Amendment
Bill No. 1180
Amendment No. 072115
CHAMBER ACTION
Senate House
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1Representative(s) Flores offered the following:
2
3     Amendment (with title amendment)
4     Remove everything after the enacting clause and insert:
5     Section 1.  Subsections (1) and (2) of section 458.307,
6Florida Statutes, are amended to read:
7     458.307  Board of Medicine.--
8     (1)  There is created within the department the Board of
9Medicine, composed of 16 15 members appointed by the Governor
10and confirmed by the Senate.
11     (2)  Twelve members of the board must be licensed
12physicians in good standing in this state who are residents of
13the state and who have been engaged in the active practice or
14teaching of medicine in this state with a full and unrestricted
15medical license for at least 5 4 years immediately preceding
16their appointment. One of the physicians must be on the full-
17time faculty of a medical school in this state, and one of the
18physicians must be in private practice and on the full-time
19staff of a statutory teaching hospital in this state as defined
20in s. 408.07. At least one of the physicians must be a graduate
21of a foreign medical school. The remaining four three members
22must be residents of the state who have lived in the state for
23at least 5 years immediately preceding their appointments, have
24never been licensed as a health care practitioner under chapter
25456 or the applicable practice act, and do not have a
26substantial personal, business, professional, or pecuniary
27connection with a licensed health care practitioner or with a
28medical education or health care facility, except as patients or
29potential patients are not, and never have been, licensed health
30care practitioners. One member must be a health care risk
31manager licensed under s. 395.10974. At least one member of the
32board must be 60 years of age or older. The requirements of this
33subsection shall be a continuing condition of membership on the
34board. Any member who ceases to meet the requirements of this
35subsection shall be removed from the board, and a new qualified
36member shall be appointed to fill the vacancy for the remainder
37of that member's term.
38     Section 2.  The requirements of section 458.307, Florida
39Statutes, as amended by this act, shall apply to appointments
40made on or after the effective date of this act and shall not be
41construed to end the term of any member of the Board of Medicine
42holding that appointment on the effective date of this act. The
43term of the additional member required to be appointed under
44section 458.307, Florida Statutes, as amended by this act, shall
45begin November 1, 2005.
46     Section 3.  Subsections (2) through (8) of section 458.311,
47Florida Statutes, are renumbered as subsections (3) through (9),
48respectively, present subsections (5) and (7) are amended, and a
49new subsection (2) is added to said section, to read:
50     458.311  Licensure by examination; requirements; fees.--
51     (2)  Notwithstanding sub-subparagraphs (1)(f)1.c.,
52(1)(f)2.c., and (1)(f)3.c. and paragraph (3)(d), except for
53passing part II of the National Board of Medical Examiners
54examination or the Educational Commission for Foreign Medical
55Graduates examination equivalent as referred to in paragraph
56(3)(d), the department may develop procedures for an applicant
57for licensure as a physician pursuant to this chapter to meet
58postgraduate training requirements by completion of a 2-year
59externship at a nonstatutory teaching hospital licensed in this
60state. The training provided in the externship shall be
61substantially similar, as defined by board rule, to the training
62provided in an approved residency as provided in sub-
63subparagraph (1)(f)1.c., sub-subparagraph (1)(f)2.c., or sub-
64subparagraph (1)(f)3.c. In order for the externship to meet the
65requirements of this subsection, it must be approved by the
66board prior to the applicant entering into the externship. The
67applicant shall not be licensed pursuant to this subsection
68unless the board finds that the applicant has successfully
69completed the externship. The board may adopt rules to implement
70this subsection, including the implementation of fees to cover
71costs.
72     (6)(5)  The board may not certify to the department for
73licensure any applicant who is under investigation in another
74jurisdiction for an offense which would constitute a violation
75of this chapter until such investigation is completed. Upon
76completion of the investigation, the provisions of s. 458.331
77shall apply. Furthermore, the department may not issue an
78unrestricted license to any individual who has committed any act
79or offense in any jurisdiction which would constitute the basis
80for disciplining a physician pursuant to s. 458.331. When the
81board finds that an individual has committed an act or offense
82in any jurisdiction which would constitute the basis for
83disciplining a physician pursuant to s. 458.331, then the board
84may enter an order imposing one or more of the terms set forth
85in subsection (9)(8).
86     (8)(7)  Upon certification by the board, the department
87shall impose conditions, limitations, or restrictions on a
88license if the applicant is on probation in another jurisdiction
89for an act which would constitute a violation of this chapter or
90if the externship requirement provided in subsection (2) was
91complied with at a nonstatutory teaching hospital.
92     Section 4.  Paragraph (a) of subsection (1) of section
93458.313, Florida Statutes, is amended to read:
94     458.313  Licensure by endorsement; requirements; fees.--
95     (1)  The department shall issue a license by endorsement to
96any applicant who, upon applying to the department on forms
97furnished by the department and remitting a fee set by the board
98not to exceed $500, the board certifies:
99     (a)  Has met the qualifications for licensure in s.
100458.311(1)(b)-(g) or in s. 458.311(1)(b)-(e) and (g) and (4)(3);
101     Section 5.  Subsection (1) of section 458.316, Florida
102Statutes, is amended to read:
103     458.316  Public health certificate.--
104     (1)  Any person desiring to obtain a public health
105certificate shall submit an application fee not to exceed $300
106and shall demonstrate to the board that he or she is a graduate
107of an accredited medical school and holds a master of public
108health degree or is board eligible or certified in public health
109or preventive medicine, or is licensed to practice medicine
110without restriction in another jurisdiction in the United States
111and holds a master of public health degree or is board eligible
112or certified in public health or preventive medicine, and shall
113meet the requirements in s. 458.311(1)(a)-(g) and (6)(5).
114     Section 6.  Section 458.3165, Florida Statutes, is amended
115to read:
116     458.3165  Public psychiatry certificate.--The board shall
117issue a public psychiatry certificate to an individual who
118remits an application fee not to exceed $300, as set by the
119board, who is a board-certified psychiatrist, who is licensed to
120practice medicine without restriction in another state, and who
121meets the requirements in s. 458.311(1)(a)-(g) and (6)(5). A
122recipient of a public psychiatry certificate may use the
123certificate to work at any public mental health facility or
124program funded in part or entirely by state funds.
125     (1)  Such certificate shall:
126     (a)  Authorize the holder to practice only in a public
127mental health facility or program funded in part or entirely by
128state funds.
129     (b)  Be issued and renewable biennially if the secretary of
130the Department of Health and the chair of the department of
131psychiatry at one of the public medical schools or the chair of
132the department of psychiatry at the accredited medical school at
133the University of Miami recommend in writing that the
134certificate be issued or renewed.
135     (c)  Automatically expire if the holder's relationship with
136a public mental health facility or program expires.
137     (d)  Not be issued to a person who has been adjudged
138unqualified or guilty of any of the prohibited acts in this
139chapter.
140     (2)  The board may take disciplinary action against a
141certificateholder for noncompliance with any part of this
142section or for any reason for which a regular licensee may be
143subject to discipline.
144     Section 7.  Paragraph (a) of subsection (1) of section
145458.317, Florida Statutes, is amended to read:
146     458.317  Limited licenses.--
147     (1)(a)  Any person desiring to obtain a limited license
148shall:
149     1.  Submit to the board, with an application and fee not to
150exceed $300, an affidavit stating that he or she has been
151licensed to practice medicine in any jurisdiction in the United
152States for at least 10 years and intends to practice only
153pursuant to the restrictions of a limited license granted
154pursuant to this section. However, a physician who is not fully
155retired in all jurisdictions may use a limited license only for
156noncompensated practice. If the person applying for a limited
157license submits a notarized statement from the employing agency
158or institution stating that he or she will not receive
159compensation for any service involving the practice of medicine,
160the application fee and all licensure fees shall be waived.
161However, any person who receives a waiver of fees for a limited
162license shall pay such fees if the person receives compensation
163for the practice of medicine.
164     2.  Meet the requirements in s. 458.311(1)(b)-(g) and
165(6)(5). If the applicant graduated from medical school prior to
1661946, the board or its appropriate committee may accept military
167medical training or medical experience as a substitute for the
168approved 1-year residency requirement in s. 458.311(1)(f).
169
170Nothing herein limits in any way any policy by the board,
171otherwise authorized by law, to grant licenses to physicians
172duly licensed in other states under conditions less restrictive
173than the requirements of this section. Notwithstanding the other
174provisions of this section, the board may refuse to authorize a
175physician otherwise qualified to practice in the employ of any
176agency or institution otherwise qualified if the agency or
177institution has caused or permitted violations of the provisions
178of this chapter which it knew or should have known were
179occurring.
180     Section 8.  Subsection (2) of section 458.331, Florida
181Statutes, is amended, and subsection (11) is added to said
182section, to read:
183     458.331  Grounds for disciplinary action; action by the
184board and department.--
185     (2)  The board may enter an order denying licensure or
186imposing any of the penalties in s. 456.072(2) against any
187applicant for licensure or licensee who is found guilty of
188violating any provision of subsection (1) of this section or who
189is found guilty of violating any provision of s. 456.072(1). A
190probable cause panel considering disciplinary action against a
191physician assistant pursuant to s. 456.073 shall include a
192licensed physician assistant designated by the Council on
193Physician Assistants, unless a physician assistant is not
194available. In determining what action is appropriate, the board
195must first consider what sanctions are necessary to protect the
196public or to compensate the patient. Only after those sanctions
197have been imposed may the disciplining authority consider and
198include in the order requirements designed to rehabilitate the
199physician. All costs associated with compliance with orders
200issued under this subsection are the obligation of the
201physician.
202     (11)  Notwithstanding any law to the contrary, a
203practitioner licensed under this chapter has a defense to an
204alleged violation, by the preponderance of the evidence, that
205the practitioner relied in good faith on the representations
206made to the practitioner by a drug manufacturer or its
207representatives and that the practitioner had no intent to
208violate the law.
209     Section 9.  Paragraph (b) of subsection (7) of section
210458.347, Florida Statutes, is amended to read:
211     458.347  Physician assistants.--
212     (7)  PHYSICIAN ASSISTANT LICENSURE.--
213     (b)1.  Notwithstanding subparagraph (a)2. and
214sub-subparagraph (a)3.a., the department shall examine each
215applicant who the Board of Medicine certifies:
216     a.  Has completed the application form and remitted a
217nonrefundable application fee not to exceed $500 and an
218examination fee not to exceed $300, plus the actual cost to the
219department to provide the examination. The examination fee is
220refundable if the applicant is found to be ineligible to take
221the examination. The department shall not require the applicant
222to pass a separate practical component of the examination. For
223examinations given after July 1, 1998, competencies measured
224through practical examinations shall be incorporated into the
225written examination through a multiple-choice format. The
226department shall translate the examination into the native
227language of any applicant who requests and agrees to pay all
228costs of such translation, provided that the translation request
229is filed with the board office no later than 9 months before the
230scheduled examination and the applicant remits translation fees
231as specified by the department no later than 6 months before the
232scheduled examination, and provided that the applicant
233demonstrates to the department the ability to communicate orally
234in basic English. If the applicant is unable to pay translation
235costs, the applicant may take the next available examination in
236English if the applicant submits a request in writing by the
237application deadline and if the applicant is otherwise eligible
238under this section. To demonstrate the ability to communicate
239orally in basic English, a passing score or grade is required,
240as determined by the department or organization that developed
241it, on the test for spoken English (TSE) by the Educational
242Testing Service (ETS), the test of English as a foreign language
243(TOEFL) by ETS, a high school or college level English course,
244or the English examination for citizenship, Bureau of
245Citizenship and Immigration Services. A notarized copy of an
246Educational Commission for Foreign Medical Graduates (ECFMG)
247certificate may also be used to demonstrate the ability to
248communicate in basic English; and
249     b.(I)  Is an unlicensed physician who graduated from a
250foreign medical school listed with the World Health Organization
251who has not previously taken and failed the examination of the
252National Commission on Certification of Physician Assistants and
253who has been certified by the Board of Medicine as having met
254the requirements for licensure as a medical doctor by
255examination as set forth in s. 458.311(1), (4)(3), (5)(4), and
256(6)(5), with the exception that the applicant is not required to
257have completed an approved residency of at least 1 year and the
258applicant is not required to have passed the licensing
259examination specified under s. 458.311 or hold a valid, active
260certificate issued by the Educational Commission for Foreign
261Medical Graduates; was eligible and made initial application for
262certification as a physician assistant in this state between
263July 1, 1990, and June 30, 1991; and was a resident of this
264state on July 1, 1990, or was licensed or certified in any state
265in the United States as a physician assistant on July 1, 1990;
266or
267     (II)  Completed all coursework requirements of the Master
268of Medical Science Physician Assistant Program offered through
269the Florida College of Physician's Assistants prior to its
270closure in August of 1996. Prior to taking the examination, such
271applicant must successfully complete any clinical rotations that
272were not completed under such program prior to its termination
273and any additional clinical rotations with an appropriate
274physician assistant preceptor, not to exceed 6 months, that are
275determined necessary by the council. The boards shall determine,
276based on recommendations from the council, the facilities under
277which such incomplete or additional clinical rotations may be
278completed and shall also determine what constitutes successful
279completion thereof, provided such requirements are comparable to
280those established by accredited physician assistant programs.
281This sub-sub-subparagraph is repealed July 1, 2001.
282     2.  The department may grant temporary licensure to an
283applicant who meets the requirements of subparagraph 1. Between
284meetings of the council, the department may grant temporary
285licensure to practice based on the completion of all temporary
286licensure requirements. All such administratively issued
287licenses shall be reviewed and acted on at the next regular
288meeting of the council. A temporary license expires 30 days
289after receipt and notice of scores to the licenseholder from the
290first available examination specified in subparagraph 1.
291following licensure by the department. An applicant who fails
292the proficiency examination is no longer temporarily licensed,
293but may apply for a one-time extension of temporary licensure
294after reapplying for the next available examination. Extended
295licensure shall expire upon failure of the licenseholder to sit
296for the next available examination or upon receipt and notice of
297scores to the licenseholder from such examination.
298     3.  Notwithstanding any other provision of law, the
299examination specified pursuant to subparagraph 1. shall be
300administered by the department only five times. Applicants
301certified by the board for examination shall receive at least 6
302months' notice of eligibility prior to the administration of the
303initial examination. Subsequent examinations shall be
304administered at 1-year intervals following the reporting of the
305scores of the first and subsequent examinations. For the
306purposes of this paragraph, the department may develop, contract
307for the development of, purchase, or approve an examination that
308adequately measures an applicant's ability to practice with
309reasonable skill and safety. The minimum passing score on the
310examination shall be established by the department, with the
311advice of the board. Those applicants failing to pass that
312examination or any subsequent examination shall receive notice
313of the administration of the next examination with the notice of
314scores following such examination. Any applicant who passes the
315examination and meets the requirements of this section shall be
316licensed as a physician assistant with all rights defined
317thereby.
318     Section 10.  Subsection (2) of section 459.015, Florida
319Statutes, is amended to read:
320     459.015  Grounds for disciplinary action; action by the
321board and department.--
322     (2)  The board may enter an order denying licensure or
323imposing any of the penalties in s. 456.072(2) against any
324applicant for licensure or licensee who is found guilty of
325violating any provision of subsection (1) of this section or who
326is found guilty of violating any provision of s. 456.072(1). A
327probable cause panel considering disciplinary action against a
328physician assistant pursuant to s. 456.073 shall include a
329licensed physician assistant designated by the Council on
330Physician Assistants, unless a physician assistant is not
331available. In determining what action is appropriate, the board
332must first consider what sanctions are necessary to protect the
333public or to compensate the patient. Only after those sanctions
334have been imposed may the disciplining authority consider and
335include in the order requirements designed to rehabilitate the
336physician. All costs associated with compliance with orders
337issued under this subsection are the obligation of the
338physician.
339     Section 11.  This act shall take effect upon becoming a
340law.
341
342================= T I T L E  A M E N D M E N T =================
343     Remove the entire title and insert:
344
A bill to be entitled
345An act relating to the practice of medicine; amending s.
346458.307, F.S.; revising membership requirements of the
347Board of Medicine; providing for the appointment of an
348additional member; providing applicability to current
349members; providing the beginning date for the term of the
350additional member; providing for continuing conditions of
351membership and replacement of unqualified members;
352amending s. 458.311, F.S.; providing an option for
353applicants for physician licensure to complete an
354externship; authorizing the Department of Health to
355develop procedures relating to completion of the
356externship; requiring board approval of externships;
357authorizing the board to adopt rules to implement
358externship requirements, including fees to cover costs;
359revising the requirement of the department to impose
360conditions, limitations, or restrictions on a license;
361amending ss. 458.313, 458.316, 458.3165, 458.317, and
362458.347, F.S.; correcting cross references; amending s.
363458.331, F.S.; providing a requirement for a probable
364cause panel considering disciplinary action against a
365physician assistant; providing an exception; providing
366practitioners a defense to alleged violations; amending s.
367459.015, F.S.; providing a requirement for a probable
368cause panel considering disciplinary action against a
369physician assistant; providing an exception; providing an
370effective date.


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