INDEPENDENT REGULATORY REVIEW COMMISSION Notice of Comments Issued [31 Pa.B. 6513] Section 5(d) of the Regulatory Review Act (71 P. S. § 745.5(d)) provides that the designated standing committees may issue comments within 20 days of the close of the public comment period, and the Independent Regulatory Review Commission (Commission) may issue comments within 10 days of the close of the committees' comment period. The Commission's Comments are based upon the criteria contained in section 5.1(h) and (i) of the Regulatory Review Act (71 P. S. § 745.5a(h) and (i)).
The Commission issued comments on the following proposed regulations. The agency must consider these comments in preparing the final-form regulation. The final-form regulation must be submitted by the date indicated.
Final-Form Submission Reg. No. Agency/Title Issued Deadline 16A-4912 State Board of Medicine
Physician Delegation of Medical Services11/8/01 10/9/03 (31 Pa.B. 5113 (September 8, 2001))
57-222 Pennsylvania Public Utility Commission
Financial Reporting
Requirements for
all Telecommu-
nications Carriers11/8/01 10/9/03 (31 Pa.B. 5110 (September 8, 2001)) State Board of Medicine Regulation No. 16A-4912 Physician Delegation of Medical Services November 8, 2001 We submit for consideration the following objections and recommendations regarding this regulation. Each objection or recommendation includes a reference to the criteria in the Regulatory Review Act (71 P. S. § 745.5a(h) and (i)) which have not been met. The State Board of Medicine must respond to these Comments when it submits the final-form regulation. If the final-form regulation is not delivered by October 9, 2003, the regulation will be deemed withdrawn.
1. General.--Need.
This regulation is designed to implement Section 422.17(a) of The Medical Practice Act (Act) (63 P. S. § 422.17(a)) which provides: ''A medical doctor may delegate to a health care practitioner or technician the performance of a medical service'' if certain conditions are met. Further, Section 422.17(b) of the Act provides: ''The board may promulgate regulations which establish criteria pursuant to which a medical doctor may delegate the performance of medical services. . . .'' (Emphasis added).
However, the regulation essentially incorporates the statutory language without adding specific criteria to guide the delegation. The Board states in the Preamblethat this regulation is necessary because it has received inquiries concerning delegation. We question how a regulation that reiterates a statutory provision can be responsive to any concerns or inquiries. However, if the Board submits the final-form regulation, it should explain the need for this regulation and respond to the following concerns.
2. Definitions.--Clarity.
The regulation does not define the terms ''medical service,'' ''health care practitioner'' or ''technician.'' We recommend that the Board add a new ''Definitions'' section to Chapter 18. This section should reference the definitions of the terms contained in the Act.
3. Section 18.401. Delegation.--Clarity.
Subsection (a)(1)
This subsection states delegation must be consistent ''with the standards of acceptable medical practice . . . .'' This phrase is unclear. In the Preamble, the Board explains ''[S]tandards of acceptable medical practice may be discerned from current medical literature and texts, medical teaching facilities publications and faculty, expert practitioners in the field and the commonly accepted practice of practitioners experienced in the field.'' This language clarifies the requirement in Subsection (a)(1). The Board should consider including the explanatory language from the Preamble in Subsection (a)(1).
Subsection (a)(4)
Subsection (a)(4) allows the medical doctor to delegate medical services once he has ''determined that the delegatee is competent to perform the medical service.'' Does the Board have a set criteria to assist medical doctors in making such determinations? The Board should explain.
Subsection (a)(5)
This subsection allows the medical doctor to determine that the delegation ''does not create an undue risk to that patient.'' Should the regulation require that the medical doctor's determination be documented in the patient's records?
Subsection (a)(6)
Subsection (a)(6) allows ''[T]he nature of the service and the delegation of the service has been explained to the patient and the patient does not object. . . .'' Will it be explained to the patient that the patient has the right to object? The Board should explain what constitutes an explanation of the nature and delegation of the service sufficient to enable a patient to object in the Preamble to the final-form regulation.
Subsection (a)(7)
This subsection allows the medical doctor to be ''available as appropriate to the difficulty of the procedure, the skill of the delegatee and risk level to the particular patient.'' We have two concerns with this subsection. First, it is not clear what the phrase ''available as appropriate to the difficulty'' means. Second, Section 422.17(c) of the Act establishes that the ''medical doctor shall be responsible for the medical services delegated to the health care practitioner or technician. . . .'' We agree with the House Professional Licensure Committee's comments that Subsection (a)(7) should be amended so that it is consistent with Section 422.17(c) of the Act.
Subsection (b)
Subsection (b) provides that a medical doctor may not delegate a medical service if recognition of the complications or risks that may result from the service ''requires medical doctor education and training.'' This provision would seem to unduly restrict a doctor's ability to delegate, since all medical functions carry a certain degree of risk. The phrase ''technical knowledge and skill not ordinarily possessed by non-physicians'' has been suggested to the Board as a replacement for the phrase ''medical doctor education and training.'' We recommend that the new language be considered.
Subsections (e) and (f)
The Board refers to ''health care provider'' in these subsections rather than the term ''health care practitioner.'' To be consistent throughout the regulation and with the language in the Act, the Board should change the references from ''health care provider'' to ''health care practitioner.''
Pennsylvania Public Utility Commission
Regulation No. 57-222Financial Reporting Requirements for All Telecommunications Carriers November 8, 2001 We submit for consideration the following objections and recommendations regarding this regulation. Each objection or recommendation includes a reference to the criteria in the Regulatory Review Act (71 P. S. § 745.5a(h) and (i)) which have not been met. The Pennsylvania Public Utility Commission (PUC) must respond to these Comments when it submits the final-form regulation. If the final-form regulation is not delivered by October 9, 2003, the regulation will be deemed withdrawn.
Chapter 71. Proprietary nature of financial reports.--Conflict with existing regulations.
This proposed regulation amends definitions of utility classes, allows for alternate accounting systems and reduces the filing frequency of some reports. These changes are based on the findings of the Collaborative, a work group convened by the PUC to examine the financial reporting requirements of the telecommunications industry in a competitive market.
The Collaborative also recommended that certain schedules of the financial reports be automatically classified as proprietary. The PUC is implementing this recommendation through adoption of internal operating procedures, and not through the formal rulemaking process. However, these procedures conflict with Section 71.9 of the PUC's existing regulations, which provides:
The financial reports are public documents. The reports will be maintained by the Secretary and will be available for public inspection. If a public utility requests proprietary treatment for information in the report, it shall be incumbent upon that utility to file a petition for protective order under § 5.43 (relating to petitions for issuance, amendment, waiver or repeal of regulations).
Under this regulation, the financial report and all of its components are a matter of public record, unless designated otherwise through issuance of a protective order. This regulation has the force and effect of law, and supersedes an internal policy to the contrary. Therefore, the PUC must propose an amendment to Section 71.9, if it wants to classify certain portions of a financial report as proprietary.
In addition, Section 71.9 allows a public utility to classify information contained in its financial reports as proprietary by filing a petition for a protective order ''under Section 5.43 (relating to petitions for issuance, amendment, waiver or repeal of regulations).'' This is a typographical error. The correct citation is Section 5.423 (relating to orders to limit availability of proprietary information).
We recommend that the PUC initiate a rulemaking to amend Section 71.9 to adopt the policy recommended by the Collaborative and to correct the citation.
JOHN R. MCGINLEY, Jr.,
Chairperson[Pa.B. Doc. No. 01-2115. Filed for public inspection November 21, 2001, 9:00 a.m.]
