448.20(4)
(4) Adhere to program objectives. In formulating standards under this section, the council shall recognize that an objective of this program is to increase the existing pool of health personnel.
448.21
448.21
Physician assistants. 448.21(1)
(1)
Prohibited practices. No physician assistant may provide medical care, except routine screening, in:
448.21(1)(a)
(a) The practice of dentistry or dental hygiene within the meaning of
ch. 447.
448.21(1)(c)
(c) The practice of chiropractic within the meaning of
ch. 446.
448.21(1)(e)
(e) The practice of acupuncture within the meaning of
ch. 451.
448.21(2)
(2) Employee status. No physician assistant may be self-employed. The employer of a physician assistant shall assume legal responsibility for any medical care provided by the physician assistant during the employment. The employer of a physician assistant, if other than a licensed physician, shall provide for and not interfere with supervision of the physician assistant by a licensed physician.
448.21(3)
(3) Prescriptive authority. A physician assistant may issue a prescription order for a drug or device in accordance with guidelines established by a supervising physician and the physician assistant and with rules promulgated by the board. If any conflict exists between the guidelines and the rules, the rules shall control.
448.22
448.22
Anesthesiologist assistants. 448.22(1)
(1) In this section, "supervision" means the use of the powers of direction and decision to coordinate, direct, and inspect the accomplishments of another, and to oversee the implementation of the anesthesiologist's intentions.
448.22(2)
(2) An anesthesiologist assistant may assist an anesthesiologist in the delivery of medical care only under the supervision of an anesthesiologist and only as described in a supervision agreement between the anesthesiologist assistant and an anesthesiologist who represents the anesthesiologist assistant's employer. The supervising anesthesiologist shall be immediately available in the same physical location or facility in which the anesthesiologist assistant assists in the delivery of medical care such that the supervising anesthesiologist is able to intervene if needed.
448.22(3)
(3) A supervision agreement under
sub. (2) shall do all of the following:
448.22(3)(b)
(b) Define the practice of the anesthesiologist assistant consistent with
subs. (2),
(4), and
(5).
448.22(4)
(4) An anesthesiologist assistant's practice may not exceed his or her education and training, the scope of practice of the supervising anesthesiologist, and the practice outlined in the anesthesiologist assistant supervision agreement. A medical care task assigned by the supervising anesthesiologist to the anesthesiologist assistant may not be delegated by the anesthesiologist assistant to another person.
448.22(5)
(5) An anesthesiologist assistant may assist only the supervising anesthesiologist in the delivery of medical care and may perform only the following medical care tasks as assigned by the supervising anesthesiologist:
448.22(5)(a)
(a) Developing and implementing an anesthesia care plan for a patient.
448.22(5)(b)
(b) Obtaining a comprehensive patient history and performing relevant elements of a physical exam.
448.22(5)(c)
(c) Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors.
448.22(5)(d)
(d) Implementing medically accepted monitoring techniques.
448.22(5)(e)
(e) Establishing basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support.
448.22(5)(f)
(f) Administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions.
448.22(5)(g)
(g) Administering anesthetic drugs, adjuvant drugs, and accessory drugs.
448.22(5)(h)
(h) Implementing spinal, epidural, and regional anesthetic procedures.
448.22(5)(i)
(i) Administering blood, blood products, and supportive fluids.
448.22(5)(j)
(j) Assisting a cardiopulmonary resuscitation team in response to a life threatening situation.
448.22(5)(k)
(k) Participating in administrative, research, and clinical teaching activities specified in the supervision agreement.
448.22(5)(L)
(L) Supervising student anesthesiologist assistants.
448.22(6)
(6) An anesthesiologist who represents an anesthesiologist assistant's employer shall review a supervision agreement with the anesthesiologist assistant at least annually. The supervision agreement shall be available for inspection at the location where the anesthesiologist assistant practices. The supervision agreement may limit the practice of an anesthesiologist assistant to less than the full scope of practice authorized under
sub. (5).
448.22(7)
(7) An anesthesiologist assistant shall be employed by a health care provider, as defined in
s. 655.001 (8), that is operated in this state for the primary purpose of providing the medical services of physicians or that is an entity described in
s. 655.002 (1) (g),
(h), or
(i). If an anesthesiologist assistant's employer is not an anesthesiologist, the employer shall provide for, and not interfere with, an anesthesiologist's supervision of the anesthesiologist assistant.
448.22(8)
(8) A student in an anesthesiologist assistant training program may assist only an anesthesiologist in the delivery of medical care and may perform only medical care tasks assigned by the anesthesiologist. An anesthesiologist may delegate the supervision of a student in an anesthesiologist assistant training program to only a qualified anesthesiologist, an anesthesiology fellow, an anesthesiology resident who has completed his or her first year of residency, or an anesthesiologist assistant, but in no case may an anesthesiologist concurrently supervise, either directly or as a delegated act, more than 2 students in training to be an anesthesiologist assistant. This section shall not be interpreted to limit the number of other qualified anesthesia providers an anesthesiologist may supervise. A student in an anesthesiologist assistant training program shall be identified as a student anesthesiologist assistant or an anesthesiologist assistant student and may not be identified as an "intern," "resident," or "fellow."
448.22 History
History: 2011 a. 160.
448.23
448.23
Council on anesthesiologist assistants. The council on anesthesiologist assistants shall guide, advise, and make recommendations to the board regarding the scope of anesthesiologist assistant practice and promote the safe and competent practice of anesthesiologist assistants in the delivery of health care services.
448.23 History
History: 2011 a. 160.
448.30
448.30
Information on alternate modes of treatment. Any physician who treats a patient shall inform the patient about the availability of all alternate, viable medical modes of treatment and about the benefits and risks of these treatments. The physician's duty to inform the patient under this section does not require disclosure of:
448.30(1)
(1) Information beyond what a reasonably well-qualified physician in a similar medical classification would know.
448.30(2)
(2) Detailed technical information that in all probability a patient would not understand.
448.30(3)
(3) Risks apparent or known to the patient.
448.30(4)
(4) Extremely remote possibilities that might falsely or detrimentally alarm the patient.
448.30(5)
(5) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.
448.30(6)
(6) Information in cases where the patient is incapable of consenting.
448.30 History
History: 1981 c. 375.
448.30 Cross-reference
Cross-reference: See also ch.
Med 18, Wis. adm. code.
448.30 Annotation
A one to three in 100 chance of a condition's existence is not an "extremely remote possibility" under sub. (4) when very serious consequences could result if the condition is present. Martin v. Richards,
192 Wis. 2d 156,
531 N.W.2d 70 (1995).
448.30 Annotation
A doctor has a duty under this section to advise of alternative modes of diagnosis as well as of alternative modes of treatment for diagnosed conditions. Martin v. Richards,
192 Wis. 2d 156,
531 N.W.2d 70 (1995).
448.30 Annotation
What constitutes informed consent emanates from what a reasonable person in the patient's position would want to know. What a physician must disclose is contingent on what a reasonable person would need to know to make an informed decision. When different physicians have substantially different success rates with a procedure and a reasonable person would consider that information material, a court may admit statistical evidence of the relative risk. Johnson v. Kokemoor,
199 Wis. 2d 615,
545 N.W.2d 495 (1996),
93-3099.
448.30 Annotation
A hospital does not have the duty to ensure that a patient has given informed consent to a procedure performed by an independent physician. Mathias v. St. Catherine's Hospital, Inc.
212 Wis. 2d 540,
569 N.W.2d 330 (Ct. App. 1997),
96-1632.
448.30 Annotation
The onset of a procedure does not categorically foreclose withdrawal of a patient's consent. Withdrawal of consent removes the doctor's authority to continue and obligates the doctor to conduct another informed consent discussion. If the patient's choice of treatment, based on disclosure of all pertinent information to the patient, is known, the objective test of what a reasonable person would have chosen is not relevant. Schreiber v. Physicians Insurance Co.
223 Wis. 2d 417,
588 N.W.2d 26 (Ct. App. 1999),
96-3676.
448.30 Annotation
As a general rule, patients have a duty to exercise ordinary care for their own health. Under limited, enumerated circumstances, contributory negligence may be a defense in an informed consent case. A doctor is not restricted to only the defenses listed under this section, but a court should be cautious in giving instructions on nonstatutory defenses. Brown v. Dibbell,
227 Wis. 2d 28,
595 N.W.2d 358 (1999),
97-2181.
448.30 Annotation
In the absence of a persistent vegetative state, the right of a parent to withhold life-sustaining treatment from a child does not exist and the need for informed consent is not triggered when life-sustaining treatment is performed. Montalvo v. Borkovec,
2002 WI App 147,
256 Wis. 2d 472,
647 N.W.2d 413,
01-1933.
448.30 Annotation
A chiropractor has a duty of informed consent to make such disclosures as will enable a reasonable person under the circumstances confronting the patient to exercise the right to consent to or to refuse the procedure proposed or to request an alternative treatment or method of diagnosis. Hannemann v. Boyson,
2005 WI 94,
282 Wis. 2d 664,
698 N.W.2d 714,
03-1527.
448.30 Annotation
A patient's consent to treatment is not categorically immutable once it has been given. A physician must initiate a new informed consent discussion when there is a substantial change in circumstances, be it medical or legal. Here, the decedent's postoperative complications did not at some point became a substantial change in medical circumstances necessitating a second informed consent discussion, because it was undisputed that the decedent was informed of the risks he later faced. Hageny v. Bodensteiner,
2009 WI App 10,
316 Wis. 2d 240,
762 N.W.2d 452,
08-0133.
448.30 Annotation
This section requires any physician who treats a patient to inform the patient about the availability of all alternate, viable medical modes of treatment, including diagnosis, as well as the benefits and risks of such treatments. Although the jury determined a physician was not negligent in his standard of care for failing to employ an alternative when treating the defendant, that did not relieve the physician of the duty to inform the patient about the availability of all alternate, viable medical modes of treatment. Bubb v. Brusky,
2009 WI 91,
321 Wis. 2d 1,
768 N.W.2d 903,
07-0619.
448.30 Annotation
Neither case law or this section limits the physician's duty to inform the patient of modes of treatment only for the final diagnosis. The distinction between conditions "related" to the final diagnosis and conditions "unrelated" to the final diagnosis finds no support in the statute or case law. A physician's duty is to inform the patient about diagnostic procedures about which a reasonable patient would want to know to make an informed, voluntary decision about his or her medical care, even if those diagnostic procedures are aimed at conditions that are unrelated to the condition that was the final diagnosis. Jandre v. Physicians Insurance Company of Wisconsin,
2012 WI 39,
340 Wis. 2d 31,
813 N.W.2d 627,
08-1972.
448.30 Annotation
The doctrine of informed consent is limited to apprising the patient of risks that inhere to proposed treatments. It does not impose a duty to apprise a patient of any knowledge the doctor may have regarding the condition of the patient or of all possible methods of diagnosis. McGeshick v. Choucair
9 F.3d 1229 (1993).
448.40(1)(1) The board may promulgate rules to carry out the purposes of this subchapter, including rules requiring the completion of continuing education, professional development, and maintenance of certification or performance improvement or continuing medical education programs for renewal of a license to practice medicine and surgery.
448.40(2)
(2) The board shall promulgate all of the following rules:
448.40(2)(b)
(b) Establishing the scope of the practice of perfusion. In promulgating rules under this paragraph, the board shall consult with the perfusionists examining council.
448.40(2)(c)
(c) Establishing continuing education requirements for renewal of a license to practice perfusion under
s. 448.13 (2). In promulgating rules under this paragraph, the board shall consult with the perfusionists examining council.
448.40(2)(e)
(e) Establishing the criteria for the substitution of uncompensated hours of professional assistance volunteered to the department of health services for some or all of the hours of continuing education credits required under
s. 448.13 (1) (a) 1. for physicians specializing in psychiatry. The eligible substitution hours shall involve professional evaluation of community programs for the certification and recertification of community mental health programs, as defined in
s. 51.01 (3n), by the department of health services.
448.40(2)(f)
(f) Establishing requirements for prescription orders issued by physician assistants under
s. 448.21 (3).
448.40 Cross-reference
Cross-reference: See also
Med, Wis. adm. code.
PHYSICAL THERAPY EXAMINING BOARD
Subch. III of ch. 448 Cross-reference
Cross-reference: See also
PT, Wis. adm. code.
448.50
448.50
Definitions. In this subchapter:
448.50(1r)
(1r) "Diagnosis" means a judgment that is made after examining the neuromusculoskeletal system or evaluating or studying its symptoms and that utilizes the techniques and science of physical therapy for the purpose of establishing a plan of therapeutic intervention, but does not include a chiropractic or medical diagnosis.
448.50(1v)
(1v) "Examining board" means the physical therapy examining board.
448.50(2)
(2) "Licensee" means a person who is licensed under this subchapter.
448.50(3)
(3) "Physical therapist" means an individual who has been graduated from a school of physical therapy and holds a license to practice physical therapy granted by the examining board.
448.50(3m)
(3m) "Physical therapist assistant" means an individual who holds a license as a physical therapist assistant granted by the examining board.
448.50(4)(a)(a) "Physical therapy" means, except as provided in
par. (b), any of the following:
448.50(4)(a)1.
1. Examining, evaluating, or testing individuals with mechanical, physiological, or developmental impairments, functional limitations related to physical movement and mobility, disabilities, or other movement-related health conditions, in order to determine a diagnosis, prognosis, or plan of therapeutic intervention or to assess the ongoing effects of intervention. In this subdivision, "testing" means using standardized methods or techniques for gathering data about a patient.
448.50(4)(a)2.
2. Alleviating impairments or functional limitations by instructing patients or designing, implementing, or modifying therapeutic interventions.
448.50(4)(a)3.
3. Reducing the risk of injury, impairment, functional limitation, or disability, including by promoting or maintaining fitness, health, or quality of life in all age populations.
448.50(4)(a)4.
4. Engaging in administration, consultation, or research that is related to any activity specified in
subds. 1. to
3.
448.50(4)(b)
(b) "Physical therapy" does not include using roentgen rays or radium for any purpose, using electricity for surgical purposes, including cauterization, or prescribing drugs or devices.
448.50(5)
(5) "Sexual misconduct with a patient" means any of the following:
448.50(5)(a)
(a) Engaging in or soliciting a consensual or nonconsensual sexual relationship with a patient.
