| 1 | Representative(s) Flores offered the following: |
| 2 |
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| 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, |
| 6 | Florida Statutes, are amended to read: |
| 7 | 458.307 Board of Medicine.-- |
| 8 | (1) There is created within the department the Board of |
| 9 | Medicine, composed of 17 15 members appointed by the Governor |
| 10 | and confirmed by the Senate. |
| 11 | (2) Twelve members of the board must be licensed |
| 12 | physicians in good standing in this state who are residents of |
| 13 | the state and who have been engaged in the active practice or |
| 14 | teaching of medicine in this state with a full and unrestricted |
| 15 | medical license for at least 5 4 years immediately preceding |
| 16 | their appointment. One of the physicians must be on the full- |
| 17 | time faculty of a medical school in this state, and one of the |
| 18 | physicians must be in private practice and on the full-time |
| 19 | staff of a statutory teaching hospital in this state as defined |
| 20 | in s. 408.07. At least one of the physicians must be a graduate |
| 21 | of a foreign medical school. The remaining five three members |
| 22 | must be residents of the state who have lived in the state for |
| 23 | at least 5 years immediately preceding their appointments, have |
| 24 | never been licensed as a health care practitioner under chapter |
| 25 | 456 or the applicable practice act, and do not have a |
| 26 | substantial personal, business, professional, or pecuniary |
| 27 | connection with a licensed health care practitioner or with a |
| 28 | medical education or health care facility, except as patients or |
| 29 | potential patients are not, and never have been, licensed health |
| 30 | care practitioners. One member must be a health care risk |
| 31 | manager licensed under s. 395.10974. At least one member of the |
| 32 | board must be 60 years of age or older. The requirements of this |
| 33 | subsection shall be a continuing condition of membership on the |
| 34 | board. Any member who ceases to meet the requirements of this |
| 35 | subsection shall be removed from the board, and a new qualified |
| 36 | member shall be appointed to fill the vacancy for the remainder |
| 37 | of that member's term. |
| 38 | Section 2. The requirements of section 458.307, Florida |
| 39 | Statutes, as amended by this act, shall apply to appointments |
| 40 | made on or after the effective date of this act and shall not be |
| 41 | construed to end the term of any member of the Board of Medicine |
| 42 | holding that appointment on the effective date of this act. The |
| 43 | term of the additional members required to be appointed under |
| 44 | section 458.307, Florida Statutes, as amended by this act, shall |
| 45 | begin November 1, 2005. |
| 46 | Section 3. Subsections (2) through (8) of section 458.311, |
| 47 | Florida Statutes, are renumbered as subsections (3) through (9), |
| 48 | respectively, present subsections (5) and (7) are amended, and a |
| 49 | new 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 |
| 53 | passing part II of the National Board of Medical Examiners |
| 54 | examination or the Educational Commission for Foreign Medical |
| 55 | Graduates examination equivalent as referred to in paragraph |
| 56 | (3)(d), the department may develop procedures for an applicant |
| 57 | for licensure as a physician pursuant to this chapter to meet |
| 58 | postgraduate training requirements by completion of a 2-year |
| 59 | externship at a nonstatutory teaching hospital licensed in this |
| 60 | state. The training provided in the externship shall be |
| 61 | substantially similar, as defined by board rule, to the training |
| 62 | provided in an approved residency as provided in sub- |
| 63 | subparagraph (1)(f)1.c., sub-subparagraph (1)(f)2.c., or sub- |
| 64 | subparagraph (1)(f)3.c. In order for the externship to meet the |
| 65 | requirements of this subsection, it must be approved by the |
| 66 | board prior to the applicant entering into the externship. The |
| 67 | applicant shall not be licensed pursuant to this subsection |
| 68 | unless the board finds that the applicant has successfully |
| 69 | completed the externship. The board may adopt rules to implement |
| 70 | this subsection, including the implementation of fees to cover |
| 71 | costs. |
| 72 | (6)(5) The board may not certify to the department for |
| 73 | licensure any applicant who is under investigation in another |
| 74 | jurisdiction for an offense which would constitute a violation |
| 75 | of this chapter until such investigation is completed. Upon |
| 76 | completion of the investigation, the provisions of s. 458.331 |
| 77 | shall apply. Furthermore, the department may not issue an |
| 78 | unrestricted license to any individual who has committed any act |
| 79 | or offense in any jurisdiction which would constitute the basis |
| 80 | for disciplining a physician pursuant to s. 458.331. When the |
| 81 | board finds that an individual has committed an act or offense |
| 82 | in any jurisdiction which would constitute the basis for |
| 83 | disciplining a physician pursuant to s. 458.331, then the board |
| 84 | may enter an order imposing one or more of the terms set forth |
| 85 | in subsection (9)(8). |
| 86 | (8)(7) Upon certification by the board, the department |
| 87 | shall impose conditions, limitations, or restrictions on a |
| 88 | license if the applicant is on probation in another jurisdiction |
| 89 | for an act which would constitute a violation of this chapter or |
| 90 | if the externship requirement provided in subsection (2) was |
| 91 | complied with at a nonstatutory teaching hospital. |
| 92 | Section 4. Paragraph (a) of subsection (1) of section |
| 93 | 458.313, 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 |
| 96 | any applicant who, upon applying to the department on forms |
| 97 | furnished by the department and remitting a fee set by the board |
| 98 | not to exceed $500, the board certifies: |
| 99 | (a) Has met the qualifications for licensure in s. |
| 100 | 458.311(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 |
| 102 | Statutes, is amended to read: |
| 103 | 458.316 Public health certificate.-- |
| 104 | (1) Any person desiring to obtain a public health |
| 105 | certificate shall submit an application fee not to exceed $300 |
| 106 | and shall demonstrate to the board that he or she is a graduate |
| 107 | of an accredited medical school and holds a master of public |
| 108 | health degree or is board eligible or certified in public health |
| 109 | or preventive medicine, or is licensed to practice medicine |
| 110 | without restriction in another jurisdiction in the United States |
| 111 | and holds a master of public health degree or is board eligible |
| 112 | or certified in public health or preventive medicine, and shall |
| 113 | meet the requirements in s. 458.311(1)(a)-(g) and (6)(5). |
| 114 | Section 6. Section 458.3165, Florida Statutes, is amended |
| 115 | to read: |
| 116 | 458.3165 Public psychiatry certificate.--The board shall |
| 117 | issue a public psychiatry certificate to an individual who |
| 118 | remits an application fee not to exceed $300, as set by the |
| 119 | board, who is a board-certified psychiatrist, who is licensed to |
| 120 | practice medicine without restriction in another state, and who |
| 121 | meets the requirements in s. 458.311(1)(a)-(g) and (6)(5). A |
| 122 | recipient of a public psychiatry certificate may use the |
| 123 | certificate to work at any public mental health facility or |
| 124 | program funded in part or entirely by state funds. |
| 125 | (1) Such certificate shall: |
| 126 | (a) Authorize the holder to practice only in a public |
| 127 | mental health facility or program funded in part or entirely by |
| 128 | state funds. |
| 129 | (b) Be issued and renewable biennially if the secretary of |
| 130 | the Department of Health and the chair of the department of |
| 131 | psychiatry at one of the public medical schools or the chair of |
| 132 | the department of psychiatry at the accredited medical school at |
| 133 | the University of Miami recommend in writing that the |
| 134 | certificate be issued or renewed. |
| 135 | (c) Automatically expire if the holder's relationship with |
| 136 | a public mental health facility or program expires. |
| 137 | (d) Not be issued to a person who has been adjudged |
| 138 | unqualified or guilty of any of the prohibited acts in this |
| 139 | chapter. |
| 140 | (2) The board may take disciplinary action against a |
| 141 | certificateholder for noncompliance with any part of this |
| 142 | section or for any reason for which a regular licensee may be |
| 143 | subject to discipline. |
| 144 | Section 7. Paragraph (a) of subsection (1) of section |
| 145 | 458.317, Florida Statutes, is amended to read: |
| 146 | 458.317 Limited licenses.-- |
| 147 | (1)(a) Any person desiring to obtain a limited license |
| 148 | shall: |
| 149 | 1. Submit to the board, with an application and fee not to |
| 150 | exceed $300, an affidavit stating that he or she has been |
| 151 | licensed to practice medicine in any jurisdiction in the United |
| 152 | States for at least 10 years and intends to practice only |
| 153 | pursuant to the restrictions of a limited license granted |
| 154 | pursuant to this section. However, a physician who is not fully |
| 155 | retired in all jurisdictions may use a limited license only for |
| 156 | noncompensated practice. If the person applying for a limited |
| 157 | license submits a notarized statement from the employing agency |
| 158 | or institution stating that he or she will not receive |
| 159 | compensation for any service involving the practice of medicine, |
| 160 | the application fee and all licensure fees shall be waived. |
| 161 | However, any person who receives a waiver of fees for a limited |
| 162 | license shall pay such fees if the person receives compensation |
| 163 | for 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 |
| 166 | 1946, the board or its appropriate committee may accept military |
| 167 | medical training or medical experience as a substitute for the |
| 168 | approved 1-year residency requirement in s. 458.311(1)(f). |
| 169 |
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| 170 | Nothing herein limits in any way any policy by the board, |
| 171 | otherwise authorized by law, to grant licenses to physicians |
| 172 | duly licensed in other states under conditions less restrictive |
| 173 | than the requirements of this section. Notwithstanding the other |
| 174 | provisions of this section, the board may refuse to authorize a |
| 175 | physician otherwise qualified to practice in the employ of any |
| 176 | agency or institution otherwise qualified if the agency or |
| 177 | institution has caused or permitted violations of the provisions |
| 178 | of this chapter which it knew or should have known were |
| 179 | occurring. |
| 180 | Section 8. Subsection (2) of section 458.331, Florida |
| 181 | Statutes, is amended, and subsection (11) is added to said |
| 182 | section, to read: |
| 183 | 458.331 Grounds for disciplinary action; action by the |
| 184 | board and department.-- |
| 185 | (2) The board may enter an order denying licensure or |
| 186 | imposing any of the penalties in s. 456.072(2) against any |
| 187 | applicant for licensure or licensee who is found guilty of |
| 188 | violating any provision of subsection (1) of this section or who |
| 189 | is found guilty of violating any provision of s. 456.072(1). A |
| 190 | probable cause panel considering disciplinary action against a |
| 191 | physician assistant pursuant to s. 456.073 shall include a |
| 192 | licensed physician assistant designated by the Council on |
| 193 | Physician Assistants, unless a physician assistant is not |
| 194 | available. In determining what action is appropriate, the board |
| 195 | must first consider what sanctions are necessary to protect the |
| 196 | public or to compensate the patient. Only after those sanctions |
| 197 | have been imposed may the disciplining authority consider and |
| 198 | include in the order requirements designed to rehabilitate the |
| 199 | physician. All costs associated with compliance with orders |
| 200 | issued under this subsection are the obligation of the |
| 201 | physician. |
| 202 | (11) Notwithstanding any law to the contrary, a |
| 203 | practitioner licensed under this chapter has a defense to an |
| 204 | alleged violation, by the preponderance of the evidence, that |
| 205 | the practitioner relied in good faith on the representations |
| 206 | made to the practitioner by a drug manufacturer or its |
| 207 | representatives and that the practitioner had no intent to |
| 208 | violate the law. |
| 209 | Section 9. Paragraph (b) of subsection (7) of section |
| 210 | 458.347, Florida Statutes, is amended to read: |
| 211 | 458.347 Physician assistants.-- |
| 212 | (7) PHYSICIAN ASSISTANT LICENSURE.-- |
| 213 | (b)1. Notwithstanding subparagraph (a)2. and |
| 214 | sub-subparagraph (a)3.a., the department shall examine each |
| 215 | applicant who the Board of Medicine certifies: |
| 216 | a. Has completed the application form and remitted a |
| 217 | nonrefundable application fee not to exceed $500 and an |
| 218 | examination fee not to exceed $300, plus the actual cost to the |
| 219 | department to provide the examination. The examination fee is |
| 220 | refundable if the applicant is found to be ineligible to take |
| 221 | the examination. The department shall not require the applicant |
| 222 | to pass a separate practical component of the examination. For |
| 223 | examinations given after July 1, 1998, competencies measured |
| 224 | through practical examinations shall be incorporated into the |
| 225 | written examination through a multiple-choice format. The |
| 226 | department shall translate the examination into the native |
| 227 | language of any applicant who requests and agrees to pay all |
| 228 | costs of such translation, provided that the translation request |
| 229 | is filed with the board office no later than 9 months before the |
| 230 | scheduled examination and the applicant remits translation fees |
| 231 | as specified by the department no later than 6 months before the |
| 232 | scheduled examination, and provided that the applicant |
| 233 | demonstrates to the department the ability to communicate orally |
| 234 | in basic English. If the applicant is unable to pay translation |
| 235 | costs, the applicant may take the next available examination in |
| 236 | English if the applicant submits a request in writing by the |
| 237 | application deadline and if the applicant is otherwise eligible |
| 238 | under this section. To demonstrate the ability to communicate |
| 239 | orally in basic English, a passing score or grade is required, |
| 240 | as determined by the department or organization that developed |
| 241 | it, on the test for spoken English (TSE) by the Educational |
| 242 | Testing Service (ETS), the test of English as a foreign language |
| 243 | (TOEFL) by ETS, a high school or college level English course, |
| 244 | or the English examination for citizenship, Bureau of |
| 245 | Citizenship and Immigration Services. A notarized copy of an |
| 246 | Educational Commission for Foreign Medical Graduates (ECFMG) |
| 247 | certificate may also be used to demonstrate the ability to |
| 248 | communicate in basic English; and |
| 249 | b.(I) Is an unlicensed physician who graduated from a |
| 250 | foreign medical school listed with the World Health Organization |
| 251 | who has not previously taken and failed the examination of the |
| 252 | National Commission on Certification of Physician Assistants and |
| 253 | who has been certified by the Board of Medicine as having met |
| 254 | the requirements for licensure as a medical doctor by |
| 255 | examination 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 |
| 257 | have completed an approved residency of at least 1 year and the |
| 258 | applicant is not required to have passed the licensing |
| 259 | examination specified under s. 458.311 or hold a valid, active |
| 260 | certificate issued by the Educational Commission for Foreign |
| 261 | Medical Graduates; was eligible and made initial application for |
| 262 | certification as a physician assistant in this state between |
| 263 | July 1, 1990, and June 30, 1991; and was a resident of this |
| 264 | state on July 1, 1990, or was licensed or certified in any state |
| 265 | in the United States as a physician assistant on July 1, 1990; |
| 266 | or |
| 267 | (II) Completed all coursework requirements of the Master |
| 268 | of Medical Science Physician Assistant Program offered through |
| 269 | the Florida College of Physician's Assistants prior to its |
| 270 | closure in August of 1996. Prior to taking the examination, such |
| 271 | applicant must successfully complete any clinical rotations that |
| 272 | were not completed under such program prior to its termination |
| 273 | and any additional clinical rotations with an appropriate |
| 274 | physician assistant preceptor, not to exceed 6 months, that are |
| 275 | determined necessary by the council. The boards shall determine, |
| 276 | based on recommendations from the council, the facilities under |
| 277 | which such incomplete or additional clinical rotations may be |
| 278 | completed and shall also determine what constitutes successful |
| 279 | completion thereof, provided such requirements are comparable to |
| 280 | those established by accredited physician assistant programs. |
| 281 | This sub-sub-subparagraph is repealed July 1, 2001. |
| 282 | 2. The department may grant temporary licensure to an |
| 283 | applicant who meets the requirements of subparagraph 1. Between |
| 284 | meetings of the council, the department may grant temporary |
| 285 | licensure to practice based on the completion of all temporary |
| 286 | licensure requirements. All such administratively issued |
| 287 | licenses shall be reviewed and acted on at the next regular |
| 288 | meeting of the council. A temporary license expires 30 days |
| 289 | after receipt and notice of scores to the licenseholder from the |
| 290 | first available examination specified in subparagraph 1. |
| 291 | following licensure by the department. An applicant who fails |
| 292 | the proficiency examination is no longer temporarily licensed, |
| 293 | but may apply for a one-time extension of temporary licensure |
| 294 | after reapplying for the next available examination. Extended |
| 295 | licensure shall expire upon failure of the licenseholder to sit |
| 296 | for the next available examination or upon receipt and notice of |
| 297 | scores to the licenseholder from such examination. |
| 298 | 3. Notwithstanding any other provision of law, the |
| 299 | examination specified pursuant to subparagraph 1. shall be |
| 300 | administered by the department only five times. Applicants |
| 301 | certified by the board for examination shall receive at least 6 |
| 302 | months' notice of eligibility prior to the administration of the |
| 303 | initial examination. Subsequent examinations shall be |
| 304 | administered at 1-year intervals following the reporting of the |
| 305 | scores of the first and subsequent examinations. For the |
| 306 | purposes of this paragraph, the department may develop, contract |
| 307 | for the development of, purchase, or approve an examination that |
| 308 | adequately measures an applicant's ability to practice with |
| 309 | reasonable skill and safety. The minimum passing score on the |
| 310 | examination shall be established by the department, with the |
| 311 | advice of the board. Those applicants failing to pass that |
| 312 | examination or any subsequent examination shall receive notice |
| 313 | of the administration of the next examination with the notice of |
| 314 | scores following such examination. Any applicant who passes the |
| 315 | examination and meets the requirements of this section shall be |
| 316 | licensed as a physician assistant with all rights defined |
| 317 | thereby. |
| 318 | Section 10. Subsection (2) of section 459.015, Florida |
| 319 | Statutes, is amended to read: |
| 320 | 459.015 Grounds for disciplinary action; action by the |
| 321 | board and department.-- |
| 322 | (2) The board may enter an order denying licensure or |
| 323 | imposing any of the penalties in s. 456.072(2) against any |
| 324 | applicant for licensure or licensee who is found guilty of |
| 325 | violating any provision of subsection (1) of this section or who |
| 326 | is found guilty of violating any provision of s. 456.072(1). A |
| 327 | probable cause panel considering disciplinary action against a |
| 328 | physician assistant pursuant to s. 456.073 shall include a |
| 329 | licensed physician assistant designated by the Council on |
| 330 | Physician Assistants, unless a physician assistant is not |
| 331 | available. In determining what action is appropriate, the board |
| 332 | must first consider what sanctions are necessary to protect the |
| 333 | public or to compensate the patient. Only after those sanctions |
| 334 | have been imposed may the disciplining authority consider and |
| 335 | include in the order requirements designed to rehabilitate the |
| 336 | physician. All costs associated with compliance with orders |
| 337 | issued under this subsection are the obligation of the |
| 338 | physician. |
| 339 | Section 11. This act shall take effect upon becoming a |
| 340 | law. |
| 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 |
| 345 | An act relating to the practice of medicine; amending s. |
| 346 | 458.307, F.S.; revising membership requirements of the |
| 347 | Board of Medicine; providing for the appointment of |
| 348 | additional members; providing applicability to current |
| 349 | members; providing the beginning date for the term of |
| 350 | additional members; membership and replacement of |
| 351 | unqualified members; amending s. 458.311, F.S.; providing |
| 352 | an option for applicants for physician licensure to |
| 353 | complete an externship; authorizing the Department of |
| 354 | Health to develop procedures relating to completion of the |
| 355 | externship; requiring board approval of externships; |
| 356 | authorizing the board to adopt rules to implement |
| 357 | externship requirements, including fees to cover costs; |
| 358 | revising the requirement of the department to impose |
| 359 | conditions, limitations, or restrictions on a license; |
| 360 | amending ss. 458.313, 458.316, 458.3165, 458.317, and |
| 361 | 458.347, F.S.; correcting cross references; amending s. |
| 362 | 458.331, F.S.; providing a requirement for a probable |
| 363 | cause panel considering disciplinary action against a |
| 364 | physician assistant; providing an exception; providing |
| 365 | practitioners a defense to alleged violations; amending s. |
| 366 | 459.015, F.S.; providing a requirement for a probable |
| 367 | cause panel considering disciplinary action against a |
| 368 | physician assistant; providing an exception; providing an |
| 369 | effective date. |