Senate Bill sb1420

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    Florida Senate - 2006                                  SB 1420

    By Senator Haridopolos





    26-1074-06

  1                      A bill to be entitled

  2         An act relating to medical practice; amending

  3         s. 458.348, F.S. and creating s. 459.025, F.S.;

  4         defining the term "physician office practice

  5         setting"; providing standards for arrangements

  6         in which a physician or osteopathic physician

  7         is in a supervisory relationship over an

  8         advanced registered nurse practitioner,

  9         physician assistant, or emergency medical

10         technician outside a physician office practice

11         setting; providing for rules; amending s.

12         464.003, F.S.; revising the makeup of the

13         committee that has approval powers over acts

14         constituting advanced or specialized nursing

15         practice; providing an effective date.

16  

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

18  

19         Section 1.  Section 458.348, Florida Statutes, is

20  amended to read:

21         458.348  Formal supervisory relationships, standing

22  orders, and established protocols; notice; standards;

23  supervisory relationships with advanced registered nurse

24  practitioners or physician assistants practicing outside the

25  physician office practice setting.--

26         (1)  NOTICE.--

27         (a)  When a physician enters into a formal supervisory

28  relationship or standing orders with an emergency medical

29  technician or paramedic licensed pursuant to s. 401.27, which

30  relationship or orders contemplate the performance of medical

31  acts, or when a physician enters into an established protocol

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    Florida Senate - 2006                                  SB 1420
    26-1074-06




 1  with an advanced registered nurse practitioner, which protocol

 2  contemplates the performance of medical acts identified and

 3  approved by the joint committee pursuant to s. 464.003(3)(c)

 4  or acts set forth in s. 464.012(3) and (4), the physician

 5  shall submit notice to the board. The notice shall contain a

 6  statement in substantially the following form:

 7  

 8         I, ...(name and professional license number of

 9  physician)..., of ...(address of physician)... have hereby

10  entered into a formal supervisory relationship, standing

11  orders, or an established protocol with ...(number of

12  persons)... emergency medical technician(s), ...(number of

13  persons)... paramedic(s), or ...(number of persons)...

14  advanced registered nurse practitioner(s).

15  

16         (b)  Notice shall be filed within 30 days of entering

17  into the relationship, orders, or protocol.  Notice also shall

18  be provided within 30 days after the physician has terminated

19  any such relationship, orders, or protocol.

20         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

21  COMMITTEE.--The joint committee created by s. 464.003(3)(c)

22  shall determine minimum standards for the content of

23  established protocols pursuant to which an advanced registered

24  nurse practitioner may perform medical acts identified and

25  approved by the joint committee pursuant to s. 464.003(3)(c)

26  or acts set forth in s. 464.012(3) and (4) and shall determine

27  minimum standards for supervision of such acts by the

28  physician, unless the joint committee determines that any act

29  set forth in s. 464.012(3) or (4) is not a medical act.  Such

30  standards shall be based on risk to the patient and acceptable

31  standards of medical care and shall take into account the

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    Florida Senate - 2006                                  SB 1420
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 1  special problems of medically underserved areas. The standards

 2  developed by the joint committee shall be adopted as rules by

 3  the Board of Nursing and the Board of Medicine for purposes of

 4  carrying out their responsibilities pursuant to part I of

 5  chapter 464 and this chapter, respectively, but neither board

 6  shall have disciplinary powers over the licensees of the other

 7  board.

 8         (3)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All

 9  protocols relating to electrolysis or electrology using laser

10  or light-based hair removal or reduction by persons other than

11  physicians licensed under this chapter or chapter 459 shall

12  require the person performing such service to be appropriately

13  trained and work only under the direct supervision and

14  responsibility of a physician licensed under this chapter or

15  chapter 459.

16         (4)  SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED

17  NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE

18  THE PHYSICIAN OFFICE PRACTICE SETTING.--

19         (a)  For purposes of this subsection, the term

20  "physician office practice setting" means a business location

21  where a physician delivers medical services regardless of

22  whether or not the business is owned by a physician. A

23  physician office practice setting includes a location where

24  medical services are performed other than at a hospital; an

25  ambulatory surgical center; an abortion clinic; or any other

26  medical facility licensed by the Department of Health, the

27  Agency for Health Care Administration, or a successor agency.

28  A business location is a physician office practice setting if

29  a physician is physically present in the business location

30  during the provision of care greater than 33 percent of the

31  hours of operation in which medical care is provided. A

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    Florida Senate - 2006                                  SB 1420
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 1  business location that does not meet this requirement shall be

 2  considered outside a physician office practice setting during

 3  all hours when a physician is not physically present,

 4  irrespective of the ownership or business name of the site.

 5         (b)  A physician who is in a supervisory relationship

 6  with an advanced registered nurse practitioner as described in

 7  s. 464.012(4)(c) or a physician assistant as described in s.

 8  458.347(2)(e) who is practicing outside a physician office

 9  practice setting of the supervising physician shall:

10         1.  Maintain a valid and unrestricted active Florida

11  license pursuant to this chapter and a valid federal

12  controlled substance registry number pursuant to chapter 893.

13         2.  Provide indirect supervision as defined by the

14  Board of Medicine to the advanced registered nurse

15  practitioner or physician assistant.

16         3.  Notwithstanding the number of supervisory

17  relationships authorized in s. 458.347(3), maintain no more

18  than two supervisory relationships with any combination of

19  advanced registered nurse practitioners or physician

20  assistants in the out-of-office practice setting at any one

21  time.

22         4.  Delegate only tasks and procedures to the advanced

23  registered nurse practitioner or physician assistant which are

24  within the supervising physician's practice and medical

25  specialty area.

26         5.  Ensure that the advanced registered nurse

27  practitioner or physician assistant has been actively

28  practicing within the medical specialty area for a minimum of

29  4 consecutive years prior to providing care in a practice

30  setting outside the physician office practice setting of the

31  supervising physician.

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    Florida Senate - 2006                                  SB 1420
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 1         6.  Ensure that the advanced registered nurse

 2  practitioner or physician assistant under supervision clearly

 3  identifies to the patient that he or she is an advanced

 4  registered nurse practitioner or a physician assistant.

 5         (c)  The Board of Medicine may adopt rules to

 6  administer this section. Such rules may impose stricter

 7  standards than those found in this section for specific

 8  medical specialties, to ensure the health and safety of

 9  patients.

10         Section 2.  Section 459.025, Florida Statutes, is

11  created to read:

12         459.025  Formal supervisory relationships, standing

13  orders, and established protocols; purpose and intent; notice;

14  standards; supervisory relationships with advanced registered

15  nurse practitioners or physician assistants practicing outside

16  the physician office practice setting.--

17         (1)  NOTICE.--

18         (a)  When an osteopathic physician enters into a formal

19  supervisory relationship or standing orders with an emergency

20  medical technician or paramedic licensed pursuant to s.

21  401.27, which relationship or orders contemplate the

22  performance of medical acts, or when an osteopathic physician

23  enters into an established protocol with an advanced

24  registered nurse practitioner, which protocol contemplates the

25  performance of medical acts identified and approved by the

26  joint committee pursuant to s. 464.003(3)(c) or acts set forth

27  in s. 464.012(3) and (4), the osteopathic physician shall

28  submit notice to the board. The notice must contain a

29  statement in substantially the following form:

30  

31  

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    Florida Senate - 2006                                  SB 1420
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 1         I, ...(name and professional license number of

 2  osteopathic physician)..., of ...(address of osteopathic

 3  physician)... have hereby entered into a formal supervisory

 4  relationship, standing orders, or an established protocol with

 5  ...(number of persons)... emergency medical technician(s),

 6  ...(number of persons)... paramedic(s), or ...(number of

 7  persons)... advanced registered nurse practitioner(s).

 8  

 9         (b)  Notice must be filed within 30 days after entering

10  into the relationship, orders, or protocol.  Notice must also

11  be provided within 30 days after the physician has terminated

12  any such relationship, orders, or protocol.

13         (2)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All

14  protocols relating to electrolysis or electrology using laser

15  or light-based hair removal or reduction by persons other than

16  osteopathic physicians licensed under this chapter shall

17  require the person performing such service to be appropriately

18  trained and work only under the direct supervision and

19  responsibility of an osteopathic physician licensed under this

20  chapter.

21         (3)  SUPERVISORY RELATIONSHIPS WITH ADVANCED REGISTERED

22  NURSE PRACTITIONERS OR PHYSICIAN ASSISTANTS PRACTICING OUTSIDE

23  THE PHYSICIAN OFFICE PRACTICE SETTING.--

24         (a)  For purposes of this subsection, the term

25  "physician office practice setting" means a business location

26  where a physician delivers medical services regardless of

27  whether or not the business is owned by a physician. A

28  physician office practice setting includes a location where

29  medical services are performed other than at a hospital; an

30  ambulatory surgical center; an abortion clinic; or any other

31  medical facility licensed by the Department of Health, the

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    Florida Senate - 2006                                  SB 1420
    26-1074-06




 1  Agency for Health Care Administration, or a successor agency.

 2  A business location is not a physician office practice setting

 3  unless a physician is physically present in the business

 4  location during the provision of care at least 33 percent of

 5  the hours of operation in which medical care is provided. A

 6  business location that does not meet this requirement shall be

 7  considered outside a physician office practice setting during

 8  all hours when a physician is not physically present,

 9  irrespective of the ownership or business name of the site.

10         (b)  A physician who is in a supervisory relationship

11  with an advanced registered nurse practitioner as described in

12  s. 464.012(4)(c) or a physician assistant as described in s.

13  459.022(2)(e) who is practicing outside a physician office

14  practice setting of the supervising physician shall:

15         1.  Maintain a valid and unrestricted active Florida

16  license pursuant to this chapter and a valid federal

17  controlled substance registry number pursuant to chapter 893.

18         2.  Provide indirect supervision as defined by the

19  Board of Medicine to the advanced registered nurse

20  practitioner or physician assistant.

21         3.  Notwithstanding the number of supervisory

22  relationships authorized in s. 459.022(3), maintain no more

23  than two supervisory relationships with any combination of

24  advanced registered nurse practitioners or physician

25  assistants in the out-of-office practice setting at any one

26  time.

27         4.  Delegate only tasks and procedures to the advanced

28  registered nurse practitioner or physician assistant which are

29  within the supervising physician's practice and medical

30  specialty area.

31  

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    Florida Senate - 2006                                  SB 1420
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 1         5.  Ensure that the advanced registered nurse

 2  practitioner or physician assistant has been actively

 3  practicing within the medical specialty area for a minimum of

 4  4 consecutive years prior to providing care in a practice

 5  setting outside the physician office practice setting of the

 6  supervising physician.

 7         6.  Ensure that the advanced registered nurse

 8  practitioner or physician assistant under supervision clearly

 9  identifies to the patient that he or she is an advanced

10  registered nurse practitioner or a physician assistant.

11         (c)  The Board of Osteopathic Medicine may adopt rules

12  to administer this section. Such rules may impose stricter

13  standards than those found in this section for specific

14  medical specialties, to ensure the health and safety of

15  patients.

16         Section 3.  Paragraph (c) of subsection (3) of section

17  464.003, Florida Statutes, is amended to read:

18         464.003  Definitions.--As used in this part:

19         (3)

20         (c)  "Advanced or specialized nursing practice" means,

21  in addition to the practice of professional nursing, the

22  performance of advanced-level nursing acts approved by the

23  board which, by virtue of postbasic specialized education,

24  training, and experience, are proper to be performed by an

25  advanced registered nurse practitioner.  Within the context of

26  advanced or specialized nursing practice, the advanced

27  registered nurse practitioner may perform acts of nursing

28  diagnosis and nursing treatment of alterations of the health

29  status.  The advanced registered nurse practitioner may also

30  perform acts of medical diagnosis and treatment, prescription,

31  and operation which are identified and approved by a joint

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    Florida Senate - 2006                                  SB 1420
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 1  committee composed of three members appointed by the Board of

 2  Nursing, two of whom shall be advanced registered nurse

 3  practitioners; three members appointed by the Board of

 4  Medicine, two of whom shall have had work experience with

 5  advanced registered nurse practitioners; one member appointed

 6  by the Board of Osteopathic Medicine; and the secretary of the

 7  department or the secretary's designee. Each committee member

 8  appointed by a board shall be appointed to a term of 4 years

 9  unless a shorter term is required to establish or maintain

10  staggered terms. The Board of Nursing shall adopt rules

11  authorizing the performance of any such acts approved by the

12  joint committee. Unless otherwise specified by the joint

13  committee, such acts shall be performed under the general

14  supervision of a practitioner licensed under chapter 458,

15  chapter 459, or chapter 466 within the framework of standing

16  protocols which identify the medical acts to be performed and

17  the conditions for their performance.  The department may, by

18  rule, require that a copy of the protocol be filed with the

19  department along with the notice required by s. 458.348.

20         Section 4.  This act shall take effect upon becoming a

21  law.

22  

23            *****************************************

24                          SENATE SUMMARY

25    Provides requirements with respect to the relationship
      when a physician or osteopathic physician is in a
26    supervisory relationship with an advanced registered
      nurse practitioner or a physician assistant who is
27    practicing outside a physician office practice setting,
      as defined. Adds a member appointed by the Board of
28    Osteopathic Medicine to the committee with oversight over
      acts permitted to advanced registered nurse
29    practitioners.

30  

31  

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