August 20, 2003 - Introduced by Senators Cowles, Schultz, Erpenbach, Robson
and Risser, cosponsored by Representatives Underheim, Krawczyk, Ott,
Nass, Seratti, Hahn, Sherman, Grothman, Coggs, Staskunas, J. Lehman,
Gunderson and Albers. Referred to Committee on Health, Children,
Families, Aging and Long Term Care.
SB232,1,11
1An Act to amend 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k),
250.49 (1) (b) (intro.), 70.47 (8) (intro.), 146.82 (3) (a), 252.07 (8) (a) 2., 252.07 (9)
3(c), 252.11 (1m), 252.11 (2), 252.11 (4), 252.11 (5), 252.11 (7), 252.11 (10), 252.12
4(2) (a) 3. (intro.), 252.15 (2) (a) 7. ak., 252.15 (5) (a) 11., 252.15 (5) (a) 12. b.,
5252.15 (5) (a) 14., 252.15 (5m) (a), 252.15 (5m) (b), 252.15 (5m) (c), 252.15 (7m)
6(intro.), 252.15 (7m) (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 252.18,
7252.23 (5), 252.24 (5), 343.16 (5) (a), 441.06 (title), 448.56 (1), 448.56 (1m) (b),
8448.67 (2), 450.01 (16) (h), 450.11 (7) (b) and 450.13 (5); and
to create 50.01 (1)
9(bm), 252.01 (1c), 441.06 (7), 450.01 (1m) and 450.11 (8) (e) of the statutes;
10relating to: authorizing medically related actions by advanced practice nurse
11prescribers.
Analysis by the Legislative Reference Bureau
Under current law, the Nursing Board grants certificates to issue prescription
orders to advanced practice nurses (advanced practice nurse prescribers) who meet
education, training, and examination requirements of the Nursing Board.
Numerous provisions under current law authorize physicians or other health
care professionals to act under specified circumstances and to affect individuals by
these authorized actions, including all of the following:
1. Unless medically contraindicated as documented by a nursing home or
community-based residential facility resident's physician in the resident's medical
record, the resident has the right to private and unrestricted communications with
his or her family, physician, attorney, and others; to share a room with his or her
spouse if the spouse is also a resident; to participate in activities of social, religious,
and community groups; and to be free from chemical and physical restraints.
2. Home health services that are provided to an individual by a home health
agency must be those specified under a plan for furnishing the services that is
established and periodically reviewed by a physician.
3. For hearings before the local board of review concerning assessments of
property taxes, an ill or disabled person who presents to the board a letter from a
physician or osteopath confirming the illness or disability may present testimony by
telephone.
4. Under laws relating to confidentiality of patient health care records, a
physician who treats a patient whose physical or mental condition, in the physician's
judgment, affects his or her ability to exercise reasonable and ordinary control over
a motor vehicle may, without the patient's informed consent, report the patient's
name and other information to the Department of Transportation. Physicians are
exempted from civil liability for reporting, or not reporting, this information in good
faith.
5. Under laws relating to communicable diseases:
a. The Department of Health and Family Services (DHFS) may order an
individual who has a confirmed diagnosis of infectious tuberculosis or symptoms
indicative of tuberculosis confined to a facility if several conditions are met, including
notifying a court of the confinement and providing to the court a physician's written
statement affirming the tuberculosis or symptoms.
b. If a court orders confinement of an individual with infectious tuberculosis
or symptoms indicative of tuberculosis, the individual must remain confined until
DHFS or a local health officer, with the concurrence of a treating physician,
determines that treatment is complete or that the individual is no longer a public
health threat.
c. A physician or other health care professional who attends a person infected
with a sexually transmitted disease must report the disease to the local health officer
and to DHFS; the physician may examine, diagnose, and treat a minor infected with
a sexually transmitted disease without obtaining consent of the minor's parents or
guardian.
d. If, following a request by an officer of DHFS or a local health officer, a person
reasonably suspected of being infected with a sexually transmitted disease refuses
or neglects examination by a physician or treatment, the DHFS officer or local health
officer may have the person committed to an institution for examination, treatment,
or observation.
e. If a person with a sexually transmitted disease ceases or refuses treatment
before reaching what is in a physician's opinion the noncommunicable stage, the
physician must notify DHFS and the person may be committed for treatment by
DHFS, a local health officer, or a court.
f. If a physician has reported to DHFS a case of sexually transmitted disease,
information regarding the disease and its treatment is not privileged before a court.
g. The State Laboratory of Hygiene must examine specimens for the diagnosis
of sexually transmitted disease for any physician or local health officer and must
report positive results to the local health officer and DHFS.
h. DHFS must promote public awareness of the risk of contracting human
immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency
syndrome) by developing and distributing information to, among other places, offices
of physicians.
i. If certain individuals, including emergency medical technicians, fire fighters,
state patrol officers, jailers, emergency care givers, and coroners, receive a
significant exposure (sustain a contact that has a potential for transmission of HIV),
the person to whom they are significantly exposed may be compelled to be tested for
the presence of HIV, and the test results may be provided to the affected individual;
one of the conditions that must be met is that a physician determines and certifies
in writing that the individual has been significantly exposed.
j. Positive results of a test for the presence of HIV that is administered to a
corpse may be provided by the individual's attending physician to persons whom the
physician knows have had sexual contact or shared intravenous drug use
paraphernalia with the deceased person, to emergency caregivers, and to funeral
directors, coroners, and medical examiners who prepare a corpse for burial or
perform an autopsy and are significantly exposed, as determined by a physician.
k. If a local health officer or DHFS officer requires it, a person who is employed
in the handling of food products or is suspected of having a disease in a form that is
communicable by food handling must submit to an examination by the officer or by
a physician.
L. Regulations of tattooists and body piercers do not apply to a dentist or
physician who tattoos or pierces the bodies of persons in the course of the dentist's
or physician's professional practice.
6. Under occupational regulation laws relating to physical therapists, a
physical therapist may practice only on the written referral of a physician,
chiropractor, dentist, or podiatrist, except under certain conditions, including
providing services to an individual for a previously diagnosed medical condition after
informing the individual's physician, chiropractor, dentist, or podiatrist.
7. Under occupational regulation laws relating to podiatrists, a podiatrist who
renders chargeable services to, among others, a patient or physician, must render a
statement of the charge directly to the person served.
8. Under laws relating to the practice of pharmacy, current law does the
following:
a. Defines the term "practice of pharmacy" to include making therapeutic
alternate drug selections in accordance with written guidelines or procedures
approved by a hospital or by a physician for his or her patients for hospital stay.
b. Prohibits from use as a privileged communication information that is
communicated to a physician in an effort unlawfully to procure a prescription drug.
c. Requires the enforcement of these laws that apply to physicians to be the
responsibility of the Department of Regulation and Licensing and the Medical
Examining Board.
d. Exempts from certain requirements for information that must be provided
when dispensing a drug product equivalent the use of drug product equivalents in
hospitals in accordance with guidelines approved by, among others, the patient's
physician.
This bill expands current laws that authorize physicians to act under specified
circumstances and to affect individuals by these authorized actions, by similarly
authorizing advanced practice nurse prescribers.
For further information see the state and local 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:
SB232, s. 1
1Section
1. 50.01 (1) (bm) of the statutes is created to read:
SB232,4,32
50.01
(1) (bm) "Advanced practice nurse prescriber" means an advanced
3practice nurse who is certified under s. 441.16 (2) to issue prescription orders.
SB232, s. 2
4Section
2. 50.09 (1) (a) (intro.) of the statutes is amended to read:
SB232,4,115
50.09
(1) (a) (intro.) Private and unrestricted communications with the
6resident's family, physician,
advanced practice nurse prescriber, attorney
, and any
7other person, unless medically contraindicated as documented by the resident's
8physician
or by the resident's advanced practice nurse prescriber in the resident's
9medical record, except that communications with public officials or with the
10resident's attorney shall not be restricted in any event. The right to private and
11unrestricted communications shall include, but is not limited to, the right to:
SB232, s. 3
12Section
3. 50.09 (1) (f) 1. of the statutes is amended to read:
SB232,5,4
150.09
(1) (f) 1. Privacy for visits by spouse. If both spouses are residents of the
2same facility, they shall be permitted to share a room unless medically
3contraindicated as documented by the resident's physician
or by the resident's
4advanced practice nurse prescriber in the resident's medical record.
SB232, s. 4
5Section
4. 50.09 (1) (h) of the statutes is amended to read:
SB232,5,96
50.09
(1) (h) Meet with, and participate in activities of social, religious
, and
7community groups at the resident's discretion, unless medically contraindicated as
8documented by the resident's physician
or by the resident's advanced practice nurse
9prescriber in the resident's medical record.
SB232, s. 5
10Section
5. 50.09 (1) (k) of the statutes is amended to read:
SB232,5,2211
50.09
(1) (k) Be free from mental and physical abuse, and be free from chemical
12and physical restraints except as authorized in writing by a physician
or by an
13advanced practice nurse prescriber for a specified and limited period of time and
14documented in the resident's medical record. Physical restraints may be used in an
15emergency when necessary to protect the resident from injury to himself or herself
16or others or to property. However, authorization for continuing use of the physical
17restraints shall be secured from a physician
or from an advanced practice nurse
18prescriber within 12 hours. Any use of physical restraints shall be noted in the
19resident's medical records. "Physical restraints" includes, but is not limited to, any
20article, device
, or garment
which
that interferes with the free movement of the
21resident and
which that the resident is unable to remove easily, and confinement in
22a locked room.
SB232, s. 6
23Section
6. 50.49 (1) (b) (intro.) of the statutes is amended to read:
SB232,6,624
50.49
(1) (b) (intro.) "Home health services" means the following items and
25services that are furnished to an individual, who is under the care of a physician,
of
1an advanced practice nurse prescriber, by a home health agency
, or by others under
2arrangements made by the home health agency, that are under a plan for furnishing
3those items and services to the individual that is established and periodically
4reviewed by a physician
or by an advanced practice nurse prescriber and that are,
5except as provided in subd. 6., provided on a visiting basis in a place of residence used
6as the individual's home:
SB232, s. 7
7Section
7. 70.47 (8) (intro.) of the statutes is amended to read:
SB232,6,138
70.47
(8) Hearing. (intro.) The board shall hear upon oath all persons who
9appear before it in relation to the assessment. The board shall hear upon oath, by
10telephone, all ill or disabled persons who present to the board a letter from a
11physician,
surgeon or osteopath
, or advanced practice nurse prescriber certified
12under s. 441.16 (2) that confirms their illness or disability. The board at such hearing
13shall proceed as follows:
SB232, s. 8
14Section
8. 146.82 (3) (a) of the statutes is amended to read:
SB232,6,2115
146.82
(3) (a) Notwithstanding sub. (1), a physician
or an advanced practice
16nurse prescriber certified under s. 441.16 (2) who treats a patient whose physical or
17mental condition in the physician's
or advanced practice nurse prescriber's judgment
18affects the patient's ability to exercise reasonable and ordinary control over a motor
19vehicle may report the patient's name and other information relevant to the
20condition to the department of transportation without the informed consent of the
21patient.
SB232, s. 9
22Section
9. 252.01 (1c) of the statutes is created to read:
SB232,6,2423
252.01
(1c) "Advanced practice nurse prescriber" means an advanced practice
24nurse who is certified under s. 441.16 (2) to issue prescription orders.
SB232, s. 10
25Section
10. 252.07 (8) (a) 2. of the statutes is amended to read:
SB232,7,3
1252.07
(8) (a) 2. The department or local health officer provides to the court a
2written statement from a physician
or an advanced practice nurse prescriber that the
3individual has infectious tuberculosis or suspect tuberculosis.
SB232, s. 11
4Section
11. 252.07 (9) (c) of the statutes is amended to read:
SB232,7,115
252.07
(9) (c) If the court orders confinement of an individual under this
6subsection, the individual shall remain confined until the department or local health
7officer, with the concurrence of a treating physician
or an advanced practice nurse
8prescriber, determines that treatment is complete or that the individual is no longer
9a substantial threat to himself or herself or to the public health. If the individual is
10to be confined for more than 6 months, the court shall review the confinement every
116 months.
SB232, s. 12
12Section
12. 252.11 (1m) of the statutes is amended to read:
SB232,7,2213
252.11
(1m) A physician
, an advanced practice nurse prescriber, or
other 14another health care professional called to attend a person infected with any form of
15sexually transmitted disease, as specified in rules promulgated by the department,
16shall report the disease to the local health officer and to the department in the
17manner directed by the department in writing on forms furnished by the
18department. A physician
or advanced practice nurse prescriber may treat a minor
19infected with a sexually transmitted disease or examine and diagnose a minor for the
20presence of such a disease without obtaining the consent of the minor's parents or
21guardian. The physician
or advanced practice nurse prescriber shall incur no civil
22liability solely by reason of the lack of consent of the minor's parents or guardian.
SB232, s. 13
23Section
13. 252.11 (2) of the statutes is amended to read:
SB232,8,924
252.11
(2) An officer of the department or a local health officer having
25knowledge of any reported or reasonably suspected case or contact of a sexually
1transmitted disease for which no appropriate treatment is being administered, or of
2an actual contact of a reported case or potential contact of a reasonably suspected
3case, shall investigate or cause the case or contact to be investigated as necessary.
4If, following a request of an officer of the department or a local health officer, a person
5reasonably suspected of being infected with a sexually transmitted disease refuses
6or neglects examination by a physician
or by an advanced practice nurse prescriber 7or treatment, an officer of the department or a local health officer may proceed to
8have the person committed under sub. (5) to an institution or system of care for
9examination, treatment or observation.
SB232, s. 14
10Section
14. 252.11 (4) of the statutes is amended to read:
SB232,8,1611
252.11
(4) If a person infected with a sexually transmitted disease ceases or
12refuses treatment before reaching what in
the a physician's
or an advanced practice
13nurse prescriber's opinion is the noncommunicable stage, the physician
or advanced
14practice nurse prescriber shall notify the department. The department shall without
15delay take the necessary steps to have the person committed for treatment or
16observation under sub. (5), or shall notify the local health officer to take these steps.
SB232, s. 15
17Section
15. 252.11 (5) of the statutes is amended to read:
SB232,9,918
252.11
(5) Any court of record may commit a person infected with a sexually
19transmitted disease to any institution or may require the person to undergo a system
20of care for examination, treatment
, or observation if the person ceases or refuses
21examination, treatment
, or observation under the supervision of a physician
or an
22advanced practice nurse prescriber. The court shall summon the person to appear
23on a date at least 48 hours, but not more than 96 hours, after service if an officer of
24the department or a local health officer petitions the court and states the facts
25authorizing commitment. If the person fails to appear or fails to accept commitment
1without reasonable cause, the court may cite the person for contempt. The court may
2issue a warrant and may direct the sheriff, any constable
, or any police officer of the
3county immediately to arrest the person and bring the person to court if the court
4finds that a summons will be ineffectual. The court shall hear the matter of
5commitment summarily. Commitment under this subsection continues until the
6disease is no longer communicable or until other provisions are made for treatment
7that satisfy the department. The certificate of the petitioning officer is prima facie
8evidence that the disease is no longer communicable or that satisfactory provisions
9for treatment have been made.
SB232, s. 16
10Section
16. 252.11 (7) of the statutes is amended to read:
SB232,9,1911
252.11
(7) Reports, examinations and inspections and all records concerning
12sexually transmitted diseases are confidential and not open to public inspection, and
13shall not be divulged except as may be necessary for the preservation of the public
14health, in the course of commitment proceedings under sub. (5)
, or as provided under
15s. 938.296 (4) or (5) or 968.38 (4) or (5). If a physician
or an advanced practice nurse
16prescriber has reported a case of sexually transmitted disease to the department
17under sub. (4), information regarding the presence of the disease and treatment is
18not privileged when the patient
or, physician
, or advanced practice nurse prescriber 19is called upon to testify to the facts before any court of record.
SB232, s. 17
20Section
17. 252.11 (10) of the statutes is amended to read:
SB232,9,2521
252.11
(10) The state laboratory of hygiene shall examine specimens for the
22diagnosis of sexually transmitted diseases for any physician
, advanced practice
23nurse prescriber, or local health officer in the state, and shall report the positive
24results of the examinations to the local health officer and to the department. All
25laboratories performing tests for sexually transmitted diseases shall report all
1positive results to the local health officer and to the department, with the name of
2the physician
or advanced practice nurse prescriber to whom reported.
SB232, s. 18
3Section
18. 252.12 (2) (a) 3. (intro.) of the statutes is amended to read:
SB232,10,134
252.12
(2) (a) 3. `Statewide public education campaign.' (intro.) The
5department shall promote public awareness of the risk of contracting HIV and
6related infections and measures for HIV and related infections protection by
7development and distribution of information through clinics providing family
8planning services, as defined in s. 253.07 (1) (b), offices of physicians
and advanced
9practice nurse prescribers and clinics for sexually transmitted diseases and by
10newsletters, public presentations or other releases of information to newspapers,
11periodicals, radio and television stations and other public information resources.
12The information shall be targeted at individuals whose behavior puts them at risk
13of contracting HIV and related infections and shall encompass the following topics:
SB232, s. 19
14Section
19. 252.15 (2) (a) 7. ak. of the statutes is amended to read:
SB232,11,215
252.15
(2) (a) 7. ak. A physician
or an advanced practice nurse prescriber, based
16on information provided to the physician
or advanced practice nurse prescriber,
17determines and certifies in writing that the affected person has been significantly
18exposed. The certification shall accompany the request for testing and disclosure.
19If the affected person who is significantly exposed is a physician
or an advanced
20practice nurse prescriber, he or she may not make this determination or certification.
21The information that is provided to a physician
or an advanced practice nurse
22prescriber to document the occurrence of a significant exposure and the physician's
23or advanced practice nurse prescriber's certification that an affected person has been
24significantly exposed, under this subd. 7. ak., shall be provided on a report form that
25is developed by the department of commerce under s. 101.02 (19) (a) or on a report
1form that the department of commerce determines, under s. 101.02 (19) (b), is
2substantially equivalent to the report form that is developed under s. 101.02 (19) (a).
SB232, s. 20
3Section
20. 252.15 (5) (a) 11. of the statutes is amended to read:
SB232,11,114
252.15
(5) (a) 11. To a person, including a person exempted from civil liability
5under the conditions specified under s. 895.48, who renders to the victim of an
6emergency or accident emergency care during the course of which the emergency
7caregiver is significantly exposed to the emergency or accident victim, if a physician
8or an advanced practice nurse prescriber, based on information provided to the
9physician
or advanced practice nurse prescriber, determines and certifies in writing
10that the emergency caregiver has been significantly exposed and if the certification
11accompanies the request for disclosure.
SB232, s. 21
12Section
21. 252.15 (5) (a) 12. b. of the statutes is amended to read:
SB232,11,1913
252.15
(5) (a) 12. b. The coroner, medical examiner
, or appointed assistant is
14significantly exposed to a person whose death is under direct investigation by the
15coroner, medical examiner
, or appointed assistant, if a physician
or an advanced
16practice nurse prescriber, based on information provided to the physician
or
17advanced practice nurse prescriber, determines and certifies in writing that the
18coroner, medical examiner
, or appointed assistant has been significantly exposed
19and if the certification accompanies the request for disclosure.
SB232, s. 22
20Section
22. 252.15 (5) (a) 14. of the statutes is amended to read:
SB232,11,2521
252.15
(5) (a) 14. If the test results of a test administered to an individual are
22positive and the individual is deceased, by the individual's attending physician
or
23advanced practice nurse prescriber, to persons, if known to the physician
or advanced
24practice nurse prescriber, with whom the individual has had sexual contact or has
25shared intravenous drug use paraphernalia.
SB232, s. 23
1Section
23. 252.15 (5m) (a) of the statutes is amended to read:
SB232,12,132
252.15
(5m) (a) If a person, including a person exempted from civil liability
3under the conditions specified under s. 895.48, who renders to the victim of an
4emergency or accident emergency care during the course of which the emergency
5caregiver is significantly exposed to the emergency or accident victim and the
6emergency or accident victim subsequently dies prior to testing for the presence of
7HIV, antigen or nonantigenic products of HIV or an antibody to HIV
, and; if a
8physician
or an advanced practice nurse prescriber, based on information provided
9to the physician
or advanced practice nurse prescriber, determines and certifies in
10writing that the emergency caregiver has been significantly exposed
; and if the
11certification accompanies the request for testing and disclosure. Testing of a corpse
12under this paragraph shall be ordered by the coroner, medical examiner
, or physician
13who certifies the victim's cause of death under s. 69.18 (2) (b), (c) or (d).
SB232, s. 24
14Section
24. 252.15 (5m) (b) of the statutes is amended to read:
SB232,12,2515
252.15
(5m) (b) If a funeral director, coroner, medical examiner
, or appointed
16assistant to a coroner or medical examiner who prepares the corpse of a decedent for
17burial or other disposition or a person who performs an autopsy or assists in
18performing an autopsy is significantly exposed to the corpse, and if a physician
or an
19advanced practice nurse prescriber, based on information provided to the physician
20or advanced practice nurse prescriber, determines and certifies in writing that the
21funeral director, coroner, medical examiner
, or appointed assistant has been
22significantly exposed and if the certification accompanies the request for testing and
23disclosure. Testing of a corpse under this paragraph shall be ordered by the
24attending physician
or the attending advanced practice nurse prescriber of the
25funeral director, coroner, medical examiner
, or appointed assistant who is so exposed.
SB232, s. 25
1Section
25. 252.15 (5m) (c) of the statutes is amended to read:
SB232,13,122
252.15
(5m) (c) If a health care provider or an agent or employee of a health
3care provider is significantly exposed to the corpse or to a patient who dies
4subsequent to the exposure and prior to testing for the presence of HIV, antigen or
5nonantigenic products of HIV or an antibody to HIV, and if a physician
or an
6advanced practice nurse prescriber who is not the health care provider, based on
7information provided to the physician
or advanced practice nurse prescriber,
8determines and certifies in writing that the health care provider, agent or employee
9has been significantly exposed and if the certification accompanies the request for
10testing and disclosure. Testing of a corpse under this paragraph shall be ordered by
11the physician
or advanced practice nurse prescriber who certifies that the significant
12exposure has occurred.
SB232, s. 26
13Section
26. 252.15 (7m) (intro.) of the statutes is amended to read: