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House Bill 2248 History
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ENGROSSED
H. B. 2248
(By Delegates P. White, Brown, S. Cook, Huntwork,
Douglas and Phillips)
[Introduced February 23, 1993; referred to the
Committee on Health and Human Resources.]
A BILL to amend and reenact section sixteen, article three,
chapter thirty of the code of West Virginia, one thousand
nine hundred thirty-one, as amended, relating to physician
assistant-midwives.
Be it enacted by the Legislature of West Virginia:
That section sixteen, article three, chapter thirty of the
code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 3. WEST VIRGINIA MEDICAL PRACTICE ACT.
§30-3-16. Physician assistants; definitions; board of medicine
rules; annual report; licensure; temporary license;
relicensure; job description required; revocation
or suspension of licensure; responsibilities of
supervising physician; legal responsibility for
physician assistants; reporting by health care
facilities; identification; limitations on
employment and duties; fees; unlawful use of title
of "physician assistant"; continuing education;
unlawful representation of physician assistant as
a physician; criminal penalties.
(a) As used in this section:
(1) "Physician assistant" means an assistant to a physician
who is a graduate of an approved program of instruction in
primary health care or surgery, has attained a baccalaureate or
master's degree, has passed the national certification
examination and is qualified to perform direct patient care
services under the supervision of a physician;
(2) "Physician assistant-midwife" means a physician
assistant who meets all qualifications set forth under
subdivision (1) above and fulfills the requirements set forth in
subsection (d); is subject to all provisions of this section; and
assists in the management and care of a woman and her infant
during the prenatal, delivery and postnatal periods;
(2) (3) "Supervising physician" means a doctor or doctors of
medicine or podiatry permanently licensed in this state who
assume legal and supervisory responsibility for the work or
training of any physician assistant under his or her supervision;
(3) (4) "Approved program" means an educational program for
physician assistants approved and accredited by the committee on
allied health education and accreditation on behalf of the
American Medical Association; and
(4) (5) "Health care facility" means any licensed hospital,
nursing home, extended care facility, state health or mental
institution, clinic or physician's office.
(b) The board shall promulgate rules governing the extent to
which physician assistants may function in this state. Such
rules shall provide that the physician assistant is limited to
the performance of those services for which he or she is trainedand that he or she performs only under the supervision and
control of a physician permanently licensed in this state, but
such supervision and control does not require the personal
presence of the supervising physician at the place or places
where services are rendered if the physician assistant's normal
place of employment is on the premises of the supervising
physician. The supervising physician may send the physician
assistant off the premises to perform duties under his or her
direction, but a separate place of work for the physician
assistant shall not be established. In promulgating such rules,
the board shall allow the physician assistant to perform those
procedures and examinations and in the case of certain authorized
physician assistants to prescribe at the direction of his or her
supervising physician in accordance with subsection (k) (l) of
this section those categories of drugs submitted to it in the job
description required by subsection (f) (g) of this section. The
board shall compile and publish a biennial report that includes
a list of currently licensed physician assistants and their
employers and location in the state; a list of approved programs;
the number of graduates of such approved programs each year; and
the number of physician assistants from other states practicing
in this state.
(c) The board shall license as a physician assistant any
person who files an application and furnishes satisfactory
evidence to it that he or she has met the following standards:
(1) He or she is a graduate of an approved program of
instruction in primary health care or surgery;
(2) He or she has passed the examination for a primary carephysician assistant administered by the National Board of Medical
Examiners on behalf of the National Commission on Certification
of Physician Assistants and has maintained certification by said
commission so as to be currently certified;
(3) He or she is of good moral character; and
(4) He or she has attained a baccalaureate or master's
degree.
(d) The board shall license as a physician assistant-midwife
any person who meets the standards set forth under subsection (c)
of this section and, in addition thereto, the following
standards:
(1) He or she is a graduate of a school of midwifery
accredited by the American college of nurse-midwives;
(2) He or she has passed an examination approved by the
board;
(3) He or she practices midwifery under the supervision of
a board certified obstetrician, gynecologist or a board certified
family practice physician who routinely practices obstetrics.
(d) (e) The board may license as a physician assistant any
person who files an application and furnishes satisfactory
evidence that he or she is of good moral character and meets
either of the following standards:
(1) He or she is a graduate of an approved program of
instruction in primary health care or surgery prior to the first
day of July, one thousand nine hundred ninety-four, and has
passed the examination for a primary care physician assistant
administered by the National Board of Medical Examiners on behalf
of the National Commission on Certification of PhysicianAssistants; or
(2) He or she had been certified by the board as a physician
assistant then classified as "Type B," prior to the first day of
July, one thousand nine hundred eighty-three.
Licensure of an assistant to a physician practicing the
specialty of ophthalmology is permitted under this section:
Provided,
That a physician assistant may not dispense a
prescription for a refraction.
(e) (f) When any graduate of an approved program, within two
years of graduation, submits an application to the board,
accompanied by a job description in conformity with subsection
(f) (g) of this section, for a physician assistant license, the
board shall issue to such applicant a temporary license allowing
such applicant to function as a physician assistant for the
period of one year. Said temporary certificate may be renewed
for one additional year upon the request of the supervising
physician. A physician assistant who has not been certified as
such by the National Board of Medical Examiners on behalf of the
National Commission on Certification of Physician Assistants will
be restricted to work under the direct supervision of the
supervising physician.
(f) (g) Any physician applying to the board to supervise a
physician assistant shall provide a job description that sets
forth the range of medical services to be provided by such
assistant. Before a physician assistant can be employed or
otherwise use his or her skills, the supervising physician must
obtain approval of the job description from the board. The board
may revoke or suspend any license of an assistant to a physicianfor cause, after giving such person an opportunity to be heard in
the manner provided by article five of chapter twenty-nine-a of
this code and as set forth in rules duly adopted by the board.
(g) (h) The supervising physician is responsible for
observing, directing and evaluating the work, records and
practices of each physician assistant performing under his or her
supervision. He or she shall notify the board in writing of any
termination of his or her supervisory relationship with a
physician assistant within ten days of the termination. The
legal responsibility for any physician assistant remains with the
supervising physician at all times, including occasions when the
assistant under his or her direction and supervision, aids in the
care and treatment of a patient in a health care facility. In
his or her absence, a supervising physician must designate an
alternate supervising physician, however, the legal
responsibility remains with the supervising physician at all
times. A health care facility is not legally responsible for the
actions or omissions of the physician assistant unless the
physician assistant is an employee of the facility.
(h) (i) The acts or omissions of a physician assistant
employed by health care facilities providing inpatient or
outpatient services shall be the legal responsibility of said
facilities. Physician assistants employed by such facilities in
staff positions shall be supervised by a permanently licensed
physician.
(i) (j) A health care facility shall report in writing to
the board within sixty days after the completion of the
facility's formal disciplinary procedure, and also after thecommencement, and again after the conclusion, of any resulting
legal action, the name of any physician assistant practicing in
the facility whose privileges at the facility have been revoked,
restricted, reduced or terminated for any cause including
resignation, together with all pertinent information relating to
such action. The health care facility shall also report any
other formal disciplinary action taken against any physician
assistant by the facility relating to professional ethics,
medical incompetence, medical malpractice, moral turpitude or
drug or alcohol abuse. Temporary suspension for failure to
maintain records on a timely basis or failure to attend staff or
section meetings need not be reported.
(j) (k) When functioning as a physician assistant, the
physician assistant shall wear a name tag that identifies him or
her as a physician assistant. A two and one-half by three and
one-half inch card of identification shall be furnished by the
board upon licensure of the physician assistant.
(k) (l) A physician assistant may write or sign
prescriptions or transmit prescriptions by word of mouth,
telephone or other means of communication at the direction of his
or her supervising physician. The board shall promulgate rules
governing the eligibility and extent to which such a physician
assistant may prescribe at the direction of the supervising
physician. The rules shall provide for a state formulary
classifying pharmacologic categories of drugs which may be
prescribed by such a physician assistant. In classifying such
pharmacologic categories, those categories of drugs which shall
be excluded shall include, but not be limited to, Schedules I and II of the Uniform Controlled Substances Act,
anticoagulants, antineoplastics, radiopharmaceuticals, general
anesthetics, and radiographic contrast materials. Drugs listed
under Schedule III shall be limited to a seventy-two hour supply
without refill. The regulations shall provide that all
pharmacological categories of drugs to be prescribed by a
physician assistant shall be listed in each job description
submitted to the board as required in subsection (f) (g) of this
section. The rules shall provide the maximum dosage a physician
assistant may prescribe. The rule shall also provide that to be
eligible for such prescription privileges, a physician assistant
shall have performed patient care services for a minimum of two
years immediately preceding the submission to the board of the
job description containing prescription privileges and shall have
successfully completed an accredited course of instruction in
clinical pharmacology approved by the board. The regulations
shall also provide that to maintain prescription privileges, a
physician assistant shall continue to maintain national
certification as a physician assistant, and in meeting such
national certification requirements shall complete a minimum of
ten hours of continuing education in rational drug therapy in
each certification period. Nothing in this subsection shall be
construed to permit a physician assistant to independently
prescribe or dispense drugs.
(l) (m) A supervising physician shall not supervise at any
one time more than two physician assistants, except that a
physician may supervise up to four hospital-employed physician
assistants.
A physician assistant shall not sign any prescription,
except in the case of an authorized physician assistant at the
direction of his or her supervising physician in accordance with
the provisions of subsection (l) of this section. A physician
assistant shall not perform any service that his or her
supervising physician is not qualified to perform. A physician
assistant shall not perform any service that is not included in
his or her job description and approved by the board as provided
for in this section.
The provisions of this section do not authorize any
physician assistant to perform any specific function or duty
delegated by this code to those persons licensed as
chiropractors, dentists, dental hygienists, optometrists or
pharmacists or certified as nurse anesthetists.
(m) (n) Each application for licensure submitted by a
licensed supervising physician under this section shall be
accompanied by a fee of one hundred dollars. A fee of fifty
dollars shall be charged for the biennial renewal of the license.
A fee of twenty-five dollars shall be charged for any change of
supervising physician.
(n) (o) Beginning with the biennial renewal forms completed
by physician assistants and submitted to the board in one
thousand nine hundred ninety-three, as a condition of renewal of
physician assistant license, each physician assistant shall
provide written documentation pursuant to rules promulgated by
the board in accordance with chapter twenty-nine-a of this code
of participation in and successful completion during the
preceding two-year period of a minimum of either forty hours ofcontinuing education designated as Category I by the American
Medical Association, American Academy of Physician Assistants or
the Academy of Family Physicians, and sixty hours of continuing
education designated as Category II by such association or either
academy. Notwithstanding any provision of this chapter to the
contrary, failure to timely submit such required written
documentation shall result in the automatic suspension of any
license as a physician assistant until such time as the written
documentation is submitted to and approved by the board.
(o) (p) It is unlawful for any person who is not licensed by
the board as a physician assistant to use the title of "physician
assistant" or to represent to any other person that he or she is
a physician assistant. Any person who violates the provisions of
this subsection is guilty of a misdemeanor, and, upon conviction
thereof, shall be fined not more than two thousand dollars.
(p) (q) It is unlawful for any physician assistant to
represent to any person that he or she is a physician, surgeon or
podiatrist. Any person who violates the provisions of this
subsection is guilty of a felony, and, upon conviction thereof,
shall be imprisoned in the penitentiary for not less than one nor
more than two years, or be fined not more than two thousand
dollars, or both fined and imprisoned.
(q) (r) All physician assistants holding valid certificates
issued by the board prior to the first day of July, one thousand
nine hundred ninety-two, shall be considered to be licensed under
this section.
NOTE: The purpose of this bill is to include physician
assistant-midwives in the criteria for licensed physician
assistants and to set forth the standards under which a person
may be licensed by the board of medicine as a physician
assistant-midwife.
HEALTH & HUMAN RESOURCES COMMITTEE AMENDMENT
On page four, line 20, by striking out the word "approved"
and inserting in lieu thereof the word "accredited".
And,
On page four, line 21, by striking out the word
"nurse-midwifery;" and inserting in lieu thereof
"nurse-midwives;".