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Chapter 04 - Health Services

31.0401 Authority.


The rules codified in this chapter are promulgated pursuant to the authority granted the health services regulatory board by 31.1005 and 31.1006 A.S.C.A.

31.0402 General definitions.


For the purposes of this chapter, unless the context clearly requires otherwise:

(a) “Attorney General” means the attorney general of American Samoa.

(b) “Board” means the health services regulatory board established by 31.1002(a) A.S.C.A.

(c) “Collaboration” means the process in which health professionals jointly contribute to the health care of patients with each collaborator performing actions he or she is licensed or otherwise authorized to perform pursuant to this rule. Within this definition:

(1) “General collaboration” means that each collaborator is available to the other collaborator for consultation either in person or by a communication device, but need not be physically present on the premises at the time the actions are performed.

(2) “Direct collaboration” means that each collaborator is available on the premises and within vocal communication, either directly or by a communication device, of the other collaborator.

(3) “Immediate collaboration” means that each collaborator is physically present in the room where the actions are being performed and is performing the actions or guiding and directing the performance of the actions.

(d) “Day” means the calendar day unless otherwise specified in this chapter. (e)“Governor” means the governor of American Samoa.

(f) “Health occupation” means a practice that is regulated under the chapter.

(g) “Health professional” means a person licensed under this chapter to practice a health occupation in the territory.

(h) “Impaired health professional” means a health professional who is unable to perform his or her professional responsibilities reliably due to a mental or physical disorder, excessive use of alcohol, or habitual use of any narcotic or controlled substance or any other drug in excess of therapeutic amounts or without valid medical indication.

(i) “Person” means an individual, corporation, trustee, receiver, guardian, representative, firm, partnership, society, school, or other entity.

(j) “Protocol” means a written agreement between an advanced registered nurse and a collaborating physician, osteopath, dentist, or other appropriate health professional as required, which shall outline, if necessary, the diagnostic and therapeutic approaches to be considered, and which shall outline actions to be taken in providing medical care to patients in accordance with the minimum levels of collaboration required by this rule, except when the parties agree to established higher of collaboration for specific actions or circumstances.

(k) “State” means any of the several states, the District of Columbia, the Commonwealth of Puerto Rico or any territory or possessi6n of the United States.

(l) ‘Territory” means the Territory of American Samoa.

(m) “Director of health” means the director of the Department of Health of American Samoa.

31.0403 Definitions of health occupations.


For purposes of this chapter, unless the context clearly requires otherwise:

(a) “Practice of acupuncture” means the insertion of needles, with or without accompanying electrical or thermal stimulation, at a certain point or points on or near the surface of the human body to relieve pain, normalize physiological functions, and treat ailments or conditions of the body. The practice of acupuncture by a non-physician acupuncturist shall be carried out in general collaboration with a licensed physician, osteopath, or dentist.

(b) “Practice of advanced registered nursing” means the performance of advanced-level

nursing actions by a nurse midwife, a nurse anesthetist, or a nurse-practitioner certified pursuant to this chapter which, by virtue of post-basic specialized education, training, and experience, are proper to be performed. The advanced registered nurse may perform actions of nursing diagnosis and nursing treatment of alterations of the health status. The advanced registered nurse may also perform actions of medical diagnosis and treatment, prescription, and other functions which are identified in this chapter and carried out in accordance with the procedures required by this chapter.

(c) “Practice of dental hygiene” means:

(1) the performance of a preliminary dental examination; a complete prophylaxis, including the removal of any deposit, accretion, or stain from the surface of a tooth or a restoration; the polishing of a tooth or of a restoration;

(2) the charting of cavities during preliminary examination, prophylaxis, or polishing;

(3) the application of a medicinal agent to a tooth for a prophylactic purpose;

(4) the taking of a dental X-ray;

(5) the instruction of individuals or groups of individuals in oral health care; and

(6) any other functions included in the curricula of approved educational programs in dental hygiene. A dental hygienist may perform the activities listed in paragraphs (c)(l) through (c)(6) of this subsection only under the general supervision of a licensed dentist, in the dentist’s office or any public school or institution rendering dental services. The board may issue rules identifying other specific functions which may be performed by a dental hygienist, and authorizing levels of supervision for the performance of these additional functions by a dental hygienist. The license of a dentist who permits a dental hygienist, operating under that dentist’s supervision, to perform any operation other than that permitted under this paragraph, may be suspended or revoked, and the license of a dental hygienist violating this paragraph may also be suspended or revoked, in accordance with the provisions of this chapter.

(d) The “Practice of dental therapy” means the application of certain diagnostic and thera¬peutic dental procedures under the general supervision of a dentist. Such procedures may include a combination of any of the following: the cleaning of teeth, individual or group instruction in oral hygiene, topical application of medicaments, examining patients and charting their dental conditions, taking of dental X-rays, performance of restorative work with application of composites in classes I, II and III, (application of class IV composites and TMS pins is not allowed), simple suturing, pulp capping and pulpotomy.

Simple extractions of deciduous and permanent teeth under local anesthesia may be performed on individuals under the age of 16, but such procedures may be carried out only after direct evaluation of the patient and clearance to do so by a dentist. Interpretation of dental X-rays is to be done only by a dentist or medical radiologist.

For the purpose of subsection, the term “general supervision” means the performance by a dental therapist of procedure permitted by paragraph (d) of this subsection based on instructions given by a licensed dentist, but not requiring the physical presence of the dentist during the performance of these procedures. The license of a dentist who permits a dental therapist, operating under that dentist’s supervision, to perform any operation other than that permitted under this paragraph, may be suspended or revoked, and the license of a dental therapist violating this paragraph, may also be suspended or revoked, in accordance with the provisions of this chapter.

(e) “Practice of dentistry” means:

(1) the diagnosis, treatment, operation, or prescription for any disease, disorder, pain, deformity, injury, deficiency, defect, or other physical condition of the human teeth, gums, alveolar process, jaws, maxilla, mandible, or adjacent tissues or structures of the oral cavity, including the removal of stains, accretions, or deposits from the human teeth;

(2) the extraction of a human tooth or teeth;

(3)the performance of any phase of any operation, relative or incident to the replacement or restoration of all or a part of a human tooth or teeth with an artificial substance, material, or device;

(4) the correction of the malposition or malformation of the human teeth; (5)the administration of appropriate anesthetic agent, by a dentist properly trained in the administration of the anesthetic agent, in the treatment of dental or oral diseases or physical conditions, or in preparation for or incident to any operation within the oral cavity;

(6) the taking or making of an impression of the human teeth, gums, or jaws;

(7) the making, building, construction, furnishing, processing, reproduction, repair, adjustment, supply or placement in the human mouth of any prosthetic denture, bridge, appliance, corrective device, or other structure designed or constructed as a substitute for a natural human tooth or teeth or as an aid in the treatment of the malposition or malformation of a tooth or teeth;

(8) the use of an X-ray machine or device for dental treatment or diagnostic purposes, or the giving of interpretations or readings of dental X-rays; or

(9) the performance of any of the clinical practices included in the curricula of accredited dental schools or colleges or qualifying residency or graduate programs in dentistry.

(f) “Practice of dietetics and nutrition” means the application of scientific principles and food management techniques to assess the dietary or nutritional needs of individuals and groups, make recommendations for short-term and long-term dietary or nutritional practices which foster good health, provide diet or nutrition counseling, and develop and manage nutritionally sound dietary plans and nutrition care systems consistent with the available resources of the patient or client. Nothing in the paragraph shall be construed as preventing or restricting the practices, services, or activities of dietetic technicians and dietetic assistants working under the supervision of a licensed dietitian or nutritionist, other health professionals licensed pursuant to this chapter, or other persons who in the course of their responsibilities offer dietary or nutrition information or deal with nutritional policies or practices on an occasional basis incidental to their primary duties, provided that they do not represent by title or description of services that they are dietitians or nutritionists.

(g) “Practice of medicine” means the application of scientific principles to prevent, diagnose, and treat physical and mental diseases, disorders, and conditions and to safeguard the life and health of any woman and infant through pregnancy and parturition.

(h) “Practice of occupational therapy” means the evaluation and treatment of individuals whose ability to manage normal daily functions is threatened or impaired by developmental deficits, the aging process, poverty and cultural differences, physical injury or illness, or psychological and social disability, utilizing task-oriented activities to prevent or correct physical or emotional disabilities and enhance developmental and functional skills rendered on the prescription of or referral by a licensed physician, osteopath, dentist, or by a licensed registered nurse certified to practice as an advanced registered nurse as authorized pursuant to Section 2 of this chapter. Specific therapeutic and diagnostic techniques used in occupational therapy include:

(l) self-care and other activities of daily living;

(2) developmental, perceptual-motor, and sensory integrative activities;

(3) training in basic work habits;

(4) prevocational evaluation and treatment;

(5) fabrication and application of splints;

(6) selection and use of adaptive equipment, and exercise and other modalities to enhance functional performance; and

(7) performing and interpreting manual muscle and range of motion tests.

(8) an individual working as an occupational therapy assistant pursuant to this chapter may assist in the practice of occupational therapy under the supervision of or in consultation with a licensed occupational therapist.

(9) nothing in this paragraph shall be construed as preventing or restricting the practices, services, or activities of an occupational therapy assistant who works only under the direct supervision of a licensed occupational therapist, and whose activities do not require advanced training in the basic anatomical, biological, psychological, and social sciences involved in the practice of occupational therapy.

An individual licensed to practice occupational therapy pursuant to this chapter may apply to the director of health for authorization to evaluate and treat patients without prescription or referral as required in paragraph (h). Such authorization may be granted by the director of health, at his discretion, to an individual occupational therapist, for a specified period of time, and under such limitations and conditions as the director of health deems appropriate.

(i) “Practice of optometry” means the application of the scientific principles of optometry in the examination of the eye and visual system to detect defects or abnormal conditions; the prescription or use of lenses, prisms, or ocular exercises to correct or alleviate defects or abnormal conditions of the eye or visual system; the use of approved therapeutic and diagnostic pharmaceutical agents in accordance with the provisions of this paragraph as an aid to the detection and treatment of visual defects or abnormal conditions; and the appropriate referral of patients to licensed physicians for the medical diagnosis and treatment of abnormal conditions.

The director of health shall issue regulations identifying the diagnostic pharmaceutical agents which may be used by optometrists pursuant to this paragraph if the director determines that the use of diagnostic pharmaceutical agents by optometrists are in the best interest of the public.

An individual licensed to practice optometry pursuant to this chapter may use diagnostic pharmaceutical agents only if certified to do so by the board.

Optometrists may use therapeutic pharmaceutical agents in a government hospital only, with prior approval of the hospital’s pharmacy committee, which shall prepare a list of such pharmaceutical agents which may be used by optometrists for both in-patients, and patients treated in the hospital’s outpatient eye-care clinics. It shall be the responsibility of the director of health to give written approval for each optometrist on the staff of the hospital to use and/or prescribe the medications listed by the pharmacy committee. Such use of pharmaceutical agents by optometrists in a non-government hospital will require additional regulation by the board.

Nothing in this paragraph shall be construed as preventing or restricting the practice, services, or activities of a licensed physician or an optician to provide eyeglasses or lenses on the prescription of a licensed physician or optometrist, or a dealer to sell eyeglasses or lenses, provided that the optician or dealer does not represent by title or description of services that he or she is an optometrist.

(j) “Practice of pharmacy” means the interpretation and evaluation of prescription orders; the compounding, dispensing, and labeling of drugs and devices, and the maintenance of proper records therefor; the responsibility of advising, where regulated or otherwise necessary, of therapeutic values and content, hazards, and use of drugs and devices; and the offering or performance of those acts, services, operations, and transactions necessary in the conduct, operation, management, and control of a pharmacy. Within the meaning of this paragraph

(l) “Pharmacy” means any establishment or institution, or arty part thereof, where the practice of pharmacy is conducted; drugs are compounded or dispensed, offered for sale, given away, or displayed for sale at retail; or prescriptions are compounded or dispensed;

(2) “Prescription” means any order for a drug, medicinal, chemical, or combination or mixtures thereof, or for a medically prescribed medical device, in writing, dated and signed by an authorized health professional, or given orally to a pharmacist by an authorized health professional or the person’s authorized agent and immediately reduced to writing by the pharmacist, specifying the address of the person for whom the drug or device is ordered and directions for use to be placed on the label.

The pharmacist shall have the right to substitute medications approved as “generic equiva¬lents” for any prescribed medication written by a health professional who is an employee of the American Samoa Government in his function as a health professional, provided that such “generic equivalents” be limited only to medications approved by the Pharmacy Committee of the government hospital(s) for such substitution.

(k) “Practice of physical therapy” means the independent evaluation of human disability, injury, or disease by means of noninvasive tests of neuromuscular functions and other standard procedures of physical therapy, and the treatment of human disability, injury, or disease by therapeutic procedures, embracing the specific scientific application of physical measures to secure the functional rehabilitation of the human body. These measures include the use of therapeutic exercise, therapeutic massage, heat or cold, air, light, water, electricity, or sound for the purpose of correcting or alleviating any physical or mental disability, or preventing the development of any physical or mental disability, or the performance of noninvasive tests of

neuromuscular functions as an aid to the detection or treatment of any human condition.

An individual, licensed to practice physical therapy pursuant to this chapter may apply to the director of health for authorization to evaluate and treat patients without prescription or referral as required in paragraph (h). Such authorization may be granted by the director of health, at his discretion to an individual physical therapist, for a specified period of time, and under such limitations and conditions as the director health deems appropriate.

(l) “Practice by physician assistants” means the performance, in general collaboration with a licensed physician or osteopath, of acts of medical diagnosis and treatment, prescription, preventive health care, and other functions which are authorized by the board pursuant to 31.0404.

(m) “Practice of practical nursing” means the performance of actions of preventive health care, health maintenance, and the care of persons who are ill, injured, or experiencing alterations in health processes, requiring a knowledge of and skill in nursing procedures gained through successful completion of an approved educational program in practical nursing.

(n) “Practice of clinical psychology” means the application of established scientific methods and principles, including the principles of psychophysiology, learning, perception, motivation, emotions, organizational and social behaviors for the purpose of understanding, assessing, treating, explaining, predicting, preventing, or influencing behavior; the application of psychological methods and procedures for interviewing, counseling, psychotherapy, including behavior therapy, behavior modification, or hypnotherapy; or the application of psychological methods or procedures for constructing, administering, or interpreting tests of intelligence, mental abilities and disorders, neuropsychological functioning, aptitudes, interests, attitudes, personality characteristics, emotions, or motivations. Nothing in this paragraph shall be construed as preventing or restricting the practice, services, or activities of:

(1) an individual bearing the title of psychologist in the employ of any, academic institution if the services are offered within the confines of the academic institution and if the services do not include psychotherapy; or

(2) a school psychologist employed by and working in accordance with regulations of the American Samoa Department of Education.

(o) “Practice of registered nursing” means the performance of acts requiring substantial specialized knowledge, judgment and skill based upon the principles of the biological, physical, behavioral, and social sciences in:

(1) the observation, assessment, and recording of physiological and behavioral signs and symptoms of health, disease, and injury, including the performance of examinations and testing and their evaluation for the purpose of differentiating normal and abnormal.

(2) the provision of direct and indirect registered nursing services of a therapeutic, preventive, and restorative nature in response to an assessment of the patient’s requirements;

(3) the performance of services, counseling, and education for the safety, comfort, personal hygiene, and protection of patients, the prevention of disease and injury, and the promotion of health in individuals, families and communities;

(4) the administration of nursing services within a health care facility, including the delegation of direct nursing functions and the evaluation of the performance of these functions;

(5) the education and training of persons in the direct nursing care of patients; or

(6) the pursuit of nursing research to improve methods of practice.

(p) “Practice of social work” means rendering or offering to render professional services to individuals, families, or groups of individuals that involve the diagnosis and treatment of psychosocial problems according to social work theory and methods. Depending upon the level at which an individual social worker is licensed under this rule, the professional services may include, but shall not be limited to, the formulation of psychosocial evaluation and assessment, counseling, referral, advocacy, consultation, research, administration, education, and community organization. Nothing in this paragraph shall be construed to authorize any person licensed as a social worker

under this chapter to engage in the practice of medicine.

31.0404 Scope of chapter.


(a)This chapter does not limit the right of an individual to practice a health occupation that he or she is otherwise authorized to practice under this chapter, nor does it limit the right of an individual to practice any other profession that he or she is authorized to practice under the laws of the territory.

(b) The practices of health occupations regulated by this chapter are not intended to be mutually exclusive.

(c) Nothing in this chapter shall be construed to require licensure for or to otherwise regulate, restrict, or prohibit individuals from engaging in practices, services, or activities set forth in the paragraphs of this section if the individuals do not hold themselves out, by title, description or services, or otherwise, to be practicing any of the health occupations regulated by this rule. Nothing in this section shall be construed as exempting any of the following categories from other applicable laws and regulations of the territory.

(1) Any minister, priest, rabbi, officer, or agent of any religious body or agent of any religious body or any practitioner of any religious belief engaging in prayer or any other religious practice or nursing practice solely in accordance with the religious tenets of any church for the purpose of fostering the physical, mental, or spiritual well-being of any person;

(2) Any person engaged in the care of a friend or member of the family, including the domestic administration of family remedies, or the care of the sick by domestic servants, housekeepers, companions, or household aides of any type, whether employed regularly or because of an emergency or illness or other volunteers;

(3) any individual engaged in the lawful practice of audiology, speech pathology, X-ray technology, laboratory technology, or respiratory therapy;

(4) any individual engaged in the commercial sale or fitting of shoes or foot appliances; or

(5) marriage and family therapist, marriage counselors, family counselors, child counselors, attorneys, or other professionals working within the legal standards and ethics of their respective professions.

31.0405 Persons licensed under prior rules.


(a) Except as expressly provided to the contrary in this chapter, any person licensed, registered, or certified by any agency of the territory established or continued by any statute amended, repealed, or superseded by this chapter is considered for all purposes to be licensed, registered or certified by the board for the duration of a term for which the license, registration, or certification are issued under the conditions of this chapter, and may in the future renew that authorization in accordance with the appropriate renewal provisions of this chapter, except that all licenses previously granted by the board shall be considered as expired unless the current licensee is employed by the American Samoa Government as a health professional in a position consonant with his licensure as a health professional Such health professional whose license has expired may apply for licensure as appropriate for his education training and position.

(b) Except as provided to the contrary in this chapter an individual who was originally licensed registered or certified under a previous rule that has been superseded by this chapter continues to meet the education and experience requirements as if that provision had not been deleted.

31.0406 Board and committees.


(a) The composition, appointment, quorum, term, powers and duties, procedures, and licensing provisions of board are as set forth in Sections 31.1001 et seq. A.S.C.A. This section supplements these.

(b) The board may appoint committees in medicine, dentistry, nursing and other health professions to:

(1) assist in the evaluation of health professionals’ credentials when expertise is not available on the board;

(2) make licensing recommendations, following a secret ballot, when a potential conflict of interest may exist between any members of the board and a candidate for licensure;

(3) make licensing recommendations, following a secret ballot, when a member of the board recommends non-licensure for a candidate of his or her profession; or

(4) make recommendation, following a secret ballot, to the board for suspension, revocation, or modification of licenses within their profession.

(c) where the board and a committee are in disagreement on a particular matter the decision of the board shall prevail.

(d) The board shall be under the administrative control of the governor.

31.0421 License required.


A license issued pursuant to this chapter is required to practice medicine acupuncture, registered nursing, practical nursing, dentistry, dental, therapy, dental hygiene, dietetics, nutrition, occupational therapy, optometry, pharmacy, physica1 therapy, podiatry, psychology, and socia1 work or to practice as, a physician assistant and as a nurse practitioner in the territory, except as provided in this chapter. Additional certification issued pursuant to this chapter is required to practice advanced registered nursing.

31.0422 Exemptions.


The provisions of this chapter prohibiting the practice of a health occupation without a license shall not apply: (1) to an individual who administers treatment or provides advice in any case of emergency(2) to an individual employed in the territory by the U.S. Federal Government, while he or she is acting in the official discharge of the duties of employment,(3) to an individual, licensed to practice a health occupation in a state, territory or country who is called in professional consultation by a health professional licensed in American Samoa by or on behalf of a specific patient, to visit, examine, treat, or advise the specific patient in the territory, or to give a demonstration or clinic in the territory, provided that the individual engaged in the consultation, demonstration, or clinic in performs in affiliation with a comparable health professional licensed pursuant to this rule.

31.0423 General qualifications of applicants.


(a) An individual applying for a license under this rule shall establish to the satisfaction of the board that the individual:

(1) has not been convicted of an offense which bears directly on the fitness of the individual to be licensed;

(2) is at least 18 years of age;

(3) has successfully completed the additional requirements set forth in 31.0424, 31.0441 through 31.0447 and 31.0451 through 31.0454 as applicable;

(4) meets any other requirements established by the board by rule to assure that the applicant

has had the proper education, training, experience, and qualifications to practice the health occupation.

(b) the board may deny a license to an applicant whose license to practice a health occupation was revoked or suspended in another state, territory or other licensing jurisdiction if the basis of the license revocation or suspension would have caused a similar result in American Samoa, or if the applicant is the subject of ending disciplinary action regarding his or her right to practice in another jurisdiction.

(c) the references in 31.0424, 31.0441 through 31.0447 and 31.0451 through 31.0454 to named professional organizations and governmental entities for purposes of accreditation or the administration of national examinations shall be considered to refer to successor organizations or entities upon a determination by the board that the successor is substantially equivalent in standards and purposes as the organization or entity named in this chapter.

31.0424 Additional qualifications.


(a) an individual applying for a license to practice medicine or dentistry under this chapter shall establish to the satisfaction of the board that the individual is a graduate of an accredited school of medicine or dentistry, and has completed at least one year of post-graduate training in a hospital or other health care or dental facility accredited for post-graduate training. Graduates from an accredited school of medicine or dentistry located in the United States, Canada, Papua-New Guinea, Australia, New Zealand, Great Britain, Switzerland, France, Belgium, West Germany, Norway, Sweden, or Denmark will be considered as having met standards of education acceptable for licensure in American Samoa. Graduates-of Fiji schools of medicine or dentistry, or of any other health profession listed in this chapter who have graduated prior to January 1, 1987, will also be considered as having met standards of education acceptable for licensure in American Samoa.

(b) individuals applying for a license to practice medicine under this chapter who have completed medical education under conditions other than those listed in subsection 31.0424(a) shall establish to the satisfaction of the board that they have successfully passed the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) and the ECFMG English Test.

(c) individuals applying for a license to practice dentistry under this chapter who have completed their dental education under conditions other than those listed in subsection 31.0424(a) shall establish to the satisfaction of the board that they have obtained equivalent education and training as those who received their education and training in the countries listed in subsection 31.0424(a) by submitting evidence of licensure, or eligibility for licensure in any state of the United States.

(d) an individual applying for a license to practice acupuncture under this rule shall establish to the satisfaction of the board that the individual:

(1) if he or she is a licensed physician under subsection 31.0424(a), has successfully completed at least 100 hours of instruction in the practice of acupuncture at a school or college accredited by the U.S. National Accreditation Commission for Schools and Colleges of Acu¬puncture and Oriental Medicine, or other training approved by the board; or has training which would qualify the applicant for licensure to practice acupuncture in any of the countries listed in subsection 31.0424(a);

(2) if he or she is not a Licensed physician, the applicant shall furnish the board with evidence of completion of an educational program in the practice of acupuncture of at least 3 academic years at the post-baccalaureate level, at a school of acupuncture accredited by the U.S. National Commission for Schools and Colleges for Acupuncture and Oriental Medicine; or has training which would qualify the applicant for licensure to practice acupuncture under the conditions listed in subsection 31.0424(a).

(e) an individual applying for a license to practice dental hygiene under this rule shall provide the board with evidence of eligibility for licensure as a dental hygienist under the conditions listed in subsection 31.0424(a).

(f) an individual applying for a license to practice dental therapy under this chapter shall provide the board with evidence of eligibility for licensure as a dental therapist under the conditions listed in subsection 31.0424(a).

(g) an individual applying for a license to practice occupational therapy under this chapter shall provide the board with evidence of eligibility for licensure to practice occupational therapy in any of the countries listed in subsection 31.0424(a) and further, the applicant shall be required to furnish proof of having satisfactorily completed a minimum of six months of post-graduate work experience in a clinical setting of an accredited occupational therapy training institution.

(h) an individual applying for a license to practice optometry under this chapter shall provide the board with evidence of eligibility for licensure to practice optometry under the conditions listed in subsection 31.0424(a).

(i) an individual applying for a license to practice pharmacy under this chapter shall provide the board with evidence of eligibility for licensure to practice pharmacy under the conditions listed in subsection 31.0424(a).

(j) an individual applying for a-license to practice physical therapy under this chapter shall provide the board with evidence of eligibility for licensure as a physical therapist under the conditions listed in subsection 31.0424(a), and further, the applicant shall furnish the board with evidence that he has satisfactorily completed a minimum of six months of supervised work. experience in a clinical setting of an accredited physical therapy training institution.

(k) an individual applying for a license to practice as a physician assistant or nurse-practitioner under this chapter shall provide the board with evidence of eligibility for licensure as a physician assistant or nurse-practitioner under the conditions listed in subsection 31.0424(a); or alternatively, provide the board with evidence that the applicant has completed educational requirements consistent with licensure as a physician assistant or nurse-practitioner; further, that such educational requirements for licensure as a physician assistant be in accordance with standards established by the U.S. National Commission on Certification of Physician Assistants; further that such applicant furnish the board with evidence of compliance with Continuing Medical Education activities as mandated by the NCCPA.

(1) an individual applying for a license to practice practical nursing under this chapter shall establish to the satisfaction of the board that the individual has successfully completed a postsecondary level educational program in practical nursing which is approved by the Board.

(m) an individual applying for a license to practice registered nursing under this rule shall establish to the satisfaction of the board that the individual has successfully completed an educational program in registered nursing approved by the board or by a state board of nursing with standards substantially equivalent to the standards of the territory.

(n) an individual applying for a license to practice clinical psychology under this rule shall establish to the satisfaction of the board that the individual has:

(1) earned a doctoral degree in psychology from an accredited college or university; and

(2) completed at least 2 years of postdoctoral experience acceptable to the board.

31.0425 Application for license.


An applicant for a license shall submit an application to the board on the form required the board.

31.0426 Issuance of license.


The board shall issue a license to an applicant who meets the requirements of this chapter to practice the health occupation regulated by the board.

31.0427 Scope of license.


(a) a person licensed under this chapter to practice a health occupation is authorized to practice that occupation in the territory while the license is effective, within the limitations imposed by the board at the time the license is issued; provided that:

(1) a person certified to practice advanced registered nursing is authorized to practice the specialty for which he or she has been certified by the board.

(b) an individual who fails to renew a license to practice a health occupation shall be considered to be unlicensed and subject to the penalties set forth in this rule and other applicable laws of the territory, if he or she continues to practice the health occupation.

(c) the board may issue licenses in four categories:

(1) active license: to be issued to a health professional who is or intends within a short period of time, to be in the active practice of his health profession.

(2) inactive license: to be issued to a health professional who is qualified to be in the active practice of his health profession, but who is unable to pursue his profession in American Samoa at the time of his application. Such licensure will apply but will not be limited to health professionals in the Armed Forces, those residing temporarily outside of American Samoa, individuals temporarily inactive due to personal factors, such as motherhood or election to government position outside the health field. Such licensure shall not exceed a period of 5 years. Granting of an inactive license recognizes an individual’s qualifications for licensure, but does not permit active practice of a health profession in the territory of American Samoa. Such return to active practice will require notification of the board by the licensee, and a request for alteration of the licensure to “active”. At the time of such reapplication it shall be the responsibility of the board to review the applicant’s qualifications and grant or deny licensure. It shall be the prerogative of the board to request additional information as to the applicant’s qualifications and status.

(3) limited license: the board shall have the right to limit the active practice of any health professional seeking licensure in the territory. Such limitations may include but not be limited to: duration of licensure, permission or proscription of any or multiple professional activities, limitations as to types of medications or treatments which may be undertaken, either for a specific time period or an unlimited duration of time; requiring of a health professional that his practice be carried out under supervision, with specifications as to type, intensity, duration of such supervision, together with specifications as to the nature of reports to be made to the board. about the results of the supervision by the named supervisor. The board shall have the right to revoke or terminate licensure of a health professional granted a limited license if the terms of the license are violated by the licensee.

(4) honorary license: may be issued to a health professional who has retired or is retiring from active practice after a minimum of 30 years of active practice, in recognition of service to the community. Such licensee shall not engage in active practice. The duration of a honorary license may be indefinite.

31.0428 Term and renewal of licenses.


(a) an active license expires 2 years from the date of its first issuance or renewal unless renewed by then board as provided in this section.

(b) the board may establish continuing education requirements as a condition for renewal of licenses under this section.

(c) at least 30 days before the license expires, or greater period as established by regulation, the board or its agent shall send to the licensee a renewal notice that states:

(1) the date on which the current license expires; and

(2) the date by which the renewal application must be received by the board for renewal to be issued and mailed before the license expires.

(d) before the license expires, the licensee may renew it for an additional term, if the licensee:

(1) submits a timely application to the board;

(2) is otherwise entitled to be licensed; and

(3) submits to the board satisfactory evidence of compliance with any continuing education requirements established by the board for license renewal.

(e) the board shall renew the license of each licensee who meets the requirements of this section.

31.0429 Reinstatement of expired licenses.


When a health professional fails for any reason to renew the license issued under this section, the board may reinstate the license if the health professional:

(1) applies to the board for reinstatement of the license within a 5 year period after the expiration of the license;

(2) complies with current requirements for renewal of a license as set forth in this section: and

(3) submits to the board satisfactory evidence of compliance with the qualifications and requirements established under this section for license reinstatements.

31.0430 Revocation, suspension, or denial of license; civil penalty; reprimand.


(a) see Sections 31.1006, 31.1009, 31.1010, and 31.l011, A.S.C.A.

(b) if the board determines, after investigation, that the conduct of a licensee presents an imminent danger to the health and safety of the residents of the territory, the board may summarily suspend or restrict, without a hearing, the license to practice a health occupation.

(c) the board, at the time of the summary suspension or restriction of a license, shall provide the licensee with written notice stating he action that is being taken, the basis for the action, and the right of the licensee to request a hearing.

(d) a licensee shall have the right to request a hearing within 72 hours after service of notice of the summary suspension or restriction of license. The board shall hold a hearing within 72 hours of receipt of a timely request, and shall issue a decision within 72 hours after the hearing.

(e) every decision and order adverse to a licensee shall be in writing and shall be accompanied by findings of fact and conclusions of law. The findings shall be supported by, and in accordance with, reliable, probative, and substantial evidence. The board shall provide a copy of the decision and order and accompanying findings of fact and conclusions of law to each party to a case or to his or her attorney of record.

31.0431 Voluntary surrender of license.


(a) any health professional who is the subject of an investigation into, or a pending proceeding involving, allegations involving misconduct may voluntarily surrender his or her license to practice in the territory, but only by delivering to the board an affidavit stating that the health professional desires to surrender the license and that the action is freely and voluntarily taken, and not the result of duress or coercion.

(b) upon receipt of the required affidavit, the board shall enter an order revoking or suspending the license of the health professional or the privilege to practice.

(c) the voluntary surrender of a license shall not preclude the imposition of civil or criminal penalties against the licensee.

31.0432 Voluntary limitation or surrender of license by impaired health professional.


(a) any license issued under this rule may be voluntarily limited by the licensee. During the period of time that the license has been limited, the licensee shall not engage in the practices or activities to which the voluntary limitation of practice relates. As a condition for accepting the voluntary limitation of practice, the board may require the licensee to do one or more of the following:

(1) accept care, counseling, or treatment by physicians or other health professionals acceptable to the board;

(2) participate in a program of education prescribed by the board; and

(3) practice under the direction of a health professional acceptable to the board for a specified period of time.

(b) any license issued under this rule may be voluntarily surrendered to the board by the licensee. During the period of time that the license has been surrendered, the individual surrendering the license shall not practice, attempt to practice, or offer to practice the health occupation for which the license is required, and shall be considered unlicensed.

(c) all records, communications, and proceeding: of the board related to the voluntary limitation or surrender of a license under this section shall be confidential.

31.0441 General authorization.


The advanced registered nurse may perform actions of medical diagnosis, treatment, prescrip-tion, and other functions authorized by this section in collaboration with a physician, osteopath, or dentist, who shall be responsible for the overall medical direction of the health care team. Collaboration shall be at the level required by this chapter, or at a higher level.

31.0442 Collaboration.


(1) Generally, nurse-midwives and nurse-practitioners shall carry out acts of advanced registered nursing in general collaboration with a physician or osteopath.

(2) Generally; nurse-anesthetists shall carry out acts of advanced registered nursing in direct collaboration with an anesthesiologist, other physician, or dentist.

(3) In accordance with this section: in collaborations between physicians, osteopaths, and dentists, and advanced registered nurses, the collaborating parties may establish by protocol higher levels of collaboration for specific acts or specific circumstances.

31.0443 Authorized acts.


Within the established protocol, an advanced registered nurse may:

(1) monitor and alter drug therapies;

(2) initiate appropriate therapies for certain conditions;

(3) make referrals for physical therapy; and

(4) perform additional functions within his or her specialty determined in accordance with 31.0444, 31.0445 and 31.0446.

31.0444 Nurse-anesthetist.


(a) in addition to the general functions specified in 31.0443, a nurse-anesthetist may perform any or all of the actions in subsection (b) of this section.

(b) the nurse-anesthetist may:

(1) determine the health status of the patient as it relates to the relative risks associated with the anesthetic management of the patient through the performance of the operative procedures;

(2) based on history, physical assessment, and supplemental laboratory results, determine, with the consent of the collaborating anesthesiologist, or other physician, or dentist, the

appropriate type of anesthesia;

(3) order preanesthetic medication;

(4) perform procedures commonly used to render the patient insensible to pain during the performance of surgical, obstetrical, therapeutic, or diagnostic clinical procedures. This shall include ordering and administering:

(A) general and regional, including spinal, anesthesia;

(B) inhalation agents and techniques; and

(C) intravenous agents and techniques and a nurse-anesthetist collaborating with a dentist shall be limited to ordering and administering anesthesia appropriate for dental procedures;

(5) order or perform monitoring procedures indicated as pertinent to the anesthetic health care management of the patient;

(6) support life functions during anesthesia health care, including induction and incubation procedures, the use of appropriate mechanical supportive devices, and the management of fluid, electrolyte, and blood component balances:

(7) recognize and take appropriate corrective action for abnormal patient responses to

anesthesia, adjunctive medication, or other forms of therapy;

(8) recognize and treat a cardiac arrhythmia while the patient is under anesthetic care;

(9) participate in management of the patient while in the postanesthesia recovery area, including ordering the administration of fluids and drugs; and

(10) place peripheral and central venous and arterial lines for blood sampling and monitoring as appropriate. (c)notwithstanding the provisions of paragraphs (b)(l) and (b)(2) of this section, a qualified advanced registered nurse without collaborating with an anesthesiologist, other physician, or dentist, may initiate and perform local anesthetic procedures and order necessary an esthetic agents to perform the procedures.

31.0445 Nurse-midwifery.


(a) in addition to the general functions specified in 31.0443 the nurse-midwife may perform any of the acts in subsection (b) of this section, provided that:

(1) the nurse-midwife and the obstetrician-gynecologist have set forth in a protocol procedures for:

(A) consultation with each other about patient conditions during the antepartum, intrapartum, and postpartum phases of maternity care, and during gynecological care, including consultations for the purpose of ensuring that the medical care provided by the nurse-midwife is for the normal obstetrical or ecological patient as required by paragraph (B)(2) of this section;

(B) emergency care to protect the health of the mother and infant.

(2) the patient has been advised and informed of the responsibilities of the obstetrician-gynecologist and the nurse-midwife; and

(3) the act is done in accordance with sub-. section (b) of this section.

(b) the nurse-midwife may:

(1) manage the medical care of the normal obstetrical patient;

(2) perform superficial minor surgical procedures;

(3) manage the normal obstretrical patient during labor and delivery to include amniotomy, episiotorny, and repair;

(4) initiate and perform local anesthetic procedures and order the necessary anesthetic agents to perform the procedures;

(5) perform postpartum examination;

(6) provide gynecological cares for the essentially normal woman;

(7) prescribe appropriate medications; and

(8) provide family planning services.

31.0446 Nurse-practitioner practice.


In addition to the general functions specified in 31.0443, the nurse-practitioner may perform any or all of the following acts provided that the act is done in accordance with 31.0442:

(1) manage selected medical problems;

(2) initiate, monitor, or alter therapies for certain uncomplicated, acute illnesses;

(3) initiate appropriate treatments and medications, and alter dosage; and

(4) monitor and manage patients with stable, chronic diseases.

31.0447 Nurse-anesthetist.


(a) in addition to the general qualifications for licensure set forth in 31.042 3 of this chapter, and any additional requirements which the board may establish by rule, a nurse-anesthetist shall:

(1) be a registered nurse holding a current, valid license pursuant to 31.0421 of this chapter, and be in good standing with the board, with no action pending or in effect against the license which could adversely affect the legal right to practice;

(2) be in good ethical standing within the profession;

(3) be a graduate of a nurse-anesthetis: educational program or school accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs/Schools of the American Association of Nurse Anesthetists, and have met all the criteria and requirements in theory and clinical practice to apply for certification; and

(4) successfully complete the comprehensive, certifying examination administered by the Council of Certification of Nurse Anesthetists of the American Association of Nurse Anesthetists, demonstrating basic scientific knowledge of and competent judgment in-nurse¬anesthesia practice.

(b) an applicant for licensure as a nurse-anesthetist from a jurisdiction other than an agency of the federal government of the United States or its states shall demonstrate to the satisfaction of the board that he has completed training and successfully passed examination equivalent to that described in paragraphs (a) (3) and (a)(4) of this section.

31.0451 Practicing without license.


No person shall practice, attempt to practice, or offer to practice a health occupation licensed or regulated under this chapter territory unless currently licensed, or exempted from licensing, under this chapter.

31.0452 Misrepresentation.


Unless authorized to practice a health occupation under this chapter, a person shall not represent to the public by title, description of services, methods, or procedures, or otherwise that the person is authorized to practice the health occupation in the territory.

31.0453 Filing false document or evidence-False statements.


(a) no person shall file or attempt to file with the board any statement diploma, certificate, credential, or other evidence of achievement in a health profession if the person knows, or should know, that it is false or misleading.

(b) no person shall knowingly make a false statement that is in fact material under oath or affirmation administered by the board or hearing officer.

31.0454 Fraudulent sale, obtaining or furnishing of documents.


(a) no person shall sell or fraudulentl3,’ obtain or furnish any diploma, license,, certificate or registration, record, or other document required by this chapter or by the board.

31.0455 Violation-Penalty.


(a) violation of any provision of this chapter is a class A misdemeanor.

31.0456 Violation-Single act sufficient evidence.


(a) in any prosecution under 31.0455, or any decision made by the board relative to licensing. it shall be sufficient to sustain such conviction or decision to show a single violative act of conduct, and it shall not be necessary to show a general course of such conduct.