CHAPTER 12 MEDICAL PRACTICES

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10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICESCHAPTER 12MEDICAL PRACTICESPART 1SOURCE: This Chapter is taken from Title XXVIII of theGovernment Code of Guam, as amended.Article 1.Article 2.Article 2A.Article 3.Article 4.Article 5.Article 6.Article 7.Article 8.Article 9.Article 10.Commission on the Healing Arts of Guam.Physicians Practice Act.Adoption of Interstate Medical Licensure Compact.Nurse Practice Act.Dental Practice Act.Optometry.Guam Pharmacy Practice Act.Occupational Therapists and OccupationalTherapist Assistants.Allied Health Practice Act.Acupuncture.Audiology.ARTICLE 1COMMISSION ON THE HEALING ARTS OF GUAM§ 12101.§ 12102.§ 12103.§ 12104.§ 12105.§ 12106.§ .Codification.Severability.Effective Date.§ 12101. Definitions.For the purpose of this Chapter the following words andphrases shall have the meanings assigned to them, respectively,except where the context otherwise requires:(a) Disease means any blemish, defect, deformity,infirmity, disorder or injury of the human body or mind, orof pregnancy and the effects of any of them.1COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICES(b) The Healing Art means the art of prevention,detecting or attempting to detect the presence of anydisease; of determining or attempting to determine thenature and state of any disease, if present; or preventing,relieving, correcting or curing of or attempting to prevent,relieve, correct or cure any disease; of safeguarding orattempting to safeguard the life of any woman or infantthrough pregnancy and parturition; and of doing orattempting to do any of the acts enumerated in thisSubsection. The healing arts include, but are not limited to,optometry, nursing, chiropractic, dentistry, medicine andsurgery, physician assistants, podiatry, psychology,osteopathic, pharmacy, physical therapy, acupuncture,speech language pathology, audiology, respiratory therapy,nutritionist/clinical dietician, cosmetology and veterinarymedicine.(c) To Practice means to do or attempt to do, or to holdoneself out or to allow oneself to be held out as ready to do,any act enumerated in Subsection (b) of this Section asconstituting a part of the healing art for a fee, gift, reward orin anticipation of any fee, gift or reward whether tangible orintangible.(d) Commission means the Commission of HealingArts created by this Chapter.(e) Practice of Optometry means engaging in thatprimary healthcare profession, of which the membersexamine, diagnose, manage, and treat certain conditions anddiseases of the human eye, visual systems and associatedstructures. It includes, but is not limited to, the use of anymeans or methods for the purpose of determining therefractive condition of the human eye or any muscular orvisual anomalies thereof, and employing, adapting orprescribing of lenses, prisms, contact lenses or otherophthalmic appliances. Optometrists certified pursuant to §12508 of this Title are authorized to make use of diagnosticor selected therapeutic pharmaceutical agents, based on thefollowing conditions and limitations.2COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICES(1) Independent use of the following therapeuticpharmaceutical agents as topical preparations: nonsteroidal anti-allergics, antibacterials and cycloplegics.(2) Under a co-management arrangement with anophthalmologist, the following additional agents maybe utilized: oral anti-allergics, oral antibacterials,topical or oral anti-glaucoma agents, topical antiinflammatories, topical anti-virals and oral analgesics.(3) Co-management is an agreement by which anoptometrist and an ophthalmologist share responsibilityfor patient care.(4) Optometrists are prohibited from performingsurgery. Surgery, as used in reference to the human eyeand its appendages, means any procedure in whichhuman tissue is cut or burned. Surgical proceduresinclude the use of sharp-edged instruments or lasers tocut or burn tissue for therapeutic or photorefractivepurposes, but do not include the removal of superficialforeign bodies. A superficial foreign body is definedas one that has not penetrated deeper than theepithelium.(5) Optometrists utilizing pharmaceutical agentsshall be held to the same standard of care as would aphysician using the same agents.(f) Practice of Nursing means:(1) The Practice of Professional Nursing meansthe performance for compensation of any act in helpingpeople cope with difficulties in daily living which areassociated with their actual or potential healthproblems or illness problems, or the treatment thereof,which require a substantial amount of scientificknowledge in the biological, physical and socialsciences and technical skills, and includes all of thefollowing:(A) direct and indirect patient care servicesthat insure the safety, comfort, personal hygiene3COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICESand protection of patients, and the performance ofdisease prevention and restorative measures;(B) direct and indirect patient care servicesincluding, but not limited to, the administration ofmedications and therapeutic agents necessary toimplement a treatment, disease prevention orrehabilitative regime prescribed by a licensedphysician or dentist;(C) the performance, according tostandardized procedures, of basic health care,testing and preventative procedures, including, butnot limited to, skin tests, immunization techniquesand the withdrawal of human blood from veinsand arteries; or(D) observation of signs and symptoms ofillness, reactions to treatment, general behavior orgeneral physical conditions; and:(i) determination of whether such signs,symptoms, reactions, behavior or generalappearance exhibit abnormal characteristics;and(ii) implementation, based on observedabnormalities, appropriate reporting, referral,standardizedprocedures,changesintreatment regime in accordance withstandardized procedures or the initiation ofemergency procedures.Standardizedprocedures as used in this Section meanspolicies and protocols developed , nurses and other healthprofessionals of an organized health caresystem.(2) Practice of Practical Nursing means theperformance for compensation of technical servicesrequiring basic knowledge of the biological, physical,behavioral, psychological and sociological sciences of4COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICESnursing procedures. These standardized proceduresleading to predictable outcomes in the observation andcare of the ill, injured and infirm, and in theadministration of medication and treatments prescribedby any authorized person.(g) Chiropractic means the science, art and philosophyof things natural, the science of locating and removinginterference with the transmissions or expression of nerveforces in the human body, by the correction ofmisalignments or subluxation of the articulations andadjacent structures, more especially those of the vertebralcolumn and pelvis, for the purpose of restoring andmaintaining health. It shall include the use of all naturalagencies to assist in the healing art, such as food, water,heat, cold, electricity and mechanical appliances. The useof X-ray procedures shall be limited to skeletal X-rays, andshall exclude the therapeutic use of X-radiation, the use ofcontrast studies that introduce dyes, isotopes or similarcontrast media through the skin, orally, via catheterizationor retrograde into any body cavity. It shall excludeoperative surgery, prescription or use of drugs or medicine,and laboratory procedures involved in the penetration ofhuman tissues.(h) Practice of Dentistry means:(1) the diagnosis, treatment, correction, change,relief, prevention, prescription of remedy or surgicaloperation for any disease, pain, deformity, deficiency,injury, lesion or other physical condition of humanteeth, gums, jaws, oral cavity or adjacent tissues by anindividual or his agent or employee, including theprescription or administration of any drug, medicine,biological, prosthetic apparatus, brace, device,anesthetic or other therapeutic or diagnostic substanceor technique;(2) the representation, directly or indirectly,publicly or privately, of an ability or willingness to doany act mentioned in Paragraph (1) of this Subsection;or5COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICES(3) with specific reference to the teeth, gums,jaws, oral cavity or adjacent tissues in living persons,for an individual, his agent or employee to do, propose,agree or attempt to do or make an examination, or givean estimate of cost with intent to:(A) perform surgery, an extraction or anyother operation, or to administer an anesthetic inconnection therewith;(B) diagnose or treat any condition, disease,pain, deformity, deficiency, injury, lesion or otherphysical condition;(C) correct a malposition;(D) treat a fracture;(E) remove calcareous deposits;(F) replace missing anatomy with an artificialsubstitute;(G) construct, make, furnish, supply,reproduce, alter or repair an artificial substitute, orrestorative or corrective appliance, or take ordersfor such work from either a regularly licenseddentist, or place an artificial substitute orrestorative or corrective appliance in the mouth orattempt to adjust it;(H) give interpretations or readings of dentalroentgenogram; or(I) do any other remedial, corrective orrestorative work.(i) Practice of Medicine means the diagnosis,correction and treatment in any manner or by any means,methods, devices or instrumentalities of any disease, illness,pain, wound, fracture, infirmity, deformity, defect orabnormal, physical and mental condition, includingphysician assistants under the supervision of a licensedphysician of medicine, but does not include the practice ofdentistry, podiatry, nursing, optometry, psychology,6COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICESchiropractic or pharmacy by a person licensed under theprovisions of this Chapter.(j) Practice of Podiatry means engaging in that primaryhealth care profession, of which the members examine,diagnose, treat and prevent by medical, surgical andmechanical means ailments affecting the human foot andankle, and the structures governing their functions, but doesnot include amputation of the foot or the personaladministration of a general anesthetic. A podiatrist, underthe laws of Guam, is defined as a foot or podiatricphysician.(k) Practice of Clinical Psychology means theassessing and alleviating of emotional and mental disorderin a hospital or clinical setting.(l) Practice of Osteopathy means subscribing to, as acomplete school of medicine and surgery, use of allmethods of diagnosis and treatment in health and disease,including, without limitation, the prescribing andadministration of drugs and biological of all kinds,operative surgery, obstetrics, radiological and other electromagnetic emission, and placing special emphasis on theinter-relationship of musculoskeletal system to all of thebody systems.(m) Practice of Pharmacy means engaging in thepreparation, compounding and dispensing of drugs andincludes the identification, preservation, proper and safestorage, selection, combination, analysis, standardization,labeling and distribution of drugs, the proper maintenanceof any records required by Federal or Guam law, andcounseling with respect to pharmaceutical practices.(n) Physical Therapy means treatment by the use ofexercise, traction, massage, heat, cold, water, radiantenergy, electricity or sound for the purpose of correcting oralleviating any physical or mental disability; or theperformance of neuro-musculoskeletal, respiratory andcirculatory tests and measurements to determine theexistence of body malfunction; provided, however, that7COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICESphysical ) Practice of Veterinary Medicine means:(1) the diagnosis, treatment, correction, in anymanner or by any means change, relief or prevention ofanimal disease, deformity, defect, injury or otherphysical or mental condition, including the prescriptionor administration of any drug, medicine, biologic,apparatus, application, surgery, anesthetic or othertherapeutic or diagnostic substance or technique, andthe use of any procedure for artificial insemination,testing for pregnancy, diagnosing and treating sterilityor infertility, or rendering advice with regard to any ofthese;(2) the representation, directly or indirectly,publicly or privately, of an ability and willingness todo any act mentioned in Paragraph (1) of thisSubsection; or(3) the use of any title, words, abbreviation orletters in a manner, or under circumstances, whichincludes the belief that the person using them isqualified to do any act mentioned in Paragraph (1) ofthis Subsection.(p) Acupuncture means a therapy developed by theancient Chinese that consists of stimulation of designatedpoints on the skin by insertion of needles, application ofheat, massage or a combination of these.(q) Speech-Language Pathology and Audiology means:(1) Practice of Speech-Language Pathology meansthe rendering or offering to render to individuals,groups, organizations or the public any service inspeech or language pathology involving the nonmedical application of principles, methods andprocedures for the measurement, testing, diagnosis,prediction, counseling and instruction related to thedevelopment and disorders of speech, voice or8COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICESlanguage for the purpose of non-medical diagnosing,preventing, treating and ameliorating such disordersand conditions in individuals and groups ofindividuals; and(2) Practice of Audiology means the applicationof principles, methods and procedures of measurement,testing, appraisal, prediction, aural rehabilitation, auralhabilitation, consultation, hearing-aid selection,counseling, instruction and research related to hearing,and disorders of hearing, for the purpose of ioration or the modification of communicativedisorders, involving speech, language, auditoryfunction or other aberrant behavior related to hearingdisorders.(r) Physician Assistants means a skilled individualnationally certified by examination, administered by theNational Certifying Commission for Physician Assistants,as being qualified by practical and academic training toprovide a specific medical service delegated to him by alicensed physician or group of physicians who isresponsible for the performance of that physician assistant.Licensure requirements and scope and procedures ofpractice for such individuals are to be promulgated by theBoard of Allied Health Professionals.(s) Individual, Family and Marriage Therapist means askilled individual qualified by practical and academictraining to provide planned intervention to help the client(s)enlarge competencies, and increase problem solving skillsand coping abilities. Licensure requirements and scope andprocedures of practice for such individuals shall bepromulgated by the Board of Allied Health Examiners.(t) Practice of Occupational Therapy means thetreatment provided to people whose lives have beendisrupted by physical injury or illness, developmentalproblems, the aging process or psychosocial difficulties inorder to assist each individual to achieve and/or return to anindependent and productive life by teaching the individual9COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICEStechniques to prevent disability, by assisting the individualin recovery from illness or accident, and by promoting thedevelopment of functions which have been impaired ordelayed. The treatment provided may include, but shall notbe limited to, the adaptation of the environment andselection, design and fabrication or assistive and orthoticdevices, and other technology to facilitate development andpromote the acquisition of functional skills.(u) Practice of Respiratory Therapy means thetreatment and the management of pulmonary diseases withmedications and machines provided to patients whosecondition or illness is that of breathing.(v) Practice of Nutritionist/Clinical Dietary means thedevelopment and coordination of menu planning to combinefoods for maximum nutritional value, taste and eye appealto meet individual nutritional needs and preferences.(w) Practice of Cosmetology means any and all, or anycombination of the following practices: arranging, dressing,curling, waving, machineless permanent waiving,permanent waving, cleansing, cutting, singeing, bleaching,tinting, coloring, straightening, dyeing, brushing,beautifying or otherwise treating by any means the hair ofany person. The massaging, cleaning or stimulating thescalp, face, neck, arms, bust or upper part of the humanbody, by means of the hands, devices, apparatus orappliances, with or without the use of cosmeticpreparations, antiseptics, tonics, lotions or creams.Beautifying the face, neck, arms, bust or upper part of thehuman body, by use of cosmetic preparations, antiseptics,tonics, lotions or creams. The removing of superfluous hairfrom the body of any person by the use of electrolysis, or bythe use of depilatories or by the use of tweezers, chemicals,preparations or by the use of devices or appliances of anykind or description, except by the use of light waves,commonly known as rays.The cutting, trimming,polishing, tinting, coloring, cleansing or manicuring thenails of any person; and, the massaging, cleansing, treatingor beautifying the hands of any person.10COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICES(x) Other Healing Arts Profession as allowed by GuamLaws.SOURCE: GC § 27000, as amended by P.L. 14-29 and 16-123, added byP.L. 18-42:11, amended by P.L. 18-49:13. Subsections (b) and (i) wereamended by P.L. 18-42:9 and (r) was added by P.L. 18-42:11 andsubsection (s) was added by P.L. 19-19; subsection (g) amended by P.L.20-107:1; subsection (i) R/R by P.L. 21-33:7; subsection (t) added by 22140:IV;6(b). Subsection (e) repealed/reenacted by P.L. 23-9:1. Repealedand reenacted by P.L. 24-321:1 (Dec. 28, 1998).2013 NOTE: Pursuant to the authority granted by 1 GCA § 1606,numbers and/or letters were altered to adhere to the Compiler’s alphanumeric scheme.§ 12102. Prohibition.(a) No person shall practice the healing art on Guam who isnot:(1) licensed so to do under the provisions of thisArticle; or(2) exempted under the provisions of this Chapter.(b) No person shall practice the healing art on Guamotherwise than in accordance with the terms of his license, or ofhis registration as the case may be.SOURCE: GC § 27100, as amended by P.L. 16-123. Transferred fromArticle 2 and renumbered from § 12201 to § 12102 by P.L. 24-208:2.Repealed and reenacted by P.L. 24-321:1 (Dec. 28, 1998).2018 NOTE: Subsection/subitem designations altered/added pursuant tothe authority granted by 1 GCA § 1606.§ 12103. Commission.(a) There is within the government of Guam a ‘Commissionon the Healing Arts of Guam,’ (‘Commission’) consisting ofeleven (11) members appointed by I Maga’lahen Guåhan asfollows:(1) the Director of Public Health and Social Services,or a designee from the Department;(2) the Chairperson of the Board of Nurse Examiners;(3) the Chairperson of the Board of MedicalExaminers;11COL11272018

10 GCA HEALTH AND SAFETYCH. 12 MEDICAL PRACTICES(4) the Chairperson of the Board of Examiners forDentistry;(5) the Chairperson of the Board of Examiners forPharmacy;(6) the Chairperson of the Board of Allied HealthExaminers;(7) the Chairperson of the Board of Examiners forOptometry;(8) the Chairperson of Board of Cosmetology;(9) the Chief Medical Officer of the Guam MemorialHospital Authority;(10) the Director of the Guam Behavioral Health andWellness Center, or a designee from the Department; and(11) one (1) member from the Mayors Council. TheCommission shall elect a president and vice-president.The Direc

nutritionist/clinical dietician, cosmetology and veterinary medicine. (c) To Practice means to do or attempt to do, or to hold oneself out or to allow oneself to be held out as ready to do, any act enumerated in Subsection (b) of this Section as constituting a part of th

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