ENGROSSED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 133
(By Senators Manchin, Miller, Ross, Scott,
Oliverio and Plymale)
___________
[Originating in the Committee on Health and Human Resources;
reported February 15, 1996.]
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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 the
approval of educational programs for physician assistants by
the successor organization to the committee on allied health
education and accreditation of the American medical
association; changing biennial reporting to an annual
report; adding current certification by the national
commission on certification of physician assistants for
licensure; changing the name of the certifying examination
for physician assistants; changing requirements for
temporary licensure; terminating temporary licensure upon
failure of the national commission on certification of physician assistants examination; and deleting conflicting
language regarding a criminal penalty for misrepresentation
as a physician assistant.
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 above 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. Such 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 such 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 not be established. In promulgating such 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.
The board shall compile and publish a biennial an annual 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 certifying examination for a
primary care physician 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 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 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 primary care physician
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 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 this section, for a physician
assistant license, the board shall issue to such that applicant
a temporary license allowing such that applicant to function as
a physician assistant for the period of one year 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. 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.
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 such the
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 physician
for cause, after giving such person 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 said the
facilities. Physician assistants employed by such 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 such 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 such a physician
assistant may prescribe at the direction of the supervising
physician. The rules shall provide for a include, but not be
limited to, the following:
(1) Provisions for approving a state formulary classifying
pharmacologic categories of drugs which that 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,
(A) The following categories of drugs shall be excluded from
the formulary: Schedules I and II of the uniform controlled substances act, anticoagulants, antineoplastics,
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) The regulations shall provide that all 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 rules shall provide the The maximum dosage a
physician assistant may prescribe;
(4) The rule shall also provide that A requirement 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; and
(5) The regulations shall also provide A requirement that to
maintain prescription privileges, a physician assistant shall continue to maintain national certification as a physician
assistant, and in meeting such 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 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.
(n) Each application for licensure submitted by a licensed
supervising physician under this section shall is to be
accompanied by a fee of one hundred dollars. A fee of fifty
dollars shall is to be charged for the biennial renewal of the
license. A fee of twenty-five dollars shall 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 such the association or
either academy. Notwithstanding any provision of this chapter to
the contrary, failure to timely submit such the 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.
(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.
(q) (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.
(r) (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.