Senate Bill 1068

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    Florida Senate - 1999                                  SB 1068

    By Senator Sullivan





    22-407-99

  1                      A bill to be entitled

  2         An act relating to physician assistants;

  3         amending s. 39.304, F.S.; allowing a physician

  4         assistant to perform a medical examination, and

  5         to authorize a radiological examination to be

  6         performed, on a child who is suspected to be a

  7         victim of abuse, abandonment, or neglect;

  8         amending ss. 458.347, 459.022, F.S.; requiring

  9         a physician assistant who prescribes controlled

10         substances to complete a course in substance

11         abuse; providing for the appointment of a

12         formulary committee to establish a formulary of

13         medicinal drugs that physician assistants may

14         prescribe; providing for terms and meetings of

15         the formulary committee; providing standards

16         for formulary drugs; providing for the Board of

17         Medicine and the Board of Osteopathic Medicine

18         to adopt the formularies; creating s. 893.045,

19         F.S.; allowing a physician assistant to apply

20         for a federal controlled substance registry

21         number; providing an effective date.

22

23  Be It Enacted by the Legislature of the State of Florida:

24

25         Section 1.  Subsection (1) of section 39.304, Florida

26  Statutes, 1998 Supplement, is amended to read:

27         39.304  Photographs, medical examinations, X rays, and

28  medical treatment of abused, abandoned, or neglected child.--

29         (1)  Any person required to investigate cases of

30  suspected child abuse, abandonment, or neglect may take or

31  cause to be taken photographs of the areas of trauma visible

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    Florida Senate - 1999                                  SB 1068
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  1  on a child who is the subject of a report.  If the areas of

  2  trauma visible on a child indicate a need for a medical

  3  examination, or if the child verbally complains or otherwise

  4  exhibits distress as a result of injury through suspected

  5  child abuse, abandonment, or neglect, or is alleged to have

  6  been sexually abused, the person required to investigate may

  7  cause the child to be referred for diagnosis to a licensed

  8  physician or an emergency department in a hospital without the

  9  consent of the child's parents, caregiver, or legal custodian.

10  Such an examination may be performed by an advanced registered

11  nurse practitioner licensed under pursuant to chapter 464 or a

12  physician assistant licensed under chapter 458 or chapter 459.

13  Any licensed physician, physician assistant licensed under

14  chapter 458 or chapter 459, or advanced registered nurse

15  practitioner licensed under pursuant to chapter 464, who has

16  reasonable cause to suspect that an injury was the result of

17  child abuse, abandonment, or neglect may authorize a

18  radiological examination to be performed on the child without

19  the consent of the child's parent, caregiver, or legal

20  custodian.

21         Section 2.  Paragraphs (e) and (f) of subsection (4) of

22  section 458.347, Florida Statutes, 1998 Supplement, are

23  amended to read:

24         458.347  Physician assistants.--

25         (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--

26         (e)  A supervisory physician may delegate to a fully

27  licensed physician assistant the authority to prescribe any

28  medication used in the supervisory physician's practice if

29  such medication is listed on the formulary created pursuant to

30  paragraph (f).  A fully licensed physician assistant may only

31  prescribe such medication under the following circumstances:

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    Florida Senate - 1999                                  SB 1068
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  1         1.  A physician assistant must clearly identify to the

  2  patient that he or she is a physician assistant.  Furthermore,

  3  the physician assistant must inform the patient that the

  4  patient has the right to see the physician prior to any

  5  prescription being prescribed by the physician assistant.

  6         2.  The supervisory physician must notify the

  7  department of his or her intent to delegate, on a

  8  department-approved form, before delegating such authority and

  9  notify the department of any change in prescriptive privileges

10  of the physician assistant.

11         3.  The physician assistant must file with the

12  department, before commencing to prescribe, evidence that he

13  or she has completed a continuing medical education course of

14  at least 3 classroom hours in prescriptive practice, conducted

15  by an accredited program approved by the boards, which course

16  covers the limitations, responsibilities, and privileges

17  involved in prescribing medicinal drugs, or evidence that he

18  or she has received education comparable to the continuing

19  education course as part of an accredited physician assistant

20  training program.

21         4.  The physician assistant must file with the

22  department, before commencing to prescribe, evidence that the

23  physician assistant has a minimum of 3 months of clinical

24  experience in the specialty area of the supervising physician.

25         5.  The physician assistant must file with the

26  department a signed affidavit that he or she has completed a

27  minimum of 10 continuing medical education hours in the

28  specialty practice in which the physician assistant has

29  prescriptive privileges with each licensure renewal

30  application. A physician assistant who prescribes drugs listed

31

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    Florida Senate - 1999                                  SB 1068
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  1  in Schedule III, Schedule IV, or Schedule V of s. 893.03 must

  2  complete a 1-hour course in substance abuse.

  3         6.  The department shall issue a license and a

  4  prescriber number to the physician assistant granting

  5  authority for the prescribing of medicinal drugs authorized

  6  within this paragraph upon completion of the foregoing

  7  requirements.

  8         7.  The prescription must be written in a form that

  9  complies with chapter 499 and must contain, in addition to the

10  supervisory physician's name, address, and telephone number,

11  the physician assistant's prescriber number. The prescription

12  must be filled in a pharmacy permitted under chapter 465 and

13  must be dispensed in that pharmacy by a pharmacist licensed

14  under chapter 465. The appearance of the prescriber number

15  creates a presumption that the physician assistant is

16  authorized to prescribe the medicinal drug and the

17  prescription is valid.

18         8.  The physician assistant must note the prescription

19  in the appropriate medical record, and the supervisory

20  physician must review and sign each notation.  For dispensing

21  purposes only, the failure of the supervisory physician to

22  comply with these requirements does not affect the validity of

23  the prescription.

24         9.  This paragraph does not prohibit a supervisory

25  physician from delegating to a physician assistant the

26  authority to order medication for a hospitalized patient of

27  the supervisory physician.

28

29  This paragraph does not apply to facilities licensed pursuant

30  to chapter 395.

31

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  1         (f)1.  There is created a five-member committee

  2  appointed by the Secretary of Health.  The committee must be

  3  composed of one fully licensed physician assistant licensed

  4  under pursuant to this section or s. 459.022, two physicians

  5  licensed under pursuant to this chapter, one of whom

  6  supervises a fully licensed physician assistant, one

  7  osteopathic physician licensed under pursuant to chapter 459,

  8  and one pharmacist licensed under pursuant to chapter 465 who

  9  is not licensed under pursuant to this chapter or chapter 459.

10  All members of the formulary committee shall be appointed for

11  initial terms commencing July 1, 1999. Committee members shall

12  be appointed to terms of 4 years, except that, of the initial

13  appointments, two members shall be appointed for terms of 2

14  years, two shall be appointed for terms of 3 years, and one

15  shall be appointed for a term of 4 years. The committee shall

16  meet at least twice annually to establish a formulary of

17  medicinal drugs that for which a fully licensed physician

18  assistant may prescribe. The formulary may include controlled

19  substances as defined in s. 893.03(3),(4), and (5). The

20  formulary may not include other controlled substances as

21  defined in chapter 893, antineoplastics, antipsychotics,

22  radiopharmaceuticals, or general anesthetics, or radiographic

23  contrast materials, or any parenteral preparations except

24  insulin and epinephrine.

25         2.  Only the committee shall add to, delete from, or

26  modify the formulary.  Any person who requests an addition,

27  deletion, or modification of a medicinal drug listed on such

28  formulary has the burden of proof to show cause why such

29  addition, deletion, or modification should be made.

30         3.  The boards shall adopt the formulary required by

31  this paragraph, and each addition, deletion, or modification

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    Florida Senate - 1999                                  SB 1068
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  1  to the formulary, by rule. Notwithstanding any provision of

  2  chapter 120 to the contrary, the formulary rule shall be

  3  effective 60 days after the date it is filed with the

  4  Secretary of State.  Upon adoption of the formulary, the

  5  department shall mail a copy of such formulary to each fully

  6  licensed physician assistant and to each pharmacy licensed by

  7  the state.  The boards shall establish, by rule, a fee not to

  8  exceed $200 to fund the provisions of this paragraph and

  9  paragraph (e). The board shall adopt the formulary required by

10  this paragraph and shall adopt each subsequent change at its

11  next regular meeting following receipt of the formulary from

12  the formulary committee.

13         Section 3.  Paragraph (e) and (f) of subsection (4) of

14  section 459.022, Florida Statutes, 1998 Supplement, are

15  amended to read:

16         459.022  Physician assistants.--

17         (4)  PERFORMANCE OF PHYSICIAN ASSISTANTS.--

18         (e)  A supervisory physician may delegate to a fully

19  licensed physician assistant the authority to prescribe any

20  medication used in the supervisory physician's practice if

21  such medication is listed on the formulary created pursuant to

22  s. 458.347.  A fully licensed physician assistant may only

23  prescribe such medication under the following circumstances:

24         1.  A physician assistant must clearly identify to the

25  patient that she or he is a physician assistant. Furthermore,

26  the physician assistant must inform the patient that the

27  patient has the right to see the physician prior to any

28  prescription being prescribed by the physician assistant.

29         2.  The supervisory physician must notify the

30  department of her or his intent to delegate, on a

31  department-approved form, before delegating such authority and

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    Florida Senate - 1999                                  SB 1068
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  1  notify the department of any change in prescriptive privileges

  2  of the physician assistant.

  3         3.  The physician assistant must file with the

  4  department, before commencing to prescribe, evidence that she

  5  or he has completed a continuing medical education course of

  6  at least 3 classroom hours in prescriptive practice, conducted

  7  by an accredited program approved by the boards, which course

  8  covers the limitations, responsibilities, and privileges

  9  involved in prescribing medicinal drugs, or evidence that she

10  or he has received education comparable to the continuing

11  education course as part of an accredited physician assistant

12  training program.

13         4.  The physician assistant must file with the

14  department, before commencing to prescribe, evidence that the

15  physician assistant has a minimum of 3 months of clinical

16  experience in the specialty area of the supervising physician.

17         5.  The physician assistant must file with the

18  department a signed affidavit that she or he has completed a

19  minimum of 10 continuing medical education hours in the

20  specialty practice in which the physician assistant has

21  prescriptive privileges with each licensure renewal

22  application. A physician assistant who prescribes drugs listed

23  in Schedule III, Schedule IV, or Schedule V of s. 893.03 must

24  complete a 1-hour course in substance abuse.

25         6.  The department shall issue a license and a

26  prescriber number to the physician assistant granting

27  authority for the prescribing of medicinal drugs authorized

28  within this paragraph upon completion of the foregoing

29  requirements.

30         7.  The prescription must be written in a form that

31  complies with chapter 499 and must contain, in addition to the

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    Florida Senate - 1999                                  SB 1068
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  1  supervisory physician's name, address, and telephone number,

  2  the physician assistant's prescriber number. The prescription

  3  must be filled in a pharmacy permitted under chapter 465, and

  4  must be dispensed in that pharmacy by a pharmacist licensed

  5  under chapter 465. The appearance of the prescriber number

  6  creates a presumption that the physician assistant is

  7  authorized to prescribe the medicinal drug and the

  8  prescription is valid.

  9         8.  The physician assistant must note the prescription

10  in the appropriate medical record, and the supervisory

11  physician must review and sign each notation.  For dispensing

12  purposes only, the failure of the supervisory physician to

13  comply with these requirements does not affect the validity of

14  the prescription.

15         9.  This paragraph does not prohibit a supervisory

16  physician from delegating to a physician assistant the

17  authority to order medication for a hospitalized patient of

18  the supervisory physician.

19

20  This paragraph does not apply to facilities licensed pursuant

21  to chapter 395.

22         (f)1.  There is created a five-member committee

23  appointed by the Secretary of Health.  The committee must be

24  composed of one fully licensed physician assistant licensed

25  under pursuant to this section or s. 458.347, two physicians

26  licensed under pursuant to chapter 458, one of whom supervises

27  a fully licensed physician assistant, one osteopathic

28  physician licensed under pursuant to this chapter, and one

29  pharmacist licensed under pursuant to chapter 465 who is not

30  licensed under pursuant to this chapter or chapter 458.  All

31  members of the formulary committee shall be appointed for

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    Florida Senate - 1999                                  SB 1068
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  1  initial terms commencing July 1, 1999. Committee members shall

  2  be appointed to terms of 4 years, except that, of the initial

  3  appointments, two members shall be appointed for terms of 2

  4  years, two shall be appointed for terms of 3 years, and one

  5  shall be appointed for a term of 4 years. The committee shall

  6  meet at least twice annually to establish a formulary of

  7  medicinal drugs that for which a fully licensed physician

  8  assistant may prescribe. The formulary may include controlled

  9  substances as defined in s. 893.03(3)(4), and (5). The

10  formulary may not include other controlled substances as

11  defined in chapter 893, antineoplastics, antipsychotics,

12  radiopharmaceuticals, general anesthetics, or radiographic

13  contrast materials, or any parenteral preparations except

14  insulin and epinephrine.

15         2.  Only the committee shall add to, delete from, or

16  modify the formulary.  Any person who requests an addition,

17  deletion, or modification of a medicinal drug listed on such

18  formulary has the burden of proof to show cause why such

19  addition, deletion, or modification should be made.

20         3.  The boards shall adopt the formulary required by

21  this paragraph, and each addition, deletion, or modification

22  to the formulary, by rule. Notwithstanding any provision of

23  chapter 120 to the contrary, the formulary rule shall be

24  effective 60 days after the date it is filed with the

25  Secretary of State.  Upon adoption of the formulary, the

26  department shall mail a copy of such formulary to each fully

27  licensed physician assistant and to each pharmacy licensed by

28  the state.  The boards shall establish, by rule, a fee not to

29  exceed $200 to fund the provisions of this paragraph and

30  paragraph (e). The board shall adopt the formulary required by

31  this paragraph and shall adopt each subsequent change at its

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  1  next regular meeting following receipt of the formulary from

  2  the formulary committee.

  3         Section 4.  Section 893.045, Florida Statutes, is

  4  created to read:

  5         893.045 Physician assistant may apply for controlled

  6  substance abuse registry number.--A physician assistant who is

  7  fully licensed under chapter 458 or chapter 459 and who has

  8  completed the required course in substance abuse may apply for

  9  a federal controlled substance registry number and, upon

10  receiving such a number, may prescribe controlled substances

11  listed in Schedule III, Schedule IV, and Schedule V, in

12  accordance with restrictions set forth in chapters 458 and

13  459.

14         Section 5.  This act shall take effect July 1, 1999.

15

16            *****************************************

17                          SENATE SUMMARY

18    Allows physician assistants to perform medical
      examinations on children who are suspected to be victims
19    of abuse, abandonment, or neglect, and to order
      radiological examinations to be performed on such
20    children. Requires a physician assistant who prescribes
      controlled substances to complete a 1-hour course in
21    substance abuse. Provides for the appointment of a
      formulary committee to establish a formulary of medicinal
22    drugs that physician assistants may prescribe. Provides
      for the terms of office and frequency of meetings of the
23    formulary committee. Provides standards for including
      drugs in and excluding drugs from the formulary. Provides
24    for the Board of Medicine and the Board of Osteopathic
      Medicine to adopt the formularies. Allows a physician
25    assistant to apply for a federal controlled substance
      registry number.
26

27

28

29

30

31

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