Bill Text: GA HB303 | 2011-2012 | Regular Session | Comm Sub
Bill Title: Physician assistants; delegation of authority by a physician; revise provisions
Spectrum: Moderate Partisan Bill (Republican 6-1)
Status: (Passed) 2011-07-01 - Effective Date [HB303 Detail]
Download: Georgia-2011-HB303-Comm_Sub.html
11 LC
33 4113S
House
Bill 303 (COMMITTEE SUBSTITUTE)
By:
Representatives Cooper of the
41st,
McCall of the
30th,
Hembree of the
67th,
Dobbs of the
53rd,
Shaw of the
176th,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia
Annotated, relating to medical practice, so as to revise provisions relating to
delegation of authority to a nurse or physician assistant by a physician; to
authorize advanced practice registered nurses to sign off on certain documents
relating to health care; to amend Article 4 of Chapter 34 of Title 43 of the
Official Code of Georgia Annotated, relating to physician assistants, so as to
revise provisions relating to delegation of authority to a physician assistant
by a physician; to authorize physician assistants to sign off on certain
documents relating to health care; to revise a provision relating to a
requirement that a supervising physician periodically see a patient; to provide
for related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Article
2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating
to medical practice, is amended in Code Section 43-34-23, relating to delegation
of authority to a nurse or physician assistant, by revising paragraph (1)
subsection (b) as follows:
"(b)(1)(A)
A physician may delegate
the authority
contained in subparagraph (B) of this
paragraph to:
(A)(i)
A physician assistant in accordance with a job description; or
(B)(ii)
A nurse recognized by the Georgia Board of Nursing as a certified nurse midwife,
certified registered nurse anesthetist, certified nurse practitioner, or
clinical nurse specialist, psychiatric/mental health in accordance with a nurse
protocol.
(B)
A physician may delegate to those health care professionals identified in
subparagraph (A) of this paragraph:
(i)
The
the
authority to order controlled substances selected from a formulary of such drugs
established by the board and the authority to order dangerous drugs, medical
treatments, and diagnostic
studies;
(ii)
The authority to request, receive, and sign for professional samples and to
distribute professional samples to patients. The office or facility at which
the health care professional identified in subparagraph (A) of this paragraph is
working shall maintain a general list of the professional samples approved by
the delegating physician for request, receipt, and distribution by the health
care professional identified in subparagraph (A) of this paragraph as well as a
complete list of the specific number and dosage of each professional sample and
medication voucher received. Professional samples that are distributed by a
health care professional identified in subparagraph (A) of this paragraph shall
be so noted in the patient's medical record. In addition to the requirements of
this Code section, all professional samples shall be maintained as required by
applicable state and federal laws and regulations; and
(iii)
The authority to sign, certify, and endorse all documents relating to health
care provided to a patient within his or her scope of authorized practice,
including, but not limited to, documents relating to physical examination forms
of all state agencies and verification and evaluation forms of the Department of
Human Services, the State Board of Education, local boards of education, the
Department of Community Health, and the Department of Corrections; provided,
however, that a health care professional identified in subparagraph (A) of this
paragraph shall not have the authority to sign death certificates or assign a
percentage of a disability
rating."
SECTION
2.
Said
article is further amended in Code Section 43-34-25, relating to delegation of
certain acts to an advanced practice registered nurse, by revising subsection
(e) and by adding a new subsection to read as follows:
"(e)
An advanced practice registered nurse may be authorized under a nurse protocol
agreement to request, receive, and sign for professional samples and may
distribute professional samples to patients. The office or facility at which
the advanced practice registered nurse is working shall maintain a
general
list of the professional samples approved by the delegating physician for
request, receipt, and distribution by the advanced practice registered nurse as
well as a complete list of the specific number and dosage of each professional
sample and medication voucher received
and
dispensed.
Professional
samples that are distributed by an advanced practice registered nurse shall be
so noted in the patient's medical record.
In addition to the requirements of this Code section, all professional samples
shall be maintained as required by applicable state and federal laws and
regulations.
(e.1)
Except for death certificates and assigning a percentage of a disability rating,
an advanced practice registered nurse may be delegated the authority to sign,
certify, and endorse all documents relating to health care provided to a patient
within his or her scope of authorized practice, including, but not limited to,
documents relating to physical examination forms of all state agencies and
verification and evaluation forms of the Department of Human Services, the State
Board of Education, local boards of education, the Department of Community
Health, and the Department of
Corrections."
SECTION
3.
Article
4 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating
to physician assistants, is amended in Code Section 43-34-103, relating to
licensure and regulation of physician assistants, by revising subsections (e.1)
and (e.2) and by adding a new subsection to read as follows:
"(e.1)(1)
In addition to and without limiting the authority granted by Code Section
43-34-23, a physician may delegate to a physician assistant, in accordance with
a job description, the authority to issue a prescription drug order or orders
for any device as defined in Code Section
26-4-5,
or to issue any dangerous drug as defined in Code Section 16-13-71 or any
Schedule III, IV, or V controlled substance as defined in Code Section 16-13-21
on a prescription drug order or prescription device order form as specified in
paragraph (3) of this subsection. Delegation of such authority shall be
contained in the job description required by this Code section. The delegating
physician shall remain responsible for the medical acts of the physician
assistant performing such delegated acts and shall adequately supervise the
physician assistant. If an existing job description for a physician assistant
does not contain such authority to order a prescription drug or device order as
provided by this subsection, that physician assistant may not issue any such
prescription drug or device order until a new job description delegating such
authority is submitted to and approved by the board. Nothing in this Code
section shall be construed to authorize the written prescription drug order of a
Schedule I or II controlled substance.
(2)
Nothing in this subsection shall be construed to create a presumption of
liability, either civil or criminal, on the part of a pharmacist who is duly
licensed under Title 26 and who in good faith fills a prescription drug or
device order presented by a patient pursuant to this subsection. The pharmacist
shall presume that the prescription drug or device order was issued by a
physician assistant duly licensed under this article who has qualified under
this Code section to prescribe pharmaceutical agents. The pharmacist shall also
presume that the pharmaceutical agent prescribed by the physician assistant is
an approved pharmaceutical agent, unless the pharmacist has actual or
constructive knowledge to the contrary.
(3)
The physician assistant shall only be authorized to exercise the rights granted
under this subsection using a prescription drug or device order form which
includes the name, address, and telephone number of the prescribing supervising
or alternate supervising physician, the patient's name and address, the drug or
device prescribed, the number of refills, and directions to the patient with
regard to the taking and dosage of the drug. A prescription drug order which is
transmitted either electronically or via facsimile shall conform to the
requirements set out in paragraphs (1) and (2) of subsection (c) of Code Section
26-4-80, respectively. Any form containing less information than that described
in this paragraph shall not be offered to or accepted by any pharmacist who is
duly licensed under Title 26.
(4)
The physician assistant or office staff shall notify the patient that the
patient has the right to see the physician prior to any prescription drug or
device order being issued by the physician assistant.
(5)
Nothing in this Code section shall be construed to authorize a physician
assistant to authorize refills of any drug for more than 12 months from the date
of the original prescription drug or device order.
(6)
A supervising physician or alternate supervising physician shall evaluate or
examine, at least every three months, any patient receiving controlled
substances.
(7)
In addition to the copy of the prescription drug or device order delivered to
the patient, a record of such prescription shall be maintained in the patient's
medical record in the following manner:
(A)
The physician assistant carrying out a prescription drug or device order shall
document such order either in writing or by electronic means; and
(B)
Except in facilities operated by the Division of Public Health of the Department
of Community Health, the supervising physician shall review the prescription
drug or device order copy and medical record entry for prescription drug or
device orders issued within the past 30 days by the physician assistant. Such
review may be achieved with a sampling of no less than 50 percent of such
prescription drug or device order copies and medical record
entries.
(8)
A physician assistant is not permitted to prescribe drugs or devices except as
authorized in the physician assistant's job description and in accordance with
this article.
(9)
The board shall adopt rules establishing procedures to evaluate an application
for a job description containing the authority to order a prescription drug or
device and any other rules the board deems necessary or appropriate
to regulate
the practice of physician assistants, to
carry out the intent and purpose of this
Code
section
article,
or to protect the public welfare.
(10)
Nothing in this Code section is intended to repeal any rules established by the
board relating to the requirements and duties of physician assistants in remote
practice sites.
(11)(10)
A physician assistant authorized by a primary supervising physician to order
controlled substances pursuant to this Code section is authorized to register
with the federal Drug Enforcement Administration.
(12)(11)
A physician assistant delegated the authority by the primary supervising
physician to issue a prescription drug or device order shall be required to
complete a minimum of three hours of continuing education biennially in practice
specific pharmaceuticals in which the physician assistant has prescriptive order
privileges.
(12)
A managed care system, health plan, hospital, insurance company, or other
similar entity shall not require a physician to be a party to a job description
as a condition for participation in or reimbursement from such
entity.
(e.2)
A physician assistant
shall
may
be
allowed
delegated the
authority to request, receive, and sign
for professional samples and may distribute professional samples to
patients,
pursuant to authority delegated by the supervising physician of that physician
assistant. Delegation
so long as
delegation of such authority
shall
be
is
contained in
the
a
job description
required by
this Code section; provided, however, the
and the
professional samples are within the specialty of the supervising physician.
The office or facility at which the
physician assistant is working must maintain a
general
list of professional samples approved by the supervising physician for request,
receipt, and distribution by the physician assistant as well as a complete list
of the specific number and dosage of each professional sample received
and
dispensed.
Professional
samples that are distributed by a physician assistant shall be so noted in the
patient's medical record. In addition to
the requirements of this Code section, all professional samples shall be
maintained as required by applicable state and federal law and regulations. As
used in this subsection, the term 'professional samples' means complimentary
doses of a drug, medication vouchers, or medical devices provided by the
manufacturer for use in patient care."
"(l)
Except for death certificates and assigning a percentage of a disability rating,
a physician assistant may be delegated the authority to sign, certify, and
endorse all documents relating to health care provided to a patient within his
or her scope of authorized practice, including, but not limited to, documents
relating to physical examination forms of all state agencies and verification
and evaluation forms of the Department of Human Services, the State Board of
Education, local boards of education, the Department of Community Health, and
the Department of
Corrections."
SECTION
4.
Said
article is further amended by revising Code Section 43-34-109, relating to the
requirement for a patient to see a physician periodically, as
follows:
"43-34-109.
If
When
a patient receives medical services from a physician
assistant, the
supervising physician's involvement in the patient's care, including patient
evaluation and follow-up care by the supervising physician, shall be appropriate
to the nature of the practice and the acuity of the patient's medical issue, as
determined by the supervising physician
more than
two times in a 12 month period, the primary or alternate supervising physician
shall see such patient on no less than one following visit by the patient during
the same 12 month
period."
SECTION
5.
All
laws and parts of laws in conflict with this Act are repealed.