Senate Bill sb1180er

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    2005 Legislature                 CS for SB 1180, 3rd Engrossed



  1                                 

  2         An act relating to the practice of medicine;

  3         amending s. 458.307, F.S.; revising membership

  4         requirements of the Board of Medicine;

  5         providing for the appointment of additional

  6         members; providing applicability to current

  7         members; providing the beginning date for the

  8         term of additional members; membership and

  9         replacement of unqualified members; amending s.

10         458.311, F.S.; providing an option for

11         applicants for physician licensure to complete

12         an externship; authorizing the Department of

13         Health to develop procedures relating to

14         completion of the externship; requiring board

15         approval of externships; authorizing the board

16         to adopt rules to implement externship

17         requirements, including fees to cover costs;

18         revising the requirement of the department to

19         impose conditions, limitations, or restrictions

20         on a license; amending ss. 458.313, 458.316,

21         458.3165, 458.317, and 458.347, F.S.;

22         correcting cross references; amending s.

23         458.331, F.S.; providing a requirement for a

24         probable cause panel considering disciplinary

25         action against a physician assistant; providing

26         an exception; providing practitioners a defense

27         to alleged violations; amending s. 459.015,

28         F.S.; providing a requirement for a probable

29         cause panel considering disciplinary action

30         against a physician assistant; providing an

31         exception; providing an effective date.


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    2005 Legislature                 CS for SB 1180, 3rd Engrossed



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

 2  

 3         Section 1.  Subsections (1) and (2) of section 458.307,

 4  Florida Statutes, are amended to read:

 5         458.307  Board of Medicine.--

 6         (1)  There is created within the department the Board

 7  of Medicine, composed of 17 15 members appointed by the

 8  Governor and confirmed by the Senate.

 9         (2)  Twelve members of the board must be licensed

10  physicians in good standing in this state who are residents of

11  the state and who have been engaged in the active practice or

12  teaching of medicine in this state with a full and

13  unrestricted medical license for at least 5 4 years

14  immediately preceding their appointment. One of the physicians

15  must be on the full-time faculty of a medical school in this

16  state, and one of the physicians must be in private practice

17  and on the full-time staff of a statutory teaching hospital in

18  this state as defined in s. 408.07. At least one of the

19  physicians must be a graduate of a foreign medical school. The

20  remaining five three members must be residents of the state

21  who have lived in the state for at least 5 years immediately

22  preceding their appointments, have never been licensed as a

23  health care practitioner under chapter 456 or the applicable

24  practice act, and do not have a substantial personal,

25  business, professional, or pecuniary connection with a

26  licensed health care practitioner or with a medical education

27  or health care facility, except as patients or potential

28  patients are not, and never have been, licensed health care

29  practitioners. One member must be a health care risk manager

30  licensed under s. 395.10974. At least one member of the board

31  must be 60 years of age or older. The requirements of this


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    2005 Legislature                 CS for SB 1180, 3rd Engrossed



 1  subsection shall be a continuing condition of membership on

 2  the board. Any member who ceases to meet the requirements of

 3  this subsection shall be removed from the board, and a new

 4  qualified member shall be appointed to fill the vacancy for

 5  the remainder of that member's term.

 6         Section 2.  The requirements of section 458.307,

 7  Florida Statutes, as amended by this act, shall apply to

 8  appointments made on or after the effective date of this act

 9  and shall not be construed to end the term of any member of

10  the Board of Medicine holding that appointment on the

11  effective date of this act. The term of the additional members

12  required to be appointed under section 458.307, Florida

13  Statutes, as amended by this act, shall begin November 1,

14  2005.

15         Section 3.  Subsections (2) through (8) of section

16  458.311, Florida Statutes, are renumbered as subsections (3)

17  through (9), respectively, present subsections (5) and (7) are

18  amended, and a new subsection (2) is added to said section, to

19  read:

20         458.311  Licensure by examination; requirements;

21  fees.--

22         (2)  Notwithstanding sub-subparagraphs (1)(f)1.c.,

23  (1)(f)2.c., and (1)(f)3.c. and paragraph (3)(d), except for

24  passing part II of the National Board of Medical Examiners

25  examination or the Educational Commission for Foreign Medical

26  Graduates examination equivalent as referred to in paragraph

27  (3)(d), the department may develop procedures for an applicant

28  for licensure as a physician pursuant to this chapter to meet

29  postgraduate training requirements by completion of a 2-year

30  externship at a nonstatutory teaching hospital licensed in

31  this state. The training provided in the externship shall be


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 1  substantially similar, as defined by board rule, to the

 2  training provided in an approved residency as provided in

 3  sub-subparagraph (1)(f)1.c., sub-subparagraph (1)(f)2.c., or

 4  sub-subparagraph (1)(f)3.c. In order for the externship to

 5  meet the requirements of this subsection, it must be approved

 6  by the board prior to the applicant entering into the

 7  externship. The applicant shall not be licensed pursuant to

 8  this subsection unless the board finds that the applicant has

 9  successfully completed the externship. The board may adopt

10  rules to implement this subsection, including the

11  implementation of fees to cover costs.

12         (6)(5)  The board may not certify to the department for

13  licensure any applicant who is under investigation in another

14  jurisdiction for an offense which would constitute a violation

15  of this chapter until such investigation is completed. Upon

16  completion of the investigation, the provisions of s. 458.331

17  shall apply. Furthermore, the department may not issue an

18  unrestricted license to any individual who has committed any

19  act or offense in any jurisdiction which would constitute the

20  basis for disciplining a physician pursuant to s. 458.331.

21  When the board finds that an individual has committed an act

22  or offense in any jurisdiction which would constitute the

23  basis for disciplining a physician pursuant to s. 458.331,

24  then the board may enter an order imposing one or more of the

25  terms set forth in subsection (9)(8).

26         (8)(7)  Upon certification by the board, the department

27  shall impose conditions, limitations, or restrictions on a

28  license if the applicant is on probation in another

29  jurisdiction for an act which would constitute a violation of

30  this chapter or if the externship requirement provided in

31  


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 1  subsection (2) was complied with at a nonstatutory teaching

 2  hospital.

 3         Section 4.  Paragraph (a) of subsection (1) of section

 4  458.313, Florida Statutes, is amended to read:

 5         458.313  Licensure by endorsement; requirements;

 6  fees.--

 7         (1)  The department shall issue a license by

 8  endorsement to any applicant who, upon applying to the

 9  department on forms furnished by the department and remitting

10  a fee set by the board not to exceed $500, the board

11  certifies:

12         (a)  Has met the qualifications for licensure in s.

13  458.311(1)(b)-(g) or in s. 458.311(1)(b)-(e) and (g) and

14  (4)(3);

15         Section 5.  Subsection (1) of section 458.316, Florida

16  Statutes, is amended to read:

17         458.316  Public health certificate.--

18         (1)  Any person desiring to obtain a public health

19  certificate shall submit an application fee not to exceed $300

20  and shall demonstrate to the board that he or she is a

21  graduate of an accredited medical school and holds a master of

22  public health degree or is board eligible or certified in

23  public health or preventive medicine, or is licensed to

24  practice medicine without restriction in another jurisdiction

25  in the United States and holds a master of public health

26  degree or is board eligible or certified in public health or

27  preventive medicine, and shall meet the requirements in s.

28  458.311(1)(a)-(g) and (6)(5).

29         Section 6.  Section 458.3165, Florida Statutes, is

30  amended to read:

31  


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    2005 Legislature                 CS for SB 1180, 3rd Engrossed



 1         458.3165  Public psychiatry certificate.--The board

 2  shall issue a public psychiatry certificate to an individual

 3  who remits an application fee not to exceed $300, as set by

 4  the board, who is a board-certified psychiatrist, who is

 5  licensed to practice medicine without restriction in another

 6  state, and who meets the requirements in s. 458.311(1)(a)-(g)

 7  and (6)(5). A recipient of a public psychiatry certificate may

 8  use the certificate to work at any public mental health

 9  facility or program funded in part or entirely by state funds.

10         (1)  Such certificate shall:

11         (a)  Authorize the holder to practice only in a public

12  mental health facility or program funded in part or entirely

13  by state funds.

14         (b)  Be issued and renewable biennially if the

15  secretary of the Department of Health and the chair of the

16  department of psychiatry at one of the public medical schools

17  or the chair of the department of psychiatry at the accredited

18  medical school at the University of Miami recommend in writing

19  that the certificate be issued or renewed.

20         (c)  Automatically expire if the holder's relationship

21  with a public mental health facility or program expires.

22         (d)  Not be issued to a person who has been adjudged

23  unqualified or guilty of any of the prohibited acts in this

24  chapter.

25         (2)  The board may take disciplinary action against a

26  certificateholder for noncompliance with any part of this

27  section or for any reason for which a regular licensee may be

28  subject to discipline.

29         Section 7.  Paragraph (a) of subsection (1) of section

30  458.317, Florida Statutes, is amended to read:

31         458.317  Limited licenses.--


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    2005 Legislature                 CS for SB 1180, 3rd Engrossed



 1         (1)(a)  Any person desiring to obtain a limited license

 2  shall:

 3         1.  Submit to the board, with an application and fee

 4  not to exceed $300, an affidavit stating that he or she has

 5  been licensed to practice medicine in any jurisdiction in the

 6  United States for at least 10 years and intends to practice

 7  only pursuant to the restrictions of a limited license granted

 8  pursuant to this section. However, a physician who is not

 9  fully retired in all jurisdictions may use a limited license

10  only for noncompensated practice. If the person applying for a

11  limited license submits a notarized statement from the

12  employing agency or institution stating that he or she will

13  not receive compensation for any service involving the

14  practice of medicine, the application fee and all licensure

15  fees shall be waived. However, any person who receives a

16  waiver of fees for a limited license shall pay such fees if

17  the person receives compensation for the practice of medicine.

18         2.  Meet the requirements in s. 458.311(1)(b)-(g) and

19  (6)(5). If the applicant graduated from medical school prior

20  to 1946, the board or its appropriate committee may accept

21  military medical training or medical experience as a

22  substitute for the approved 1-year residency requirement in s.

23  458.311(1)(f).

24  

25  Nothing herein limits in any way any policy by the board,

26  otherwise authorized by law, to grant licenses to physicians

27  duly licensed in other states under conditions less

28  restrictive than the requirements of this section.

29  Notwithstanding the other provisions of this section, the

30  board may refuse to authorize a physician otherwise qualified

31  to practice in the employ of any agency or institution


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 1  otherwise qualified if the agency or institution has caused or

 2  permitted violations of the provisions of this chapter which

 3  it knew or should have known were occurring.

 4         Section 8.  Subsection (2) of section 458.331, Florida

 5  Statutes, is amended, and subsection (11) is added to said

 6  section, to read:

 7         458.331  Grounds for disciplinary action; action by the

 8  board and department.--

 9         (2)  The board may enter an order denying licensure or

10  imposing any of the penalties in s. 456.072(2) against any

11  applicant for licensure or licensee who is found guilty of

12  violating any provision of subsection (1) of this section or

13  who is found guilty of violating any provision of s.

14  456.072(1). A probable cause panel considering disciplinary

15  action against a physician assistant pursuant to s. 456.073

16  shall include a licensed physician assistant designated by the

17  Council on Physician Assistants, unless a physician assistant

18  is not available. In determining what action is appropriate,

19  the board must first consider what sanctions are necessary to

20  protect the public or to compensate the patient. Only after

21  those sanctions have been imposed may the disciplining

22  authority consider and include in the order requirements

23  designed to rehabilitate the physician. All costs associated

24  with compliance with orders issued under this subsection are

25  the obligation of the physician.

26         (11)  Notwithstanding any law to the contrary, a

27  practitioner licensed under this chapter has a defense to an

28  alleged violation, by the preponderance of the evidence, that

29  the practitioner relied in good faith on the representations

30  made to the practitioner by a drug manufacturer or its

31  


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 1  representatives and that the practitioner had no intent to

 2  violate the law.

 3         Section 9.  Paragraph (b) of subsection (7) of section

 4  458.347, Florida Statutes, is amended to read:

 5         458.347  Physician assistants.--

 6         (7)  PHYSICIAN ASSISTANT LICENSURE.--

 7         (b)1.  Notwithstanding subparagraph (a)2. and

 8  sub-subparagraph (a)3.a., the department shall examine each

 9  applicant who the Board of Medicine certifies:

10         a.  Has completed the application form and remitted a

11  nonrefundable application fee not to exceed $500 and an

12  examination fee not to exceed $300, plus the actual cost to

13  the department to provide the examination. The examination fee

14  is refundable if the applicant is found to be ineligible to

15  take the examination. The department shall not require the

16  applicant to pass a separate practical component of the

17  examination. For examinations given after July 1, 1998,

18  competencies measured through practical examinations shall be

19  incorporated into the written examination through a

20  multiple-choice format. The department shall translate the

21  examination into the native language of any applicant who

22  requests and agrees to pay all costs of such translation,

23  provided that the translation request is filed with the board

24  office no later than 9 months before the scheduled examination

25  and the applicant remits translation fees as specified by the

26  department no later than 6 months before the scheduled

27  examination, and provided that the applicant demonstrates to

28  the department the ability to communicate orally in basic

29  English. If the applicant is unable to pay translation costs,

30  the applicant may take the next available examination in

31  English if the applicant submits a request in writing by the


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 1  application deadline and if the applicant is otherwise

 2  eligible under this section. To demonstrate the ability to

 3  communicate orally in basic English, a passing score or grade

 4  is required, as determined by the department or organization

 5  that developed it, on the test for spoken English (TSE) by the

 6  Educational Testing Service (ETS), the test of English as a

 7  foreign language (TOEFL) by ETS, a high school or college

 8  level English course, or the English examination for

 9  citizenship, Bureau of Citizenship and Immigration Services. A

10  notarized copy of an Educational Commission for Foreign

11  Medical Graduates (ECFMG) certificate may also be used to

12  demonstrate the ability to communicate in basic English; and

13         b.(I)  Is an unlicensed physician who graduated from a

14  foreign medical school listed with the World Health

15  Organization who has not previously taken and failed the

16  examination of the National Commission on Certification of

17  Physician Assistants and who has been certified by the Board

18  of Medicine as having met the requirements for licensure as a

19  medical doctor by examination as set forth in s. 458.311(1),

20  (4)(3), (5)(4), and (6)(5) , with the exception that the

21  applicant is not required to have completed an approved

22  residency of at least 1 year and the applicant is not required

23  to have passed the licensing examination specified under s.

24  458.311 or hold a valid, active certificate issued by the

25  Educational Commission for Foreign Medical Graduates; was

26  eligible and made initial application for certification as a

27  physician assistant in this state between July 1, 1990, and

28  June 30, 1991; and was a resident of this state on July 1,

29  1990, or was licensed or certified in any state in the United

30  States as a physician assistant on July 1, 1990; or

31  


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 1         (II)  Completed all coursework requirements of the

 2  Master of Medical Science Physician Assistant Program offered

 3  through the Florida College of Physician's Assistants prior to

 4  its closure in August of 1996. Prior to taking the

 5  examination, such applicant must successfully complete any

 6  clinical rotations that were not completed under such program

 7  prior to its termination and any additional clinical rotations

 8  with an appropriate physician assistant preceptor, not to

 9  exceed 6 months, that are determined necessary by the council.

10  The boards shall determine, based on recommendations from the

11  council, the facilities under which such incomplete or

12  additional clinical rotations may be completed and shall also

13  determine what constitutes successful completion thereof,

14  provided such requirements are comparable to those established

15  by accredited physician assistant programs. This

16  sub-sub-subparagraph is repealed July 1, 2001.

17         2.  The department may grant temporary licensure to an

18  applicant who meets the requirements of subparagraph 1.

19  Between meetings of the council, the department may grant

20  temporary licensure to practice based on the completion of all

21  temporary licensure requirements. All such administratively

22  issued licenses shall be reviewed and acted on at the next

23  regular meeting of the council. A temporary license expires 30

24  days after receipt and notice of scores to the licenseholder

25  from the first available examination specified in subparagraph

26  1. following licensure by the department. An applicant who

27  fails the proficiency examination is no longer temporarily

28  licensed, but may apply for a one-time extension of temporary

29  licensure after reapplying for the next available examination.

30  Extended licensure shall expire upon failure of the

31  licenseholder to sit for the next available examination or


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 1  upon receipt and notice of scores to the licenseholder from

 2  such examination.

 3         3.  Notwithstanding any other provision of law, the

 4  examination specified pursuant to subparagraph 1. shall be

 5  administered by the department only five times. Applicants

 6  certified by the board for examination shall receive at least

 7  6 months' notice of eligibility prior to the administration of

 8  the initial examination. Subsequent examinations shall be

 9  administered at 1-year intervals following the reporting of

10  the scores of the first and subsequent examinations. For the

11  purposes of this paragraph, the department may develop,

12  contract for the development of, purchase, or approve an

13  examination that adequately measures an applicant's ability to

14  practice with reasonable skill and safety. The minimum passing

15  score on the examination shall be established by the

16  department, with the advice of the board. Those applicants

17  failing to pass that examination or any subsequent examination

18  shall receive notice of the administration of the next

19  examination with the notice of scores following such

20  examination. Any applicant who passes the examination and

21  meets the requirements of this section shall be licensed as a

22  physician assistant with all rights defined thereby.

23         Section 10.  Subsection (2) of section 459.015, Florida

24  Statutes, is amended to read:

25         459.015  Grounds for disciplinary action; action by the

26  board and department.--

27         (2)  The board may enter an order denying licensure or

28  imposing any of the penalties in s. 456.072(2) against any

29  applicant for licensure or licensee who is found guilty of

30  violating any provision of subsection (1) of this section or

31  who is found guilty of violating any provision of s.


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    2005 Legislature                 CS for SB 1180, 3rd Engrossed



 1  456.072(1). A probable cause panel considering disciplinary

 2  action against a physician assistant pursuant to s. 456.073

 3  shall include a licensed physician assistant designated by the

 4  Council on Physician Assistants, unless a physician assistant

 5  is not available. In determining what action is appropriate,

 6  the board must first consider what sanctions are necessary to

 7  protect the public or to compensate the patient. Only after

 8  those sanctions have been imposed may the disciplining

 9  authority consider and include in the order requirements

10  designed to rehabilitate the physician. All costs associated

11  with compliance with orders issued under this subsection are

12  the obligation of the physician.

13         Section 11.  This act shall take effect upon becoming a

14  law.

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