SB184: Bill Text

SB184,25,9 2. A physician assistant practicing under the supervision and direction of a podiatrist under sub. (2) (a) 2m. may issue a prescription order for a drug or device in accordance with guidelines established by the supervising podiatrist 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.

SB184,25,13 (c) A physician assistant may practice in ambulatory care, acute care, long-term care, home care, or other settings as a primary, specialty, or surgical care provider who may serve as a patient's primary care provider or specialty care provider.

SB184,25,16 (2) (a) 1. Except as provided in subds. 2m. and 3. and sub. (5) (a) 1. a. or b., a physician assistant who provides care to patients shall maintain and provide to the board upon request one of the following:

SB184,25,23 a. Evidence that, pursuant to the physician assistant's employment, there is a physician who is primarily responsible for the overall direction and management of the physician assistant's professional activities and for assuring that the services provided by the physician assistant are medically appropriate. In this subd. 1. a., “employment” includes an arrangement between the physician assistant and a 3rd party in which the 3rd party receives payment for services provided by the physician assistant.

SB184,26,3 b. A written collaborative agreement with a physician that, subject to subd. 1m., describes the physician assistant's individual scope of practice, that includes a protocol for identifying an alternative collaborating physician for situations in which the collaborating physician or the physician's designee is not available for consultation, and that includes other information as required by the board.

SB184,26,5 1m. All of the following apply to a written collaborative agreement between a physician and physician assistant under subd. 1. b.:

SB184,26,8 a. The agreement may be terminated by either party by providing written notice at least 30 days prior to the date of termination, or as otherwise agreed to by the physician and physician assistant.

SB184,26,13 b. The agreement shall specify that the collaborating physician shall remain reasonably available to the physician assistant through the use of telecommunications or other electronic means within a medically appropriate time frame and that the collaborating physician may designate an alternate collaborator during periods of unavailability.

SB184,26,16 c. The agreement shall specify an arrangement for physician consultation with the patient within a medically appropriate time frame for consultation, if requested by the patient or the physician assistant.

SB184,26,18 d. The agreement shall be signed by the physician assistant and the collaborating physician.

SB184,26,20 2. Subdivision 1. does not require the physical presence of a physician at the time and place a physician assistant renders a service.

SB184,26,25 2m. A physician assistant may practice under the supervision and direction of a podiatrist. A physician assistant who is practicing under the supervision and direction of a podiatrist shall be limited to providing nonsurgical patient services. Subdivision 1. does not apply to a physician assistant who is practicing under the supervision and direction of a podiatrist.

SB184,27,3 3. Subdivision 1. does not apply with respect to a physician assistant who is employed by the federal government as a civilian or member of the uniformed services while performing duties incident to that employment or service.

SB184,27,5 (b) A physician assistant shall limit his or her practice to the scope of his or her experience, education, and training.

SB184,27,7 (c) No physician assistant may provide medical care, except routine screening and emergency care, in any of the following:

SB184,27,8 1. The practice of dentistry or dental hygiene within the meaning of ch. 447.

SB184,27,9 2. The practice of optometry within the meaning of ch. 449.

SB184,27,10 3. The practice of chiropractic within the meaning of ch. 446.

SB184,27,11 4. The practice of acupuncture within the meaning of ch. 451.

SB184,27,14 5. The practice of podiatry, except when the physician assistant is acting under the supervision and direction of a podiatrist, subject to par. (a) 2m. and the rules promulgated under s. 448.695 (4).

SB184,27,16 (3) (a) It shall be the obligation of a physician assistant to ensure all of the following:

SB184,27,18 1. That the scope of the practice of the physician assistant is identified and is appropriate with respect to his or her experience, education, and training.

SB184,27,20 2. For purposes of sub. (2) (a) 1. b., that the relationship with and access to a collaborating physician by the physician assistant is defined.

SB184,27,22 3. That the requirements and standards of licensure under this subchapter are complied with.

SB184,28,2 4. That consultation with or referral to other licensed health care providers with a scope of practice appropriate for a patient's care needs occurs when the patient's care needs exceed the physician assistant's experience, education, or training. A physician assistant shall ensure that he or she has awareness of options for the management of situations that are beyond the physician assistant's expertise.

SB184,28,4 (b) A physician assistant is individually and independently responsible for the quality of the care he or she renders.

SB184,28,9 (4) A physician assistant may delegate a care task or order to another clinically trained health care worker if the physician assistant is competent to perform the delegated task or order and has reasonable evidence that the clinically trained health care worker is minimally competent to perform the task or issue the order under the circumstances.

SB184,28,11 (5) (a) 1. The board shall, subject to subd. 2. and s. 448.695 (4), promulgate any rules necessary to implement this section, including rules to do any of the following:

SB184,28,14 a. Allow for temporary practice, specifically defined and actively monitored by the board, in the event of an interruption of a collaborative relationship under sub. (2) (a) 1. b.

SB184,28,18 b. Allow a physician assistant, in the absence of an employment or collaborative relationship under sub. (2) (a) 1., to provide medical care at the scene of an emergency, during a declared state of emergency or other disaster, or when volunteering at sporting events or at camps.

SB184,29,3 2. Rules promulgated by the board may not permit a broader scope of practice than that which may be exercised in accordance with subs. (1) and (2). Notwithstanding s. 15.085 (5) (b) 2., if the Medical Examining Board reasonably determines that a rule submitted to it by the Physician Assistant Affiliated Credentialing Board under s. 15.085 (5) (b) 1. permits a broader scope of practice than that which may be exercised in accordance with subs. (1) and (2), then the Physician Assistant Examining Board shall, prior to submitting the proposed rule to the legislative council staff under s. 227.15 (1), revise the proposed rule so that it does not exceed or permit a broader scope of practice than that which may be exercised in accordance with subs. (1) and (2).

SB184,29,6 (b) The board shall develop and recommend to the podiatry affiliated credentialing board practice standards for physician assistants practicing under podiatrists under sub. (2) (a) 2m.

SB184,29,12 (6) The practice permissions provided in this section are permissions granted by the state authorizing the licensed practice of physician assistants. Nothing in this section prohibits an employer, hospital, health plan, or other similar entity employing or with a relationship with a physician assistant from establishing additional requirements for a physician assistant as a condition of employment or relationship.

SB184,29,14 448.976 Civil liability. No physician assistant shall be liable for any civil damages for either of the following:

SB184,29,18 (1) Reporting in good faith to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the physician assistant's judgment impairs the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB184,29,22 (2) In good faith, not reporting to the department of transportation under s. 146.82 (3) a patient's name and other information relevant to a physical or mental condition of the patient that in the physician assistant's judgment does not impair the patient's ability to exercise reasonable and ordinary control over a motor vehicle.

SB184,30,2 448.977 Malpractice liability insurance. (1) Except as provided in subs. (2) and (3), no physician assistant may practice as authorized under s. 448.975 unless he or she has in effect malpractice liability insurance coverage evidenced by one of the following:

SB184,30,4 (a) Personal liability coverage in the amounts specified for health care providers under s. 655.23 (4).

SB184,30,6 (b) Coverage under a group liability policy providing individual coverage for the physician assistant in the amounts under s. 655.23 (4).

SB184,30,12 (2) The board may promulgate rules requiring a practicing physician assistant to have in effect malpractice liability insurance coverage in amounts greater than those specified in sub. (1) (a) or (b) or (4). If the board promulgates rules under this subsection, no physician assistant may practice as authorized under s. 448.975 unless he or she has in effect malpractice liability insurance coverage as required under those rules, except as provided in sub. (3).

SB184,30,16 (3) A physician assistant who is a state, county, or municipal employee, or federal employee or contractor covered under the federal tort claims act, as amended, and who is acting within the scope of his or her employment or contractual duties is not required to maintain in effect malpractice insurance coverage.

SB184,30,20 (4) Except as provided in subs. (2) and (3), a physician assistant may comply with sub. (1) if the physician assistant's employer has in effect malpractice liability insurance that is at least the minimum amount specified under s. 655.23 (4) and that provides coverage for claims against the physician assistant.

SB184,30,24 448.978 Professional discipline. (1) Subject to the rules promulgated under s. 440.03 (1), the board may conduct investigations and hearings to determine whether a person has violated this subchapter or a rule promulgated under this subchapter.

SB184,31,3 (2) Subject to the rules promulgated under s. 440.03 (1), if a person who applies for or holds a license issued under s. 448.974 does any of the following, the board may reprimand the person or deny, limit, suspend, or revoke the person's license:

SB184,31,5 (a) Makes a material misstatement in an application for a license or an application for renewal of a license under s. 448.974.

SB184,31,8 (b) Violates any law of this state or federal law that substantially relates to the practice of a physician assistant, violates this subchapter, or violates a rule promulgated under this subchapter.

SB184,31,9 (c) Advertises, practices, or attempts to practice under another person's name.

SB184,31,11 (d) Engages in unprofessional conduct. In this paragraph, “unprofessional conduct" does not include any of the following:

SB184,31,12 1. Providing expedited partner therapy as described in s. 448.9725.

SB184,31,14 2. Prescribing or delivering an opioid antagonist in accordance with s. 448.9727 (2).

SB184,31,16 (e) Subject to ss. 111.321, 111.322, and 111.335, is arrested for or convicted of a felony.

SB184,31,18 (f) Subject to ss. 111.321, 111.322, and 111.34, practices as a physician assistant while his or her ability is impaired by alcohol or other drugs.

SB184,31,19 (g) Engages in fraud or deceit in obtaining or using his or her license.

SB184,31,20 (h) Is adjudicated mentally incompetent by a court.

SB184,31,21 (i) Demonstrates gross negligence, incompetence, or misconduct in practice.

SB184,31,24 (j) Knowingly, recklessly, or negligently divulges a privileged communication or other confidential patient health care information except as required or permitted by state or federal law.

SB184,32,2 (k) Fails to cooperate with the board, or fails to timely respond to a request for information by the board, in connection with an investigation under this section.

SB184,32,4 (L) Prescribes, sells, administers, distributes, orders, or provides a controlled substance for a purpose other than a medical purpose.

SB184,32,6 (m) Demonstrates a lack of physical or mental ability to safely practice as a physician assistant.

SB184,32,8 (n) Engages in any practice that is outside the scope of his or her experience, education, or training.

SB184,32,10 (o) Is disciplined or has been disciplined by another state or jurisdiction based upon acts or conduct similar to acts or conduct prohibited under pars. (a) to (n).

SB184,32,19 448.9785 Informed consent. Any physician assistant who treats a patient shall inform the patient about the availability of reasonable alternate medical modes of treatment and about the benefits and risks of these treatments. The reasonable physician assistant standard is the standard for informing a patient under this section. The reasonable physician assistant standard requires disclosure only of information that a reasonable physician assistant in the same or a similar medical specialty would know and disclose under the circumstances. The physician assistant's duty to inform the patient under this section does not require disclosure of any of the following:

SB184,32,21 (1) Detailed technical information that in all probability a patient would not understand.

SB184,32,22 (2) Risks apparent or known to the patient.

SB184,32,24 (3) Extremely remote possibilities that might falsely or detrimentally alarm the patient.

SB184,33,2 (4) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.

SB184,33,3 (5) Information in cases where the patient is incapable of consenting.

SB184,33,6 (6) Information about alternate medical modes of treatment for any condition the physician assistant has not included in his or her diagnosis at the time the physician informs the patient.

SB184,33,8 448.979 Penalties. Any person who violates this subchapter is subject to a fine not to exceed $10,000 or imprisonment not to exceed 9 months, or both.

SB184,33,14 448.9793 Injunction. If it appears upon complaint to the board by any person or if it is known to the board that any person is violating this subchapter, or rules adopted by the board under this subchapter, the board or the attorney general may investigate and may, in addition to any other remedies, bring action in the name and on behalf of the state against any such person to enjoin such person from such violation. The attorney general shall represent the board in all proceedings.

SB184,33,18 448.9795 Duty to report. (1)  A physician assistant who has reason to believe any of the following about another physician assistant shall promptly submit a written report to the board that includes facts relating to the conduct of the other physician assistant:

SB184,33,20 (a) The other physician assistant is engaging or has engaged in acts that constitute a pattern of unprofessional conduct.

SB184,33,22 (b) The other physician assistant is engaging or has engaged in an act that creates an immediate or continuing danger to one or more patients or to the public.

SB184,33,23 (c) The other physician assistant is or may be medically incompetent.

SB184,33,25 (d) The other physician assistant is or may be mentally or physically unable safely to engage in the practice of a physician assistant.

SB184,34,3 (2) No physician assistant who reports to the board under sub. (1) may be held civilly or criminally liable or be found guilty of unprofessional conduct for reporting in good faith.

SB184,53 Section 53 . Subchapter VIII of chapter 448 [precedes 448.980] of the statutes is renumbered subchapter IX of chapter 448 [precedes 448.980].

SB184,54 Section 54 . Subchapter IX of chapter 448 [precedes 448.985] of the statutes is renumbered subchapter X of chapter 448 [precedes 448.985].

SB184,55 Section 55 . 450.01 (15r) of the statutes is repealed.

SB184,56 Section 56 . 450.01 (16) (hm) 3. of the statutes is amended to read:

SB184,34,11 450.01 (16) (hm) 3. The patient's physician assistant , if the physician assistant is under the supervision of the patient's personal attending physician.

SB184,57 Section 57 . 450.11 (1) of the statutes is amended to read:

SB184,35,3 450.11 (1) Dispensing. Except as provided in sub. (1i) (b) 2., no person may dispense any prescribed drug or device except upon the prescription order of a practitioner. All prescription orders shall, except as provided in sub. (1a), specify the date of issue, the name and address of the practitioner, the name and quantity of the drug product or device prescribed, directions for the use of the drug product or device, the symptom or purpose for which the drug is being prescribed if required under sub. (4) (a) 8., and, if the order is written by the practitioner, the signature of the practitioner. Except as provided in ss. 118.2925 (3), 255.07 (2), 441.18 (2) (a) 1., 448.035 (2), and 448.037 (2) (a) 1., 448.9725 (2), and 448.9727 (2) (a) 1. and except for standing orders issued under s. 441.18 (2) (a) 2. or , 448.037 (2) (a) 2., or 448.9727 (2) (a) 2., all prescription orders shall also specify the name and address of the patient. A prescription order issued under s. 118.2925 (3) shall specify the name and address of the school. A prescription order issued under s. 255.07 (2) shall specify the name and address of the authorized entity or authorized individual. Any oral prescription order shall be immediately reduced to writing by the pharmacist and filed according to sub. (2).

SB184,58 Section 58 . 450.11 (1g) (b) of the statutes is amended to read:

SB184,35,18 450.11 (1g) (b) A pharmacist may, upon the prescription order of a practitioner providing expedited partner therapy, as specified in s. 448.035 or 448.9725, that complies with the requirements of sub. (1), dispense an antimicrobial drug as a course of therapy for treatment of chlamydial infections, gonorrhea, or trichomoniasis to the practitioner's patient or a person with whom the patient has had sexual contact for use by the person with whom the patient has had sexual contact. The pharmacist shall provide a consultation in accordance with rules promulgated by the board for the dispensing of a prescription to the person to whom the antimicrobial drug is dispensed. A pharmacist providing a consultation under this paragraph shall ask whether the person for whom the antimicrobial drug has been prescribed is allergic to the antimicrobial drug and advise that the person for whom the antimicrobial drug has been prescribed must discontinue use of the antimicrobial drug if the person is allergic to or develops signs of an allergic reaction to the antimicrobial drug.

SB184,59 Section 59 . 450.11 (1i) (a) 1. of the statutes is amended to read:

SB184,36,6 450.11 (1i) (a) 1. A pharmacist may, upon and in accordance with the prescription order of an advanced practice nurse prescriber under s. 441.18 (2) (a) 1., or of a physician or physician assistant under s. 448.037 (2) (a) 1., or of a physician assistant under s. 448.9727 (2) (a) 1. that complies with the requirements of sub. (1), deliver an opioid antagonist to a person specified in the prescription order and may, upon and in accordance with the standing order of an advanced practice nurse prescriber under s. 441.18 (2) (a) 2., or of a physician or physician assistant under s. 448.037 (2) (a) 2., or of a physician assistant under s. 448.9727 (2) (a) 2. that complies with the requirements of sub. (1), deliver an opioid antagonist to an individual in accordance with the order. The pharmacist shall provide a consultation in accordance with rules promulgated by the board for the delivery of a prescription to the person to whom the opioid antagonist is delivered.

SB184,60 Section 60 . 450.11 (1i) (b) 2. c. of the statutes is amended to read:

SB184,36,10 450.11 (1i) (b) 2. c. A physician or physician assistant may only deliver or dispense an opioid antagonist in accordance with s. 448.037 (2) or in accordance with his or her other legal authority to dispense prescription drugs.