Archives > 1976 South Carolina Code of Laws - Previous Versions > 2005 Session > Title 40

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Title 40 - Professions and Occupations

CHAPTER 47.

PHYSICIANS, SURGEONS AND OSTEOPATHS

ARTICLE 1.

GENERAL PROVISIONS

SECTION 40-47-5. "Physician" or "surgeon" defined.

As used in this chapter, "physician" or "surgeon" shall mean a doctor of medicine.

SECTION 40-47-10. State Board of Medical Examiners; appointment, terms and vacancies.

There is created the State Board of Medical Examiners to be composed of twelve members, three of whom must be lay members, one of whom must be a doctor of osteopathy, two of whom must be physicians or surgeons from the State-at-large, and six of whom must be physicians or surgeons representing each of six congressional districts. All members of the board must be residents of this State, and each member representing a congressional district shall reside in the district the member represents. All physician members of the board must be licensed by the board and must be practicing their profession in South Carolina.

The members of the board shall serve for terms of four years or until their successors are appointed and qualify.

The members of the board are limited to two terms. All members of the board have full voting rights.

One lay member and one physician or surgeon from the State-at-large must be appointed by the Governor, with the advice and consent of the Senate. The board shall conduct an election to nominate one physician or surgeon from the State-at-large. The election must provide for participation by all physicians or surgeons currently licensed and residing in South Carolina. To nominate the physicians or surgeons who will represent the six congressional districts the board shall conduct an election within each district. These elections must provide for participation by all licensed physicians residing in the particular district. The board shall conduct an election to nominate the doctor of osteopathy from the State-at-large, and this election must provide for participation by any physician currently licensed in South Carolina as a doctor of osteopathy. The board shall certify in writing to the Governor the results of each election. The Governor may reject any or all of the nominees upon satisfactory showing of the unfitness of those rejected. If the Governor declines to appoint any of the nominees submitted, additional nominees must be submitted in the same manner following another election. Vacancies must be filled in a like manner by appointment by the Governor, with the advice and consent of the Senate, for the unexpired portion of the term.

The Governor may remove a member of the board who is guilty of continued neglect of board duties or who is found to be incompetent, unprofessional, or dishonorable. No member may be removed without first giving the member an opportunity to refute the charges filed against the member. The member must be given a copy of the charges at the time they are filed.

In addition to the above members of the board, the Governor, with the advice and consent of the Senate, shall appoint two lay members, one upon the recommendation of the President Pro Tempore of the Senate and one upon the recommendation of the Speaker of the House of Representatives. Lay members must be residents of this State, must have a baccalaureate degree or higher, must not be employed in, or have a member of their immediate family employed in, a health or medically related field, and must not have been convicted of a felony or a crime of moral turpitude. These lay members shall serve for terms of four years and until their successors are appointed and qualify. Vacancies in these two offices must be filled in the manner of original appointment.

SECTION 40-47-20. Meetings; officers; rules and regulations; quorum.

The State Board of Medical Examiners shall meet at least twice a year at such time and place as determined by the Board. The Board shall hold elections for its officers each year. The Board may call additional meetings when necessary for the transaction of Board business. The Board shall adopt rules and regulations for its government, for the practice of medicine and for the practice of osteopathy, for judging the professional and ethical competence of physicians and surgeons including a code of medical ethics, and for the discipline of physicians and surgeons (medical and osteopathic). A majority of the Board shall constitute a quorum for the transaction of business.

SECTION 40-47-25. Representation of physicians' assistants at meetings of Board.

(A) A representative of the South Carolina Academy of Physicians' Assistants has the privilege of attendance at all meetings of the State Board of Medical Examiners (board) and must be permitted to speak to matters affecting physicians' assistants. However, this representative is not a member of the board and is not entitled to vote.

(B) The board shall explore the possibility of administering its own examination for purposes of determining a physician's assistant's competency before issuing a temporary or permanent certificate. The board may impose an examination fee to cover the costs and expenses of administering this examination.

SECTION 40-47-30. Compensation of members of Board and persons engaged in its business.

Members of the Board and persons authorized by the Board, engaged in business for the Board, shall receive for their services a per diem as determined by the Board, and travel expenses as provided by law for State boards, committees and commissions. Such compensation shall be paid from Board funds.

SECTION 40-47-40. "Practice of medicine" defined.

Any person shall be regarded as practicing medicine within the meaning of this article who (a) shall as a business treat, operate on or prescribe for any physical ailment of another, (b) shall engage in any branch or specialty of the healing art or (c) shall diagnose, cure, relieve in any degree or profess or attempt to diagnose, cure or relieve any human disease, ailment, defect, abnormality or complaint, whether of physical or mental origin, by attendance or advice, by prescribing, using or furnishing any drug, appliance, manipulation, adjustment or method or by any therapeutic agent whatsoever.

SECTION 40-47-50. "Osteopathy" defined; examination and certificate to practice; use of letters D.O.

(A) "Osteopathy" is defined as a complete school of medicine and surgery utilizing all methods of diagnosis and treatment in health and disease and placing special emphasis on the interrelationship of the musculo-skeletal system to all other body systems.

(B) A person is eligible for examination before the board before or after completing a board-approved one-year internship if the person:

(1) holds a diploma from an osteopathic college approved by the American Osteopathic Association;

(2) gives evidence of completing at least three years' preprofessional education in an accredited college or university; and

(3) has attended an osteopathic college for four full courses of lectures of at least thirty-six weeks each or any combination of these courses aggregating one hundred and forty-four weeks.

A person who successfully passes the examination is eligible for a temporary certificate to practice osteopathy which is good for one year. At the end of one year, if the person has completed a one-year internship, the person is eligible for a certificate to practice osteopathy.

(C) Doctors of osteopathy shall use only the letters D.O. after their names when used in connection with their profession.

SECTION 40-47-60. Practice of medicine or osteopathy restricted.

No person shall practice medicine, surgery or osteopathy within the State unless he is twenty-one years of age and has been authorized so to do pursuant to the provisions of this article. But nothing in this article shall be construed:

(1) To prohibit service in cases of emergency or the domestic administration of family remedies;

(2) To apply to those who practice the religious tenets of their church without pretending a knowledge of medicine or surgery if the laws, rules and regulations relating to contagious diseases and sanitary matters are not violated; or

(3) To prohibit licensed druggists from selling, using and dispensing drugs in their places of business, respectively.

(4) To apply to any act, task or function performed by an assistant to a physician certified by the Board of Medical Examiners, provided that (a) such assistant is approved and certified by the Board as one qualified by training or experience to function as an assistant to a specified physician or a specified physicians' group or professional association; and (b) such act, task or function is performed at the direction and under the supervision of such physician, or physicians' group or professional association, in accordance with rules and regulations promulgated by the Board. Provided, however, that under no circumstances will these physicians' assistants nor optometrists' assistants be allowed to make a refraction for glasses or give a contact lens fitting.

(5) To prohibit a licensed physician from delegating tasks to unlicensed personnel in his employ and on his premises if:

a. the task is of a routine nature involving neither the special skill of a licensed person nor significant risk to the patient if improperly done;

b. the task is performed while the physician is present on the premises and in such close proximity as to be readily available to the unlicensed person if needed;

c. the task does not involve the verbal transmission of a physician's order or prescription to a licensed person if the licensed person requires the order or prescription to be in writing;

d. the unlicensed person wears an appropriate badge denoting to any patient his status.

SECTION 40-47-65. Restrictions on dispensing amphetamine substances.

(1) Amphetamine, methamphetamine, phenmetrazine, their salts and isomers, as identified in Section 44-53-210, Schedule II, hereafter referred to as "the assigned drugs", shall not be dispensed or prescribed except as provided in this section. A departure from these provisions is deemed to constitute an act of professional misconduct subject to discipline under Section 40-47-200.

(2) A physician, medical or osteopathic, shall not dispense or prescribe the assigned drugs without taking into account the high potential for abuse of such drugs, the possibility that such drugs may lead to severe psychic or physical dependence, the possibility that the patient will obtain the drug for a nontherapeutic use or distribution to others, and the existence of extensive abuse and an illicit market for such drugs. The physician shall note on his records the purpose for which the assigned drugs are prescribed. In no event shall there be a prescription for the purpose of treating obesity.

(3) The assigned drugs shall not be dispensed or prescribed in the treatment of a hyperkinetic child syndrome prior to the taking of a complete history and physical examination.

(4) A sufficient history and physical examination and appropriate diagnostic studies of a patient shall be taken to establish that the condition exists prior to dispensing or prescribing the assigned drugs in the treatment of narcolepsy. The findings upon which the diagnosis of narcolepsy was made shall be entered in the patient's record.

(5) A physician, medical or ostopathic, may apply for a written waiver of the requirements of this section by submitting a written request to the Board. The request shall include all information necessary for a comprehensive evaluation of its merit. If the physician, medical or ostopathic, requesting the waiver demonstrates to the satisfaction of the Board that a waiver would further legitimize medical purposes without undermining the purposes of this section, the Board may issue a written waiver with such terms and conditions as may be deemed appropriate.

(6) This section shall not be construed to endorse the use of the assigned drugs in the treatment of obesity nor shall it be construed to diminish a physician's, medical or ostopathic, responsibility to comply with those standards of medical practice in the dispensing or prescribing of the assigned drugs which are not set forth in this section.

SECTIONS 40-47-70, 40-47-75. Repealed by 2005 Act No. 10, Section 4, eff January 13, 2005.

SECTIONS 40-47-70, 40-47-75. Repealed by 2005 Act No. 10, Section 4, eff January 13, 2005.

SECTION 40-47-80. Temporary licenses and limited certificates.

The Board shall have the power to issue temporary licenses and limited certificates to practice medicine and to practice osteopathy to any physician who meets the requirements as set by the Board. A temporary license or a limited certificate may be cancelled upon notice from the Board.

SECTION 40-47-90. Eligibility for examination.

No person is eligible to appear before the board for examination unless the person has given evidence of preliminary and medical education as may be prescribed by the board or as defined by law.

SECTION 40-47-95. Board of Medical Examiners to promulgate regulations with respect to special license for retired physicians for volunteer service.

The South Carolina Board of Medical Examiners shall promulgate regulations, no later than November 1, 1992, outlining qualifications for the issuance of a special class of license for physicians who are retired from active practice and wish to donate their expertise for the care and treatment of needy patients or patients in underserved areas.

SECTION 40-47-97. Athletic team physician licensed in another jurisdiction.

(A) A physician licensed in another state, territory, or other jurisdiction of the United States or of any other nation or foreign jurisdiction is exempt from the requirements of licensure in this State, if the physician:

(1) holds an active license to practice in the other jurisdiction;

(2) engages in the active practice of medicine in the other jurisdiction; and

(3) is employed or designated as the team physician by an athletic team visiting the State for a specific sporting event.

(B) A physician's practice under this section is limited to the members, coaches, and staff of the team by which the physician is employed or designated. A physician practicing in this State under the authority of this section does not have practice privileges in any licensed health care facility and is not authorized to issue orders or prescriptions or to order testing at a medical facility in this State.

SECTION 40-47-100. Special provisions for certain persons licensed to practice healing arts prior to January 1, 1956.

Any person who is, and was on January 1, 1963, duly licensed by the State of South Carolina to operate a nursing home for the chronically ill and the infirm and who had immediately prior to said date continuously operated a hospital or nursing home for a period of at least seven years, and who was duly licensed by this State to practice the healing arts eighteen years prior to January 1, 1956, and who is qualified and experienced in the practice of eclectic medicine and who has a diploma certifying that he is a graduate of a recognized institution teaching eclecticism, shall be and he is hereby licensed to practice eclectic medicine in this State. Provided, that no such person shall perform major surgery.

SECTION 40-47-110. Examination fee.

Each applicant, before being allowed to take the examination, shall pay to the treasurer of the Board a fee, to be fixed by the Board at an amount which, with other available resources of the Board, will fully cover the cost of the examination, including the compensation and expenses of members of the examining board.

SECTION 40-47-120. Examinations; certificates of qualification.

The Board, when organized, shall examine all candidates for examination, as herein provided, and shall pass upon their qualifications and fitness to practice medicine or osteopathy in this State and give each successful applicant a temporary certificate to practice medicine or osteopathy which shall be good for one year. At the end of one year, if he has also completed all of his other requirements, he shall be eligible for a permanent certificate to practice medicine or osteopathy. The osteopathic member of the Board shall participate in Board action only in relation to the examination and licensing of doctors of osteopathy.

SECTION 40-47-130. Subjects and conduct of examination.

For each examination the Board shall present suitable questions and testing material for thoroughly testing the knowledge and ability of the applicants in such subjects as are approved by the Board. The examinations conducted by the Board may be written or as otherwise prescribed by the Board. All applicants shall be examined by number only; neither names nor schools of practice shall be known to the examiners.

SECTION 40-47-140. Standards to be attained on examination.

(A) The board by regulation shall establish minimum standards of performance to be attained on examinations for an applicant to qualify for a license.

(B) For FLEX examinations taken before June 1, 1985, the following standards apply:

An applicant for permanent licensure shall obtain, in one sitting, a FLEX weighted average score of at least seventy-five on the examination.

(C) For FLEX examinations taken after June 1, 1985, the following standards apply:

An applicant for permanent licensure shall obtain a score of seventy-five or more on both Component I and Component II. An applicant shall pass both components within five years of the first taking of any component of this examination.

(D) For the SPEX (Special Purpose) and COMVEX examinations, the following standards apply:

An applicant for permanent licensure who has not passed national boards, FLEX, SPEX, COMVEX, or been certified, recertified, or awarded a certificate of added qualifications by a specialty board recognized by the American Board of Medical Specialities or the American Osteopathic Association within ten years of the date of filing the application with this board shall pass the SPEX or COMVEX exam. A passing score on the SPEX examination is seventy-five or better. A passing score on the COMVEX examination must be established by the testing agency. This requirement is in addition to all other requirements for licensure. The SPEX or COMVEX examination requirement does not apply to a physician employed full time by the South Carolina Department of Corrections, South Carolina Department of Health and Environmental Control, State Department of Mental Health, and Department of Disabilities and Special Needs acting within the scope of his employment. A license issued to this physician is revoked immediately if he leaves the full-time employment or acts outside his scope of employment. However, the SPEX or COMVEX examination requirement applies to a physician providing services under a contract for the State and a physician providing services for which there is an expectation of payment, is payment for services, or should have been payment from a source other than the salary the physician receives from the State.

SECTION 40-47-150. Reexamination.

In case of failure at any examination, the applicant shall have the privilege of a second examination with the payment of the regular fee. In case of failure in a second examination the applicant, to be eligible, in addition to the requirements for previous examinations, must have pursued his studies for such time as the Board may approve and furnish satisfactory evidence thereof.

If the applicant has not met the Board's criteria for passing the examination after three takings, he shall not be permitted to retake the examination and any score received after three takings shall not be considered except by special permission of the Board. It shall be the responsibility of the applicant to demonstrate special or compelling circumstances in order to have a fourth taking considered. A petition for special permission shall be filed with the Board setting forth in detail the special or compelling circumstances the applicant wishes the Board to consider. These special or compelling circumstances include, but are not limited to, the following:

(1) the applicant's successful completion of additional medical education in an American Medical Association approved medical school;

(2) the applicant's score on the third examination and its closeness to the passing score required by the Board; or

(3) other special or compelling factors presented by the applicant to the Board.

If an individual is granted special permission to have the results of a fourth taking of the examination considered and he still has not passed the examination as required by the Board, no further attempts at or scores from the examination shall be considered by the Board.

SECTION 40-47-155. Further conditions under which Board to issue license.

The South Carolina Board of Medical Examiners shall review and issue, at the board's discretion and subject to the provisions in this subsection, a license to practice medicine to an applicant who has passed all required examinations, irrespective of the number of times an exam was taken or the time frame within which the applicant successfully passed the examinations, if the applicant otherwise qualifies for licensure; and

(1) has been licensed to practice medicine in another state in the United States;

(2) has not had his license revoked, suspended, or restricted in this State or another state and has no disciplinary matters pending in this State or any other state;

(3) holds certification by a specialty board recognized by either the American Board of Medical Specialties or the American Osteopathic Association; and

(4) has undertaken to establish himself in a rural area of this State.

SECTION 40-47-160. Reciprocal certification.

(A) The board may grant or refuse certifications to licentiates of the National Board of Medical Examiners, the Medical Council of Canada, or of the National Board of Examiners for Osteopathic Physicians and Surgeons without further examination and may make and establish all necessary rules and regulations for the reciprocal recognition of certificates issued by other state boards having an equal standing. This section applies only to doctors of osteopathy who graduated after January 1, 1955, from a school approved by the American Osteopathic Association and who now hold unlimited license. Graduates before January 1, 1955, may make application and appear before the Board of Medical Examiners for interview, with each applicant considered for approval on the basis of his training and experience.

(B) The State Board of Medical Examiners may not grant reciprocity or issue a limited or temporary or permanent license to a licensed physician or an intern of another state of the United States who applies for licensure after May 31, 1985, and:

(1) whose license is currently restricted in any way or who is currently on a probationary status in that state; or

(2) who currently has disciplinary action pending against him in that state.

SECTION 40-47-165. Effect of disciplinary sanctions imposed by other states on physicians who have applied for or been granted limited or temporary licenses.

Notwithstanding any other provisions of this chapter, if a physician has applied for or been granted a limited or temporary license in South Carolina prior to December 31, 1984, and has been sanctioned by another state, that physician's license in South Carolina must be limited, at minimum, by the same disciplinary conditions or restrictions imposed by the previous disciplining state.

SECTION 40-47-170. Review of action of Board.

Any action of the board relating to the granting, refusal or cancellation of a license, or any other official action of the board relating to a license or licensee hereunder, shall be subject to review by an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 on the record of the board, as in certiorari, upon petition of the applicant or licensee within ten days from receipt of official notice from the board of the action of which review is sought. Service of such notice shall be conclusively presumed ten days after mailing by registered or certified mail to such applicant or licensee of such notice at such person's last known address.

SECTION 40-47-180. Rights of persons licensed as osteopaths under Chapter 19 of Title 56 of Code of Laws of South Carolina, 1962, not diminished.

Nothing in this article shall change or diminish practice rights of those licensed as osteopaths under Chapter 19 of Title 56 of Code of Laws of South Carolina, 1962. All persons holding a valid certificate of this State to practice osteopathy under Chapter 19 of Title 56 of Code of Laws of South Carolina, 1962 and who are actively engaged in such practice in this State on July 14, 1969 shall be issued a license to practice osteopathy as defined under this article.

SECTION 40-47-190. Physician, surgeon or osteopath, under influence of whiskey or drugs, shall not attend patient.

Any practicing osteopath, physician or surgeon licensed by the State Board of Medical Examiners to practice as an osteopath, physician or surgeon, who shall attend any patient while he is under the influence of whiskey or drugs, shall be guilty of a misdemeanor and, upon conviction, shall suffer a fine of not more than two hundred dollars or be imprisoned for a period of not more than sixty days and, in addition thereto, upon conviction, the license granted to such osteopath, physician or surgeon shall be revoked and deemed null and void and he shall be disqualified from ever practicing osteopathy, medicine or surgery in this State until he shall thereafter satisfy the State Board of Medical Examiners that he is qualified to resume the practice of medicine or surgery. The provisions of this section shall be construed as being in addition to the remedies otherwise of force relating to osteopaths, physicians and surgeons who may be addicted to the use of liquor or habitually use drugs.

SECTION 40-47-200. Suspension or revocation of license; other disciplinary action.

(A) The State Board of Medical Examiners, if it has reason to believe grounds exist, may order the revocation or suspension of a license to practice medicine or osteopathy, publicly or privately reprimand the holder of a license to practice medicine or osteopathy, or take other reasonable action short of revocation or suspension, such as requiring the licensee to undertake additional professional training subject to the direction and supervision of the board or imposing restraint upon the medical or osteopathic practice of the licensee as circumstances warrant until the licensee demonstrates to the board adequate professional competence. In addition to or in lieu of action taken by the board affecting the license of a licensee, when it is established that the individual has violated this chapter or any regulation promulgated by the board, the board may require the licensee to pay a civil penalty of up to ten thousand dollars to the board and the costs of the disciplinary action. All penalties must be remitted to the State Treasurer for deposit in a special fund from which the State Board of Medical Examiners must be reimbursed for administrative costs for each case upon the approval of the Budget and Control Board. At any time the special fund exceeds twenty thousand dollars, the excess funds must be remitted to the general fund. An action of the board relating to the revocation or suspension of a license or other action either restricting a license or limiting or disciplining a licensee may not be taken until after an initial complaint of misconduct, in writing, has been filed with the board in accordance with regulations promulgated by the board. In subsequently determining whether to approve the issuance of a formal complaint in accordance with regulations promulgated by the board, the board may consult with the Attorney General's office. The Attorney General's office, after investigation, must issue a written recommendation to the board. The board may act upon this written recommendation, but no review of the potential testimony or substantive evidence by the board or a member of the board is permitted. A formal hearing must be held upon thirty days' notice to the complainant and the licensee or their counsel before a panel as provided in Section 40-47-211.

(B) Upon receipt of the panel's report in accordance with Section 40-47-211, the board must notify the complainant and the licensee and their counsel of the time and place at which the board will consider the report for the purpose of determining its action on the report, and the notice must be given not less than ten days before the meeting. The complainant and the licensee and their counsel have the right to appear before the board at the meeting and to submit briefs and be heard in oral argument in opposition to or in support of the recommendations of the panel. The Attorney General's office has the right to appear before the board and to submit briefs and be heard in oral argument if it has participated in the hearing before the panel.

(C) Upon consideration of the report of the panel and of the showing made to the board, the board may:

(1) refer the matter back to the panel for further hearing;

(2) order a further hearing before the board; or

(3) proceed upon the certified report of the prior proceedings before the panel.

(D) Upon its final review, the board may either dismiss the complaint or find that the licensee is guilty of misconduct meriting sanction. In either event, the board must file a final certified report of the proceedings before it with the secretary of the board and the secretary must notify the complainant and the licensee and their counsel of the board's action.

(E) A decision by the board to revoke, suspend, or restrict a license or to limit or discipline a licensee must be by majority vote of the total membership of the board. A licensee against whom disciplinary action is taken pursuant to this article has the right to judicial review. A disciplinary action is subject to review by an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 upon petition filed by the licensee with an administrative law judge and a copy of the petition served upon the secretary of the board within thirty days from the date of delivery of the board's decision to the licensee. An appeal taken to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 has precedence on the calendar of an administrative law judge, is considered an emergency appeal if the board has revoked, suspended, or restricted a license for more than six months, and should be heard not later than thirty days from the date the petition is filed. The review is limited to the record established by the board hearing. No stay or supersedeas may be granted pending appeal from a decision by the board to revoke, suspend, or restrict a license for more than six months.

(F) "Misconduct" which constitutes grounds for revocation, suspension, or restriction of a license or limitation on or discipline of a licensee is a satisfactory showing to the board that the holder of a license:

(1) has used a false, fraudulent, or forged statement or document or practiced a fraudulent, deceitful, or dishonest act in connection with a licensing requirement;

(2) has been convicted of, has pled guilty to, or has pled nolo contendere to a felony or other crime involving moral turpitude or drugs. For purposes of this item, "drugs" includes a substance whose possession, use, or distribution is governed by Section 44-53-110 through Section 44-53-580 (Narcotics and Controlled Substances) or which is listed in the current edition of the Physician's Desk Reference;

(3) is addicted to alcohol or drugs to such a degree as to render the holder unfit to practice medicine or osteopathy;

(4) has been convicted of the illegal or unauthorized practice of medicine or osteopathy;

(5) has knowingly performed an act which in any way assists an unlicensed person to practice medicine or osteopathy;

(6) has sustained a physical or mental disability which renders further practice by the holder dangerous to the public;

(7) has violated the principles of ethics as adopted by the State Board of Medical Examiners and published in its regulations;

(8) is guilty of engaging in dishonorable, unethical, or unprofessional conduct that is likely to deceive, defraud, or harm the public;

(9) is guilty of the use of a false or fraudulent statement in a document connected with the practice of medicine;

(10) is guilty of obtaining fees or assisting in obtaining fees under dishonorable, false, or fraudulent circumstances;

(11) has intentionally violated or attempted to violate, directly or indirectly, or is assisting in or abetting the violation of or conspiring to violate the medical practice laws; or

(12) is guilty of violating the code of medical ethics adopted by the board in accordance with Section 40-47-20 or has been found by the board to lack the ethical or professional competence to practice medicine or osteopathy.

(G) In addition to all other remedies and actions incorporated in this chapter, the license of a medical or osteopathic physician adjudged mentally incompetent by a court of competent jurisdiction must be automatically suspended by the board until the physician is adjudged by a court of competent jurisdiction or in any other manner provided by law as being restored to mental competency.

(H) The license of a person who is convicted of or who pleads guilty or nolo contendere to a crime stated in subsection (F) (2) immediately must be suspended temporarily pending final disposition of a disciplinary proceeding to be commenced upon the conviction or the filing of a plea of guilty or nolo contendere. A person suspended under this subsection must be reinstated immediately upon the filing of a certificate that the conviction has been reversed. The reinstatement does not terminate a disciplinary action pending against the person.

(I) In enforcing subsections (F) (3) and (6) the board upon reasonable grounds may require a licensee or applicant to submit to a mental or physical examination by physicians designated by the board. The results of an examination are admissible in a hearing before the board, notwithstanding a claim of privilege under a contrary rule of law or statute. A person who accepts the privilege of practicing medicine in this State or who files an application for a license to practice medicine in this State is deemed to have consented to submit to a mental or physical examination and to have waived all objections to the admissibility of the results in a hearing before the board upon the grounds that the same constitutes a privileged communication. If a licensee or applicant fails to submit to an examination when properly directed to do so by the board, unless the failure was due to circumstances beyond the person's control, the board shall enter an order automatically suspending or denying the license pending compliance and further order of the board. A licensee or applicant who is prohibited from practicing medicine under this subsection must be afforded at reasonable intervals an opportunity to demonstrate to the board the ability to resume or begin the practice of medicine with reasonable skill and safety to patients.

(J) In enforcing subsections (F) (3) and (6) the board upon reasonable grounds may obtain records relating to the mental or physical condition of a licensee or applicant including, but not limited to, psychiatric records; and these records are admissible in a hearing before the board, notwithstanding any other provision of law. A person who accepts the privilege of practicing medicine in this State or who files an application to practice medicine in this State is deemed to have consented to the board obtaining these records and to have waived all objections to the admissibility of these records in a hearing before the board upon the grounds that the same constitute a privileged communication. If a licensee or applicant refuses to sign a written consent for the board to obtain these records when properly requested by the board, unless the failure was due to circumstances beyond the person's control, the board shall enter an order automatically suspending or denying the license pending compliance and further order of the board. A licensee or applicant who is prohibited from practicing medicine under this subsection must be afforded at reasonable intervals an opportunity to demonstrate to the board the ability to resume or begin the practice of medicine with reasonable skill and safety to patients.

(K) If a person's license is suspended, reissued, or reinstated by any South Carolina board for any reason, it shall report that action to the licensee's last known employer and, if applicable, to any place where the person has been granted privileges to practice medicine.

SECTION 40-47-201. Disciplinary action based upon denial, revocation or suspension of license to practice medicine in another state.

Acts or omissions by a licensee causing the denial, revocation, suspension, or restriction of a license to practice medicine in another state will support the issuance of a formal complaint and the commencement of disciplinary proceedings as described in Section 40-47-200 and, if required by law, pursuant to Section 40-47-211. This provision applies only when the disciplinary action taken in another state is based on grounds that would constitute misconduct under Section 40-47-200.

Proof of such acts or omissions may be shown by a copy of the transcript of record of the disciplinary proceedings in another state or a copy of the final order, consent order, or similar order stating the basis for the action taken.

Upon the filing of an initial complaint alleging that the licensee has been disciplined in another state, the licensee must produce for the State Board of Medical Examiners or the Medical Disciplinary Commission of the board, if required by law, copies of all transcripts, documents, and orders used, relied upon, or issued by the licensing authority in the other state. Failure to produce such items within ninety days of the board's or Medical Disciplinary Commission's request for them shall result in the suspension of the individual's license to practice medicine in this State until such time as the items have been supplied to the board or the Medical Disciplinary Commission.

The licensee may present mitigating testimony to the board or the Medical Disciplinary Commission regarding disciplinary action taken in another state or evidence that the acts or omissions committed in another state do not constitute misconduct under Section 40-47-200.

SECTION 40-47-202. Conduct which subverts integrity of medical licensing examination; sanctions.

Any individual found by the board to have engaged in conduct which subverts or attempts to subvert the security or integrity of the medical licensing examination process may, in the discretion of the board, have his scores on the licensing examination withheld or declared invalid, be disqualified from the practice of medicine, or be subjected to the imposition of any other appropriate sanction provided by Section 40-47-200.

Conduct which subverts or attempts to subvert the security or integrity of the medical licensing examination process includes, but is not limited to:

(1) conduct which violates the security of examination materials, including, but not limited to, the improper reproduction or reconstruction of any portion of the licensing examination; aiding in the improper reproduction or reconstruction of any portion of the licensing examination; or selling, distributing, buying, receiving, or having unauthorized possession of any portion of a future, current, or previously administered licensing examination.

(2) conduct which violates the standard of test administration, including, but not limited to, improperly communicating with any other examinee during the administration of a licensing examination; copying answers from another examinee or permitting one's own answers to be copied by another examinee during the administration of a licensing examination; or having in one's possession during the administration of a licensing examination any books, notes, other written or printed materials, or data of any kind other than the examination materials or other materials authorized by the board.

(3) conduct which violates the credentials process, including, but not limited to, falsifying or misrepresenting educational credentials or other information required for admission to the licensing examination, impersonating an examinee, or having an impersonator take the licensing examination in one's behalf.

SECTION 40-47-210. Administration of oaths, subpoenas and the like; enforcement of article by injunction.

For the purpose of any investigation or proceeding under the provisions of this article, the board or any person designated by it may administer oaths and affirmations, subpoena witnesses, take evidence, and require the production of any documents or records which the board deems relevant to the inquiry. In the case of contumacy by, or refusal to obey a subpoena issued to any person, an administrative law judge as provided under Article 5 of Chapter 23 of Title 1, may issue an order requiring the person to appear before the board or the person designated by it and produce documentary evidence and to give other evidence concerning the matter under inquiry.

Whenever the board has reason to believe that any person is violating or intends to violate any provision of this article, it may, in addition to all other remedies, order such person to immediately desist and refrain from such conduct. The board may apply to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 for an injunction restraining the person from such conduct. An administrative law judge may issue a temporary injunction ex parte, and upon notice and full hearing may issue any other order in the matter it deems proper. No bond shall be required of the board by an administrative law judge as a condition to the issuance of any injunction or order contemplated by the provisions of this section.

SECTION 40-47-211. Medical Disciplinary Commission created; membership; terms of office; vacancies; hearing of complaints; reports.

(A) There is created the Medical Disciplinary Commission of the State Board of Medical Examiners to be composed of forty-eight members. Of these, thirty-six must be licensed physicians practicing their profession. Five physician commissioners must be elected from each of the six congressional districts, and six physician members of the commission must be elected at large from across the State. The board shall conduct the elections, and the elections for the physician members shall provide for participation by any physician currently licensed and actively practicing medicine in South Carolina and residing in the congressional district in which the election is held. At-large physician members must be currently licensed and actively practicing medicine in South Carolina and must reside within the State at the time of election and throughout their terms. One physician commissioner initially elected from each district shall serve for a term of one year and until his successor is elected and qualifies, one physician commissioner initially elected from each district shall serve for a term of two years and until his successor is elected and qualifies, and one physician commissioner initially elected from each district shall serve for a term of three years and until his successor is elected and qualifies. The successors of the initial physician commissioners shall serve for terms of three years or until their successors are elected and qualify. The members of the commission are limited to three terms. The members appointed to the board may not simultaneously serve as a commissioner. In case of any vacancy by way of death, resignation, or otherwise, the board shall appoint a successor to serve for the unexpired term. Where justice, fairness, or other circumstances so require, the board may appoint past commissioners to hear complaints in individual cases.

(B) Twelve members of the commission must be lay commissioners who each must have, at a minimum, a baccalaureate degree or higher, must not be employed in, or have a member of their immediate family employed in, a health care related field, and must not have been convicted of a felony or a crime of moral turpitude. Two lay commissioners must be appointed by the Governor from each of the six congressional districts, with the advice and consent of the Senate. Each lay commissioner must be a registered voter and reside in the congressional district he represents throughout his term. Each lay commissioner initially elected from each district shall serve for a term of three years and until his successor is elected and qualifies. Vacancies must be filled in the manner of the original appointment for the remainder of the unexpired term. The Governor may appoint a lay commissioner to serve a full term; however, a lay commissioner may not serve more than three terms.

(C) The commission is empowered to investigate and hear those complaints against physicians (medical and osteopathic) filed with the board pursuant to Section 40-47-200. The hearing must be conducted in accordance with Act 176 of 1977 (Administrative Procedures Act) and with regulations promulgated by the board and must be before a panel composed of at least three commissioners designated by the board, and one of those three commissioners must be a lay member. The panel is empowered to hear the matters complained of and to make findings of fact and recommendations as to disposition of those matters to the board. The panel shall make a certified report of the proceedings before it, including its findings of fact, conclusions, and recommendations, which must be filed together with a transcript of the testimony taken and exhibits as may have been in evidence before it with the administrator of the board, and a copy of the report must be delivered to the office of general counsel and the licensee or his counsel.

SECTION 40-47-212. Communications to Board regarding discipline of licensees as privileged; due process.

Every communication, whether oral or written, made by or on behalf of any person, firm or corporation to the Board or any person designated by it to investigate or otherwise hear matters relating to the revocation, suspension or other restriction on a license or the limitation on or other discipline of a licensee, whether by way of complaint or testimony, shall be privileged; and no action or proceeding, civil or criminal, shall lie against any such person, firm or corporation by or on whose behalf such communication shall have been made by reason thereof, except upon proof that such communication was made with malice.

No part of this article shall be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law, nor to prohibit the respondent from normal access to the charges and evidence filed against him as a part of due process under the law.

SECTION 40-47-213. Disclosure of information relating to misconduct proceedings.

(A)(1) A person connected with any complaint, investigation, or other proceeding before the board, including, but not limited to, any witness, counsel, counsel's staff, board member, board employee, court reporter, or investigator, may not mention the existence of the complaint, investigation, or other proceeding or disclose any information tending to identify the initial complainant or a witness, or discuss testimony or other evidence in the complaint, investigation, or other proceeding, except as otherwise provided in this section.

(2) Information may be disclosed to persons involved and having a direct interest in the complaint, investigation, or other proceeding to the extent necessary for the proper disposition of the complaint, investigation, or other proceeding. The name of the initial complainant must be provided to the licensee who is the subject of the complaint, investigation, or proceeding unless the board, hearing officer, or panel determines there is good cause to withhold that information.

(3) When the board receives information in any complaint, investigation, or other proceeding before it indicating a violation of state or federal law, the board may provide that information, to the extent the board considers necessary, to the appropriate state or federal law enforcement agency or regulatory body.

(B) When a formal complaint is made regarding allegations of misconduct, the formal complaint and an answer must become available for public inspection and copying ten days after the filing of the answer or, if no answer is filed, ten days after the expiration of the time to answer. Once the formal complaint becomes available for public inspection and copying, subsequent records and proceedings relating to the misconduct allegations must be open to the public except as otherwise provided in this section.

(1) Patient records and identities shall remain confidential unless the patient or legal representative of the patient consents in writing to the release of the records.

(2) If allegations of incapacity of licensee due to physical or mental causes are raised in the complaint or answer, all records, information, and proceedings, relating to those allegations of incapacity must remain confidential; provided, however, any order relating to the licensee's authorization to practice must be made public, but the order must not disclose the nature of the incapacity.

(C) Once a proceeding becomes public as provided in this section, there is a presumption that any hearing, other proceeding, or record must remain public unless a party to a proceeding makes a showing on the record before the board, hearing officer, or panel that closure of the hearing or the record, in whole or in part, is essential to protect patients, witnesses, or the respondent from unreasonable disclosure of personal or confidential information. Public notice must be given of the request or motion to close any portion of a hearing or record, and the board, hearing officer, or panel shall provide an opportunity for a person opposing the closure to be heard prior to the decision on closure being made.

(D) Subject to the right of public access and utilizing the procedure regarding closure described in this section, a witness in a proceeding or a patient whose care is at issue in a proceeding may petition the board, hearing officer, or panel for an order to close the hearing or record, in whole or part, to protect the witness or patient from unreasonable disclosure of personal or confidential information; provided, however, the identity of a minor or sexual boundary victim must remain confidential without a motion being made.

(E) Upon a finding on the record that the health or safety or the personal privacy of a witness or patient would be put at risk unreasonably by the public disclosure of identifying information or of other personal information, the board, hearing officer, or panel may issue an order to protect the witness or patient from the harm shown to be probable from public disclosure.

SECTION 40-47-230. Records of Board; register of applicants.

The Board shall keep a record of all the proceedings thereof and also a record or register of all applicants for a license, together with their ages, the time spent in the study of medicine and the names and locations of all institutions granting such applicants' degrees or certificates of lectures in medicine or surgery. Such books and register shall be prima facie evidence of all the matters therein recorded.

SECTION 40-47-240. Exemptions.

This article shall not apply to surgeons of the United States Army, Navy or public health service, practicing in the discharge of their official duties as such, nor to physicians or surgeons of other states or territories in actual consultation with a licensed physician or surgeon of this State, nor shall it be construed to apply to or to change the laws relating to dentists, trained nurses, pharmaceutists, opticians and optometrists or midwives.

SECTION 40-47-250. Disqualifications for failure to comply with article.

Any practitioner of medicine or surgery or any branch or specialty thereof, within the meaning of this article, failing to comply with the requirements of this article shall not (a) be exempt from jury or military duty, (b) be permitted to collect any fees or charges for services rendered, (c) be allowed to testify as a medical or surgical expert in any court in this State, execute any certificate as a physician or surgeon, or hold any medical office or be recognized by the State or any county or municipal corporation as a physician or surgeon or (d) be entitled to enjoy any of the privileges, rights or exemptions granted to physicians or surgeons by the laws of this State.

SECTION 40-47-255. Chairman to serve as advisory member of State Board of Nursing; meetings of Board of Nursing; notice.

The Chairman of the State Board of Medical Examiners or his designee from the board shall serve as an advisory nonvoting member of the State Board of Nursing to provide consultation on matters requested by such board. The Board of Nursing shall be required to send written notice of meetings that it wants the member representing the Board of Medical Examiners to attend at least ten days prior to the meeting date. Such member and the Board of Nursing shall meet at least twice a year, and thereafter as necessary.

SECTION 40-47-260. Penalties.

It shall be unlawful for any person in this State to practice medicine or osteopathy, within the meaning of this article, in violation of the provisions of this article, and anyone violating any provisions thereof shall, upon conviction by any court of competent jurisdiction, be fined not more than one thousand dollars or imprisoned for a period of not more than two years, or both, in the discretion of the court. Each violation shall constitute a separate offense. The provisions of this section shall apply to any corporation, association or person aiding or abetting in any violation of this article.

SECTION 40-47-270. Limitation on number of certificates to be issued to doctors of osteopathy.

No more than one hundred seventy doctors of osteopathy shall be issued certificates to practice within five years of July 14, 1969.

ARTICLE 3.

REREGISTRATION OF PERSONS LICENSED TO PRACTICE MEDICINE OR OSTEOPATHY

SECTION 40-47-410. Annual reregistration required.

All persons authorized to practice medicine or osteopathy in this State shall by the first of July of each year apply to the State Board of Medical Examiners for a reregistration certificate which shall be furnished by the Board after payment of a fee to be set by the Board.

SECTION 40-47-420. Applications for reregistration.

By May first of each year the Board shall mail to every registered physician an application for reregistration addressed to the last address of such physician on file with the Board. The failure to receive such application shall not excuse failure to reregister. The application shall contain proper spaces for insertion by the applicant of the information required by the Board and such instructions as may be required to properly complete the application form.

SECTION 40-47-430. Penalty for nonregistration; placing license on inactive status.

Any licensed physician who fails to comply with the reregistration provisions of this article shall pay to the Board a penalty of ten dollars for each month of default. If nonregistration continues for more than six months, the Board may place a physician's license on an inactive status.

SECTION 40-47-440. Resumption of practice by physician with inactive license.

Prior to any resumption of the practice of medicine or osteopathy in this State, a physician with an inactive license must notify the Board in writing that he desires to resume practice. The Board may require such information as it deems necessary to be currently advised of the past and present activities of such physician and a hearing may be required if unsatisfactory information is received by the Board. If nonregistration continues for more than six months and the physician is practicing in the State, the penalty shall thereafter be five dollars per day. The Board shall issue an order requiring payment of the penalties, and upon the failure of the physician to remit within thirty days, the Attorney General shall institute an action on behalf of the Board to recover such penalties, which for good cause shown, may be compromised at the sole discretion of the Board. Wilful refusal to comply with this section will subject the person concerned to the provisions of Sections 40-47-250 and 40-47-260.

SECTION 40-47-450. Publication and distribution of directory; physician shall notify Board of change of address.

During each year the Board shall publish and mail to every registered physician in the State a directory of all physicians reregistered. The publication shall contain the Medical Practice Laws of South Carolina. A physician who changes the address of his usual place of practice shall notify the Board within thirty days thereafter.

ARTICLE 5.

RESPIRATORY CARE

SECTION 40-47-500. Short title.

This article is known and may be cited as the "South Carolina Respiratory Care Practice Act".

SECTION 40-47-510. Definitions.

As used in this article:

(1) "Board" means the Board of Medical Examiners of South Carolina.

(2) "Committee" means the Respiratory Care Committee which is established by this article as an advisory committee responsible to the board.

(3) "Respiratory care or respiratory therapy" means the allied health profession or specialty which provides educational, therapeutic, or diagnostic procedures utilized in the prevention, detection, and management of deficiencies or abnormalities, or both, of the cardiopulmonary systems.

(4) "Practice of respiratory care" may include, but is not limited to, the administration of pharmacologic, diagnostic, and therapeutic agents related to respiratory care procedures necessary to implement a treatment, disease prevention, pulmonary rehabilitative, or diagnostic regimen prescribed by a physician; transcription and implementation of written or verbal orders of a physician pertaining to the practice of respiratory care; observing and monitoring the signs and symptoms, general behavior, general physical response to respiratory care treatment and diagnostic testing including determination of whether such signs, symptoms, reactions, behavior, or general response exhibit abnormal characteristics and implementation, based on observed abnormalities or appropriate reporting, referral, respiratory care protocols or changes in treatment pursuant to the written or verbal orders of a person licensed to practice medicine under the laws of this State; or the initiation of emergency procedures under the regulations of the board or as otherwise permitted in this article. The practice of respiratory care may be performed in a clinic, hospital, skilled nursing facility, private dwelling, or other place considered appropriate or necessary by the board in accordance with the written or verbal order of a physician and must be performed under a qualified medical director.

(5) "Respiratory care practitioner" means a respiratory therapist or a respiratory therapy technician licensed to practice respiratory therapy who is a graduate of a school for respiratory therapy approved by the American Medical Association or a successor accrediting authority recognized as such by the board.

(6) "Medical director" means a physician licensed to practice medicine in South Carolina who has special interest and knowledge in the diagnosis, treatment, and assessment of respiratory problems. The practice of respiratory care or respiratory therapy must occur under the supervision of a qualified medical director. In the home care of cardiopulmonary patients, the existence of qualified physician sponsorship must be submitted and documented to the committee and approved by the board.

SECTION 40-47-520. Licensing requirement.

Individuals practicing as respiratory therapists and respiratory therapy technicians employed to provide respiratory therapy procedures for inpatients, outpatients, and home patients must be licensed in accordance with this article.

SECTION 40-47-530. Persons not subject to provisions of this article.

(A) This article does not affect:

(1) a person employed to provide respiratory care by the United States government if the person provides respiratory care solely under the direction or control of the organization by which the person is employed;

(2) a person actively pursuing a course of study leading to a degree or certificate in respiratory therapy in a program accredited by the American Medical Association or a successor accrediting authority recognized as such by the board if the activities and services constitute a part of a supervised course of study and if the person is designated by a title which clearly indicates the status of student;

(3) an individual or other health care professional who is licensed by the State or who has proven competency in one or more of the functions included in the definition of the practice of respiratory care as long as the person does not represent himself as a respiratory care practitioner. As it relates to respiratory care, individuals exempt pursuant to this section must provide proof of formal training for these functions which includes an evaluation of competence through a mechanism that is determined by the board and the committee to be both valid and reliable. The clinical assessment of artificial pressure adjuncts to the respiratory system may not be performed by any other person without proof of formal training and exemption by the board.

(4) a respiratory therapy student, active and in good standing, who may be employed and works under the direct supervision of a respiratory care practitioner and practices to the person's level of proven clinical competency as certified by a program approved by the American Medical Association or a successor accrediting authority recognized as such by the board;

(5) employees of durable medical equipment companies delivering and setting up respiratory equipment in an individual's home, pursuant to a written prescription by a physician, except that any instructions to the patient regarding the clinical use of the equipment, any patient monitoring, patient assessment or other procedures designed to evaluate the effectiveness of the treatment must be performed by a licensed respiratory care practitioner or other individual who is exempt by statute or regulation.

(B) Nothing in this article is intended to limit, preclude, or otherwise interfere with the practice of other persons and health providers formally trained and licensed by the appropriate agencies of this State.

SECTION 40-47-540. Creation of, and membership of, Respiratory Care Committee.

There is created the Respiratory Care Committee as an advisory committee to the board which consists of nine members to be appointed by the board. Five of the members must be respiratory care practitioners with at least five years' experience each, one member must be a consumer, and three members must be physicians who are licensed to practice in South Carolina who have special interest and knowledge in the diagnosis, treatment, and assessment of respiratory problems. All of the respiratory care practitioners must be certified except for the first members of the committee, who must be certified as soon after their appointment as possible. All organizations, groups, or interested individuals may submit recommendations to the board of at least two individuals for each position to be filled on the committee.

SECTION 40-47-550. Terms of committee members; appointment and removal; expenses.

The members shall serve for terms of four years and until their successors are appointed and qualify, except that initial terms of two practitioners, the consumer member, and one physician, are for two years. Vacancies must be filled in the manner of the original appointment for the unexpired portion of a term. The board, after notice and opportunity for hearing, may remove any member of the committee for neglect of duty, incompetence, revocation or suspension of certification, or other dishonorable conduct. Members of the committee shall receive mileage, subsistence, and per diem provided by law for members of state boards, commissions, and committees for each meeting attended. No member may serve more than one full four-year term consecutively, but he is eligible for reappointment two years from the date the full four-year term expires.

SECTION 40-47-560. Committee meetings; election of officers; recommendation, review, and approval of regulations.

The committee shall meet at least twice each year and at other times as its regulations provide. The quorum for meetings consists of five members with no more than three of these being respiratory care practitioners. At its initial meeting the committee shall elect from its membership a chairman, vice-chairman, and a secretary to serve for one-year terms. The committee may recommend regulations regarding respiratory care necessary to perform its duties which must be reviewed and approved by the board prior to adoption.

SECTION 40-47-570. Employment of additional staff by Director.

The Director of the Department of Labor, Licensing, and Regulation, pursuant to Section 40-73-15, may employ additional staff as necessary for the performance of its duties under this article.

SECTION 40-47-580. Requirement that board receive and account for monies and pay them to State Treasurer.

The board shall receive and account for all monies collected under the provision of this article and shall pay the monies to the State Treasurer for deposit in the state general fund.

SECTION 40-47-590. Responsibilities of committee; investigatory powers of board.

(A) The committee shall evaluate the qualifications and supervise the examinations of applicants for licensure and shall make appropriate recommendations to the board.

(B) The board may issue subpoenas, examine witnesses, and administer oaths, and may investigate allegations of practices violating the provisions of this article.

(C) The committee:

(1) shall recommend regulations to the board relating to professional conduct to carry out the policy of this article including, but not limited to, professional licensure and the establishment of ethical standards of practice for persons holding a license to practice respiratory care or respiratory therapy in this State;

(2) shall conduct hearings and keep records and minutes necessary to carry out its functions;

(3) shall provide notice of all hearings authorized under this article pursuant to the Administrative Procedures Act;

(4) shall determine the qualifications and make appropriate recommendations regarding the issuance of licenses to qualified respiratory care practitioners;

(5) shall recommend to the board whether to issue or renew licenses under those conditions prescribed in this article;

(6) may recommend continuing professional education to the board;

(7) shall keep a record of its proceedings and a register of all persons licensed. The register shall show the name of every registrant and the registrant's last known place of employment and residence. The board annually shall compile and make available a list of respiratory care practitioners authorized to practice in this State. Any interested person may obtain a copy of this list upon application to the board and payment of an amount fixed by the board;

(8) shall make an annual report to the board containing an account of duties performed, actions taken, and appropriate recommendations;

(9) shall hear all disciplinary cases and recommend findings of fact, conclusions, and sanctions to the board. The board shall conduct a final order hearing at which it makes a final decision.

SECTION 40-47-600. Requirements for certification of respiratory care practitioners.

An applicant for licensure as a respiratory care practitioner shall file a written application on forms provided by the board showing to the satisfaction of the committee and the board that the applicant has successfully passed the entry-level examination given by the National Board for Respiratory Care, Inc., or other examination or requirement as the committee may administer or approve.

SECTION 40-47-610. Licensure of practitioners of other states; educational and examination requirements.

(A) The board may license as a respiratory care practitioner, upon payment of the fee set by the board, an applicant who is a respiratory therapist or a respiratory therapy technician of another state, territory, or the District of Columbia, if the requirements were substantially equal to the requirements of this State as determined by the board;

(B) The committee initially shall waive the professional education and examination requirements and issue a license to any person who can demonstrate to the committee, through evidence verified under oath, that the person was employed as or actively performing the duties of a respiratory care practitioner in South Carolina in November and December of 1998; however, within three years of applying for initial licensure, the person must have complied with the educational and examination requirements provided for in Section 40-47-600. The applicants shall produce proof of high school graduation or the equivalent and shall apply within ninety days after public notification by the department.

SECTION 40-47-620. Issuance of license by board.

The board shall issue a license to any person who meets the requirements of this article upon payment of the license fee.

SECTION 40-47-625. Temporary licenses.

The board may issue a temporary license if all licensing requirements have been met.

SECTION 40-47-630. Grounds for disciplinary action; recommendations of committee as to disciplinary action; appeal.

(A) The committee may recommend to the board that it revoke, suspend, issue a public or private reprimand, or impose any other reasonable limitation or practice where the unprofessional, unethical, or illegal conduct of the respiratory care practitioner is likely to endanger the health, welfare, or safety of the public. This conduct includes a license:

(1) using any false, fraudulent, or forged statement or engaging in any fraudulent, deceitful, or dishonest act in connection with any of the certifying requirements;

(2) having an addiction to alcohol or drugs to such a degree as to render the licensee unfit to practice respiratory care;

(3) having been convicted of the illegal or unauthorized practice of respiratory care;

(4) knowingly performing an act which in any way assists an unlicensed person to practice respiratory care;

(5) having sustained any physical or mental disability which renders further practice by the licensee dangerous to the public;

(6) having violated the code of ethics or regulations as adopted by the committee and the board;

(7) guilty of engaging in any dishonorable, unethical, or unprofessional conduct that is likely to deceive or harm the public;

(8) guilty of the use of any false or fraudulent statement in any document connected with the practice of respiratory care;

(9) having intentionally violated or attempted to violate, directly or indirectly, or assisting in or abetting the violation or conspiring to violate any provisions of this article;

(10) guilty of the commission of any act, during the course of practice conducted pursuant to a license issued under this article, that constitutes fraud, dishonest dealing, illegality, incompetence, or gross negligence.

(B) The suspension, revocation, reprimand, or imposition of probationary conditions upon a respiratory care practitioner may be recommended by the committee to the board after a hearing is conducted in accordance with the Administrative Procedures Act. A transcribed record of the hearing must be made.

(C) A respiratory care practitioner aggrieved by a decision of the committee or board under this section may appeal the decision to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 on the record made before the committee or board.

SECTION 40-47-640. Renewal and reinstatement of licenses.

(A) Licenses issued under this article are subject to annual renewal and expire unless renewed in the manner prescribed by the regulations of the committee. The committee may recommend additional requirements for license renewal which provide evidence of continued competency. The board may provide for the late renewal of a license upon payment of a late fee.

(B) An inactive license is subject to expiration and may be renewed as provided in this section, but renewal does not entitle the respiratory care practitioner, while the license remains inactive, to engage in the certified activity of respiratory therapy. If a certificate suspended on disciplinary grounds is reinstated, the respiratory care practitioner, as a condition of reinstatement, shall pay the renewal fee and any applicable late fee.

SECTION 40-47-650. Fees.

The board and the committee shall prescribe fees in amounts recommended by the committee for:

(1) initial licensure, not to exceed two hundred dollars;

(2) renewal of license fee, not to exceed fifty dollars;

(3) late renewal fee, not to exceed double renewal fee.

The fees must be set in such an amount as to reimburse the State to the extent feasible for the cost of the services rendered by the board.

SECTION 40-47-655. Limited license to practice respiratory care.

(A) Upon payment of a fee prescribed by the committee and approved by the board, the board may issue a limited license to practice respiratory care under the direct supervision of a licensed respiratory care practitioner to an applicant who presents written documentation, verified by oath, that the applicant is a graduate of or student of a respiratory care program approved by the American Medical Association or a successor accrediting authority recognized as such by the board. If a student, the applicant must be scheduled to graduate from this program within forty-five days of the date on which the limited license is to be issued.

(B) A limited license issued under this section is valid for a period of six months. Upon expiration of a limited license and payment of the fee prescribed by the committee and approved by the board, the board may renew the limited license once for a period of six months. A limited license must not be renewed more than twelve months from the date it was originally issued.

SECTION 40-47-660. Enforcement of article.

(A) It is unlawful for any person who is not licensed under this article to hold himself out as a respiratory care practitioner, respiratory therapist, or a respiratory therapy technician. A person who holds himself out or practices as a respiratory care practitioner without being licensed under this article, during a period of suspension, or after his certificate has been revoked by the board is guilty of a misdemeanor and, upon conviction, must be fined not more than three hundred dollars or imprisoned for not more than ninety days, or both.

(B) For the purpose of an investigation or proceeding under this article, the board or a person designated by it may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production of documents or records which the board considers relevant to the inquiry. In the case of contumacy by, or refusal to obey a subpoena issued to a person, an administrative law judge as provided under Article 5 of Chapter 23 of Title 1, upon application by the board, may issue an order requiring the person to appear before the board or the person designated by it, produce documentary evidence, and give other evidence concerning the matter under inquiry.

When the board has sufficient evidence that a person is violating any provisions of this article, it may, in addition to all other remedies, order the person to immediately desist and refrain from this conduct. The board may apply to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 for an injunction restraining the person from this conduct. An administrative law judge may issue a temporary injunction ex parte and upon notice and full hearing may issue any other order in the matter it considers proper. No bond may be required of the board by an administrative law judge as a condition to the issuance of any injunction or order contemplated by the provisions of this section.

(C) Every communication, whether oral or written, made by or on behalf of a person or firm to the board or any person designated by it to investigate or otherwise hear matters relating to the revocation, suspension, or other restriction on a license or other discipline of a licensee, whether by way of complaint or testimony, is privileged. No action or proceeding, civil or criminal, may lie against the person or firm for the communication except upon proof that the communication was made with malice.

(D) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law nor prohibiting the respondent from normal access to the charges and evidence filed against him as a part of due process under the law.

ARTICLE 6.

ACUPUNCTURE ACT OF SOUTH CAROLINA

SECTION 40-47-700. Citation of article.

This article may be cited as the "Acupuncture Act of South Carolina".

SECTION 40-47-705. Definitions.

For purposes of this article:

(1) "Acupuncture" means a form of health care developed from traditional and modern oriental concepts for health care that employs oriental medical techniques, treatment, and adjunctive therapies for the promotion, maintenance, and restoration of health and the prevention of disease. The practice of acupuncture does not include:

(a) osteopathic medicine and osteopathic manipulative treatment;

(b) "chiropractic" or "chiropractic practice" as defined in Section 40-9-10; or

(c) "physical therapy" as defined in Section 40-45-20 or therapies allowed as part of the practice of physical therapy.

(2) "Auricular (ear) detoxification therapy" means the insertion of disposable sterile acupuncture needles into the five auricular acupuncture points stipulated by the National Acupuncture Detoxification Association protocol for the sole purpose of treatment of chemical dependency, detoxification, and substance abuse.

(3) "Board" means the State Board of Medical Examiners.

(4) "Committee" means the Acupuncture Advisory Committee as established by this article as an advisory committee responsible to the board.

(5) "NADA" means the National Acupuncture Detoxification Association.

(6) "NCAAOM" means the National Certification Commission for Acupuncture and Oriental Medicine.

(7) "ACAOM" means Accreditation Commission for Acupuncture and Oriental Medicine.

(8) "Auricular therapy" means the insertion of disposable needles into and limited only to the ear, to treat a limited number of conditions.

SECTION 40-47-710. Acupuncture Advisory Committee; membership; terms; filling vacancies; removal of members; meeting schedule; officers.

(A) There is established the Acupuncture Advisory Committee to be composed of five members to be appointed by the Board of Medical Examiners for terms of four years and until their successors are appointed and qualify. Three members must be licensed to practice acupuncture under this article; one of whom has practiced acupuncture for a minimum of three years; one member must be licensed to practice medicine under this chapter and may be an acupuncturist; and one member must be from the State at large. The advisory committee members shall receive mileage, per diem, and subsistence as provided by law for members of state boards, committees, and commissions and have such responsibilities as provided for in this article and as the board may determine.

(B) Vacancies must be filled in the manner of the original appointment for the unexpired portion of the term. The board, after notice and opportunity for hearing, may remove any member of the committee for negligence, neglect of duty, incompetence, revocation or suspension of license, or other dishonorable conduct. No member may serve more than two full four-year terms consecutively but may be eligible for reappointment four years from the date the last full four-year term expired.

(C) The committee shall meet at least two times yearly and at other times as may be necessary. Four members constitute a quorum. At its initial meeting, and at the beginning of each year thereafter, the committee shall elect from its membership a chairman, vice chairman, and secretary to serve for a term of one year.

(D) The committee shall receive and account for all monies under the provisions of this article and shall pay all monies collected to the board for deposit with the State Treasurer as provided for by law.

SECTION 40-47-715. Powers and duties.

(A) The committee may:

(1) recommend regulations to the board relating to professional conduct to carry out the provisions of this article including, but not limited to, professional certification and the establishment of ethical standards of practice for persons holding a license to practice as acupuncturists, auricular therapists, and auricular detoxification specialists in this State;

(2) recommend requirements to the board for continuing professional education acupuncturists, auricular therapists, and auricular detoxification specialists to the board;

(3) request and receive the assistance of state educational institutions or other state agencies and recommend to the board information of consumer interest describing the regulatory functions of the advisory committee and the procedures by which consumer complaints are filed with and resolved by the board. The board shall make the information available to the public and appropriate state agencies.

(B) The committee shall:

(1) conduct hearings and keep records and minutes necessary to carry out its functions;

(2) provide notice of all hearings authorized under this article pursuant to the Administrative Procedures Act;

(3) determine the qualifications and make recommendations regarding the issuance of licenses to qualified acupuncturists, auricular therapists, and auricular detoxification specialists;

(4) recommend to the board whether to issue or renew licenses under those conditions prescribed in this article;

(5) keep a record of its proceedings and a register of all licensees, including their names and last known places of employment and residence. The board shall annually compile and make available a list of acupuncturists, auricular therapists, and auricular detoxification specialists authorized to practice in this State. An interested person may obtain a copy of this list upon application to the board and payment of an amount sufficient to cover the cost of printing and mailing;

(6) report annually to the board on duties performed, actions taken, and recommendations made;

(7) hear disciplinary cases and recommend findings of fact, conclusions of law, and sanctions to the board. The board shall conduct a final hearing at which it shall make a final decision;

(8) perform such duties and tasks as may be delegated to the committee by the board.

SECTION 40-47-720. License to practice acupuncture; requirements and qualifications; temporary licenses.

(A) Each applicant for a license to practice acupuncture shall:

(1) submit a completed application as prescribed by the board;

(2) submit fees as provided for in Section 40-47-800;

(3) hold an active certification in acupuncture by the National Commission for the Certification of Acupuncturists and Oriental Medicine;

(4) be of good moral character;

(5) not have pled guilty or nolo contendere to or been convicted of a felony or crime of moral turpitude.

(B) The application must be complete in every detail before it may be approved. When the administrative staff of the board has reviewed the entire application for completeness and correctness, has found the applicant eligible, and the applicant has appeared before the committee or a designated board member, a temporary license may be issued. At the next committee meeting the entire application must be considered, and if qualified, the committee may recommend to the board that a permanent license be issued. If the committee declines to recommend issuance of a permanent license, the committee may extend or withdraw the temporary license.

SECTION 40-47-725. Licensing of current acupuncture practitioners.

(A)(1) An acupuncturist who is currently approved by the board to practice acupuncture in this State, who has remained in good standing, and who has successfully completed a nationally recognized clean needle technique course approved by the board must receive initial licensure under this article after submitting:

(a) a completed application as prescribed by the board;

(b) fees as provided for in Section 40-47-800.

(2) However, a license issued pursuant to subsection (A)(1) is only valid for two years. Thereafter for license renewal, the individual must hold an active certification from the National Commission for the Certification of Acupuncture and Oriental Medicine and satisfy the licensure and renewal requirements prescribed in this article.

(B) An individual who has continuously practiced acupuncture in this State since 1980, who has remained in good standing, must be issued a license and renewal licenses without meeting the requirements of this chapter after submitting:

(1) a completed application as prescribed by the board; and

(2) fees as provided for in Section 40-47-800.

SECTION 40-47-730. Licenses to perform auricular therapy; qualifications; temporary licenses.

(A) An applicant for a license to perform auricular therapy:

(1) must be twenty-one years of age;

(2) shall submit a completed application as prescribed by the medical board;

(3) shall submit fees as provided for in Section 40-47-800;

(4) shall provide evidence of certification as having been trained to utilize auricular points only, in addition to those utilized by a detoxification specialist;

(5) successful completion of a national certified program approved by the Acupuncture Advisory Committee and the State Board of Medical Examiners;

(6) successful completion of a Clean Needle Technique course approved by the board.

(B) The application must be complete in every detail before it may be approved. When the administrative staff of the board has reviewed the entire application for completeness and correctness, has found the applicant eligible, and the applicant has appeared before the committee or a designated board member, a temporary license may be issued. At the next committee meeting the entire application must be considered, and if qualified, the committee may recommend to the board that a permanent license be issued, if the committee declines to recommend issuance of a permanent license, the committee may extend or withdraw the temporary license.

SECTION 40-47-735. Licenses to perform auricular detoxification therapy; qualifications; temporary licenses.

(A) An applicant for a license to perform auricular detoxification therapy:

(1) must be at least twenty-one years of age;

(2) shall submit a completed application as prescribed by the board;

(3) shall submit fees as provided for in Section 40-47-800;

(4) shall have successfully completed a nationally recognized training program in auricular detoxification therapy for the treatment of chemical dependency detoxification and substance abuse, as approved by the board;

(5) shall have successfully completed a nationally recognized clean needle technique course approved by the board.

(B) The application must be complete in every detail before it may be approved. When the administrative staff of the board has reviewed the entire application for completeness and correctness, has found the applicant eligible, and the applicant has appeared before the committee or a designated board member, a temporary license may be issued. At the next committee meeting the entire application must be considered, and if qualified, the committee may recommend to the board that a permanent license be issued. If the committee declines to recommend issuance of a permanent license, the committee may extend or withdraw the temporary license.

SECTION 40-47-740. Licensing of current auricular therapists or auricular detoxification specialists.

(A) An auricular therapist or an auricular detoxification specialist who is currently approved by the board to practice in this State, who has remained in good standing, and who has successfully completed a nationally recognized clean needle technique course approved by the board must receive initial licensure under this article after submitting:

(1) a completed application as prescribed by the board;

(2) fees as provided for in Section 40-47-800.

(B) However, a license issued pursuant to subsection (A) is only valid for two years. Thereafter for license renewal the individual must have successfully passed a board-approved nationally recognized training program in auricular therapy or auricular detoxification and satisfy the licensure requirements prescribed in this article.

SECTION 40-47-745. Unauthorized practice; penalty; cease and desist orders and injunctions; privileged communications.

(A) It is unlawful for a person not licensed under this article to hold himself out as an acupuncturist, auricular therapist, or auricular detoxification specialist. The titles "Licensed Acupuncturist" (L.Ac.) and "Acupuncturist" may only be used by a person licensed to practice acupuncture pursuant to this article. Further, a person licensed to practice auricular therapy or auricular detoxification may not practice acupuncture or hold himself out as an acupuncturist. The title "Auricular Detoxification Specialist" (ADS) may only be used by a person licensed to practice auricular detoxification therapy pursuant to this article. Possession of a license as an auricular therapist or an auricular detoxification specialist does not, by itself, entitle a person to identify himself or herself as an acupuncturist. A person who holds himself out as an acupuncturist, auricular therapist, or auricular detoxification specialist without being licensed pursuant to this article, during a period of suspension, or after his or her license has been revoked by the board is guilty of a misdemeanor and, upon conviction, must be fined not more than three hundred dollars or imprisoned not more than ninety days, or both.

(B) For the purpose of any investigation or proceeding under this article, the board or a person designated by the board may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production for any documents or records which the board considers relevant to the inquiry.

(C) If the board has sufficient evidence that a person is violating a provision of this article, the board, in addition to all other remedies, may order the person to immediately cease and desist from this conduct. The board may apply to an administrative law judge as provided under Article 5, Chapter 23 of Title 1 for an injunction restraining the person from this conduct. An administrative law judge may issue a temporary injunction ex parte and upon notice and full hearing may issue any other order in the matter it considers proper. No bond may be required of the board by an administrative law judge as a condition to the issuance of an injunction or order contemplated by the provisions of this section.

(D) Each communication, whether oral or written, made by or on behalf of a person or firm to the board or a person designated by the board to investigate or otherwise hear matters relating to the revocation, suspension, or other restriction on a license or other discipline of a license holder, whether by way of complaint or testimony, is privileged and exempt from disclosure for any reason except to the extent disclosed in proceedings before the board. No action or proceeding, civil or criminal, may lie against the person or firm for the communication except upon other proof that the communication was made with malice.

(E) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law or prohibiting the respondent from normal access to the charges and evidence filed against him as part of due process under the law.

SECTION 40-47-750. Auricular therapy defined; supervision.

Auricular therapy may take place under the supervision of a licensed acupuncturist or a person licensed to practice medicine under this chapter. A treatment by an auricular therapist is strictly limited to inserting needles into the ear. Inserting needles anywhere else on the body is considered practicing acupuncture without a license.

SECTION 40-47-755. Auricular detoxification therapy defined; supervision.

Auricular detoxification therapy may take place under the direct supervision of a licensed acupuncturist or a person licensed to practice medicine under this chapter. A treatment by an auricular detoxification specialist is strictly limited to the five ear-point treatment protocol for detoxification, substance abuse, or chemical dependency as stipulated by NADA.

SECTION 40-47-760. Exempted activities.

This article does not apply to:

(1) the practice of acupuncture if it is an integral part of the program of study by students enrolled in an acupuncture education program under the direct clinical supervision of a licensed acupuncturist with at least five years of clinical experience and the program is accredited or is a candidate for accreditation or is actively seeking accreditation from ACAOM;

(2) a person employed as an acupuncturist or an auricular detoxification specialist by the United States Government if these services are provided solely under the direction or control of the United States Government.

SECTION 40-47-765. Grounds for revocation, suspension or denial of license.

Misconduct constituting grounds for revocation, suspension, probation, reprimand, restrictions, or denial of a license must be found when an acupuncturist, auricular therapist, or auricular detoxification specialist:

(1) has knowingly allowed himself or herself to be misrepresented as a medical doctor;

(2) has filed or has had filed on his or her behalf with the board any false, fraudulent, or forged statement or documents;

(3) has performed any work assignment, task, or other activity which is outside the scope of practice of licensure;

(4) misuses alcohol or drugs to such a degree to render him or her unfit to practice;

(5) has been convicted of a felony or a crime involving moral turpitude or drugs;

(6) has sustained any physical or mental disability which renders further practice dangerous to the public;

(7) has engaged in any dishonorable or unethical conduct that is likely to deceive or harm patients;

(8) has used or made any false or fraudulent statement in any document connected with practice or licensure;

(9) has obtained or assisted another person in obtaining fees under dishonorable, false, or fraudulent circumstances;

(10) has violated or conspired with another person to violate any provision of this article;

(11) otherwise demonstrates a lack of the ethical or professional competence required to practice;

(12) has failed to refer to a licensed medical doctor or dentist, as appropriate, a patient whose medical condition should have been determined to be beyond their scope of practice; or

(13) continues to provide acupuncture, auricular detoxification therapy, or auricular therapy services to any patient who the licensee treats at least one time per month for three consecutive months, and has not demonstrated clinical improvement, unless the licensee provides the patient with written notice, on or before the expiration of the third month, that the patient may need to seek a medical diagnosis from a licensed medical doctor or dentist before continuing with acupuncture, auricular detoxification therapy, or auricular therapy services, unless the patient was referred to the licensee by a licensed medical doctor or dentist.

Upon a finding of misconduct, the board may impose any sanction that the board is otherwise authorized to impose for misconduct under this chapter.

SECTION 40-47-770. Inspections.

The board or a person designated by the board may make unscheduled inspections of any office or facility employing an acupuncturist or auricular detoxification specialist.

SECTION 40-47-775. Display of license.

A person who holds a license issued in accordance with this article and who is engaged in the active practice of acupuncture, or the active practice of auricular therapy or the active practice of auricular detoxification, shall display the license in an appropriate and conspicuous location in the person's place of practice.

SECTION 40-47-780. Renewal of licenses.

(A) An acupuncture license issued under this article must be renewed biennially if the person holding the license:

(1) submits a completed license renewal application as prescribed by the board;

(2) submits the applicable fees provided for in Section 40-47-800;

(3) is not in violation of this article at the time of application for renewal;

(4) fulfills requirements for continuing education and professional development, as prescribed by the board in regulation;

(5) remains actively certified by the NCCAOM.

(B) An auricular therapist or auricular detoxification specialist license issued under this article must be renewed biennially if the person holding the license:

(1) submits a completed license renewal application prescribed by the board;

(2) submits the applicable fees provided for in Section 40-47-800;

(3) is not in violation of this article or any regulation promulgated under this article at the time of application for renewal;

(4) fulfills requirements for continuing education and professional development as prescribed by the board in regulation;

(5) remains active in the practice of auricular therapy or auricular detoxification.

SECTION 40-47-785. Request for inactive status.

Under procedures and conditions established by the board, a license holder may request that his or her license be declared inactive. The licensee may apply for active status at any time and, upon meeting the conditions established by the board in regulation, may be declared active.

SECTION 40-47-790. Licensee not to hold himself or herself out as authorized to practice medicine.

No person licensed under this article may advertise or hold himself or herself out to the public as being authorized to practice medicine under this chapter.

SECTION 40-47-800. Licensing fees.

Fees for acupuncturist, auricular therapist, and auricular detoxification specialist licensure must be established and adjusted biennially in accordance with Section 40-1-50(D) to ensure that they are sufficient but not excessive to cover expenses including the total of the direct and indirect costs to the State for the operations of the committee:

(1) initial licensing fee;

(2) renewal of license fee;

(3) late renewal fee;

(4) reactivation application fee.

SECTION 40-47-810. Third party reimbursement.

Nothing in this article may be construed to require third party reimbursement directly to an acupuncturist, auricular therapist, or auricular detoxification specialist for services rendered.

ARTICLE 7.

PHYSICIAN ASSISTANTS

SECTION 40-47-905. Short title.

This article may be cited as the "South Carolina Physician Assistants Practice Act".

SECTION 40-47-910. Definitions.

As used in this article:

(1) "Alternate physician supervisor" or " alternate" means a South Carolina licensed physician currently possessing an active, unrestricted permanent license to practice medicine in South Carolina who accepts the responsibility to supervise a physician assistant's activities in the absence of the supervising physician and this physician is approved by the board in writing.

(2) "Board" means the Board of Medical Examiners of South Carolina.

(3) "Committee" means the Physician Assistant Committee as established by this article as an advisory committee responsible to the board.

(4) "NCCPA" means the National Commission on Certification of Physician Assistants, Inc., the agency recognized to examine and evaluate the education of physician assistants, or its successor organization as recognized by the board.

(5) "Physician assistant" means a health care professional licensed to assist in the practice of medicine with a physician supervisor.

(6) "Physician supervisor" means a South Carolina licensed physician currently possessing an active, unrestricted permanent license to practice medicine in South Carolina who is approved to supervise no more than two physician assistants.

(7) "Supervising" means overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant in a manner approved by the board.

SECTION 40-47-915. Application of article.

This article does not apply to a person:

(1) who is employed as a physician assistant by the United States Government, where such services are provided solely under the direction or control of the United States Government.

(2) pursuing a course of study leading to a degree or certificate to practice as a physician assistant in a program approved by the Commission on Accreditation of Allied Health Education Programs or its successor agency, where such activities and services constitute a part of a supervised course of study; however, the person must be clearly identified by a badge or other adornment with that person's name and the words "Physician Assistant-Student" clearly legible. The badge or adornment must be at least one inch by three inches in size.

SECTION 40-47-920. Authority to employ staff.

The Director of the Department of Labor, Licensing and Regulation may employ additional staff as necessary for the performance of the department's duties under this article.

SECTION 40-47-925. Physician Assistant Committee; membership; term; filling vacancies; meetings; duty to receive and account for monies collected under article.

(A) There is created the Physician Assistant Committee as an advisory committee to the board which consists of nine members to be appointed by the Board of Medical Examiners. Three of the members must be licensed physician assistants with a minimum of three years of patient care experience in this State. Two members must be consumers, and three members must be physicians who are licensed to practice in this State. Of the three physician members, at least one must regularly employ a physician assistant. One member of the Board of Medical Examiners shall serve on the committee ex officio. All organizations, groups, or interested individuals may submit recommendations to the board of at least two individuals for each position to be filled on the committee.

(B) The members shall serve for terms of four years and until their successors are appointed and qualify, except the initial term of two physician assistants, the consumer member, and one physician are for two years. Vacancies must be filled in the manner of the original appointment for the unexpired portion of the term. The board, after notice and opportunity for hearing, may remove any member of the committee for negligence, neglect of duty, incompetence, revocation or suspension of license, or other dishonorable conduct. Members of the committee shall receive mileage, subsistence, and per diem as provided by law for members of state boards, commissions, and committees for each meeting attended. No member may serve more than two full four-year terms consecutively, but may be eligible for reappointment four years from the date the last full four-year term expired.

(C) The committee shall meet at least two times yearly and at other times as may be necessary. A quorum for all meetings shall consist of five members. At its initial meeting, and at the beginning of each year thereafter, the committee shall elect from its membership a chairman, vice-chairman, and secretary to serve for a term of one year.

(D) The committee shall receive and account for all monies under the provisions of this article and shall pay all monies collected to the board for deposit with the State Treasurer as provided for by law.

SECTION 40-47-930. Powers and duties of committee and board.

(A) The committee shall evaluate the qualifications and supervise the examinations of applicants for licensure and make recommendations to the board.

(B) The board may issue subpoenas, examine witnesses, and administer oaths and may investigate allegations of practices violating the provisions of this article.

(C) The committee:

(1) may recommend regulations to the board relating to professional conduct to carry out the provisions of this article including, but not limited to, professional certification and the establishment of ethical standards of practice for persons holding a license to practice as physician assistants in this State;

(2) shall conduct hearings and keep records and minutes necessary to carry out its functions;

(3) shall provide notice of all hearings authorized under this article pursuant to the Administrative Procedures Act;

(4) shall determine the qualifications and make recommendations regarding the issuance of licenses to qualified physician assistants;

(5) shall recommend to the board whether to issue or renew licenses under those conditions prescribed in this article;

(6) may recommend requirements to the board for continuing professional education of physician assistants to the board;

(7) shall keep a record of its proceedings and a register of all licensees, including their names and last known places of employment and residence. The board shall annually compile and make available a list of physician assistants authorized to practice in this State. An interested person may obtain a copy of this list upon application to the board and payment of an amount sufficient to cover the cost of printing and mailing;

(8) shall report annually to the board on duties performed, actions taken, and recommendations;

(9) shall hear disciplinary cases and recommend findings of fact, conclusions of law, and sanctions to the board. The board shall conduct a final hearing at which it shall make a final decision;

(10) shall perform such duties and tasks as may be delegated to the committee by the board.

SECTION 40-47-935. Act and duties physician assistant authorized to perform; agency relationship to supervising physician.

Physician assistants may perform:

(1) medical acts, tasks, or functions with written scope of practice guidelines under physician supervision;

(2) those duties and responsibilities, including the prescribing and dispensing of drugs and medical devices, that are lawfully delegated by their supervising physicians.

A physician assistant is an agent of his or her supervising physician in the performance of all practice related activities including, but not limited to, the ordering of diagnostic, therapeutic, and other medical services.

SECTION 40-47-940. Application for license; appearance before committee; temporary and permanent licenses.

An application must be submitted to the board on forms supplied by the board. The application must be complete in every detail before it may be approved and must be accompanied by a nonrefundable fee. As part of the application process, the supervising physician and physician assistant must clearly specify in detail those tasks for which approval is being sought. The specific tasks must be included in the scope of practice guidelines and the scope of practice guidelines must accompany the application. When the administrative staff of the board has reviewed the entire application for completeness and correctness, has found the applicant eligible, and the supervising physician and physician assistant have appeared before the committee or a designated board member, a temporary license may be issued. At the next committee meeting the entire application, including scope of practice guidelines, must be considered and, if qualified, the committee may recommend to the board that a permanent license be issued to the physician assistant. If the committee declines to recommend issuance of a permanent license, the committee may extend or withdraw the temporary license.

SECTION 40-47-945. Conditions for granting license.

Except as otherwise provided in this article, an individual must obtain a license from the board before the individual may practice as a physician assistant. The board shall grant a license as a physician assistant to an applicant who has:

(1) submitted a completed application on forms provided by the board;

(2) paid the nonrefundable application fees established in this article;

(3) successfully completed an educational program for physician assistants approved by the Commission on Accredited Allied Health Education Programs or its successor organization;

(4) successfully completed the NCCPA certifying examination and provide documentation that he or she possesses a current, active, NCCPA certificate;

(5) certified that he or she is mentally and physically able to engage safely in practice as a physician assistant;

(6) no licensure, certificate, or registration as a physician assistant under current discipline, revocation, suspension, probation, or investigation for cause resulting from the applicant's practice as a physician assistant;

(7) good moral character;

(8) submitted to the board any other information the board considers necessary to evaluate the applicant's qualifications;

(9) appeared before a board member with his or her supervising physician and all original diplomas and certificates and demonstrated knowledge of the contents of this article;

(10) successfully completed an examination administered by the committee on the statutes and regulations regarding physician assistant practice and supervision.

SECTION 40-47-950. Limited physician assistant license; conditions for issuance; duration; responsibilities of supervising physician.

(A) The board may issue a limited physician assistant license to an applicant who has:

(1) submitted a completed application on forms provided by the board;

(2) paid the nonrefundable application fees established by this regulation;

(3) successfully completed an educational program for physician assistants approved by the American Medical Association Counsel on Medical Education;

(4) never previously failed two consecutive NCCPA certifying examinations and has registered for, or intends to register to take the next offering of, the NCCPA examination;

(5) certified that he or she is mentally and physically able to engage safely in practice as a physician assistant;

(6) no licensure, certificate, or registration as a physician assistant under current discipline, revocation, suspension, probation, or investigation for cause resulting from the applicant's practice as a physician assistant;

(7) good moral character;

(8) submitted to the board any other information the board considers necessary to evaluate the applicant's qualifications;

(9) appeared before a board member with his or her supervising physician and all original diplomas and certificates and demonstrated knowledge of the contents of this article;

(10) successfully completed an examination administered by the committee on the statutes and regulations regarding physician assistant practice and supervision.

(B) A limited license is not renewable and is valid only until the results of a limited licensee's two consecutive NCCPA certifying examinations are reported to the board. When a limited licensee has failed two consecutive NCCPA certifying examinations, or fails one exam and does not take the NCCPA certifying examination at the next opportunity or, after applying for a limited license, fails to register for the next offering of the examination, the limited license is immediately void and the applicant is no longer eligible to apply for further limited licensure.

(C) The supervising physician of a limited licensee must be physically present on the premises at all times when the limited licensee is performing any task. No on-the-job training, or task not listed on the application, may be approved for a limited license holder.

SECTION 40-47-955. Scope of physician assistant's practice; physical presence requirements of supervising physician; practices in separate locations; granting of exceptions.

(A) The supervising physician is responsible for all aspects of the physician assistant's practice. Supervision must be continuous but must not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where the services are rendered, except as otherwise required for limited licensees. The supervising physician shall identify the physician assistant's scope of practice and determine the delegation of medical tasks. All tasks must be defined in approved written guidelines which must be appropriate to the physician assistant's ability and knowledge.

(B) The supervising physician or alternate supervising physician must be physically present at least seventy-five percent of the time the physician assistant is providing services. A physician assistant must have six months' clinical experience with the current supervising physician before being permitted to practice in the absence of the supervising physician. The physician assistant may provide services in the absence of his or her supervising physician or alternate supervising physician for a period not to exceed seven consecutive days without prior written permission from the board.

(C) A physician assistant may not practice at any location more than forty-five miles or sixty minutes travel time from the supervising physician without written approval of the board. The supervising physician or alternate must review, initial, and date the charts within seventy-two hours of patients seen by the physician assistant when the supervising physician or alternate was not present at the practice site. A supervising physician may not supervise more than two physician assistants.

(D) Upon written request, and recommendation of the committee, the board may authorize exceptions to the requirements of this section.

SECTION 40-47-960. Scope of practice guidelines; signature and filing requirements; contents.

A physician assistant practicing at all sites shall practice pursuant to written scope of practice guidelines signed by all supervisory physicians and the physician assistant. Copies of the guidelines must be on file at all practice sites. The guidelines shall include at a minimum the:

(1) name, license number, and practice addresses of all supervising physicians;

(2) name and practice address of the physician assistant;

(3) date the guidelines were developed and dates they were reviewed and amended;

(4) medical conditions for which therapies may be initiated, continued, or modified;

(5) treatments that may be initiated, continued, or modified;

(6) drug therapy, if any, that may be prescribed with drug-specific classifications; and

(7) situations that require direct evaluation by or immediate referral to the physician.

SECTION 40-47-965. Requirements for writing prescriptions for drugs and devices.

(A) If the written scope of practice guidelines authorize the physician's assistant to prescribe drug therapy:

(1) prescriptions for authorized drugs and devices shall comply with all applicable state and federal laws;

(2) prescriptions must be limited to drugs and devices authorized by the supervising physician and set forth in the written scope of practice guidelines;

(3) prescriptions must be signed by the physician assistant and must bear the physician assistant's identification number as assigned by the board. The prescription form shall include the physician assistant's and physician's name, address, and phone number pre-printed on the form and shall comply with the provisions of Section 39-24-40;

(4) drugs or devices prescribed must be specifically documented in the patient record;

(5) the physician assistant may request, receive, and sign for professional samples, except for controlled substances in Schedules II through IV, and may distribute professional samples to patients in compliance with appropriate federal and state regulations.

(B) A physician assistant's prescriptive authorization may be terminated by the board if the physician assistant:

(1) practices outside the written scope of practice guidelines;

(2) violates any state or federal law or regulation applicable to prescriptions; or

(3) violates a state or federal law applicable to physician assistants.

SECTION 40-47-970. Limitations on permissible tasks for physician assistant's.

A physician assistant may not:

(1) perform a task which has not been listed and approved on the scope of practice guidelines currently on file with the board;

(2) prescribe drugs, medications, or devices not specifically authorized by the supervising physician and documented in the written scope of practice guidelines;

(3) prescribe, under any circumstances, controlled substances in Schedules II through IV.

SECTION 40-47-975. On-the-job training requests.

A physician who has supervised a licensed physician assistant for a period of at least six months, or a physician assistant who has been licensed for at least one year, may request on-the-job training for the physician assistant. A request for on-the-job training must be submitted to the board in writing and shall describe in detail the additional training and additional tasks involved.

SECTION 40-47-980. Treatment of patients in chronic care and long-term care facilities.

In the treatment of patients in chronic care and long-term care facilities including, but not limited to, nursing homes or chronic dialysis units, the supervising physician must conduct the initial patient visit. Thereafter, the physician supervisor or alternate must see the patient every six months for routine evaluation.

SECTION 40-47-985. Inspection of office or facility employing physician assistant.

The board or a person designated by the board may make unscheduled inspections of any office or facility employing a physician assistant.

SECTION 40-47-990. Identification as physician assistant; badge size and content.

A physician assistant must clearly identify himself or herself as a physician assistant to ensure that the physician assistant is not mistaken or misrepresented as a physician. A physician assistant shall wear a clearly legible identification badge or other adornment at least one inch by three inches in size bearing the physician assistant's name and the words "Physician Assistant".

SECTION 40-47-995. Termination of supervisory relationship; notice to board.

If the supervisory relationship between a physician assistant and the supervising physician is terminated for any reason, the physician assistant and the supervising physician shall inform the board immediately in writing of the termination, including the reasons for the termination. The approval of the practice setting terminates coterminous with the termination of the relationship, and practice shall cease until a new application is submitted by a supervising physician and is approved by the board.

SECTION 40-47-1000. Unlicensed person holding himself out as physician assistant; penalty; investigation; desist and refrain order; injunction; privileged communications; due process rights of respondent protected.

(A) It is unlawful for a person who is not licensed under this article to hold himself out as a physician assistant. A person who holds himself out as a physician assistant without being licensed under this article, during a period of suspension, or after his license has been revoked by the board is guilty of a misdemeanor and, upon conviction, must be fined not more than three hundred dollars or imprisoned for not more than ninety days, or both.

(B) For the purpose of any investigation or proceeding under the provisions of this article, the board or a person designated by the board may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production of any documents or records which the board considers relevant to the inquiry.

(C) If the board has sufficient evidence that a person is violating a provision of this article, the board, in addition to all other remedies, may order the person to immediately desist and refrain from this conduct. The board may apply to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 for an injunction restraining the person from this conduct. An administrative law judge may issue a temporary injunction ex parte and upon notice and full hearing may issue any other order in the matter it considers proper. No bond may be required of the board by an administrative law judge as a condition to the issuance of any injunction or order contemplated by the provisions of this section.

(D) Every communication, whether oral or written, made by or on behalf of any person or firm to the board or any person designated by the board to investigate or otherwise hear matters relating to the revocation, suspension, or other restriction on a license or other discipline of a license holder, whether by way of complaint or testimony, is privileged and exempt from disclosure for any reason except to the extent disclosed in proceedings before the board. No action or proceeding, civil or criminal, may lie against the person or firm for the communication except upon other proof that the communication was made with malice.

(E) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law or prohibiting the respondent from normal access to the charges and evidence filed against him as a part of due process under the law.

SECTION 40-47-1005. Misconduct mandating revocation or denial of license.

Misconduct constituting grounds for revocation, suspension, probation, reprimand, restrictions, or denial of a license must be found when a physician assistant:

(1) has knowingly allowed himself or herself to be misrepresented as a physician;

(2) has filed or has had filed on his or her behalf with the board any false, fraudulent, or forged statement or documents;

(3) has performed any work assignment, task, or other activity which is not on the physician assistant scope of practice guidelines;

(4) misuses alcohol or drugs to such a degree to render him or her unfit to practice as a physician assistant;

(5) has been convicted of a felony or a crime involving moral turpitude or drugs;

(6) has sustained any physical or mental disability which renders further practice dangerous to the public;

(7) has engaged in any dishonorable or unethical conduct that is likely to deceive or harm patients;

(8) has used or made any false or fraudulent statement in any document connected with practice or licensure as a physician assistant;

(9) has obtained or assisted another person in obtaining fees under dishonorable, false, or fraudulent circumstances;

(10) has violated or conspired with another person to violate any provision of this article; or

(11) otherwise demonstrates a lack of the ethical or professional competence required to act as a physician assistant.

SECTION 40-47-1010. Renewal of license.

A physician assistant's license must be renewed on or before the first of January of each licensure period. Upon payment of the nonrefundable renewal fee provided for in Section 40-47-1015 and submission of documentation that the physician assistant certificate with the National Commission on Certification of Physician Assistants, Inc., or its successor, is active and current, the board shall renew the physician assistant's license.

SECTION 40-47-1015. Fees for licensure.

Fees for physician assistant licensure are established as follows:

(1) initial licensing fee, not to exceed five hundred dollars;

(2) renewal of license fee, not to exceed one hundred and fifty dollars;

(3) late renewal fee, not to exceed the renewal fee doubled;

(4) reactivation application fee, not to exceed two hundred dollars;

(5) change in supervisor fee, not to exceed one hundred and fifty dollars;

(6) additional primary supervisor for dual employment fee, not to exceed one hundred and fifty dollars.

Fees may be adjusted biennially to ensure that they are sufficient but not excessive to cover expenses including the total of the direct and indirect costs to the State for the operations of the board.

SECTION 40-47-1020. Third party reimbursement to physician assistant.

Nothing in this article may be construed to require third party reimbursement directly to a physician assistant for services rendered.

ARTICLE 9.

ANESTHESIOLOGIST'S ASSISTANTS

SECTION 40-47-1205. Short title.

This article may be cited as the "South Carolina Anesthesiologist's Assistants Practice Act".

SECTION 40-47-1210. Definitions.

As used in this article:

(1) "Anesthesiologist" means a physician who has successfully completed an approved anesthesiology training program including, but not limited to, a program approved by the Accreditation Committee on Graduate Medical Education, or its equivalent or successor.

(2) "Anesthesiologist's assistant" means an allied health graduate of an accredited anesthesiologist's assistant program who is currently certified by the National Commission for Certification of Anesthesiologist's Assistants and who works under the direct supervision of an anesthesiologist who is immediately available in the operating suite and is physically present during the most demanding portions of the anesthetic including, but not limited to, induction and emergence.

(3) "Board" means the Board of Medical Examiners of South Carolina.

(4) "Committee" means the Anesthesiologist's Assistant Committee as established by this article as an advisory committee responsible to the board.

(5) "NCCAA" means the National Commission on Certification of Anesthesiologist's Assistants, Inc., the agency recognized to examine and evaluate the education of anesthesiologist's assistants, or its successor organization as recognized by the board.

(6) "Sponsoring anesthesiologist" means the physician specialist in anesthesiology who signs the anesthesiologist's assistant's application for licensure.

(7) "Supervising anesthesiologist" means a South Carolina licensed physician currently possessing an active, unrestricted license to practice medicine in South Carolina who practices in the medical specialty of anesthesiology and has successfully completed a residency in anesthesiology, approved by the Accreditation Committee on Graduate Medical Education, or its equivalent or successor.

(8) "Supervision" means medically directing and accepting responsibility for the anesthesia services rendered by an anesthesiologist's assistant in a manner approved by the board. The supervising anesthesiologist must be in the hospital and in the anesthetizing or operative area such that he can be immediately available to participate directly in the care of the patient with whom the anesthesiologist's assistant and the anesthesiologist are jointly involved.

SECTION 40-47-1215. Application of this article.

This article does not apply to a person who is employed as an anesthesiologist's assistant by the United States Government, where such services are provided solely under the direction or control of the United States Government.

SECTION 40-47-1220. Department of Labor staff.

The Director of the Department of Labor, Licensing and Regulation may employ additional staff as necessary for the performance of the department's duties under this article.

SECTION 40-47-1225. Anesthesiologist's Assistant Committee.

(A) There is created the Anesthesiologist's Assistant Committee as an advisory committee to the Board of Medical Examiners which consists of nine members to be appointed by the board. Three of the members must be licensed anesthesiologist's assistants with a minimum of three years of patient care experience. Two members must be consumers and three members must be physicians who are licensed to practice in this State. Of the three physician members, at least one must regularly employ an anesthesiologist's assistant. One member of the Board of Medical Examiners shall serve on the committee ex officio, with full rights to participate and vote. All organizations, groups, or interested individuals may submit recommendations to the board of at least two individuals for each position to be filled on the committee.

(B) The members shall serve for terms of four years and until their successors are appointed and qualify, except the initial term of two anesthesiologist's assistants, the consumer member, and one physician are for two years. Vacancies must be filled in the manner of the original appointment for the unexpired portion of the term. The board, after notice and opportunity for hearing, may remove any member of the committee for negligence, neglect of duty, incompetence, revocation or suspension of license, or other dishonorable conduct. Members of the committee shall receive mileage, subsistence, and per diem as provided by law for members of state boards, commissions, and committees for each meeting attended. No member may serve more than two full four-year terms consecutively but may be eligible for reappointment four years from the date the last full four-year term expired.

(C) The committee shall meet at least two times yearly and at other times as may be necessary. A majority of the members currently serving, not less than two of whom must be physician members, constitutes a quorum. At its initial meeting, and at the beginning of each year thereafter, the committee shall elect from its membership a chairman, vice-chairman, and secretary to serve for a term of one year.

SECTION 40-47-1230. Duties of Anesthesiologist's Assistant Committee.

(A) The committee shall evaluate the qualifications for licensure and make recommendations to the board.

(B) The committee:

(1) may recommend regulations to the board relating to professional conduct to carry out the provisions of this article including, but not limited to, professional certification and the establishment of ethical standards of practice for persons holding a license to practice as an anesthesiologist's assistant in this State;

(2) shall conduct hearings and keep records and minutes necessary to carry out its functions;

(3) shall provide notice of all hearings authorized under this article pursuant to the Administrative Procedures Act;

(4) shall determine the additional qualifications and make recommendations regarding the issuance of licenses to qualified anesthesiologist's assistants; however, these recommendations may not be less stringent than the requirements for national licensure;

(5) shall recommend to the board whether to issue or renew licenses under those conditions prescribed in this article;

(6) may recommend requirements to the board for continuing professional education of anesthesiologist's assistants;

(7) shall keep a record of its proceedings and a register of all licensees, including names and last known places of employment and residence. The board shall annually compile and make available a list of anesthesiologist's assistants authorized to practice in this State. An interested person may obtain a copy of this list upon application to the board and payment of an amount sufficient to cover the cost of printing and mailing;

(8) shall report annually to the board on duties performed, actions taken, and recommendations;

(9) shall hear disciplinary cases and recommend findings of fact, conclusions of law, and sanctions to the board. The board shall conduct a final order hearing at which it shall make a final decision;

(10) shall perform such duties and tasks as may be delegated to the committee by the board.

SECTION 40-47-1235. Functions and duties of anesthesiologist's assistants.

Anesthesiologist's assistants may perform medical tasks and services within the framework of a written practice protocol developed for the anesthesiologist's assistant. Within this practice protocol the anesthesiologist's assistant, under the direction of the anesthesiologist may engage in these functions and duties:

(1) obtaining relevant preoperative health history by record or chart review and by direct contact with the patient in the preoperative period;

(2) presenting preoperative health information to the supervising anesthesiologist for the collaborative formulation of an anesthetic plan;

(3) performing initial acute cardio-pulmonary resuscitation in life-threatening situations as directed by a physician;

(4) initiating medically directed multi-parameter monitoring before anesthesia and in other acute care settings. Modalities that may be used include, but are not limited to, American Society of Anesthesiologists Standard Monitors, arterial and venous catheters, or any other current medically accepted modality. The anesthesiologist's assistant may obtain data from monitors or devices that are indicated and may initiate medically directed therapy. The anesthesiologist's assistant may administer drugs used in anesthetic practice by written protocol or as directed by the supervising anesthesiologist;

(5) using current advanced treatment modalities to effect the prescribed anesthetic plan during the procedure. These advanced treatment modalities may include, but are not limited to, basic and advanced airway interventions, including intubation of the trachea; administering intermittent vasoactive drugs, starting and adjusting vasoactive infusions, administering anesthetic, adjuvant, and accessory drugs; administering blood and blood products; and any other treatment modalities prescribed by the medically directing anesthesiologist and within the training and expertise of the anesthesiologist's assistant;

(6) supporting the patient upon emergence and recovery from an anesthetic by airway intervention or ventilatory support and administering any supportive medication and fluids;

(7) participating in administrative, educational, and research activities as appropriate.

An anesthesiologist's assistant may not present himself or herself as an anesthesiologist, any other type of physician, or a nurse anesthetist. The required nomenclature is: "Anesthesiologist's Assistant".

SECTION 40-47-1240. Licensure of anesthesiologist's assistants.

Except as otherwise provided in this article, an individual must obtain a license in accordance with this article before the individual may practice as an anesthesiologist's assistant. The board shall grant a license as an anesthesiologist's assistant to an applicant who has:

(1) submitted a completed application on forms provided by the board;

(2) paid the nonrefundable application fees established in this article;

(3) certified that he or she is mentally and physically able to engage safely in practice as an anesthesiologist's assistant;

(4) submitted evidence to the board that the applicant has obtained a baccalaureate or higher degree from an institution of higher education accredited by an organization recognized by the Commission on Higher Education. This degree program must have included courses in these areas of study:

(a) general biology;

(b) general chemistry;

(c) organic chemistry;

(d) physics;

(e) calculus; and

(5) submitted evidence to the board that the applicant has obtained a graduate-level degree from a program accredited by the Commission on Accreditation of Allied Health Education Programs, or any of the commission's successor organizations, and the graduate degree program must have included the following:

(a) courses in the basic sciences of anesthesia, including general pharmacology, physiology, pathophysiology, anatomy, and biochemistry, and these courses must be presented as a continuum of didactic courses designed to teach students the foundations of human biological existence on which clinical correlations to anesthesia practice are based;

(b) pharmacology for the anesthetic sciences which must include instruction in the anesthetic principles of pharmacology, pharmacodynamics, pharmacokinetics, uptake and distribution, intravenous anesthetics and narcotics, and volatile anesthetics;

(c) physics in anesthesia; and

(d) fundamentals of anesthetic sciences, presented as a continuum of courses covering a series of topics in basic medical sciences with special emphasis on the effects of anesthetics on normal physiology and pathophysiology;

(6) submitted evidence satisfactory to the board that the applicant holds current certification from the National Commission for Certification of Anesthesiologist's Assistants and that the requirements for receiving the certification included passage of an examination to determine the individual's competence to practice as an anesthesiologist's assistant;

(7) no licensure, certificate, or registration as an anesthesiologist's assistant under current discipline, revocation, suspension, probation, or investigation for cause resulting from the applicant's practice as an anesthesiologist's assistant in any jurisdiction;

(8) appeared before a board member with his or her sponsoring anesthesiologist, presenting all original diplomas and certificates and demonstrated knowledge of the contents of this article; and

(9) submitted to the board any other information the board considers necessary to evaluate the applicant's qualifications.

SECTION 40-47-1245. Supervising anesthesiologist; protocol delineating services provided by anesthesiologist's assistant.

An anesthesiologist who agrees to act as the supervising anesthesiologist of an anesthesiologist's assistant shall adopt a written practice protocol that delineates the service that the anesthesiologist's assistant is authorized to provide and the manner in which the anesthesiologist will supervise the anesthesiologist's assistant. The anesthesiologist shall base the provisions of the protocol on consideration of relevant quality assurance standards, including being present at the most important times of the case and timely review of the patient's anesthesia record at appropriate times during the course of the anesthetic procedure. The protocol must be reviewed by the anesthesiologist at least once a year.

SECTION 40-47-1250. Supervision of anesthesiologist's assistants.

An anesthesiologist's assistant shall practice only under the supervision of a physician who is actively and directly engaged in the clinical practice of medicine as an anesthesiologist. An anesthesiologist may not supervise more than two anesthesiologist's assistants at any one time.

SECTION 40-47-1255. Anesthesiologist's assistants to practice pursuant to written protocol.

An anesthesiologist's assistant practicing at all sites shall practice pursuant to written scope of practice protocols signed by all supervising anesthesiologists and the anesthesiologist's assistant. Copies of the protocols must be on file at all practice sites. The protocols shall include at a minimum the:

(1) name, license number, and practice addresses of the sponsoring anesthesiologist;

(2) name and practice address of the anesthesiologist's assistant;

(3) date the protocol was developed and dates it was reviewed or amended;

(4) situations that require direct evaluation by or immediate referral to the anesthesiologist.

SECTION 40-47-1260. Limitations on practice of anesthesiologist's assistants.

An anesthesiologist's assistant may not:

(1) perform a task which has not been listed and approved on the scope of the practice protocol currently on file with the board;

(2) prescribe drugs, medications, or devices of any kind.

SECTION 40-47-1265. Inspections.

The board or a person designated by the board may make unscheduled inspections of any office or facility employing an anesthesiologist's assistant.

SECTION 40-47-1270. Identification of anesthesiologist's assistants.

An anesthesiologist's assistant must clearly identify himself or herself as an anesthesiologist's assistant to ensure that the anesthesiologist's assistant is not mistaken or misrepresented as a physician. An anesthesiologist's assistant shall wear a clearly legible identification badge or other adornment at least one inch by three inches in size bearing the anesthesiologist's assistant's name and the words "Anesthesiologist's Assistant". Patients in facilities utilizing anesthesiologist's assistants must be informed when an anesthesiologist's assistant will be involved in their anesthesia care.

SECTION 40-47-1275. Termination of supervisory relationship between anesthesiologist and assistant.

If the supervisory relationship between an anesthesiologist's assistant and the supervising anesthesiologist is terminated for any reason, both the anesthesiologist's assistant and the supervising anesthesiologist shall inform the board immediately in writing of the termination, including the reasons for the termination. The approval of the practice setting terminates coterminous with the termination of the relationship, and practice shall cease until a new application is submitted by a supervising anesthesiologist and is approved by the board.

SECTION 40-47-1280. Violations of this article.

(A) It is unlawful for a person who is not licensed under this article to hold himself out as an anesthesiologist's assistant. A person who holds himself out as an anesthesiologist's assistant without being licensed under this article, during a period of suspension, or after his license has been revoked by the board is guilty of a misdemeanor and, upon conviction, must be fined not more than three hundred dollars or imprisoned for not more than ninety days, or both.

(B) For the purpose of any investigation or proceeding under this article, the board or a person designated by the board may administer oaths and affirmations, subpoena witnesses, take testimony, and require the production of any documents or records which the board considers relevant to the inquiry.

(C) If the board has sufficient evidence that a person is violating a provision of this article, the board, in addition to all other remedies, may order the person to immediately desist and refrain from this conduct. The board may apply to an administrative law judge as provided under Article 5 of Chapter 23 of Title 1 for an injunction restraining the person from this conduct. An administrative law judge may issue a temporary injunction ex parte and upon notice and full hearing may issue any other order in the matter it considers proper. No bond may be required of the board by an administrative law judge as a condition to the issuance of any injunction or order contemplated by the provisions of this section.

(D) No provision of this article may be construed as prohibiting the respondent or his legal counsel from exercising the respondent's constitutional right of due process under the law or prohibiting the respondent from normal access to the charges and evidence filed against him as a part of due process under the law.

SECTION 40-47-1285. Grounds for disciplinary action.

Misconduct constituting grounds for revocation, suspension, probation, reprimand, restrictions, or denial of a license must be found when an anesthesiologist's assistant:

(1) has knowingly allowed himself or herself to be misrepresented as a physician;

(2) has filed or has had filed on his or her behalf with the board any false, fraudulent, or forged statement or documents;

(3) has performed any work assignment, task, or other activity which is not on the anesthesiologist's assistant's written practice protocol;

(4) misuses alcohol or drugs to such a degree to render him or her unfit to practice as an anesthesiologist's assistant;

(5) has been convicted of a felony or a crime involving moral turpitude or drugs;

(6) has sustained any physical or mental disability which renders further practice dangerous to the public;

(7) has engaged in any dishonorable or unethical conduct that is likely to deceive or harm patients;

(8) has used or made any false or fraudulent statement in any document connected with practice or licensure as an anesthesiologist's assistant;

(9) has obtained or assisted another person in obtaining fees under dishonorable, false, or fraudulent circumstances;

(10) has violated or conspired with another person to violate any provision of this article; or

(11) otherwise demonstrates a competence required to act as an anesthesiologist's assistant.

SECTION 40-47-1290. License renewal.

An anesthesiologist's assistant's license must be renewed on or before the first of January of each licensure period. Upon payment of the nonrefundable renewal fee provided for in Section 40-47-1295 and submission of documentation that the anesthesiologist's assistant certificate issued by the National Commission for Certification of Anesthesiologist's Assistants, or its successor, is active and current, the board shall renew the anesthesiologist's assistant's license.

SECTION 40-47-1295. Maximum fees.

(A) Fees for anesthesiologist's assistant licensure are established as follows:

(1) initial licensing fee, not to exceed one thousand dollars;

(2) renewal of license fee, not to exceed three hundred dollars;

(3) late renewal fee, not to exceed the renewal fee doubled;

(4) reactivation application fee, not to exceed three hundred dollars;

(5) change in supervisor fee, not to exceed three hundred dollars.

(B) Fees may be adjusted biennially in accordance with Section 40-1-50 to ensure that they are sufficient but not excessive to cover expenses including the total of the direct and indirect costs to the State for the operations of the committee.

SECTION 40-47-1300. Third party reimbursement.

Nothing in this article may be construed to require third party reimbursement directly to an anesthesiologist's assistant for services rendered.

ARTICLE 10.

REGISTERED CARDIOVASCULAR INVASIVE SPECIALISTS

SECTION 40-47-1510. Citation of article.

This article may be cited as the "South Carolina Registered Cardiovascular Invasive Specialist Act".

SECTION 40-47-1520. Definitions.

As used in this article:

(1) "Cardiologist" means a physician who has successfully completed an approved cardiology training program including, but not limited to, a program approved by the Accreditation Committee on Graduate Medical Education, or its equivalent or successor.

(2) "Cardiovascular Invasive Specialist" means a cardiovascular invasive specialist who is currently registered by Cardiovascular Credentialing International, has graduated from an accredited program of Cardiovascular Invasive Technology and who working under the direct supervision of a cardiologist performs procedures on patients resulting in accurate diagnosis and/or optimal treatment of congenital or acquired heart disease.

(3) "Supervising cardiologist" means a South Carolina licensed physician currently possessing an active, unrestricted license to practice medicine in South Carolina who practices in the medical specialty of cardiology and has successfully completed a residency in cardiology, approved by the Accreditation Committee on Graduate Medical Education, or its equivalent or successor.

(4) "Supervision" means medically directing and accepting responsibility for the cardiac services rendered by a registered cardiovascular invasive specialist in a manner provided for in law and the adopted protocol of the licensed facility. The supervising cardiologist must be in the facility and in the operative area such that he can be immediately available to participate directly in the care of the patient with whom the invasive cardiovascular specialist and the cardiologist are jointly involved.

SECTION 40-47-1530. Registration requirement.

A person may not wilfully practice or offer to practice as a cardiovascular invasive specialist unless that person is registered by the department. A person who uses the title cardiovascular specialist in any advertisement, business card or letterhead, or billing document or who makes another verbal or written communication indicating that the person is a cardiovascular specialist or who acquiesces in that representation violates this section.

SECTION 40-47-1540. Application for registration.

To be registered by the department as a cardiovascular invasive specialist, a person must:

(1) apply in writing to the department on a form available from the department;

(2) successfully complete an approved cardiology training program including, but not limited to, a program approved by the Accreditation Committee of Graduate Medical Education, or its equivalent or successor approved by the South Carolina Board of Medical Examiners;

(3) provide satisfactory evidence of current registration with Cardiovascular Credentialing International;

(4) provide satisfactory evidence that the applicant's practice protocol is in place, signed by each supervising cardiologist and by an appropriate representative of each licensed facility where practice is anticipated;

(5) pay a fee established by the department.

SECTION 40-47-1550. Renewal; lapse of registration.

(A) Registration by the department as a cardiovascular invasive specialist must be renewed every two years. To renew a registration, a person shall:

(1) submit a complete application in writing;

(2) demonstrate continued competency including current registration with Cardiovascular Credentialing International and other requirements as provided by this article or regulation;

(3) pay a fee established by the department.

(B) A registration by the department as a cardiovascular invasive specialist automatically lapses if the registered person fails to make a timely and complete application for renewal or if the registered person fails to maintain current registration with Cardiovascular Credentialing International or another organization approved by the board.

SECTION 40-47-1560. Authorized tasks and services; supervision by cardiologist; written protocols.

(A) Cardiovascular invasive specialists may perform medical tasks and services within the framework of a facility's written practice protocol developed for the cardiovascular invasive specialist. Within this practice protocol the registered cardiovascular invasive specialist, under the supervision of a cardiologist may engage in these functions and duties:

(1) perform baseline patient assessment;

(2) evaluate patient response to diagnostic or interventional maneuvers and medications during cardiac catheterization laboratory procedures;

(3) provide patient care and drug administration commonly used in the cardiac catheterization laboratory under the direction of a qualified physician and subject to the oversight of the facility;

(4) act as the first assistant during diagnostic and therapeutic catheterization procedures; and

(5) assist in advanced cardiac life support procedures.

(B) A cardiovascular invasive specialist shall practice only under the supervision of a physician who is actively and directly engaged in the clinical practice of medicine as a cardiologist.

(C) A cardiovascular invasive specialist practicing at all sites shall practice pursuant to written scope of the facility's practice protocols signed by all supervising cardiologists and the cardiovascular invasive specialists. Copies of the protocols must be on file at all practice sites. The protocols shall include at a minimum the:

(1) name, license number, and practice addresses of the supervising cardiologists;

(2) name and practice address of the cardiovascular invasive specialists;

(3) date the protocol was developed and dates it was reviewed or amended;

(4) situations that require direct evaluation by or immediate referral to a cardiologist.

SECTION 40-47-1570. Administration of registration program; registry maintenance and availability; promulgation of regulations.

(A) The department is responsible for all administrative activities of the registration program. The department shall employ and supervise personnel necessary to effectuate the provisions of this article and shall establish fees sufficient, but not excessive, to cover expenses including direct and indirect costs to the State for the operations of this registration program. Fees must be adjusted as required by Title 40, Chapter 1.

(B) The department shall maintain a registry of all applications for registration and of all persons holding registration and shall make the roster of registered cardiovascular invasive specialists available on the department web site.

(C) The Board of Medical Examiners may promulgate regulations as necessary to effectuate this chapter.

SECTION 40-47-1580. Investigations of unfitness to practice or unauthorized practice.

If the department has reason to believe that a person registered pursuant to this article has become unfit to practice as a registered cardiovascular invasive specialist or if a complaint is filed with the department charging the registered person with the violation of a provision of this article or if a complaint is filed with the department alleging that an unregistered person is fraudulently holding himself or herself out as registered, the department shall institute an investigation in accordance with the procedures of Chapter 40, Title 1 and this article.

SECTION 40-47-1590. Hearing before Administrative Law Judge Division; grounds for revocation, suspension, or other discipline.

(A) If, after investigation, it appears that the person registered pursuant to this article has become unfit to practice or has violated this article, the department shall file a petition with the Administrative Law Judge Court, stating the facts and the particular statutes and regulations at issue.

(B) The Administrative Law Judge Court, after opportunity for hearing, may order that the registration be revoked, suspended, or otherwise disciplined in accordance with Section 40-1-120 on the grounds that the registrant:

(1) used a false, fraudulent, or forged statement or document or committed a fraudulent, deceitful, or dishonest act or omitted a material fact in obtaining registration pursuant to this article;

(2) has had an authorization to practice a regulated profession or occupation in another state or jurisdiction canceled, revoked, or suspended, or has otherwise been disciplined by another jurisdiction;

(3) has lost or let lapse an underlying credential that served as the basis of registration;

(4) has intentionally used a false or fraudulent statement in a document connected with the practice of a registered cardiovascular invasive specialist;

(5) has obtained fees or assisted in obtaining fees under fraudulent circumstances; or

(6) has sustained a physical or mental disability or uses alcohol or drugs to such a degree as to render further practice as a registered cardiovascular invasive specialist dangerous to the public.

SECTION 40-47-1600. Proscribed activities; identification badges and notification of involvement in cardiac care.

(A) A cardiovascular invasive specialist may not:

(1) perform a task which has not been listed and approved on the scope of the practice protocol currently on file with the facility;

(2) prescribe drugs, medications, or devices of any kind.

(B) A cardiovascular invasive specialist must clearly identify himself or herself to ensure that the cardiovascular invasive specialist is not mistaken or misrepresented as a physician. A cardiovascular invasive specialist must wear a clearly legible identification badge or other adornment at least one inch by three inches in size bearing the cardiovascular invasive specialist's name and the words "Registered Cardiovascular Invasive Specialist". Patients in facilities utilizing cardiovascular invasive specialists must be informed when a cardiovascular invasive specialist will be involved in their cardiac care.

SECTION 40-47-1610. Injunctions; fines; actions by unregistered persons..

(A) The Administrative Law Judge Division, after opportunity for hearing, may order injunctive relief against a person who, without possessing a valid certificate pursuant to this article, uses the title or term registered cardiovascular invasive specialist. For each violation the administrative law judge may impose a fine of no more than ten thousand dollars.

(B) A person who is not registered as required by this article may not bring an action either at law or in equity to enforce the provisions of a contract for providing services as a registered cardiovascular invasive specialist.

SECTION 40-47-1620. Promulgation of regulations.

The Department of Labor, Licensing and Regulation shall promulgate regulations necessary to ensure implementation or the provisions of this article.