SB515: Bill Text

SB515,23,15 2. The applicant is at least 18 years of age.

SB515,23,16 3. The applicant provides evidence of one of the following:

SB515,23,21 a. That the applicant has successfully completed an educational program for physician assistants or physician associates that is accredited by the Accreditation Review Commission on Education for the Physician Assistant or its successor or, prior to 2001, by the Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs.

SB515,23,25 b. If the applicant does not satisfy subd. 3. a., that the applicant, prior to January 1, 1986, successfully passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants.

SB515,24,2 4. The applicant passes the National Commission on Certification of Physician Assistants examination or an equivalent national examination adopted by the board.

SB515,24,4 5. The applicant provides a listing with all employers, practice settings, internships, residencies, fellowships, and other employment for the past 7 years.

SB515,24,6 6. Subject to ss. 111.321, 111.322, and 111.335, the applicant does not have an arrest or conviction record.

SB515,24,13 (b) Paragraph (a) 3. does not apply to an applicant if the applicant provides evidence that he or she is licensed as a physician assistant or physician associate in another state, the District of Columbia, Puerto Rico, the United States Virgin Islands, or any territory or insular possession subject to the jurisdiction of the United States and the board determines that the requirements for obtaining the license in that state or territory are substantially equivalent to the requirements under par. (a).

SB515,24,16 (2) (a) The renewal date for a license issued under this chapter is specified under s. 440.08 (2) (a), and the renewal fees for such licenses are determined by the department under s. 440.03 (9) (a). Renewal of a license is subject to par. (b).

SB515,24,21 (b) An applicant for the renewal of a license under this chapter shall submit with his or her application for renewal proof of having satisfied the continuing education requirements imposed by the board under s. 461.05 (1) (b). This paragraph does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the board initially granted the license.

SB515,24,25 (3) Notwithstanding sub. (1), an individual who, on the effective date of this subsection .... [LRB inserts date], was licensed by the medical examining board as a physician assistant under subch. II of ch. 448, 2017 stats., shall be considered to have been licensed under sub. (1) for purposes of this chapter.

SB515,25,4 461.10 Practice and employment. (1) (a) Subject to the limitations and requirements under sub. (2); the physician assistant's experience, education, and training; and any rules promulgated under sub. (5), a physician assistant may do any of the following:

SB515,25,6 1. Examine into the fact, condition, or cause of human health or disease, or treat, operate, prescribe, or advise for the same, by any means or instrumentality.

SB515,25,8 2. Apply principles or techniques of medical sciences in the diagnosis or prevention of any of the conditions described in subd. 1. and in s. 461.01 (2).

SB515,25,9 3. Penetrate, pierce, or sever the tissues of a human being.

SB515,25,11 4. Offer, undertake, attempt, or hold oneself out in any manner as able to do any of the acts described in this paragraph.

SB515,25,15 (b) Subject to any rules promulgated by the board and consistent with his or her experience, education, and training, a physician assistant may order, prescribe, procure, dispense, and administer prescription drugs, medical devices, services, and supplies.

SB515,25,19 (c) A physician assistant may practice in ambulatory care, acute care, long-term care, home care, or other settings as a primary, specialty, or surgical care provider who may serve as a patient's primary care provider or specialty care provider.

SB515,25,22 (2) (a) 1. Except as provided in subd. 3. and sub. (5) (a) or (b), a physician assistant who provides care to patients shall maintain and provide to the board upon request one of the following:

SB515,26,4 a. Evidence that, pursuant to the physician assistant's employment, there is a physician who is primarily responsible for the overall direction and management of the physician assistant's professional activities and for assuring that the services provided by the physician assistant are medically appropriate. In this subd. 1. a., “employment” includes an arrangement between the physician assistant and a 3rd party in which the 3rd party receives payment for services provided by the physician assistant.

SB515,26,7 b. A written collaborative agreement with a physician that describes the physician assistant's individual scope of practice and that includes other information as required by the board.

SB515,26,11 c. If the physician assistant's practice is limited to the practice of podiatry, a written collaborative agreement with a podiatrist or physician that describes the physician assistant's individual scope of podiatry practice and that includes other information as required by the board.

SB515,26,13 2. Subdivision 1. does not require the physical presence of a physician or podiatrist at the time and place a physician assistant renders a service.

SB515,26,16 3. Subdivision 1. does not apply with respect to a physician assistant who is employed by the federal government as a civilian or member of the uniformed services while performing duties incident to that employment or service.

SB515,26,18 (b) A physician assistant shall limit his or her practice to the scope of his or her experience, education, and training.

SB515,26,20 (c) No physician assistant may provide medical care, except routine screening and emergency care, in any of the following:

SB515,26,21 1. The practice of dentistry or dental hygiene within the meaning of ch. 447.

SB515,26,22 2. The practice of optometry within the meaning of ch. 449.

SB515,26,23 3. The practice of chiropractic within the meaning of ch. 446.

SB515,26,24 4. The practice of acupuncture within the meaning of ch. 451.

SB515,27,2 (3) (a) It shall be the obligation of a physician assistant to ensure all of the following:

SB515,27,4 1. That the scope of the practice of a physician assistant is identified and is appropriate with respect to his or her experience, education, and training.

SB515,27,6 2. For purposes of sub. (2) (a) 1. b. and c., that the relationship with and access to a collaborating physician or podiatrist by the physician assistant is defined.

SB515,27,8 3. That the requirements and standards of licensure under this chapter are complied with.

SB515,27,13 4. That consultation with and referral to other licensed health care providers with a scope of practice appropriate for a patient's care needs occurs when the patient's care needs exceed the physician assistant's experience, education, or training. A physician assistant shall ensure that he or she has awareness of options for the management of situations that are beyond the physician assistant's expertise.

SB515,27,15 (b) A physician assistant is individually and independently responsible for the quality of the care he or she renders.

SB515,27,20 (4) A physician assistant may delegate a care task or order to another clinically trained health care worker if the physician assistant is competent to perform the delegated task or order and has reasonable evidence that the clinically trained health care worker is minimally competent to perform the task or issue the order under the circumstances.

SB515,27,22 (5) The board shall promulgate any rules necessary to implement this section, including rules to do any of the following:

SB515,27,25 (a) Allow for temporary practice, specifically defined and actively monitored by the board, in the event of an interruption of a collaborative relationship under sub. (2) (a) 1. b. or c.

SB515,28,4 (b) Allow a physician assistant, in the absence of an employment or collaborative relationship under sub. (2) (a) 1., to provide medical care at the scene of an emergency, during a declared state of emergency or other disaster, or when volunteering at sporting events or at camps.

SB515,28,10 (6) The practice permissions provided in this section are permissions granted by the state authorizing the licensed practice of physician assistants. Nothing in this section prohibits an employer, hospital, health plan, or other similar entity employing or with a relationship with a licensed physician assistant from establishing additional requirements for a licensed physician assistant as a condition of employment or relationship.

SB515,28,12 461.11 Civil liability. No physician assistant shall be liable for any civil damages for either of the following:

SB515,28,16 (1) Reporting in good faith to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the physician assistant's judgment impairs the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB515,28,20 (2) In good faith, not reporting to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the physician assistant's judgment does not impair the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB515,28,24 461.12 Malpractice liability insurance. (1) Except as provided in subs. (2) and (3), no physician assistant may practice as authorized under s. 461.10 unless he or she has in effect malpractice liability insurance coverage evidenced by one of the following:

SB515,29,2 (a) Personal liability coverage in the amounts specified for health care providers under s. 655.23 (4).

SB515,29,4 (b) Coverage under a group liability policy providing individual coverage for the physician assistant in the amounts under s. 655.23 (4).

SB515,29,10 (2) The board may promulgate rules requiring a practicing physician assistant to have in effect malpractice liability insurance coverage in amounts greater than those specified in sub. (1) (a) or (b) or (4). If the board promulgates rules under this subsection, no physician assistant may practice as authorized under s. 461.10 unless he or she has in effect malpractice liability insurance coverage as required under those rules, except as provided in sub. (3).

SB515,29,14 (3) A physician assistant who is a state, county, or municipal employee, or federal employee or contractor covered under the federal tort claims act, as amended, and who is acting within the scope of his or her employment or contractual duties is not required to maintain in effect malpractice insurance coverage.

SB515,29,18 (4) Except as provided in subs. (2) and (3), a physician assistant may comply with sub. (1) if the physician assistant's employer has in effect malpractice liability insurance that is at least the minimum amount specified under s. 655.23 (4) and that provides coverage for claims against the physician assistant.

SB515,29,21 461.30 Professional discipline. (1) Subject to the rules promulgated under s. 440.03 (1), the board may conduct investigations and hearings to determine whether a person has violated this chapter or a rule promulgated under this chapter.

SB515,29,24 (2) Subject to the rules promulgated under s. 440.03 (1), if a person who applies for or holds a license issued under s. 461.07 does any of the following, the board may reprimand the person or deny, limit, suspend, or revoke the person's license:

SB515,30,2 (a) Makes a material misstatement in an application for a license or an application for renewal of a license under s. 461.07.

SB515,30,5 (b) Violates any law of this state or federal law that substantially relates to the practice of a physician assistant, violates this chapter, or violates a rule promulgated under this chapter.

SB515,30,6 (c) Advertises, practices, or attempts to practice under another person's name.

SB515,30,8 (d) Engages in unprofessional conduct. In this paragraph, “unprofessional conduct" does not include any of the following:

SB515,30,9 1. Providing expedited partner therapy as described in s. 461.035.

SB515,30,11 2. Prescribing or delivering an opioid antagonist in accordance with s. 461.037 (2).

SB515,30,13 (e) Subject to ss. 111.321, 111.322, and 111.335, is arrested for or convicted of a felony.

SB515,30,15 (f) Subject to ss. 111.321, 111.322, and 111.34, practices as a physician assistant while his or her ability is impaired by alcohol or other drugs.

SB515,30,16 (g) Engages in fraud or deceit in obtaining or using his or her license.

SB515,30,17 (h) Is adjudicated mentally incompetent by a court.

SB515,30,18 (i) Demonstrates gross negligence, incompetence, or misconduct in practice.

SB515,30,21 (j) Knowingly, recklessly, or negligently divulges a privileged communication or other confidential patient health care information except as required or permitted by state or federal law.

SB515,30,23 (k) Fails to cooperate with the board, or fails to timely respond to a request for information by the board, in connection with an investigation under this section.

SB515,30,25 (L) Prescribes, sells, administers, distributes, orders, or provides a controlled substance for a purpose other than a medical purpose.

SB515,31,2 (m) Demonstrates a lack of physical or mental ability to safely practice as a physician assistant.

SB515,31,4 (n) Engages in any practice that is outside the scope of his or her experience, education, or training.

SB515,31,6 (o) Is disciplined or has been disciplined by another state or jurisdiction based upon acts or conduct similar to acts or conduct prohibited under pars. (a) to (n).

SB515,31,15 461.40 Informed consent. Any physician assistant who treats a patient shall inform the patient about the availability of reasonable alternate medical modes of treatment and about the benefits and risks of these treatments. The reasonable physician assistant standard is the standard for informing a patient under this section. The reasonable physician assistant standard requires disclosure only of information that a reasonable physician assistant in the same or a similar medical specialty would know and disclose under the circumstances. The physician assistant's duty to inform the patient under this section does not require disclosure of any of the following:

SB515,31,17 (1) Detailed technical information that in all probability a patient would not understand.

SB515,31,18 (2) Risks apparent or known to the patient.

SB515,31,20 (3) Extremely remote possibilities that might falsely or detrimentally alarm the patient.

SB515,31,22 (4) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.

SB515,31,23 (5) Information in cases where the patient is incapable of consenting.

SB515,32,3 (6) Information about alternate medical modes of treatment for any condition the physician assistant has not included in his or her diagnosis at the time the physician informs the patient.

SB515,32,5 461.50 Penalties. Any person who violates this chapter is subject to a fine not to exceed $10,000 or imprisonment not to exceed 9 months, or both.

SB515,32,11 461.51 Injunction. If it appears upon complaint to the board by any person or if it is known to the board that any person is violating this subchapter, or rules adopted by the board under this subchapter, the board or the attorney general may investigate and may, in addition to any other remedies, bring action in the name and on behalf of the state against any such person to enjoin such person from such violation. The attorney general shall represent the board in all proceedings.

SB515,32,15 461.52 Duty to report. (1)  A physician assistant who has reason to believe any of the following about another physician assistant shall promptly submit a written report to the board that includes facts relating to the conduct of the other physician assistant:

SB515,32,17 (a) The other physician assistant is engaging or has engaged in acts that constitute a pattern of unprofessional conduct.

SB515,32,19 (b) The other physician assistant is engaging or has engaged in an act that creates an immediate or continuing danger to one or more patients or to the public.

SB515,32,20 (c) The other physician assistant is or may be medically incompetent.

SB515,32,22 (d) The other physician assistant is or may be mentally or physically unable safely to engage in the practice of a physician assistant.

SB515,32,25 (2) No physician assistant who reports to the board under sub. (1) may be held civilly or criminally liable or be found guilty of unprofessional conduct for reporting in good faith.

SB515,72 Section 72. 462.02 (2) (e) of the statutes is amended to read:

SB515,33,2 462.02 (2) (e) A physician assistant licensed under s. 448.04 (1) (f) 461.07.

SB515,73 Section 73. 462.04 of the statutes is amended to read:

SB515,33,11 462.04 Prescription or order required. A person who holds a license or limited X-ray machine operator permit under this chapter may not use diagnostic X-ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under s. 448.04 (1) (a), a dentist licensed under s. 447.04 (1), a podiatrist licensed under s. 448.63, a chiropractor licensed under s. 446.02, an advanced practice nurse certified under s. 441.16 (2), a physician assistant licensed under s. 448.04 (1) (f) 461.07, or, subject to s. 448.56 (7) (a), a physical therapist licensed under s. 448.53.

SB515,74 Section 74. 895.48 (1m) (a) (intro.) of the statutes is amended to read: