SB354: Bill Text

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 Section 1. 50.01 (1b) of the statutes is created to read:

SB354,4,3 50.01 (1b) "Advanced practice nurse prescriber" means an advanced practice nurse who is certified under s. 441.16 (2) to issue prescription orders.

SB354, s. 2 Section 2. 50.01 (4p) of the statutes is created to read:

SB354,4,5 50.01 (4p) "Physician assistant" has the meaning given in s. 448.01 (6).

SB354, s. 3 Section 3. 50.09 (1) (a) (intro.) of the statutes is amended to read:

SB354,4,13 50.09 (1) (a) (intro.) Private and unrestricted communications with the resident's family, physician, advanced practice nurse prescriber, physician assistant, attorney, and any other person, unless medically contraindicated as documented by the resident's physician, advanced practice nurse prescriber, or physician assistant in the resident's medical record, except that communications with public officials or with the resident's attorney shall not be restricted in any event. The right to private and unrestricted communications shall include, but is not limited to, the right to:

SB354, s. 4 Section 4. 50.09 (1) (f) 1. of the statutes is amended to read:

SB354,5,4 50.09 (1) (f) 1. `Privacy for visits by spouse.' If both spouses are residents of the same facility, they shall be permitted to share a room unless medically contraindicated as documented by the resident's physician, advanced practice nurse prescriber, or physician assistant in the resident's medical record.

SB354, s. 5 Section 5. 50.09 (1) (h) of the statutes is amended to read:

SB354,5,9 50.09 (1) (h) Meet with, and participate in activities of social, religious, and community groups at the resident's discretion, unless medically contraindicated as documented by the resident's physician, advanced practice nurse prescriber, or physician assistant in the resident's medical record.

SB354, s. 6 Section 6. 50.09 (1) (k) of the statutes is amended to read:

SB354,5,22 50.09 (1) (k) Be free from mental and physical abuse, and be free from chemical and physical restraints except as authorized in writing by a physician , advanced practice nurse prescriber, or physician assistant for a specified and limited period of time and documented in the resident's medical record. Physical restraints may be used in an emergency when necessary to protect the resident from injury to himself or herself or others or to property. However, authorization for continuing use of the physical restraints shall be secured from a physician, advanced practice nurse prescriber, or physician assistant within 12 hours. Any use of physical restraints shall be noted in the resident's medical records. "Physical restraints" includes, but is not limited to, any article, device, or garment which that interferes with the free movement of the resident and which that the resident is unable to remove easily, and confinement in a locked room.

SB354, s. 7 Section 7. 50.49 (1) (b) (intro.) of the statutes is amended to read:

SB354,6,6 50.49 (1) (b) (intro.) "Home health services" means the following items and services that are furnished to an individual, who is under the care of a physician, an advanced practice nurse prescriber, or physician assistant, by a home health agency, or by others under arrangements made by the home health agency, that are under a plan for furnishing those items and services to the individual that is established and periodically reviewed by a physician, advanced practice nurse prescriber, or physician assistant and that are, except as provided in subd. 6., provided on a visiting basis in a place of residence used as the individual's home:

SB354, s. 8 Section 8. 70.47 (8) (intro.) of the statutes is amended to read:

SB354,6,13 70.47 (8) Hearing. (intro.) The board shall hear upon oath all persons who appear before it in relation to the assessment. The board shall hear upon oath, by telephone, all ill or disabled persons who present to the board a letter from a physician, surgeon or osteopath, advanced practice nurse prescriber certified under s. 441.16 (2), or physician assistant, as defined in s. 448.01 (6), that confirms their illness or disability. The board at such hearing shall proceed as follows:

SB354, s. 9 Section 9. 146.82 (3) (a) of the statutes is amended to read:

SB354,6,21 146.82 (3) (a) Notwithstanding sub. (1), a physician , advanced practice nurse prescriber certified under s. 441.16 (2), or physician assistant, as defined in s. 448.01 (6), who treats a patient whose physical or mental condition in the physician's, advanced practice nurse prescriber's, or physician assistant's judgment affects the patient's ability to exercise reasonable and ordinary control over a motor vehicle may report the patient's name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

SB354, s. 10 Section 10. 252.01 (1c) of the statutes is created to read:

SB354,6,24 252.01 (1c) "Advanced practice nurse prescriber" means an advanced practice nurse who is certified under s. 441.16 (2) to issue prescription orders.

SB354, s. 11 Section 11. 252.01 (5) of the statutes is created to read:

SB354,7,1 252.01 (5) "Physician assistant" has the meaning given in s. 448.01 (6).

SB354, s. 12 Section 12. 252.07 (8) (a) 2. of the statutes is amended to read:

SB354,7,5 252.07 (8) (a) 2. The department or local health officer provides to the court a written statement from a physician, advanced practice nurse prescriber, or physician assistant that the individual has infectious tuberculosis or suspect tuberculosis.

SB354, s. 13 Section 13. 252.07 (9) (c) of the statutes is amended to read:

SB354,7,13 252.07 (9) (c) If the court orders confinement of an individual under this subsection, the individual shall remain confined until the department or local health officer, with the concurrence of a treating physician, advanced practice nurse prescriber, or physician assistant, determines that treatment is complete or that the individual is no longer a substantial threat to himself or herself or to the public health. If the individual is to be confined for more than 6 months, the court shall review the confinement every 6 months.

SB354, s. 14 Section 14. 252.11 (2) of the statutes is amended to read:

SB354,7,25 252.11 (2) An officer of the department or a local health officer having knowledge of any reported or reasonably suspected case or contact of a sexually transmitted disease for which no appropriate treatment is being administered, or of an actual contact of a reported case or potential contact of a reasonably suspected case, shall investigate or cause the case or contact to be investigated as necessary. If, following a request of an officer of the department or a local health officer, a person reasonably suspected of being infected with a sexually transmitted disease refuses or neglects examination by a physician, advanced practice nurse prescriber, or physician assistant or treatment, an officer of the department or a local health officer may proceed to have the person committed under sub. (5) to an institution or system of care for examination, treatment or observation.

SB354, s. 15 Section 15. 252.11 (4) of the statutes is amended to read:

SB354,8,8 252.11 (4) If a person infected with a sexually transmitted disease ceases or refuses treatment before reaching what in the a physician's, advanced practice nurse prescriber's, or physician assistant's opinion is the noncommunicable stage, the physician, advanced practice nurse prescriber, or physician assistant shall notify the department. The department shall without delay take the necessary steps to have the person committed for treatment or observation under sub. (5), or shall notify the local health officer to take these steps.

SB354, s. 16 Section 16. 252.11 (5) of the statutes is amended to read:

SB354,9,2 252.11 (5) Any court of record may commit a person infected with a sexually transmitted disease to any institution or may require the person to undergo a system of care for examination, treatment, or observation if the person ceases or refuses examination, treatment, or observation under the supervision of a physician, advanced practice nurse prescriber, or physician assistant. The court shall summon the person to appear on a date at least 48 hours, but not more than 96 hours, after service if an officer of the department or a local health officer petitions the court and states the facts authorizing commitment. If the person fails to appear or fails to accept commitment without reasonable cause, the court may cite the person for contempt. The court may issue a warrant and may direct the sheriff, any constable, or any police officer of the county immediately to arrest the person and bring the person to court if the court finds that a summons will be ineffectual. The court shall hear the matter of commitment summarily. Commitment under this subsection continues until the disease is no longer communicable or until other provisions are made for treatment that satisfy the department. The certificate of the petitioning officer is prima facie evidence that the disease is no longer communicable or that satisfactory provisions for treatment have been made.

SB354, s. 17 Section 17. 252.11 (7) of the statutes is amended to read:

SB354,9,13 252.11 (7) Reports, examinations and inspections and all records concerning sexually transmitted diseases are confidential and not open to public inspection, and shall may not be divulged except as may be necessary for the preservation of the public health, in the course of commitment proceedings under sub. (5), or as provided under s. 938.296 (4) or (5) or 968.38 (4) or (5). If a physician, advanced practice nurse prescriber, or physician assistant has reported a case of sexually transmitted disease to the department under sub. (4), information regarding the presence of the disease and treatment is not privileged when the patient or, physician, advanced practice nurse prescriber, or physician assistant is called upon to testify to the facts before any court of record.

SB354, s. 18 Section 18. 252.11 (10) of the statutes is amended to read:

SB354,9,22 252.11 (10) The state laboratory of hygiene shall examine specimens for the diagnosis of sexually transmitted diseases for any physician, advanced practice nurse prescriber, physician assistant, or local health officer in the state, and shall report the positive results of the examinations to the local health officer and to the department. All laboratories performing tests for sexually transmitted diseases shall report all positive results to the local health officer and to the department, with the name of the physician, advanced practice nurse prescriber, or physician assistant to whom reported.

SB354, s. 19 Section 19. 252.14 (1) (ar) 14. of the statutes is amended to read:

SB354,9,24 252.14 (1) (ar) 14. A physician assistant licensed under ch. 448.

SB354, s. 20 Section 20. 252.15 (2) (a) 7. ak. of the statutes is amended to read:

SB354,10,15 252.15 (2) (a) 7. ak. A physician, advanced practice nurse prescriber, or physician assistant, based on information provided to the physician , advanced practice nurse prescriber, or physician assistant, determines and certifies in writing that the affected person has been significantly exposed. The certification shall accompany the request for testing and disclosure. If the affected person who is significantly exposed is a physician, advanced practice nurse prescriber, or physician assistant, he or she may not make this determination or certification. The information that is provided to a physician, advanced practice nurse prescriber, or physician assistant to document the occurrence of a significant exposure and the physician's, advanced practice nurse prescriber's, or physician assistant's certification that an affected person has been significantly exposed, under this subd. 7. ak., shall be provided on a report form that is developed by the department of commerce under s. 101.02 (19) (a) or on a report form that the department of commerce determines, under s. 101.02 (19) (b), is substantially equivalent to the report form that is developed under s. 101.02 (19) (a).

SB354, s. 21 Section 21. 252.15 (5) (a) 11. of the statutes is amended to read:

SB354,10,24 252.15 (5) (a) 11. To a person, including a person exempted from civil liability under the conditions specified under s. 895.48, who renders to the victim of an emergency or accident emergency care during the course of which the emergency caregiver is significantly exposed to the emergency or accident victim, if a physician, advanced practice nurse prescriber, or physician assistant, based on information provided to the physician, advanced practice nurse prescriber, or physician assistant, determines and certifies in writing that the emergency caregiver has been significantly exposed and if the certification accompanies the request for disclosure.

SB354, s. 22 Section 22. 252.15 (5) (a) 12. b. of the statutes is amended to read:

SB354,11,8 252.15 (5) (a) 12. b. The coroner, medical examiner, or appointed assistant is significantly exposed to a person whose death is under direct investigation by the coroner, medical examiner, or appointed assistant, if a physician, advanced practice nurse prescriber, or physician assistant, based on information provided to the physician, advanced practice nurse prescriber, or physician assistant, determines and certifies in writing that the coroner, medical examiner, or appointed assistant has been significantly exposed and if the certification accompanies the request for disclosure.

SB354, s. 23 Section 23. 252.15 (5) (a) 14. of the statutes is amended to read:

SB354,11,15 252.15 (5) (a) 14. If the test results of a test administered to an individual are positive and the individual is deceased, by the individual's attending physician, advanced practice nurse prescriber, or physician assistant, to persons, if known to the physician, advanced practice nurse prescriber, or physician assistant, with whom the individual has had sexual contact or has shared intravenous drug use paraphernalia.

SB354, s. 24 Section 24. 252.15 (5m) (a) of the statutes is amended to read:

SB354,12,4 252.15 (5m) (a) If a person, including a person exempted from civil liability under the conditions specified under s. 895.48, who renders to the victim of an emergency or accident emergency care during the course of which the emergency caregiver is significantly exposed to the emergency or accident victim and the emergency or accident victim subsequently dies prior to testing for the presence of HIV, antigen or nonantigenic products of HIV, or an antibody to HIV, and; if a physician, advanced practice nurse prescriber, or physician assistant, based on information provided to the physician, advanced practice nurse prescriber, or physician assistant, determines and certifies in writing that the emergency caregiver has been significantly exposed; and if the certification accompanies the request for testing and disclosure. Testing of a corpse under this paragraph shall be ordered by the coroner, medical examiner, or physician who certifies the victim's cause of death under s. 69.18 (2) (b), (c) or (d).

SB354, s. 25 Section 25. 252.15 (5m) (b) of the statutes is amended to read:

SB354,12,17 252.15 (5m) (b) If a funeral director, coroner, medical examiner, or appointed assistant to a coroner or medical examiner who prepares the corpse of a decedent for burial or other disposition or a person who performs an autopsy or assists in performing an autopsy is significantly exposed to the corpse, and; if a physician, advanced practice nurse prescriber, or physician assistant, based on information provided to the physician, advanced practice nurse prescriber, or physician assistant, determines and certifies in writing that the funeral director, coroner, medical examiner, or appointed assistant has been significantly exposed; and if the certification accompanies the request for testing and disclosure. Testing of a corpse under this paragraph shall be ordered by the attending physician, advanced practice nurse prescriber, or physician assistant of the funeral director, coroner, medical examiner, or appointed assistant who is so exposed.

SB354, s. 26 Section 26. 252.15 (5m) (c) of the statutes is amended to read:

SB354,13,4 252.15 (5m) (c) If a health care provider or an agent or employee of a health care provider is significantly exposed to the corpse or to a patient who dies subsequent to the exposure and prior to testing for the presence of HIV, antigen or nonantigenic products of HIV, or an antibody to HIV , and; if a physician, advanced practice nurse prescriber, or physician assistant who is not the health care provider, based on information provided to the physician, advanced practice nurse prescriber, or physician assistant, determines and certifies in writing that the health care provider, agent or employee has been significantly exposed ; and if the certification accompanies the request for testing and disclosure. Testing of a corpse under this paragraph shall be ordered by the physician, advanced practice nurse prescriber, or physician assistant who certifies that the significant exposure has occurred.

SB354, s. 27 Section 27. 252.15 (7m) (intro.) of the statutes is amended to read:

SB354,13,13 252.15 (7m) Reporting of persons significantly exposed. (intro.) If a positive, validated test result is obtained from a test subject, the test subject's physician, advanced practice nurse prescriber, or physician assistant who maintains a record of the test result under sub. (4) (c) may report to the state epidemiologist the name of any person known to the physician, advanced practice nurse prescriber, or physician assistant to have been significantly exposed to the test subject, only after the physician, advanced practice nurse prescriber, or physician assistant has done all of the following:

SB354, s. 28 Section 28. 252.15 (7m) (b) of the statutes is amended to read:

SB354,13,18 252.15 (7m) (b) Notified the test subject that the name of any person known to the physician, advanced practice nurse prescriber, or physician assistant to have been significantly exposed to the test subject will be reported to the state epidemiologist.

SB354, s. 29 Section 29. 252.16 (3) (c) (intro.) of the statutes is amended to read:

SB354,13,22 252.16 (3) (c) (intro.) Has submitted to the department a certification from a physician, as defined in s. 448.01 (5), advanced practice nurse prescriber, or physician assistant of all of the following:

SB354, s. 30 Section 30. 252.17 (3) (c) (intro.) of the statutes is amended to read:

SB354,14,3 252.17 (3) (c) (intro.) Has submitted to the department a certification from a physician, as defined in s. 448.01 (5), advanced practice nurse prescriber, or physician assistant of all of the following:

SB354, s. 31 Section 31. 252.18 of the statutes is amended to read:

SB354,14,17 252.18 Handling foods. No person in charge of any public eating place or other establishment where food products to be consumed by others are handled may knowingly employ any person handling food products who has a disease in a form that is communicable by food handling. If required by the local health officer or any officer of the department for the purposes of an investigation, any person who is employed in the handling of foods or is suspected of having a disease in a form that is communicable by food handling shall submit to an examination by the officer or by a physician, advanced practice nurse prescriber, or physician assistant designated by the officer. The expense of the examination, if any, shall be paid by the person examined. Any person knowingly infected with a disease in a form that is communicable by food handling who handles food products to be consumed by others and any persons knowingly employing or permitting such a person to handle food products to be consumed by others shall be punished as provided by s. 252.25.

SB354, s. 32 Section 32. 343.16 (5) (a) of the statutes is amended to read:

SB354,15,17 343.16 (5) (a) The secretary may require any applicant for a license or any licensed operator to submit to a special examination by such persons or agencies as the secretary may direct to determine incompetency, physical or mental disability, disease, or any other condition which that might prevent such applicant or licensed person from exercising reasonable and ordinary control over a motor vehicle. When If the department requires the applicant to submit to an examination, the applicant shall pay for the cost thereof examination. If the department receives an application for a renewal or duplicate license after voluntary surrender under s. 343.265 or receives a report from a physician, advanced practice nurse prescriber certified under s. 441.16 (2), physician assistant, as defined in s. 448.01 (6), or optometrist under s. 146.82 (3), or if the department has a report of 2 or more arrests within a one-year period for any combination of violations of s. 346.63 (1) or (5) or a local ordinance in conformity therewith with s. 346.63 (1) or (5) or a law of a federally recognized American Indian tribe or band in this state in conformity with s. 346.63 (1) or (5), or s. 346.63 (1m), 1985 stats., or s. 346.63 (2) or (6) or 940.25, or s. 940.09 where the offense involved the use of a vehicle, the department shall determine, by interview or otherwise, whether the operator should submit to an examination under this section. The examination may consist of an assessment. If the examination indicates that education or treatment for a disability, disease or condition concerning the use of alcohol, a controlled substance or a controlled substance analog is appropriate, the department may order a driver safety plan in accordance with s. 343.30 (1q). If there is noncompliance with assessment or the driver safety plan, the department shall revoke the person's operating privilege in the manner specified in s. 343.30 (1q) (d).

SB354, s. 33 Section 33. 441.06 (title) of the statutes is amended to read:

SB354,15,19 441.06 (title) Licensure; civil liability exemption exemptions.

SB354, s. 34 Section 34. 441.06 (7) of the statutes is created to read: