2011 - 2012 LEGISLATURE
February 1, 2012 - Introduced by Representatives Petryk, Ringhand, T. Larson,
Nygren, Pasch, Radcliffe, Rivard, Severson, Steineke, Thiesfeldt, Tranel,
Brooks, Ballweg, Spanbauer and Bewley, cosponsored by Senators Vukmir,
S. Fitzgerald, Olsen, Schultz and Shilling. Referred to Committee on
Health.
AB512,1,8
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 (2), 252.11 (4), 252.11 (5), 252.11 (7), 252.11 (10), 252.14 (1) (ar) 14.,
4252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 252.18, 343.16 (5) (a), 448.03 (5) (b),
5448.56 (1), 448.56 (1m) (b), 448.67 (2), 450.11 (7) (b) and 450.11 (8) (b); and
to
6create 50.01 (4p), 252.01 (5), 450.01 (15r), 450.01 (16) (h) 3. and 450.13 (5) (c)
7of the statutes;
relating to: authorizing medically related actions by physician
8assistants.
Analysis by the Legislative Reference Bureau
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 or domestic partner if the spouse or domestic partner 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 Services (DHS) 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
DHS 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 DHS 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 DHS 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 DHS and the person may be committed by a court for
examination or treatment.
e. If a physician has reported to DHS 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 DHS.
g. If a local health officer or DHS 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 a 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.
Currently, an advanced practice nurse prescriber may act in the same manner
physicians may act in the instances specified above.
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 individuals licensed as physician assistants.
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:
AB512, s. 1
1Section
1. 50.01 (4p) of the statutes is created to read:
AB512,3,22
50.01
(4p) "Physician assistant" has the meaning given in s. 448.01 (6).
AB512, s. 2
3Section
2. 50.09 (1) (a) (intro.) of the statutes is amended to read:
AB512,4,7
150.09
(1) (a) (intro.) Private and unrestricted communications with the
2resident's family, physician,
physician assistant, advanced practice nurse prescriber,
3attorney, and any other person, unless medically contraindicated as documented by
4the resident's physician
, physician assistant, or advanced practice nurse prescriber
5in the resident's medical record, except that communications with public officials or
6with the resident's attorney shall not be restricted in any event. The right to private
7and unrestricted communications shall include, but is not limited to, the right to:
AB512, s. 3
8Section
3. 50.09 (1) (f) 1. of the statutes is amended to read:
AB512,4,139
50.09
(1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses
10or both domestic partners under ch.770 are residents of the same facility, the spouses
11or domestic partners shall be permitted to share a room unless medically
12contraindicated as documented by the resident's physician
, physician assistant, or
13advanced practice nurse prescriber in the resident's medical record.
AB512, s. 4
14Section
4. 50.09 (1) (h) of the statutes is amended to read:
AB512,4,1815
50.09
(1) (h) Meet with, and participate in activities of social, religious, and
16community groups at the resident's discretion, unless medically contraindicated as
17documented by the resident's physician
, physician assistant, or advanced practice
18nurse prescriber in the resident's medical record.
AB512, s. 5
19Section
5. 50.09 (1) (k) of the statutes is amended to read:
AB512,5,620
50.09
(1) (k) Be free from mental and physical abuse, and be free from chemical
21and physical restraints except as authorized in writing by a physician
, physician
22assistant, or advanced practice nurse prescriber for a specified and limited period of
23time and documented in the resident's medical record. Physical restraints may be
24used in an emergency when necessary to protect the resident from injury to himself
25or herself or others or to property. However, authorization for continuing use of the
1physical restraints shall be secured from a physician
, physician assistant, or
2advanced practice nurse prescriber within 12 hours. Any use of physical restraints
3shall be noted in the resident's medical records. "Physical restraints" includes, but
4is not limited to, any article, device, or garment that interferes with the free
5movement of the resident and that the resident is unable to remove easily, and
6confinement in a locked room.
AB512, s. 6
7Section
6. 50.49 (1) (b) (intro.) of the statutes is amended to read:
AB512,5,158
50.49
(1) (b) (intro.) "Home health services" means the following items and
9services that are furnished to an individual, who is under the care of a physician
,
10physician assistant, or advanced practice nurse prescriber, by a home health agency,
11or by others under arrangements made by the home health agency, that are under
12a plan for furnishing those items and services to the individual that is established
13and periodically reviewed by a physician
, physician assistant, or advanced practice
14nurse prescriber and that are, except as provided in subd. 6., provided on a visiting
15basis in a place of residence used as the individual's home:
AB512, s. 7
16Section
7. 70.47 (8) (intro.) of the statutes is amended to read:
AB512,5,2217
70.47
(8) Hearing. (intro.) The board shall hear upon oath all persons who
18appear before it in relation to the assessment. The board shall hear upon oath, by
19telephone, all ill or disabled persons who present to the board a letter from a
20physician, osteopath,
physician assistant, as defined in s. 448.01 (6), or advanced
21practice nurse prescriber certified under s. 441.16 (2) that confirms their illness or
22disability. The board at such hearing shall proceed as follows:
AB512, s. 8
23Section
8. 146.82 (3) (a) of the statutes is amended to read:
AB512,6,524
146.82
(3) (a) Notwithstanding sub. (1), a physician
, physician assistant, as
25defined in s. 448.01 (6), or advanced practice nurse prescriber certified under s.
1441.16 (2) who treats a patient whose physical or mental condition in the physician's
,
2physician assistant's, or advanced practice nurse prescriber's judgment affects the
3patient's ability to exercise reasonable and ordinary control over a motor vehicle may
4report the patient's name and other information relevant to the condition to the
5department of transportation without the informed consent of the patient.
AB512, s. 9
6Section
9. 252.01 (5) of the statutes is created to read:
AB512,6,77
252.01
(5) "Physician assistant" has the meaning given in s. 448.01 (6).
AB512, s. 10
8Section
10. 252.07 (8) (a) 2. of the statutes is amended to read:
AB512,6,119
252.07
(8) (a) 2. The department or local health officer provides to the court a
10written statement from a physician
, physician assistant, or advanced practice nurse
11prescriber that the individual has infectious tuberculosis or suspect tuberculosis.
AB512, s. 11
12Section
11. 252.07 (9) (c) of the statutes is amended to read:
AB512,6,1913
252.07
(9) (c) If the court orders confinement of an individual under this
14subsection, the individual shall remain confined until the department or local health
15officer, with the concurrence of a treating physician
, physician assistant, or advanced
16practice nurse prescriber, determines that treatment is complete or that the
17individual is no longer a substantial threat to himself or herself or to the public
18health. If the individual is to be confined for more than 6 months, the court shall
19review the confinement every 6 months.
AB512, s. 12
20Section
12. 252.11 (2) of the statutes is amended to read:
AB512,7,621
252.11
(2) An officer of the department or a local health officer having
22knowledge of any reported or reasonably suspected case or contact of a sexually
23transmitted disease for which no appropriate treatment is being administered, or of
24an actual contact of a reported case or potential contact of a reasonably suspected
25case, shall investigate or cause the case or contact to be investigated as necessary.
1If, following a request of an officer of the department or a local health officer, a person
2reasonably suspected of being infected with a sexually transmitted disease refuses
3or neglects examination by a physician
, physician assistant, or advanced practice
4nurse prescriber or treatment, an officer of the department or a local health officer
5may proceed to have the person committed under sub. (5) to an institution or system
6of care for examination, treatment
, or observation.
AB512, s. 13
7Section
13. 252.11 (4) of the statutes is amended to read:
AB512,7,148
252.11
(4) If a person infected with a sexually transmitted disease ceases or
9refuses treatment before reaching what in a physician's
, physician assistant's, or
10advanced practice nurse prescriber's opinion is the noncommunicable stage, the
11physician
, physician assistant, or advanced practice nurse prescriber shall notify the
12department. The department shall without delay take the necessary steps to have
13the person committed for treatment or observation under sub. (5), or shall notify the
14local health officer to take these steps.
AB512, s. 14
15Section
14. 252.11 (5) of the statutes is amended to read:
AB512,8,716
252.11
(5) Any court of record may commit a person infected with a sexually
17transmitted disease to any institution or may require the person to undergo a system
18of care for examination, treatment, or observation if the person ceases or refuses
19examination, treatment, or observation under the supervision of a physician
,
20physician assistant, or advanced practice nurse prescriber. The court shall summon
21the person to appear on a date at least 48 hours, but not more than 96 hours, after
22service if an officer of the department or a local health officer petitions the court and
23states the facts authorizing commitment. If the person fails to appear or fails to
24accept commitment without reasonable cause, the court may cite the person for
25contempt. The court may issue a warrant and may direct the sheriff, any constable,
1or any police officer of the county immediately to arrest the person and bring the
2person to court if the court finds that a summons will be ineffectual. The court shall
3hear the matter of commitment summarily. Commitment under this subsection
4continues until the disease is no longer communicable or until other provisions are
5made for treatment that satisfy the department. The certificate of the petitioning
6officer is prima facie evidence that the disease is no longer communicable or that
7satisfactory provisions for treatment have been made.
AB512, s. 15
8Section
15. 252.11 (7) of the statutes is amended to read:
AB512,8,189
252.11
(7) Reports, examinations and inspections and all records concerning
10sexually transmitted diseases are confidential and not open to public inspection, and
11may not be divulged except as may be necessary for the preservation of the public
12health, in the course of commitment proceedings under sub. (5), or as provided under
13s. 938.296 (4) or 968.38 (4). If a physician
, physician assistant, or advanced practice
14nurse prescriber has reported a case of sexually transmitted disease to the
15department under sub. (4), information regarding the presence of the disease and
16treatment is not privileged when the patient, physician,
physician assistant, or
17advanced practice nurse prescriber is called upon to testify to the facts before any
18court of record.
AB512, s. 16
19Section
16. 252.11 (10) of the statutes is amended to read:
AB512,9,220
252.11
(10) The state laboratory of hygiene shall examine specimens for the
21diagnosis of sexually transmitted diseases for any physician,
physician assistant, 22advanced practice nurse prescriber, or local health officer in the state, and shall
23report the positive results of the examinations to the local health officer and to the
24department. All laboratories performing tests for sexually transmitted diseases
25shall report all positive results to the local health officer and to the department, with
1the name of the physician
, physician assistant, or advanced practice nurse prescriber
2to whom reported.
AB512, s. 17
3Section
17. 252.14 (1) (ar) 14. of the statutes is amended to read:
AB512,9,44
252.14
(1) (ar) 14. A physician assistant
licensed under ch. 448.
AB512, s. 18
5Section
18. 252.16 (3) (c) (intro.) of the statutes is amended to read:
AB512,9,86
252.16
(3) (c) (intro.) Has submitted to the department a certification from a
7physician, as defined in s. 448.01 (5),
physician assistant, or advanced practice nurse
8prescriber of all of the following:
AB512, s. 19
9Section
19. 252.17 (3) (c) (intro.) of the statutes is amended to read:
AB512,9,1210
252.17
(3) (c) (intro.) Has submitted to the department a certification from a
11physician, as defined in s. 448.01 (5),
physician assistant, or advanced practice nurse
12prescriber of all of the following:
AB512, s. 20
13Section
20. 252.18 of the statutes is amended to read:
AB512,9,24
14252.18 Handling foods. No person in charge of any public eating place or
15other establishment where food products to be consumed by others are handled may
16knowingly employ any person handling food products who has a disease in a form
17that is communicable by food handling. If required by the local health officer or any
18officer of the department for the purposes of an investigation, any person who is
19employed in the handling of foods or is suspected of having a disease in a form that
20is communicable by food handling shall submit to an examination by the officer or
21by a physician
, physician assistant, or advanced practice nurse prescriber
22designated by the officer. The expense of the examination, if any, shall be paid by the
23person examined. Any person knowingly infected with a disease in a form that is
24communicable by food handling who handles food products to be consumed by others
1and any persons knowingly employing or permitting such a person to handle food
2products to be consumed by others shall be punished as provided by s. 252.25.
AB512, s. 21
3Section
21. 343.16 (5) (a) of the statutes is amended to read:
AB512,11,24
343.16
(5) (a) The secretary may require any applicant for a license or any
5licensed operator to submit to a special examination by such persons or agencies as
6the secretary may direct to determine incompetency, physical or mental disability,
7disease, or any other condition that might prevent such applicant or licensed person
8from exercising reasonable and ordinary control over a motor vehicle. If the
9department requires the applicant to submit to an examination, the applicant shall
10pay for the examination. If the department receives an application for a renewal or
11duplicate license after voluntary surrender under s. 343.265 or receives a report from
12a physician,
physician assistant, as defined in s. 448.01 (6), advanced practice nurse
13prescriber certified under s. 441.16 (2), or optometrist under s. 146.82 (3), or if the
14department has a report of 2 or more arrests within a one-year period for any
15combination of violations of s. 346.63 (1) or (5) or a local ordinance in conformity with
16s. 346.63 (1) or (5) or a law of a federally recognized American Indian tribe or band
17in this state in conformity with s. 346.63 (1) or (5), or s. 346.63 (1m), 1985 stats., or
18s. 346.63 (2) or (6) or 940.25, or s. 940.09 where the offense involved the use of a
19vehicle, the department shall determine, by interview or otherwise, whether the
20operator should submit to an examination under this section. The examination may
21consist of an assessment. If the examination indicates that education or treatment
22for a disability, disease or condition concerning the use of alcohol, a controlled
23substance or a controlled substance analog is appropriate, the department may order
24a driver safety plan in accordance with s. 343.30 (1q). If there is noncompliance with
1assessment or the driver safety plan, the department shall revoke the person's
2operating privilege in the manner specified in s. 343.30 (1q) (d).
AB512, s. 22
3Section
22. 448.03 (5) (b) of the statutes is amended to read:
AB512,11,54
448.03
(5) (b) No physician
or physician assistant shall be liable for any civil
5damages for either of the following:
AB512,11,96
1. Reporting in good faith to the department of transportation under s. 146.82
7(3) a patient's name and other information relevant to a physical or mental condition
8of the patient which in the physician's
or physician assistant's judgment impairs the
9patient's ability to exercise reasonable and ordinary control over a motor vehicle.
AB512,11,1410
2. In good faith, not reporting to the department of transportation under s.
11146.82 (3) a patient's name and other information relevant to a physical or mental
12condition of the patient which in the physician's
or physician assistant's judgment
13does not impair the patient's ability to exercise reasonable and ordinary control over
14a motor vehicle.
AB512, s. 23
15Section
23. 448.56 (1) of the statutes is amended to read:
AB512,12,416
448.56
(1) Written referral. Except as provided in this subsection and s.
17448.52, a person may practice physical therapy only upon the written referral of a
18physician,
physician assistant, chiropractor, dentist, podiatrist, or advanced practice
19nurse prescriber certified under s. 441.16 (2). Written referral is not required if a
20physical therapist provides services in schools to children with disabilities, as
21defined in s. 115.76 (5), pursuant to rules promulgated by the department of public
22instruction; provides services as part of a home health care agency; provides services
23to a patient in a nursing home pursuant to the patient's plan of care; provides services
24related to athletic activities, conditioning, or injury prevention; or provides services
25to an individual for a previously diagnosed medical condition after informing the
1individual's physician,
physician assistant, chiropractor, dentist, podiatrist, or
2advanced practice nurse prescriber certified under s. 441.16 (2) who made the
3diagnosis. The examining board may promulgate rules establishing additional
4services that are excepted from the written referral requirements of this subsection.
AB512, s. 24
5Section
24. 448.56 (1m) (b) of the statutes is amended to read:
AB512,12,106
448.56
(1m) (b) The examining board shall promulgate rules establishing the
7requirements that a physical therapist must satisfy if a physician,
physician
8assistant, chiropractor, dentist, podiatrist, or advanced practice nurse prescriber
9makes a written referral under sub. (1). The purpose of the rules shall be to ensure
10continuity of care between the physical therapist and the health care practitioner.