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REFERENCE TITLE: physician assistants; physician relationship |
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State of Arizona House of Representatives Fifty-fourth Legislature First Regular Session 2019
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HB 2519 |
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Introduced by Representative Barto
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AN ACT
Amending sections 32‑2501, 32‑2502, 32‑2531, 32‑2532, 32‑2533, 32‑2534, 32‑2535 and 32‑2551, Arizona Revised Statutes; relating to physician assistants.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 32-2501, Arizona Revised Statutes, is amended to read:
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.
16. 6. "Supervising Collaborating physician" means a physician who holds a current unrestricted license, who supervises collaborates with a physician assistant and who assumes legal responsibility for health care tasks performed by the physician assistant.
7. "Collaboration":
(a) Means a physician's opportunity or ability to provide or exercise direction and control over the services of a physician assistant.
(b) Does not require a physician's constant physical presence if the collaborating physician is or can be easily in contact with the physician assistant by telecommunication.
6. 8. "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. 9. "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. 10. "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. 11. "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. 12. "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. 13. "Minor surgery" means those invasive procedures that may be delegated to a physician assistant by a supervising collaborating 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. 14. "Physician" means a physician who is licensed pursuant to chapter 13 or 17 of this title.
13. 15. "Physician assistant" means a person who is licensed pursuant to this chapter and who practices medicine with physician supervision collaboration.
14. 16. "Regular license" means a valid and existing license that is issued pursuant to section 32‑2521 to perform health care tasks.
15. 17. "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.
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 collaborating physician.
(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, except as provided in section 32‑2532.
(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.
Sec. 2. Section 32-2502, Arizona Revised Statutes, is amended to read:
32-2502. Arizona regulatory board of physician assistants; membership; appointment; terms; immunity
A. The Arizona regulatory board of physician assistants is established consisting of the following members:
1. Five physician assistants who hold a current regular license pursuant to this chapter. The governor may appoint these members from a list of qualified candidates submitted by the Arizona state association of physician assistants. The governor may seek additional input and nominations before the governor makes the physician assistant appointments.
2. Two public members who are appointed by the governor.
3. Two physicians who are actively engaged in the practice of medicine and who are licensed pursuant to chapter 17 of this title, at least one of whom supervises collaborates with a physician assistant at the time of appointment, and who are appointed by the governor.
4. Two physicians who are actively engaged in the practice of medicine and who are licensed pursuant to chapter 13 of this title, at least one of whom supervises collaborates with a physician assistant at the time of appointment, and who are appointed by the governor.
B. Before appointment by the governor, a prospective member of the board shall submit a full set of fingerprints to the governor for the purpose of obtaining a state and federal criminal records check pursuant to section 41‑1750 and Public Law 92‑544. The department of public safety may exchange this fingerprint data with the federal bureau of investigation.
C. The term of office of members of the board is four years to begin and end on July 1.
D. Each board member is eligible for appointment to not more than two full terms, except that the term of office for a member appointed to fill a vacancy that is not caused by the expiration of a full term is for the unexpired portion of that term and the governor may reappoint that member to not more than two additional full terms. Each board member may continue to hold office until the appointment and qualification of that member's successor. However, the governor may remove a member after notice and a hearing, on a finding of continued neglect of duty, incompetence or unprofessional or dishonorable conduct. That member's term ends when the finding is made.
E. A board member's term automatically ends:
1. On written resignation submitted to the board chairperson or to the governor.
2. If the member is absent from this state for more than six months during a one‑year period.
3. If the member fails to attend three consecutive regular board meetings.
4. Five years after retirement from active practice.
F. Board members are immune from civil liability for all good faith actions they take pursuant to this chapter.
Sec. 3. Section 32-2531, Arizona Revised Statutes, is amended to read:
32-2531. Physician assistant scope of practice; health care tasks; collaborating physician duties; civil penalty
A. A supervising collaborating physician may delegate health care tasks to a physician assistant.
B. A physician assistant shall not perform surgical abortions as defined in section 36‑2151.
C. The physician assistant may perform those duties and responsibilities, including the ordering, prescribing, dispensing and administration of drugs and medical devices, that are delegated by the supervising collaborating physician.
D. The physician assistant may provide any medical service that is delegated by the supervising collaborating physician if the service is within the physician assistant's skills, is within the physician's scope of practice and is supervised by in collaboration with the physician.
E. The physician assistant may pronounce death and, if delegated, may authenticate by the physician assistant's signature any form that may be authenticated by a physician's signature.
F. The physician assistant is the agent of the physician assistant's supervising collaborating physician in the performance of all practice related activities, including the ordering of diagnostic, therapeutic and other medical services.
G. The physician assistant may perform health care tasks in any setting authorized by the supervising collaborating physician, including physician offices, clinics, hospitals, ambulatory surgical centers, patient homes, nursing homes and other health care institutions. These tasks may include:
1. Obtaining patient histories.
2. Performing physical examinations.
3. Ordering and performing diagnostic and therapeutic procedures.
4. Formulating a diagnostic impression.
5. Developing and implementing a treatment plan.
6. Monitoring the effectiveness of therapeutic interventions.
7. Assisting in surgery.
8. Offering counseling and education to meet patient needs.
9. Making appropriate referrals.
10. Prescribing schedule IV or V controlled substances as defined in the federal controlled substances act of 1970 (P.L. 91‑513; 84 Stat. 1242; 21 United States Code section 802) and prescription‑only medications.
11. Prescribing schedule II and III controlled substances as defined in the federal controlled substances act of 1970.
12. Performing minor surgery as defined in section 32‑2501.
13. Performing other nonsurgical health care tasks that are normally taught in courses of training approved by the board, that are consistent with the training and experience of the physician assistant and that have been properly delegated by the supervising collaborating physician.
H. The supervising collaborating physician shall:
1. Meet the requirements established by the board for supervising collaborating with a physician assistant.
2. Accept responsibility for all tasks and duties the physician delegates to a physician assistant.
3. Notify the board and the physician assistant in writing if the physician assistant exceeds the scope of the delegated health care tasks.
4. Maintain a written agreement with the physician assistant. The agreement must state that the physician will exercise supervision over collaborate with the physician assistant and retains professional and legal responsibility for the care rendered by the physician assistant. The agreement must be signed by the supervising collaborating physician and the physician assistant and updated annually. The agreement must be kept on file at the practice site and made available to the board on request. Each year the board shall randomly audit at least five per cent percent of these agreements for compliance.
I. A physician's ability to supervise collaborate with a physician assistant is not affected by restrictions imposed by the board on a physician assistant pursuant to disciplinary action taken by the board.
J. Supervision Collaboration must be continuous but does not require the personal presence of the physician at the place where health care tasks are performed if the physician assistant is in contact with the supervising collaborating physician by telecommunication. If the physician assistant practices in a location where a supervising collaborating physician is not routinely present, the physician assistant must meet in person or by telecommunication with a supervising collaborating physician at least once each week to ensure ongoing direction and oversight of the physician assistant's work. The board by order may require the personal presence of a supervising collaborating physician when designated health care tasks are performed.
K. At all times while a physician assistant is on duty, the physician assistant shall wear a name tag with the designation "physician assistant" on it.
L. The board by rule may prescribe a civil penalty for a violation of this article. The penalty shall not exceed fifty dollars $50 for each violation. The board shall deposit, pursuant to sections 35‑146 and 35‑147, all monies it receives from this penalty in the state general fund. A physician assistant and the supervising collaborating physician may contest the imposition of this penalty pursuant to board rule. The imposition of a civil penalty is public information, and the board may use this information in any future disciplinary actions.
Sec. 4. Section 32-2532, Arizona Revised Statutes, is amended to read:
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 collaborating 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 collaborating physician.
3. Prescription‑only medication without delegation by the supervising collaborating 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 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 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 benzodiazepine is not refillable without the written consent of the supervising collaborating 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 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 implantable device or 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 a pharmacist.
2. Labeled to show the name of the physician assistant.
H. A physician assistant shall not obtain a drug from any source other than the supervising collaborating physician or a pharmacist. A physician assistant may receive manufacturers' samples if delegated to do so by the supervising collaborating 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 implantable devices or opioids that are for medication‑assisted treatment for substance use disorders.
J. The Arizona REGULATORY board of physician assistants 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.
Sec. 5. Section 32-2533, Arizona Revised Statutes, is amended to read:
32-2533. Collaborating physicians; responsibilities
A. A supervising collaborating physician is responsible for all aspects of the performance of a physician assistant, whether or not the supervising collaborating physician actually pays the physician assistant a salary. The supervising collaborating physician is responsible for supervising collaborating with the physician assistant and ensuring that the health care tasks performed by a physician assistant are within the physician assistant's scope of training and experience and have been properly delegated by the supervising collaborating physician.
B. Each physician-physician assistant team must ensure that:
1. The physician assistant's scope of practice is identified.
2. The delegation of medical tasks is appropriate to the physician assistant's level of competence.
3. The relationship of, and access to, the supervising collaborating physician is defined.
4. A process for evaluation of the physician assistant's performance is established.
C. A supervising collaborating physician shall not supervise collaborate with more than four physician assistants who work at the same time.
D. A supervising collaborating physician shall develop a system for recordation and review of all instances in which the physician assistant prescribes schedule II or schedule III controlled substances.
Sec. 6. Section 32-2534, Arizona Revised Statutes, is amended to read:
32-2534. Initiation of practice
A physician assistant may not perform health care tasks until the physician assistant has completed and signed a written agreement with a supervising collaborating physician pursuant to section 32‑2531, subsection H, paragraph 4.
Sec. 7. Section 32-2535, Arizona Revised Statutes, is amended to read:
32-2535. Emergency medical care; collaboration
A. Notwithstanding the requirements of this article, in response to a natural disaster, accident or other emergency, a physician assistant who is licensed pursuant to this chapter, licensed or certified by another regulatory jurisdiction in the United States or credentialed as a physician assistant by a federal employer may provide medical care at any location and with or without supervision a collaborating physician.
B. A physician who supervises collaborates with a physician assistant who is providing medical care pursuant to this section is not required to comply with the requirements of this article relating to supervising collaborating physicians.
Sec. 8. Section 32-2551, Arizona Revised Statutes, is amended to read:
32-2551. Grounds for disciplinary action; duty to report; immunity; proceedings; board action; notice; civil penalty
A. The board on its own motion may investigate any evidence that appears to show that a physician assistant is or may be medically incompetent, is or may be guilty of unprofessional conduct or is or may be mentally or physically unable to carry out approved health care tasks. Any physician, physician assistant or health care institution as defined in section 36‑401 shall, and any other person may, report to the board any information the physician, physician assistant, health care institution or other person has that appears to show that a physician assistant is or may be medically incompetent, is or may be guilty of unprofessional conduct or is or may be mentally or physically unable to carry out approved health care tasks. If the board begins an investigation pursuant to this section, it may require the physician assistant to promptly provide the name and address of the physician assistant’s supervising collaborating physician or physicians. The board or the executive director shall notify the physician assistant and the supervising collaborating physician of the content of the reported information in writing within one hundred twenty days of after its receipt of the information. Any physician, physician assistant, health care institution or other person that reports or provides information to the board in good faith is not subject to an action for civil damages as a result of reporting or providing information, and, if requested, the name of the reporter shall not be disclosed unless the information is essential to proceedings conducted pursuant to this section.
B. The board or, if delegated by the board, the executive director may require a mental, physical or medical competency examination or any combination of those examinations or may make investigations including investigational interviews between representatives of the board and the physician assistant and the supervising collaborating physician as it deems necessary to fully inform itself with respect to any information reported pursuant to subsection A of this section. These examinations may include biological fluid testing and other examinations known to detect the presence of alcohol or other drugs. The board or, if delegated by the board, the executive director may require the physician assistant, at the physician assistant's expense, to undergo assessment by a board approved rehabilitative, retraining or assessment program.
C. If the board finds, based on the information it receives under subsections A and B of this section, that the public safety imperatively requires emergency action, and incorporates a finding to that effect in its order, the board may restrict a license or order a summary suspension of a license pending proceedings for revocation or other action. If the board acts pursuant to this subsection, the physician assistant shall also be served with a written notice of complaint and formal hearing, setting forth the charges, and is entitled to a formal hearing before the board or an administrative law judge on the charges within sixty days pursuant to title 41, chapter 6, article 10.
D. If, after completing its investigation, the board finds that the information provided pursuant to subsection A of this section is not of sufficient seriousness to merit disciplinary action against the physician assistant's license, it may take the following actions:
1. Dismiss if, in the opinion of the board, the complaint is without merit.
2. File an advisory letter. The licensee may file a written response with the board within thirty days after receiving the advisory letter.
3. Require the licensee to complete designated continuing medical education courses.
E. If the board finds that it can take rehabilitative or disciplinary action without the presence of the physician assistant at a formal interview, it may enter into a consent agreement with the physician assistant to limit or restrict the physician assistant's practice or to rehabilitate the physician assistant, protect the public and ensure the physician assistant's ability to safely practice. The board may also require the physician assistant to successfully complete a board approved board-approved rehabilitative, retraining or assessment program at the physician assistant's own expense.
F. The board shall not disclose the name of the person who provided the information regarding a licensee's drug or alcohol impairment or the name of the person who files a complaint if that person requests anonymity.
G. If, after completing its investigation, the board believes that the information is or may be true and that the information may be of sufficient seriousness to merit direct action against the physician assistant's license, it may request a formal interview with the physician assistant and the supervising collaborating physician. If the physician assistant refuses the invitation for a formal interview, the board may issue a formal complaint and order that a hearing be held pursuant to title 41, chapter 6, article 10. The board shall notify the physician assistant in writing of the time, date and place of the formal interview at least twenty days before the interview. The notice shall include the right to be represented by counsel and shall fully set forth the conduct or matters to be discussed.
H. After the formal interview, the board may take the following actions:
1. Dismiss if, in the opinion of the board, the information is without merit.
2. File an advisory letter. The licensee may file a written response with the board within thirty days after receiving the advisory letter.
3. Enter into a stipulation with the physician assistant to restrict or limit the physician assistant's practice or medical activities or to rehabilitate, retrain or assess the physician assistant, in order to protect the public and ensure the physician assistant's ability to safely perform health care tasks. The board may also require the physician assistant to successfully complete a board approved rehabilitative, retraining or assessment program at the physician assistant's own expense as prescribed in subsection E of this section.
4. File a letter of reprimand.
5. Issue a decree of censure. A decree of censure is a disciplinary action against the physician assistant's license and may include a requirement for restitution of fees to a patient resulting from violations of this chapter or rules adopted under this chapter.
6. Fix a period and terms of probation best adapted to protect the public health and safety and rehabilitate or educate the physician assistant. Failure to comply with any terms of probation is cause for initiating formal proceedings pursuant to title 41, chapter 6, article 10. Probation may include:
(a) Restrictions on the health care tasks the physician assistant may perform.
(b) Temporary suspension for not to exceed twelve months.
(c) Restitution of patient fees.
(d) Education or rehabilitation at the licensee's own expense.
7. Require the licensee to complete designated continuing medical education courses.
I. If the board finds that the information provided pursuant to subsection A of this section warrants suspension or revocation of a physician assistant's license, it shall immediately initiate formal proceedings for the suspension or revocation of the license as provided in title 41, chapter 6, article 10. The notice of complaint and hearing is fully effective by mailing a true copy of the notice of complaint and hearing by certified mail addressed to the physician assistant's last known address of record in the board's files. The notice of complaint and hearing is complete at the time of its deposit in the mail.
J. A physician assistant who after a formal hearing pursuant to title 41, chapter 6, article 10 is found to be medically incompetent, guilty of unprofessional conduct or mentally or physically unable to safely carry out the physician assistant's approved health care tasks, or any combination of these, is subject to censure, probation, suspension or revocation, or any combination of these, for a period of time or permanently and under conditions the board deems appropriate for the protection of the public health and safety.
K. In a formal interview pursuant to subsection G of this section or in a hearing pursuant to subsection I of this section, the board in addition to any other action may impose a civil penalty in the amount of not less than three hundred dollars $300 nor more than ten thousand dollars $10,000 for each violation of this chapter or a rule adopted under this chapter.
L. An advisory letter is a public document and may be used in future disciplinary actions against a physician assistant.
M. The board may charge the costs of a formal hearing to the licensee if it finds the licensee in violation of this chapter.
N. If the Arizona regulatory board of physician assistants acts to modify a physician assistant's prescription writing privileges, the Arizona regulatory board of physician assistants shall immediately notify the Arizona state board of pharmacy and the United States drug enforcement administration of this modification.
O. If during the course of an investigation the Arizona regulatory board of physician assistants determines that a criminal violation may have occurred involving the performance of health care tasks, it shall provide evidence of the violation to the appropriate criminal justice agency.
P. The board may accept the surrender of an active license from a person who admits in writing to any of the following:
1. Being unable to safely engage in the practice of medicine.
2. Having committed an act of unprofessional conduct.
3. Having violated this chapter or a board rule.
Q. In determining the appropriate disciplinary action under this section, the board shall consider all previous nondisciplinary and disciplinary actions against a licensee.