AB257: Bill Text

Malpractice liability insurance

The bill requires all APRNs to maintain malpractice liability insurance coverage evidenced by personal liability coverage in the amounts specified under current law for physicians and nurse anesthetists or coverage under a group liability policy providing individual coverage for the APRN in the amounts specified under current law for physicians and nurse anesthetists. Additionally, the bill requires APRNs who have qualified to practice independently and who practice outside a collaborative or employment relationship to participate in the Injured Patients and Families Compensation Fund. The Injured Patients and Families Compensation Fund provides excess medical malpractice coverage for health care providers who participate in the fund and meet all other participation requirements, which includes maintaining malpractice liability insurance in coverage amounts specified under current law.

OTHER CHANGES

The bill makes numerous other changes throughout the statutes relating to APRNs, including various terminology changes.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB257,1 Section 1. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:

AB257,4,6 29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one or both arms or one or both hands and fails to meet the minimum standards of any one of the following standard tests, administered under the direction of a licensed physician, a licensed physician assistant, a licensed chiropractor, or a certified licensed advanced practice registered nurse prescriber:

AB257,2 Section 2. 29.193 (2) (b) 2. of the statutes is amended to read:

AB257,5,4 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared and furnished by the department, which shall include a written statement or report prepared and signed by a licensed physician, a licensed physician assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice registered nurse prescriber prepared no more than 6 months preceding the application and verifying that the applicant is physically disabled.

AB257,3 Section 3. 29.193 (2) (c) 3. of the statutes is amended to read:

AB257,5,17 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the applicant and the recommendation of a licensed physician, a licensed physician assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice registered nurse prescriber selected by the applicant from a list of licensed physicians, licensed physician assistants, licensed chiropractors, licensed podiatrists, and certified licensed advanced practice nurse prescribers registered nurses compiled by the department, the department finds that issuance of a permit complies with the intent of this subsection. The use of this review procedure is discretionary with the department and all costs of the review procedure shall be paid by the applicant.

AB257,4 Section 4. 29.193 (2) (cd) 2. b. of the statutes is amended to read:

AB257,6,2 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function in one or both arms and fails to meet the minimum standards of the standard upper extremity pinch test, the standard grip test, or the standard nine-hole peg test, administered under the direction of a licensed physician, a licensed physician assistant, a licensed chiropractor, or a certified licensed advanced practice registered nurse prescriber.

AB257,5 Section 5. 29.193 (2) (cd) 2. c. of the statutes is amended to read:

AB257,6,8 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in one or both shoulders and fails to meet the minimum standards of the standard shoulder strength test, administered under the direction of a licensed physician, a licensed physician assistant, a licensed chiropractor, or a certified licensed advanced practice registered nurse prescriber.

AB257,6 Section 6. 29.193 (2) (e) of the statutes is amended to read:

AB257,6,19 29.193 (2) (e) Review of decisions. An applicant denied a permit under this subsection, except a permit under par. (c) 3., may obtain a review of that decision by a licensed physician, a licensed physician assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice registered nurse prescriber designated by the department and with an office located in the department district in which the applicant resides. The department shall pay for the cost of a review under this paragraph unless the denied application on its face fails to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is the only method of review of a decision to deny a permit under this subsection and is not subject to further review under ch. 227.

AB257,7 Section 7. 29.193 (3) (a) of the statutes is amended to read:

AB257,7,2 29.193 (3) (a) Produces a certificate from a licensed physician, a licensed physician assistant, a licensed optometrist, or a certified licensed advanced practice registered nurse prescriber stating that his or her sight is impaired to the degree that he or she cannot read ordinary newspaper print with or without corrective glasses.

AB257,8 Section 8. 45.40 (1g) (a) of the statutes is amended to read:

AB257,7,10 45.40 (1g) (a) “Health care provider” means an advanced practice registered nurse prescriber who is certified who may issue prescription orders under s. 441.16 441.09 (2), an audiologist who is licensed under subch. II of ch. 459 or who holds a compact privilege under subch. III of ch. 459, a dentist who is licensed under subch. I of ch. 447 or who holds a compact privilege under subch. II of ch. 447, an optometrist who is licensed under ch. 449, a physician who is licensed under s. 448.02, or a podiatrist who is licensed under s. 448.63.

AB257,9 Section 9. 46.03 (44) of the statutes is amended to read:

AB257,7,21 46.03 (44) Sexually transmitted disease treatment information. Prepare and keep current an information sheet to be distributed to a patient by a physician, a physician assistant, or certified an advanced practice registered nurse prescriber who may issue prescription orders under s. 441.09 (2) providing expedited partner therapy to that patient under s. 441.092, 448.035, or 448.9725. The information sheet shall include information about sexually transmitted diseases and their treatment and about the risk of drug allergies. The information sheet shall also include a statement advising a person with questions about the information to contact his or her physician, advanced practice registered nurse, pharmacist, or local health department, as defined in s. 250.01 (4).

AB257,10 Section 10. 50.01 (1b) of the statutes is repealed.

AB257,11 Section 11. 50.08 (2) of the statutes is amended to read:

AB257,8,4 50.08 (2) A physician, an advanced practice registered nurse prescriber certified who may issue prescription orders under s. 441.16 441.09 (2), or a physician assistant who prescribes a psychotropic medication to a nursing home resident who has degenerative brain disorder shall notify the nursing home if the prescribed medication has a boxed warning under 21 CFR 201.57.

AB257,12 Section 12. 50.09 (1) (a) (intro.) of the statutes is amended to read:

AB257,8,13 50.09 (1) (a) (intro.) Private and unrestricted communications with the resident’s family, physician, physician assistant, advanced practice registered nurse prescriber, attorney, and any other person, unless medically contraindicated as documented by the resident’s physician, physician assistant, or advanced practice registered nurse prescriber in the resident’s medical record, except that communications with public officials or with the resident’s attorney shall not be restricted in any event. The right to private and unrestricted communications shall include, but is not limited to, the right to:

AB257,13 Section 13. 50.09 (1) (f) 1. of the statutes is amended to read:

AB257,8,20 50.09 (1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses or both domestic partners under ch. 770 are residents of the same facility, the spouses or domestic partners shall be permitted to share a room unless medically contraindicated as documented by the resident’s physician, physician assistant, or advanced practice registered nurse prescriber in the resident’s medical record.

AB257,14 Section 14. 50.09 (1) (h) of the statutes is amended to read:

AB257,9,2 50.09 (1) (h) Meet with, and participate in activities of social, religious, and community groups at the resident’s discretion, unless medically contraindicated as documented by the resident’s physician, physician assistant, or advanced practice registered nurse prescriber in the resident’s medical record.

AB257,15 Section 15. 50.09 (1) (k) of the statutes is amended to read:

AB257,9,15 50.09 (1) (k) Be free from mental and physical abuse, and be free from chemical and physical restraints except as authorized in writing by a physician, physician assistant, or advanced practice registered nurse prescriber for a specified and limited period of time and documented in the resident’s medical record. Physical restraints may be used in an emergency when necessary to protect the resident from injury to himself or herself or others or to property. However, authorization for continuing use of the physical restraints shall be secured from a physician, physician assistant, or advanced practice registered nurse prescriber within 12 hours. Any use of physical restraints shall be noted in the resident’s medical records. “Physical restraints” includes, but is not limited to, any article, device, or garment that interferes with the free movement of the resident and that the resident is unable to remove easily, and confinement in a locked room.

AB257,16 Section 16. 50.49 (1) (b) (intro.) of the statutes is amended to read:

AB257,9,23 50.49 (1) (b) (intro.) “Home health services” means the following items and services that are furnished to an individual, who is under the care of a physician, physician assistant, or advanced practice registered nurse prescriber, by a home health agency, or by others under arrangements made by the home health agency, that are under a plan for furnishing those items and services to the individual that is established and periodically reviewed by a physician, physician assistant, or advanced practice registered nurse prescriber and that are, except as provided in subd. 6., provided on a visiting basis in a place of residence used as the individual’s home:

AB257,17 Section 17. 51.41 (1d) (b) 4. of the statutes is amended to read:

AB257,10,13 51.41 (1d) (b) 4. A psychiatric mental health advanced practice registered nurse who is suggested by the Milwaukee County board of supervisors. The Milwaukee County board of supervisors shall solicit suggestions from organizations including the Wisconsin Nurses Association for individuals who specialize in a full continuum of behavioral health and medical services including emergency detention, inpatient, residential, transitional, partial hospitalization, intensive outpatient, and wraparound community-based services. The Milwaukee County board of supervisors shall suggest to the Milwaukee County executive 4 psychiatric mental health advanced practice registered nurses for this board membership position.

AB257,18 Section 18. 70.47 (8) (intro.) of the statutes is amended to read:

AB257,11,4 70.47 (8) Hearing. (intro.) The board shall hear upon oath all persons who appear before it in relation to the assessment. Instead of appearing in person at the hearing, the board may allow the property owner, or the property owner’s representative, at the request of either person, to appear before the board, under oath, by telephone or to submit written statements, under oath, to the board. The board shall hear upon oath, by telephone, all ill or disabled persons who present to the board a letter from a physician, physician assistant, or advanced practice registered nurse prescriber certified under s. 441.16 (2) licensed under ch. 441 that confirms their illness or disability. At the request of the property owner or the property owner’s representative, the board may postpone and reschedule a hearing under this subsection, but may not postpone and reschedule a hearing more than once during the same session for the same property. The board at such hearing shall proceed as follows:

AB257,19 Section 19. 77.54 (14) (f) 3. of the statutes is repealed.

AB257,20 Section 20. 77.54 (14) (f) 4. of the statutes is amended to read:

AB257,11,8 77.54 (14) (f) 4. An advanced practice registered nurse who may issue prescription orders under s. 441.09 (2).

AB257,21 Section 21. 97.59 of the statutes is amended to read:

AB257,11,23 97.59 Handling foods. No person in charge of any public eating place or other establishment where food products to be consumed by others are handled may knowingly employ any person handling food products who has a disease in a form that is communicable by food handling. If required by the local health officer or any officer of the department for the purposes of an investigation, any person who is employed in the handling of foods or is suspected of having a disease in a form that is communicable by food handling shall submit to an examination by the officer or by a physician, physician assistant, or advanced practice registered nurse prescriber designated by the officer. The expense of the examination, if any, shall be paid by the person examined. Any person knowingly infected with a disease in a form that is communicable by food handling who handles food products to be consumed by others and any persons knowingly employing or permitting such a person to handle food products to be consumed by others shall be punished as provided by s. 97.72.

AB257,22 Section 22. 106.30 (1) of the statutes is amended to read:

AB257,12,6 106.30 (1) Definition. In this section, “nurse” means a registered nurse licensed under s. 441.06 or permitted under s. 441.08, a licensed practical nurse licensed or permitted under s. 441.10, or an advanced practice registered nurse prescriber certified under s. 441.16 (2), or a nurse-midwife licensed under s. 441.15 441.09.

AB257,23 Section 23. 118.15 (3) (a) of the statutes is amended to read:

AB257,12,19 118.15 (3) (a) Any child who is excused by the school board because the child is temporarily not in proper physical or mental condition to attend a school program but who can be expected to return to a school program upon termination or abatement of the illness or condition. The school attendance officer may request the parent or guardian of the child to obtain a written statement from a licensed physician, naturopathic doctor, dentist, chiropractor, optometrist, psychologist, physician assistant, or nurse practitioner, as defined in s. 255.06 (1) (d), or certified advanced practice registered nurse prescriber, or registered nurse described under s. 255.06 (1) (f) 1. or Christian Science practitioner living and residing in this state, who is listed in the Christian Science Journal, as sufficient proof of the physical or mental condition of the child. An excuse under this paragraph shall be in writing and shall state the time period for which it is valid, not to exceed 30 days.

AB257,24 Section 24. 118.25 (1) (a) of the statutes is amended to read:

AB257,13,2 118.25 (1) (a) “Practitioner” means a person licensed as a physician, naturopathic doctor, or physician assistant in any state or licensed as an advanced practice registered nurse or certified as an advanced practice registered nurse prescriber in any state. In this paragraph, “physician” has the meaning given in s. 448.01 (5).

AB257,25 Section 25. 118.29 (1) (e) of the statutes is amended to read:

AB257,13,6 118.29 (1) (e) “Practitioner” means any physician, naturopathic doctor, dentist, optometrist, physician assistant, advanced practice registered nurse prescriber with prescribing authority, or podiatrist licensed in any state.

AB257,26 Section 26. 118.2915 (1) (a) of the statutes is repealed and recreated to read:

AB257,13,9 118.2915 (1) (a) “Advanced practice registered nurse” means an individual licensed under s. 441.09 who may issue prescription orders under s. 441.09 (2).

AB257,27 Section 27. 118.2915 (2) (a) of the statutes is amended to read:

AB257,13,17 118.2915 (2) (a) The governing body of a school may adopt a plan for the management of pupils attending the school who have asthma. If the governing body of a school adopts a plan under this paragraph, it shall specify in the plan the training necessary to perform the activities under sub. (4). The governing body of a school may not adopt a plan under this paragraph unless the plan has been approved by a physician, an advanced practice registered nurse prescriber, or a physician assistant.

AB257,28 Section 28. 118.2915 (3) (a) of the statutes is amended to read:

AB257,13,23 118.2915 (3) (a) A physician, an advanced practice registered nurse prescriber, or a physician assistant may provide a prescription or standing order for a short-acting bronchodilator or components in the name of a school that has adopted a plan under sub. (2) (a) to be maintained by the school for use under sub. (4).

AB257,29 Section 29. 118.2915 (4) (c) of the statutes is amended to read:

AB257,14,6 118.2915 (4) (c) In accordance with a prescription or standing order from a physician, an advanced practice registered nurse prescriber, or a physician assistant, administer a short-acting bronchodilator to a pupil or other person who the school nurse or designated school personnel believes in good faith is experiencing respiratory distress, regardless of whether the pupil or other person has a prescription for a short-acting bronchodilator.

AB257,30 Section 30. 118.2915 (6) (a) (intro.) of the statutes is amended to read:

AB257,14,13 118.2915 (6) (a) (intro.) None of the following are liable for any injury that results from the administration or self-administration of a short-acting bronchodilator under this section, regardless of whether authorization was given by the pupil’s parent or guardian or by the pupil’s physician, physician assistant, or advanced practice registered nurse prescriber, unless the injury is the result of an act or omission that constitutes gross negligence or willful or wanton misconduct:

AB257,31 Section 31. 118.2915 (6) (a) 2. of the statutes is amended to read:

AB257,14,17 118.2915 (6) (a) 2. A physician, advanced practice registered nurse prescriber, or physician assistant who provides a prescription or standing order for a short- acting bronchodilator or components to a school under sub. (3) (a).

AB257,32 Section 32. 118.2915 (6) (a) 3. of the statutes is amended to read:

AB257,14,22 118.2915 (6) (a) 3. A physician, advanced practice registered nurse prescriber, physician assistant, or pharmacist who dispenses a short-acting bronchodilator or components to a school in accordance with a prescription or standing order under sub. (3) (a).

AB257,33 Section 33. 118.2925 (1) (b) of the statutes is repealed.

AB257,34 Section 34. 118.2925 (3) of the statutes is amended to read:

AB257,15,5 118.2925 (3) Prescriptions for schools. A physician, an advanced practice registered nurse prescriber who may issue prescription orders under s. 441.09 (2), or a physician assistant may prescribe epinephrine delivery systems in the name of a school that has adopted a plan under sub. (2) (a), to be maintained by the school for use under sub. (4).

AB257,35 Section 35. 118.2925 (4) (c) of the statutes is amended to read:

AB257,15,19 118.2925 (4) (c) Administer an epinephrine delivery system to a pupil or other person who the school nurse or designated school personnel in good faith believes is experiencing anaphylaxis in accordance with a standing protocol from a physician, an advanced practice registered nurse prescriber who may issue prescription orders under s. 441.09 (2), or a physician assistant, regardless of whether the pupil or other person has a prescription for an epinephrine delivery system. If the pupil or other person does not have a prescription for an epinephrine delivery system, or the person who administers the epinephrine delivery system does not know whether the pupil or other person has a prescription for an epinephrine delivery system, the person who administers the epinephrine delivery system shall, as soon as practicable, report the administration by dialing the telephone number “911” or, in an area in which the telephone number “911” is not available, the telephone number for an emergency medical service provider.

AB257,36 Section 36. 118.2925 (5) of the statutes is amended to read:

AB257,16,8 118.2925 (5) Immunity from civil liability; exemption from practice of medicine. A school and its designated school personnel, and a physician, an advanced practice registered nurse prescriber who may issue prescription orders under s. 441.09 (2), or a physician assistant who provides a prescription or standing protocol for school epinephrine delivery systems, are not liable for any injury that results from the administration or self-administration of an epinephrine delivery system under this section, regardless of whether authorization was given by the pupil’s parent or guardian or by the pupil’s physician, physician assistant, or advanced practice registered nurse prescriber, unless the injury is the result of an act or omission that constitutes gross negligence or willful or wanton misconduct. The immunity from liability provided under this subsection is in addition to and not in lieu of that provided under s. 895.48.

AB257,37 Section 37. 118.294 (1) (a) of the statutes is repealed.

AB257,38 Section 38. 118.294 (1) (am) of the statutes is amended to read:

AB257,16,13 118.294 (1) (am) “Advanced practice registered nurse” has the meaning given in s. 154.01 (1g) means an individual licensed under s. 441.09 who may issue prescription orders under s. 441.09 (2).

AB257,39 Section 39. 118.294 (2) of the statutes is amended to read:

AB257,16,18 118.294 (2) Prescriptions for schools. A physician, an advanced practice registered nurse prescriber, or a physician assistant may prescribe undesignated glucagon in the name of a school to be maintained by the school for use under sub. (3).

AB257,40 Section 40. 118.294 (4) (a) of the statutes is amended to read:

AB257,17,4 118.294 (4) (a) A school and its school personnel, and a physician, an advanced practice registered nurse prescriber, or a physician assistant who provides a prescription or standing order for undesignated glucagon are not liable for any injury that results from the administration of undesignated glucagon under this section, regardless of whether authorization was given by the pupil’s parent or guardian or by the pupil’s diabetes provider, unless the injury is the result of an act or omission that constitutes gross negligence or willful or wanton misconduct. The immunity from liability provided under this paragraph is in addition to and not in lieu of that provided under s. 895.48.

AB257,41 Section 41. 146.615 (1) (a) of the statutes is amended to read:

AB257,17,9 146.615 (1) (a) “Advanced practice clinician” means a physician assistant or an advanced practice registered nurse, including a nurse practitioner, certified nurse-midwife, clinical nurse specialist, or certified registered nurse anesthetist licensed under s. 441.09.

AB257,42 Section 42. 146.82 (3) (a) of the statutes is amended to read:

AB257,17,19 146.82 (3) (a) Notwithstanding sub. (1), a physician, a naturopathic doctor, a limited-scope naturopathic doctor, a physician assistant, or an advanced practice registered nurse prescriber certified under s. 441.16 (2) licensed under s. 441.09 who treats a patient whose physical or mental condition in the physician’s, naturopathic doctor’s, limited-scope naturopathic doctor’s, physician assistant’s, or advanced practice nurse prescriber’s registered nurse’s judgment affects the patient’s ability to exercise reasonable and ordinary control over a motor vehicle may report the patient’s name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

AB257,43 Section 43. 146.89 (1) (r) 1. of the statutes is amended to read: