PROPOSED
HOUSE OF REPRESENTATIVES AMENDMENTS TO H.B. 2250
(Reference to printed bill)
Page 1, line 2, after the second comma insert "as amended by Laws 2018, first special session, chapter 1, section 24,"
Strike lines 4 through 45
Strike pages 2 through 5
Page 6, strike lines 1 through 5, insert:
"32-2501. Definitions
In this chapter, unless the context otherwise requires:
1. "Active license" means a regular license issued pursuant to this chapter.
2. "Adequate records" means legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another practitioner to assume continuity of the patient's care at any point in the course of treatment.
3. "Advisory letter" means a nondisciplinary letter to notify a physician assistant that either:
(a) While there is insufficient evidence to support disciplinary action, the board believes that continuation of the activities that led to the investigation may result in further board action against the licensee.
(b) The violation is a minor or technical violation that is not of sufficient merit to warrant disciplinary action.
(c) While the licensee has demonstrated substantial compliance through rehabilitation or remediation that has mitigated the need for disciplinary action, the board believes that repetition of the activities that led to the investigation may result in further board action against the licensee.
4. "Approved program" means a physician assistant educational program accredited by the accreditation review commission on education for physician assistants, or one of its predecessor agencies, the committee on allied health education and accreditation or the commission on the accreditation of allied health educational programs.
5. "Board" means the Arizona regulatory board of physician assistants.
6. "Completed application" means an application for which the applicant has supplied all required fees, information and correspondence requested by the board on forms and in a manner acceptable to the board.
7. "Immediate family" means the spouse, natural or adopted children, father, mother, brothers and sisters of the physician assistant and the natural or adopted children, father, mother, brothers and sisters of the physician assistant's spouse.
8. "Letter of reprimand" means a disciplinary letter that is issued by the board and that informs the physician assistant that the physician assistant's conduct violates state or federal law and may require the board to monitor the physician assistant.
9. "Limit" means a nondisciplinary action that is taken by the board and that alters a physician assistant's practice or medical activities if there is evidence that the physician assistant is or may be mentally or physically unable to safely engage in health care tasks.
10. "Medically incompetent" means that a physician assistant lacks sufficient medical knowledge or skills, or both, in performing delegated health care tasks to a degree likely to endanger the health or safety of patients.
11. "Minor surgery" means those invasive procedures that may be delegated to a physician assistant by a supervising physician, that are consistent with the training and experience of the physician assistant, that are normally taught in courses of training approved by the board and that have been approved by the board as falling within a scope of practice of a physician assistant. Minor surgery does not include a surgical abortion.
12. "Physician" means a physician who is licensed pursuant to chapter 13 or 17 of this title.
13. "Physician assistant" means a person who is licensed pursuant to this chapter and who practices medicine with physician supervision.
14. "Regular license" means a valid and existing license that is issued pursuant to section 32‑2521 to perform health care tasks.
15. "Restrict" means a disciplinary action that is taken by the board and that alters a physician assistant's practice or medical activities if there is evidence that the physician assistant is or may be medically incompetent or guilty of unprofessional conduct.
16. "Supervising physician" means a physician who holds a current unrestricted license, who supervises a physician assistant and who assumes legal responsibility for health care tasks performed by the physician assistant.
17. "Supervision" means a physician's opportunity or ability to provide or exercise direction and control over the services of a physician assistant. Supervision does not require a physician's constant physical presence if the supervising physician is or can be easily in contact with the physician assistant by telecommunication.
18. "Unprofessional conduct" includes the following acts by a physician assistant that occur in this state or elsewhere:
(a) Violating any federal or state law or rule that applies to the performance of health care tasks as a physician assistant. Conviction in any court of competent jurisdiction is conclusive evidence of a violation.
(b) Claiming to be a physician or knowingly permitting another person to represent that person as a physician.
(c) Performing health care tasks that have not been delegated by the supervising physician.
(d) Exhibiting habitual intemperance in the use of alcohol or habitual substance abuse.
(d) Exhibiting a pattern of using or being under the influence of alcohol or drugs or a similar substance while performing health care tasks or to the extent that judgment may be impaired and the ability to perform health care tasks detrimentally affected.
(e) Signing a blank, undated or predated prescription form.
(f) Committing gross malpractice, repeated malpractice or any malpractice resulting in the death of a patient.
(g) Representing that a manifestly incurable disease or infirmity can be permanently cured or that a disease, ailment or infirmity can be cured by a secret method, procedure, treatment, medicine or device, if this is not true.
(h) Refusing to divulge to the board on demand the means, method, procedure, modality of treatment or medicine used in the treatment of a disease, injury, ailment or infirmity.
(i) Prescribing or dispensing controlled substances or prescription‑only drugs for which the physician assistant is not approved or in excess of the amount authorized pursuant to this chapter.
(j) Committing any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.
(k) Violating a formal order, probation or stipulation issued by the board.
(l) Failing to clearly disclose the person's identity as a physician assistant in the course of the physician assistant's employment.
(m) Failing to use and affix the initials "P.A." or "P.A.‑C." after the physician assistant's name or signature on charts, prescriptions or professional correspondence.
(n) Procuring or attempting to procure a physician assistant license by fraud, misrepresentation or knowingly taking advantage of the mistake of another.
(o) Having professional connection with or lending the physician assistant's name to an illegal practitioner of any of the healing arts.
(p) Failing or refusing to maintain adequate records on a patient.
(q) Using controlled substances that have not been prescribed by a physician, physician assistant, dentist or nurse practitioner for use during a prescribed course of treatment.
(r) Prescribing or dispensing controlled substances to members of the physician assistant's immediate family.
(s) Prescribing, dispensing or administering any controlled substance or prescription‑only drug for other than accepted therapeutic purposes.
(t) Dispensing a schedule II controlled substance that is an opioid.
(u) Knowingly making any written or oral false or fraudulent statement in connection with the performance of health care tasks or when applying for privileges or renewing an application for privileges at a health care institution.
(v) Committing a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission.
(w) Having a certification or license refused, revoked, suspended, limited or restricted by any other licensing jurisdiction for the inability to safely and skillfully perform health care tasks or for unprofessional conduct as defined by that jurisdiction that directly or indirectly corresponds to any act of unprofessional conduct as prescribed by this paragraph.
(x) Having sanctions including restriction, suspension or removal from practice imposed by an agency of the federal government.
(y) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate a provision of this chapter.
(z) Using the term "doctor" or the abbreviation "Dr." on a name tag or in a way that leads the public to believe that the physician assistant is licensed to practice as an allopathic or an osteopathic physician in this state.
(aa) Failing to furnish legally requested information to the board or its investigator in a timely manner.
(bb) Failing to allow properly authorized board personnel to examine on demand documents, reports and records of any kind relating to the physician assistant's performance of health care tasks.
(cc) Knowingly making a false or misleading statement on a form required by the board or in written correspondence or attachments furnished to the board.
(dd) Failing to submit to a body fluid examination and other examinations known to detect the presence of alcohol or other drugs pursuant to an agreement with the board or an order of the board.
(ee) Violating a formal order, probation agreement or stipulation issued or entered into by the board or its executive director.
(ff) Except as otherwise required by law, intentionally betraying a professional secret or intentionally violating a privileged communication.
(gg) Allowing the use of the licensee's name in any way to enhance or permit the continuance of the activities of, or maintaining a professional connection with, an illegal practitioner of medicine or the performance of health care tasks by a person who is not licensed pursuant to this chapter.
(hh) Committing false, fraudulent, deceptive or misleading advertising by a physician assistant or the physician assistant's staff or representative.
(ii) Knowingly failing to disclose to a patient on a form that is prescribed by the board and that is dated and signed by the patient or guardian acknowledging that the patient or guardian has read and understands that the licensee has a direct financial interest in a separate diagnostic or treatment agency or in nonroutine goods or services that the patient is being prescribed and if the prescribed treatment, goods or services are available on a competitive basis. This subdivision does not apply to a referral by one physician assistant to another physician assistant or to a doctor of medicine or a doctor of osteopathic medicine within a group working together.
(jj) With the exception of heavy metal poisoning, using chelation therapy in the treatment of arteriosclerosis or as any other form of therapy without adequate informed patient consent or without conforming to generally accepted experimental criteria including protocols, detailed records, periodic analysis of results and periodic review by a medical peer review committee, or without approval by the United States food and drug administration or its successor agency.
(kk) Prescribing, dispensing or administering anabolic or androgenic steroids for other than therapeutic purposes.
(ll) Prescribing, dispensing or furnishing a prescription medication or a prescription‑only device as defined in section 32‑1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a professional relationship with the person. This subdivision does not apply to:
(i) A physician assistant who provides temporary patient care on behalf of the patient's regular treating licensed health care professional.
(ii) Emergency medical situations as defined in section 41‑1831.
(iii) Prescriptions written to prepare a patient for a medical examination.
(iv) Prescriptions written or antimicrobials dispensed to a contact as defined in section 36-661 who is believed to have had significant exposure risk as defined in section 36-661 with another person who has been diagnosed with a communicable disease as defined in section 36-661 by the prescribing or dispensing physician assistant.
(mm) Engaging in sexual conduct with a current patient or with a former patient within six months after the last medical consultation unless the patient was the licensee’s spouse at the time of the contact or, immediately preceding the professional relationship, was in a dating or engagement relationship with the licensee. For the purposes of this subdivision, "sexual conduct" includes:
(i) Engaging in or soliciting sexual relationships, whether consensual or nonconsensual.
(ii) Making sexual advances, requesting sexual favors or engaging in other verbal conduct or physical contact of a sexual nature with a patient.
(iii) Intentionally viewing a completely or partially disrobed patient in the course of treatment if the viewing is not related to patient diagnosis or treatment under current practice standards.
(nn) Performing health care tasks under a false or assumed name in this state."
Page 6, line 35, strike "thirty‑day" insert "ninety‑day"
Line 36, after "substances" insert "that are not opioids or benzodiasepine"
Page 7, line 19, after the second comma insert "as amended by Laws 2018, first special session, chapter 1, section 25,"
Strike lines 21 through 45
Strike page 8, insert:
"32-2532. Prescribing, administering and dispensing drugs; limits and requirements; notice
A. Except as provided in subsection F of this section, a physician assistant shall not prescribe, dispense or administer:
1. A schedule II or schedule III controlled substance as defined in the federal controlled substances act of 1970 (P.L. 91‑513; 84 Stat. 1242; 21 United States Code section 802) without delegation by the supervising physician, board approval and United States drug enforcement administration registration.
2. A schedule IV or schedule V controlled substance as defined in the federal controlled substances act of 1970 without United States drug enforcement administration registration and delegation by the supervising physician.
3. Prescription‑only medication without delegation by the supervising physician.
4. Prescription medication intended to perform or induce an abortion.
B. All prescription orders issued by a physician assistant shall contain the name, address and telephone number of the supervising physician assistant. A physician assistant shall issue prescription orders for controlled substances under the physician assistant's own United States drug enforcement administration registration number.
C. Unless certified for thirty-day ninety‑day prescription privileges pursuant to section 32‑2504, subsection A, a physician assistant shall not prescribe a schedule II or schedule III controlled substance for a period exceeding seventy‑two hours. For each schedule IV or schedule V controlled substance, a physician assistant may not prescribe the controlled substance more than five times in a six-month period for each patient.
D. A prescription for a schedule II or III controlled substance that is an opioid or benzodiasepine is not refillable without the written consent of the supervising physician.
E. Prescription‑only drugs shall not be dispensed, prescribed or refillable for a period exceeding one year.
F. Except in an emergency, a physician assistant may dispense schedule II or schedule III controlled substances for a period of use of not to exceed seventy‑two hours with board approval or any other controlled substance for a period of use of not to exceed thirty‑four ninety days and may administer controlled substances without board approval if it is medically indicated in an emergency dealing with potential loss of life or limb or major acute traumatic pain. Notwithstanding the authority granted in this subsection, a physician assistant may not dispense a schedule II controlled substance that is an opioid, except for an opioid that is for medication‑assisted treatment for substance use disorders.
G. Except for samples provided by manufacturers, all drugs dispensed by a physician assistant shall be:
1. Prepackaged in a unit‑of‑use package by the supervising physician or a pharmacist acting on a written order of the supervising physician.
2. Labeled to show the name of the supervising physician and physician assistant.
H. A physician assistant shall not obtain a drug from any source other than the supervising physician or a pharmacist acting on a written order of the supervising physician. A physician assistant may receive manufacturers' samples if allowed delegated to do so by the supervising physician.
I. If a physician assistant is approved by the board to prescribe, administer or dispense schedule II and schedule III controlled substances, the physician assistant shall maintain an up‑to‑date and complete log of all schedule II and schedule III controlled substances the physician assistant administers or dispenses. The board may not grant a physician assistant the authority to dispense schedule II controlled substances that are opioids, except for opioids that are for medication‑assisted treatment for substance use disorders.
J. The board shall advise the Arizona state board of pharmacy and the United States drug enforcement administration of all physician assistants who are authorized to prescribe or dispense drugs and any modification of their authority.
K. The Arizona state board of pharmacy shall notify all pharmacies at least quarterly of physician assistants who are authorized to prescribe or dispense drugs."
Amend title to conform