AB356: Bill Text

Delegations by chiropractors

Under current law, a chiropractor licensed by the Chiropractic Examining Board is allowed to delegate services that are adjunctive to the practice of chiropractic to individuals who are not licensed by the Chiropractic Examining Board, but only if the services are performed under the direct, on-premises supervision of the chiropractor. In addition, current law prohibits a chiropractor from delegating to individuals not licensed by the Chiropractic Examining Board the making of a diagnosis, the performance of a chiropractic adjustment, the analysis of a diagnostic test or clinical information, or any practice or service that the Chiropractic Examining Board specifies in rules.

This bill creates an exception to the prohibition described above. Under the bill, a chiropractor may delegate to a physician assistant licensed by the Medical Examining Board the making of a diagnosis, the analysis of a diagnostic test or clinical information, or any practice or service that the Chiropractic Examining Board specifies in rules. However, a chiropractor may not delegate the performance of a chiropractic adjustment to a physician assistant. Also, a delegation may not exceed the chiropractor's scope of practice or the education, training, or experience of the physician assistant. A delegation to a physician assistant allowed under the bill does not have to be under the direct, on-premises supervision of a chiropractor.

The bill also requires a chiropractor who applies to renew his or her license to identify each employee to whom clinical work is delegated, except that the following do not have to be identified: nurses, physician assistants, physical therapists, and athletic trainers. In addition, if the Chiropractic Examining Board has promulgated rules that require an employee who is required to be identified to complete a training program or course of instruction to perform the delegated work, the chiropractor must also provide in his or her application for renewal the name, date, and sponsoring organization for the training program or course of instruction that the employee completed.

Finally, the bill changes the definitions of "practical nursing" and "professional nursing" to include actions taken under the supervision or direction of a chiropractor, in addition to actions taken under the supervision or direction of other health care professionals that are specified under current law.

Continuing education

Under current law, a chiropractor licensed by the Chiropractic Examining Board must complete any continuing education that the board requires in order to renew his or her license, which must be renewed every two years. This bill creates additional requirements regarding continuing education.

Under the bill, the Chiropractic Examining Board must establish the minimum number of hours of continuing education courses that must be completed during the two-year licensure period. As under current law, a chiropractor does not have to begin complying with continuing education requirements under the bill until the first two-year licensure period beginning after he or she initially receives his or her license.

Also under the bill, only courses that are approved by the Chiropractic Examining Board may be used to satisfy the minimum hours required. The Chiropractic Examining Board may only approve a course if the organization that sponsors the course (sponsoring organization) satisfies certain requirements. The sponsoring organization must be the Wisconsin, American, or International Chiropractic Association, or an approved chiropractic, medical, or osteopathic college or university. Also, the sponsoring organization must carry out specified duties, including selecting the course instructor, preparing course materials, evaluating the course, maintaining transcripts, performing financial administration, proctoring attendance, providing attendance vouchers, and supplying a list of attendees to the Chiropractic Examining Board. The sponsoring organization is also allowed to delegate these duties to another organization. The Chiropractic Examining Board must withdraw or withhold approval from a sponsoring organization for a two-year period if the sponsoring organization fails to carry out any of the duties, or if an organization to which a duty is delegated fails to carry out any of the duties.

The bill requires the Chiropractic Examining Board periodically to publish an updated list of approved courses. A chiropractor who applies to renew his or her license must identify the courses used to satisfy the minimum hour requirement on a form provided by the Department of Regulation and Licensing. The bill requires the Department of Regulation and Licensing to audit a percentage, as determined by the department, of the renewal applications received during each two-year licensure period to determine whether an applicant has attended the courses that he or she identifies on the form.

Finally, the bill allows the Chiropractic Examining Board to take disciplinary action against a licensed chiropractor who violates any state law or rule regulating chiropractors, including the continuing education requirements.

Nutritional guidance

This bill requires certain chiropractors licensed by the Chiropractic Examining Board to complete a postgraduate course of study in nutrition before they may provide counsel, guidance, direction, advice, or recommendations to patients regarding the health benefits of vitamins, herbs, or nutritional supplements. However, the requirement applies only to chiropractors who were granted licenses on or before January 1, 2003. In addition, the requirement does not apply to chiropractors who are also certified as dietitians by the Dietitians Affiliated Credentialing Board. The required course of study must consist of 48 hours and must be approved by the Chiropractic Examining Board.

Statutory references to physicians and chiropractors

Under current law, if the term "physician" is used in the statutes, it means a physician licensed by the Medical Examining Board, except if that meaning is inconsistent with the legislature's manifest intent. Also, under current law, if "chiropractor" is used in the statutes, it means a chiropractor licensed by the Chiropractic Examining Board, with the same exception regarding legislative intent.

Under this bill, if the term "physician" is used in the statutes, it means either a physician licensed by the Medical Examining Board or a chiropractor licensed by the Chiropractic Examining Board, with the same exception under current law regarding legislative intent. As a result, the following provisions that refer to a "physician" under current law are changed under the bill to refer to either a physician licensed by the Medical Examining Board or a chiropractor licensed by the Chiropractic Examining Board:

1. Certifications, reports, or other requirements regarding handicap, disability, illness, physical fitness, or other physical condition that are related to class B hunting permits, testimony by telephone at tax dispute hearings conducted by a board of review, releases of land from farmland preservation agreements, polygraph testing by employers, verification of illness of striking municipal workers, duty of hospitals to provide emergency treatment, notification of the Department of Transportation about a patient's ability to drive, and participation in a property tax loan program administered by the Wisconsin Housing and Economic Development Authority, and driver's instructor licenses.

2. Certifications, reports, or examinations regarding handicap, disability, or other physical condition required for participation in a program for state agencies to make procurements from work centers for the severely physically handicapped, disability annuities administered by the Employee Trust Funds Board, eligibility of veterans for public employment, and exemptions of unemployed persons from certain supervision fees otherwise required by the Department of Corrections.

3. Appointments to the Private Employer Health Coverage Board in the Department of Employee Trust Funds.

4. Privacy requirements for medical communications regarding residents of nursing homes and community-based residential facilities and for releases of information by the Department of Health and Family Services, and requirements regarding the release of employee medical records by employers.

5. Reports required for accidents involving all-terrain vehicles and snowmobiles and investigations of snowmobile accidents by the Department of Natural Resources.

6. Requirements for drawing blood for testing persons arrested for intoxicated operation of motor vehicles, all-terrain vehicles, snowmobiles, or boats.

7. Physical examinations required for civil service employees of first class cities, for participation in the Wisconsin service and conservation corps programs, and for certain school employees and statements about job applicants obtained by the Division of Merit Recruitment and Selection of the Department of Employment Relations.

8. Access to physical examinations and medical evidence in personal injury actions.

9. Requirements for participating in the Volunteer Health Care Provider program administered by the Department of Health and Family Services.

10. Eligibility of nonprofit hospitals for property tax exemption regarding certain health and fitness centers.

11. Reduced railroad rates allowed for physicians.

12. Exception to immunity from civil liability for emergency care that applies to care provided in a physician's office.

Finally, the bill specifies that other references to a "physician" under current law mean a physician licensed by the Medical Examining Board. As a result, the bill does not change the meaning of those references under current law.

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:

AB356, s. 1 Section 1. 15.165 (5) (a) 7. of the statutes is amended to read:

AB356,7,2 15.165 (5) (a) 7. One member who is a physician, as defined in s. 448.01 (5).

AB356, s. 2 Section 2. 15.197 (25) (a) 1. of the statutes is amended to read:

AB356,7,5 15.197 (25) (a) 1. Four physicians, as defined in s. 448.01 (5), who represent urban and rural areas.

AB356, s. 3 Section 3. 15.405 (7m) of the statutes is amended to read:

AB356,8,8 15.405 (7m) Nursing home administrator examining board. There is created a nursing home administrator examining board in the department of regulation and licensing consisting of 9 members appointed for staggered 4-year terms and the secretary of health and family services or a designee, who shall serve as a nonvoting member. Five members shall be nursing home administrators licensed in this state. One member shall be a physician as defined in s. 448.01 (5). One member shall be a nurse licensed under ch. 441. Two members shall be public members. No more than 2 members may be officials or full-time employees of this state.

AB356, s. 4 Section 4. 15.407 (1m) of the statutes is amended to read:

AB356,8,21 15.407 (1m) Respiratory care practitioners examining council. There is created a respiratory care practitioners examining council in the department of regulation and licensing and serving the medical examining board in an advisory capacity in the formulating of rules to be promulgated by the medical examining board for the regulation of respiratory care practitioners. The respiratory care practitioners examining council shall consist of 3 certified respiratory care practitioners, each of whom shall have engaged in the practice of respiratory care for at least 3 years preceding appointment, one physician, as defined in s. 448.01 (5), and one public member. The respiratory care practitioner and physician members shall be appointed by the medical examining board. The members of the examining council shall serve 3-year terms. Section 15.08 (1) to (4) (a) and (6) to (10) shall apply to the respiratory care practitioners examining council.

AB356, s. 5 Section 5. 15.915 (2) (b) of the statutes is amended to read:

AB356,9,4 15.915 (2) (b) A representative of local health departments who is not an employee of the department of health and family services, one physician , as defined in s. 448.01 (5), representing clinical laboratories, one member representing private environmental testing laboratories, one member representing occupational health laboratories and 3 additional members, one of whom shall be a medical examiner or coroner, appointed for 3-year terms. No member appointed under this paragraph may be an employee of the laboratory of hygiene.

AB356, s. 6 Section 6. 16.009 (1) (h) of the statutes is repealed.

AB356, s. 7 Section 7. 20.927 (1m) of the statutes is amended to read:

AB356,9,12 20.927 (1m) Except as provided under subs. (2) and (3), no funds of this state or of any county, city, village, town or family care district under s. 46.2895 or of any subdivision or agency of this state or of any county, city, village or town and no federal funds passing through the state treasury shall be authorized for or paid to a physician, as defined in s. 448.01 (5), or surgeon or a hospital, clinic or other medical facility for the performance of an abortion.

AB356, s. 8 Section 8. 29.193 (3) (a) of the statutes is amended to read:

AB356,9,16 29.193 (3) (a) Produces a certificate from a licensed physician, as defined in s. 448.01 (5), or optometrist 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.

AB356, s. 9 Section 9. 30.67 (6) (b) of the statutes is amended to read:

AB356,9,25 30.67 (6) (b) In cases of death involving a boat in which the person died within 6 hours of the time of the accident, a blood specimen of at least 10 cc. shall be withdrawn from the body of the decedent within 12 hours after his or her death, by the coroner or medical examiner or by a physician, as defined in s. 448.01 (5), so designated by the coroner or medical examiner or by a qualified person at the direction of the physician. All morticians shall obtain a release from the coroner or medical examiner prior to proceeding with embalming any body coming under the scope of this section. The blood so drawn shall be forwarded to a laboratory approved by the state health officer for analysis of the alcoholic content of the blood specimen. The coroner or medical examiner causing the blood to be withdrawn shall be notified of the results of each analysis made and shall forward the results of each analysis to the state health officer. The state health officer shall keep a record of all examinations to be used for statistical purposes only. The cumulative results of the examinations, without identifying the individuals involved, shall be disseminated and made public by the state health officer. The department shall reimburse coroners and medical examiners for the costs incurred in submitting reports and taking blood specimens and laboratories for the costs incurred in analyzing blood specimens under this section.

AB356, s. 10 Section 10. 36.25 (11) (b) of the statutes is amended to read:

AB356,10,18 36.25 (11) (b) The laboratory shall provide complete laboratory services in the areas of water quality, air quality, public health and contagious diseases for appropriate state agencies, and may perform examinations for licensed physicians, as defined in s. 448.01 (5), veterinarians, local health officers, as defined in s. 250.01 (5), and resource management officials as may be necessary for the prevention and control of those diseases and environmental hazards which cause concern for public health and environmental quality.

AB356, s. 11 Section 11. 36.25 (13g) (b) 2. of the statutes is amended to read:

AB356,10,22 36.25 (13g) (b) 2. Providing an environment suitable for instructing medical and other health professions students, physicians, as defined in s. 448.01 (5), nurses and members of other health-related disciplines.

AB356, s. 12 Section 12. 39.16 (2) (d) of the statutes is amended to read:

AB356,11,2 39.16 (2) (d) Encourage the development of continuing education programs for practicing physicians, as defined in s. 448.01 (5), in this state, including communication links with outlying regions of the state that would allow practitioners to have access to their medical schools.

AB356, s. 13 Section 13. 46.18 (10) of the statutes is amended to read:

AB356,11,10 46.18 (10) Annual report. On July 1 of each year the trustees shall prepare a report for the preceding fiscal year and shall transmit a copy to the department of health and family services and a copy to the county clerk, and keep a copy on file at the institution. The report shall be accompanied by an inventory of all properties on hand on the last day of the fiscal year, an estimate of the receipts and expenditures for the current fiscal year, and the reports of the superintendent and visiting physician, as defined in s. 448.01 (5), of the institution.

AB356, s. 14 Section 14. 46.19 (4) of the statutes is amended to read:

AB356,11,14 46.19 (4) The salaries of the superintendent, visiting physician, as defined in s. 448.01 (5), and all necessary additional officers and employees shall be fixed by the county board.

AB356, s. 15 Section 15. 46.21 (2) (m) of the statutes is amended to read:

AB356,12,13 46.21 (2) (m) May establish and maintain in connection with such county hospital, an emergency unit or department for the treatment, subject to such rules as may be prescribed by the county board of supervisors, of persons in the county who may meet with accidents or be suddenly afflicted with illness not contagious; provided that medical care and treatment shall only be furnished in such unit or department until such time as the patient may be safely removed to another hospital or to his or her place of abode, or regularly admitted to the county hospital. The county board of supervisors may also contract with any private hospital or nonprofit hospital within the county for the use of its facilities and for medical service to be furnished by a licensed physician, or physicians, as defined in s. 448.01 (5), to patients who require emergency medical treatment or first aid as a result of any accident, injury or sudden affliction of illness occurring within the county, except that reasonable compensation may only be authorized until the patient is regularly admitted as an inpatient or safely removed to another hospital or to his place of abode. In this paragraph, "hospital" includes, without limitation due to enumeration, public health centers, medical facilities and general, tuberculosis, mental, chronic disease and other types of hospitals and related facilities, such as laboratories, outpatient departments, nurses' home and training facilities, and central service facilities operated in connection with hospitals. In this paragraph, "hospital" does not include any hospital furnishing primarily domiciliary care. In this paragraph "nonprofit hospital" means any hospital owned and operated by a corporation or association, no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual.

AB356, s. 16 Section 16. 46.21 (4m) (a) of the statutes is amended to read:

AB356,12,21 46.21 (4m) (a) The county hospitals and county sanatoriums of a county with a population of 500,000 or more shall be devoted to hospital service and the treatment of patients upon such terms and conditions as the county board of supervisors establishes. The hospitals and sanatoriums may be utilized for instruction of medical students, physicians, as defined in s. 448.01 (5), and nurses and for scientific and clinical research that will promote the welfare of the patients and assist the application of science to the alleviation of human suffering.

AB356, s. 17 Section 17. 46.245 of the statutes is amended to read:

AB356,13,7 46.245 Information for certain pregnant women. Upon request, a county department under s. 46.215, 46.22 or 46.23 shall distribute the materials described under s. 253.10 (3) (d), as prepared and distributed by the department. A physician, as defined in s. 448.01 (5), who intends to perform or induce an abortion or another qualified physician, as defined in s. 253.10 (2) (g), who reasonably believes that he or she might have a patient for whom the information under s. 253.10 (3) (d) is required to be given, shall request a reasonably adequate number of the materials from the county department under this section or from the department under s. 253.10 (3) (d). An individual may request a reasonably adequate number of the materials.

AB356, s. 18 Section 18. 46.27 (1) (bg) of the statutes is created to read:

AB356,13,9 46.27 (1) (bg) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 19 Section 19. 46.297 (2) (a) of the statutes is amended to read:

AB356,13,13 46.297 (2) (a) The person is certified as deaf or severely hearing impaired by a physician, as defined in s. 448.01 (5), an audiologist licensed under subch. II of ch. 459, or the department.

AB356, s. 20 Section 20. 46.298 of the statutes is amended to read:

AB356,13,24 46.298 Vehicle sticker for the hearing impaired. Upon the request of a person who is certified as hearing impaired by the department, by a physician, as defined in s. 448.01 (5), by a hearing instrument specialist licensed under subch. I of ch. 459 or by an audiologist licensed under subch. II of ch. 459, the department shall issue to the person a decal or sticker for display on a motor vehicle owned or frequently operated by the person to apprise law enforcement officers of the fact that the vehicle is owned or operated by a hearing-impaired person. No charge shall be made for issuance of the decal or sticker. The department shall specify the design of the decal or sticker. The department shall designate the location on the vehicle at which the decal or sticker shall be affixed by its own adhesive.

AB356, s. 21 Section 21. 46.56 (3) (b) 3. of the statutes is amended to read:

AB356,14,2 46.56 (3) (b) 3. Physicians, as defined in s. 448.01 (5), specializing in care for children.

AB356, s. 22 Section 22. 46.87 (5) (a) 1. of the statutes is amended to read:

AB356,14,6 46.87 (5) (a) 1. At least one member of the household must be a person who has been diagnosed by a physician, as defined in s. 448.01 (5), as having Alzheimer's disease.

AB356, s. 23 Section 23. 48.02 (14k) of the statutes is created to read:

AB356,14,8 48.02 (14k) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 24 Section 24. 49.148 (1m) (b) of the statutes is amended to read:

AB356,14,19 49.148 (1m) (b) Receipt of a grant under this subsection constitutes participation in a Wisconsin works employment position for purposes of the time limits under ss. 49.145 (2) (n) and 49.147 (3) (c), (4) (b) or (5) (b) 2. if the child is born to the participant more than 10 months after the date that the participant was first determined to be eligible for assistance under s. 49.19 or for a Wisconsin works employment position unless the child was conceived as a result of a sexual assault in violation of s. 940.225 (1), (2) or (3) in which the mother did not indicate a freely given agreement to have sexual intercourse or of incest in violation of s. 944.06 or 948.06 and that incest or sexual assault has been reported to a physician, as defined in s. 448.01 (5), and to law enforcement authorities.

AB356, s. 25 Section 25. 49.19 (11s) (b) 2. of the statutes is amended to read:

AB356,14,25 49.19 (11s) (b) 2. The child was conceived as a result of a sexual assault in violation of s. 940.225 (1), (2) or (3) in which the mother did not indicate a freely given agreement to have sexual intercourse or of incest in violation of s. 944.06 or 948.06 and that incest or sexual assault has been reported to a physician , as defined in s. 448.01 (5), and to law enforcement authorities.

AB356, s. 26 Section 26. 49.26 (1) (g) 11. of the statutes is amended to read:

AB356,15,4 49.26 (1) (g) 11. If the individual is the mother of a child, a physician, as defined in s. 448.01 (5), has not determined that the individual should delay her return to school after giving birth.

AB356, s. 27 Section 27. 49.43 (9) of the statutes is amended to read:

AB356,15,8 49.43 (9) "Physician" means a person licensed to practice medicine and surgery, and includes graduates of osteopathic colleges holding an unlimited license to practice medicine and surgery has the meaning given in s. 448.01 (5).

AB356, s. 28 Section 28. 50.01 (4p) of the statutes is created to read:

AB356,15,10 50.01 (4p) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 29 Section 29. 50.09 (1) (a) (intro.) of the statutes is amended to read:

AB356,15,17 50.09 (1) (a) (intro.) Private and unrestricted communications with the resident's family, physician, chiropractor, attorney and any other person, unless medically contraindicated as documented by the resident's physician or chiropractor 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: