HOUSE BILL NO. 4912

May 25, 2021, Introduced by Reps. Bezotte, Brixie, Wozniak, Paquette, Whiteford and Whitsett and referred to the Committee on Agriculture.

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 16215, 16283, 16286, 16287, 16288, 18802, 18805, 18811, 18812, and 18814 (MCL 333.16215, 333.16283, 333.16286, 333.16287, 333.16288, 333.18802, 333.18805, 333.18811, 333.18812, and 333.18814), section 16215 as amended by 2019 PA 140, sections 16283, 16286, and 16288 as added by 2016 PA 359, section 16287 as amended by 2017 PA 22, section 18802 as amended by 2000 PA 22, section 18805 as amended by 1982 PA 353, section 18811 as amended by 2006 PA 406, and section 18812 as amended by 1982 PA 337, and by adding sections 18811a, 18818, 18819, and 18829; and to repeal acts and parts of acts.

the people of the state of michigan enact:

Sec. 16215. (1) Subject to subsections (2) to (6), (7), a licensee who holds a license other than a health profession subfield license may delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions where if the acts, tasks, or functions fall within the scope of practice of the licensee's profession and will be performed under the licensee's supervision. A licensee shall not delegate an act, task, or function under this section if the act, task, or function, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of the licensee under this article.

(2) Subject to subsection (1) and except as otherwise provided in this subsection and subsections (3) and (4), a licensee who is an allopathic physician or osteopathic physician and surgeon shall delegate an act, task, or function that involves the performance of a procedure that requires the use of surgical instrumentation only to an individual who is licensed under this article. A licensee who is an allopathic physician or osteopathic physician and surgeon may delegate an act, task, or function described in this subsection to an individual who is not licensed under this article if the unlicensed individual is 1 or more of the following and if the procedure is directly supervised by a licensed allopathic physician or osteopathic physician and surgeon who is physically present during the performance of the procedure:

(a) A student enrolled in a school of medicine or osteopathic medicine approved by the Michigan board of medicine or the Michigan board of osteopathic medicine and surgery.

(b) A student enrolled in a physician's assistant training program approved by the joint physician's assistant task force created under part 170.

(3) Subject to subsection (1), a licensee who is an allopathic physician or osteopathic physician and surgeon may delegate an act, task, or function described in subsection (2) to an individual who is not licensed under this article and who is 1 of the following:

(a) Performing acupuncture. This subdivision does not apply beginning 36 months after the effective date of the rules promulgated under section 16525 on the licensure of acupuncturists.

(b) Surgically removing only bone, skin, blood vessels, cartilage, dura mater, ligaments, tendons, pericardial tissue, or heart valves only from a deceased individual for transplantation, implantation, infusion, injection, or other medical or scientific purpose.

(4) Subject to subsection (1), a licensee who is an allopathic physician or osteopathic physician and surgeon may delegate an act, task, or function described in subsection (2) to an individual who is not licensed under this article if the procedure is directly supervised by a licensed allopathic physician or osteopathic physician and surgeon who is physically present during the performance of the procedure, the delegation of such procedure is not prohibited or otherwise restricted by the board or that health facility or agency, and the delegation of that act, task, or function is specifically authorized by that health facility or agency to be delegated and performed by either of the following unlicensed individuals:

(a) A surgical technologist who meets the qualifications established by the health facility or agency with which he or she is employed or under contract.

(b) A surgical first assistant who meets the qualifications established by the health facility or agency with which he or she is employed or under contract.

(5) Subject to subsection (1), a veterinarian may delegate the performance of an act, task, or function if both of the following are met:

(a) Except as otherwise provided in this subdivision, the veterinarian has established a veterinarian-client-patient relationship for the patient on which the delegated act, task, or function is to be performed and has determined the need for the act, task, or function. A veterinarian-client-patient relationship is not required if any of the following apply:

(i) The delegated act, task, or function is for the purpose of rendering or attempting to render, in good faith, emergency or urgent care to a patient when the client cannot be identified.

(ii) The patient on whom the delegated act, task, or function is to be performed is in the custody of an animal shelter or rescue and the client is not identified.

(b) The supervision required under subsection (1) includes that degree of monitoring necessary for the supervising veterinarian to ensure that an individual to whom an act, task, or function is delegated is performing within the scope of an order, assignment, or prescription of the supervising veterinarian.

(6) (5) A board may promulgate rules to further prohibit or otherwise restrict delegation of specific acts, tasks, or functions to a licensed or unlicensed individual if the board determines that the delegation constitutes or may constitute a danger to the health, safety, or welfare of the patient or public.

(7) (6) To promote safe and competent practice, a board may promulgate rules to specify conditions under which, and categories and types of licensed and unlicensed individuals for whom, closer supervision may be required for acts, tasks, and functions delegated under this section.

(8) (7) An individual who performs acts, tasks, or functions delegated pursuant to under this section does not violate the part that regulates the scope of practice of that health profession.

(9) (8) The amendatory act that added this subsection does not require new or additional third party reimbursement or mandated worker's compensation benefits for services rendered by an individual authorized to perform those services under subsection (4).

(10) As used in subsection (5), "client" and "patient" mean those terms as defined in section 18818 and "veterinarian-client-patient relationship" means that term as described in section 18818.

Sec. 16283. As used in this section and sections 16284 16285 to 16288:

(a) "Health professional" means an individual who is engaging in the practice of a health profession.

(b) "Prescriber" means that term as defined in section 17708.

(c) "Telehealth" means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, "telemedicine" means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

(d) "Telehealth service" means a health care service that is provided through telehealth.

Sec. 16286. In a manner consistent with this part and in addition to the provisions set forth in this part, a disciplinary subcommittee may place restrictions or conditions on a health professional's ability to provide a telehealth service if the disciplinary subcommittee finds that the health professional has violated section 16284 or 16285.

Sec. 16287. The department, in consultation with a board, shall promulgate rules to implement sections 16284 and section 16285.

Sec. 16288. Sections 16284 16285 to 16287 do not do any of the following:

(a) Require new or additional third party reimbursement for health care services rendered by a health professional through telehealth.

(b) Limit the provision of a health care service otherwise allowed by law.

(c) Authorize a health care service otherwise prohibited by law.

Sec. 18802. (1) "Abandoned by its owner" means any of the following:

(a) Failure of an owner to return to regain custody of an animal left in the custody of a veterinarian by its owner for treatment, boarding, or other services at the scheduled time for the animal's return or at completion of the services.

(b) Refusal of an owner to accept custody of an animal left in the custody of a veterinarian by its owner for treatment, boarding, or other services at the scheduled time for the animal's return or at completion of the services.

(c) Failure of an owner to provide payment for treatment, boarding, or other services on an animal left in the custody of a veterinarian by its owner as agreed upon on by the owner and the veterinarian.

(2) "Animal" means an animal other than a human being and includes all fowl, birds, fish, and reptiles, wild or domestic, living or dead, which may be carriers of infectious diseases.

(3) "Complementary, alternative, and integrative therapy" means a preventative, diagnostic, and therapeutic philosophy and practice that is not considered part of conventional, Western veterinary medicine and includes, but is not limited to, all of the following:

(a) Veterinary acupuncture, acutherapy, and acupressure.

(b) Veterinary homeopathy.

(c) Veterinary manual or manipulative therapy.

(d) Veterinary nutraceutical therapy.

(e) Veterinary phytotherapy.

(4) (3) "Owner" means the actual owner of an animal, an agent of the owner of the animal, or a person with the apparent authority to act as the owner or as the agent of the owner of an animal.

(4) "Supervision" includes that degree of close physical proximity necessary for the supervising veterinarian to observe and monitor the performance of a veterinary technician.

Sec. 18805. (1) "Practice as a veterinary technician" means the practice of veterinary medicine based on less comprehensive knowledge and skill than that required of a veterinarian and performed under supervision of a veterinarian.

(2) "Practice of veterinary medicine" means:

(a) Prescribing or administering a drug, medicine, treatment, or method of procedure, including, but not limited to, administering vaccinations; performing an operation, physical therapy, or manipulation; performing a dental procedure; applying an apparatus or appliance; or giving an instruction or demonstration designed to alter an animal from its normal the condition of an animal.

(b) Curing, ameliorating, correcting, reducing, or modifying a disease, deformity, defect, wound, or injury in or to an animal.

(c) Diagnosing or prognosing, or both, a disease, deformity, or defect in an animal by a test, procedure, manipulation, technique, autopsy, biopsy, or other examination.

(d) Providing a complementary, alternative, and integrative therapy.

(3) "Veterinarian" means an individual who is licensed under this article to engage in the practice of veterinary medicine.

Sec. 18811. (1) A person An individual shall not engage in the practice of veterinary medicine unless licensed or otherwise authorized by this article.

(2) After July 1, 1979, an An individual shall not practice as a veterinary technician without a license.

(3) A veterinary technician shall not diagnose animal diseases, prescribe medical or surgical treatment, or perform as a surgeon.

(4) The following words, titles, or letters or a combination thereof, of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons individuals authorized under this part to use the terms and in a way prescribed in this part: "veterinary", "veterinarian", "veterinary doctor", "veterinary surgeon", "doctor of veterinary medicine", "v.m.d.", "d.v.m.", "animal technician", or "animal technologist".

Sec. 18811a. (1) During a qualified state of emergency or to respond to a large-scale animal cruelty case, the board may grant a license to engage in the practice of veterinary medicine or practice as a veterinary technician for up to 90 days to an individual if all of the following requirements are met:

(a) The individual is authorized to engage in the practice of veterinary medicine or practice as a veterinary technician in another state that maintains licensing standards substantially equivalent to those of this state.

(b) The applicant has established that disciplinary proceedings before a similar licensure board of any other state are not pending against the applicant.

(c) The applicant has established that if sanctions have been imposed against the applicant by a similar licensure board of any other state, the sanctions are not in force at the time of application.

(d) The applicant agrees to not receive any direct or indirect payment or compensation for any services performed under the emergency license unless he or she is receiving the payment or compensation from this state, the federal government, or a nonprofit organization.

(2) The board shall grant a license within 48 to 72 hours of receiving a completed application under this section and shall not charge a fee for a license under this section.

(3) As used in this section, "qualified state of emergency" means a state of disaster or state of emergency declared under the emergency management act, 1976 PA 390, MCL 30.401 to 30.421, that impacts animals.

Sec. 18812. (1) A limited license for practice apart from veterinary education shall must require that the individual be a senior student in an approved school of veterinary medicine and be under the supervision of a veterinarian licensed by this state.

(2) Graduates of nonapproved veterinary education programs may be granted a limited license under section 16182(1).

Sec. 18814. An individual is not engaging in the practice of veterinary medicine in this state who meets any of the following:

(a) Administers to livestock owned by that individual, except when the title to the livestock is vested in him or her for the purpose of circumventing this act.

(b) Conducts experimentation and scientific research in the development of methods, techniques, or treatments directly or indirectly applicable to the problems of medicine and who in connection therewith uses animals.

(c) Conducts routine vaccination and pullorum testing of poultry under supervision of the national poultry improvement plan National Poultry Improvement Plan as administered by the official state agency and the United States department of agriculture.Department of Agriculture.

(d) Is a regularly employed veterinarian of the United States department of agriculture Department of Agriculture or a full-time veterinary food inspector while engaged in the inspection of animals as food for human consumption.

Sec. 18818. (1) Except as otherwise provided in subsections (3) and (4), a veterinarian shall not engage in the practice of veterinary medicine unless it is within the context of a veterinarian-client-patient relationship. All of the following requirements must be met for a veterinarian-client-patient relationship to exist:

(a) The veterinarian must assume responsibility for making clinical judgments regarding the health of the patient and the need for medical treatment and the client must have agreed to follow the veterinarian's instructions.

(b) The veterinarian must have sufficient knowledge of the patient to initiate, at a minimum, a general or preliminary diagnosis of the medical condition of the patient. As used in this subdivision, "sufficient knowledge of the patient" means recently seen and be personally acquainted with the keeping and care of the patient by the client by virtue of examining the patient or by medically appropriate and timely professional visits to the location where the patient is kept.

(c) The veterinarian must be readily available, or must arrange for emergency coverage, for a follow-up evaluation in the event of an adverse reaction or the failure of the treatment regimen.

(2) A veterinarian may terminate a veterinarian-client-patient relationship by notifying the client that the veterinarian no longer wishes to serve the patient and the client. If a veterinarian terminates the veterinarian-client-patient relationship under this subsection when the patient that is the subject of the relationship has an ongoing medical or surgical condition, the veterinarian shall refer the client to another veterinarian for the diagnosis, care, and treatment of the patient and shall continue to provide lifesaving support to the patient, as needed, until a new veterinarian-client-patient relationship is established.

(3) In an emergency and subject to section 16285, a veterinarian may engage in the practice of veterinary medicine through telehealth without a veterinarian-client-patient relationship until the patient can be seen in person by a veterinarian. However, the veterinarian shall make a good-faith effort to arrange an in-person visit as soon as practicable to establish a veterinarian-client-patient relationship.

(4) A veterinarian may engage in the practice of veterinary medicine without a veterinarian-client-patient relationship if any of the following apply:

(a) The veterinarian renders or attempts to render, in good faith, emergency or urgent care to a patient when the client cannot be identified.

(b) The patient is in the custody of an animal shelter and the client cannot be identified.

(5) As used in this section:

(a) "Client" means the owner of the animal.

(b) "Patient" means the animal.

(c) "Telehealth" means that term as defined in section 16283.

Sec. 18819. A veterinarian who recommends a prescription drug for an animal shall, on request of the animal's owner, issue the owner a prescription for the prescription drug instead of dispensing the prescription drug.

Sec. 18829. A licensee shall ensure that a facility does not represent that it is an emergency veterinary hospital unless all of the following requirements are met:

(a) The facility's primary function is receiving, treating, and monitoring animals that are emergency patients during its designated hours of operation as an emergency veterinary hospital.

(b) A veterinarian is in attendance during all hours of the facility's operation and sufficient staff is available to provide timely and appropriate care.

(c) The number of licensees, instruments, medications, and supplies is sufficient to provide animals with the appropriate level of emergency care.

(d) The facility is a full-services hospital or provides 1 of the following:

(i) Independent, after-hours emergency veterinary services.

(ii) Independent, 24-hour emergency veterinary services.

Enacting section 1. Section 16284 of the public health code, 1978 PA 368, MCL 333.16284, is repealed.