Connecticut Seal

General Assembly

 

Raised Bill No. 300

February Session, 2018

 

LCO No. 1543

 

*01543_______PH_*

Referred to Committee on PUBLIC HEALTH

 

Introduced by:

 

(PH)

 

AN ACT CONCERNING COLLABORATIVE ARRANGEMENTS BETWEEN PHYSICIAN ASSISTANTS AND PHYSICIANS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subdivision (1) of subsection (a) of section 20-8a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(a) There shall be within the Department of Public Health a Connecticut Medical Examining Board.

(1) Said board shall consist of twenty-one members, thirteen of whom are physicians, one of whom is a physician assistant and seven of whom are public members, all of whom are appointed by the Governor, subject to the provisions of section 4-1a, as follows: Three physicians of any specialty; three physicians who are specialists in internal medicine; one physician who is a psychiatrist; one physician who is a surgeon; one physician who is an obstetrician-gynecologist; one physician who is a pediatrician; one physician who is an emergency medical physician; one physician who is a [supervising physician for] collaborating physician with one or more physician assistants; one physician who is a graduate of a medical education program accredited by the American Osteopathic Association; one physician assistant licensed pursuant to section 20-12b, as amended by this act; and seven public members.

Sec. 2. Subsection (b) of section 20-9 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(b) The provisions of this chapter shall not apply to:

(1) Dentists while practicing dentistry only;

(2) Any person in the employ of the United States government while acting in the scope of his employment;

(3) Any person who furnishes medical or surgical assistance in cases of sudden emergency;

(4) Any person residing out of this state who is employed to come into this state to render temporary assistance to or consult with any physician or surgeon who has been licensed in conformity with the provisions of this chapter;

(5) Any physician or surgeon residing out of this state who holds a current license in good standing in another state and who is employed to come into this state to treat, operate or prescribe for any injury, deformity, ailment or disease from which the person who employed such physician, or the person on behalf of whom such physician is employed, is suffering at the time when such nonresident physician or surgeon is so employed, provided such physician or surgeon may practice in this state without a Connecticut license for a period not to exceed thirty consecutive days;

(6) Any person rendering service as (A) an advanced practice registered nurse if such service is rendered in accordance with section 20-87a, or (B) an advanced practice registered nurse maintaining classification from the American Association of Nurse Anesthetists if such service is under the direction of a licensed physician;

(7) Any nurse-midwife practicing nurse-midwifery in accordance with the provisions of chapter 377;

(8) Any podiatrist licensed in accordance with the provisions of chapter 375;

(9) Any Christian Science practitioner who does not use or prescribe in his practice any drugs, poisons, medicines, chemicals, nostrums or surgery;

(10) Any person licensed to practice any of the healing arts named in section 20-1, who does not use or prescribe in his practice any drugs, medicines, poisons, chemicals, nostrums or surgery;

(11) Any graduate of any school or institution giving instruction in the healing arts who has been issued a permit in accordance with subsection (a) of section 20-11a and who is serving as an intern, resident or medical officer candidate in a hospital;

(12) Any student participating in a clinical clerkship program who has the qualifications specified in subsection (b) of section 20-11a;

(13) Any person, otherwise qualified to practice medicine in this state except that he is a graduate of a medical school located outside of the United States or the Dominion of Canada which school is recognized by the American Medical Association or the World Health Organization, to whom the Connecticut Medical Examining Board, subject to such regulations as the Commissioner of Public Health, with advice and assistance from the board, prescribes, has issued a permit to serve as an intern or resident in a hospital in this state for the purpose of extending his education;

(14) Any person rendering service as [a physician assistant licensed pursuant to section 20-12b,] a registered nurse, a licensed practical nurse or a paramedic, as defined in subdivision (15) of section 19a-175, acting within the scope of regulations adopted pursuant to section 19a-179, if such service is rendered under the supervision, control and responsibility of a licensed physician;

(15) Any person rendering service as a physician assistant, as defined in section 20-12a, as amended by this act, acting in accordance with the provisions of chapter 370;

[(15)] (16) Any student enrolled in an accredited physician assistant program or paramedic program approved in accordance with regulations adopted pursuant to section 19a-179, who is performing such work as is incidental to his course of study;

[(16)] (17) Any person who, on June 1, 1993, has worked continuously in this state since 1979 performing diagnostic radiology services and who, as of October 31, 1997, continued to render such services under the supervision, control and responsibility of a licensed physician solely within the setting where such person was employed on June 1, 1993;

[(17)] (18) Any person practicing athletic training, as defined in section 20-65f;

[(18)] (19) When deemed by the Connecticut Medical Examining Board to be in the public's interest, based on such considerations as academic attainments, specialty board certification and years of experience, to a foreign physician or surgeon whose professional activities shall be confined within the confines of a recognized medical school;

[(19)] (20) Any technician engaging in tattooing in accordance with the provisions of section 20-266o or 20-266p and any regulations adopted thereunder;

[(20)] (21) Any person practicing perfusion, as defined in section 20-162aa;

[(21)] (22) Any foreign physician or surgeon (A) participating in supervised clinical training under the direct supervision and control of a physician or surgeon licensed in accordance with the provisions of this chapter, and (B) whose professional activities are confined to a licensed hospital that has a residency program accredited by the Accreditation Council for Graduate Medical Education or that is a primary affiliated teaching hospital of a medical school accredited by the Liaison Committee on Medical Education. Such hospital shall verify that the foreign physician or surgeon holds a current valid license in another country; or

[(22)] (23) Any person practicing as a nuclear medicine technologist, as defined in section 20-74uu, while performing under the supervision and direction of a physician licensed in accordance with the provisions of this chapter.

Sec. 3. Section 20-12a of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

As used in sections 20-12a to 20-12g, inclusive:

(1) "Accredited physician assistant program" means a physician assistant program accredited, at the time of the applicant's graduation, by the Committee on Allied Health Education and Accreditation of the American Medical Association, the Commission on Accreditation of Allied Health Education Programs or such successor organization for the accreditation of physician assistant programs as may be approved by the department.

(2) "Board" means the Connecticut Medical Examining Board, established pursuant to section 20-8a, as amended by this act.

(3) "Collaboration" means the continuous process by which a physician assistant and one or more physicians who have training or experience related to the work of such physician assistant jointly contribute to the provision of health care services and medical treatment to a patient. "Collaboration" includes a reasonable and appropriate level of consultation and referral, coverage by the physician in the absence of the physician assistant, review of patient outcomes, disclosure of the collaborative relationship to the patient and exercise of prescriptive authority by the physician assistant, provided the physician expresses, in writing, the (A) type of schedule II and III controlled substances that the physician assistant may prescribe, and (B) methods by which the physician and physician assistant will review medical therapeutics, corrective measures, laboratory tests and other diagnostic procedures that the physician assistant may prescribe, dispense and administer.

[(3)] (4) "Department" means the Department of Public Health.

[(4)] (5) "National commission" means the National Commission on Certification of Physician Assistants or a successor organization for the certification or recertification of physician assistants that may be approved by the department.

[(5)] (6) "Physician assistant" means an individual who: (A) Functions in a [dependent] collaborative relationship with [a physician] one or more physicians licensed pursuant to this chapter; and (B) is licensed pursuant to section 20-12b, as amended by this act, to provide patient services [under the supervision, control, responsibility and direction of said physician] in collaboration with one or more physicians licensed pursuant to this chapter.

[(6) "Supervising physician" means a physician licensed pursuant to this chapter who assumes responsibility for the supervision of services rendered by a physician assistant.

(7) (A) "Supervision" in hospital settings means the exercise by the supervising physician of oversight, control and direction of the services of a physician assistant. Supervision includes but is not limited to: (i) Continuous availability of direct communication either in person or by radio, telephone or telecommunications between the physician assistant and the supervising physician; (ii) active and continuing overview of the physician assistant's activities to ensure that the supervising physician's directions are being implemented and to support the physician assistant in the performance of his or her services; (iii) personal review by the supervising physician of the physician assistant's practice on a regular basis as necessary to ensure quality patient care in accordance with a written delegation agreement, as described in subsection (a) of section 20-12d, as amended by this act; (iv) review of the charts and records of the physician assistant on a regular basis as necessary to ensure quality patient care; (v) delineation of a predetermined plan for emergency situations; and (vi) designation of an alternate licensed physician in the absence of the supervising physician.

(B) "Supervision" in settings other than hospital settings means the exercise by the supervising physician of oversight, control and direction of the services of a physician assistant. Supervision includes, but is not limited to: (i) Continuous availability of direct communication either in person or by radio, telephone or telecommunications between the physician assistant and the supervising physician; (ii) active and continuing overview of the physician assistant's activities to ensure that the supervising physician's directions are being implemented and to support the physician assistant in the performance of his or her services; (iii) personal review by the supervising physician of the physician assistant's services at a facility or practice location where the physician assistant or supervising physician performs services, in accordance with a written delegation agreement, as described in subsection (a) of section 20-12d, as amended by this act, to ensure quality patient care; (iv) review of the charts and records of the physician assistant on a regular basis as necessary to ensure quality patient care and written documentation by the supervising physician of such review at the facility or practice location where the physician assistant or supervising physician performs services; (v) delineation of a predetermined plan for emergency situations; and (vi) designation of an alternate licensed physician in the absence of the supervising physician.]

Sec. 4. Subsection (b) of section 20-12b of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(b) The department may, upon receipt of a fee of one hundred fifty dollars, issue a temporary permit to an applicant who (1) is a graduate of an accredited physician assistant program; (2) has completed not less than sixty hours of didactic instruction in pharmacology for physician assistant practice approved by the department; and (3) if applying for such permit on and after September 30, 1991, holds a baccalaureate or higher degree in any field from a regionally accredited institution of higher education. Such temporary permit shall authorize the holder to practice as a physician assistant only in those settings where [the supervising] a collaborating physician is physically present on the premises and is immediately available to the physician assistant when needed, but shall not authorize the holder to prescribe or dispense drugs. Such temporary permit shall be valid for a period not to exceed one hundred twenty calendar days after the date of graduation and shall not be renewable. Such permit shall become void and shall not be reissued in the event that the applicant fails to pass a certification examination scheduled by the national commission following the applicant's graduation from an accredited physician assistant program. Violation of the restrictions on practice set forth in this subsection may constitute a basis for denial of licensure as a physician assistant.

Sec. 5. Section 20-12c of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(a) Each physician assistant [practicing in this state or] participating in a resident physician assistant program shall have a clearly identified supervising physician who maintains the final responsibility for the care of patients and the performance of the physician assistant.

[(b) A physician may function as a supervising physician for as many physician assistants as is medically appropriate under the circumstances, provided (1) the supervision is active and direct, and (2) the physician is supervising not more than six full-time physician assistants concurrently, or the part-time equivalent thereof.]

[(c)] (b) Nothing in this chapter shall be construed to [prohibit the employment of physician assistants in a hospital or other health care facility where such physician assistants function under the direction of a supervising physician] limit the employment arrangement of a physician assistant.

[(d)] (c) Nothing in this chapter shall be construed to prohibit a licensed physician assistant who is (1) part of the Connecticut Disaster Medical Assistance Team or the Medical Reserve Corps, under the auspices of the Department of Public Health, or the Connecticut Urban Search and Rescue Team, under the auspices of the Department of Emergency Services and Public Protection, and is engaged in officially authorized civil preparedness duty or civil preparedness training conducted by such team or corps, or (2) licensed in another state as a physician assistant or its equivalent and is an active member of the Connecticut Army or Air National Guard, from providing patient services [under the supervision, control, responsibility and direction of a licensed physician] with a collaborating physician.

Sec. 6. Subsection (a) of section 20-12d of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(a) A physician assistant who has complied with the provisions of sections 20-12b, as amended by this act, and 20-12c, as amended by this act, may [perform medical functions delegated by a supervising physician when: (1) The supervising physician is satisfied as to the ability and demonstrated competency of the physician assistant; (2) such delegation is consistent with the health and welfare of the patient and in keeping with sound medical practice; and (3) such functions are performed under the oversight, control and direction of the supervising physician. The functions that may be performed under such delegation are those that are within the scope of the supervising physician's license, within the scope of such physician's competence as evidenced by such physician's postgraduate education, training and experience and within the normal scope of such physician's actual practice. Delegated functions shall be implemented in accordance with a written delegation agreement between the supervising physician and the physician assistant. A supervising physician shall establish the terms of a written delegation agreement that shall include, but not be limited to: (A) A description of the professional relationship between the supervising physician and the physician assistant; (B) identification of the medical services that the physician assistant may perform; (C) a description of the manner in which the physician assistant's prescribing of controlled substances shall be documented in the patient's medical record; and (D) a description of the process for the supervising physician to evaluate the physician assistant's performance, including, but not limited to (i) the frequency with which the supervising physician intends to personally review the physician assistant's practice and performance of delegated medical services, and (ii) a description of the manner in which, and the frequency with which, the supervising physician intends to review the physician assistant's prescription and administration of controlled substances in schedule II or III. A supervising physician in a hospital setting shall reference or include applicable hospital policies, protocols and procedures in the written delegation agreement. The supervising physician shall review the written delegation agreement not less than annually and shall revise such written delegation agreement as the supervising physician deems necessary to reflect any change in the professional relationship between the supervising physician and the physician assistant, the medical services that the physician assistant is authorized to perform or the process for the supervising physician to evaluate the physician assistant's performance. A physician assistant may, as delegated by the supervising physician within the scope of such physician's license, (I) prescribe and administer drugs, including controlled substances in schedule IV or V in all settings, (II) renew prescriptions for controlled substances in schedule II, III, IV or V in all settings, (III) prescribe and administer controlled substances in schedule II or III in all settings, provided in all cases where the physician assistant prescribes a controlled substance in schedule II or III, the physician under whose supervision the physician assistant is prescribing shall document such physician's approval of the order in the patient's medical record in the manner prescribed in the written delegation agreement, and (IV) prescribe and approve the use of durable medical equipment. The physician assistant may, as delegated by the supervising physician within the scope of such physician's license, request, sign for, receive and dispense drugs to patients, in the form of professional samples, as defined in section 20-14c, or when dispensing in an outpatient clinic as defined in the regulations of Connecticut state agencies and licensed pursuant to subsection (a) of section 19a-491 that operates on a not-for-profit basis, or when dispensing in a clinic operated by a state agency or municipality. Nothing in this subsection shall be construed to allow the physician assistant to request, sign for, receive or dispense any drug the physician assistant is not authorized under this subsection to prescribe] in all settings, as delineated by agreement and in collaboration with one or more physicians licensed pursuant to chapter 370, (1) prescribe, dispense and administer medical and surgical therapeutics, corrective measures and medical devices, and (2) request, sign for, receive and dispense drugs in the form of professional samples in accordance with the provisions of sections 20-14c to 20-14e, inclusive. Nothing in this section, sections 20-12a to 20-12c, inclusive, as amended by this act, or sections 20-12e to 20-12i, inclusive, shall be construed to require the physical presence of such physician or physicians at the time and place at which the physician assistant performs the functions delineated in subdivisions (1) and (2) of this subsection.

This act shall take effect as follows and shall amend the following sections:

Section 1

October 1, 2018

20-8a(a)(1)

Sec. 2

October 1, 2018

20-9(b)

Sec. 3

October 1, 2018

20-12a

Sec. 4

October 1, 2018

20-12b(b)

Sec. 5

October 1, 2018

20-12c

Sec. 6

October 1, 2018

20-12d(a)

Statement of Purpose:

To allow physician assistants to collaborate with physicians.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]