2005 - 2006 LEGISLATURE
September 30, 2005 - Introduced by Senators Cowles, Robson, Olsen, A. Lasee,
Darling, Erpenbach, Grothman
and Reynolds, cosponsored by
Representatives Vukmir, Richards, Underheim, Albers, Hundertmark,
Krawczyk, Nerison, LeMahieu, Gunderson, Sheridan, Seidel, Strachota,
Wood, Lothian, Nelson, Townsend, Owens, Ott, Petrowski, Lehman,
Kessler, Cullen, Kreibich
and Gronemus. Referred to Committee on Health,
Children, Families, Aging and Long Term Care.
SB354,1,12 1An Act to renumber and amend 450.01 (16) (h) and 450.13 (5); to amend 50.09
2(1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k), 50.49 (1) (b) (intro.),
370.47 (8) (intro.), 146.82 (3) (a), 252.07 (8) (a) 2., 252.07 (9) (c), 252.11 (2), 252.11
4(4), 252.11 (5), 252.11 (7), 252.11 (10), 252.14 (1) (ar) 14., 252.15 (2) (a) 7. ak.,
5252.15 (5) (a) 11., 252.15 (5) (a) 12. b., 252.15 (5) (a) 14., 252.15 (5m) (a), 252.15
6(5m) (b), 252.15 (5m) (c), 252.15 (7m) (intro.), 252.15 (7m) (b), 252.16 (3) (c)
7(intro.), 252.17 (3) (c) (intro.), 252.18, 343.16 (5) (a), 441.06 (title), 448.03 (5) (b),
8448.56 (1), 448.56 (1m) (b), 448.67 (2), 450.11 (7) (b) and 450.11 (8) (b); and to
50.01 (1b), 50.01 (4p), 252.01 (1c), 252.01 (5), 441.06 (7), 450.01 (1m),
10450.01 (15m), 450.01 (16) (h) 2., 450.01 (16) (h) 3., 450.11 (8) (e), 450.13 (5) (b)
11and 450.13 (5) (c) of the statutes; relating to: authorizing medically related
12actions by advanced practice nurse prescribers and physician assistants.
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. Also
under current law, the Medical Examining Board grants physician assistant licenses
to individuals who meet training and examination requirements and any other
requirements established in rules promulgated by the Medical Examining Board.
The following provisions under current law authorize physicians or other
health care professionals to act under specified circumstances and to affect
individuals by these authorized actions:
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
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
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. 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.
d. 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.
e. 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.
f. 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.
g. 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 prerequisite for compulsory testing is a written determination and certification
by a physician that the individual has been significantly exposed.
h. If a test administered to a corpse indicates the presence of HIV, the deceased
person's physician may provide the results of the test 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 who are significantly exposed
to HIV in the course of performing an autopsy.
i. 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.
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
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 and by a physician for his or her patients for hospital stay.
b. Provides that information communicated to a physician in an effort
unlawfully to procure a prescription drug is not privileged communication.
c. Requires the enforcement of prescription drug laws that apply to physicians
to be the responsibility of the Department of Regulation and Licensing and the
Medical Examining Board.
d. Exempts pharmacists from requirements that they provide certain
information when dispensing a drug product equivalent, if the patient is in a hospital

and the drug product equivalent is dispensed in accordance with guidelines
approved by, among others, the patient's physician.
This bill expands the current laws described above that authorize physicians
to act under specified circumstances and to affect individuals by these authorized
actions, by similarly authorizing advanced practice nurse prescribers and
individuals licensed as physician assistants. With respect to approving therapeutic
alternate drug selections and exempting pharmacists from certain requirements
related to dispensing drug product equivalents (items 8 a. and d. above), the bill
authorizes an advanced practice nurse prescriber to act only if the advanced practice
nurse prescriber has entered into a written agreement to collaborate with a
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:
SB354, s. 1 1Section 1. 50.01 (1b) of the statutes is created to read:
SB354,4,32 50.01 (1b) "Advanced practice nurse prescriber" means an advanced practice
3nurse who is certified under s. 441.16 (2) to issue prescription orders.
SB354, s. 2 4Section 2. 50.01 (4p) of the statutes is created to read:
SB354,4,55 50.01 (4p) "Physician assistant" has the meaning given in s. 448.01 (6).
SB354, s. 3 6Section 3. 50.09 (1) (a) (intro.) of the statutes is amended to read:
SB354,4,137 50.09 (1) (a) (intro.) Private and unrestricted communications with the
8resident's family, physician, advanced practice nurse prescriber, physician assistant,
9attorney, and any other person, unless medically contraindicated as documented by
10the resident's physician, advanced practice nurse prescriber, or physician assistant
11in the resident's medical record, except that communications with public officials or
12with the resident's attorney shall not be restricted in any event. The right to private
13and unrestricted communications shall include, but is not limited to, the right to:
SB354, s. 4 14Section 4. 50.09 (1) (f) 1. of the statutes is amended to read:
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, advanced practice nurse
4prescriber, or physician assistant
in the resident's medical record.
SB354, s. 5 5Section 5. 50.09 (1) (h) of the statutes is amended to read:
SB354,5,96 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, advanced practice nurse prescriber, or
9physician assistant
in the resident's medical record.
SB354, s. 6 10Section 6. 50.09 (1) (k) of the statutes is amended to read:
SB354,5,2211 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 , advanced
13practice nurse prescriber, or physician assistant
for a specified and limited period of
14time and documented in the resident's medical record. Physical restraints may be
15used in an emergency when necessary to protect the resident from injury to himself
16or herself or others or to property. However, authorization for continuing use of the
17physical restraints shall be secured from a physician, advanced practice nurse
18prescriber, or physician assistant
within 12 hours. Any use of physical restraints
19shall be noted in the resident's medical records. "Physical restraints" includes, but
20is not limited to, any article, device, or garment which that interferes with the free
21movement of the resident and which that the resident is unable to remove easily, and
22confinement in a locked room.
SB354, s. 7 23Section 7. 50.49 (1) (b) (intro.) of the statutes is amended to read:
SB354,6,624 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, an

1advanced practice nurse prescriber, or physician assistant,
by a home health agency,
2or by others under arrangements made by the home health agency, that are under
3a plan for furnishing those items and services to the individual that is established
4and periodically reviewed by a physician, advanced practice nurse prescriber, or
5physician assistant
and that are, except as provided in subd. 6., provided on a visiting
6basis in a place of residence used as the individual's home:
SB354, s. 8 7Section 8. 70.47 (8) (intro.) of the statutes is amended to read:
SB354,6,138 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, advanced practice nurse prescriber certified under
12s. 441.16 (2), or physician assistant, as defined in s. 448.01 (6),
that confirms their
13illness or disability. The board at such hearing shall proceed as follows: