HB 1561

1	A bill to be entitled
2	An act relating to medical practice; amending s. 458.348,
3	F.S.; providing purpose and intent with respect to formal
4	supervisory relationships, standing orders, and
5	established protocols; defining the term "physician office
6	practice setting"; providing requirements for supervisory
7	relationships with advanced registered nurse practitioners
8	or physician assistants practicing outside the physician
9	office practice setting; providing an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Section 458.348, Florida Statutes, is amended
14	to read:
15	458.348  Formal supervisory relationships, standing orders,
16	and established protocols; purpose and intent; notice;
17	standards; supervisory relationships with advanced registered
18	nurse practitioners or physician assistants practicing outside
19	the physician office practice setting.--
20	(1)  PURPOSE AND INTENT.--The Legislature recognizes that
21	the practice of medicine is potentially dangerous to the public
22	if conducted by insufficiently trained practitioners. The
23	Legislature finds further that it is difficult for the public to
24	make an informed choice when selecting a practitioner and that
25	the consequences of a wrong decision could seriously harm the
26	public health and safety. The primary legislative purpose of
27	this section is to ensure that, if a physician chooses to
28	delegate medical services to other licensed practitioners within
29	the health care delivery team who are not under the immediate
30	and proximate supervision of the physician, minimum requirements
31	for safe practice are followed. It is the legislative intent
32	that physicians who fall below minimum criteria set forth in
33	this section shall be prohibited from practicing in this state.
34	(2)(1)  NOTICE.--
35	(a)  When a physician enters into a formal supervisory
36	relationship or standing orders with an emergency medical
37	technician or paramedic licensed pursuant to s. 401.27, which
38	relationship or orders contemplate the performance of medical
39	acts, or when a physician enters into an established protocol
40	with an advanced registered nurse practitioner, which protocol
41	contemplates the performance of medical acts identified and
42	approved by the joint committee pursuant to s. 464.003(3)(c) or
43	acts set forth in s. 464.012(3) and (4), the physician shall
44	submit notice to the board. The notice shall contain a statement
45	in substantially the following form:
46
47	I, ...  (name and professional license number of physician)
48	..., of ...  (address of physician)  ... have hereby entered
49	into a formal supervisory relationship, standing orders, or an
50	established protocol with ...  (number of persons)  ...
51	emergency medical technician(s), ...  (number of persons)  ...
52	paramedic(s), or ...  (number of persons)  ... advanced
53	registered nurse practitioner(s).
54
55	(b)  Notice shall be filed within 30 days of entering into
56	the relationship, orders, or protocol. Notice also shall be
57	provided within 30 days after the physician has terminated any
58	such relationship, orders, or protocol.
59	(3)(2)  ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.--The
60	joint committee created by s. 464.003(3)(c) shall determine
61	minimum standards for the content of established protocols
62	pursuant to which an advanced registered nurse practitioner may
63	perform medical acts identified and approved by the joint
64	committee pursuant to s. 464.003(3)(c) or acts set forth in s.
65	464.012(3) and (4) and shall determine minimum standards for
66	supervision of such acts by the physician, unless the joint
67	committee determines that any act set forth in s. 464.012(3) or
68	(4) is not a medical act. Such standards shall be based on risk
69	to the patient and acceptable standards of medical care and
70	shall take into account the special problems of medically
71	underserved areas. The standards developed by the joint
72	committee shall be adopted as rules by the Board of Nursing and
73	the Board of Medicine for purposes of carrying out their
74	responsibilities pursuant to part I of chapter 464 and this
75	chapter, respectively, but neither board shall have disciplinary
76	powers over the licensees of the other board.
77	(4)(3)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All
78	protocols relating to electrolysis or electrology using laser or
79	light-based hair removal or reduction by persons other than
80	physicians licensed under this chapter or chapter 459 shall
81	require the person performing such service to be appropriately
82	trained and work only under the direct supervision and
83	responsibility of a physician licensed under this chapter or
84	chapter 459.
85	(5)  SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED
86	NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE
87	THE PHYSICIAN OFFICE PRACTICE SETTING.--
88	(a)  For purposes of this subsection, the term "physician
89	office practice setting" means a business location where the
90	physician delivers medical services regardless of whether the
91	business is physician owned or nonphysician owned. The physician
92	office practice setting includes medical services performed
93	outside a hospital, an ambulatory surgical center, an abortion
94	clinic, or any other medical facility licensed by the Department
95	of Health, the Agency for Health Care Administration, or a
96	successor agency. A business location is not a physician office
97	practice setting unless the physician is physically present in
98	the facility during the provision of care at least 33 percent of
99	its hours of operation. Any facility that does not meet this
100	requirement shall be considered outside the physician office
101	practice setting during all hours when the physician is not
102	physically present, irrespective of the ownership or business
103	name of the site.
104	(b)  A physician who is in a supervisory relationship with
105	an advanced registered nurse practitioner as described in s.
106	464.012(4)(c) or a physician assistant as described in s.
107	458.347(2)(e) who is practicing outside the physician office
108	practice setting of the supervising physician shall:
109	1.  Maintain a valid active Florida license pursuant to
110	this chapter and a valid federal controlled substance registry
111	number pursuant to chapter 893.
112	2.  Be practicing a minimum of half-time in the medical
113	service community in which the advanced registered nurse
114	practitioner or physician assistant is performing.
115	3.  Maintain no more than two supervisory relationships at
116	any one time.
117	4.  Delegate only tasks and procedures to the advanced
118	registered nurse practitioner or physician assistant which are
119	within the supervising physician's practice and medical
120	specialty area.
121	5.  Ensure that the advanced registered nurse practitioner
122	or physician assistant has been actively practicing within the
123	medical specialty area for a minimum of 4 consecutive years
124	prior to providing care in a practice setting outside the
125	physician office practice setting of the supervising physician.
126	6.  Ensure that the advanced registered nurse practitioner
127	or physician assistant under supervision clearly identifies to
128	the patient that he or she is an advanced registered nurse
129	practitioner or a physician assistant.
130	Section 2.  This act shall take effect upon becoming a law.

CODING: Words stricken are deletions; words underlined are additions.