PRIOR PRINTER'S NOS. 1453, 1513               PRINTER'S NO. 1605

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 1158 Session of 1985


        INTRODUCED BY BELL, OCTOBER 16, 1985

        AS AMENDED ON THIRD CONSIDERATION, NOVEMBER 19, 1985

                                     AN ACT

     1  Relating to the right to practice medicine and surgery and the
     2     right to practice medically related acts; reestablishing the
     3     State Board of Medical Education and Licensure as the State
     4     Board of Medicine and providing for its composition, powers
     5     and duties; providing for the issuance of licenses AND         <--
     6     CERTIFICATES and the suspension and revocation of licenses
     7     AND CERTIFICATES; providing penalties; and making repeals.     <--

     8                         TABLE OF CONTENTS
     9  Section 1.  Short title.
    10  Section 2.  Definitions.
    11  Section 3.  State Board of Medicine.
    12  Section 4.  Impaired professionals.
    13  Section 5.  Consultants.
    14  Section 6.  Fees, fines and civil penalties.
    15  Section 7.  Reports of the board.
    16  Section 8.  Regulatory powers of the board.
    17  Section 9.  Procedure, oaths and subpoenas.
    18  Section 10.  Unauthorized practice of medicine and surgery.
    19  Section 11.  Clinical clerks.
    20  Section 12.  Midwifery.

     1  Section 13.  Physician assistants.
     2  Section 14.  Drugless therapist.
     3  Section 15.  Certified registered nurse practitioner.
     4  Section 16.  Consultation.
     5  Section 17.  Delegation of duties to health care professional     <--
     6                 PRACTITIONER or technician.                        <--
     7  Section 18.  Federal medical personnel.
     8  Section 19.  Osteopathic act.
     9  Section 20.  Other health care professionals PRACTITIONERS.       <--
    10  Section 21.  Acts outside nonphysician license or certificate.
    11  Section 22.  Licenses and certificates; general qualification.
    12  Section 23.  Standards for medical training facilities.
    13  Section 24.  Examinations.
    14  Section 25.  Licenses and certificates; biennial registration.
    15  Section 26.  Certification of license or certificate.
    16  Section 27.  Reciprocity or endorsement.
    17  Section 28.  License to practice medicine and surgery.
    18  Section 29.  License without restriction.
    19  Section 30.  License with restriction.
    20  Section 31.  Graduate license.
    21  Section 32.  Institutional license.
    22  Section 33.  Temporary license.
    23  Section 34.  Extraterritorial license.
    24  Section 35.  Nurse-midwife license.
    25  Section 36.  Physician assistant certificate.
    26  Section 37.  Reporting of multiple licensure.
    27  Section 38.  Injunctions against unlawful practice.
    28  Section 39.  Penalties.
    29  Section 40.  Temporary and automatic suspensions.
    30  Section 41.  Reasons for refusal, revocation, suspension or
    19850S1158B1605                  - 2 -

     1                 other corrective actions against a licensee or
     2                 certificate holder.
     3  Section 42.  Types of corrective action.
     4  Section 43.  Reinstatement of license, certificate or
     5                 registration.
     6  Section 44.  Surrender of suspended or revoked license.
     7  Section 45.  Reestablishment.
     8  Section 46.  Severability.
     9  Section 47.  Repeals.
    10  Section 48.  Applicability of act.
    11  Section 49.  Existing board.
    12  Section 50.  Existing rules and regulations.
    13  Section 51.  Existing licenses, certificates and registrations.
    14  Section 52.  Effective date.
    15     The General Assembly of the Commonwealth of Pennsylvania
    16  hereby enacts as follows:
    17  Section 1.  Short title.
    18     This act shall be known and may be cited as the Medical
    19  Practice Act of 1985.
    20  Section 2.  Definitions.
    21     The following words and phrases when used in this act shall
    22  have the meanings given to them in this section unless the
    23  context clearly indicates otherwise:
    24     "Accredited medical college."  An institution of higher
    25  learning which has been fully accredited by the Association of
    26  American Medical Colleges, its successors or assigns, or the
    27  American Medical Association, either directly or through their
    28  respective accrediting bodies, as an agency to provide courses
    29  in the art and science of medicine and surgery and empowered to
    30  grant Academic Degrees in Medicine.
    19850S1158B1605                  - 3 -

     1     "Affiliate."  A member of a group of two or more medical
     2  training facilities legally united by an agreement of
     3  affiliation, approved by the board and formed to enhance the
     4  potential of all participants in the provision of health care
     5  and medical education.
     6     "Applicant."  An applicant for any license or certificate
     7  issued by the board.
     8     "Board."  The State Board of Medicine.
     9     "BOARD REGULATED PRACTITIONER."  A MEDICAL DOCTOR, MIDWIFE,    <--
    10  PHYSICIAN ASSISTANT, DRUGLESS THERAPIST, OR AN APPLICANT FOR A
    11  LICENSE OR CERTIFICATE THE BOARD MAY ISSUE.
    12     "Clinical clerk."  An undergraduate student in good standing
    13  in an accredited medical college who is assigned to provide
    14  medical services in a hospital by the medical college and the
    15  hospital.
    16     "Commissioner."  The Commissioner of Professional and
    17  Occupational Affairs in the Department of State.
    18     "Doctor of osteopathy or osteopathic doctor."  An individual
    19  licensed to practice osteopathic medicine and surgery by the
    20  State Board of Osteopathic Medical Examiners.
    21     "Graduate medical training."  Training approved or recognized
    22  by the board which is either:
    23         (1)  accredited as graduate medical education by the
    24     Accreditation Council for Graduate Medical Education or by
    25     any other accrediting body recognized by the board for the
    26     purpose of accrediting graduate medical education; or
    27         (2)  provided by a hospital accredited by the Joint
    28     Commission on Accreditation of Hospitals, its successors or
    29     assigns, and is acceptable to an American specialty board
    30     towards the training it requires for the certification it
    19850S1158B1605                  - 4 -

     1     issues in a medical specialty or subspecialty.
     2     "Healing arts."  The science and skill of diagnosis and
     3  treatment in any manner whatsoever of disease or any ailment of
     4  the human body.
     5     "Health care professional." PRACTITIONER."  An individual,     <--
     6  other than a physician assistant, who is authorized to practice
     7  some component of the healing arts by a license, permit,
     8  certificate or registration issued by a Commonwealth licensing
     9  agency or board.
    10     "Hospital."  An institution licensed or regulated as a
    11  hospital by the Department of Health or the Department of Public
    12  Welfare or a facility owned or operated by the Federal
    13  Government and accredited by the Joint Commission on
    14  Accreditation of Hospitals as a hospital.
    15     "Medical doctor."  An individual who has acquired one of the
    16  following licenses to practice medicine and surgery issued by
    17  the board:
    18         (1)  License without restriction.
    19         (2)  License with restriction.
    20         (3)  Graduate license.
    21         (4)  Institutional license.
    22         (5)  Temporary license.
    23         (6)  Extraterritorial license.
    24     "Medical service."  Activity which lies within the scope of
    25  the practice of medicine and surgery.
    26     "Medical training facility."  A medical college, hospital or
    27  other institution which provides courses in the art and science
    28  of medicine and surgery and related subjects for the purpose of
    29  enabling a matriculant to qualify for a license or practice
    30  medicine and surgery, graduate medical training, midwife
    19850S1158B1605                  - 5 -

     1  certificate or physician assistant certificate.
     2     "Medicine and surgery."  The art and science of which the
     3  objectives are the cure of diseases and the preservation of the
     4  health of man, including the practice of the healing art with or
     5  without drugs, except healing by spiritual means or prayer.
     6     "Midwife or nurse-midwife."  An individual who is licensed as
     7  a midwife by the board.
     8     "Physician."  A medical doctor or doctor of osteopathy.
     9     "Physician assistant."  An individual who is certified as a
    10  physician assistant by the board.
    11     "Professional."  A medical doctor, midwife, physician          <--
    12  assistant, drugless therapist, or an applicant for a license or
    13  certificate the board may issue.
    14     "Resident."  A medical doctor who is participating in
    15  graduate training.
    16     "Technician."  A person, other than a health care
    17  professional PRACTITIONER or physician assistant, who through     <--
    18  training, education or experience has achieved expertise in the
    19  technical details of a subject or occupation which is a
    20  component of the healing art.
    21     "Unaccredited medical college."  An institution of higher
    22  learning which provides courses in the art and science of
    23  medicine and surgery and related subjects, is empowered to grant
    24  professional degrees in medicine, is not accredited by the
    25  Association of American Medical Colleges, its successors or
    26  assigns, or the American Medical Association, either directly or
    27  through their respective accrediting bodies, and is listed by
    28  the World Health Organization, its successors or assigns, or is
    29  otherwise recognized as a medical college by the country in
    30  which it is situated.
    19850S1158B1605                  - 6 -

     1  Section 3.  State Board of Medicine.
     2     (a)  Establishment.--The State Board of Medicine shall
     3  consist of the commissioner, the Secretary of Health, two
     4  members appointed by the Governor who shall be persons
     5  representing the public at large and seven members appointed by
     6  the Governor, six of whom shall be medical doctors with
     7  unrestricted licenses to practice medicine and surgery in this
     8  Commonwealth for five years immediately preceding their
     9  appointment, and one who shall be a nurse midwife, physician
    10  assistant or certified registered nurse practitioner licensed or
    11  certified under the laws of this Commonwealth.
    12     (b)  Terms of office.--The term of each professional and
    13  public member of the board shall be four years or until his or
    14  her successor has been appointed and qualified, but not longer
    15  than six months beyond the four-year period. In the event that
    16  any of said members shall die or resign or otherwise becomes
    17  disqualified during his or her term, a successor shall be
    18  appointed in the same way and with the same qualifications and
    19  shall hold office for the unexpired term. No member shall be
    20  eligible for appointment to serve more than two consecutive
    21  terms.
    22     (c)  Quorum.--A majority of the members of the board serving
    23  in accordance with law shall constitute a quorum for purposes of
    24  conducting the business of the board. A EXCEPT FOR TEMPORARY AND  <--
    25  AUTOMATIC SUSPENSIONS UNDER SECTION 40, A member may not be
    26  counted as part of a quorum or vote on any issue, other than      <--
    27  temporary and automatic suspensions under section 40, unless he
    28  or she is physically in attendance at the meeting.
    29     (d)  Chairman.--The board shall select annually a chairman
    30  from among its professional members.
    19850S1158B1605                  - 7 -

     1     (e)  Compensation.--Each member of the board, except the
     2  commissioner and the Secretary of Health, shall receive $60 per
     3  diem when actually attending to the work of the board. Members
     4  shall also receive the amount of reasonable traveling, hotel and
     5  other necessary expenses incurred in the performance of their
     6  duties in accordance with Commonwealth regulations.
     7     (f)  Sunset.--The board is subject to evaluation, review and
     8  termination within five years and in the manner provided in the   <--
     9  act of December 22, 1981 (P.L.508, No.142), known as the Sunset
    10  Act.
    11     (g)  Attendance at meetings.--A member of the board who fails
    12  to attend three consecutive meetings shall forfeit his or her
    13  seat unless the commissioner, upon written request from the
    14  member, finds that the member should be excused from a meeting
    15  because of illness or the death of a family member.
    16     (h)  Attendance at training seminars.--A public member who
    17  fails to attend two consecutive statutorily mandated training
    18  seminars in accordance with section 813(e) of the act of April
    19  9, 1929 (P.L.177, No.175), known as The Administrative Code of
    20  1929, shall forfeit his or her seat unless the commissioner,
    21  upon written request from the public member, finds that the
    22  public member should be excused from a meeting because of
    23  illness or the death of a family member.
    24     (i)  Meetings.--The board shall meet at least once every two
    25  months, and at such additional times as may be necessary to
    26  conduct the business of the board.
    27     (j)  Executive secretary.--The board, with the approval of
    28  the commissioner, shall appoint and fix the compensation of an
    29  executive secretary who shall be responsible for the day-to-day
    30  operation of the board and administration of board activities.
    19850S1158B1605                  - 8 -

     1  Section 4.  Impaired professionals.
     2     (a)  Appointment of Disciplinary Advisory Committee.--The
     3  board, with the approval of the commissioner, shall appoint a
     4  Disciplinary Advisory Committee composed of three medical
     5  doctors, not members of the board, who shall be compensated at
     6  the same rate as members of the board and who shall receive the
     7  amount of reasonable traveling, hotel and other necessary
     8  expenses incurred in the performance of their duties in
     9  accordance with Commonwealth regulations.
    10     (b)  Recommendations involving potential disciplinary
    11  actions.--The committee shall review and make recommendations to  <--
    12  the board on cases involving potential disciplinary actions
    13  under this act. ACTIONS.--THE BOARD MAY REFER TO THE COMMITTEE    <--
    14  CASES INVOLVING POTENTIAL DISCIPLINARY ACTIONS UNDER THIS ACT.
    15  UPON SUCH REFERRAL, THE COMMITTEE SHALL REVIEW THE CASE AND MAKE
    16  RECOMMENDATIONS TO THE BOARD WITHIN SUCH TIME AS THE BOARD SHALL
    17  DESIGNATE; PROVIDED, THAT ONCE THE COMMITTEE HAS ACCEPTED AN
    18  IMPAIRED PROFESSIONAL IN AN APPROVED TREATMENT PROGRAM IN
    19  ACCORDANCE WITH THIS SECTION, THE COMMITTEE MAY NOT THEREAFTER
    20  ACCEPT REFERRAL OF A DISCIPLINARY CASE REGARDING THAT INDIVIDUAL
    21  FROM THE BOARD.
    22     (c)  Liaison.--The committee shall act as a liaison between
    23  the board and treatment programs, such as Alcoholics Anonymous,   <--
    24  Narcotics Anonymous ALCOHOL AND DRUG TREATMENT PROGRAMS LICENSED  <--
    25  BY THE DEPARTMENT OF HEALTH, psychological counseling and
    26  impaired professional support groups, which are approved by the
    27  board and which provide services to licensees or certificate
    28  holders under this act.
    29     (d)  Review of corrective action by the board.--The board may
    30  defer and ultimately dismiss any of the types of corrective
    19850S1158B1605                  - 9 -

     1  action set forth in this act for an impaired professional so
     2  long as the professional is progressing satisfactorily in an
     3  approved treatment program, provided that the provisions of this
     4  subsection shall not apply to a professional convicted of a
     5  felonious act prohibited by the act of April 14, 1972 (P.L.233,
     6  No.64), known as The Controlled Substance, Drug, Device and
     7  Cosmetic Act, or the conviction of a felony relating to a
     8  controlled substance in a court of law of the United States or
     9  any other state, territory or country. An approved program
    10  provider shall, upon request, disclose to the Disciplinary
    11  Advisory Committee all information in its possession regarding
    12  an impaired professional in treatment.
    13     (e)  Voluntary suspension or limitation.--An impaired
    14  professional who enrolls in an approved treatment program shall,
    15  if necessary, agree to a limitation of his or her ability to
    16  practice. Failure to do so disqualifies the professional from
    17  the impaired professional program and shall activate an
    18  immediate investigation and disciplinary proceeding by the
    19  board.
    20     (f)  Failure to satisfactorily progress.--If, in the opinion
    21  of the committee after consultation with the provider, an
    22  impaired professional who is enrolled in an approved treatment
    23  has not progressed satisfactorily, the committee shall disclose
    24  to the board all information in its possession regarding the
    25  professional; and such disclosure shall constitute the basis for
    26  instituting proceedings to suspend or revoke the license or
    27  certificate of said professional.
    28     (g)  Immunity.--An approved program provider who makes a
    29  disclosure pursuant to this subsection shall not be subject to
    30  civil liability for such disclosure or its consequences.
    19850S1158B1605                 - 10 -

     1     (h)  Reports to the board.--Any hospital or health care
     2  facility, peer or colleague who knows or has evidence to suspect
     3  a professional has an addictive disease, is diverting a
     4  controlled substance, or is mentally or physically incompetent
     5  to carry out the duties of his or her license or certificate,
     6  shall make, or cause to be made, a report to the board: Provided
     7  that any person or facility who acts in a treatment capacity to
     8  an impaired professional in an approved treatment program is
     9  exempt from the mandatory reporting requirements of this
    10  subsection. Any person or facility who reports pursuant to this
    11  section in good faith and without malice shall be immune from
    12  any civil or criminal liability arising from such report.
    13  Failure to provide such report within a reasonable time from
    14  receipt of knowledge of impairment shall subject the person or
    15  facility to a fine not to exceed $1,000. The board shall levy
    16  this penalty only after affording the accused party the
    17  opportunity for a hearing, as provided in Title 2 of the
    18  Pennsylvania Consolidated Statutes (relating to administrative
    19  law and procedure).
    20  Section 5.  Consultants.
    21     The board shall establish consultant panels or use individual
    22  consultants, as it deems appropriate, to assist it in carrying
    23  out its responsibilities. The board may not delegate any of its
    24  final decisionmaking responsibilities to a consultant or panel
    25  of consultants.
    26  Section 6.  Fees, fines and civil penalties.
    27     (a)  Setting of fees.--All fees required under this act shall
    28  be fixed by the board by regulation and shall be subject to the
    29  act of June 25, 1982 (P.L.633, No.181), known as the Regulatory
    30  Review Act. If the revenues raised by fees, fines and civil
    19850S1158B1605                 - 11 -

     1  penalties imposed under this act are not sufficient to meet
     2  expenditures over a two-year period, the board shall increase
     3  those fees by regulation so that the projected revenues will
     4  meet or exceed projected expenditures.
     5     (b)  Inadequate fees.--If the Bureau of Professional and
     6  Occupational Affairs determines that the fees established by the
     7  board under subsection (a) are inadequate to meet the minimum
     8  enforcement efforts required by this act, then the bureau after
     9  consultation with the board and subject to the Regulatory Review
    10  Act, shall increase the fees by regulation in an amount that
    11  adequate revenues are raised to meet the required enforcement
    12  effort.
    13     (c)  Disposition.--All fees, fines and civil penalties
    14  imposed in accordance with this act and collected in accordance
    15  with section 907(a) of the act of October 15, 1975 (P.L.390,
    16  No.111), known as the Health Care Services Malpractice Act,
    17  along with any interest generated thereby, shall be for the
    18  exclusive use by the board in carrying out the provisions of
    19  this act, and shall be annually appropriated for that purpose.
    20     (d)  Charging of fees.--The board may charge a reasonable
    21  fee, as set by the board by regulation, for all examinations,
    22  registrations, certificates, licensures or applications
    23  permitted by this act or the regulations thereunder.
    24  Section 7.  Reports of the board.
    25     (a)  Reports to Department of State.--The board shall submit
    26  annually to the Department of State an estimate of the financial
    27  requirements of the board for its administrative, investigative,
    28  legal and miscellaneous expenses.
    29     (b)  Reports to House and Senate Appropriations Committees.--
    30  The board shall submit annually to the House and Senate
    19850S1158B1605                 - 12 -

     1  Appropriations Committees, 15 days after the Governor has
     2  submitted his budget to the General Assembly, a copy of the
     3  budget request for the upcoming fiscal year which the board
     4  previously submitted to the department.
     5     (c)  Reports to other House and Senate committees.--The board
     6  shall submit annually a report to the Professional Licensure
     7  Committee of the House of Representatives and to the Consumer
     8  Protection and Professional Licensure Committee of the Senate a
     9  description of the types of complaints received, status of
    10  cases, board action which has been taken and the length of time
    11  from the initial complaint to final board resolution. The report
    12  shall also include a statement of the numbers and types of
    13  licenses granted and a statement on physician assistant use in
    14  this Commonwealth, including geographic location and practice
    15  settings.
    16  Section 8.  Regulatory powers of the board.
    17     The board, in the exercise of its duties under this act,
    18  shall have the power to adopt such regulations as are reasonably
    19  necessary to carry out the purposes of this act. Regulations
    20  shall be adopted in conformity with the provisions of the act of
    21  July 31, 1968 (P.L.769, No.240), referred to as the Commonwealth
    22  Documents Law, and the act of June 25, 1982 (P.L.633, No.181),
    23  known as the Regulatory Review Act.
    24  Section 9.  Procedure, oaths and subpoenas.
    25     (a)  All actions of the board.--All actions of the board
    26  shall be taken subject to the right of notice, hearing and
    27  adjudication, and the right of appeal therefrom, in accordance
    28  with the provisions in Title 2 of the Pennsylvania Consolidated
    29  Statutes (relating to administrative law and procedure).
    30     (b)  Disciplinary proceedings.--All disciplinary proceedings
    19850S1158B1605                 - 13 -

     1  conducted by hearing examiners shall be conducted in accordance
     2  with sections 901 through 905 of the act of October 15, 1975
     3  (P.L.390, No.111), known as the Health Care Services Malpractice
     4  Act.
     5     (c)  Subpoena power.--The board shall have the authority to
     6  issue subpoenas, upon application of an attorney responsible for
     7  representing the Commonwealth in disciplinary matters before the
     8  board, for the purpose of investigating alleged violations of
     9  the disciplinary provisions and administered by the board. The    <--
    10  board shall have the power to subpoena witnesses, to administer
    11  oaths, to examine witnesses or to take testimony or compel the
    12  production of books, records, papers and documents as it may
    13  deem necessary or proper in and pertinent to any proceeding,
    14  investigation or hearing held by it. Medical records may not be
    15  subpoenaed without consent of the patient or without order of a
    16  court of competent jurisdiction on a showing that the records
    17  are reasonably necessary for the conduct of the investigation.
    18  The court may impose such limitations on the scope of the
    19  subpoena as are necessary to prevent unnecessary intrusion in
    20  patient confidential information. The board is authorized to
    21  apply to Commonwealth Court to enforce its subpoenas.
    22  Section 10.  Unauthorized practice of medicine and surgery.
    23     No person other than a medical doctor shall engage in any of
    24  the following conduct except as authorized or exempted in this
    25  act:
    26         (1)  Practice medicine and surgery.
    27         (2)  Purport to practice medicine and surgery.
    28         (3)  Hold forth as authorized to practice medicine and
    29     surgery through use of a title, including, but not
    30     necessarily limited to, medical doctor, doctor of medicine,
    19850S1158B1605                 - 14 -

     1     doctor of medicine and surgery, doctor of a designated
     2     disease, physician, physician of a designated disease, or any
     3     abbreviation for the foregoing.
     4         (4)  Otherwise hold forth as authorized to practice
     5     medicine and surgery.
     6  Section 11.  Clinical clerks.
     7     (a)  Authorized services.--A clinical clerk may perform the
     8  following services in a hospital to which the clerk is assigned,
     9  provided the services are performed within the restrictions
    10  contained in or authorized by this section:
    11         (1)  Make notes on a patient's chart.
    12         (2)  Conduct a physical examination.
    13         (3)  Perform a medical procedure or laboratory test.
    14     (b)  Regulations.--A clinical clerk shall not perform a
    15  medical service unless the performance of such by the clinical
    16  clerk under the circumstances is consistent with the standards
    17  of acceptable medical practice embraced by the medical doctor
    18  community in this Commonwealth. The board shall promulgate
    19  regulations which define the medical services those standards
    20  permit a clinical clerk to perform and the circumstances under
    21  which those standards permit a clinical clerk to perform a
    22  medical service.
    23     (c)  Supervision.--A clinical clerk shall not perform a
    24  medical service without the direct and immediate supervision of
    25  the medical doctor members of the medical staff or residents at
    26  the hospital in which the service is performed. The board shall
    27  promulgate regulations which define the supervision required by
    28  those standards.
    29     (d)  Drugs.--A clinical clerk shall not prescribe or dispense
    30  drugs.
    19850S1158B1605                 - 15 -

     1     (e)  Notes on patients' charts.--Notes made on a patient's
     2  chart by a clinical clerk become official only when
     3  countersigned by a medical doctor member of the hospital's
     4  medical staff or resident beyond a first-year level of graduate
     5  medical education at the hospital.
     6     (f)  Other licenses or certificates.--Nothing in this section
     7  or the regulations authorized by this section shall be construed
     8  to prohibit a clinical clerk who is licensed or certified to
     9  practice a profession by a Commonwealth agency or board from
    10  practicing within the scope of that license or certificate or as
    11  otherwise authorized by law.
    12  Section 12.  Midwifery.
    13     (a)  Previous licensure.--A midwife who has been licensed
    14  previously by the board may continue to practice midwifery in
    15  accordance with regulations promulgated by the board.
    16     (b)  Use of title.--A midwife may use the title midwife,
    17  nurse-midwife or an appropriate abbreviation of those titles.
    18     (c)  Other licenses or certificates.--Nothing in this section
    19  or the regulations authorized by this section shall be construed
    20  to prohibit a midwife who is licensed or certified to practice
    21  another profession by a Commonwealth agency or board from
    22  practicing within the scope of that license or certificate or as
    23  otherwise authorized by law.
    24  Section 13.  Physician assistants.
    25     (a)  Authorized services.--A physician assistant may perform
    26  a medical service delegated by an approved physician and as
    27  approved by the appropriate board. An approved physician is a
    28  physician identified in the writing required by subsection (e).
    29     (b)  Use of title.--A physician assistant may use the title
    30  physician assistant or an appropriate abbreviation for that
    19850S1158B1605                 - 16 -

     1  title, such as "P.A.-C."
     2     (c)  Regulations.--The board shall promulgate regulations
     3  which define the services and circumstances under which a
     4  physician assistant may perform a medical service.
     5     (d)  Supervision.--A physician assistant shall not perform a
     6  medical service without the supervision and personal direction
     7  of an approved physician. The board shall promulgate regulations
     8  which define the supervision and personal direction required by
     9  those standards.
    10     (e)  Written agreement.--A physician assistant shall not
    11  provide a medical service without a written agreement with one
    12  or more physicians which provides for all of the following:
    13         (1)  Identifies and is signed by each physician the
    14     physician assistant will be assisting.
    15         (2)  Describes the manner in which the physician
    16     assistant will be assisting each named physician.
    17         (3)  Describes the nature and degree of supervision and
    18     direction each named physician will provide the physician
    19     assistant.
    20         (4)  Designates one of the named physicians as having the
    21     primary responsibility for supervising and directing the
    22     physician assistant.
    23         (5)  Has been approved by the board as satisfying the
    24     foregoing and as consistent with the restrictions contained
    25     in or authorized by this section.
    26  A physician assistant shall not assist a physician in a manner
    27  not described in the agreement or without the nature and degree
    28  of supervision and direction described in the agreement. The
    29  physician designated as having primary responsibility for the
    30  physician assistant shall not have primary responsibility for
    19850S1158B1605                 - 17 -

     1  more than two physician assistants.
     2     (f)  Drugs.--A physician assistant shall not independently
     3  prescribe or dispense drugs. The board and the State Board of
     4  Pharmacy shall jointly promulgate regulations which permit a
     5  physician assistant to prescribe and dispense drugs at the
     6  direction of a physician.
     7     (g)  Supervision.--A physician assistant may be employed by a
     8  medical care facility under the supervision and direction of an
     9  approved physician or group of such physicians, provided one of
    10  those physicians is designated as having the primary
    11  responsibility for supervising and directing the physician
    12  assistant and provided that a physician assistant shall not be
    13  responsible to more than three physicians.
    14     (h)  Reimbursement.--For reimbursement purposes a physician
    15  assistant shall be an employee subject to the normal employer-
    16  employee reimbursement procedures.
    17     (i)  Eye services.--No medical services may be performed by a
    18  physician assistant under this act which include the measurement
    19  of the range or powers of human vision or the determination of
    20  the refractive status of the human eye. This subsection does not
    21  prohibit the performance of routine vision screenings or the
    22  performance of refractive screenings in the physician's office.
    23     (j)  Chiropractic practice.--Nothing in this act shall be
    24  construed to allow physician assistants to practice
    25  chiropractic.
    26     (k)  Other licenses or certificates.--Nothing in this section
    27  or the regulations authorized by this section shall be construed
    28  to prohibit a physician assistant who is licensed or certified
    29  to practice another profession by a Commonwealth agency or board
    30  from practicing within the scope of that license or certificate
    19850S1158B1605                 - 18 -

     1  or as otherwise authorized by law.
     2  Section 14.  Drugless therapist.
     3     (a)  Previous licensure.--A drugless therapist who has been
     4  licensed previously by the board may continue to provide
     5  drugless therapy in accordance with the regulations promulgated
     6  by the board.
     7     (b)  Drugs.--A drugless therapist shall not prescribe or
     8  dispense drugs.
     9     (c)  Other licenses or certificates.--Nothing in this section
    10  or the regulations authorized by this section shall be construed
    11  to prohibit a drugless therapist who is licensed or certified to
    12  practice another profession by a Commonwealth agency or board
    13  from practicing within the scope of that license or certificate
    14  or as otherwise authorized by law.
    15  Section 15.  Certified registered nurse practitioner.
    16     (a)  General rule.--A certified registered nurse practitioner
    17  shall act in accordance with regulations authorized by this
    18  section.
    19     (b)  Regulations.--The board and the State Board of Nurse
    20  Examiners shall jointly promulgate regulations authorizing a
    21  certified registered nurse practitioner to perform acts of
    22  medical diagnoses and prescription of medical, therapeutic,
    23  diagnostic or corrective measures.
    24     (c)  Other licenses or certificates.--Nothing in this section
    25  or the regulations authorized by this section shall be construed
    26  to prohibit a certified registered nurse practitioner who is
    27  licensed or certified to practice another profession by a
    28  Commonwealth agency or board from practicing within the scope of
    29  that license or certificate as otherwise authorized by law.
    30  Section 16.  Consultation.
    19850S1158B1605                 - 19 -

     1     A person authorized to practice medicine or surgery or
     2  osteopathy without restriction by any other state may, upon
     3  request by a medical doctor, provide consultation to the medical
     4  doctor regarding the treatment of a patient under the care of
     5  the medical doctor.
     6  Section 17.  Delegation of duties to health care professional     <--
     7                 PRACTITIONER or technician.                        <--
     8     (a)  General rule.--A health care professional PRACTITIONER    <--
     9  or technician may perform a medical service if:
    10         (1)  The performance of the service was delegated by a
    11     medical doctor.
    12         (2)  The delegation is consistent with the standards of
    13     acceptable medical practice embraced by the medical doctor
    14     community in this Commonwealth.
    15         (3)  The delegation is not prohibited by regulations
    16     promulgated by the board.
    17         (4)  The delegation is not prohibited by statutes or
    18     regulations relating to other licensed health care
    19     professionals PRACTITIONERS.                                   <--
    20     (b)  Regulations.--The board may promulgate regulations which
    21  establish criteria pursuant to which a medical doctor may
    22  delegate the performance of medical services, preclude a medical
    23  doctor from delegating the performance of certain types of
    24  medical services, or otherwise limit the ability of a medical
    25  doctor to delegate medical services.
    26     (c)  Responsibility.--Nothing in this section shall be
    27  construed to limit the medical doctor's responsibility for the
    28  medical service delegated to the health care professional         <--
    29  PRACTITIONER or technician.                                       <--
    30  Section 18.  Federal medical personnel.
    19850S1158B1605                 - 20 -

     1     Nothing in this act shall be construed to prohibit a medical
     2  doctor in the medical service of the armed forces of the United
     3  States, the United States Public Health Service or the Veterans'
     4  Administration, or a Federal employee, from discharging official
     5  duties.
     6  Section 19.  Osteopathic act.
     7     (a)  General rule.--Nothing in this act shall be construed to
     8  prohibit a doctor of osteopathy from practicing osteopathic
     9  medicine and surgery.
    10     (b)  Specific authorization.--Nothing in this act shall be
    11  construed to prohibit a person authorized to practice
    12  osteopathic medicine and surgery by the act of October 5, 1978
    13  (P.L.1109, No.261), known as the Osteopathic Medical Practice
    14  Act, to practice as authorized by that act.
    15  Section 20.  Other health care professionals PRACTITIONERS.       <--
    16     Nothing in this act shall be construed to prohibit a health
    17  care professional PRACTITIONER from practicing that profession    <--
    18  within the scope of the health care professional's                <--
    19  PRACTITIONER'S license or certificate or as otherwise authorized  <--
    20  by the law, including using the title authorized by the
    21  professional's PRACTITIONER'S licensing act.                      <--
    22  Section 21.  Acts outside nonmedical doctor license or
    23                 certificate.
    24     (a)  Medical doctor involvement.--In the event the law,
    25  including this act, conditions a person's authorization to
    26  perform one or more medical services upon medical doctor
    27  involvement, and the person performs a covered service without
    28  the required involvement, the person shall be deemed to have
    29  acted outside the scope of the person's license or certificate.
    30     (b)  Included involvements.--The medical doctor involvement
    19850S1158B1605                 - 21 -

     1  referred to in subsection (a) shall include, but shall not
     2  necessarily be limited to, any of the following:
     3         (1)  An order.
     4         (2)  Direction or supervision.
     5         (3)  Presence.
     6         (4)  Immediate availability.
     7         (5)  Referral.
     8         (6)  Consultation.
     9  Section 22.  Licenses and certificates; general qualification.
    10     (a)  Types of licenses and certificates.--The board may grant
    11  the following licenses and certificates:
    12         (1)  License without restriction.
    13         (2)  License with restriction.
    14         (3)  Graduate license.
    15         (4)  Institutional license.
    16         (5)  Temporary license.
    17         (6)  Extraterritorial license.
    18         (7)  Midwife license.
    19         (8)  Physician assistant certificate.
    20     (b)  Qualifications.--The board shall not issue a license or
    21  certificate to an applicant unless the applicant establishes
    22  with evidence, verified by an affidavit or affirmation of the
    23  applicant, that the applicant is of legal age, is of good moral
    24  character and is not addicted to the intemperate use of alcohol
    25  or the habitual use of narcotics or other habit-forming drugs,
    26  and that the applicant has completed the educational
    27  requirements prescribed by the board, and otherwise satisfies
    28  the qualifications for the license or certificate contained in
    29  or authorized by this act.
    30     (c)  Refusal.--The board may refuse to issue a license or
    19850S1158B1605                 - 22 -

     1  certificate to an applicant based upon a ground for such action
     2  contained in section 41.
     3     (d)  Limitation.--The board shall not refuse to issue a
     4  license or certificate to an applicant unless the applicant has
     5  been afforded the procedural protections required by this act.
     6     (e)  Action on application.--The application, upon filing by
     7  the applicant of the evidence required under subsection (b) and
     8  the expiration of a period of 90 days, shall be deemed to meet
     9  the requirements of this act and become effective, the license
    10  or certificate shall be deemed issued, and the board shall take
    11  no action against the applicant for practicing without a license
    12  or certificate, unless within that period the application has
    13  been disapproved by the board or proceedings have been initiated
    14  against the applicant under this act.
    15  Section 23.  Standards for medical training facilities.
    16     (a)  General rule.--The educational qualifications for
    17  acceptance as a matriculant in a medical college or other
    18  medical training facility incorporated within this Commonwealth
    19  and the curricula and training to be offered by such medical
    20  colleges or other medical training facility shall meet the
    21  requirements set by the board and any accrediting body which may
    22  be recognized by the board.
    23     (b)  Duties of the board.--It shall be the duty of the board,
    24  in its discretion, periodically to ascertain the character of
    25  the instruction and the facilities possessed by each of the
    26  medical colleges and other medical training facilities offering
    27  or desiring to offer medical training in accordance with the
    28  requirements of this act. In shall further be the duty of the
    29  board, by inspection and otherwise, to ascertain the facilities
    30  and qualifications of medical colleges and other medical
    19850S1158B1605                 - 23 -

     1  training facilities outside this Commonwealth, whose graduates
     2  or trainees desire to obtain licensure, graduate medical
     3  training or certification in this Commonwealth, provided further
     4  that the board shall have the authority to refuse to license
     5  graduates of any such medical institutions, colleges or
     6  hospitals which in its judgment do not meet similar standards
     7  for medical training and facilities as are required of medical
     8  institutions in this Commonwealth. In enforcing this provision,
     9  the board shall give due notice to any medical institution,
    10  college or hospital upon which it has rendered a decision that
    11  its training and facilities do not meet the standards required
    12  by the board.
    13     (c)  Refusal of recognition.--In the event that the board
    14  determines that a medical training facility has failed to
    15  provide adequate facilities, curricula or training, the board
    16  shall not recognize the education or degrees obtained from the
    17  medical training facility during the period of inadequacy.
    18  Section 24.  Examinations.
    19     (a)  General rule.--The board may require an applicant to
    20  take and pass an examination to the satisfaction of the board.
    21     (b)  Proficiency in English language.--In addition to any
    22  other examination required by this act or by regulation of the
    23  board, applicants for a license or certificate, whose principal
    24  language is other than English, may also be required to
    25  demonstrate, by examination, proficiency in the English language
    26  to any agency considered competent by the board.
    27     (c)  Authority to call in medical consultants.--For the
    28  purpose of conducting all examinations, the board shall have the
    29  privilege of calling to its aid medical consultants who shall be
    30  compensated for their services at a reasonable rate in an amount
    19850S1158B1605                 - 24 -

     1  as determined, from time to time, by the board in addition to
     2  all incurred expenses, IN ACCORDANCE WITH COMMONWEALTH            <--
     3  REGULATIONS.
     4     (d)  Examining agency.--When the board accepts an examination
     5  given by an examining agency, the board may establish the
     6  criteria for passing, or may accept the criteria for passing,
     7  established by the examining agency. If the examination is
     8  offered in parts, the board may establish, by regulation, a time
     9  period in which the entire examination must be successfully
    10  completed. The board may establish, by regulation, a maximum
    11  number of examination attempts it will recognize for the purpose
    12  of receiving a passing score on an examination recognized but
    13  not given by the board.
    14  Section 25.  Licenses and certificates; biennial registration.
    15     (a)  Issuance of licenses and certificates.--All applicants
    16  who have complied with the requirements of the board, and who
    17  shall have passed a final examination, and who have otherwise
    18  complied with the provisions of this act, shall receive from the
    19  commissioner, or whoever exercises equivalent authority acting
    20  for the board, a license or certificate entitling them to the
    21  right to practice in this Commonwealth. Each such license or
    22  certificate shall be duly recorded in the office of the board,
    23  in a record to be properly kept for that purpose which shall be
    24  open to public inspection and a certified copy of said record
    25  shall be received as evidence in all courts in this Commonwealth
    26  in the trial of any case.
    27     (b)  Renewals.--It shall be the duty of all persons now or
    28  hereafter licensed or certified to be registered with the board
    29  and, thereafter, to register in like manner at such intervals
    30  and by such methods as the board shall determine by regulations,
    19850S1158B1605                 - 25 -

     1  but in no case shall such renewal period be longer than two
     2  years. The form and method of such registration shall be
     3  determined by the board.
     4     (c)  Fees.--Each person so registering with the board shall
     5  pay, for each biennial registration, a reasonable fee which, if
     6  any, shall accompany the application for such registration.
     7     (d)  Evidence of registration.--Upon receiving a proper
     8  application for such registration accompanied by the fee, if
     9  any, above provided for, the board shall issue a certificate of
    10  registration to the applicant. Said certificate together with
    11  its renewals shall be good and sufficient evidence of
    12  registration under the provisions of this act.
    13  Section 26.  Certification of license or certificate.
    14     The status of a license or certificate issued by the board
    15  shall be certified by the board to other jurisdictions or
    16  persons upon formal application and payment of a reasonable fee.
    17  Section 27.  Reciprocity or endorsement.
    18     Reciprocity or endorsement may be established at the
    19  discretion of the board. As used in this section, the term
    20  "reciprocity" means the act of the board and a licensing
    21  authority in another jurisdiction, each recognizing that the
    22  requirements for a license or certificate in this Commonwealth
    23  and in the other jurisdiction are equivalent, issuing a license
    24  or certificate to an applicant who possesses a similar license
    25  or certificate in the other jurisdiction. As used in this
    26  section, the term "endorsement" means the issuance of a license
    27  or certificate by the board to an applicant who does not meet
    28  standard requirements, if the applicant has achieved cumulative
    29  qualifications which are accepted by the board as being
    30  equivalent to the standard requirements for the license or
    19850S1158B1605                 - 26 -

     1  certificate.
     2  Section 28.  License to practice medicine and surgery.
     3     An individual is not qualified for a license to practice
     4  medicine and surgery unless the individual has received an
     5  academic degree in medicine and surgery from a medical college
     6  and the individual satisfies the other qualifications for the
     7  license contained in or authorized by this act.
     8  Section 29.  License without restriction.
     9     (a)  General rule.--A license without restriction empowers
    10  the licensee to practice medicine and surgery without any
    11  restriction or limitation.
    12     (b)  Graduates of accredited medical colleges.--No license
    13  without restriction may be issued to a graduate of an accredited
    14  medical college unless the applicant has completed successfully
    15  as a resident two years of approved graduate medical training.
    16     (c)  Graduates of unaccredited medical colleges.--No license
    17  without restriction may be issued to a graduate of an
    18  unaccredited medical college unless the applicant has completed
    19  successfully as a resident three years of approved graduate
    20  medical training, educational requirements prescribed by the
    21  board and certification by the Educational Council for Foreign
    22  Medical Graduates, or its successors.
    23     (d)  Examinations.--The board shall hold at least two
    24  examinations for applicants for a license without restriction
    25  each year. Special examinations may be designated by the board.
    26  The examinations shall be held at such times and places as
    27  designated by the board. In case of failure at any such
    28  examination, the applicant shall have, after the expiration of
    29  six months and within two years, the privilege of a second
    30  examination by the board. In case of failure in a second
    19850S1158B1605                 - 27 -

     1  examination, or after the expiration of two years, the applicant
     2  must thereafter successfully complete, as a resident, one year
     3  of graduate medical training approved by the board, apply de
     4  novo, and qualify under the conditions in existence at the time
     5  of the application.
     6  Section 30.  License with restriction.
     7     (a)  General rule.--A license with restriction empowers the
     8  licensee to practice medicine and surgery with such restrictions
     9  or limitations as may be established by the board, including
    10  restrictions in the scope of permitted practice, a requirement
    11  that the applicant take one or more refresher educational
    12  courses or mandated submission of medical care, counseling or
    13  treatment.
    14     (b)  Prerequisite.--No license with restriction may by issued
    15  unless the applicant has otherwise been issued, or is qualified
    16  to be issued, a license without restriction in accordance with
    17  this act.
    18     (c)  Disciplinary proceedings or voluntary request.--The
    19  board may issue a license with restriction only upon completion
    20  of disciplinary proceedings in accordance with this act or upon
    21  a voluntary request of the applicant.
    22  Section 31.  Graduate license.
    23     (a)  General rule.--A graduate license empowers the licensee
    24  to participate for a period of up to 12 consecutive months in
    25  graduate medical training within the complex of the hospital to
    26  which the licensee is assigned AND ANY SATELLITE FACILITY OR      <--
    27  OTHER TRAINING LOCATION UTILIZED IN THE GRADUATE TRAINING
    28  PROGRAM.
    29     (b)  Requirements.--No graduate license may be issued unless
    30  the applicant is a graduate of an accredited medical college or
    19850S1158B1605                 - 28 -

     1  an unaccredited medical college and has received a medical
     2  degree. A graduate license may be issued to an applicant who
     3  holds the equivalent of a license without restriction granted by
     4  another state or territory of the United States or the Dominion
     5  of Canada.
     6     (c)  Extensions; waivers.--The board may extend the validity
     7  of a graduate license upon application when such action is
     8  warranted. In the event a graduate license holder is issued a
     9  license without restriction and wishes to continue graduate
    10  medical training, the graduate license holder shall complete and
    11  keep current a form satisfactory to the board containing
    12  information desired by the board on the graduate medical
    13  training program. A graduate of an unaccredited medical college,
    14  who does not possess all of the qualifications for the issuance
    15  of a graduate license but desires to train in a hospital within
    16  this Commonwealth in an area of advanced medical training, may
    17  have the unmet qualifications waived by the board if the board
    18  determines that the applicant possesses the technical skills and
    19  educational background to participate in such training and that
    20  its issuance is beneficial to the health, safety and welfare of
    21  the general public of this Commonwealth.
    22  Section 32.  Institutional license.
    23     (a)  General rule.--An institutional license empowers the
    24  licensee to teach or practice medicine and surgery in one of the
    25  medical colleges, affiliates or hospitals within this
    26  Commonwealth.
    27     (b)  Requirements.--No institutional license may be issued
    28  unless the applicant:
    29         (1)  is a graduate of an unaccredited medical college who
    30     has attained through professional growth and teaching
    19850S1158B1605                 - 29 -

     1     experience the status of teacher; or
     2         (2)  is not otherwise licensed to practice medicine and
     3     surgery in this Commonwealth but has achieved outstanding
     4     medical skills in a particular area of medicine and surgery
     5     and wishes to practice, demonstrate or teach with those
     6     outstanding medical skills.
     7     (c)  Determinations by the board.--The board shall issue an
     8  institutional license VALID FOR NO MORE THAN THREE YEARS, AS THE  <--
     9  BOARD SHALL DETERMINE AND only when it determines that its
    10  issuance is beneficial to the health, safety and welfare of the
    11  general public of this Commonwealth. A person granted an
    12  institutional license who subsequently desires to obtain a
    13  license without restriction shall be required to meet all of the
    14  requirements of such license as set forth in this act.
    15  Section 33.  Temporary license.
    16     (a)  General rule.--A temporary license empowers the licensee
    17  to:
    18         (1)  teach medicine and surgery or participate in a
    19     medical procedure necessary for the well-being of a specified
    20     patient within this Commonwealth; or
    21         (2)  practice medicine and surgery at a camp or resort
    22     for no more than three months.
    23     (b)  Requirements.--No temporary license may be issued unless
    24  the applicant holds the equivalent of a license without
    25  restriction granted by another state, territory or country.
    26     (c)  Additional conditions.--The board may impose any
    27  appropriate limitation in scope, duration or site of practice on
    28  the temporary license. Temporary licensees shall be deemed
    29  health care providers who conduct 50% or less of their health
    30  care business or practice within this Commonwealth for the
    19850S1158B1605                 - 30 -

     1  purposes of the act of October 15, 1975 (P.L.390, No.111), known
     2  as the Health Care Services Malpractice Act.
     3  Section 34.  Extraterritorial license.
     4     (a)  General rule.--An extraterritorial license empowers the
     5  licensee residing in or maintaining the office of practice in
     6  any adjoining state near the boundary line between such state
     7  and this Commonwealth, whose medical practice extends into this
     8  Commonwealth, to practice medicine and surgery with or without
     9  restriction in this Commonwealth on such patients.
    10     (b)  Requirements.--No extraterritorial license may be issued
    11  unless the applicant holds the equivalent of a license without
    12  restriction granted by a state adjoining this Commonwealth.
    13     (c)  Additional conditions.--An extraterritorial license may
    14  be granted by the board so long as the board is provided with:
    15         (1)  An application for the license, which shall include
    16     information on malpractice insurance coverage compliance.
    17         (2)  A certification by the authorized licensing body of
    18     such state of the current license in the state of residence
    19     and primary practice.
    20  The exercise of the discretion of the board in granting such a
    21  license will depend primarily upon the needs of patients in this
    22  Commonwealth, the availability of medical care in the specific
    23  area involved and whether the adjoining state of licensure
    24  reciprocates by extending similar privileges to medical doctors
    25  who reside and have their office of practice in this
    26  Commonwealth. Such a license will be automatically revoked if
    27  such medical doctor relocates the office of practice or
    28  residence. A medical doctor granted such a license has the duty
    29  to inform the board of any changes in practice which may in any
    30  way affect the maintenance of the license.
    19850S1158B1605                 - 31 -

     1  Section 35.  Nurse-midwife license.
     2     (a)  General rule.--A nurse-midwife license empowers the
     3  licensee to practice midwifery in this Commonwealth as provided
     4  in this act. The board shall formulate and issue such rules and
     5  regulations, from time to time, as may be necessary for the
     6  examination, licensing and proper conduct of the practice of
     7  midwifery.
     8     (b)  Requirements.--No nurse-midwife license will be issued
     9  unless the applicant is a registered nurse licensed in this
    10  Commonwealth. An applicant for a midwife license must have
    11  completed an academic and clinical program of study in midwifery
    12  which has been approved by the board or an accrediting body
    13  recognized by the board.
    14  Section 36.  Physician assistant certificate.
    15     (a)  General rule.--A physician assistant certificate
    16  empowers the holder to assist a medical doctor in the provision
    17  of medical care and services under the supervision and direction
    18  of that medical doctor as provided in this act.
    19     (b)  Requirements.--No physician assistant certificate may be
    20  issued to the applicant unless the requirements set forth by
    21  this act and such rules and regulations issued by the board are
    22  met, including requirements for the physician assistant
    23  certificate of training and educational programs which shall be
    24  formulated by the board in accordance with such national
    25  criteria as are established by national organizations or
    26  societies as the board may accept.
    27     (c)  Criteria.--The board shall grant physician assistant
    28  certificates to applicants who have fulfilled the following
    29  criteria:
    30         (1)  Satisfactory performance on the proficiency
    19850S1158B1605                 - 32 -

     1     examination to the extent that a proficiency examination
     2     exists.
     3         (2)  Satisfactory completion of a certified program for
     4     the training and education of physician assistants.
     5     (d)  Biennial renewal.--A physician assistant certificate
     6  shall be subject to biennial renewal by the board.
     7     (e)  Description of manner of assistance.--The application
     8  shall include a written request from the applicant's supervising
     9  medical doctor who shall file with the board a description of
    10  the manner in which the physician assistant will assist the
    11  supervising medical doctor, which description shall be subject
    12  to the approval of the board.
    13  Section 37.  Reporting of multiple licensure.
    14     Any licensed medical doctor in this Commonwealth who is also
    15  licensed to practice medicine and surgery in any other state,
    16  territory or country shall report this information to the board
    17  on the biennial registration application or within 90 days of
    18  final disposition, whichever is sooner. Any disciplinary action
    19  taken in other states must be reported to the board on the
    20  biennial registration application. Multiple licensure will be
    21  noted on the medical doctor's record and such state, territory
    22  or country will be notified of any disciplinary actions taken
    23  against said medical doctor in this Commonwealth.
    24  Section 38.  Injunctions against unlawful practice.
    25     It shall be unlawful for any person to practice, or attempt
    26  to offer to practice, medicine and surgery, as defined in this
    27  act, without having at the time of so doing a valid, unexpired,
    28  unrevoked and unsuspended license issued under this act. The
    29  unlawful practice of medicine and surgery as defined in this act
    30  may be enjoined by the courts on petition of the board or by the
    19850S1158B1605                 - 33 -

     1  commissioner. In any such proceeding it shall not be necessary
     2  to show that any person is individually injured by the actions
     3  complained of. If it is determined the respondent has engaged in
     4  the unlawful practice of medicine and surgery, the court shall
     5  enjoin him from so practicing unless and until he has been duly
     6  licensed. Procedure in such cases shall be the same as in any
     7  other injunction suit. The remedy by injunction hereby given is
     8  in addition to any other civil or criminal prosecution and
     9  punishment.
    10  Section 39.  Penalties.
    11     (a)  General rule.--Any person, or the responsible officer or
    12  employee of any corporation or partnership, institution or
    13  association, violating any provisions of this act, or any rule
    14  or regulation of the board commits of a misdemeanor of the third
    15  degree and shall, upon conviction, be sentenced to pay a fine of
    16  not more than $2,000 or to imprisonment for not more than six
    17  months, or both, for the first violation. On the second and each
    18  subsequent conviction, he or she shall be sentenced to pay a
    19  fine of not less than $5,000 nor more than $20,000 or to
    20  imprisonment for not less than six months nor more than one
    21  year, or both.
    22     (b)  Civil penalties.--In addition to any other civil remedy
    23  or criminal penalty provided for in this act, the board, by a
    24  vote of the majority of the maximum number of the authorized
    25  membership of the board as provided by law, or by a vote of the
    26  majority of the duly qualified and confirmed membership or a
    27  minimum of four members, whichever is greater, may levy a civil
    28  penalty of up to $1,000 on any current licensee who violates any
    29  provision of this act or on any person who practices medicine or
    30  other areas of practice regulated by the board without being
    19850S1158B1605                 - 34 -

     1  properly licensed or certificated to do so under this act. The
     2  board shall levy this penalty only after affording the accused
     3  party the opportunity for a hearing, as provided in Title 2 of
     4  the Pennsylvania Consolidated Statutes (relating to
     5  administrative law and procedure). The board shall, within six
     6  months after the effective date of this act, adopt guidelines
     7  setting forth the amounts and circumstances for which a fine may
     8  be imposed. No fines may be imposed in accordance with this
     9  subsection until the board has adopted the required guidelines.
    10  Nothing in this subsection shall be construed to give the board
    11  authority to impose a civil penalty upon any person licensed by
    12  another licensing board when acting within the scope of practice
    13  of that profession.
    14  Section 40.  Temporary and automatic suspensions.
    15     (a)  Temporary suspensions.--A license or certificate issued
    16  under this act may be temporarily suspended under circumstances
    17  as determined by the board to be an immediate and clear danger
    18  to the public health and safety. The board shall issue an order
    19  to that effect without a hearing, but upon due notice, to the
    20  licensee or certificate holder concerned at his or her last
    21  known address, which shall include a written statement of all
    22  allegations against the licensee or certificate holder. The
    23  provisions of section 9 shall not apply to temporary suspension.
    24  The board shall thereupon commence formal action to suspend,
    25  revoke and restrict the license or certificate of the person
    26  concerned as otherwise provided for in this act. All actions
    27  shall be taken promptly and without delay. Within 30 days
    28  following the issuance of an order temporarily suspending a
    29  license, the board shall conduct or cause to be conducted, a
    30  preliminary hearing to determine that there is a prima facie
    19850S1158B1605                 - 35 -

     1  case supporting the suspension. The licensee or certificate
     2  holder whose license or certificate has been temporarily
     3  suspended may be present at the preliminary hearing and may be
     4  represented by council, cross-examine witnesses, inspect
     5  physical evidence, call witnesses, offer evidence and testimony
     6  and make a record of the proceedings. If it is determined that
     7  there is not a prima facie case, the suspended license shall be
     8  immediately restored. The temporary suspension shall remain in
     9  effect until vacated by the board, but in no event longer than
    10  180 days.
    11     (b)  Automatic suspensions.--A license or certificate issued
    12  under this act shall automatically be suspended upon the legal
    13  commitment to an institution of a licensee or certificate holder
    14  because of mental incompetency from any cause upon filing with
    15  the board a certified copy of such commitment, conviction of a
    16  felony under the act of April 14, 1972 (P.L.233, No.64), known
    17  as The Controlled Substance, Drug, Device and Cosmetic Act, or
    18  conviction of an offense under the laws of another jurisdiction,
    19  which if committed in this Commonwealth, would be a felony under
    20  The Controlled Substance, Drug, Device and Cosmetic Act. As used
    21  in this section the term "conviction" shall include a judgment,
    22  an admission of guilt or a plea of nolo contendere. Automatic
    23  suspension under this subsection shall not be stayed pending any
    24  appeal of a conviction. Restoration of such license or
    25  certificate shall be made as hereinafter provided in the case of
    26  revocation or suspension of such license or certificate.
    27  Section 41.  Reasons for refusal, revocation, suspension or
    28                 other corrective actions against a licensee or
    29                 certificate holder.
    30     The board shall have authority to impose disciplinary or
    19850S1158B1605                 - 36 -

     1  corrective measures on a professional PRACTITIONER for any or     <--
     2  all of the following reasons:
     3         (1)  Failing to demonstrate the qualifications or
     4     standards for a license, certification or registration
     5     contained in this act, or regulations of the board.
     6         (2)  Making misleading, deceptive, untrue or fraudulent
     7     representations in the practice of the profession or
     8     practicing fraud or deceit, either alone or as a conspirator
     9     in obtaining a license, certification or registration, or in
    10     obtaining admission to a medical college.
    11         (3)  Being convicted of a felony, a misdemeanor relating
    12     to a health profession, or receiving probation without
    13     verdict, disposition in lieu of trial or an accelerated
    14     rehabilitative disposition in the disposition of felony
    15     charges, in the courts of this Commonwealth, a Federal court
    16     or a court of any other state, territory or country.
    17         (4)  Having a license or other authorization to practice
    18     the profession revoked or suspended or having other
    19     disciplinary action taken, or an application for a license or
    20     other authorization refused, revoked or suspended by a proper
    21     licensing authority of another state, territory or country,
    22     or a branch of the Federal Government.
    23         (5)  Being unable to practice the profession with
    24     reasonable skill and safety to patients by reason of illness,
    25     addiction to drugs or alcohol, having been convicted of a
    26     felonious act prohibited by the act of April 14, 1972
    27     (P.L.233, No.64), known as The Controlled Substance, Drug,
    28     Device and Cosmetic Act, or convicted of a felony relating to
    29     a controlled substance in a court of law of the United States
    30     or any other state, territory or country, or if he or she is
    19850S1158B1605                 - 37 -

     1     or shall become mentally incompetent. An applicant's
     2     statement on the application declaring the absence of a
     3     conviction shall be deemed satisfactory evidence of the
     4     absence of a conviction unless the board has some evidence to
     5     the contrary. In enforcing this paragraph, the board shall,
     6     upon probable cause, have authority to compel a professional   <--
     7     PRACTITIONER to submit to a mental or physical examination by  <--
     8     physicians approved by the board. Failure of a professional    <--
     9     PRACTITIONER to submit to such examination when directed by    <--
    10     the board, unless such failure is due to circumstances beyond
    11     his or her control, shall constitute an admission of the
    12     allegations against him or her, consequent upon which a
    13     default and final order may be entered without the taking of
    14     testimony or presentation of evidence. A professional          <--
    15     PRACTITIONER affected under this paragraph shall at            <--
    16     reasonable intervals be afforded an opportunity to
    17     demonstrate that he or she can resume a competent practice of
    18     his or her profession with reasonable skill and safety to
    19     patients.
    20         (6)  Violating a lawful regulation promulgated by the
    21     board or violating a lawful order of the board previously
    22     entered by the board in a disciplinary proceeding.
    23         (7)  Knowingly maintaining a professional connection or
    24     association with any person who is in violation of this act
    25     or regulations of the board or knowingly aiding, assisting,
    26     procuring or advising any unlicensed person to practice a
    27     profession contrary to this act, or regulations of the board.
    28         (8)  Being guilty of immoral or unprofessional conduct.
    29     Unprofessional conduct shall include departure from or
    30     failing to conform to an ethical or quality standard of the
    19850S1158B1605                 - 38 -

     1     profession.
     2             (i)  The ethical standards of a profession are those
     3         ethical tenets which are embraced by the professional
     4         community in this Commonwealth.
     5             (ii)  A professional PRACTITIONER departs from, or     <--
     6         fails to conform to, a quality standard of the profession
     7         when the professional PRACTITIONER provides a medical      <--
     8         service at a level beneath the accepted standard of care.
     9         The board may promulgate regulations which define the
    10         accepted standard of care. In the event the board has not
    11         promulgated an applicable regulation, the accepted
    12         standard of care for a professional PRACTITIONER is that   <--
    13         which would be normally exercised by the average
    14         professional of the same kind in this Commonwealth under
    15         the circumstances, including locality and whether the
    16         professional PRACTITIONER is or purports to be a           <--
    17         specialist in the area.
    18         (9)  Acting is such manner as to present an immediate and
    19     clear danger to publish health or safety.
    20         (10)  Acting outside the scope of a license or
    21     certificate.
    22  Section 42.  Types of corrective action.
    23     (a)  Authorized actions.--When the board is empowered to take
    24  disciplinary or corrective action against a professional          <--
    25  PRACTITIONER under the provisions of this act or pursuant to      <--
    26  other statutory authority, the board may:
    27         (1)  Deny the application for a license, certificate or
    28     any other privilege granted by the board.
    29         (2)  Administer a public reprimand with or without
    30     probation.
    19850S1158B1605                 - 39 -

     1         (3)  Administer a private reprimand with or without
     2     probation.
     3         (4)  Revoke, suspend, limit or otherwise restrict a
     4     license or certificate.
     5         (5)  Require the professional to submit to the care,
     6     counseling or treatment of a physician or other health care
     7     professional designated by the board.
     8         (6)  Require the professional to take refresher
     9     educational courses.
    10         (7)  Suspend enforcement of any suspension, other than
    11     that imposed in accordance with section 41, or revocation and
    12     place a professional PRACTITIONER on probation with the right  <--
    13     to vacate the probationary order from noncompliance.
    14         (8)  Impose a monetary penalty in accordance with this
    15     act.
    16     (b)  Failure to comply with conditions.--Failure of a
    17  professional to comply with conditions set forth by the board
    18  shall be grounds for reconsideration of the matter and
    19  institution of formal charges against the licensee or
    20  certificate holder.
    21  Section 43.  Reinstatement of license, certificate or
    22                 registration.
    23     Unless ordered to do so by Commonwealth Court or an ON appeal  <--
    24  therefrom, the board shall not reinstate the license,
    25  certificate or registration of a person to practice medicine
    26  pursuant to this act which has been revoked. Any person whose
    27  license, certificate or registration has been revoked may apply
    28  for reinstatement, after a period of at least five years, but
    29  must meet all of the licensing qualifications of this act for
    30  the license applied for, to include the examination requirement,
    19850S1158B1605                 - 40 -

     1  if he or she desires to practice at any time after such
     2  revocation.
     3  Section 44.  Surrender of suspended or revoked license.
     4     The board shall require a person whose license, certificate
     5  or registration has been suspended or revoked to return, in such
     6  manner as the board directs, the license, certificate or
     7  registration. A person who fails to do so commits a misdemeanor
     8  of the third degree.
     9  Section 45.  Reestablishment.
    10     This act, with respect to the State Board of Medical
    11  Education and Licensure, shall constitute the legislation
    12  required to reestablish an agency pursuant to the act of
    13  December 22, 1981 (P.L.508, No.142), known as the Sunset Act.
    14  Section 46.  Severability.
    15     The provisions of this act are severable. If any provision of
    16  this act or its application to any person or circumstance is
    17  held invalid, the invalidity shall not affect other provisions
    18  or applications of this act which can be given effect without
    19  the invalid provision or application.
    20  Section 47.  Repeals.
    21     (a)  Specific repeals.--Section 412 of the act of April 9,
    22  1929 (P.L.177, No.175), know as The Administrative Code of 1929,
    23  is repealed.
    24     The act of July 20, 1974 (P.L.551, No.190), known as the
    25  Medical Practice Act of 1974, is repealed.
    26     (b)  General repeal.--All other acts and parts of acts are
    27  repealed insofar as they are inconsistent with this act.
    28  Section 48.  Applicability of act.
    29     (a)  General rule.--The provisions of this act shall not
    30  apply either directly or indirectly, by intent or purpose, to
    19850S1158B1605                 - 41 -

     1  affect the practice of:
     2         (1)  Chiropractic, as authorized by the act of August 10,
     3     1951 (P.L.1182, No.264), known as the Chiropractic
     4     Registration Act of 1951.
     5         (2)  Dentistry, as authorized by the act of May 1, 1933
     6     (P.L.216, No.76), known as The Dental Law.
     7         (3)  Optometry, as authorized by the act of June 6, 1980
     8     (P.L.197, No.57), known as the Optometric Practice and
     9     Licensure Act.
    10         (4)  Osteopathy, as authorized by the act of October 5,
    11     1978 (P.L.1109, No.261), known as the Osteopathic Medical
    12     Practice Act.
    13         (5)  Pharmacy, as authorized by the acts of April 14,
    14     1972 (P.L.233, No.64), known as The Controlled Substance,
    15     Drug, Device and Cosmetic Act, and September 27, 1961
    16     (P.L.1700, No.699), known as the Pharmacy Act.
    17         (6)  Physical Therapy, as authorized by the act of
    18     October 10, 1975 (P.L.383, No.110), known as the Physical
    19     Therapy Practice Act.
    20         (7)  Podiatry, as authorized by the act of March 2, 1956
    21     (P.L.1206, No.375), known as the Podiatry Act of 1956.
    22         (8)  Professional Nursing, as authorized by the act of
    23     May 22, 1951 (P.L.317, No.69), known as The Professional
    24     Nursing Law.
    25         (9)  Psychologists, as authorized by the act of March 23,
    26     1972 (P.L.136, No.52), referred to as the Psychologists
    27     License Act.
    28     (b)  Exemption.--This act shall not be construed so as to
    29  give the Board of Medicine any jurisdiction over any of the
    30  schools or colleges of the methods exempted in this section.
    19850S1158B1605                 - 42 -

     1     (c)  No application to practice of hypnosis.--The provisions
     2  of this act shall not apply either directly or indirectly, by
     3  intent or purpose, to the practice of hypnosis.
     4  Section 49.  Existing board.
     5     The presently confirmed members of the State Board of Medical
     6  Education and Licensure constituted under section 412 of the act
     7  of April 9, 1929 (P.L.177, No.175), known as The Administrative
     8  Code of 1929, as of December 31, 1985, shall continue to serve
     9  as board members until their present terms of office expire and
    10  a successor has been appointed and qualified, but no longer than
    11  six months after the effective date of this act.
    12  Section 50.  Existing rules and regulations.
    13     Each rule and regulation of the board in effect on December
    14  31, 1985, not inconsistent with this act, shall remain in effect
    15  after such date until repealed or amended by the board. Each fee
    16  of the board in effect on December 31, 1985, and not
    17  inconsistent with this act, shall remain in effect after such
    18  date until repealed or amended by the board or the commissioner.
    19  Section 51.  Existing licenses, certificates and registrations.
    20     Any person who holds a valid license, certificate or
    21  registration issued by the State Board of Medical Education and
    22  Licensure under the act of July 20, 1974 (P.L.551, No.190),
    23  known as the Medical Practice Act of 1974, relating to the
    24  practice of medicine, prior to the effective date of this act
    25  shall, on and after the effective date hereof, be deemed
    26  licensed, certificated or registered by the State Board of
    27  Medicine as provided for in this act.
    28  Section 52.  Effective date.
    29     This act shall take effect January 1, 1986.

    J10L63CHF/19850S1158B1605       - 43 -