HOUSE AMENDED
PRIOR PRINTER'S NOS. 616, 1049, ,1095, PRINTER'S NO. 1727
1109
No. 586 Session of 1977
INTRODUCED BY COPPERSMITH, ROMANELLI, HILL, HESS, STAUFFER,
FLEMING AND O'PAKE, MARCH 28, 1977
AS REPORTED FROM COMMITTEE ON HEALTH AND WELFARE, HOUSE OF
REPRESENTATIVES, AS AMENDED, APRIL 3, 1978
AN ACT
1 Amending the act of July 20, 1974 (P.L.551, No.190), entitled
2 "An act relating to the right to practice medicine and
3 surgery in the Commonwealth of Pennsylvania; and establishing
4 means and methods whereby the right to practice medicine and
5 surgery and any of its branches and limited right to practice
6 medically related acts may be obtained, and exemptions
7 therefrom; imposing powers and duties on the State Board of
8 Medical Education and Licensure; providing for appropriation
9 of board fees to carry out the provisions thereof, and for
10 the granting, revocation and suspension of licenses;
11 providing penalties for violations; and making repeals,"
12 further regulating the practice of medicine and surgery,
13 imposing certain duties on the Department of Health and <--
14 providing penalties.
15 The General Assembly of the Commonwealth of Pennsylvania
16 hereby enacts as follows:
17 Section 1. Section 2, act of July 20, 1974 (P.L.551,
18 No.190), known as the "Medical Practice Act of 1974," is amended
19 by adding definitions to read:
20 Section 2. Definitions.--As used in this act, the following
21 terms shall have the following meanings ascribed to them in this
22 section unless the context clearly determines otherwise:
1 * * *
2 (11) "Certification." The approval of individuals by the
3 board to serve as physicians' PHYSICIAN assistants. It shall <--
4 also mean the approval of programs by the board for the training
5 and education of physicians' PHYSICIAN assistants. <--
6 (12) "Medical care facility." A general, tuberculosis,
7 mental, chronic disease or other type of hospital, an ambulatory
8 clinic or center, a health maintenance organization, institution
9 and corporation medical departments and centers, student health
10 centers, a physical rehabilitation facility, a skilled or
11 intermediate care nursing facility, a radiology laboratory, a
12 renal dialysis center, a diagnostic center, a home health care
13 agency, or a clinical laboratory, regardless of whether such
14 medical care facility is for profit, nonprofit or governmental;
15 or a program affiliated with a medical care facility which
16 renders treatment or care for drug or alcohol abuse or
17 dependence; or other settings where medical care and services
18 are rendered.
19 (13) "Physician's "PHYSICIAN assistant." A person certified <--
20 by the board to assist a physician or group of physicians in the
21 provision of medical care and services and under the supervision
22 and direction of the physician or group of physicians.
23 (14) "Physician's "PHYSICIAN assistant to a primary care <--
24 physician." A person certified by the board to assist a
25 physician or group of physicians engaged in primary care.
26 (15) "Physician's assistant to a secondary care physician." <--
27 A person certified by the board to assist a physician or group
28 of physicians engaged in medical specialties.
29 (16) (15) "Proficiency examination." An examination
30 approved by the board for the national certification of
19770S0586B1727 - 2 -
1 physicians' PHYSICIAN assistants, including, but not limited to <--
2 those examinations, approved for such purpose by the National
3 Commission on Certification of Physicians' PHYSICIAN Assistants. <--
4 Section 2. Section 3 of the act is amended to read:
5 Section 3. Practice of Medicine and Surgery without License
6 Prohibited; Penalties.--It shall be unlawful for any person in
7 the Commonwealth to engage in the practice of medicine and
8 surgery, or pretend to a knowledge of any branch or branches of
9 medicine and surgery, or to hold himself or herself forth as a
10 practitioner in medicine and surgery, or to assume the title of
11 doctor of medicine and surgery or doctor of any specific
12 disease, or to diagnose diseases, or to treat diseases by the
13 use of medicines and surgery as defined in clause (3) of section
14 2 of this act or by any other means, or to sign any death
15 certificate, unless otherwise authorized by law or to hold
16 himself or herself forth as able to do so, excepting those
17 hereinafter exempted, unless he or she has first fulfilled the
18 requirements of this act and has received a certificate of
19 licensure or permission from the board, which license shall be
20 properly recorded in the office of the board. [Acts of medical <--
21 diagnosis or prescription of medical therapeutic or corrective
22 measures may be performed by persons licensed pursuant to the
23 act of May 22, 1951 (P.L.317, No.69), known as "The Professional
24 Nursing Law," if authorized by rules and regulations jointly
25 promulgated by the board and the State Board of Nurse
26 Examiners.] Nothing in this act shall be construed to prohibit <--
27 services and acts rendered by a qualified physician's PHYSICIAN <--
28 assistant, registered nurse, technician or other allied medical <--
29 person if such services and acts are rendered under the
30 supervision, direction or control of a licensed physician. It
19770S0586B1727 - 3 -
1 shall be unlawful for any person to practice as a physician's <--
2 PHYSICIAN assistant unless certified and approved by the board. <--
3 It shall also be unlawful for any physician's PHYSICIAN <--
4 assistant to render medical care and services except under the
5 supervision and direction of the supervising physician. The
6 aborting of a pregnancy shall be considered the practice of
7 surgery. On first offense any person wilfully violating the
8 provisions of this section of this act shall, upon conviction,
9 be guilty of a misdemeanor and shall be subject to a fine of not
10 more than one thousand dollars ($1,000) or imprisonment for not
11 more than six months in the county prison, or both, at the
12 discretion of the court; and on each additional offense shall be
13 subject to a fine of not less than two thousand dollars ($2,000)
14 and imprisonment of not less than six months or more than one
15 year, at the discretion of the court. In the event the violation
16 is the aborting of a pregnant woman the person convicted thereof
17 shall be guilty of a misdemeanor and shall be subject to a fine
18 of not less than ten thousand dollars ($10,000) or imprisonment
19 for five years, or both.
20 Section 3. Section 5 of the act is amended by adding a
21 subsection to read:
22 Section 5. Standards for Medical Training and Facilities.--
23 * * *
24 (d) Requirements for the certification of training and
25 educational programs for physicians' PHYSICIAN assistants shall <--
26 be formulated by the board in accordance with such national
27 criteria as are established by national organizations or
28 societies as the board may accept.
29 Section 4. Sections 10 and 12 of the act are amended to
30 read:
19770S0586B1727 - 4 -
1 Section 10. Licenses; Exemptions, Non-resident
2 Practitioners; Graduate Students; Biennial Registration.--(a)
3 All physicians who have complied with the requirements of the
4 board, and who shall have passed a final examination, and who
5 have otherwise complied with the provisions of this act, shall
6 receive from the Commissioner of Professional and Occupational
7 Affairs in the Department of State, or whoever exercises
8 equivalent authority acting for the board, a license entitling
9 them to the right to practice medicine and surgery without
10 restriction in this Commonwealth. Each such license shall be
11 duly recorded in the office of the board, in a record to be
12 properly kept for that purpose which shall be open to public
13 inspection; and a certified copy of said record shall be
14 received as evidence in all courts in this Commonwealth in the
15 trial of any case: Provided, That this section relating to
16 licenses to practice medicine and surgery shall not apply to
17 medical officers in the medical service of the Armed Forces of
18 the United States, or the United States Public Health Service,
19 or Veterans Administration, or physicians employed within
20 Federal services, while in discharge of their official duties;
21 or to any one who may be a duly licensed practitioner of
22 medicine in any state or commonwealth who may be called upon by
23 a licensed physician of this Commonwealth to consult with him in
24 a case under treatment; or to physicians of other jurisdictions
25 who are training [for certification] to be certified in special
26 departments of medicine and surgery under subsection (b) of this
27 section; or anyone while actually serving as a clinical clerk
28 under the supervision of the medical or surgical staff in any
29 hospital. Nothing contained in this section shall be construed
30 to entitle a clinical clerk to practice medicine and surgery or
19770S0586B1727 - 5 -
1 to prescribe drugs: And provided further, That any duly licensed
2 physician residing in or maintaining his office of practice in
3 any state near the boundary line between said state and this
4 Commonwealth whose practice extends into this Commonwealth shall
5 have the right to practice in this Commonwealth, at the
6 discretion of the board, provided he files with the secretary of
7 the board a certified copy of his license in the state where he
8 resides, and provided that the board of examiners of the
9 adjoining state reciprocates by extending the same privilege to
10 physicians in this Commonwealth when he shall receive from the
11 secretary of the board a license which shall be automatically
12 revoked if he changes his said residence or office of practice.
13 A record of all persons so licensed shall be kept in the office
14 of the board and shall have the standing before the law of any
15 other license issued by the board.
16 (b) Physicians who are legally authorized to practice
17 medicine and surgery in this or other states or territories of
18 the United States and the Dominion of Canada, and who apply for
19 training and [certification] to be certified in special
20 departments of medicine and surgery in institutions in this
21 Commonwealth recognized by the board with advice and
22 consultation with the various examining boards in medical
23 specialties approved by the Council on Medical Education of the
24 American Medical Association as proper for such training, shall
25 receive a graduate certificate that is limited to said training
26 within the complex of the hospital and/or its affiliates or
27 community hospitals where he is engaged in such training. This
28 training experience shall not be converted into a staff service.
29 It shall be valid for one year but may be renewed from year to
30 year. Any person who has been certified in a specialty
19770S0586B1727 - 6 -
1 discipline recognized by the board, and who makes an application
2 for licensure to practice medicine and surgery without
3 restriction in the Commonwealth, upon the payment of a
4 reasonable fee as determined from time to time by the board and
5 at the discretion of the board may be given a qualifying
6 examination. Such examination shall emphasize the subject matter
7 of the specialty discipline for which the applicant has been
8 trained but may also include material from the general field of
9 medical science.
10 (c) It shall be the duty of all persons now or hereafter
11 licensed to practice medicine and surgery without restriction to
12 be registered with the board; and, thereafter, to register in
13 like manner at such intervals and by such methods as the board
14 shall determine by regulations; but in no case shall such
15 renewal period be longer than two years. The form and method of
16 such registration shall be determined by the board.
17 (d) Each person so registering with the board shall pay, for
18 each biennial registration, a reasonable fee as determined from
19 time to time by the board which fee shall accompany the
20 application for such registration.
21 (e) Upon receiving a proper application for such
22 registration accompanied by the fee above provided for, the
23 board shall issue its certificate of registration to the
24 applicant. Said certificate together with its renewals shall be
25 good and sufficient evidence of registration under the
26 provisions of this act.
27 (f) The board shall grant certification to physicians' <--
28 PHYSICIAN assistants. The board shall grant certification to <--
29 applicants who have fulfilled the following criteria:
30 (1) satisfactory performance on the proficiency examination,
19770S0586B1727 - 7 -
1 to the extent that a proficiency examination exists as <--
2 determined by the board; and
3 (2) satisfactory completion of a certified program for the
4 training and education of physicians' PHYSICIAN assistants. <--
5 In the event that completion of a formal training and
6 educational program is a prerequisite to taking the proficiency
7 examination, the board shall have the power if it determines
8 that the experience of the applicant is of such magnitude and
9 scope so as to render further formal training and education
10 nonessential to the applicant in assisting a physician in the
11 provision of medical care and services, to waive the training
12 and education requirements under this section FOR A PERIOD NOT <--
13 TO EXTEND BEYOND TWO YEARS FROM THE EFFECTIVE DATE OF THIS ACT.
14 (g) The certification of physicians' PHYSICIAN assistants <--
15 shall be subject to biennial renewal by the board.
16 (h) The board shall grant provisional certification under <--
17 the following conditions:
18 (1) The applicant shall be eligible to take the proficiency
19 examination upon completion of the provisional certification
20 period.
21 (2) (H) The application shall include a written request from <--
22 the applicant's supervising physician.
23 (3) The period of provisional certification may not extend <--
24 beyond twenty-four consecutive months.
25 (i) The supervising physician shall file with the board an
26 application to utilize a physician's PHYSICIAN assistant <--
27 containing a description of the manner in which the physician's <--
28 PHYSICIAN assistant will assist the supervising physician in his <--
29 practice, THE METHOD AND FREQUENCY OF SUPERVISION, THE <--
30 GEOGRAPHIC LOCATION OF THE PHYSICIAN ASSISTANT AND IN NO
19770S0586B1727 - 8 -
1 INSTANCE MAY A PHYSICIAN SUPERVISE MORE THAN TWO PHYSICIAN
2 ASSISTANTS AT ANY TIME. In cases where a group of physicians
3 will supervise a physician's PHYSICIAN assistant, the names of <--
4 all supervisory physicians shall be included on the application.
5 (j) The board shall approve the applications which meet the
6 criteria set by this act and the regulations promulgated
7 pursuant thereto.
8 (k) The board shall establish such rules and regulations as
9 it deems necessary to protect the public and to implement the
10 provisions of this act, including, but not limited to the
11 following:
12 (1) Reasonable procedures for identification of physicians' <--
13 PHYSICIAN assistants and for informing patients and the public <--
14 at large of the use of physicians' PHYSICIAN assistants. <--
15 (2) Criteria to distinguish between a physician's assistant <--
16 to a primary care physician and a physician's assistant to a
17 secondary care physician. Information concerning the use of each
18 type of physician's PHYSICIAN assistant shall be collected and <--
19 reports thereof furnished to the General Assembly annually by
20 the Department of Health. BOARD OF MEDICAL EDUCATION AND <--
21 LICENSURE, INCLUDING THE GEOGRAPHIC LOCATION OF PHYSICIAN
22 ASSISTANTS AND THE SETTING OF THEIR PRACTICE I.E., RURAL,
23 CLINIC, HOSPITALS OR PHYSICIAN'S OFFICES.
24 (l) Nothing in this act shall be construed to permit a
25 certified physician's PHYSICIAN assistant to practice medicine <--
26 without the supervision and direction of a licensed physician
27 approved by the appropriate board, but such supervision and
28 direction shall not be construed to necessarily require the
29 personal presence of the supervising physician at the place
30 where the services are rendered.
19770S0586B1727 - 9 -
1 (m) This act shall not be construed to prohibit the
2 performance by the physician's PHYSICIAN assistant of any <--
3 service within his skills, which is delegated by the supervising
4 physician, and which forms a usual component of that physician's
5 scope of practice.
6 (n) Nothing in this act shall be construed to prohibit the
7 employment of physicians' PHYSICIAN assistants by a medical care <--
8 facility where such physicians' PHYSICIAN assistants function <--
9 under the supervision and direction of a physician or group of
10 physicians.
11 (o) No medical services may be performed by a physician's <--
12 assistant under this act which include the measurement of the
13 powers or range of human vison or the determination of the
14 refractive status of the human eye. This subsection does not
15 prohibit the performance of routine vision screenings.
16 (O) THE PHYSICIAN ASSISTANT BEING CERTIFIED IN THIS ACT AND <--
17 FUNCTIONING UNDER THE SUPERVISION OF THE PHYSICIAN DEFINES
18 HIS/HER STATUS AS AN EMPLOYE AND SUBJECT TO THE NORMAL
19 EMPLOYER/EMPLOYE REIMBURSEMENT PROCEDURES.
20 (P) NO MEDICAL SERVICES MAY BE PERFORMED BY A PHYSICIAN
21 ASSISTANT UNDER THIS ACT WHICH INCLUDE THE MEASUREMENT OF THE
22 RANGE OR POWERS OF HUMAN VISION OR THE DETERMINATION OF THE
23 REFRACTIVE STATUS OF THE HUMAN EYE. THIS SUBSECTION DOES NOT
24 PROHIBIT THE PERFORMANCE OF ROUTINE VISION SCREENINGS OR THE
25 PERFORMANCE OF REFRACTIVE SCREENINGS IN THE PHYSICIAN'S OFFICE.
26 (p) (Q) Nothing in this act shall be construed to allow <--
27 physicians' PHYSICIAN assistants to practice chiropractic. <--
28 (R) NOTHING IN THIS ACT SHALL BE CONSTRUED TO PERMIT A <--
29 PHYSICIAN ASSISTANT TO INDEPENDENTLY PRESCRIBE OR DISPENSE
30 DRUGS. THE BOARD OF MEDICAL EDUCATION AND LICENSURE AND THE
19770S0586B1727 - 10 -
1 STATE BOARD OF PHARMACY WILL JOINTLY DEVELOP REGULATIONS TO
2 PERMIT A PHYSICIAN ASSISTANT TO PRESCRIBE AND DISPENSE DRUGS AT
3 THE DIRECTION OF A LICENSED PHYSICIAN.
4 Section 12. [Examination] Fees.--The board shall have the
5 power to charge a reasonable fee for all examinations, as
6 determined from time to time by the board. A fee of ten dollars
7 ($10) shall be charged for each initial certification and
8 biennial renewal of certificates for physicians' PHYSICIAN <--
9 assistants. A fee of twenty-five dollars ($25) shall be charged
10 for each application by a physician or group of physicians to
11 supervise a physician's PHYSICIAN assistant. <--
12 Section 5. Section 15 of the act is amended by adding a <--
13 subsection SUBSECTIONS to read: <--
14 Section 15. Reasons for Refusal; Revocation or Suspension of
15 License.--* * *
16 (d) The board shall have authority to refuse, revoke or
17 suspend the license of a physician's CERTIFICATION OF A <--
18 PHYSICIAN assistant for any or all of the following reasons:
19 (1) Failing to demonstrate the qualification for
20 certification contained in this act or regulations of the board.
21 (2) Making misleading, deceptive, untrue or fraudulent
22 representations in his serving as a physician's PHYSICIAN <--
23 assistant; practicing fraud or deceit in obtaining a
24 certification to serve as a physician's PHYSICIAN assistant; or <--
25 making a false or deceptive biennial registration with the
26 board.
27 (3) Conviction of a felony in this Commonwealth or any other
28 state, territory or country. Conviction as used in this
29 paragraph shall include a finding or verdict of guilt, an
30 admission of guilt or a plea of nolo contendere.
19770S0586B1727 - 11 -
1 (4) Having his certification to serve as a physician's <--
2 PHYSICIAN assistant revoked or suspended or having other <--
3 disciplinary action taken, or his application for certification
4 refused, revoked or suspended by the proper certifying authority
5 of another state, territory or country.
6 (5) Being unable to serve as a physician'S PHYSICIAN <--
7 assistant with reasonable skill and safety to the physician's
8 patients by reason of illness, drunkenness, excessive use of
9 drugs, narcotics, chemicals, or any other type of material, or
10 as a result of any mental or physical condition.
11 (6) In enforcing clause (5), the board shall, upon probable
12 cause, have authority to compel a physician's PHYSICIAN <--
13 assistant to submit to a mental or physical examination by
14 physicians designated by it. Failure of a physician's PHYSICIAN <--
15 assistant to submit to such examination shall constitute an
16 admission of the allegations against him unless the failure is
17 due to circumstances beyond his control, consequent upon which a
18 default and final order may be entered without the taking of
19 testimony or presentation of evidence. A physician's PHYSICIAN <--
20 assistant affected under this clause shall at reasonable
21 intervals be afforded an opportunity to demonstrate that he can
22 resume the competent assistance of a physician in the
23 physician's practice of medicine, with reasonable skill and
24 safety to the physician's patients.
25 (7) Violating a lawful regulation promulgated by the board
26 or violating a lawful order of the board, previously entered by
27 the board in a disciplinary proceeding.
28 (8) Knowingly rendering medical care and services except
29 under the supervision and direction of the supervising
30 physician.
19770S0586B1727 - 12 -
1 (9) Being guilty of immoral or unprofessional conduct shall
2 include any departure from, or the failure to conform to, the
3 standards of acceptable and prevailing practice for physicians' <--
4 PHYSICIAN assistants, in which proceeding actual injury to a <--
5 patient need not be established.
6 (E) When the board finds that the certification of a <--
7 physician's PHYSICIAN assistant may be refused, revoked or <--
8 suspended under the terms of subsection (a), it may:
9 (1) Deny the application for certification.
10 (2) Administer a public or private reprimand.
11 (3) Revoke, suspend, limit, or otherwise restrict a
12 certification as determined by the board.
13 (4) Require a physician's PHYSICIAN assistant to submit to <--
14 the care, counseling, or treatment of a physician or physicians
15 designated by the board.
16 (5) Suspend enforcement of its finding thereof and place him
17 on probation with the right to vacate the probationary order for
18 noncompliance.
19 (6) Restore or reissue, in its discretion, a certification
20 to serve as a physician's PHYSICIAN assistant, and impose any <--
21 disciplinary or corrective measure which it might originally
22 have imposed.
23 Section 6. Nothing herein shall make illegal any type of
24 relationship directly supervised by a physician which was proper
25 before the enactment of this act.
26 Section 7. The last sentence of clause (1) of section 2, act <--
27 of May 22, 1951 (P.L.317, No.69), known as "The Professional
28 Nursing Law," is repealed.
29 Section 8 7. This act shall take effect January 1, 1978 <--
30 1979.
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