2017 - 2018 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 582
December 19, 2017 - Offered by Representative Murphy.
1An Act to renumber
448.05 (5) (a) 1. and 2.; to renumber and amend
(5) (a) (intro.); to amend
441.16 (6), 448.01 (6), 448.20 (1), 448.21 (1) (d), 448.21 3
(2), 448.21 (3) and Med 8.01 (2); and to create
448.015 (1u), 448.015 (1w), 4
448.20 (3m), 448.21 (4), 448.62 (2m), 448.62 (7) and 448.695 (4) of the statutes; 5relating to: delegation of the practice of podiatry, practice of a physician
6assistant under the supervision of a podiatrist, modifying administrative rules
7of the Medical Examining Board relating to practice of physician assistants,
8and providing an exemption from emergency rule procedures.
Analysis by the Legislative Reference Bureau
Generally, under current law, no person may practice podiatry unless the
person is licensed as a podiatrist. This substitute amendment creates an exception
to this prohibition for an advanced practice nurse prescriber who is providing
nonsurgical patient services as directed, supervised, and inspected by a podiatrist.
The substitute amendment also modifies various provisions governing the
practice of physician assistants that require a physician assistant to be supervised
by a physician to instead allow for supervision of a physician assistant by a
podiatrist. The substitute amendment allows a physician assistant who is under the
supervision of a podiatrist to engage in the practice of podiatry, except that, like an
advanced practice nurse prescriber, the practice of the physician assistant is limited
to providing nonsurgical patient services. The substitute amendment allows the
Podiatry Affiliated Credentialing Board to promulgate rules regarding the practice
of podiatry by physician assistants.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
441.16 (6) of the statutes is amended to read:
Nothing in this section prohibits a nurse from issuing a prescription 3
order as an act delegated by a physician, and nothing in this section prohibits an
4advanced practice nurse certified under this section from issuing a prescription order
5as an act delegated by a podiatrist
448.01 (6) of the statutes is amended to read:
“Physician assistant" means an individual licensed by the medical 8
examining board to provide medical care with physician supervision and direction 9or to practice podiatry with podiatrist supervision and direction
448.015 (1u) of the statutes is created to read:
“Podiatrist" has the meaning given in s. 448.60 (3).
448.015 (1w) of the statutes is created to read:
“Podiatry" has the meaning given in s. 448.60 (4).
448.05 (5) (a) (intro.) of the statutes is renumbered 448.05 (5) (a) 15
and amended to read:
(a) The Except as provided in s. 448.695 (4), the
board shall 17
promulgate rules establishing licensing standards and practice standards for 18
physician assistants and shall license persons under those rules.
The board may not grant a license as a physician assistant to an applicant 2
unless the applicant submits evidence satisfactory to the board of all of the following:
448.05 (5) (a) 1. and 2. of the statutes are renumbered 448.05 (5) 4
(b) 1. and 2.
448.20 (1) of the statutes is amended to read:
448.20 (1) Recommend licensing and practice standards.
The council on 7
physician assistants shall develop and recommend to the examining board licensing 8
and practice standards for physician assistants practicing under physicians and
9shall develop and recommend to the podiatry affiliated credentialing board practice
10standards for physician assistants practicing under podiatrists
. In developing the 11
standards, the council shall consider the following factors: an individual's training, 12
wherever given; experience, however acquired, including experience obtained in a 13
hospital, a physician's or podiatrist's
office, the armed services or the federal health 14
service of the United States, or their equivalent as found by the examining board; and 15
education, including that offered by a medical school and the technical college system 16
448.20 (3m) of the statutes is created to read:
448.20 (3m) Advise podiatry affiliated credentialing board.
The council 19
shall advise the podiatry affiliated credentialing board on revising practice 20
standards for physician assistants practicing podiatry.
448.21 (1) (d) of the statutes is amended to read:
(d) The practice of podiatry within the meaning of s. 448.60 (4),
23except when the physician assistant is acting under the supervision and direction of
24a podiatrist, subject to sub. (4) and the rules promulgated under s. 448.695 (4)
448.21 (2) of the statutes is amended to read:
448.21 (2) Employee status.
No physician assistant may be self-employed. 2
The employer of a physician assistant shall assume legal responsibility for any 3
medical care, including the practice of podiatry,
provided by the physician assistant 4
during the employment. The employer of a physician assistant, if other than a 5
licensed physician or podiatrist
, shall provide for and not interfere with supervision 6
of the physician assistant by a licensed physician or podiatrist
448.21 (3) of the statutes is amended to read:
448.21 (3) Prescriptive authority.
A physician assistant may issue a 9
prescription order for a drug or device in accordance with guidelines established by 10
a supervising physician or podiatrist
and the physician assistant and with rules 11
promulgated by the board. If any conflict exists between the guidelines and the rules, 12
the rules shall control.
448.21 (4) of the statutes is created to read:
448.21 (4) Practice of podiatry.
A physician assistant who is acting under the 15
supervision and direction of a podiatrist shall be limited to providing nonsurgical 16
448.62 (2m) of the statutes is created to read:
An advanced practice nurse who is certified to issue prescription 19
orders under s. 441.16 and who is providing nonsurgical patient services as directed, 20
supervised, and inspected by a podiatrist who has the power to direct, decide, and 21
oversee the implementation of the patient services rendered.
448.62 (7) of the statutes is created to read:
A physician assistant who is acting under the supervision and 24
direction of a podiatrist, subject to s. 448.21 (4).
448.695 (4) of the statutes is created to read:
The affiliated credentialing board shall promulgate rules 2
establishing all of the following:
(a) Practice standards for a physician assistant practicing podiatry as provided 4
in s. 448.21 (4).
(b) Requirements for a podiatrist who is supervising a physician assistant as 6
provided in s. 448.21 (4).
Med 8.01 (2) of the statutes is amended to read:
Med 8.01 (2) Physician assistants provide health care services as part of 9
physician-led or podiatrist-led
teams, the objectives of which include safe, efficient, 10
and economical health care. The realities of the modern practice of medicine and 11
surgery require supervising physicians and podiatrists
and physician assistants to 12
use discretion in delivering health care services, typically at the level of general 13
supervision. The constant physical presence of a supervising physician
or podiatrist 14
is often unnecessary. The supervising physician or podiatrist
and the physician 15
assistant are jointly responsible for employing more intensive supervision when 16
circumstances require direct observation or hands-on assistance from the 17
Med 8.02 (5x) of the administrative code is created to read:
Med 8.02 (5x)
“Podiatrist” has the meaning given in s. 448.60 (3), Stats.
Med 8.05 (4) of the administrative code is amended to read:
Med 8.05 (4) Licensure; renewal.
At the time of licensure and each biennial 22
registration of licensure thereafter, a physician assistant shall list with the board the 23
name and address of the supervising physician or podiatrist
and shall notify the 24
board within 20 days of any change of a supervising physician or podiatrist
Med 8.07 (1), (2) (i) and (3) of the administrative code are amended 2