1.1                          A bill for an act 
  1.2             relating to health occupations; authorizing physician 
  1.3             assistant registration before the completion of a 
  1.4             physician and physician assistant agreement; 
  1.5             permitting a physician assistant to perform 
  1.6             radiography to administer anesthetic agents in 
  1.7             emergency situations and to rapid sequence intubation; 
  1.8             amending Minnesota Statutes 2002, sections 147A.02; 
  1.9             147A.20; Minnesota Statutes 2003 Supplement, section 
  1.10            147A.09, subdivision 2.  
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 2002, section 147A.02, is 
  1.13  amended to read: 
  1.14     147A.02 [QUALIFICATIONS FOR REGISTRATION.] 
  1.15     Except as otherwise provided in this chapter, an individual 
  1.16  shall be registered by the board before the individual may 
  1.17  practice as a physician assistant. 
  1.18     The board may grant registration as a physician assistant 
  1.19  to an applicant who: 
  1.20     (1) submits an application on forms approved by the board; 
  1.21     (2) pays the appropriate fee as determined by the board; 
  1.22     (3) has current certification from the National Commission 
  1.23  on Certification of Physician Assistants, or its successor 
  1.24  agency as approved by the board; 
  1.25     (4) certifies that the applicant is mentally and physically 
  1.26  able to engage safely in practice as a physician assistant; 
  1.27     (5) has no licensure, certification, or registration as a 
  1.28  physician assistant under current discipline, revocation, 
  2.1   suspension, or probation for cause resulting from the 
  2.2   applicant's practice as a physician assistant, unless the board 
  2.3   considers the condition and agrees to licensure; 
  2.4      (6) ~~has a physician-physician assistant agreement, and~~ 
  2.5   ~~internal protocol and prescribing delegation form, if the~~ 
  2.6   ~~physician assistant has been delegated prescribing authority, as~~ 
  2.7   ~~described in section 147A.18 in place at the address of record;~~ 
  2.8      ~~(7)~~ submits ~~to the board a practice setting description and~~ 
  2.9   any other information the board deems necessary to evaluate the 
  2.10  applicant's qualifications; and 
  2.11     ~~(8)~~ (7) has been approved by the board. 
  2.12     All persons registered as physician assistants as of June 
  2.13  30, 1995, are eligible for continuing registration renewal.  All 
  2.14  persons applying for registration after that date shall be 
  2.15  registered according to this chapter. 
  2.16     Sec. 2.  Minnesota Statutes 2003 Supplement, section 
  2.17  147A.09, subdivision 2, is amended to read: 
  2.18     Subd. 2.  [DELEGATION.] Patient services may include, but 
  2.19  are not limited to, the following, as delegated by the 
  2.20  supervising physician and authorized in the agreement: 
  2.21     (1) taking patient histories and developing medical status 
  2.22  reports; 
  2.23     (2) performing physical examinations; 
  2.24     (3) interpreting and evaluating patient data; 
  2.25     (4) ordering or performing diagnostic procedures, including 
  2.26  radiography; 
  2.27     (5) ordering or performing therapeutic procedures; 
  2.28     (6) providing instructions regarding patient care, disease 
  2.29  prevention, and health promotion; 
  2.30     (7) assisting the supervising physician in patient care in 
  2.31  the home and in health care facilities; 
  2.32     (8) creating and maintaining appropriate patient records; 
  2.33     (9) transmitting or executing specific orders at the 
  2.34  direction of the supervising physician; 
  2.35     (10) prescribing, administering, and dispensing legend 
  2.36  drugs and medical devices if this function has been delegated by 
  3.1   the supervising physician pursuant to and subject to the 
  3.2   limitations of section ~~147.34~~ 147A.18 and chapter 151.  
  3.3   Physician assistants who have been delegated the authority to 
  3.4   prescribe controlled substances shall maintain a separate 
  3.5   addendum to the delegation form which lists all schedules and 
  3.6   categories of controlled substances which the physician 
  3.7   assistant has the authority to prescribe.  This addendum shall 
  3.8   be maintained with the physician-physician assistant agreement, 
  3.9   and the delegation form at the address of record; 
  3.10     (11) for physician assistants not delegated prescribing 
  3.11  authority, administering legend drugs and medical devices 
  3.12  following prospective review for each patient by and upon 
  3.13  direction of the supervising physician; 
  3.14     (12) functioning as an emergency medical technician with 
  3.15  permission of the ambulance service and in compliance with 
  3.16  section 144E.127, and ambulance service rules adopted by the 
  3.17  commissioner of health; 
  3.18     (13) initiating evaluation and treatment procedures 
  3.19  essential to providing an appropriate response to emergency 
  3.20  situations, including administering anesthetic agents for the 
  3.21  purpose of airway management and to facilitate emergency 
  3.22  procedures; and 
  3.23     (14) certifying a physical disability under section 
  3.24  169.345, subdivision 2a.  
  3.25     Orders of physician assistants shall be considered the 
  3.26  orders of their supervising physicians in all practice-related 
  3.27  activities, including, but not limited to, the ordering of 
  3.28  diagnostic, therapeutic, and other medical services. 
  3.29     Sec. 3.  Minnesota Statutes 2002, section 147A.20, is 
  3.30  amended to read: 
  3.31     147A.20 [PHYSICIAN AND PHYSICIAN ASSISTANT AGREEMENT.] 
  3.32     (a) A physician assistant and supervising physician must 
  3.33  sign an agreement which specifies scope of practice and amount 
  3.34  and manner of supervision as required by the board.  The 
  3.35  agreement must contain: 
  3.36     (1) a description of the practice setting; 
  4.1      (2) a statement of practice type/specialty; 
  4.2      (3) a listing of categories of delegated duties; 
  4.3      (4) a description of supervision type, amount, and 
  4.4   frequency; and 
  4.5      (5) a description of the process and schedule for review of 
  4.6   prescribing, dispensing, and administering legend and controlled 
  4.7   drugs and medical devices by the physician assistant authorized 
  4.8   to prescribe.  
  4.9      (b) The agreement must be maintained by the supervising 
  4.10  physician and physician assistant and made available to the 
  4.11  board upon request.  If there is a delegation of prescribing, 
  4.12  administering, and dispensing of legend drugs, controlled 
  4.13  substances, and medical devices, the agreement shall include an 
  4.14  internal protocol and delegation form.  Physician assistants 
  4.15  shall have a separate agreement for each place of employment.  
  4.16  Agreements must be reviewed and updated on an annual basis.  The 
  4.17  supervising physician and physician assistant must maintain the 
  4.18  agreement, delegation form, and internal protocol at the address 
  4.19  of record.  Copies shall be provided to the board upon request. 
  4.20     (c) Physician assistants must provide written notification 
  4.21  to the board within 30 days of the following: 
  4.22     (1) name change; 
  4.23     (2) address of record change; 
  4.24     (3) telephone number of record change; and 
  4.25     (4) addition or deletion of alternate supervising physician 
  4.26  provided that the information submitted includes, for an 
  4.27  additional alternate physician, an affidavit of consent to act 
  4.28  as an alternate supervising physician signed by the alternate 
  4.29  supervising physician. 
  4.30     (d) Modifications requiring submission prior to the 
  4.31  effective date are changes to the practice setting description 
  4.32  which include: 
  4.33     (1) supervising physician change, excluding alternate 
  4.34  supervising physicians; or 
  4.35     (2) delegation of prescribing, administering, or dispensing 
  4.36  of legend drugs, controlled substances, or medical devices. 
  5.1      (e) The agreement must be completed and the practice 
  5.2   setting description submitted to the board before providing 
  5.3   medical care as a physician assistant.