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S.B. 46 Enrolled

    

PHYSICIAN ASSISTANT PRACTICE ACT AMENDMENTS

    
1997 GENERAL SESSION

    
STATE OF UTAH

    
Sponsor: Robert C. Steiner

    Robert F. Montgomery
Millie M. Peterson



    AN ACT RELATING TO HEALTH; REPEALING THE CURRENT PHYSICIAN ASSISTANT
    PRACTICE ACT AND ENACTING A PHYSICIAN ASSISTANT CHAPTER;
    PROVIDING DEFINITIONS; CREATING A BOARD; ESTABLISHING LICENSURE
    QUALIFICATIONS AND SCOPE OF PRACTICE; DEFINING UNLAWFUL AND
    UNPROFESSIONAL ACTS; AND PROVIDING PENALTIES.
    This act affects sections of Utah Code Annotated 1953 as follows:
    ENACTS:
         58-70a-101, Utah Code Annotated 1953
         58-70a-102, Utah Code Annotated 1953
         58-70a-201, Utah Code Annotated 1953
         58-70a-301, Utah Code Annotated 1953
         58-70a-302, Utah Code Annotated 1953
         58-70a-303, Utah Code Annotated 1953
         58-70a-304, Utah Code Annotated 1953
         58-70a-305, Utah Code Annotated 1953
         58-70a-306, Utah Code Annotated 1953
         58-70a-401, Utah Code Annotated 1953
         58-70a-501, Utah Code Annotated 1953
         58-70a-502, Utah Code Annotated 1953
         58-70a-503, Utah Code Annotated 1953
         58-70a-504, Utah Code Annotated 1953
    REPEALS:
         58-70-101, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-102, as renumbered and amended by Chapter 253, Laws of Utah 1996


         58-70-201, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-301, as last amended by Chapter 247 and renumbered and amended by Chapter 253,
    Laws of Utah 1996
         58-70-302, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-303, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-304, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-401, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-501, as renumbered and amended by Chapter 253, Laws of Utah 1996
         58-70-502, as renumbered and amended by Chapter 253, Laws of Utah 1996
    Be it enacted by the Legislature of the state of Utah:
        Section 1. Section 58-70a-101 is enacted to read:
    
CHAPTER 70a. PHYSICIAN ASSISTANT ACT

    
Part 1. General Provisions

         58-70a-101. Title.
        This chapter is known as the "Physician Assistant Act."
        Section 2. Section 58-70a-102 is enacted to read:
         58-70a-102. Definitions.
        In addition to the definitions in Section 58-1-102, as used in this chapter:
        (1) "Board" means the Physician Assistant Licensing Board created in Section 58-70a-201.
        (2) (a) "Delegation of services agreement" means written criteria jointly developed by a
    physician assistant's supervising physician and any substitute supervising physicians and the
    physician assistant, that permits a physician assistant, working under the direction or review of the
    supervising physician, to assist in the management of common illnesses and injuries.
        (b) The agreement defines the working relationship and delegation of duties between the
    supervising physician and the physician assistant as specified by division rule and shall include:
        (i) the prescribing of controlled substances;
        (ii) the degree and means of supervision;
        (iii) the frequency and mechanism of chart review;

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        (iv) procedures addressing situations outside the scope of practice of the physician assistant;
    and
        (v) procedures for providing backup for the physician assistant in emergency situations.
        (3) "Direct supervision" means the supervising physician is:
        (a) physically present at the point of patient treatment on site where the physician assistant
    he is supervising is practicing; and
        (b) immediately available for consultation with the physician assistant.
        (4) "Practice as a physician assistant" means:
        (a) the professional activities and conduct of a physician assistant in diagnosing, treating,
    advising, or prescribing for any human disease, ailment, injury, infirmity, deformity, pain, or other
    condition, dependent upon and under the supervision of a supervising physician or substitute
    supervising physician in accordance with a delegation of services agreement; and
        (b) the physician assistant acts as the agent of the supervising physician or substitute
    supervising physician when acting in accordance with a delegation of services agreement.
        (5) "Substitute supervising physician" means an individual who meets the requirements of
    a supervising physician under this chapter and acts as the supervising physician in the absence of the
    supervising physician.
        (6) "Supervising physician" means an individual who:
        (a) is currently licensed to practice under Title 58, Chapter 67, Utah Medical Practice Act,
    or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
        (b) acts as the primary supervisor of a physician assistant and takes responsibility for the
    professional practice and conduct of a physician assistant in accordance with this chapter; and
        (c) is not an employee of the physician assistant he supervises.
        (7) "Supervision" means the supervising physician is available for consultation with the
    physician assistant, either personally or by other means permitting direct verbal communication
    between the physician and physician assistant.
        (8) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-70a-502.
        (9) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-70a-503 and as may

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    be further defined by rule.
        Section 3. Section 58-70a-201 is enacted to read:
    
Part 2. Board

         58-70a-201. Board.
        (1) There is created the Physician Assistant Licensing Board, which consists of seven
    members:
        (a) four licensed physicians, at least two of whom are individuals who are supervising or
    who have supervised a physician assistant, and one of whom may be a member of a physician
    licensing board under Section 58-67-201or 58-68-201;
        (b) one physician assistant;
        (c) one person who is involved in the administration of an approved physician assistant
    education program within the state; and
        (d) one person from the general public.
        (2) The board shall be appointed and serve in accordance with Section 58-1-201.
        (3) The duties and responsibilities of the board are in accordance with Sections 58-1-202 and
    58-1-203. In addition, the board shall designate one of its members on a permanent or rotating basis
    to:
        (a) assist the division in reviewing complaints concerning the unlawful or unprofessional
    conduct of a licensee; and
        (b) advise the division in its investigation of these complaints.
        (4) A board member who has, under Subsection (3), reviewed a complaint or advised in its
    investigation may be disqualified from participating with the board when the board serves as a
    presiding officer in an adjudicative proceeding concerning the complaint. The board member may
    be disqualified:
        (a) on his own motion, due to actual or perceived bias or lack of objectivity; or
        (b) upon challenge for cause raised on the record by any party to the adjudicative
    proceeding.
        Section 4. Section 58-70a-301 is enacted to read:

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Part 3. Licensing

         58-70a-301. Licensure required -- License classifications.
        (1) A license is required to engage in practice as a physician assistant, except as specifically
    provided in Section 58-70a-305 or 58-1-307.
        (2) The division shall issue to a person who qualifies under this chapter a license in the
    classification of physician assistant.
        Section 5. Section 58-70a-302 is enacted to read:
         58-70a-302. Qualifications for licensure.
        Each applicant for licensure as a physician assistant shall:
        (1) submit an application in a form prescribed by the division;
        (2) pay a fee determined by the department under Section 63-38-3.2;
        (3) be of good moral character;
        (4) have successfully completed a physician assistant program accredited by the Commission
    on Accreditation of Allied Health Education Programs;
        (5) have passed the licensing examinations required by division rule made in collaboration
    with the board;
        (6) meet with the board and representatives of the division, if requested, for the purpose of
    evaluating the applicant's qualifications for licensure; and
        (7) (a) if the applicant desires to practice in Utah, complete a form provided by the division
    indicating:
        (i) the applicant has completed a delegation of services agreement signed by the physician
    assistant, supervising physician, and substitute supervising physicians; and
        (ii) the agreement is on file at the Utah practice sites; or
        (b) complete a form provided by the division indicating the applicant is not practicing in
    Utah and, prior to practicing in Utah, the applicant will meet the requirements of Subsection (7)(a).
        Section 6. Section 58-70a-303 is enacted to read:
         58-70a-303. Term of license -- Expiration -- Renewal.
        (1) (a) The division shall issue each license under this chapter in accordance with a two-year

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    renewal cycle established by division rule.
        (b) The division may by rule extend or shorten a renewal period by as much as one year to
    stagger the renewal cycles it administers.
        (2) At the time of renewal, the licensee shall show compliance with renewal requirements
    of:
        (a) continuing education; and
        (b) quality review program participation.
        (3) Each license issued under this chapter expires on the expiration date shown on the license
    unless renewed in accordance with Section 58-1-308.
        Section 7. Section 58-70a-304 is enacted to read:
         58-70a-304. License renewal -- Continuing education and quality review requirements.
        (1) (a) Prior to license renewal, each licensee shall, during each two-year licensure cycle or
    other cycle defined by division rule, complete qualified continuing professional education
    requirements as defined by division rule made in collaboration with the board.
        (b) If a renewal period is extended or shortened under Section 58-70a-303, the continuing
    education hours required for license renewal under this section are increased or decreased
    proportionally.
        (2) As a condition precedent for license renewal on and after July 1, 2000, each licensee
    shall participate in the quality review program in which his or her supervising physician is
    participating under Section 58-67-304 or 58-68-304.
        Section 8. Section 58-70a-305 is enacted to read:
         58-70a-305. Exemptions from licensure.
        In addition to the exemptions from licensure in Section 58-1-307, the following persons may
    engage in acts included within the definition of practice as a physician assistant, subject to the stated
    circumstances and limitations, without being licensed under this chapter:
        (1) a student enrolled in an accredited physician assistant education program while engaged
    in activities as a physician assistant:
        (a) that are a part of the education program;

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        (b) that are conducted under the direct supervision of a physician associated with the
    program; and
        (c) for which the program accepts in writing the responsibility for the student; and
        (2) a person acting as a "medical assistant," as defined in Sections 58-67-102 and 58-68-102,
    and who:
        (a) is working under the direct supervision of a physician;
        (b) does not diagnose, advise, independently treat, or prescribe to or on behalf of any person;
    and
        (c) for whom the supervising physician accepts responsibility.
        Section 9. Section 58-70a-306 is enacted to read:
         58-70a-306. Temporary license.
        (1) An applicant for licensure as a physician assistant who has met all qualifications for
    licensure except passing an examination component as required in Section 58-70a-302, may apply
    for and be granted a temporary license to practice under Subsection (2).
        (2) (a) The applicant shall submit to the division evidence of completion of a physician
    assistant program as defined in Subsection 58-70a-302(4).
        (b) The temporary license shall be issued for a period ending on the earlier of the date of the
    next succeeding physician assistant examination, if the applicant does not take that examination, or
    ten days after the date examination results of the next succeeding physician assistant examination
    are available to those taking the examination.
        (c) A physician assistant holding a temporary license may work only under the direct
    supervision of an approved supervising or substitute supervising physician in accordance with a
    delegation of services agreement, and all patient charts shall be reviewed and countersigned by the
    supervising or substitute supervising physician.
        Section 10. Section 58-70a-401 is enacted to read:
    
Part 4. License Denial and Discipline

         58-70a-401. Grounds for denial of license -- Disciplinary proceedings.
        Grounds for the following division actions regarding a licensee are under Section 58-1-401:

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        (1) refusing to issue a license to an applicant;
        (2) refusing to renew the license of a licensee;
        (3) revoking, suspending, restricting, or placing on probation the license of a licensee;
        (4) issuing a public or private reprimand to a licensee; and
        (5) issuing a cease and desist order.
        Section 11. Section 58-70a-501 is enacted to read:
    
Part 5. Scope of Practice - Unlawful and Unprofessional Conduct - Penalties

         58-70a-501. Scope of practice.
        (1) A physician assistant may provide any medical services that are not specifically
    prohibited under this chapter or rules adopted under this chapter, and that are:
        (a) within the physician assistant's skills and scope of competence;
        (b) within the usual scope of practice of the physician assistant's supervising physician; and
        (c) provided under the supervision of a supervising physician and in accordance with a
    delegation of services agreement.
        (2) A physician assistant, in accordance with a delegation of services agreement, may
    prescribe or administer an appropriate controlled substance if:
        (a) the physician assistant holds a Utah controlled substance license and a DEA registration;
        (b) the prescription or administration of the controlled substance is within the prescriptive
    practice of the supervising physician and also within the delegated prescribing stated in the
    delegation of services agreement; and
        (c) the supervising physician cosigns any medical chart record of a prescription of a
    Schedule 2 or Schedule 3 controlled substance made by the physician assistant.
        (3) A physician assistant shall, while practicing as a physician assistant, wear an
    identification badge showing his license classification as a practicing physician assistant.
        (4) A physician assistant may not:
        (a) independently charge or bill a patient, or others on behalf of the patient, for services
    rendered;
        (b) identify himself to any person in connection with activities allowed under this chapter

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    other than as a physician assistant; or
        (c) use the title "doctor" or "physician," or by any knowing act or omission lead or permit
    anyone to believe he is a physician.
        (5) During the initial six months of a physician assistant's licensed practice:
        (a) the physician assistant shall work only under the direct supervision of a supervising or
    substitute supervising physician in accordance with a delegation of services agreement; and
        (b) all patient charts in which the physician assistant enters information shall be reviewed
    and countersigned by the supervising or substitute supervising physician.
        Section 12. Section 58-70a-502 is enacted to read:
         58-70a-502. Unlawful conduct.
        "Unlawful conduct" includes engaging in practice as a licensed physician assistant while not
    under the supervision of a supervising physician or substitute supervising physician.
        Section 13. Section 58-70a-503 is enacted to read:
         58-70a-503. Unprofessional conduct.
        "Unprofessional conduct" includes:
        (1) violation of a patient confidence to any person who does not have a legal right and a
    professional need to know the information concerning the patient;
        (2) knowingly prescribing, selling, giving away, or directly or indirectly administering, or
    offering to prescribe, sell, furnish, give away, or administer any prescription drug except for a
    legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
    prescribed or provided;
        (3) prescribing prescription drugs for himself or administering prescription drugs to himself,
    except those that have been legally prescribed for him by a licensed practitioner and that are used
    in accordance with the prescription order for the condition diagnosed;
        (4) failure to maintain at the practice site a delegation of services agreement that accurately
    reflects current practices; and
        (5) failure to make the delegation of services agreement available to the division for review
    upon request.

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        Section 14. Section 58-70a-504 is enacted to read:
         58-70a-504. Penalty for unlawful conduct.
        (1) Any person who violates the unlawful conduct provision defined in Subsection
    58-1-501(1)(a) is guilty of a third degree felony.
        (2) Any person who violates any of the unlawful conduct provisions defined in Subsections
    58-1-501(1)(b) through (1)(e) or Section 58-70a-502 is guilty of a class A misdemeanor.
        Section 15. Repealer.
        This act repeals:
        Section 58-70-101, Title.
        Section 58-70-102, Definitions.
        Section 58-70-201, Physician Assistant Licensing Board.
        Section 58-70-301, License -- Exceptions from licensure.
        Section 58-70-302, Qualifications for licensure.
        Section 58-70-303, Temporary license.
        Section 58-70-304, Term of license -- Expiration -- Renewal.
        Section 58-70-401, Grounds for denial of license -- Disciplinary proceedings.
        Section 58-70-501, Scope of practice -- Prohibited activities.
        Section 58-70-502, Penalty for unlawful conduct.

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