Bill Text: OR SB224 | 2011 | Regular Session | Enrolled

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Bill Title: Relating to physician assistants; and declaring an emergency.

Spectrum: Slight Partisan Bill (Democrat 7-3)

Status: (Passed) 2011-06-30 - Effective date, June 28, 2011. [SB224 Detail]

Download: Oregon-2011-SB224-Enrolled.html

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     76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session

                            Enrolled

                         Senate Bill 224

Sponsored by Senator MONNES ANDERSON; Senators BATES, COURTNEY,
  KRUSE, Representatives COWAN, GREENLICK, KENNEMER, NATHANSON,
  ROBLAN, THOMPSON (Presession filed.)

                     CHAPTER ................

                             AN ACT

Relating to physician assistants; creating new provisions;
  amending ORS 677.097, 677.495, 677.500, 677.510, 677.512,
  677.515, 677.535 and 677.545; and declaring an emergency.

Be It Enacted by the People of the State of Oregon:

  SECTION 1. ORS 677.495, as amended by section 1, chapter 43,
Oregon Laws 2010, is amended to read:
  677.495. As used in ORS 677.495 to 677.545, unless the context
requires otherwise:
    { - (1) 'Agent' means a physician designated by the
supervising physician of a physician assistant who supervises the
medical services of the physician assistant for a predetermined
period of time. - }
    { - (2) 'Committee' means the Physician Assistant Committee
created in ORS 677.540. - }
    { - (3) - }   { + (1) + } 'Physician assistant' means a
person who is licensed in accordance with ORS 677.505 to 677.525.
   { +  (2) 'Practice agreement' means a written agreement
between a physician assistant and a supervising physician or
supervising physician organization that describes the manner in
which the services of the physician assistant will be used. + }
    { - (4) - }   { + (3) + } 'Supervising physician' means a
physician licensed to practice medicine under this chapter who
supervises a physician assistant.
    { - (5) - }   { + (4) + } 'Supervising physician
organization' means a group of supervising physicians that
collectively supervises a physician assistant.
    { - (6) - }   { + (5) + } 'Supervision' means the
 { - routine direction and regular review by the supervising
physician or supervising physician organization, as determined to
be appropriate by the Oregon Medical Board, of the medical
services provided by the physician assistant - }  { +  acts of
overseeing and accepting responsibility for the medical services
provided by a physician assistant in accordance with a practice
agreement, including regular and routine oversight and chart
review + }.
  SECTION 2. ORS 677.500, as amended by section 2, chapter 43,
Oregon Laws 2010, is amended to read:
  677.500. It is the intent of the Legislative Assembly in
requiring the licensure of physician assistants   { - that there
be reasonable utilization of the physician assistant by the

Enrolled Senate Bill 224 (SB 224-A)                        Page 1

supervising physician or supervising physician organization - }
 { +  to encourage appropriate use of physician assistants in the
delivery of health care services to the extent of a physician
assistant's education and experience + }.
  SECTION 3. ORS 677.510, as amended by section 3, chapter 43,
Oregon Laws 2010, is amended to read:
  677.510. (1) A person licensed to practice medicine under this
chapter   { - shall - }   { + may + } not use the services of a
physician assistant without the prior approval of the Oregon
Medical Board.
  (2) A supervising physician or a supervising physician
organization may apply to the board to use the services of a
physician assistant. The application shall:
  (a)   { - State the name of the physician assistant - }  { +
If the applicant is not a supervising physician organization,
state the name and contact information of the supervising
physician + };
  (b) If the applicant is a supervising physician organization:
  (A) State the names  { + and contact information + } of all
supervising physicians; and
  (B) State the name of the primary supervising physician
required by subsection (5) of this section;
    { - (c) Describe the manner and extent to which the physician
assistant's services would be used and supervised; - }
    { - (d) Include a practice description that provides for the
maintenance of direct, verbal communication between the physician
assistant and one or more supervising physicians either in person
or by means described in ORS 677.515 (4); - }
    { - (e) State the education, training and experience of the
physician assistant; and - }
   { +  (c) Generally describe the medical services provided by
each supervising physician;
  (d) Contain a statement acknowledging that each supervising
physician has reviewed statutes and rules relating to the
practice of physician assistants and the role of a supervising
physician; and + }
    { - (f) - }   { + (e) + } Provide such other information in
such a form as the board may require.
  (3) The board   { - may - }   { + shall + } approve or reject
an application  { +  within seven working days after the board
receives the application, unless the board is conducting an
investigation of the supervising physician or of any of the
supervising physicians in a supervising physician organization
applying to use the services of a physician assistant.  + }
 { - , or it may modify the proposed use of the services of the
physician assistant and approve the application as modified. The
board may not require that a supervising physician be physically
present at all times. - }
  (4) A supervising physician organization shall provide the
board with a list of the supervising physicians in the
supervising physician organization. The supervising physician
organization shall continually update the list and notify the
board of any changes.
  (5) A supervising physician organization shall designate a
primary supervising physician and notify the board in the manner
prescribed by the board.
    { - (6) When it appears to the board that the services of a
physician assistant are being used in a manner inconsistent with
the approval granted, the board may withdraw its approval. If a
hearing is requested by the supervising physician, the

Enrolled Senate Bill 224 (SB 224-A)                        Page 2

supervising physician organization or the physician assistant
upon the rejection of an application or upon the withdrawal of an
approval, a hearing shall be conducted in accordance with ORS
677.200. - }
    { - (7) A supervising physician may have a different
specialty from the physician assistant. - }
   { +  (6)(a) A physician assistant may not practice medicine
until the physician assistant enters into a practice agreement
with a supervising physician or supervising physician
organization whose application has been approved under subsection
(3) of this section. The practice agreement must:
  (A) Include the name, contact information and license number of
the physician assistant and each supervising physician.
  (B) Describe the degree and methods of supervision that the
supervising physician or supervising physician organization will
use. The degree of supervision, whether general, direct or
personal, must be based on the level of competency of the
physician assistant as judged by the supervising physician.
  (C) Generally describe the medical duties delegated to the
physician assistant.
  (D) Describe the services or procedures common to the practice
or specialty that the physician assistant is not permitted to
perform.
  (E) Describe the prescriptive and medication administration
privileges that the physician assistant will exercise.
  (F) Provide the list of settings and licensed facilities in
which the physician assistant will provide services.
  (G) State that the physician assistant and each supervising
physician is in full compliance with the laws and regulations
governing the practice of medicine by physician assistants,
supervising physicians and supervising physician organizations
and acknowledge that violation of laws or regulations governing
the practice of medicine may subject the physician assistant and
supervising physician or supervising physician organization to
discipline.
  (H) Be signed by the supervising physician or the primary
supervising physician of the supervising physician organization
and by the physician assistant.
  (I) Be updated at least every two years.
  (b) The supervising physician or supervising physician
organization shall provide the board with a copy of the practice
agreement within 10 days after the physician assistant begins
practice with the supervising physician or supervising physician
organization. The supervising physician or supervising physician
organization shall keep a copy of the practice agreement at the
practice location and make a copy of the practice agreement
available to the board on request. The practice agreement is not
subject to board approval, but the board may request a meeting
with a supervising physician or supervising physician
organization and a physician assistant to discuss a practice
agreement.
  (7) A physician assistant's supervising physician shall ensure
that the physician assistant is competent to perform all duties
delegated to the physician assistant. The supervising physician
or supervising physician organization and the physician assistant
are responsible for ensuring the competent practice of the
physician assistant.
  (8) A supervising physician or the agent of a supervising
physician must be competent to perform the duties delegated to

Enrolled Senate Bill 224 (SB 224-A)                        Page 3

the physician assistant by the supervising physician or by a
supervising physician organization.
  (9) The board may not require that a supervising physician be
physically present at all times when the physician assistant is
providing services, but may require that:
  (a) The physician assistant have access to personal or
telephone communication with a supervising physician when the
physician assistant is providing services; and
  (b) The proximity of a supervising physician and the methods
and means of supervision be appropriate to the practice setting
and the patient conditions treated in the practice setting. + }
    { - (8)(a) - }   { + (10)(a) + } A supervising physician
organization may supervise any number of physician assistants.
The board may not adopt rules limiting the number of physician
assistants that a supervising physician organization may
supervise.
  (b) A physician assistant who is supervised by a supervising
physician organization may be supervised by any of the
supervising physicians in the supervising physician organization.
    { - (9) - }   { + (11) + } If a physician assistant is not
supervised by a supervising physician organization, the physician
assistant may be supervised by no more than four supervising
physicians  { - . - }  { + , unless the board approves a request
from the physician assistant, or from a supervising physician,
for the physician assistant to be supervised by more than four
supervising physicians.
  (12) + } A supervising physician who is not acting as part of a
supervising physician organization may supervise four physician
assistants  { - . - }  { + , unless the board approves a request
from the supervising physician or from a physician assistant for
the supervising physician to supervise more than four physician
assistants.
  (13) + } A supervising physician who is not acting as part of a
supervising physician organization may designate a physician to
serve as the agent of the supervising physician for a
predetermined period of time.
    { - (10) The board may review and approve applications from
physicians serving federally designated underserved populations,
or physicians in federally designated health professional
shortage areas, federally designated medically underserved areas
or areas designated as medically disadvantaged and in need of
primary health care providers by the Director of the Oregon
Health Authority or the Office of Rural Health to supervise more
than four physician assistants, and applications from physician
assistants to be supervised by more than four physicians. - }
   { +  (14) + } A physician assistant may render services in
 { - an emergency room and other hospital settings, a nursing
home, a corrections institution and any site - }   { + any
setting + } included in the practice   { - description - }  { +
agreement + }.
    { - (11) - }   { + (15) + } A   { - licensed - }  physician
assistant may   { - make application - }   { + apply + } to the
board for emergency drug dispensing authority. The board shall
consider the criteria adopted by the Physician Assistant
Committee under ORS 677.545 (4) in reviewing the application.
 { - Such emergency dispensing shall be of - }   { + A physician
assistant with emergency drug dispensing authority may dispense
only + } drugs  { + that have been + } prepared or prepackaged by
a licensed pharmacist, manufacturing drug outlet or wholesale
drug outlet authorized to do so under ORS chapter 689.

Enrolled Senate Bill 224 (SB 224-A)                        Page 4

    { - (12) - }   { + (16) + } A physician assistant for whom an
application under this section has been approved by the board on
or after January 2, 2006, shall submit to the board, within 24
months after the approval, documentation of completion of:
  (a) A pain management education program approved by the board
and developed in conjunction with the Pain Management Commission
established under ORS 409.500; or
  (b) An equivalent pain management education program, as
determined by the board.
  SECTION 4. ORS 677.512 is amended to read:
  677.512. (1) A person seeking licensure as a physician
assistant shall complete an application form provided by the
Oregon Medical Board and submit the form to the board,
accompanied by nonrefundable fees for the application and for the
license in amounts determined by rule of the board.
  (2)   { - Upon application, - }  The board may issue a license
to a physician assistant who   { - meets the requirements for
licensure under ORS 677.495 and 677.505 to 677.525 - }  { + :
  (a) Submits an application as required by the board by rule;
  (b) Pays the application fee established by the board by rule;
  (c) Has completed an educational program accredited by a
nationally recognized accreditation organization for physician
assistant educational programs;
  (d) Has passed the initial national examination required of
physician assistants to become nationally certified;
  (e) Is mentally and physically able to engage safely in
practice as a physician assistant;
  (f) Has not had been disciplined by a physician assistant
licensing board in another state, unless the board considers the
discipline and determines that the person is competent to
practice as a physician assistant; and
  (g) Is of good moral character as determined by the board.
  (3) The board may issue a license by reciprocity to a person
who is licensed as a physician assistant in another state and
meets the requirements of subsection (2)(c) and (d) of this
section + }.
    { - (3) - }   { + (4) + } The board shall adopt necessary and
proper rules to govern the renewal of licenses issued under this
section.
  SECTION 5. ORS 677.515, as amended by section 4, chapter 43,
Oregon Laws 2010, is amended to read:
  677.515.   { - (1) This chapter does not prohibit a person from
rendering medical services: - }
    { - (a) If the person has satisfactorily completed an
educational program for physician assistants approved by the
Oregon Medical Board; - }
    { - (b) If the services are rendered under the supervision
and control of a supervising physician or supervising physician
organization and the use of the physician assistant's services
has been approved by the board as provided by ORS 677.510;
and - }
    { - (c) If the person is licensed as a physician assistant as
provided by ORS 677.495 and 677.505 to 677.525. - }
   { +  (1) A physician assistant licensed under ORS 677.512 may
provide any medical service, including prescribing and
administering controlled substances in schedules II through V
under the federal Controlled Substances Act:
  (a) That is delegated by the physician assistant's supervising
physician or supervising physician organization;

Enrolled Senate Bill 224 (SB 224-A)                        Page 5

  (b) That is within the scope of practice of the physician
assistant;
  (c) That is within the scope of practice of the supervising
physician or supervising physician organization;
  (d) That is provided under the supervision of the supervising
physician or supervising physician organization;
  (e) That is generally described in and in compliance with the
practice agreement; and
  (f) For which the physician assistant has obtained informed
consent as provided in ORS 677.097, if informed consent is
required. + }
  (2) This chapter does not prohibit a student enrolled in an
  { - approved - }  program for educating physician assistants
 { + approved by the board + } from rendering medical services if
the services are rendered in the course of the program.
  (3)   { - Notwithstanding subsections (1) and (2) of this
section, - }  The degree of independent judgment that a physician
assistant may exercise shall be determined by the supervising
physician, or supervising physician organization, and the
physician assistant in accordance with   { - a practice
description approved by the board - }  { +  the practice
agreement + }.
    { - (4) A physician assistant may provide medical services to
patients in a setting where a supervising physician does not
regularly practice if the following conditions exist: - }
    { - (a) Direct communication between the physician assistant
and one or more supervising physicians either in person or by
telephone, radio, radiotelephone, television or similar means is
maintained; and - }
    { - (b) The medical services provided by the physician
assistant are reviewed by a supervising physician or supervising
physician organization on a regularly scheduled basis as
determined by the board. - }
    { - (5) - }   { + (4) + } A supervising physician, upon the
approval of the board and in accordance with the rules
established by the board, may delegate to the physician assistant
the authority to administer and dispense limited emergency
medications and to prescribe medications pursuant to this section
and ORS 677.535 to 677.545. Neither the board nor the Physician
Assistant Committee shall limit the privilege of administering,
dispensing and prescribing to population groups federally
designated as underserved, or to geographic areas of the state
that are federally designated health professional shortage areas,
federally designated medically underserved areas or areas
designated as medically disadvantaged and in need of primary
health care providers by the Director of the Oregon Health
Authority or the Office of Rural Health. All prescriptions
written pursuant to this subsection shall bear the name, office
address and telephone number of the supervising physician.
    { - (6) - }   { + (5) + }   { - Nothing in - }  This chapter
 { - is intended to - }   { + does not + } require or prohibit a
physician assistant from practicing in a hospital licensed
pursuant to ORS 441.015 to 441.089.
    { - (7) - }   { + (6) + } Prescriptions for medications
prescribed by a physician assistant in accordance with this
section and ORS 475.005, 677.010, 677.500, 677.510 and 677.535 to
677.545 and dispensed by a licensed pharmacist may be filled by
the pharmacist according to the terms of the prescription, and
the filling of such a prescription   { - shall - }   { + does + }
not constitute evidence of negligence on the part of the

Enrolled Senate Bill 224 (SB 224-A)                        Page 6

pharmacist if the prescription was dispensed within the
reasonable and prudent practice of pharmacy.
  SECTION 6. ORS 677.535, as amended by section 6, chapter 43,
Oregon Laws 2010, is amended to read:
  677.535. The Oregon Medical Board may grant a limited license
to a physician assistant if  { - : - }
    { - (1) - }  the applicant meets the qualifications of the
board, the application file is complete and no derogatory
information has been submitted but board approval is
pending { + . + }  { - ; or - }
    { - (2) The physician assistant is changing employment or
changing supervising physicians or supervising physician
organizations. - }
  SECTION 7. ORS 677.545, as amended by section 7, chapter 43,
Oregon Laws 2010, is amended to read:
  677.545. The Physician Assistant Committee shall:
    { - (1) Review all applications for physician assistants'
licensure and for renewal thereof. - }
   { +  (1) Review and make recommendations to the Oregon Medical
Board regarding all matters relating to physician assistants,
including but not limited to:
  (a) Applications for licensure;
  (b) Disciplinary proceedings; and
  (c) Renewal requirements. + }
  (2) Review applications of physician assistants for dispensing
privileges.
  (3) Recommend approval or disapproval of applications submitted
under subsection (1) or (2) of this section to the
  { - Oregon Medical - }  board.
  (4) Recommend criteria to be used in granting dispensing
privileges under ORS 677.515.
  (5)   { - Recommend the formulary - }   { + Review the
criteria + } for prescriptive privileges that may include all or
parts of Schedules II, III, IV and V controlled substances and
the procedures for physician assistants, supervising physicians
and supervising physician organizations to follow in exercising
the prescriptive privileges.
    { - (6) Recommend the approval, disapproval or modification
of the application for prescriptive privileges for any physician
assistant. An application for - }   { + A statement regarding + }
Schedule II controlled substances prescriptive privileges must be
 { - submitted to the Oregon Medical Board by the physician
assistant's supervising physician or supervising physician
organization and must be accompanied by - }   { + included in + }
the practice   { - description of the physician assistant - }
 { +  agreement + }. The Schedule II controlled substances
prescriptive privileges of a physician assistant shall be limited
by the practice   { - description approved by the board - }
 { + agreement + } and may be restricted further by the
supervising physician or supervising physician organization at
any time. The supervising physician or supervising physician
organization shall notify the physician assistant and the board
of any additional restrictions imposed by the supervising
physician or supervising physician organization  { - , and the
practice description on file with the board shall be amended to
reflect the additional restrictions imposed - } . To be eligible
for Schedule II controlled substances prescriptive privileges, a
physician assistant must be certified by the National Commission
on Certification of Physician Assistants and must complete all
required continuing medical education coursework.

Enrolled Senate Bill 224 (SB 224-A)                        Page 7

  SECTION 8. ORS 677.097 is amended to read:
  677.097. (1) In order to obtain the informed consent of a
patient, a physician   { - or - }  { + , + } podiatric physician
and surgeon  { + or physician assistant + } shall explain the
following:
  (a) In general terms the procedure or treatment to be
undertaken;
  (b) That there may be alternative procedures or methods of
treatment, if any; and
  (c) That there are risks, if any, to the procedure or
treatment.
  (2) After giving the explanation specified in subsection (1) of
this section, the physician   { - or - }  { + , + } podiatric
physician and surgeon  { + or physician assistant + } shall ask
the patient if the patient wants a more detailed explanation. If
the patient requests further explanation, the physician
 { - or - }  { + , + } podiatric physician and surgeon  { + or
physician assistant + } shall disclose in substantial detail the
procedure, the viable alternatives and the material risks unless
to do so would be materially detrimental to the patient. In
determining that further explanation would be materially
detrimental the physician   { - or - }  { + , + } podiatric
physician and surgeon  { + or physician assistant + } shall give
due consideration to the standards of practice of reasonable
medical or podiatric practitioners in the same or a similar
community under the same or similar circumstances.
  SECTION 9.  { + Notwithstanding the amendments to ORS 677.097,
677.495, 677.500, 677.510, 677.512, 677.515, 677.535 and 677.545
by sections 1 to 8 of this 2011 Act:
  (1) A physician assistant practicing under a practice
description approved by the Oregon Medical Board under ORS
677.510 as in effect immediately before the operative date of the
amendments to ORS 677.510 by section 3 of this 2011 Act may
continue to practice in accordance with the practice description
and is not required to enter into a practice agreement under ORS
677.510.
  (2) A physician assistant licensed under ORS 677.512 as in
effect immediately before the operative date of the amendments to
ORS 677.512 by section 4 of this 2011 Act may renew the physician
assistant's license without meeting the requirements of ORS
677.512 (2)(c) and (d). + }
  SECTION 10.  { + (1) The amendments to ORS 677.097, 677.495,
677.500, 677.510, 677.512, 677.515, 677.535 and 677.545 by
sections 1 to 8 of this 2011 Act become operative on January 1,
2012.
  (2) The Oregon Medical Board may take any action on or before
the operative date specified in subsection (1) of this section
that is necessary to enable the board to exercise, on and after
the operative date specified in subsection (1) of this section,
all of the duties, functions and powers conferred on the board by
the amendments to ORS 677.097, 677.495, 677.500, 677.510,
677.512, 677.515, 677.535 and 677.545 by sections 1 to 8 of this
2011 Act. + }
  SECTION 11.  { + This 2011 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2011 Act takes effect on
its passage. + }
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Enrolled Senate Bill 224 (SB 224-A)                        Page 8

Passed by Senate June 14, 2011

    .............................................................
                               Robert Taylor, Secretary of Senate

    .............................................................
                              Peter Courtney, President of Senate

Passed by House June 20, 2011

    .............................................................
                                    Bruce Hanna, Speaker of House

    .............................................................
                                   Arnie Roblan, Speaker of House

Enrolled Senate Bill 224 (SB 224-A)                        Page 9

Received by Governor:

......M.,............., 2011

Approved:

......M.,............., 2011

    .............................................................
                                         John Kitzhaber, Governor

Filed in Office of Secretary of State:

......M.,............., 2011

    .............................................................
                                   Kate Brown, Secretary of State

Enrolled Senate Bill 224 (SB 224-A)                       Page 10