1859.

12. "DISPENSE" MEANS THE DELIVERY BY A PHYSICIAN OF A PRESCRIPTION DRUG OR DEVICE TO A PATIENT, EXCEPT FOR SAMPLES PACKAGED FOR INDIVIDUAL USE BY LICENSED MANUFACTURERS OR REPACKAGERS OF DRUGS, AND INCLUDES THE PRESCRIBING, ADMINISTERING, PACKAGING, LABELING AND SECURITY NECESSARY TO PREPARE AND SAFEGUARD THE DRUG OR DEVICE FOR DELIVERY.

13. "DOCTOR OF OSTEOPATHY" MEANS A PERSON WHO HOLDS A LICENSE, REGISTRATION OR PERMIT TO PRACTICE MEDICINE PURSUANT TO THIS CHAPTER.

10. 14. "Immediate family" means the spouse, natural or adopted children, father, mother, brothers and sisters of the physician and the natural and adopted children, father, mother, brothers and sisters of the physician's spouse.

11. 15. "Inappropriate fee" means a fee that is not supported by documentation of time, complexity or extreme skill required to perform the service.

12. 16. "Informal interview" means a meeting between the board and a physician to discuss issues set forth in the informal interview notice and during which the board may hear statements from board staff, the complainant and the physician.

17. "FULL-TIME FACULTY MEMBER" MEANS A PHYSICIAN EMPLOYED FULL TIME AS A FACULTY MEMBER WHILE HOLDING THE ACADEMIC POSITION OF ASSISTANT PROFESSOR OR A HIGHER POSITION AT AN APPROVED SCHOOL OF OSTEOPATHIC MEDICINE.

18. "JOINT BOARD" MEANS THE JOINT BOARD ON THE REGULATION OF PHYSICIAN ASSISTANTS ESTABLISHED PURSUANT TO CHAPTER 25 OF THIS TITLE.

13. 19. "Letter of concern" means an advisory letter to notify a physician that while there is insufficient evidence to support direct action against the physician's license there is sufficient evidence for the board to notify the physician of its concern. A letter of concern is a public document and may be used in future disciplinary actions against the physician.

14. 20. "Medical assistant" means an unlicensed person who has completed an educational program approved by the board, who assists in a medical practice under the supervision of a doctor of osteopathic medicine and who performs delegated procedures commensurate with the assistant's education and training but who does not diagnose, interpret, design or modify established treatment programs or violate any statute.

21. "MEDICAL PEER REVIEW" MEANS THE PARTICIPATION BY A DOCTOR OF OSTEOPATHY IN THE REVIEW AND EVALUATION OF THE MEDICAL MANAGEMENT OF A PATIENT AND THE USE OF RESOURCES FOR PATIENT CARE AS WELL AS ACTIVITIES RELATING TO A HEALTH CARE INSTITUTION'S DECISION TO GRANT OR CONTINUE PRIVILEGES TO PRACTICE AT THAT INSTITUTION.

22. "MEDICALLY INCOMPETENT" MEANS THAT A PERSON LACKS SUFFICIENT MEDICAL KNOWLEDGE OR SKILLS, OR BOTH, TO A DEGREE LIKELY TO ENDANGER THE HEALTH OF PATIENTS OR FAILS TO OBTAIN A SCALED SCORE OF AT LEAST SEVENTY-FIVE PER CENT ON THE WRITTEN SPECIAL PURPOSE LICENSING EXAMINATION ADMINISTERED BY THE BOARD.

23. "MEDICINE" MEANS OSTEOPATHIC MEDICINE AS PRACTICED BY A PERSON WHO RECEIVES A DEGREE OF DOCTOR OF OSTEOPATHY.

15. 24. "Physician" means a doctor of osteopathic medicine who holds a license to practice osteopathic medicine pursuant to this chapter.

16. 25. "Practice of medicine" OR "PRACTICE OF OSTEOPATHIC MEDICINE" means the practice of osteopathic medicine in which a person purports ALL OF THE FOLLOWING:

(a) To EXAMINE, diagnose, treat , PRESCRIBE FOR, PALLIATE, PREVENT or correct human diseases, injuries, ailments, infirmities and deformities, physical or mental CONDITIONS , real or imaginary, by any THE USE OF DRUGS, SURGERY, MANIPULATION, ELECTRICITY OR ANY PHYSICAL, MECHANICAL OR OTHER means as provided by this chapter.

(b) SUGGESTING, RECOMMENDING, PRESCRIBING OR ADMINISTERING ANY FORM OF TREATMENT, OPERATION OR HEALING FOR THE INTENDED PALLIATION, RELIEF OR CURE OF ANY PHYSICAL OR MENTAL DISEASE, AILMENT, INJURY, CONDITION OR DEFECT.

(e) (c) The practice of osteopathic medicine includes The practice of osteopathic medicine alone or the practice of osteopathic surgery or osteopathic manipulative therapy, or any combination of either practice.

27. "SPECIAL PURPOSE LICENSING EXAMINATION" MEANS AN EXAMINATION DEVELOPED BY THE NATIONAL BOARD OF MEDICAL EXAMINERS, ON BEHALF OF THE FEDERATION OF STATE MEDICAL BOARDS OR THE NATIONAL BOARD OF OSTEOPATHIC MEDICAL EXAMINERS FOR USE BY STATE LICENSING BOARDS, TO TEST THE BASIC MEDICAL COMPETENCY OF PHYSICIANS WHO ARE APPLYING FOR LICENSURE AND WHO HAVE BEEN IN PRACTICE IN ANOTHER JURISDICTION OR TO DETERMINE THE COMPETENCY OF A PHYSICIAN UNDER INVESTIGATION.

17. 28. "Specialist" means a physician who has successfully completed postdoctoral training in an approved fellowship program, an approved preceptorship or an approved residency or who is board certified by a specialty board approved by the board.

18. 29. "Subscription provider of health care" means an entity which, through contractual agreement, is responsible for the payment, in whole or in part, of debts incurred by a person for medical or other health care services.

30. "TEACHING HOSPITAL'S ACCREDITED GRADUATE MEDICAL EDUCATION PROGRAM" MEANS THAT A HOSPITAL IS INCORPORATED AND HAS AN INTERNSHIP, FELLOWSHIP OR RESIDENCY TRAINING PROGRAM THAT IS ACCREDITED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION, THE AMERICAN OSTEOPATHIC ASSOCIATION OR A SIMILAR BODY APPROVED BY THE BOARD.

31. "TEACHING LICENSE" MEANS A VALID LICENSE TO PRACTICE OSTEOPATHIC MEDICINE AS A FULL-TIME FACULTY MEMBER OF AN APPROVED SCHOOL OF MEDICAL EDUCATION PROGRAM.

Sec. 2. Section 32-1803, Arizona Revised Statutes, is amended to read:

32-1803 . Powers and duties

A. The board shall:

1. PROTECT THE PUBLIC FROM UNLAWFUL, INCOMPETENT, UNQUALIFIED, IMPAIRED AND UNPROFESSIONAL PRACTITIONERS OF OSTEOPATHIC MEDICINE.

1. 2. Conduct examinations for applicants for a license under this chapter, issue licenses, conduct hearings, place physicians on probation, revoke or suspend licenses, enter into stipulated orders, issue letters of concern or decrees of censure and administer and enforce all provisions of this chapter.

3. ORDER AND EVALUATE PHYSICAL, PSYCHOLOGICAL, PSYCHIATRIC AND COMPETENCY TESTING OF LICENSED PHYSICIANS AND CANDIDATES FOR LICENSURE AS THE BOARD DETERMINES IS NECESSARY TO ENFORCE THIS CHAPTER.

4. INITIATE INVESTIGATIONS AND DETERMINE ON ITS OWN MOTION IF A DOCTOR OF OSTEOPATHIC MEDICINE HAS ENGAGED IN UNPROFESSIONAL CONDUCT OR PROVIDED INCOMPETENT MEDICAL CARE OR IS MENTALLY OR PHYSICALLY UNABLE TO ENGAGE IN THE PRACTICE OF MEDICINE.

2. 5. Enforce, within the osteopathic profession in this state, the standards of practice prescribed by this chapter and the rules adopted by the board pursuant to the authority granted by this chapter.

3. 6. Collect and account for all fees provided for by this chapter and cause them to be paid to the state treasurer.

4. 7. Charge additional fees for services which the board deems appropriate to carry out its intent and purpose and which do not exceed the costs of rendering the services.

5. 8. Maintain a record of its acts and proceedings, including, but not limited to, the issuance, refusal, renewal, suspension or revocation of licenses to practice according to the terms of this chapter.

6. 9. Maintain a roster of all osteopathic physicians and surgeons registered under WHO ARE LICENSED PURSUANT TO this chapter , which indicates THAT INCLUDES :

(a) The name of the licensed physician.

(b) His THE PHYSICIAN'S current professional office address.

(c) The date and number of the certificate LICENSE issued to him under this chapter THE PHYSICIAN PURSUANT TO THIS CHAPTER .

(d) Whether the license is in good standing.

7. 10. Adopt rules regarding the regulation and the qualifications of medical assistants.

8. 11. Establish a program that is reasonable and necessary to educate physicians regarding the uses and advantages of autologous blood transfusions.

B. The records of the board shall be open to public inspection at all reasonable times.

C. The board may:

1. Adopt rules necessary or proper for the administration of this chapter.

2. Appoint hearing officers to conduct hearings pursuant to this chapter.

3. Appoint one of its members to the jurisdiction arbitration panel pursuant to section 32-2907, subsection B.

D. The board shall adopt and use a seal, the imprint of which, together with the signature of either the president, vice-president or executive director, shall evidence its official acts.

E. IN CONDUCTING INVESTIGATIONS PURSUANT TO THIS CHAPTER THE BOARD MAY RECEIVE AND REVIEW CONFIDENTIAL INTERNAL STAFF REPORTS RELATING TO COMPLAINTS AND MALPRACTICE CLAIMS.

F. THE BOARD MAY MAKE PUBLIC RECORDS REGARDING STATISTICAL INFORMATION ON DOCTORS OF OSTEOPATHIC MEDICINE AND APPLICANTS FOR LICENSURE AVAILABLE TO ACADEMIC AND RESEARCH ORGANIZATIONS.

Sec. 3. Section 32-1804, Arizona Revised Statutes, is amended to read:

32-1804 . Executive director; compensation; duties

A. The board shall appoint an executive director who is not a member of the board. The executive director shall serve at the pleasure of the board and shall receive compensation as determined pursuant to section 38-611 to be paid from the board fund.

B. The executive director OR THAT PERSON'S DESIGNEE shall:

1. Serve as administrative assistant to the board AND MANAGE THE BOARD'S OFFICES .

2. Collect all monies due and payable to the board.

3. Pay to the state treasurer any monies received by the board.

4. Prepare bills for authorized expenditures of the board and obtain warrants from the department of administration for payment of bills certified by a board member.

4. PAY ALL BILLS FOR AUTHORIZED BOARD EXPENDITURES.

5. Administer oaths.

6. Act as custodian of the board's seal, books, records, minutes and proceedings.

7. Employ special consultants or other agents to make investigations, gather information, review complaints, review malpractice claims, suits and settlements, prepare reports and perform other duties the executive director determines are necessary to enforce this chapter. Compensation for special consultants or agents may be determined on an hourly, daily or case basis but shall not exceed one hundred fifty dollars per day.

8. Employ , EVALUATE, DISMISS, DISCIPLINE AND DIRECT PROFESSIONAL, CLERICAL, TECHNICAL, INVESTIGATIVE AND ADMINISTRATIVE permanent or temporary personnel necessary to carry out the purposes of this chapter. The personnel are eligible to receive compensation pursuant to section 38-611.

9. Issue licenses , and registrations , PERMITS, LICENSE RENEWAL EXTENSIONS AND EXEMPTIONS to applicants who meet the requirements of this chapter.

10. Enter into contracts pursuant to title 41, chapter 23 for goods and services that are necessary to carry out board policies and directives.

11. PREPARE MINUTES, RECORDS, REPORTS, REGISTRIES, DIRECTORIES, BOOKS AND NEWSLETTERS AND RECORDS OF ALL BOARD TRANSACTIONS AND ORDERS.

12. PREPARE A BIANNUAL BUDGET.

13. AS DIRECTED BY THE BOARD, PREPARE AND SUBMIT RECOMMENDATIONS FOR CHANGES TO THIS CHAPTER FOR CONSIDERATION BY THE LEGISLATURE.

14. INITIATE AN INVESTIGATION IF EVIDENCE APPEARS TO DEMONSTRATE THAT A PHYSICIAN MAY BE ENGAGED IN UNPROFESSIONAL CONDUCT OR MAY BE MEDICALLY INCOMPETENT OR PHYSICALLY UNABLE TO SAFELY PRACTICE MEDICINE.

15. ISSUE SUBPOENAS IF NECESSARY TO COMPEL THE ATTENDANCE AND TESTIMONY OF A WITNESS AND THE PRODUCTION OF EVIDENCE.

16. AS DIRECTED BY THE BOARD, PROVIDE ASSISTANCE TO THE ATTORNEY GENERAL IN PREPARING AND EXECUTING DISCIPLINARY ORDERS, REHABILITATION ORDERS

AND NOTICES OF HEARINGS.

17. EXECUTE BOARD DIRECTIVES.

18. REPRESENT THE BOARD WITH THE FEDERAL GOVERNMENT, OTHER STATES AND JURISDICTIONS OF THE UNITED STATES, THIS STATE, POLITICAL SUBDIVISIONS OF THIS STATE, THE NEWS MEDIA AND THE PUBLIC.

11. 19. Perform any other duty required by the board.

Sec. 4. Section 32-1822, Arizona Revised Statutes, is amended to read:

32-1822 . Qualifications of applicant; application; fees

A. An applicant for licensure shall:

1. Be a citizen of the United States or a resident alien.

2. Be a graduate of a board approved school of osteopathic medicine.

3. Submit to the board the following:

(a) THE APPLICANT'S FULL NAME AND ALL ALIASES AND OTHER NAMES EVER USED, CURRENT ADDRESS, SOCIAL SECURITY NUMBER AND DATE AND PLACE OF BIRTH.

(b) A RECENT PHOTOGRAPH SIGNED BY THE APPLICANT.

(c) THE ORIGINALS OF ALL DOCUMENTS AND CREDENTIALS REQUIRED BY THE BOARD OR NOTARIZED PHOTOCOPIES OR OTHER VERIFICATION ACCEPTABLE TO THE BOARD OF THESE DOCUMENTS AND CREDENTIALS.

(a) (d) Affidavits from three physicians and surgeons who are in active practice and who can attest to the applicant's fitness to practice medicine and surgery as an osteopathic physician and surgeon and submit to any other investigation deemed necessary by the board.

(b) (e) A diploma conferring the degree of doctor of osteopathy or doctor of osteopathic medicine that was issued by a board approved school of medicine that at the time it issued the degree met the requirements prescribed by the American osteopathic association for that year. If the applicant cannot find the diploma the applicant shall submit proof satisfactory to the board that the applicant received a degree that meets these requirements.

(c) (f) Proof that the applicant has served a board approved internship of at least one year or an approved residency or the equivalent as determined by the board.

(d) (g) A verified application, upon forms furnished by the board, stating, in addition to other information requested, that the applicant is the person named in the diploma, that the applicant obtained the diploma without fraud or misrepresentation and that the applicant's license to practice medicine and surgery as an osteopathic physician and surgeon has never been revoked, suspended or denied by any regulatory jurisdiction within the United States or in any other country.

4. Successfully pass an examination approved by the board or possess a currently active and unrestricted license to practice as an osteopathic physician and surgeon issued under the authority of any state, district or territory that has standards that are comparable to those prescribed in this chapter.

5. Submit with the application the application fee prescribed in section 32-1826 and pay the prescribed license fee to the board at the time the license is issued. All fees shall be paid by certified check, by money order or by cash.

6. Receive a score of at least seventy-five per cent on an examination prescribed by the board that covers this chapter and board rules.

B. The board may require an applicant to submit to a personal interview, a physical examination or a mental evaluation or any combination of these at a reasonable time and place as prescribed by the board if the board determines that this is necessary to provide the board adequate information regarding the applicant's ability to meet the licensure requirements of this chapter. An interview may include medical knowledge questions and other matters that are relevant to licensure.

C. The board may deny a license for any unprofessional conduct THAT WOULD CONSTITUTE GROUNDS FOR DISCIPLINARY ACTION PURSUANT TO THIS CHAPTER AND AS DETERMINED BY A COMPETENT DOMESTIC OR FOREIGN JURISDICTION .

D. The board may issue a license that is contingent on the applicant entering into a stipulated order that may include a period of probation or a restriction on the licensee's practice.

E. The executive director may issue licenses to applicants who meet the requirements of this section.

F. A person who has had his license revoked OR DENIED may apply for licensure two years after the revocation OR DENIAL .

Sec. 5. Section 32-1825, Arizona Revised Statutes, is amended to read:

32-1825 . Renewal of licenses; continuing medical education; failure to renew; penalty; reinstatement; waiver of continuing medical education

A. Each licensee shall renew the license before January 1 every two years YEAR . At least sixty days before that date the executive director shall notify each licensee whose license is up for renewal of this requirement. The executive director shall send this notification by first class mail to the licensee at the address the licensee last provided to the executive director.

B. The licensee shall furnish to the executive director a statement of having attended , within each of the two calendar years prior to the renewal date, educational programs, approved by the board, totaling at least twenty clock hours and shall pay to the board the prescribed annual renewal fee for each year . The executive director shall then issue a renewal receipt to the licensee. The board may require a licensee to submit documentation of continuing medical education.

C. The board shall not renew the license of a licensee who does not fully document the licensee's compliance with the continuing education requirements of subsection A B of this section unless that person receives a waiver of those requirements. The board may waive the continuing education requirements of subsection A B of this section for a particular twelve month period if it is satisfied that the licensee's noncompliance was due to the licensee's disability, military service or absence from the United States or to other circumstances beyond the control of the licensee. If a licensee fails to attend the required number of clock hours for reasons other than those specified in this subsection, the board may grant an extension of time of not to exceed one hundred twenty days UNTIL MAY 1 OF THAT YEAR for the licensee to comply.

D. Unless the board grants an extension pursuant to subsection C of this section, a licensee who fails to renew the license before February 1 shall pay a penalty fee in addition to the prescribed renewal fee. Failure to renew a license on or before April 1 results in expiration of the license except as provided in section 32-3202. A person who practices osteopathic medicine after that time is in violation of this chapter. A person whose license expires may reapply for a license pursuant to this chapter.

Sec. 6. Section 32-1826, Arizona Revised Statutes, is amended to read:

32-1826 . Fees; penalty

A. The board shall by a formal vote at its annual January meeting establish fees of not to exceed the following:

1. For an application to practice osteopathic medicine, three hundred dollars.

2. For issuance of a license, one hundred dollars.

3. For renewal of a license, three hundred dollars per year.

4. For locum tenens registration, two hundred dollars.

5. FOR ISSUANCE OF A DUPLICATE LICENSE, FIFTY DOLLARS.

6. FOR ANNUAL REGISTRATION OF AN APPROVED INTERNSHIP, RESIDENCY, CLINICAL FELLOWSHIP PROGRAM OR SHORT-TERM RESIDENCY PROGRAM, FIFTY DOLLARS.

7. FOR AN ANNUAL TEACHING LICENSE AT AN APPROVED SCHOOL OF MEDICINE OR AT AN APPROVED TEACHING HOSPITAL'S ACCREDITED GRADUATE MEDICAL EDUCATION PROGRAM, THREE HUNDRED DOLLARS.

8. FOR A FIVE DAY EDUCATIONAL TEACHING PERMIT AT AN APPROVED SCHOOL OF MEDICINE OR AT AN APPROVED TEACHING HOSPITAL'S ACCREDITED GRADUATE MEDICAL EDUCATION PROGRAM, ONE HUNDRED DOLLARS.

9. FOR THE SALE OF THOSE COPIES OF THE ANNUAL OSTEOPATHIC MEDICAL DIRECTORY THAT ARE NOT DISTRIBUTED FREE OF CHARGE, THIRTY DOLLARS.

10. FOR THE SALE OF COMPUTERIZED TAPES OR DISKETTES THAT DO NOT REQUIRE PROGRAMMING, ONE HUNDRED DOLLARS.

11. FOR INITIAL AND ANNUAL REGISTRATION TO DISPENSE DRUGS AND DEVICES, TWO HUNDRED DOLLARS.

B. The board shall charge a one hundred fifty dollar penalty fee for late renewal of a license.

C. The board may charge additional fees for services the board determines are necessary and appropriate to carry out the provisions of this chapter. These fees shall not exceed the actual cost of providing the services.

Sec. 7. Title 32, chapter 17, article 2, Arizona Revised Statutes, is amended by adding sections 32-1828, 32-1829 and 32-1830, to read:

32-1828 . Education teaching permits

A. THE DEAN OF A BOARD APPROVED SCHOOL OF OSTEOPATHIC MEDICINE OR THE CHAIRMAN OF A TEACHING HOSPITAL'S ACCREDITED GRADUATE MEDICAL EDUCATION PROGRAM MAY INVITE A DOCTOR OF OSTEOPATHY WHO IS NOT LICENSED IN THIS STATE TO DEMONSTRATE AND PERFORM MEDICAL PROCEDURES AND SURGICAL TECHNIQUES FOR THE SOLE PURPOSE OF PROMOTING PROFESSIONAL EDUCATION FOR STUDENTS, INTERNS, RESIDENTS, FELLOWS AND DOCTORS OF OSTEOPATHY IN THIS STATE.

B. THE CHAIRMAN OR DEAN OF THE INVITING INSTITUTION SHALL PROVIDE TO THE BOARD EVIDENCE THAT AN APPLICANT FOR AN EDUCATIONAL PERMIT HAS MALPRACTICE INSURANCE IN AN AMOUNT THAT MEETS THE REQUIREMENTS OF THAT INSTITUTION AND THAT THE APPLICANT ACCEPTS ALL RESPONSIBILITY AND LIABILITY FOR THE PROCEDURES THE APPLICANT PERFORMS WITHIN THE SCOPE OF THE APPLICANT'S PERMIT.

C. IN A LETTER TO THE BOARD, THE CHAIRMAN OR DEAN OF THE INVITING INSTITUTION SHALL OUTLINE THE PROCEDURES AND TECHNIQUES THAT THE DOCTOR OF MEDICINE WILL PERFORM OR DEMONSTRATE AND THE DATES THAT THIS ACTIVITY WILL OCCUR. THE LETTER SHALL ALSO INCLUDE A SUMMARY OF THE DOCTOR OF OSTEOPATHY'S EDUCATION AND PROFESSIONAL BACKGROUND AND SHALL BE ACCOMPANIED BY THE FEE REQUIRED PURSUANT TO THIS CHAPTER.

D. THE INVITING INSTITUTIONS SHALL SUBMIT THE FEES AND DOCUMENTS REQUIRED PURSUANT TO THIS SECTION NO LATER THAN TWO WEEKS BEFORE THE SCHEDULED ACTIVITY.

E. THE BOARD THROUGH ITS STAFF SHALL ISSUE AN EDUCATIONAL TEACHING PERMIT FOR NOT MORE THAN FIVE DAYS FOR EACH APPROVED ACTIVITY.

32-1829 . Training permits; short-term permits

A. THE BOARD SHALL GRANT A ONE YEAR RENEWABLE TRAINING PERMIT TO A PERSON PARTICIPATING IN A TEACHING HOSPITAL'S ACCREDITED INTERNSHIP, RESIDENCY OR CLINICAL FELLOWSHIP TRAINING PROGRAM TO ALLOW THAT PERSON TO FUNCTION ONLY IN THE SUPERVISED SETTING OF THAT PROGRAM. BEFORE THE BOARD ISSUES THE PERMIT THE PERSON SHALL COMPLY WITH THE APPLICABLE REGISTRATION REQUIREMENTS OF THIS ARTICLE AND PAY THE FEE PRESCRIBED IN THIS CHAPTER.

B. IF A PERSON WHO IS PARTICIPATING IN A TEACHING HOSPITAL'S ACCREDITED INTERNSHIP, RESIDENCY OR CLINICAL FELLOWSHIP TRAINING PROGRAM MUST REPEAT OR MAKE UP TIME IN THE PROGRAM DUE TO RESIDENT PROGRESSION OR FOR OTHER REASONS, THE BOARD MAY GRANT THAT PERSON A TRAINING PERMIT IF REQUESTED TO DO SO BY THE PROGRAM'S DIRECTOR OF MEDICAL EDUCATION OR A PERSON WHO HOLDS AN EQUIVALENT POSITION. THE PERMIT LIMITS THE PERMITTEE TO PRACTICING ONLY IN THE SUPERVISED SETTING OF THAT PROGRAM.

C. THE BOARD SHALL GRANT A TRAINING PERMIT TO A PERSON WHO IS NOT LICENSED IN THIS STATE AND WHO IS PARTICIPATING IN A SHORT-TERM TRAINING PROGRAM OF FOUR MONTHS OR LESS CONDUCTED IN AN APPROVED SCHOOL OF OSTEOPATHIC MEDICINE OR A HOSPITAL THAT HAS AN ACCREDITED HOSPITAL INTERNSHIP, RESIDENCY OR CLINICAL FELLOWSHIP TRAINING PROGRAM IN THIS STATE FOR THE PURPOSE OF CONTINUING MEDICAL EDUCATION. BEFORE THE BOARD ISSUES THE PERMIT THE PERSON SHALL COMPLY WITH THE APPLICABLE REGISTRATION REQUIREMENTS OF THIS ARTICLE AND PAY THE FEE PRESCRIBED IN THIS CHAPTER.

D. A PERMITTEE IS SUBJECT TO THE DISCIPLINARY PROVISIONS OF THIS CHAPTER.

32-1830 . Training permits; approved schools

THE EXECUTIVE DIRECTOR MAY GRANT A ONE YEAR TRAINING PERMIT TO A PERSON WHO:

1. PARTICIPATES IN A PROGRAM AT AN APPROVED SCHOOL OF MEDICINE OR A HOSPITAL THAT HAS AN APPROVED HOSPITAL INTERNSHIP, RESIDENCY OR CLINICAL FELLOWSHIP TRAINING PROGRAM IF THE PURPOSE OF THE PROGRAM IS TO EXCHANGE TECHNICAL AND EDUCATIONAL INFORMATION.

2. PAYS THE FEE AS PRESCRIBED IN THIS ARTICLE.

3. SUBMITS A WRITTEN STATEMENT FROM THE DEAN OF THE APPROVED SCHOOL OF OSTEOPATHIC MEDICINE OR FROM THE CHAIRMAN OF A TEACHING HOSPITAL'S ACCREDITED GRADUATE MEDICAL EDUCATION PROGRAM THAT:

(a) INCLUDES A REQUEST FOR THE PERMIT AND DESCRIBES THE PURPOSE OF THE EXCHANGE PROGRAM.

(b) SPECIFIES THAT THE HOST INSTITUTION SHALL PROVIDE LIABILITY COVERAGE.

(c) PROVIDES PROOF THAT A DOCTOR OF MEDICINE WILL SERVE AS THE PRECEPTOR OF THE HOST INSTITUTION AND PROVIDE APPROPRIATE SUPERVISION OF THE PARTICIPANT.

(d) STATES THAT THE HOST INSTITUTION HAS ADVISED THE PARTICIPANT THAT THE PARTICIPANT MAY SERVE AS A MEMBER OF AN ORGANIZED MEDICAL TEAM BUT SHALL NOT PRACTICE MEDICINE INDEPENDENTLY AND THAT THIS TRAINING DOES NOT ACCRUE TOWARD POSTGRADUATE TRAINING REQUIREMENTS FOR LICENSURE.

Sec. 8. Section 32-1854, Arizona Revised Statutes, is amended to read:

32-1854 . Definition of unprofessional conduct

"Unprofessional conduct" includes the following acts, whether occurring in this state or elsewhere:

1. Wilfully betraying a professional secret or wilfully violating a privileged communication except as either of these may otherwise be required by law. This paragraph does not prevent members of the board from exchanging information with the licensing and disciplinary boards of other states, territories or districts of the United States or with foreign countries or with osteopathic medical organizations located in this state or in any state, district or territory of this country or in any foreign country.

2. Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case conviction by any court of competent jurisdiction is conclusive evidence of the commission.

3. Practicing medicine while under the influence of alcohol, narcotic or hypnotic drugs or any substance that impairs or may impair the licensee's ability to safely and skillfully practice medicine.

4. Being diagnosed by a physician licensed under this chapter or chapter 13 of this title or a psychologist licensed under chapter 19.1 of this title as excessively or illegally using alcohol or a controlled substance.

5. Prescribing, dispensing or administering controlled substances or prescription only drugs for other than accepted therapeutic purposes.

6. Engaging in the practice of medicine in a manner that harms or may harm a patient or that the board determines falls below the community standard.

7. Impersonating another physician.

8. Acting or assuming to act as a member of the board if this is not true.

9. Procuring or attempting to procure a license to practice osteopathic medicine by fraud or misrepresentation.

10. Having professional connection with or lending one's name to an illegal practitioner of osteopathic medicine or any of the other healing arts.

11. Representing that a manifestly incurable disease, injury, ailment or infirmity can be permanently cured or that a curable disease, injury, ailment or infirmity can be cured within a stated time, if this is not true.

12. Failing to reasonably disclose and inform the patient or the patient's representative of the method, device or instrumentality the licensee uses to treat the patient's disease, injury, ailment or infirmity.

13. Refusing to divulge to the board upon demand the means, method, device or instrumentality used in the treatment of a disease, injury, ailment or infirmity.

14. Charging a fee for services not rendered or dividing a professional fee for patient referrals.

15. Knowingly making any false or fraudulent statement, written or oral, in connection with the practice of medicine except as the same may be necessary for accepted therapeutic purposes.

16. Advertising in a false, deceptive or misleading manner.

17. Representing or holding oneself out as being an osteopathic medical specialist if the physician has not satisfied the applicable requirements of this chapter or board rules.

18. The refusal, revocation or suspension of a license by any other state, territory, district or country, unless it can be shown that this occurred for reasons that did not relate to the person's ability to safely and skillfully practice osteopathic medicine or to any act of unprofessional conduct as provided in this section.

19. Any conduct or practice contrary to recognized standards of ethics of the osteopathic medical profession.

20. Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any of the provisions of this chapter.

21. Failing or refusing to maintain adequate records on a patient.

22. Using controlled substances or prescription-only drugs unless they are provided by a medical practitioner, as defined in section 32-1901, as part of a lawful course of treatment.

23. Prescribing controlled substances to members of one's immediate family unless there is no other physician available within fifty miles to treat a member of the family and an emergency exists.

24. Prescribing, dispensing or administering schedule II controlled substances as defined in section 36-2513 including amphetamines and similar schedule II sympathomimetic drugs in the treatment of exogenous obesity for a period in excess of thirty days in any one year.

25. Nontherapeutic use of injectable amphetamines.

26. Violating a formal order, probation or a stipulation issued by the board under this chapter.

27. Charging or collecting an inappropriate fee. This paragraph does not apply to a fee which is fixed in a written contract between the physician and the patient and entered into before treatment begins.

28. Using experimental forms of therapy without adequate informed patient consent or without conforming to generally accepted criteria and complying with federal and state statutes and regulations governing experimental therapies.

29. Failing to make patient medical records in the physician's possession promptly available to a physician assistant, a nurse practitioner, a person licensed pursuant to this chapter or a podiatrist, chiropractor, naturopathic physician, a physician licensed under chapter 13, or homeopathic physician licensed under chapter 7, 8, 13, 14 or 29 of this title on receipt of proper authorization to do so from the patient, a minor patient's parent, the patient's legal guardian or the patient's authorized representative or failing to comply with title 12, chapter 13, article 7.1.

30. Failing to allow properly authorized board personnel to have, on demand, access to any documents, reports or records maintained by the physician relating to his medical practice or medically related activities pursuant to section 32-1855.01.

31. Signing a blank, undated or predated prescription form.

32. Obtaining a fee by fraud, deceit or misrepresentation.

33. Falsely claiming attendance at continuing medical education programs to meet license renewal requirements.

34. Failing to report to the board an osteopathic physician and surgeon who is or may be guilty of unprofessional conduct or is or may be mentally or physically unable safely to engage in the practice of medicine.

35. Referring a patient to a diagnostic or treatment facility or prescribing goods and services without disclosing that the physician has a direct pecuniary interest in the facility, goods or services to which the patient has been referred or prescribed. This paragraph does not apply to a referral by one physician to another physician within a group of physicians practicing together.

36. Lack of or inappropriate direction, collaboration or supervision of a licensed, certified or registered health care provider or office personnel employed by or assigned to the physician in the medical care of patients.

37. Violating a federal law, a state law or a rule applicable to the practice of medicine.

38. Prescribing or dispensing controlled substances or prescription-only medications without maintaining adequate and appropriate patient records.

39. Failing to dispense drugs and devices in compliance with article 4 of this chapter.

40. Any conduct or practice that endangers a patient's or the public's health or may reasonably be expected to do so.

41. Any conduct or practice that impairs the licensee's ability to safely and skillfully practice medicine or that may reasonably be expected to do so.

42. With the exception of heavy metal poisoning, using chelation therapy in the treatment of arteriosclerosis or as any other form of therapy without adequate informed patient consent and without conforming to generally accepted experimental criteria, including protocols, detailed records, periodic analysis of results and periodic review by a medical peer review committee.

43. Prescribing, dispensing or administering anabolic-androgenic steroids to a person for other than therapeutic purposes.

44. Sexual intimacies with a patient.

45. Fetal experiments conducted in violation of section 36-2302.

46. Conduct that the board determines constitutes gross negligence, repeated negligence or negligence that results in harm or death of a patient.

47. CONDUCT IN THE PRACTICE OF MEDICINE WHICH EVIDENCES MORAL UNFITNESS TO PRACTICE MEDICINE.

48. WILLFULLY HARASSING, ABUSING OR INTIMIDATING A PATIENT EITHER PHYSICALLY OR VERBALLY.

Sec. 9. Requirements for enactment

Pursuant to article IX, section 22, Constitution of Arizona, this act is effective only on the affirmative vote of at least two-thirds of the members of each house of the legislature and is effective immediately on the signature of the governor or, if the governor vetoes this act, on the subsequent affirmative vote of at least three-fourths of the members of each house of the legislature.

APPROVED BY THE GOVERNOR MAY 29, 1998.

FILED IN THE OFFICE OF THE SECRETARY OF STATE JUNE 2, 1998.