Pennsylvania Joins Growing List of States to License Genetic Counselors
Jennifer K. Wagner, J.D., Ph.D., is a solo-practicing attorney in State College, PA and a research associate at the University of Pennsylvania’s Center for the Integration of Genetic Healthcare Technologies.
On December 22, 2011, the Pennsylvania General Assembly adopted two bills (H.B. 332 and H.B. 333) to amend the commonwealth’s Medical Practice Act of 1985 (P.L. 457, No. 112) and the Osteopathic Medical Practice Act of 1978 (P.L. 1109, No. 261) to include provisions that regulate genetic counselors. Pennsylvania Governor Corbett approved the bills and signed them into law the same day.
PA’s GC Law in Context. According to the National Conference of State Legislatures’ survey of state requirements for genetic counselors, in 2008 only six states required licenses to practice genetic counseling (California, Illinois, Massachusetts, Oklahoma, Tennessee, and Utah). Pennsylvania is the latest to join a number of states (including Delaware, Hawaii, Indiana, New Jersey, New Mexico, South Dakota and Washington) that have enacted GC licensing laws since 2008. The National Society of Genetic Counselors reports that additional states (e.g. Florida, Michigan, Minnesota, New York, Rhode Island, Texas, and Wisconsin) are considering similar legislation. While the state licensing requirements are similar, state-by-state variation and nuances in the statutes may exist. The following information pertains to Pennsylvania’s new licensing law only.
Defining the GC Field. Specifically, the two laws define genetic counseling as “[t]he provision of services to individuals, couples, families and organizations by one or more appropriately trained individuals to address the physical and psychological issues associated with the occurrence or risk of occurrence of a genetic disorder, birth defect or genetically influenced condition or disease in an individual or a family.” They define genetic counselor as “[a]n individual who is licensed to practice genetic counseling by the State Board of Medicine or the State Board of Osteopathic Medicine.” (63 P.S. §422.2 and 63 P.S. §271.2)
The laws prohibit individuals from holding themselves out as genetic counselors unless they are licensed. There are a few notable exemptions to this licensure mandate. One exemption permits individuals licensed to practice medicine (though not licensed as genetic counselors) to provide services that constitute genetic counseling so long as two requirements are met: (1) they are acting within the scope of their licenses and training when they provide those services, and (2) they do not hold themselves out as genetic counselors. Another exemption permits students to perform genetic counseling, so long as (1) the students are enrolled in a genetic counseling education program that is accredited by either the ABGC (i.e. the American Board of Genetic Counseling) or ABMG (i.e. the American Board of Medical Genetics), (2) the counseling is an “integral part of the student’s course of study,” and (3) the counseling “is performed under the direct supervision of a genetic counselor, licensed physician, certified registered nurse practitioner with a specialty or subspecialty in genetics or clinical nurse specialist with a specialty or subspecialty in genetics.” (63 P.S. §422.13.4(d) and §271.10.3(d))
The laws also stipulate what is required for licensure as a genetic counselor (63 P.S. §422.13.4(e) and §271.10.3(e)): the individual must (1) be at least 21 years of age, (2) be “of good moral character,” (3) have a master’s or doctoral degree in human genetics or genetic counseling from an ABGC- or ABMG-accredited program or otherwise meet the ABGC or ABMG certification requirements, (4) pass the certification exam by the ABGC or ABMG, and (5) complete the application and pay the appropriate fees.
There is a transition phase of three years that permits noncertified individuals to become licensed.
While initial licenses appear to have no continuing education requirements for the initial two years, license renewal will require no less than 30 hours of continuing education within the two years immediately preceding the renewal. (63 P.S. §422.13.4(j) and §271.10.3(j)).
Additionally, genetic counselors are required by these laws to carry professional liability insurance coverage (i.e. malpractice insurance) in the minimum amount of $1,000,000 per occurrence or claims made. (63 P.S. §422.13.4(k) and §271.10.3(k)).
Expanding or Limiting a GC’s Duties? A provision worth noting for ELSI scholars (particularly those contemplating duties to report, ongoing duties to patients) may be 63 P.S. §422.13.4 (c)(2) and §271.10.3(c)(2)). These sections state:
“When in the course of providing genetic counseling services to a client, if a genetic counselor finds any indication of a disease or condition that requires diagnosis and treatment outside the scope of practice defined in this section, the genetic counselor shall refer the client to a licensed physician or appropriate health care practitioner.”
While it remains to be seen how this provision will be enforced, as written the statute seems to impose a number of duties on genetic counselors. Notice the language is not restricted to “patients” but, rather, imposes a duty to “clients.” It is possible that this word choice was simply in recognition of the fact that those individuals seeking genetic counseling services may not be symptomatic or otherwise fitting of the term “patients.” However, this word choice potentially conveys a much broader class of statutorily protected individuals and will likely permit a fair degree of play if legal disputes ever arise (e.g. who exactly is the client – the individuals tested, the individuals in the room during the counseling, the individual’s family members (all? only first-degree relatives? only first degree genetic relatives?), the person paying for the counseling, etc – and to whom did the genetic counselor owe duties of care).
The provisions’ introductory clause may limit these duties if the clause is interpreted as imposing a temporal restriction to the time of the counseling session (as opposed to ongoing duties if, for example, variants of unknown significance become better understood subsequently) or as suggesting a narrow definition of “client” that would release the genetic counselor from any duties to family members and extended relatives who are outside the clinic’s office door.
The provisions of Pennsylvania’s GC licensing law are scheduled to take effect 60 days after the law was signed, which would be on or about February 20, 2012.