HB 0521CS

CHAMBER ACTION




1The Health & Families Council recommends the following:
2
3     Council/Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to the practice of medicine; amending s.
7458.307, F.S.; revising membership requirements of the
8Board of Medicine; providing for the appointment of an
9additional member; providing applicability to current
10members; providing the beginning date for the term of the
11additional member; amending s. 458.311, F.S.; providing an
12option for applicants for physician licensure to complete
13an externship; authorizing the Department of Health to
14develop procedures relating to completion of the
15externship; requiring board approval of externships;
16authorizing the board to adopt rules to implement
17externship requirements, including fees to cover costs;
18revising the requirement of the department to impose
19conditions, limitations, or restrictions on a license;
20amending ss. 458.313, 458.316, 458.3165, 458.317, and
21458.347, F.S.; correcting cross references; amending ss.
22458.331 and 459.015, F.S.; providing a requirement for a
23probable cause panel considering disciplinary action
24against a physician assistant; providing an effective
25date.
26
27Be It Enacted by the Legislature of the State of Florida:
28
29     Section 1.  Subsections (1) and (2) of section 458.307,
30Florida Statutes, are amended to read:
31     458.307  Board of Medicine.--
32     (1)  There is created within the department the Board of
33Medicine, composed of 16 15 members appointed by the Governor
34and confirmed by the Senate.
35     (2)  Twelve members of the board must be licensed
36physicians in good standing in this state who are residents of
37the state and who have been engaged in the active practice or
38teaching of medicine in this state with a full and unrestricted
39medical license for at least 5 4 years immediately preceding
40their appointment. One of the physicians must be on the full-
41time faculty of a medical school in this state, and one of the
42physicians must be in private practice and on the full-time
43staff of a statutory teaching hospital in this state as defined
44in s. 408.07. At least one of the physicians must be a graduate
45of a foreign medical school. The remaining four three members
46must be residents of the state who have lived in the state for
47at least 5 years immediately preceding their appointments, have
48never been licensed as a health care practitioner under chapter
49456 or the applicable practice act, and do not have a
50substantial personal, business, professional, or pecuniary
51connection with a licensed health care practitioner or with a
52medical education or health care facility, except as patients or
53potential patients are not, and never have been, licensed health
54care practitioners. One member must be a health care risk
55manager licensed under s. 395.10974. At least one member of the
56board must be 60 years of age or older.
57     Section 2.  The requirements of section 458.307, Florida
58Statutes, as amended by this act, shall apply to appointments
59made on or after the effective date of this act and shall not be
60construed to end the term of any member of the Board of Medicine
61holding that appointment on the effective date of this act. The
62term of the additional member required to be appointed under
63section 458.307, Florida Statutes, as amended by this act, shall
64begin November 1, 2005.
65     Section 3.  Subsections (2) through (8) of section 458.311,
66Florida Statutes, are renumbered as subsections (3) through (9),
67respectively, present subsections (5) and (7) are amended, and a
68new subsection (2) is added to said section, to read:
69     458.311  Licensure by examination; requirements; fees.--
70     (2)  Notwithstanding sub-subparagraphs (1)(f)1.c.,
71(1)(f)2.c., and (1)(f)3.c. and paragraph (3)(d), except for
72passing part II of the National Board of Medical Examiners
73examination or the Educational Commission for Foreign Medical
74Graduates examination equivalent as referred in paragraph
75(3)(d), the department may develop procedures for an applicant
76for licensure as a physician pursuant to this chapter to meet
77postgraduate training requirements by completion of a 2-year
78externship at a nonstatutory teaching hospital licensed in this
79state. The training provided in the externship shall be
80substantially similar, as defined by board rule, to the training
81provided in an approved residency as provided in sub-
82subparagraph (1)(f)1.c., sub-subparagraph (1)(f)2.c., or sub-
83subparagraph (1)(f)3.c. In order for the externship to meet the
84requirements of this subsection, it must be approved by the
85board prior to the applicant entering into the externship. The
86applicant shall not be licensed pursuant to this subsection
87unless the board finds that the applicant has successfully
88completed the externship. The board may adopt rules to implement
89this subsection, including the implementation of fees to cover
90costs.
91     (6)(5)  The board may not certify to the department for
92licensure any applicant who is under investigation in another
93jurisdiction for an offense which would constitute a violation
94of this chapter until such investigation is completed. Upon
95completion of the investigation, the provisions of s. 458.331
96shall apply. Furthermore, the department may not issue an
97unrestricted license to any individual who has committed any act
98or offense in any jurisdiction which would constitute the basis
99for disciplining a physician pursuant to s. 458.331. When the
100board finds that an individual has committed an act or offense
101in any jurisdiction which would constitute the basis for
102disciplining a physician pursuant to s. 458.331, then the board
103may enter an order imposing one or more of the terms set forth
104in subsection (9)(8).
105     (8)(7)  Upon certification by the board, the department
106shall impose conditions, limitations, or restrictions on a
107license if the applicant is on probation in another jurisdiction
108for an act which would constitute a violation of this chapter or
109if the externship requirement provided in subsection (2) was
110complied with at a nonstatutory teaching hospital.
111     Section 4.  Paragraph (a) of subsection (1) of section
112458.313, Florida Statutes, is amended to read:
113     458.313  Licensure by endorsement; requirements; fees.--
114     (1)  The department shall issue a license by endorsement to
115any applicant who, upon applying to the department on forms
116furnished by the department and remitting a fee set by the board
117not to exceed $500, the board certifies:
118     (a)  Has met the qualifications for licensure in s.
119458.311(1)(b)-(g) or in s. 458.311(1)(b)-(e) and (g) and (4)(3);
120     Section 5.  Subsection (1) of section 458.316, Florida
121Statutes, is amended to read:
122     458.316  Public health certificate.--
123     (1)  Any person desiring to obtain a public health
124certificate shall submit an application fee not to exceed $300
125and shall demonstrate to the board that he or she is a graduate
126of an accredited medical school and holds a master of public
127health degree or is board eligible or certified in public health
128or preventive medicine, or is licensed to practice medicine
129without restriction in another jurisdiction in the United States
130and holds a master of public health degree or is board eligible
131or certified in public health or preventive medicine, and shall
132meet the requirements in s. 458.311(1)(a)-(g) and (6)(5).
133     Section 6.  Section 458.3165, Florida Statutes, is amended
134to read:
135     458.3165  Public psychiatry certificate.--The board shall
136issue a public psychiatry certificate to an individual who
137remits an application fee not to exceed $300, as set by the
138board, who is a board-certified psychiatrist, who is licensed to
139practice medicine without restriction in another state, and who
140meets the requirements in s. 458.311(1)(a)-(g) and (6)(5). A
141recipient of a public psychiatry certificate may use the
142certificate to work at any public mental health facility or
143program funded in part or entirely by state funds.
144     (1)  Such certificate shall:
145     (a)  Authorize the holder to practice only in a public
146mental health facility or program funded in part or entirely by
147state funds.
148     (b)  Be issued and renewable biennially if the secretary of
149the Department of Health and the chair of the department of
150psychiatry at one of the public medical schools or the chair of
151the department of psychiatry at the accredited medical school at
152the University of Miami recommend in writing that the
153certificate be issued or renewed.
154     (c)  Automatically expire if the holder's relationship with
155a public mental health facility or program expires.
156     (d)  Not be issued to a person who has been adjudged
157unqualified or guilty of any of the prohibited acts in this
158chapter.
159     (2)  The board may take disciplinary action against a
160certificateholder for noncompliance with any part of this
161section or for any reason for which a regular licensee may be
162subject to discipline.
163     Section 7.  Paragraph (a) of subsection (1) of section
164458.317, Florida Statutes, is amended to read:
165     458.317  Limited licenses.--
166     (1)(a)  Any person desiring to obtain a limited license
167shall:
168     1.  Submit to the board, with an application and fee not to
169exceed $300, an affidavit stating that he or she has been
170licensed to practice medicine in any jurisdiction in the United
171States for at least 10 years and intends to practice only
172pursuant to the restrictions of a limited license granted
173pursuant to this section. However, a physician who is not fully
174retired in all jurisdictions may use a limited license only for
175noncompensated practice. If the person applying for a limited
176license submits a notarized statement from the employing agency
177or institution stating that he or she will not receive
178compensation for any service involving the practice of medicine,
179the application fee and all licensure fees shall be waived.
180However, any person who receives a waiver of fees for a limited
181license shall pay such fees if the person receives compensation
182for the practice of medicine.
183     2.  Meet the requirements in s. 458.311(1)(b)-(g) and
184(6)(5). If the applicant graduated from medical school prior to
1851946, the board or its appropriate committee may accept military
186medical training or medical experience as a substitute for the
187approved 1-year residency requirement in s. 458.311(1)(f).
188
189Nothing herein limits in any way any policy by the board,
190otherwise authorized by law, to grant licenses to physicians
191duly licensed in other states under conditions less restrictive
192than the requirements of this section. Notwithstanding the other
193provisions of this section, the board may refuse to authorize a
194physician otherwise qualified to practice in the employ of any
195agency or institution otherwise qualified if the agency or
196institution has caused or permitted violations of the provisions
197of this chapter which it knew or should have known were
198occurring.
199     Section 8.  Subsection (2) of section 458.331, Florida
200Statutes, is amended to read:
201     458.331  Grounds for disciplinary action; action by the
202board and department.--
203     (2)  The board may enter an order denying licensure or
204imposing any of the penalties in s. 456.072(2) against any
205applicant for licensure or licensee who is found guilty of
206violating any provision of subsection (1) of this section or who
207is found guilty of violating any provision of s. 456.072(1). A
208probable cause panel considering disciplinary action against a
209physician assistant pursuant to s. 456.073 shall include a
210licensed physician assistant designated by the Council on
211Physician Assistants. In determining what action is appropriate,
212the board must first consider what sanctions are necessary to
213protect the public or to compensate the patient. Only after
214those sanctions have been imposed may the disciplining authority
215consider and include in the order requirements designed to
216rehabilitate the physician. All costs associated with compliance
217with orders issued under this subsection are the obligation of
218the physician.
219     Section 9.  Paragraph (b) of subsection (7) of section
220458.347, Florida Statutes, is amended to read:
221     458.347  Physician assistants.--
222     (7)  PHYSICIAN ASSISTANT LICENSURE.--
223     (b)1.  Notwithstanding subparagraph (a)2. and
224sub-subparagraph (a)3.a., the department shall examine each
225applicant who the Board of Medicine certifies:
226     a.  Has completed the application form and remitted a
227nonrefundable application fee not to exceed $500 and an
228examination fee not to exceed $300, plus the actual cost to the
229department to provide the examination. The examination fee is
230refundable if the applicant is found to be ineligible to take
231the examination. The department shall not require the applicant
232to pass a separate practical component of the examination. For
233examinations given after July 1, 1998, competencies measured
234through practical examinations shall be incorporated into the
235written examination through a multiple-choice format. The
236department shall translate the examination into the native
237language of any applicant who requests and agrees to pay all
238costs of such translation, provided that the translation request
239is filed with the board office no later than 9 months before the
240scheduled examination and the applicant remits translation fees
241as specified by the department no later than 6 months before the
242scheduled examination, and provided that the applicant
243demonstrates to the department the ability to communicate orally
244in basic English. If the applicant is unable to pay translation
245costs, the applicant may take the next available examination in
246English if the applicant submits a request in writing by the
247application deadline and if the applicant is otherwise eligible
248under this section. To demonstrate the ability to communicate
249orally in basic English, a passing score or grade is required,
250as determined by the department or organization that developed
251it, on the test for spoken English (TSE) by the Educational
252Testing Service (ETS), the test of English as a foreign language
253(TOEFL) by ETS, a high school or college level English course,
254or the English examination for citizenship, Bureau of
255Citizenship and Immigration Services. A notarized copy of an
256Educational Commission for Foreign Medical Graduates (ECFMG)
257certificate may also be used to demonstrate the ability to
258communicate in basic English; and
259     b.(I)  Is an unlicensed physician who graduated from a
260foreign medical school listed with the World Health Organization
261who has not previously taken and failed the examination of the
262National Commission on Certification of Physician Assistants and
263who has been certified by the Board of Medicine as having met
264the requirements for licensure as a medical doctor by
265examination as set forth in s. 458.311(1), (4)(3), (5)(4), and
266(6)(5), with the exception that the applicant is not required to
267have completed an approved residency of at least 1 year and the
268applicant is not required to have passed the licensing
269examination specified under s. 458.311 or hold a valid, active
270certificate issued by the Educational Commission for Foreign
271Medical Graduates; was eligible and made initial application for
272certification as a physician assistant in this state between
273July 1, 1990, and June 30, 1991; and was a resident of this
274state on July 1, 1990, or was licensed or certified in any state
275in the United States as a physician assistant on July 1, 1990;
276or
277     (II)  Completed all coursework requirements of the Master
278of Medical Science Physician Assistant Program offered through
279the Florida College of Physician's Assistants prior to its
280closure in August of 1996. Prior to taking the examination, such
281applicant must successfully complete any clinical rotations that
282were not completed under such program prior to its termination
283and any additional clinical rotations with an appropriate
284physician assistant preceptor, not to exceed 6 months, that are
285determined necessary by the council. The boards shall determine,
286based on recommendations from the council, the facilities under
287which such incomplete or additional clinical rotations may be
288completed and shall also determine what constitutes successful
289completion thereof, provided such requirements are comparable to
290those established by accredited physician assistant programs.
291This sub-sub-subparagraph is repealed July 1, 2001.
292     2.  The department may grant temporary licensure to an
293applicant who meets the requirements of subparagraph 1. Between
294meetings of the council, the department may grant temporary
295licensure to practice based on the completion of all temporary
296licensure requirements. All such administratively issued
297licenses shall be reviewed and acted on at the next regular
298meeting of the council. A temporary license expires 30 days
299after receipt and notice of scores to the licenseholder from the
300first available examination specified in subparagraph 1.
301following licensure by the department. An applicant who fails
302the proficiency examination is no longer temporarily licensed,
303but may apply for a one-time extension of temporary licensure
304after reapplying for the next available examination. Extended
305licensure shall expire upon failure of the licenseholder to sit
306for the next available examination or upon receipt and notice of
307scores to the licenseholder from such examination.
308     3.  Notwithstanding any other provision of law, the
309examination specified pursuant to subparagraph 1. shall be
310administered by the department only five times. Applicants
311certified by the board for examination shall receive at least 6
312months' notice of eligibility prior to the administration of the
313initial examination. Subsequent examinations shall be
314administered at 1-year intervals following the reporting of the
315scores of the first and subsequent examinations. For the
316purposes of this paragraph, the department may develop, contract
317for the development of, purchase, or approve an examination that
318adequately measures an applicant's ability to practice with
319reasonable skill and safety. The minimum passing score on the
320examination shall be established by the department, with the
321advice of the board. Those applicants failing to pass that
322examination or any subsequent examination shall receive notice
323of the administration of the next examination with the notice of
324scores following such examination. Any applicant who passes the
325examination and meets the requirements of this section shall be
326licensed as a physician assistant with all rights defined
327thereby.
328     Section 10.  Subsection (2) of section 459.015, Florida
329Statutes, is amended to read:
330     459.015  Grounds for disciplinary action; action by the
331board and department.--
332     (2)  The board may enter an order denying licensure or
333imposing any of the penalties in s. 456.072(2) against any
334applicant for licensure or licensee who is found guilty of
335violating any provision of subsection (1) of this section or who
336is found guilty of violating any provision of s. 456.072(1). A
337probable cause panel considering disciplinary action against a
338physician assistant pursuant to s. 456.073 shall include a
339licensed physician assistant designated by the Council on
340Physician Assistants. In determining what action is appropriate,
341the board must first consider what sanctions are necessary to
342protect the public or to compensate the patient. Only after
343those sanctions have been imposed may the disciplining authority
344consider and include in the order requirements designed to
345rehabilitate the physician. All costs associated with compliance
346with orders issued under this subsection are the obligation of
347the physician.
348     Section 11.  This act shall take effect upon becoming a
349law.


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