PERMANENT RULES
(Podiatric Medical Board)
Date of Adoption: May 14, 1999.
Purpose: The rules identify and clarify the types of services being provided to consumers. These changes will give the board a mechanism to take action against practitioners who misrepresent their products.
The delegation of acts to unlicensed personnel is clarified so that it is clear they may not perform procedures that require a license.
Citation of Existing Rules Affected by this Order: Repealing WAC 246-922-090 Delegation of acts to unlicensed persons; and amending WAC 246-922-010 Definitions and 246-922-100 Acts that may be delegated to an unlicensed person.
Statutory Authority for Adoption: RCW 18.22.015, 18.130.050.
Adopted under notice filed as WSR 99-08-100 on April 6, 1999.
Changes Other than Editing from Proposed to Adopted Version: WAC 246-922-100 was clarified that delegation involves the extent of delegation.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 1.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 2, Repealed 1; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 1. Effective Date of Rule: Thirty-one days after filing.
May 14, 1999
William Ith, Chair
Podiatric Medical Board
OTS-2415.3
AMENDATORY SECTION(Amending Order 158B, filed 4/25/91, effective 5/26/91)
WAC 246-922-010
Definitions.
(1) Chiropody, podiatry, and podiatric medicine and surgery shall be synonymous.
(2) "Board" shall mean the Washington state podiatric medical board.
(3) "Secretary" shall mean the secretary of the department of health.
(4) "Supervision" shall mean that a licensed podiatric physician and surgeon whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized and directed the procedures to be performed. A podiatric physician and surgeon shall be physically present in the treatment facility while the procedures are performed.
(5) "Treatment facility" means a podiatric medical office or connecting suite of offices, podiatric medical clinic, room or area with equipment to provide podiatric medical treatment, or the immediately adjacent rooms or areas. A treatment facility does not extend to any other area of a building in which the treatment facility is located.
(6) "Unlicensed person" means a person who is not a podiatric physician and surgeon duly licensed pursuant to the provisions of chapter 18.22 RCW.
(7) Orthotic devices defined:
(a) Prefabricated or off-the-shelf orthotics, are devices that are manufactured as commercially available stock items for no specific patient. It is appropriate to dispense prefabricated orthotic devices for some conditions.
(b) Direct-formed orthotics are devices formed or shaped during the molding process directly on the patient's foot.
(c) Custom-fabricated orthotics, also known as custom-made orthotics, are devices designed and fabricated, in turn, from raw materials for a specific patient, and require the generation of an image, form, or mold that replicates the patient's foot, and, in turn, involves the rectification of dimensions, contours, and volumes to achieve proper fit, comfort, and function for that specific patient.
Prefabricated orthotic devices that have been adjusted or modified may not be dispensed and sold to consumers as custom fabricated or custom-made orthotics. All orthotic devices must be correctly represented and charged to the patient.
[Statutory Authority: RCW 18.22.015. 91-10-041 (Order 158B), § 246-922-010, filed 4/25/91, effective 5/26/91; 91-03-095 (Order 118B), recodified as § 246-922-010, filed 1/18/91, effective 2/18/91; 84-02-077 (Order PL 450), § 308-31-020, filed 1/4/84; Order PL 128, § 308-31-020, filed 7/7/72.]
A podiatric physician and surgeon may authorize the delegation of certain duties to nonpodiatric personnel and prohibit the delegation of certain other duties. The licensed podiatric physician and surgeon is ultimately responsible for all treatments performed at his or her direction. Duties that may be delegated to a person not licensed to practice podiatric medicine and surgery may be performed only under the supervision of a licensed podiatric physician and surgeon. The extent of delegation and the degree of supervision required to assure that the treatment is appropriate and does not jeopardize the systemic or pedal health of the patient varies with, among other considerations, the nature of the procedure and the qualifications of the person to whom the duty is delegated. A podiatric physician and surgeon may allow an unlicensed person to perform the following acts under the podiatric physician and surgeon's supervision limited to the following:
(1) Patient education in foot hygiene.
(2) Deliver a sedative drug in an oral dosage form to patient.
(3) Give preoperative and postoperative instructions.
(4) Assist in administration of nitrous oxide analgesia or sedation, but the unlicensed person shall not start the administration of the gases and shall not adjust the flow of the gases unless instructed to do so by the podiatric physician and surgeon. Patients must never be left unattended while nitrous oxide analgesia or sedation is administered to them. This regulation shall not be construed to prevent any person from taking appropriate action in the event of a medical emergency.
(5) Take health histories.
(6) Determine rate and quality of patient's radial pulses.
(7) Measure the patient's blood pressure.
(8) Perform a plethysmographic or doppler study.
(9) Observe the nature of the patient's shoes and hose.
(10) Observe and report wearing patterns on the patient's shoes.
(11) Assist in obtaining material for a culture-sensitivity test.
(12) Take scrapings from the skin or nails of the feet, prepare them for microscopic and culture examination.
(13) Perform weightbearing and nonweightbearing x-rays.
(14) Photograph patient's foot disorder.
(15) Debride hyperkeratotic ((lesions)) tissues of the foot.
(16) Remove and apply dressing and/or padding.
(17) Make necessary adjustments to the biomechanical device.
(18) Produce impression casting of the foot.
(19) Produce the following:
(a) Removable impression insoles and modifications.
(b) Protective devices for alleviating or dispersing pressure on certain deformities or skin lesions such as ulcers, corns, calluses, digital amputation stumps (e.g., latex shields).
(20) Apply strap and/or pad to the foot and/or leg.
(21) Prepare the foot for anesthesia as needed.
(22) Know the indications for and application of cardiopulmonary resuscitation (CPR).
(23) Prepare and maintain a surgically sterile field.
(24) Apply flexible cast (e.g., Unna Boot).
(25) Apply cast material for immobilization of the foot and leg.
(26) Remove sutures.
(27) Debride nails.
(28) Administer ((physical therapy)) mechanical, manipulative and electrical treatment as
directed by the podiatric physician and surgeon.
(29) Counsel and instruct patients in the basics of:
(a) Their examination, treatment regimen and prophylaxis for a problem.
(b) Patient and family foot health promotion practices.
(c) Patient and family care of specific diseases affecting the foot (e.g., diabetes, cerebrovascular accident, arthritis).
(d) Performing certain exercises and their importance.
(30) Give patient or family supplementary health education materials.
[Statutory Authority: RCW 18.22.015. 94-05-051, § 246-922-100, filed 2/10/94, effective 3/13/94; 91-10-041 (Order 158B), § 246-922-100, filed 4/25/91, effective 5/26/91; 91-03-095 (Order 118B), recodified as § 246-922-100, filed 1/18/91, effective 2/18/91; 84-02-077 (Order PL 450), § 308-31-110, filed 1/4/84.]
The following section of the Washington Administrative Code is repealed:
| WAC 246-922-090 | Delegation of acts to unlicensed persons. |