LRB-3637/1
CTS:lmk:pg
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
9create
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
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. 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
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 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
physician.
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:
SB354,5,4
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, 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:
SB354, s. 9 14Section 9. 146.82 (3) (a) of the statutes is amended to read:
SB354,6,2115 146.82 (3) (a) Notwithstanding sub. (1), a physician , advanced practice nurse
16prescriber certified under s. 441.16 (2), or physician assistant, as defined in s. 448.01
17(6),
who treats a patient whose physical or mental condition in the physician's,
18advanced practice nurse prescriber's, or physician assistant's
judgment affects the
19patient's ability to exercise reasonable and ordinary control over a motor vehicle may
20report the patient's name and other information relevant to the condition to the
21department of transportation without the informed consent of the patient.
SB354, s. 10 22Section 10. 252.01 (1c) of the statutes is created to read:
SB354,6,2423 252.01 (1c) "Advanced practice nurse prescriber" means an advanced practice
24nurse who is certified under s. 441.16 (2) to issue prescription orders.
SB354, s. 11 25Section 11. 252.01 (5) of the statutes is created to read:
SB354,7,1
1252.01 (5) "Physician assistant" has the meaning given in s. 448.01 (6).
SB354, s. 12 2Section 12. 252.07 (8) (a) 2. of the statutes is amended to read:
SB354,7,53 252.07 (8) (a) 2. The department or local health officer provides to the court a
4written statement from a physician, advanced practice nurse prescriber, or physician
5assistant
that the individual has infectious tuberculosis or suspect tuberculosis.
SB354, s. 13 6Section 13. 252.07 (9) (c) of the statutes is amended to read:
SB354,7,137 252.07 (9) (c) If the court orders confinement of an individual under this
8subsection, the individual shall remain confined until the department or local health
9officer, with the concurrence of a treating physician, advanced practice nurse
10prescriber, or physician assistant
, determines that treatment is complete or that the
11individual is no longer a substantial threat to himself or herself or to the public
12health. If the individual is to be confined for more than 6 months, the court shall
13review the confinement every 6 months.
SB354, s. 14 14Section 14. 252.11 (2) of the statutes is amended to read:
SB354,7,2515 252.11 (2) An officer of the department or a local health officer having
16knowledge of any reported or reasonably suspected case or contact of a sexually
17transmitted disease for which no appropriate treatment is being administered, or of
18an actual contact of a reported case or potential contact of a reasonably suspected
19case, shall investigate or cause the case or contact to be investigated as necessary.
20If, following a request of an officer of the department or a local health officer, a person
21reasonably suspected of being infected with a sexually transmitted disease refuses
22or neglects examination by a physician, advanced practice nurse prescriber, or
23physician assistant
or treatment, an officer of the department or a local health officer
24may proceed to have the person committed under sub. (5) to an institution or system
25of care for examination, treatment or observation.
SB354, s. 15
1Section 15. 252.11 (4) of the statutes is amended to read:
SB354,8,82 252.11 (4) If a person infected with a sexually transmitted disease ceases or
3refuses treatment before reaching what in the a physician's, advanced practice nurse
4prescriber's, or physician assistant's
opinion is the noncommunicable stage, the
5physician, advanced practice nurse prescriber, or physician assistant shall notify the
6department. The department shall without delay take the necessary steps to have
7the person committed for treatment or observation under sub. (5), or shall notify the
8local health officer to take these steps.
SB354, s. 16 9Section 16. 252.11 (5) of the statutes is amended to read:
SB354,9,210 252.11 (5) Any court of record may commit a person infected with a sexually
11transmitted disease to any institution or may require the person to undergo a system
12of care for examination, treatment, or observation if the person ceases or refuses
13examination, treatment, or observation under the supervision of a physician,
14advanced practice nurse prescriber, or physician assistant
. The court shall summon
15the person to appear on a date at least 48 hours, but not more than 96 hours, after
16service if an officer of the department or a local health officer petitions the court and
17states the facts authorizing commitment. If the person fails to appear or fails to
18accept commitment without reasonable cause, the court may cite the person for
19contempt. The court may issue a warrant and may direct the sheriff, any constable,
20or any police officer of the county immediately to arrest the person and bring the
21person to court if the court finds that a summons will be ineffectual. The court shall
22hear the matter of commitment summarily. Commitment under this subsection
23continues until the disease is no longer communicable or until other provisions are
24made for treatment that satisfy the department. The certificate of the petitioning

1officer is prima facie evidence that the disease is no longer communicable or that
2satisfactory provisions for treatment have been made.
SB354, s. 17 3Section 17. 252.11 (7) of the statutes is amended to read:
SB354,9,134 252.11 (7) Reports, examinations and inspections and all records concerning
5sexually transmitted diseases are confidential and not open to public inspection, and
6shall may not be divulged except as may be necessary for the preservation of the
7public health, in the course of commitment proceedings under sub. (5), or as provided
8under s. 938.296 (4) or (5) or 968.38 (4) or (5). If a physician, advanced practice nurse
9prescriber, or physician assistant
has reported a case of sexually transmitted disease
10to the department under sub. (4), information regarding the presence of the disease
11and treatment is not privileged when the patient or, physician, advanced practice
12nurse prescriber, or physician assistant
is called upon to testify to the facts before any
13court of record.
SB354, s. 18 14Section 18. 252.11 (10) of the statutes is amended to read:
SB354,9,2215 252.11 (10) The state laboratory of hygiene shall examine specimens for the
16diagnosis of sexually transmitted diseases for any physician, advanced practice
17nurse prescriber, physician assistant,
or local health officer in the state, and shall
18report the positive results of the examinations to the local health officer and to the
19department. All laboratories performing tests for sexually transmitted diseases
20shall report all positive results to the local health officer and to the department, with
21the name of the physician, advanced practice nurse prescriber, or physician assistant
22to whom reported.
SB354, s. 19 23Section 19. 252.14 (1) (ar) 14. of the statutes is amended to read:
SB354,9,2424 252.14 (1) (ar) 14. A physician assistant licensed under ch. 448.
SB354, s. 20 25Section 20. 252.15 (2) (a) 7. ak. of the statutes is amended to read:
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