H. B. 4082
(By Delegates Everson, Martin, Douglas,
Compton, Mezzatesta, Flanigan and Stalnaker)
[Introduced Janaury 28, 1998; referred to the
Committee on Health and Human Resources then Government
Organization.]
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 certain
authorized physician assistants being permitted to pronounce
death in accordance with rules promulgated by the board of
medicine; requiring a proposed job description to be filed
with application for licensure; changing requirements for
temporary licensure; changing requirements of physician
applying to board to supervise physician assistant; and
allowing a supervising physician to supervise up to four
physician assistants.
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;
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) of this subsection and fulfills the requirements
set forth in subsection (d) of this section; 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;
(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;
(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 or its successor; and
(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 pursuant to the
provisions of article three, chapter twenty-nine-a of this code
governing the extent to which physician assistants may function
in this state. The rules shall provide that the physician
assistant is limited to the performance of those services for
which he or she is trained and that he or she performs only under
the supervision and control of a physician permanently licensed
in this state, but that 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 may not be established. In promulgating the
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
(l) of this section those categories of drugs submitted to it in
the job description required by
subsection (g) of this section.
Certain authorized physician assistants may pronounce death in
accordance with the rules proposed by the board which receive
legislative approval. The board shall compile and publish an
annual report that includes a list of currently licensed
physician assistants and their employers and location in the
state.
(c) The board shall license as a physician assistant any
person who files an application
together with a proposed job
description 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 certifying examination for a
primary care physician assistant administered by the national
commission on certification of physician assistants and has
maintained certification by that 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.
(e) The board may license as a physician assistant any
person who files an application
together with a proposed job
description 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 certifying examination for a physician assistant
administered by the national commission on certification of
physician assistants and has maintained certification by that
commission so as to be currently certified; 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.
(f) When any graduate of an approved program,
within two
years of graduation, submits an application to the board for a
physician assistant license, accompanied by a job description
in
conformity with subsection (g) of as referenced by this section,
the board shall issue to that applicant a temporary license
allowing that applicant to function as a physician assistant
until the applicant successfully passes the national commission on certification of physician assistants' certifying examination:
Provided, That
the applicant shall sit for and obtain a passing
score on the next offered examination within one year of issuance
of the temporary license the applicant shall sit for and obtain
a passing score on the examination next offered following
graduation from the approved program. No applicant shall receive
a temporary license who, following graduation from an approved
program, has sat for and not obtained a passing score on the
examination. A physician assistant who has not been certified 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.
A physician assistant who has been issued a temporary
license shall, within thirty days of receipt of written notice
from the national commission on certification of physician
assistants of his or her performance on the certifying
examination, notify the board in writing of his or her results.
In the event of failure of that examination, the temporary
license shall expire and terminate automatically, and the board
shall so notify the physician assistant in writing.
(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 the
assistant affirm that the range of medical services set forth in
the physician assistant's job description are consistent with
the skills and training of the supervising physician and the
physician assistant. Before a physician assistant can be
employed or otherwise use his or her skills, the supervising
physician
and the physician assistant must obtain approval of the
job description from the board. The board may revoke or suspend
any license of an assistant to a physician for cause, after
giving that assistant 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.
(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.
(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 the facilities.
Physician assistants employed by facilities in staff positions
shall be supervised by a permanently licensed physician.
(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 the commencement,
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 the 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.
(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.
(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 pursuant to the
provisions of article three, chapter twenty-nine-a of this code
governing the eligibility and extent to which a physician
assistant may prescribe at the direction of the supervising
physician. The rules shall include, but not be limited to, the
following:
(1) Provisions for approving a state formulary classifying
pharmacologic categories of drugs that may be prescribed by a
physician assistant:
(A) The following categories of drugs shall be excluded from
the formulary: Schedules I and II of the uniform controlled
substances act, anticoagulants, antineoplastic,
radiopharmaceuticals, general anesthetics and radiographic contrast materials;
(B) Drugs listed under Schedule III shall be limited to a
seventy-two hour supply without refill;
(C) Categories of other drugs may be excluded as determined
by the board;
(2) 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 (g) of this
section;
(3) The maximum dosage a physician assistant may prescribe;
(4) A requirement that to be eligible for 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; and
(5) A requirement that to maintain prescription privileges,
a physician assistant shall continue to maintain national
certification as a physician assistant, and in meeting the
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.
(m) A supervising physician
shall may not supervise at any
one time more than
two four physician assistants.
except that a
physician may supervise up to four hospital-employed physician
assistants
A physician assistant
shall may 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 may not perform any service that his or her
supervising physician is not qualified to perform. A physician
assistant
shall may 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.
(n) Each application for licensure submitted by a licensed
supervising physician under this section is to be accompanied by
a fee of one hundred dollars. A fee of fifty dollars is to be charged for the biennial renewal of the license. A fee of
twenty-five dollars is to be charged for any change of
supervising physician.
(o) Beginning with the biennial renewal forms completed by
physician assistants and submitted to the board in the year 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 forty hours of
continuing 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 the association or either
academy. Notwithstanding any provision of this chapter to the
contrary, failure to timely submit the required written
documentation shall result in the automatic suspension of any
license as a physician assistant until the written documentation
is submitted to and approved by the board.
(p) 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) 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 permit certain
authorized physician assistants to pronounce death in accordance
with rules promulgated by the board of medicine; require a
proposed job description to be filled by a physician assistant
with application for licensure; change requirements for temporary
licensure; change requirements of physician applying to board to
supervise physician assistant; and allowing a supervising
physician to supervise up to four physician assistants.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
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