AB742: Bill Text

LRB-2237/1

MED:jld:rs

2013 - 2014 LEGISLATURE

2013 Assembly BILL 742

February 7, 2014 - Introduced by Representative Severson, cosponsored by Senator Vukmir. Referred to Committee on Health.

AB742,1,11 An Act to repeal 448.04 (1) (b) 2., 448.04 (1) (c), 448.065, 448.10 (1), (4) and (5), 448.10 (2m) and 448.10 (3m); to renumber 448.10 (1m); to amend 440.08 (2) (a) (intro.), 448.02 (1), 448.02 (3) (a), 448.02 (3) (b), 448.02 (3) (c), 448.02 (3) (e), 448.02 (3) (h), 448.02 (4) (a), 448.02 (4) (b), 448.02 (5), 448.02 (6), 448.02 (8) (a), 448.02 (8) (b), 448.02 (8) (c), 448.05 (1) (c), 448.05 (1) (d), 448.05 (6) (a), 448.06 (title), 448.06 (1), 448.06 (1), 448.07 (1) (d), 448.08 (1) (a), 448.08 (1) (a) and 462.01 (4); to repeal and recreate 448.05 (2); and to create 448.04 (1) (ac), 448.04 (1) (bg) and (bm), 448.05 (2c), 448.05 (6) (at), 448.063 and 448.10 (1m), (2m) and (3m) of the statutes; relating to: licensure of physicians; providing an exemption from emergency rule procedures; and granting rule-making authority.

Analysis by the Legislative Reference Bureau

Under current law, physicians are licensed under the authority of the Medical Examining Board (MEB), a credentialing board attached to the Department of Safety and Professional Services. A physician's credential to practice is known as a license to practice medicine and surgery. This bill makes various changes regarding the licenses to practice medicine and surgery and related credentials issued by the MEB. Significant changes in the bill are described as follows:

Regular licenses to practice medicine and surgery

Current law

Current law provides that an applicant for any class of license to practice medicine and surgery must supply evidence satisfactory to the MEB that the applicant is a graduate of and possesses a diploma from a medical or osteopathic college approved by the MEB and has completed postgraduate training of 12 months in a facility approved by the MEB. Current law also contains provisions for issuing licenses to practice medicine and surgery to graduates of foreign medical schools that are not approved by the MEB. Such a graduate of a foreign medical school may be admitted to examination for a license to practice medicine and surgery if he or she satisfies certain requirements.

The bill — licensure of accredited medical and osteopathic college graduates

The bill repeals the provisions described above and replaces them with the following requirements that an applicant other than a graduate of a foreign medical college must satisfy in order to be eligible for a regular license to practice medicine and surgery:

1. That the applicant is a graduate of and possesses a diploma from a medical or osteopathic college that is accredited by the Liaison Committee on Medical Education, the American Osteopathic Association, or a successor organization and that is approved by the MEB.

2. That the applicant either: a) has successfully completed and received credit for 24 months of postgraduate training in one or more programs accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or a successor organization; or b) be currently enrolled in a postgraduate training program accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or a successor organization; has successfully completed and received credit for 12 consecutive months of postgraduate training in that program; and has received an unrestricted endorsement from the postgraduate training program director that includes confirmation that the applicant is expected to continue in the program and complete at least 24 months of postgraduate training.

3. That the applicant satisfies any other requirement established by the MEB by rule.

The bill — licensure of graduates of foreign medical colleges

The bill repeals the provisions described above and replaces them with the following requirements that an applicant who is a graduate of a foreign medical college must satisfy in order to be eligible for a regular license to practice medicine and surgery:

1. That the applicant be a graduate of and possess a diploma from a foreign medical college credentialed by an agency approved by the MEB.

2. That the applicant has obtained certification by the Educational Council for Foreign Medical Graduates or a successor organization.

3. That the applicant has passed all steps of the United States Medical Licensing Examination administered by the National Board of Medical Examiners and the Federation of State Medical Boards, or their successor organizations.

4. That the applicant has successfully completed and received credit for 24 months of postgraduate training in one or more programs accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association or a successor organization, the last 12 months of which were completed in a single program.

5. That the applicant satisfies any other requirement established by the MEB by rule for issuing the license.

The bill — exceptions

The bill allows the MEB to promulgate rules specifying circumstances in which the MEB, in cases of hardship or in cases in which the applicant possesses a medical license issued by another jurisdiction, may grant a waiver from any requirement described above for a regular license to practice medicine and surgery. The MEB may grant such a waiver only in accordance with those rules.

The bill also grandfathers existing holders of a regular license to practice medicine and surgery so that they may retain and continue to renew their licenses notwithstanding the requirements in the bill described above.

Credentials for medical residents

Current law — temporary educational permits

Under current law, the MEB may grant a temporary educational permit to practice medicine and surgery (TEP) to a person who meets the requirements for a license to practice medicine and surgery, other than required examinations. A TEP may be issued for a period not to exceed one year and may be renewed annually for not more than four years. A TEP permits the holder to take postgraduate educational training in a facility approved by the MEB, and the holder of a TEP may, under the direction of a licensed physician, perform services requisite to that training, but must confine training and practice to the facility in which the holder is taking the training.

The bill — resident educational licenses

The bill repeals the provisions for granting a TEP and replaces them with provisions allowing the MEB to grant a resident educational license (REL). An applicant must, under the bill, satisfy the following requirements in order to be granted an REL:

1. Provide proof that he or she has been accepted into a postgraduate training program accredited by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or a successor organization.

2. Provide written confirmation from the institution sponsoring the postgraduate training program into which he or she has been accepted confirming the appointment to that program.

3. Provide proof that he or she is a graduate of and possesses a diploma from a medical or osteopathic college that is approved by the MEB.

The bill provides that an REL is valid for one year and may be renewed for additional one-year terms while the REL holder is enrolled in his or her postgraduate training program. The bill also provides that an REL remains valid only while the REL holder is actively engaged in the practice of medicine and surgery in his or her postgraduate training program and is lawfully entitled to work in the United States. Finally, the bill provides that the holder of an REL may engage in the practice of medicine and surgery only in connection with his or her duties under his or her postgraduate training program.

The bill grandfathers existing TEP holders so that they may retain and renew their TEPs for up to three years following enactment of the bill.

Licenses for visiting physicians

Current law — temporary licenses for visiting professors

Under current law, an applicant who is a graduate of a foreign medical school and who, because of noteworthy professional attainment, is invited to serve on the academic staff of a medical college in this state as a visiting professor, may be granted a temporary license to practice medicine and surgery (visiting professor license). A visiting professor license remains in force only while the holder is serving full time on the academic staff of a medical college and the license holder's practice is limited to the duties of the academic position.

The bill — restricted licenses to practice as a visiting physician

The bill repeals the provisions for granting a visiting professor license and replaces them with provisions allowing the MEB to grant a restricted license to practice medicine and surgery as a visiting physician (visiting physician license). An applicant must, under the bill, satisfy the following requirements in order to be granted a visiting physician license:

1. Provide proof that he or she is a graduate of and possesses a diploma from a medical or osteopathic college that is approved by the board.

2. Provide proof that he or she teaches medicine, engages in medical research, or practices medicine and surgery outside this state.

3. Provide proof that the applicant is licensed to practice medicine and surgery outside this state.

4. Provide documentation that he or she intends to teach, research, or practice medicine and surgery at a medical education facility, medical research facility, or medical college in this state, which must include a signed letter from the dean or president of the facility or college.

5. Provide proof that he or she satisfies any other requirement established by the MEB by rule for issuing the license.

The bill provides that the holder of a visiting physician license may engage in the practice of medicine and surgery only at the medical education facility, medical research facility, or medical college where he or she is teaching, researching, or practicing, and only in accordance with the terms and restrictions established by the MEB. The bill provides that a visiting physician license is valid for one year and may be renewed at the discretion of the MEB. Finally, the bill provides that a visiting physician license remains valid only while the license holder is actively engaged in teaching, researching, or practicing medicine and surgery and is lawfully entitled to work in the United States.

The bill grandfathers existing visiting professor license holders so that they may retain and renew their visiting professor licenses for up to three years following enactment of the bill.

Administrative physician license

The bill allows the MEB to grant a new type of license known under the bill as an administrative physician license (APL). The MEB may grant an APL to an applicant who satisfies the requirements for a regular license to practice medicine and surgery, other than any requirement established by the MEB relating to the active practice of medicine and surgery.

The bill provides that the holder of an APL may not, under that APL, take any action that constitutes the practice of medicine and surgery.

Examinations for a license to practice medicine and surgery

The bill provides that, when examining an applicant for a license to practice medicine and surgery or an APL, the MEB may only use examinations prepared, administered, and scored by national examining agencies, subject to the exception that the MEB may interview an individual applicant as needed to determine information specific to that applicant.

For further information see the state 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:

AB742,1 Section 1. 440.08 (2) (a) (intro.) of the statutes is amended to read:

AB742,5,4 440.08 (2) (a) (intro.) Except as provided in par. (b) and in ss. 440.51, 442.04, 444.03, 444.11, 447.04 (2) (c) 2., 448.065, 449.17 (1m) (d), and 449.18 (2) (d) and subch. II of ch. 448, the renewal dates for credentials are as follows:

AB742,2 Section 2. 448.02 (1) of the statutes is amended to read:

AB742,5,9 448.02 (1) License. The board may grant licenses, including various classes of temporary licenses, to practice medicine and surgery, to practice as an administrative physician, to practice perfusion, to practice as an anesthesiologist assistant, and to practice as a physician assistant.

AB742,3 Section 3. 448.02 (3) (a) of the statutes is amended to read:

AB742,6,20 448.02 (3) (a) The board shall investigate allegations of unprofessional conduct and negligence in treatment by persons holding a license, or certificate or limited permit granted by the board. An allegation that a physician has violated s. 253.10 (3), 448.30 or 450.13 (2) or has failed to mail or present a medical certification required under s. 69.18 (2) within 21 days after the pronouncement of death of the person who is the subject of the required certificate or that a physician has failed at least 6 times within a 6-month period to mail or present a medical certificate required under s. 69.18 (2) within 6 days after the pronouncement of death of the person who is the subject of the required certificate is an allegation of unprofessional conduct. Information contained in reports filed with the board under s. 49.45 (2) (a) 12r., 50.36 (3) (b), 609.17 or 632.715, or under 42 CFR 1001.2005, shall be investigated by the board. Information contained in a report filed with the board under s. 655.045 (1), as created by 1985 Wisconsin Act 29, which is not a finding of negligence or in a report filed with the board under s. 50.36 (3) (c) may, within the discretion of the board, be used as the basis of an investigation of a person named in the report. The board may require a person holding a license, or certificate or limited permit to undergo and may consider the results of one or more physical, mental or professional competency examinations if the board believes that the results of any such examinations may be useful to the board in conducting its investigation.

AB742,4 Section 4. 448.02 (3) (b) of the statutes is amended to read:

AB742,7,17 448.02 (3) (b) After an investigation, if the board finds that there is probable cause to believe that the person is guilty of unprofessional conduct or negligence in treatment, the board shall hold a hearing on such conduct. The board may use any information obtained by the board or the department under s. 655.17 (7) (b), as created by 1985 Wisconsin Act 29, in an investigation or a disciplinary proceeding, including a public disciplinary proceeding, conducted under this subsection and the board may require a person holding a license, or certificate or limited permit to undergo and may consider the results of one or more physical, mental or professional competency examinations if the board believes that the results of any such examinations may be useful to the board in conducting its hearing. A unanimous finding by a panel established under s. 655.02, 1983 stats., or a finding by a court that a physician has acted negligently in treating a patient is conclusive evidence that the physician is guilty of negligence in treatment. A finding that is not a unanimous finding by a panel established under s. 655.02, 1983 stats., that a physician has acted negligently in treating a patient is presumptive evidence that the physician is guilty of negligence in treatment. A certified copy of the findings of fact, conclusions of law and order of the panel or the order of a court is presumptive evidence that the finding of negligence in treatment was made. The board shall render a decision within 90 days after the date on which the hearing is held or, if subsequent proceedings are conducted under s. 227.46 (2), within 90 days after the date on which those proceedings are completed.

AB742,5 Section 5. 448.02 (3) (c) of the statutes is amended to read:

AB742,8,5 448.02 (3) (c) Subject to par. (cm), after a disciplinary hearing, the board may, when it determines that a panel established under s. 655.02, 1983 stats., has unanimously found or a court has found that a person has been negligent in treating a patient or when it finds a person guilty of unprofessional conduct or negligence in treatment, do one or more of the following: warn or reprimand that person, or limit, suspend or revoke any license, or certificate or limited permit granted by the board to that person. The board may condition the removal of limitations on a license, or certificate or limited permit or the restoration of a suspended or revoked license, or certificate or limited permit upon obtaining minimum results specified by the board on one or more physical, mental or professional competency examinations if the board believes that obtaining the minimum results is related to correcting one or more of the bases upon which the limitation, suspension or revocation was imposed.

AB742,6 Section 6. 448.02 (3) (e) of the statutes is amended to read:

AB742,8,15 448.02 (3) (e) A person whose license, or certificate or limited permit is limited under this subchapter shall be permitted to continue practice upon condition that the person will refrain from engaging in unprofessional conduct; that the person will appear before the board or its officers or agents at such times and places as may be designated by the board from time to time; that the person will fully disclose to the board or its officers or agents the nature of the person's practice and conduct; that the person will fully comply with the limits placed on his or her practice and conduct by the board; that the person will obtain additional training, education or supervision required by the board; and that the person will cooperate with the board.

AB742,7 Section 7. 448.02 (3) (h) of the statutes is amended to read:

AB742,8,21 448.02 (3) (h) Nothing in this subsection prohibits the board, in its discretion, from investigating and conducting disciplinary proceedings on allegations of unprofessional conduct by persons holding a license, or certificate or limited permit granted by the board when the allegations of unprofessional conduct may also constitute allegations of negligence in treatment.

AB742,8 Section 8. 448.02 (4) (a) of the statutes is amended to read:

AB742,9,9 448.02 (4) (a) The board may summarily suspend any license, or certificate, or limited permit granted by the board when the board has in its possession evidence establishing probable cause to believe that the holder of the license , or certificate, or limited permit has violated the provisions of this subchapter and that it is necessary to suspend the license, or certificate , or limited permit immediately to protect the public health, safety, or welfare. The holder of the license, or certificate, or limited permit shall be granted an opportunity to be heard during the determination of probable cause. The board chair and 2 board members designated by the chair or, if the board chair is not available, the board vice-chair and 2 board members designated by the vice-chair, shall exercise the authority granted by this paragraph to suspend summarily a license, or certificate, or limited permit in the manner provided under par. (b).

AB742,9 Section 9. 448.02 (4) (b) of the statutes is amended to read:

AB742,9,25 448.02 (4) (b) An order of summary suspension shall be served upon the holder of the license, or certificate, or limited permit in the manner provided in s. 801.11 for service of summons. The order of summary suspension shall be effective upon service or upon actual notice of the summary suspension given to the holder of the license, or certificate, or limited permit or to the attorney of the license, permit, or limited permit certificate holder, whichever is sooner. A notice of hearing commencing a disciplinary proceeding shall be issued no more than 10 days following the issuance of the order of summary suspension. The order of summary suspension remains in effect until the effective date of a final decision and order in the disciplinary proceeding against the holder or until the order of summary suspension is discontinued by the board following a hearing to show cause. The holder of the license, or certificate, or limited permit shall have the right to request a hearing to show cause why the order of summary suspension should not be continued and the order of summary suspension shall notify the holder of the license , or certificate, or limited permit of that right. If a hearing to show cause is requested by the holder of the license, or certificate , or limited permit, the hearing shall be scheduled on a date within 20 days of receipt by the board of the request for the hearing to show cause.

AB742,10 Section 10. 448.02 (5) of the statutes is amended to read: