PRIOR PRINTER'S NOS. 1453, 1513, 1605         PRINTER'S NO. 1608

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 1158 Session of 1985


        INTRODUCED BY BELL, OCTOBER 16, 1985

        AS AMENDED ON THIRD CONSIDERATION, NOVEMBER 20, 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 practitioner
     6                 or technician.
     7  Section 18.  Federal medical personnel.
     8  Section 19.  Osteopathic act.
     9  Section 20.  Other health care 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
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     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.
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     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
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     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 practitioner."  An individual, other than a
     6  physician assistant, who is authorized to practice some
     7  component of the healing arts by a license, permit, certificate
     8  or registration issued by a Commonwealth licensing agency or
     9  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
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     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     "Resident."  A medical doctor who is participating in
    12  graduate training.
    13     "Technician."  A person, other than a health care
    14  practitioner or physician assistant, who through training,
    15  education or experience has achieved expertise in the technical
    16  details of a subject or occupation which is a component of the
    17  healing art.
    18     "Unaccredited medical college."  An institution of higher
    19  learning which provides courses in the art and science of
    20  medicine and surgery and related subjects, is empowered to grant
    21  professional degrees in medicine, is not accredited by the
    22  Association of American Medical Colleges, its successors or
    23  assigns, or the American Medical Association, either directly or
    24  through their respective accrediting bodies, and is listed by
    25  the World Health Organization, its successors or assigns, or is
    26  otherwise recognized as a medical college by the country in
    27  which it is situated.
    28  Section 3.  State Board of Medicine.
    29     (a)  Establishment.--The State Board of Medicine shall
    30  consist of the commissioner, the Secretary of Health, two
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     1  members appointed by the Governor who shall be persons
     2  representing the public at large and seven members appointed by
     3  the Governor, six of whom shall be medical doctors with
     4  unrestricted licenses to practice medicine and surgery in this
     5  Commonwealth for five years immediately preceding their
     6  appointment, and one who shall be a nurse midwife, physician
     7  assistant or certified registered nurse practitioner licensed or
     8  certified under the laws of this Commonwealth.
     9     (b)  Terms of office.--The term of each professional and
    10  public member of the board shall be four years or until his or
    11  her successor has been appointed and qualified, but not longer
    12  than six months beyond the four-year period. In the event that
    13  any of said members shall die or resign or otherwise becomes
    14  disqualified during his or her term, a successor shall be
    15  appointed in the same way and with the same qualifications and
    16  shall hold office for the unexpired term. No member shall be
    17  eligible for appointment to serve more than two consecutive
    18  terms.
    19     (c)  Quorum.--A majority of the members of the board serving
    20  in accordance with law shall constitute a quorum for purposes of
    21  conducting the business of the board. Except for temporary and
    22  automatic suspensions under section 40, a member may not be
    23  counted as part of a quorum or vote on any issue unless he or
    24  she is physically in attendance at the meeting.
    25     (d)  Chairman.--The board shall select annually a chairman
    26  from among its professional members.
    27     (e)  Compensation.--Each member of the board, except the
    28  commissioner and the Secretary of Health, shall receive $60 per
    29  diem when actually attending to the work of the board. Members
    30  shall also receive the amount of reasonable traveling, hotel and
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     1  other necessary expenses incurred in the performance of their
     2  duties in accordance with Commonwealth regulations.
     3     (f)  Sunset.--The board is subject to evaluation, review and
     4  termination in the manner provided in the act of December 22,
     5  1981 (P.L.508, No.142), known as the Sunset Act.
     6     (g)  Attendance at meetings.--A member of the board who fails
     7  to attend three consecutive meetings shall forfeit his or her
     8  seat unless the commissioner, upon written request from the
     9  member, finds that the member should be excused from a meeting
    10  because of illness or the death of a family member.
    11     (h)  Attendance at training seminars.--A public member who
    12  fails to attend two consecutive statutorily mandated training
    13  seminars in accordance with section 813(e) of the act of April
    14  9, 1929 (P.L.177, No.175), known as The Administrative Code of
    15  1929, shall forfeit his or her seat unless the commissioner,
    16  upon written request from the public member, finds that the
    17  public member should be excused from a meeting because of
    18  illness or the death of a family member.
    19     (i)  Meetings.--The board shall meet at least once every two
    20  months, and at such additional times as may be necessary to
    21  conduct the business of the board.
    22     (j)  Executive secretary.--The board, with the approval of
    23  the commissioner, shall appoint and fix the compensation of an
    24  executive secretary who shall be responsible for the day-to-day
    25  operation of the board and administration of board activities.
    26  Section 4.  Impaired professionals.
    27     (a)  Appointment of Disciplinary Advisory Committee.--The
    28  board, with the approval of the commissioner, shall appoint a
    29  Disciplinary Advisory Committee composed of three medical
    30  doctors, not members of the board, who shall be compensated at
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     1  the same rate as members of the board and who shall receive the
     2  amount of reasonable traveling, hotel and other necessary
     3  expenses incurred in the performance of their duties in
     4  accordance with Commonwealth regulations.
     5     (b)  Recommendations involving potential disciplinary
     6  actions.--The board may refer to the committee cases involving
     7  potential disciplinary actions under this act. Upon such
     8  referral, the committee shall review the case and make
     9  recommendations to the board within such time as the board shall
    10  designate; provided, that once the committee has accepted an
    11  impaired professional in an approved treatment program in
    12  accordance with this section, the committee may not thereafter
    13  accept referral of a disciplinary case regarding that individual
    14  from the board.
    15     (c)  Liaison.--The committee shall act as a liaison between
    16  the board and treatment programs, such as alcohol and drug
    17  treatment programs licensed by the Department of Health,
    18  psychological counseling and impaired professional support
    19  groups, which are approved by the board and which provide
    20  services to licensees or certificate holders under this act.
    21     (d)  Review of corrective action by the board.--The board may
    22  defer and ultimately dismiss any of the types of corrective
    23  action set forth in this act for an impaired professional so
    24  long as the professional is progressing satisfactorily in an
    25  approved treatment program, provided that the provisions of this
    26  subsection shall not apply to a professional convicted of a
    27  felonious act prohibited by the act of April 14, 1972 (P.L.233,
    28  No.64), known as The Controlled Substance, Drug, Device and
    29  Cosmetic Act, or the conviction of a felony relating to a
    30  controlled substance in a court of law of the United States or
    19850S1158B1608                  - 9 -

     1  any other state, territory or country. An approved program
     2  provider shall, upon request, disclose to the Disciplinary
     3  Advisory Committee all information in its possession regarding
     4  an impaired professional in treatment.
     5     (e)  Voluntary suspension or limitation.--An impaired
     6  professional who enrolls in an approved treatment program shall,
     7  if necessary, agree to a limitation of his or her ability to
     8  practice. Failure to do so disqualifies the professional from
     9  the impaired professional program and shall activate an
    10  immediate investigation and disciplinary proceeding by the
    11  board.
    12     (f)  Failure to satisfactorily progress.--If, in the opinion
    13  of the committee after consultation with the provider, an
    14  impaired professional who is enrolled in an approved treatment
    15  has not progressed satisfactorily, the committee shall disclose
    16  to the board all information in its possession regarding the
    17  professional; and such disclosure shall constitute the basis for
    18  instituting proceedings to suspend or revoke the license or
    19  certificate of said professional.
    20     (g)  Immunity.--An approved program provider who makes a
    21  disclosure pursuant to this subsection shall not be subject to
    22  civil liability for such disclosure or its consequences.
    23     (h)  Reports to the board.--Any hospital or health care
    24  facility, peer or colleague who knows or has evidence to suspect
    25  a professional has an addictive disease, is diverting a
    26  controlled substance, or is mentally or physically incompetent
    27  to carry out the duties of his or her license or certificate,
    28  shall make, or cause to be made, a report to the board: Provided
    29  that any person or facility who acts in a treatment capacity to
    30  an impaired professional in an approved treatment program is
    19850S1158B1608                 - 10 -

     1  exempt from the mandatory reporting requirements of this
     2  subsection. Any person or facility who reports pursuant to this
     3  section in good faith and without malice shall be immune from
     4  any civil or criminal liability arising from such report.
     5  Failure to provide such report within a reasonable time from
     6  receipt of knowledge of impairment shall subject the person or
     7  facility to a fine not to exceed $1,000. The board shall levy
     8  this penalty only after affording the accused party the
     9  opportunity for a hearing, as provided in Title 2 of the
    10  Pennsylvania Consolidated Statutes (relating to administrative
    11  law and procedure).
    12  Section 5.  Consultants.
    13     The board shall establish consultant panels or use individual
    14  consultants, as it deems appropriate, to assist it in carrying
    15  out its responsibilities. The board may not delegate any of its
    16  final decisionmaking responsibilities to a consultant or panel
    17  of consultants.
    18  Section 6.  Fees, fines and civil penalties.
    19     (a)  Setting of fees.--All fees required under this act shall
    20  be fixed by the board by regulation and shall be subject to the
    21  act of June 25, 1982 (P.L.633, No.181), known as the Regulatory
    22  Review Act. If the revenues raised by fees, fines and civil
    23  penalties imposed under this act are not sufficient to meet
    24  expenditures over a two-year period, the board shall increase
    25  those fees by regulation so that the projected revenues will
    26  meet or exceed projected expenditures.
    27     (b)  Inadequate fees.--If the Bureau of Professional and
    28  Occupational Affairs determines that the fees established by the
    29  board under subsection (a) are inadequate to meet the minimum
    30  enforcement efforts required by this act, then the bureau after
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     1  consultation with the board and subject to the Regulatory Review
     2  Act, shall increase the fees by regulation in an amount that
     3  adequate revenues are raised to meet the required enforcement
     4  effort.
     5     (c)  Disposition.--All fees, fines and civil penalties
     6  imposed in accordance with this act and collected in accordance
     7  with section 907(a) of the act of October 15, 1975 (P.L.390,
     8  No.111), known as the Health Care Services Malpractice Act,
     9  along with any interest generated thereby, shall be for the
    10  exclusive use by the board in carrying out the provisions of
    11  this act, and shall be annually appropriated for that purpose.
    12     (d)  Charging of fees.--The board may charge a reasonable
    13  fee, as set by the board by regulation, for all examinations,
    14  registrations, certificates, licensures or applications
    15  permitted by this act or the regulations thereunder.
    16  Section 7.  Reports of the board.
    17     (a)  Reports to Department of State.--The board shall submit
    18  annually to the Department of State an estimate of the financial
    19  requirements of the board for its administrative, investigative,
    20  legal and miscellaneous expenses.
    21     (b)  Reports to House and Senate Appropriations Committees.--
    22  The board shall submit annually to the House and Senate
    23  Appropriations Committees, 15 days after the Governor has
    24  submitted his budget to the General Assembly, a copy of the
    25  budget request for the upcoming fiscal year which the board
    26  previously submitted to the department.
    27     (c)  Reports to other House and Senate committees.--The board
    28  shall submit annually a report to the Professional Licensure
    29  Committee of the House of Representatives and to the Consumer
    30  Protection and Professional Licensure Committee of the Senate a
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     1  description of the types of complaints received, status of
     2  cases, board action which has been taken and the length of time
     3  from the initial complaint to final board resolution. The report
     4  shall also include a statement of the numbers and types of
     5  licenses granted and a statement on physician assistant use in
     6  this Commonwealth, including geographic location and practice
     7  settings.
     8  Section 8.  Regulatory powers of the board.
     9     The board, in the exercise of its duties under this act,
    10  shall have the power to adopt such regulations as are reasonably
    11  necessary to carry out the purposes of this act. Regulations
    12  shall be adopted in conformity with the provisions of the act of
    13  July 31, 1968 (P.L.769, No.240), referred to as the Commonwealth
    14  Documents Law, and the act of June 25, 1982 (P.L.633, No.181),
    15  known as the Regulatory Review Act.
    16  Section 9.  Procedure, oaths and subpoenas.
    17     (a)  All actions of the board.--All actions of the board
    18  shall be taken subject to the right of notice, hearing and
    19  adjudication, and the right of appeal therefrom, in accordance
    20  with the provisions in Title 2 of the Pennsylvania Consolidated
    21  Statutes (relating to administrative law and procedure).
    22     (b)  Disciplinary proceedings.--All disciplinary proceedings
    23  conducted by hearing examiners shall be conducted in accordance
    24  with sections 901 through 905 of the act of October 15, 1975
    25  (P.L.390, No.111), known as the Health Care Services Malpractice
    26  Act.
    27     (c)  Subpoena power.--The board shall have the authority to
    28  issue subpoenas, upon application of an attorney responsible for
    29  representing the Commonwealth in disciplinary matters before the
    30  board, for the purpose of investigating alleged violations of
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     1  the disciplinary provisions administered by the board. The board
     2  shall have the power to subpoena witnesses, to administer oaths,
     3  to examine witnesses or to take testimony or compel the
     4  production of books, records, papers and documents as it may
     5  deem necessary or proper in and pertinent to any proceeding,
     6  investigation or hearing held by it. Medical records may not be
     7  subpoenaed without consent of the patient or without order of a
     8  court of competent jurisdiction on a showing that the records
     9  are reasonably necessary for the conduct of the investigation.
    10  The court may impose such limitations on the scope of the
    11  subpoena as are necessary to prevent unnecessary intrusion in
    12  patient confidential information. The board is authorized to
    13  apply to Commonwealth Court to enforce its subpoenas.
    14  Section 10.  Unauthorized practice of medicine and surgery.
    15     No person other than a medical doctor shall engage in any of
    16  the following conduct except as authorized or exempted in this
    17  act:
    18         (1)  Practice medicine and surgery.
    19         (2)  Purport to practice medicine and surgery.
    20         (3)  Hold forth as authorized to practice medicine and
    21     surgery through use of a title, including, but not
    22     necessarily limited to, medical doctor, doctor of medicine,
    23     doctor of medicine and surgery, doctor of a designated
    24     disease, physician, physician of a designated disease, or any
    25     abbreviation for the foregoing.
    26         (4)  Otherwise hold forth as authorized to practice
    27     medicine and surgery.
    28  Section 11.  Clinical clerks.
    29     (a)  Authorized services.--A clinical clerk may perform the
    30  following services in a hospital to which the clerk is assigned,
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     1  provided the services are performed within the restrictions
     2  contained in or authorized by this section:
     3         (1)  Make notes on a patient's chart.
     4         (2)  Conduct a physical examination.
     5         (3)  Perform a medical procedure or laboratory test.
     6     (b)  Regulations.--A clinical clerk shall not perform a
     7  medical service unless the performance of such by the clinical
     8  clerk under the circumstances is consistent with the standards
     9  of acceptable medical practice embraced by the medical doctor
    10  community in this Commonwealth. The board shall promulgate
    11  regulations which define the medical services those standards
    12  permit a clinical clerk to perform and the circumstances under
    13  which those standards permit a clinical clerk to perform a
    14  medical service.
    15     (c)  Supervision.--A clinical clerk shall not perform a
    16  medical service without the direct and immediate supervision of
    17  the medical doctor members of the medical staff or residents at
    18  the hospital in which the service is performed. The board shall
    19  promulgate regulations which define the supervision required by
    20  those standards.
    21     (d)  Drugs.--A clinical clerk shall not prescribe or dispense
    22  drugs.
    23     (e)  Notes on patients' charts.--Notes made on a patient's
    24  chart by a clinical clerk become official only when
    25  countersigned by a medical doctor member of the hospital's
    26  medical staff or resident beyond a first-year level of graduate
    27  medical education at the hospital.
    28     (f)  Other licenses or certificates.--Nothing in this section
    29  or the regulations authorized by this section shall be construed
    30  to prohibit a clinical clerk who is licensed or certified to
    19850S1158B1608                 - 15 -

     1  practice a profession by a Commonwealth agency or board from
     2  practicing within the scope of that license or certificate or as
     3  otherwise authorized by law.
     4  Section 12.  Midwifery.
     5     (a)  Previous licensure.--A midwife who has been licensed
     6  previously by the board may continue to practice midwifery in
     7  accordance with regulations promulgated by the board.
     8     (b)  Use of title.--A midwife may use the title midwife,
     9  nurse-midwife or an appropriate abbreviation of those titles.
    10     (c)  Other licenses or certificates.--Nothing in this section
    11  or the regulations authorized by this section shall be construed
    12  to prohibit a midwife who is licensed or certified to practice
    13  another profession by a Commonwealth agency or board from
    14  practicing within the scope of that license or certificate or as
    15  otherwise authorized by law.
    16  Section 13.  Physician assistants.
    17     (a)  Authorized services.--A physician assistant may perform
    18  a medical service delegated by an approved physician and as
    19  approved by the appropriate board. An approved physician is a
    20  physician identified in the writing required by subsection (e).
    21     (b)  Use of title.--A physician assistant may use the title
    22  physician assistant or an appropriate abbreviation for that
    23  title, such as "P.A.-C."
    24     (c)  Regulations.--The board shall promulgate regulations
    25  which define the services and circumstances under which a
    26  physician assistant may perform a medical service.
    27     (d)  Supervision.--A physician assistant shall not perform a
    28  medical service without the supervision and personal direction
    29  of an approved physician. The board shall promulgate regulations
    30  which define the supervision and personal direction required by
    19850S1158B1608                 - 16 -

     1  those standards.
     2     (e)  Written agreement.--A physician assistant shall not
     3  provide a medical service without a written agreement with one
     4  or more physicians which provides for all of the following:
     5         (1)  Identifies and is signed by each physician the
     6     physician assistant will be assisting.
     7         (2)  Describes the manner in which the physician
     8     assistant will be assisting each named physician.
     9         (3)  Describes the nature and degree of supervision and
    10     direction each named physician will provide the physician
    11     assistant.
    12         (4)  Designates one of the named physicians as having the
    13     primary responsibility for supervising and directing the
    14     physician assistant.
    15         (5)  Has been approved by the board as satisfying the
    16     foregoing and as consistent with the restrictions contained
    17     in or authorized by this section.
    18  A physician assistant shall not assist a physician in a manner
    19  not described in the agreement or without the nature and degree
    20  of supervision and direction described in the agreement. The
    21  physician designated as having primary responsibility for the
    22  physician assistant shall not have primary responsibility for
    23  more than two physician assistants.
    24     (f)  Drugs.--A physician assistant shall not independently
    25  prescribe or dispense drugs. The board and the State Board of
    26  Pharmacy shall jointly promulgate regulations which permit a
    27  physician assistant to prescribe and dispense drugs at the
    28  direction of a physician.
    29     (g)  Supervision.--A physician assistant may be employed by a
    30  medical care facility under the supervision and direction of an
    19850S1158B1608                 - 17 -

     1  approved physician or group of such physicians, provided one of
     2  those physicians is designated as having the primary
     3  responsibility for supervising and directing the physician
     4  assistant and provided that a physician assistant shall not be
     5  responsible to more than three physicians.
     6     (h)  Reimbursement.--For reimbursement purposes a physician
     7  assistant shall be an employee subject to the normal employer-
     8  employee reimbursement procedures.
     9     (i)  Eye services.--No medical services may be performed by a
    10  physician assistant under this act which include the measurement
    11  of the range or powers of human vision or the determination of
    12  the refractive status of the human eye. This subsection does not
    13  prohibit the performance of routine vision screenings or the
    14  performance of refractive screenings in the physician's office.
    15     (j)  Chiropractic practice.--Nothing in this act shall be
    16  construed to allow physician assistants to practice
    17  chiropractic.
    18     (k)  Other licenses or certificates.--Nothing in this section
    19  or the regulations authorized by this section shall be construed
    20  to prohibit a physician assistant who is licensed or certified
    21  to practice another profession by a Commonwealth agency or board
    22  from practicing within the scope of that license or certificate
    23  or as otherwise authorized by law.
    24  Section 14.  Drugless therapist.
    25     (a)  Previous licensure.--A drugless therapist who has been
    26  licensed previously by the board may continue to provide
    27  drugless therapy in accordance with the regulations promulgated
    28  by the board.
    29     (b)  Drugs.--A drugless therapist shall not prescribe or
    30  dispense drugs.
    19850S1158B1608                 - 18 -

     1     (c)  Other licenses or certificates.--Nothing in this section
     2  or the regulations authorized by this section shall be construed
     3  to prohibit a drugless therapist who is licensed or certified to
     4  practice another profession by a Commonwealth agency or board
     5  from practicing within the scope of that license or certificate
     6  or as otherwise authorized by law.
     7  Section 15.  Certified registered nurse practitioner.
     8     (a)  General rule.--A certified registered nurse practitioner
     9  shall act in accordance with regulations authorized by this
    10  section.
    11     (b)  Regulations.--The board and the State Board of Nurse
    12  Examiners shall jointly promulgate regulations authorizing a
    13  certified registered nurse practitioner to perform acts of
    14  medical diagnoses and prescription of medical, therapeutic,
    15  diagnostic or corrective measures.
    16     (c)  Other licenses or certificates.--Nothing in this section
    17  or the regulations authorized by this section shall be construed
    18  to prohibit a certified registered nurse practitioner who is
    19  licensed or certified to practice another profession by a
    20  Commonwealth agency or board from practicing within the scope of
    21  that license or certificate as otherwise authorized by law.
    22  Section 16.  Consultation.
    23     A person authorized to practice medicine or surgery or
    24  osteopathy without restriction by any other state may, upon
    25  request by a medical doctor, provide consultation to the medical
    26  doctor regarding the treatment of a patient under the care of
    27  the medical doctor.
    28  Section 17.  Delegation of duties to health care practitioner or
    29                 technician.
    30     (a)  General rule.--A health care practitioner or technician
    19850S1158B1608                 - 19 -

     1  may perform a medical service if:
     2         (1)  The performance of the service was delegated by a
     3     medical doctor.
     4         (2)  The delegation is consistent with the standards of
     5     acceptable medical practice embraced by the medical doctor
     6     community in this Commonwealth.
     7         (3)  The delegation is not prohibited by regulations
     8     promulgated by the board.
     9         (4)  The delegation is not prohibited by statutes or
    10     regulations relating to other licensed health care
    11     practitioners.
    12     (b)  Regulations.--The board may promulgate regulations which
    13  establish criteria pursuant to which a medical doctor may
    14  delegate the performance of medical services, preclude a medical
    15  doctor from delegating the performance of certain types of
    16  medical services, or otherwise limit the ability of a medical
    17  doctor to delegate medical services.
    18     (c)  Responsibility.--Nothing in this section shall be
    19  construed to limit the medical doctor's responsibility for the
    20  medical service delegated to the health care practitioner or
    21  technician.
    22  Section 18.  Federal medical personnel.
    23     Nothing in this act shall be construed to prohibit a medical
    24  doctor in the medical service of the armed forces of the United
    25  States, the United States Public Health Service or the Veterans'
    26  Administration, or a Federal employee, from discharging official
    27  duties.
    28  Section 19.  Osteopathic act.
    29     (a)  General rule.--Nothing in this act shall be construed to
    30  prohibit a doctor of osteopathy from practicing osteopathic
    19850S1158B1608                 - 20 -

     1  medicine and surgery.
     2     (b)  Specific authorization.--Nothing in this act shall be
     3  construed to prohibit a person authorized to practice
     4  osteopathic medicine and surgery by the act of October 5, 1978
     5  (P.L.1109, No.261), known as the Osteopathic Medical Practice
     6  Act, to practice as authorized by that act.
     7  Section 20.  Other health care practitioners.
     8     Nothing in this act shall be construed to prohibit a health
     9  care practitioner from practicing that profession within the
    10  scope of the health care practitioner's license or certificate
    11  or as otherwise authorized by the law, including using the title
    12  authorized by the practitioner's licensing act.
    13  Section 21.  Acts outside nonmedical doctor license or
    14                 certificate.
    15     (a)  Medical doctor involvement.--In the event the law,
    16  including this act, conditions a person's authorization to
    17  perform one or more medical services upon medical doctor
    18  involvement, and the person performs a covered service without
    19  the required involvement, the person shall be deemed to have
    20  acted outside the scope of the person's license or certificate.
    21     (b)  Included involvements.--The medical doctor involvement
    22  referred to in subsection (a) shall include, but shall not
    23  necessarily be limited to, any of the following:
    24         (1)  An order.
    25         (2)  Direction or supervision.
    26         (3)  Presence.
    27         (4)  Immediate availability.
    28         (5)  Referral.
    29         (6)  Consultation.
    30  Section 22.  Licenses and certificates; general qualification.
    19850S1158B1608                 - 21 -

     1     (a)  Types of licenses and certificates.--The board may grant
     2  the following licenses and certificates:
     3         (1)  License without restriction.
     4         (2)  License with restriction.
     5         (3)  Graduate license.
     6         (4)  Institutional license.
     7         (5)  Temporary license.
     8         (6)  Extraterritorial license.
     9         (7)  Midwife license.
    10         (8)  Physician assistant certificate.
    11     (b)  Qualifications.--The board shall not issue a license or
    12  certificate to an applicant unless the applicant establishes
    13  with evidence, verified by an affidavit or affirmation of the
    14  applicant, that the applicant is of legal age, is of good moral
    15  character and is not addicted to the intemperate use of alcohol
    16  or the habitual use of narcotics or other habit-forming drugs,
    17  and that the applicant has completed the educational
    18  requirements prescribed by the board, and otherwise satisfies
    19  the qualifications for the license or certificate contained in
    20  or authorized by this act. THE BOARD SHALL NOT ISSUE A LICENSE    <--
    21  OR CERTIFICATE TO AN APPLICANT WHO HAS BEEN CONVICTED OF A
    22  FELONY UNDER THE ACT OF APRIL 14, 1972 (P.L.233, NO.64), KNOWN
    23  AS THE CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC ACT, OR
    24  OF AN OFFENSE UNDER THE LAWS OF ANOTHER JURISDICTION WHICH IF
    25  COMMITTED IN THIS COMMONWEALTH WOULD BE A FELONY UNDER THE
    26  CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC ACT, UNLESS:
    27         (1)  AT LEAST TEN YEARS HAVE ELAPSED FROM THE DATE OF
    28     CONVICTION;
    29         (2)  THE APPLICANT SATISFACTORILY DEMONSTRATES TO THE
    30     BOARD THAT HE HAS MADE SIGNIFICANT PROGRESS IN PERSONAL
    19850S1158B1608                 - 22 -

     1     REHABILITATION SINCE THE CONVICTION SUCH THAT LICENSURE OF
     2     THE APPLICANT SHOULD NOT BE EXPECTED TO CREATE A SUBSTANTIAL
     3     RISK OF HARM TO THE HEALTH AND SAFETY OF HIS PATIENTS OR THE
     4     PUBLIC OR A SUBSTANTIAL RISK OF FURTHER CRIMINAL VIOLATIONS;
     5     AND
     6         (3)  THE APPLICANT OTHERWISE SATISFIES THE QUALIFICATIONS
     7     CONTAINED IN OR AUTHORIZED BY THIS ACT.
     8  AS USED IN THIS SECTION THE TERM "CONVICTED" SHALL INCLUDE A
     9  JUDGMENT, AND ADMISSION OF GUILT OR A PLEA OF NOLO CONTENDERE.
    10     (c)  Refusal.--The board may refuse to issue a license or
    11  certificate to an applicant based upon a ground for such action
    12  contained in section 41.
    13     (d)  Limitation.--The board shall not refuse to issue a
    14  license or certificate to an applicant unless the applicant has
    15  been afforded the procedural protections required by this act.
    16     (e)  Action on application.--The application, upon filing by
    17  the applicant of the evidence required under subsection (b) and
    18  the expiration of a period of 90 days, shall be deemed to meet
    19  the requirements of this act and become effective, the license
    20  or certificate shall be deemed issued, and the board shall take
    21  no action against the applicant for practicing without a license
    22  or certificate, unless within that period the application has
    23  been disapproved by the board or proceedings have been initiated
    24  against the applicant under this act.
    25  Section 23.  Standards for medical training facilities.
    26     (a)  General rule.--The educational qualifications for
    27  acceptance as a matriculant in a medical college or other
    28  medical training facility incorporated within this Commonwealth
    29  and the curricula and training to be offered by such medical
    30  colleges or other medical training facility shall meet the
    19850S1158B1608                 - 23 -

     1  requirements set by the board and any accrediting body which may
     2  be recognized by the board.
     3     (b)  Duties of the board.--It shall be the duty of the board,
     4  in its discretion, periodically to ascertain the character of
     5  the instruction and the facilities possessed by each of the
     6  medical colleges and other medical training facilities offering
     7  or desiring to offer medical training in accordance with the
     8  requirements of this act. In shall further be the duty of the
     9  board, by inspection and otherwise, to ascertain the facilities
    10  and qualifications of medical colleges and other medical
    11  training facilities outside this Commonwealth, whose graduates
    12  or trainees desire to obtain licensure, graduate medical
    13  training or certification in this Commonwealth, provided further
    14  that the board shall have the authority to refuse to license
    15  graduates of any such medical institutions, colleges or
    16  hospitals which in its judgment do not meet similar standards
    17  for medical training and facilities as are required of medical
    18  institutions in this Commonwealth. In enforcing this provision,
    19  the board shall give due notice to any medical institution,
    20  college or hospital upon which it has rendered a decision that
    21  its training and facilities do not meet the standards required
    22  by the board.
    23     (c)  Refusal of recognition.--In the event that the board
    24  determines that a medical training facility has failed to
    25  provide adequate facilities, curricula or training, the board
    26  shall not recognize the education or degrees obtained from the
    27  medical training facility during the period of inadequacy.
    28  Section 24.  Examinations.
    29     (a)  General rule.--The board may require an applicant to
    30  take and pass an examination to the satisfaction of the board.
    19850S1158B1608                 - 24 -

     1     (b)  Proficiency in English language.--In addition to any
     2  other examination required by this act or by regulation of the
     3  board, applicants for a license or certificate, whose principal
     4  language is other than English, may also be required to
     5  demonstrate, by examination, proficiency in the English language
     6  to any agency considered competent by the board.
     7     (c)  Authority to call in medical consultants.--For the
     8  purpose of conducting all examinations, the board shall have the
     9  privilege of calling to its aid medical consultants who shall be
    10  compensated for their services at a reasonable rate in an amount
    11  as determined, from time to time, by the board in addition to
    12  all incurred expenses, in accordance with Commonwealth
    13  regulations.
    14     (d)  Examining agency.--When the board accepts an examination
    15  given by an examining agency, the board may establish the
    16  criteria for passing, or may accept the criteria for passing,
    17  established by the examining agency. If the examination is
    18  offered in parts, the board may establish, by regulation, a time
    19  period in which the entire examination must be successfully
    20  completed. The board may establish, by regulation, a maximum
    21  number of examination attempts it will recognize for the purpose
    22  of receiving a passing score on an examination recognized but
    23  not given by the board.
    24  Section 25.  Licenses and certificates; biennial registration.
    25     (a)  Issuance of licenses and certificates.--All applicants
    26  who have complied with the requirements of the board, and who
    27  shall have passed a final examination, and who have otherwise
    28  complied with the provisions of this act, shall receive from the
    29  commissioner, or whoever exercises equivalent authority acting
    30  for the board, a license or certificate entitling them to the
    19850S1158B1608                 - 25 -

     1  right to practice in this Commonwealth. Each such license or
     2  certificate shall be duly recorded in the office of the board,
     3  in a record to be properly kept for that purpose which shall be
     4  open to public inspection and a certified copy of said record
     5  shall be received as evidence in all courts in this Commonwealth
     6  in the trial of any case.
     7     (b)  Renewals.--It shall be the duty of all persons now or
     8  hereafter licensed or certified to be registered with the board
     9  and, thereafter, to register in like manner at such intervals
    10  and by such methods as the board shall determine by regulations,
    11  but in no case shall such renewal period be longer than two
    12  years. The form and method of such registration shall be
    13  determined by the board.
    14     (c)  Fees.--Each person so registering with the board shall
    15  pay, for each biennial registration, a reasonable fee which, if
    16  any, shall accompany the application for such registration.
    17     (d)  Evidence of registration.--Upon receiving a proper
    18  application for such registration accompanied by the fee, if
    19  any, above provided for, the board shall issue a certificate of
    20  registration to the applicant. Said certificate together with
    21  its renewals shall be good and sufficient evidence of
    22  registration under the provisions of this act.
    23  Section 26.  Certification of license or certificate.
    24     The status of a license or certificate issued by the board
    25  shall be certified by the board to other jurisdictions or
    26  persons upon formal application and payment of a reasonable fee.
    27  Section 27.  Reciprocity or endorsement.
    28     Reciprocity or endorsement may be established at the
    29  discretion of the board. As used in this section, the term
    30  "reciprocity" means the act of the board and a licensing
    19850S1158B1608                 - 26 -

     1  authority in another jurisdiction, each recognizing that the
     2  requirements for a license or certificate in this Commonwealth
     3  and in the other jurisdiction are equivalent, issuing a license
     4  or certificate to an applicant who possesses a similar license
     5  or certificate in the other jurisdiction. As used in this
     6  section, the term "endorsement" means the issuance of a license
     7  or certificate by the board to an applicant who does not meet
     8  standard requirements, if the applicant has achieved cumulative
     9  qualifications which are accepted by the board as being
    10  equivalent to the standard requirements for the license or
    11  certificate.
    12  Section 28.  License to practice medicine and surgery.
    13     An individual is not qualified for a license to practice
    14  medicine and surgery unless the individual has received an
    15  academic degree in medicine and surgery from a medical college
    16  and the individual satisfies the other qualifications for the
    17  license contained in or authorized by this act.
    18  Section 29.  License without restriction.
    19     (a)  General rule.--A license without restriction empowers
    20  the licensee to practice medicine and surgery without any
    21  restriction or limitation.
    22     (b)  Graduates of accredited medical colleges.--No license
    23  without restriction may be issued to a graduate of an accredited
    24  medical college unless the applicant has completed successfully
    25  as a resident two years of approved graduate medical training.
    26     (c)  Graduates of unaccredited medical colleges.--No license
    27  without restriction may be issued to a graduate of an
    28  unaccredited medical college unless the applicant has completed
    29  successfully as a resident three years of approved graduate
    30  medical training, educational requirements prescribed by the
    19850S1158B1608                 - 27 -

     1  board and certification by the Educational Council for Foreign
     2  Medical Graduates, or its successors.
     3     (d)  Examinations.--The board shall hold at least two
     4  examinations for applicants for a license without restriction
     5  each year. Special examinations may be designated by the board.
     6  The examinations shall be held at such times and places as
     7  designated by the board. In case of failure at any such
     8  examination, the applicant shall have, after the expiration of
     9  six months and within two years, the privilege of a second
    10  examination by the board. In case of failure in a second
    11  examination, or after the expiration of two years, the applicant
    12  must thereafter successfully complete, as a resident, one year
    13  of graduate medical training approved by the board, apply de
    14  novo, and qualify under the conditions in existence at the time
    15  of the application.
    16  Section 30.  License with restriction.
    17     (a)  General rule.--A license with restriction empowers the
    18  licensee to practice medicine and surgery with such restrictions
    19  or limitations as may be established by the board, including
    20  restrictions in the scope of permitted practice, a requirement
    21  that the applicant take one or more refresher educational
    22  courses or mandated submission of medical care, counseling or
    23  treatment.
    24     (b)  Prerequisite.--No license with restriction may by issued
    25  unless the applicant has otherwise been issued, or is qualified
    26  to be issued, a license without restriction in accordance with
    27  this act.
    28     (c)  Disciplinary proceedings or voluntary request.--The
    29  board may issue a license with restriction only upon completion
    30  of disciplinary proceedings in accordance with this act or upon
    19850S1158B1608                 - 28 -

     1  a voluntary request of the applicant.
     2  Section 31.  Graduate license.
     3     (a)  General rule.--A graduate license empowers the licensee
     4  to participate for a period of up to 12 consecutive months in
     5  graduate medical training within the complex of the hospital to
     6  which the licensee is assigned and any satellite facility or
     7  other training location utilized in the graduate training
     8  program.
     9     (b)  Requirements.--No graduate license may be issued unless
    10  the applicant is a graduate of an accredited medical college or
    11  an unaccredited medical college and has received a medical
    12  degree. A graduate license may be issued to an applicant who
    13  holds the equivalent of a license without restriction granted by
    14  another state or territory of the United States or the Dominion
    15  of Canada.
    16     (c)  Extensions; waivers.--The board may extend the validity
    17  of a graduate license upon application when such action is
    18  warranted. In the event a graduate license holder is issued a
    19  license without restriction and wishes to continue graduate
    20  medical training, the graduate license holder shall complete and
    21  keep current a form satisfactory to the board containing
    22  information desired by the board on the graduate medical
    23  training program. A graduate of an unaccredited medical college,
    24  who does not possess all of the qualifications for the issuance
    25  of a graduate license but desires to train in a hospital within
    26  this Commonwealth in an area of advanced medical training, may
    27  have the unmet qualifications waived by the board if the board
    28  determines that the applicant possesses the technical skills and
    29  educational background to participate in such training and that
    30  its issuance is beneficial to the health, safety and welfare of
    19850S1158B1608                 - 29 -

     1  the general public of this Commonwealth.
     2  Section 32.  Institutional license.
     3     (a)  General rule.--An institutional license empowers the
     4  licensee to teach or practice medicine and surgery in one of the
     5  medical colleges, affiliates or hospitals within this
     6  Commonwealth.
     7     (b)  Requirements.--No institutional license may be issued
     8  unless the applicant:
     9         (1)  is a graduate of an unaccredited medical college who
    10     has attained through professional growth and teaching
    11     experience the status of teacher; or
    12         (2)  is not otherwise licensed to practice medicine and
    13     surgery in this Commonwealth but has achieved outstanding
    14     medical skills in a particular area of medicine and surgery
    15     and wishes to practice, demonstrate or teach with those
    16     outstanding medical skills.
    17     (c)  Determinations by the board.--The board shall issue an
    18  institutional license valid for no more than three years, as the
    19  board shall determine and only when it determines that its
    20  issuance is beneficial to the health, safety and welfare of the
    21  general public of this Commonwealth. A person granted an
    22  institutional license who subsequently desires to obtain a
    23  license without restriction shall be required to meet all of the
    24  requirements of such license as set forth in this act.
    25  Section 33.  Temporary license.
    26     (a)  General rule.--A temporary license empowers the licensee
    27  to:
    28         (1)  teach medicine and surgery or participate in a
    29     medical procedure necessary for the well-being of a specified
    30     patient within this Commonwealth; or
    19850S1158B1608                 - 30 -

     1         (2)  practice medicine and surgery at a camp or resort
     2     for no more than three months.
     3     (b)  Requirements.--No temporary license may be issued unless
     4  the applicant holds the equivalent of a license without
     5  restriction granted by another state, territory or country.
     6     (c)  Additional conditions.--The board may impose any
     7  appropriate limitation in scope, duration or site of practice on
     8  the temporary license. Temporary licensees shall be deemed
     9  health care providers who conduct 50% or less of their health
    10  care business or practice within this Commonwealth for the
    11  purposes of the act of October 15, 1975 (P.L.390, No.111), known
    12  as the Health Care Services Malpractice Act.
    13  Section 34.  Extraterritorial license.
    14     (a)  General rule.--An extraterritorial license empowers the
    15  licensee residing in or maintaining the office of practice in
    16  any adjoining state near the boundary line between such state
    17  and this Commonwealth, whose medical practice extends into this
    18  Commonwealth, to practice medicine and surgery with or without
    19  restriction in this Commonwealth on such patients.
    20     (b)  Requirements.--No extraterritorial license may be issued
    21  unless the applicant holds the equivalent of a license without
    22  restriction granted by a state adjoining this Commonwealth.
    23     (c)  Additional conditions.--An extraterritorial license may
    24  be granted by the board so long as the board is provided with:
    25         (1)  An application for the license, which shall include
    26     information on malpractice insurance coverage compliance.
    27         (2)  A certification by the authorized licensing body of
    28     such state of the current license in the state of residence
    29     and primary practice.
    30  The exercise of the discretion of the board in granting such a
    19850S1158B1608                 - 31 -

     1  license will depend primarily upon the needs of patients in this
     2  Commonwealth, the availability of medical care in the specific
     3  area involved and whether the adjoining state of licensure
     4  reciprocates by extending similar privileges to medical doctors
     5  who reside and have their office of practice in this
     6  Commonwealth. Such a license will be automatically revoked if
     7  such medical doctor relocates the office of practice or
     8  residence. A medical doctor granted such a license has the duty
     9  to inform the board of any changes in practice which may in any
    10  way affect the maintenance of the license.
    11  Section 35.  Nurse-midwife license.
    12     (a)  General rule.--A nurse-midwife license empowers the
    13  licensee to practice midwifery in this Commonwealth as provided
    14  in this act. The board shall formulate and issue such rules and
    15  regulations, from time to time, as may be necessary for the
    16  examination, licensing and proper conduct of the practice of
    17  midwifery.
    18     (b)  Requirements.--No nurse-midwife license will be issued
    19  unless the applicant is a registered nurse licensed in this
    20  Commonwealth. An applicant for a midwife license must have
    21  completed an academic and clinical program of study in midwifery
    22  which has been approved by the board or an accrediting body
    23  recognized by the board.
    24  Section 36.  Physician assistant certificate.
    25     (a)  General rule.--A physician assistant certificate
    26  empowers the holder to assist a medical doctor in the provision
    27  of medical care and services under the supervision and direction
    28  of that medical doctor as provided in this act.
    29     (b)  Requirements.--No physician assistant certificate may be
    30  issued to the applicant unless the requirements set forth by
    19850S1158B1608                 - 32 -

     1  this act and such rules and regulations issued by the board are
     2  met, including requirements for the physician assistant
     3  certificate of training and educational programs which shall be
     4  formulated by the board in accordance with such national
     5  criteria as are established by national organizations or
     6  societies as the board may accept.
     7     (c)  Criteria.--The board shall grant physician assistant
     8  certificates to applicants who have fulfilled the following
     9  criteria:
    10         (1)  Satisfactory performance on the proficiency
    11     examination to the extent that a proficiency examination
    12     exists.
    13         (2)  Satisfactory completion of a certified program for
    14     the training and education of physician assistants.
    15     (d)  Biennial renewal.--A physician assistant certificate
    16  shall be subject to biennial renewal by the board.
    17     (e)  Description of manner of assistance.--The application
    18  shall include a written request from the applicant's supervising
    19  medical doctor who shall file with the board a description of
    20  the manner in which the physician assistant will assist the
    21  supervising medical doctor, which description shall be subject
    22  to the approval of the board.
    23  Section 37.  Reporting of multiple licensure.
    24     Any licensed medical doctor in this Commonwealth who is also
    25  licensed to practice medicine and surgery in any other state,
    26  territory or country shall report this information to the board
    27  on the biennial registration application or within 90 days of
    28  final disposition, whichever is sooner. Any disciplinary action
    29  taken in other states must be reported to the board on the
    30  biennial registration application. Multiple licensure will be
    19850S1158B1608                 - 33 -

     1  noted on the medical doctor's record and such state, territory
     2  or country will be notified of any disciplinary actions taken
     3  against said medical doctor in this Commonwealth.
     4  Section 38.  Injunctions against unlawful practice.
     5     It shall be unlawful for any person to practice, or attempt
     6  to offer to practice, medicine and surgery, as defined in this
     7  act, without having at the time of so doing a valid, unexpired,
     8  unrevoked and unsuspended license issued under this act. The
     9  unlawful practice of medicine and surgery as defined in this act
    10  may be enjoined by the courts on petition of the board or by the
    11  commissioner. In any such proceeding it shall not be necessary
    12  to show that any person is individually injured by the actions
    13  complained of. If it is determined the respondent has engaged in
    14  the unlawful practice of medicine and surgery, the court shall
    15  enjoin him from so practicing unless and until he has been duly
    16  licensed. Procedure in such cases shall be the same as in any
    17  other injunction suit. The remedy by injunction hereby given is
    18  in addition to any other civil or criminal prosecution and
    19  punishment.
    20  Section 39.  Penalties.
    21     (a)  General rule.--Any person, or the responsible officer or
    22  employee of any corporation or partnership, institution or
    23  association, violating any provisions of this act, or any rule
    24  or regulation of the board commits of a misdemeanor of the third
    25  degree and shall, upon conviction, be sentenced to pay a fine of
    26  not more than $2,000 or to imprisonment for not more than six
    27  months, or both, for the first violation. On the second and each
    28  subsequent conviction, he or she shall be sentenced to pay a
    29  fine of not less than $5,000 nor more than $20,000 or to
    30  imprisonment for not less than six months nor more than one
    19850S1158B1608                 - 34 -

     1  year, or both.
     2     (b)  Civil penalties.--In addition to any other civil remedy
     3  or criminal penalty provided for in this act, the board, by a
     4  vote of the majority of the maximum number of the authorized
     5  membership of the board as provided by law, or by a vote of the
     6  majority of the duly qualified and confirmed membership or a
     7  minimum of four members, whichever is greater, may levy a civil
     8  penalty of up to $1,000 on any current licensee who violates any
     9  provision of this act or on any person who practices medicine or
    10  other areas of practice regulated by the board without being
    11  properly licensed or certificated to do so under this act. The
    12  board shall levy this penalty only after affording the accused
    13  party the opportunity for a hearing, as provided in Title 2 of
    14  the Pennsylvania Consolidated Statutes (relating to
    15  administrative law and procedure). The board shall, within six
    16  months after the effective date of this act, adopt guidelines
    17  setting forth the amounts and circumstances for which a fine may
    18  be imposed. No fines may be imposed in accordance with this
    19  subsection until the board has adopted the required guidelines.
    20  Nothing in this subsection shall be construed to give the board
    21  authority to impose a civil penalty upon any person licensed by
    22  another licensing board when acting within the scope of practice
    23  of that profession.
    24  Section 40.  Temporary and automatic suspensions.
    25     (a)  Temporary suspensions.--A license or certificate issued
    26  under this act may be temporarily suspended under circumstances
    27  as determined by the board to be an immediate and clear danger
    28  to the public health and safety. The board shall issue an order
    29  to that effect without a hearing, but upon due notice, to the
    30  licensee or certificate holder concerned at his or her last
    19850S1158B1608                 - 35 -

     1  known address, which shall include a written statement of all
     2  allegations against the licensee or certificate holder. The
     3  provisions of section 9 shall not apply to temporary suspension.
     4  The board shall thereupon commence formal action to suspend,
     5  revoke and restrict the license or certificate of the person
     6  concerned as otherwise provided for in this act. All actions
     7  shall be taken promptly and without delay. Within 30 days
     8  following the issuance of an order temporarily suspending a
     9  license, the board shall conduct or cause to be conducted, a
    10  preliminary hearing to determine that there is a prima facie
    11  case supporting the suspension. The licensee or certificate
    12  holder whose license or certificate has been temporarily
    13  suspended may be present at the preliminary hearing and may be
    14  represented by council, cross-examine witnesses, inspect
    15  physical evidence, call witnesses, offer evidence and testimony
    16  and make a record of the proceedings. If it is determined that
    17  there is not a prima facie case, the suspended license shall be
    18  immediately restored. The temporary suspension shall remain in
    19  effect until vacated by the board, but in no event longer than
    20  180 days.
    21     (b)  Automatic suspensions.--A license or certificate issued
    22  under this act shall automatically be suspended upon the legal
    23  commitment to an institution of a licensee or certificate holder
    24  because of mental incompetency from any cause upon filing with
    25  the board a certified copy of such commitment, conviction of a
    26  felony under the act of April 14, 1972 (P.L.233, No.64), known
    27  as The Controlled Substance, Drug, Device and Cosmetic Act, or
    28  conviction of an offense under the laws of another jurisdiction,
    29  which if committed in this Commonwealth, would be a felony under
    30  The Controlled Substance, Drug, Device and Cosmetic Act. As used
    19850S1158B1608                 - 36 -

     1  in this section the term "conviction" shall include a judgment,
     2  an admission of guilt or a plea of nolo contendere. Automatic
     3  suspension under this subsection shall not be stayed pending any
     4  appeal of a conviction. Restoration of such license or
     5  certificate shall be made as hereinafter provided in the case of
     6  revocation or suspension of such license or certificate.
     7  Section 41.  Reasons for refusal, revocation, suspension or
     8                 other corrective actions against a licensee or
     9                 certificate holder.
    10     The board shall have authority to impose disciplinary or
    11  corrective measures on a practitioner for any or all of the
    12  following reasons:
    13         (1)  Failing to demonstrate the qualifications or
    14     standards for a license, certification or registration
    15     contained in this act, or regulations of the board.
    16         (2)  Making misleading, deceptive, untrue or fraudulent
    17     representations in the practice of the profession or
    18     practicing fraud or deceit, either alone or as a conspirator
    19     in obtaining a license, certification or registration, or in
    20     obtaining admission to a medical college.
    21         (3)  Being convicted of a felony, a misdemeanor relating
    22     to a health profession, or receiving probation without
    23     verdict, disposition in lieu of trial or an accelerated
    24     rehabilitative disposition in the disposition of felony
    25     charges, in the courts of this Commonwealth, a Federal court
    26     or a court of any other state, territory or country.
    27         (4)  Having a license or other authorization to practice
    28     the profession revoked or suspended or having other
    29     disciplinary action taken, or an application for a license or
    30     other authorization refused, revoked or suspended by a proper
    19850S1158B1608                 - 37 -

     1     licensing authority of another state, territory or country,
     2     or a branch of the Federal Government.
     3         (5)  Being unable to practice the profession with
     4     reasonable skill and safety to patients by reason of illness,
     5     addiction to drugs or alcohol, having been convicted of a
     6     felonious act prohibited by the act of April 14, 1972
     7     (P.L.233, No.64), known as The Controlled Substance, Drug,
     8     Device and Cosmetic Act, or convicted of a felony relating to
     9     a controlled substance in a court of law of the United States
    10     or any other state, territory or country, or if he or she is
    11     or shall become mentally incompetent. An applicant's
    12     statement on the application declaring the absence of a
    13     conviction shall be deemed satisfactory evidence of the
    14     absence of a conviction unless the board has some evidence to
    15     the contrary. In enforcing this paragraph, the board shall,
    16     upon probable cause, have authority to compel a practitioner
    17     to submit to a mental or physical examination by physicians
    18     approved by the board. Failure of a practitioner to submit to
    19     such examination when directed by the board, unless such
    20     failure is due to circumstances beyond his or her control,
    21     shall constitute an admission of the allegations against him
    22     or her, consequent upon which a default and final order may
    23     be entered without the taking of testimony or presentation of
    24     evidence. A practitioner affected under this paragraph shall
    25     at reasonable intervals be afforded an opportunity to
    26     demonstrate that he or she can resume a competent practice of
    27     his or her profession with reasonable skill and safety to
    28     patients.
    29         (6)  Violating a lawful regulation promulgated by the
    30     board or violating a lawful order of the board previously
    19850S1158B1608                 - 38 -

     1     entered by the board in a disciplinary proceeding.
     2         (7)  Knowingly maintaining a professional connection or
     3     association with any person who is in violation of this act
     4     or regulations of the board or knowingly aiding, assisting,
     5     procuring or advising any unlicensed person to practice a
     6     profession contrary to this act, or regulations of the board.
     7         (8)  Being guilty of immoral or unprofessional conduct.
     8     Unprofessional conduct shall include departure from or
     9     failing to conform to an ethical or quality standard of the
    10     profession.
    11             (i)  The ethical standards of a profession are those
    12         ethical tenets which are embraced by the professional
    13         community in this Commonwealth.
    14             (ii)  A practitioner departs from, or fails to
    15         conform to, a quality standard of the profession when the
    16         practitioner provides a medical service at a level
    17         beneath the accepted standard of care. The board may
    18         promulgate regulations which define the accepted standard
    19         of care. In the event the board has not promulgated an
    20         applicable regulation, the accepted standard of care for
    21         a practitioner is that which would be normally exercised
    22         by the average professional of the same kind in this
    23         Commonwealth under the circumstances, including locality
    24         and whether the practitioner is or purports to be a
    25         specialist in the area.
    26         (9)  Acting is such manner as to present an immediate and
    27     clear danger to publish health or safety.
    28         (10)  Acting outside the scope of a license or
    29     certificate.
    30  Section 42.  Types of corrective action.
    19850S1158B1608                 - 39 -

     1     (a)  Authorized actions.--When the board is empowered to take
     2  disciplinary or corrective action against a practitioner under
     3  the provisions of this act or pursuant to other statutory
     4  authority, the board may:
     5         (1)  Deny the application for a license, certificate or
     6     any other privilege granted by the board.
     7         (2)  Administer a public reprimand with or without
     8     probation.
     9         (3)  Administer a private reprimand with or without
    10     probation.
    11         (4)  Revoke, suspend, limit or otherwise restrict a
    12     license or certificate.
    13         (5)  Require the professional to submit to the care,
    14     counseling or treatment of a physician or other health care
    15     professional designated by the board.
    16         (6)  Require the professional to take refresher
    17     educational courses.
    18         (7)  Suspend enforcement of any suspension, other than
    19     that imposed in accordance with section 41, or revocation and
    20     place a practitioner on probation with the right to vacate
    21     the probationary order from noncompliance.
    22         (8)  Impose a monetary penalty in accordance with this
    23     act.
    24     (b)  Failure to comply with conditions.--Failure of a
    25  professional to comply with conditions set forth by the board
    26  shall be grounds for reconsideration of the matter and
    27  institution of formal charges against the licensee or
    28  certificate holder.
    29  Section 43.  Reinstatement of license, certificate or
    30                 registration.
    19850S1158B1608                 - 40 -

     1     (A)  IN GENERAL.--Unless ordered to do so by Commonwealth      <--
     2  Court or on appeal therefrom, the board shall not reinstate the
     3  license, certificate or registration of a person to practice
     4  medicine pursuant to this act which has been revoked. Any EXCEPT  <--
     5  AS PROVIDED IN SUBSECTION (B), ANY person whose license,
     6  certificate or registration has been revoked may apply for
     7  reinstatement, after a period of at least five years, but must
     8  meet all of the licensing qualifications of this act for the
     9  license applied for, to include the examination requirement, if
    10  he or she desires to practice at any time after such revocation.
    11     (B)  REINSTATEMENT AFTER FELONY CONVICTION.--ANY PERSON WHOSE  <--
    12  LICENSE, CERTIFICATE OR REGISTRATION HAS BEEN SUSPENDED OR
    13  REVOKED BECAUSE OF A FELONY CONVICTION UNDER THE ACT OF APRIL
    14  14, 1972 (P.L.233, NO.64), KNOWN AS THE CONTROLLED SUBSTANCE,
    15  DRUG, DEVICE AND COSMETIC ACT, OR SIMILAR LAW OF ANOTHER
    16  JURISDICTION, MAY APPLY FOR REINSTATEMENT AFTER A PERIOD OF AT
    17  LEAST TEN YEARS HAS ELAPSED FROM THE DATE OF CONVICTION. THE
    18  BOARD MAY REINSTATE THE LICENSE IF THE BOARD IS SATISFIED THAT
    19  THE PERSON HAS MADE SIGNIFICANT PROGRESS IN PERSONAL
    20  REHABILITATION SINCE THE CONVICTION SUCH THAT HIS REINSTATEMENT
    21  SHOULD NOT BE EXPECTED TO CREATE A SUBSTANTIAL RISK OF HARM TO
    22  THE HEALTH AND SAFETY OF HIS PATIENTS OR THE PUBLIC OR A
    23  SUBSTANTIAL RISK OF FURTHER CRIMINAL VIOLATIONS AND IF THE
    24  PERSON MEETS ALL OTHER LICENSING QUALIFICATIONS OF THIS ACT.
    25  Section 44.  Surrender of suspended or revoked license.
    26     The board shall require a person whose license, certificate
    27  or registration has been suspended or revoked to return, in such
    28  manner as the board directs, the license, certificate or
    29  registration. A person who fails to do so commits a misdemeanor
    30  of the third degree.
    19850S1158B1608                 - 41 -

     1  Section 45.  Reestablishment.
     2     This act, with respect to the State Board of Medical
     3  Education and Licensure, shall constitute the legislation
     4  required to reestablish an agency pursuant to the act of
     5  December 22, 1981 (P.L.508, No.142), known as the Sunset Act.
     6  Section 46.  Severability.
     7     The provisions of this act are severable. If any provision of
     8  this act or its application to any person or circumstance is
     9  held invalid, the invalidity shall not affect other provisions
    10  or applications of this act which can be given effect without
    11  the invalid provision or application.
    12  Section 47.  Repeals.
    13     (a)  Specific repeals.--Section 412 of the act of April 9,
    14  1929 (P.L.177, No.175), know as The Administrative Code of 1929,
    15  is repealed.
    16     The act of July 20, 1974 (P.L.551, No.190), known as the
    17  Medical Practice Act of 1974, is repealed.
    18     (b)  General repeal.--All other acts and parts of acts are
    19  repealed insofar as they are inconsistent with this act.
    20  Section 48.  Applicability of act.
    21     (a)  General rule.--The provisions of this act shall not
    22  apply either directly or indirectly, by intent or purpose, to
    23  affect the practice of:
    24         (1)  Chiropractic, as authorized by the act of August 10,
    25     1951 (P.L.1182, No.264), known as the Chiropractic
    26     Registration Act of 1951.
    27         (2)  Dentistry, as authorized by the act of May 1, 1933
    28     (P.L.216, No.76), known as The Dental Law.
    29         (3)  Optometry, as authorized by the act of June 6, 1980
    30     (P.L.197, No.57), known as the Optometric Practice and
    19850S1158B1608                 - 42 -

     1     Licensure Act.
     2         (4)  Osteopathy, as authorized by the act of October 5,
     3     1978 (P.L.1109, No.261), known as the Osteopathic Medical
     4     Practice Act.
     5         (5)  Pharmacy, as authorized by the acts of April 14,
     6     1972 (P.L.233, No.64), known as The Controlled Substance,
     7     Drug, Device and Cosmetic Act, and September 27, 1961
     8     (P.L.1700, No.699), known as the Pharmacy Act.
     9         (6)  Physical Therapy, as authorized by the act of
    10     October 10, 1975 (P.L.383, No.110), known as the Physical
    11     Therapy Practice Act.
    12         (7)  Podiatry, as authorized by the act of March 2, 1956
    13     (P.L.1206, No.375), known as the Podiatry Act of 1956.
    14         (8)  Professional Nursing, as authorized by the act of
    15     May 22, 1951 (P.L.317, No.69), known as The Professional
    16     Nursing Law.
    17         (9)  Psychologists, as authorized by the act of March 23,
    18     1972 (P.L.136, No.52), referred to as the Psychologists
    19     License Act.
    20     (b)  Exemption.--This act shall not be construed so as to
    21  give the Board of Medicine any jurisdiction over any of the
    22  schools or colleges of the methods exempted in this section.
    23     (c)  No application to practice of hypnosis.--The provisions
    24  of this act shall not apply either directly or indirectly, by
    25  intent or purpose, to the practice of hypnosis.
    26  Section 49.  Existing board.
    27     The presently confirmed members of the State Board of Medical
    28  Education and Licensure constituted under section 412 of the act
    29  of April 9, 1929 (P.L.177, No.175), known as The Administrative
    30  Code of 1929, as of December 31, 1985, shall continue to serve
    19850S1158B1608                 - 43 -

     1  as board members until their present terms of office expire and
     2  a successor has been appointed and qualified, but no longer than
     3  six months after the effective date of this act.
     4  Section 50.  Existing rules and regulations.
     5     Each rule and regulation of the board in effect on December
     6  31, 1985, not inconsistent with this act, shall remain in effect
     7  after such date until repealed or amended by the board. Each fee
     8  of the board in effect on December 31, 1985, and not
     9  inconsistent with this act, shall remain in effect after such
    10  date until repealed or amended by the board or the commissioner.
    11  Section 51.  Existing licenses, certificates and registrations.
    12     Any person who holds a valid license, certificate or
    13  registration issued by the State Board of Medical Education and
    14  Licensure under the act of July 20, 1974 (P.L.551, No.190),
    15  known as the Medical Practice Act of 1974, relating to the
    16  practice of medicine, prior to the effective date of this act
    17  shall, on and after the effective date hereof, be deemed
    18  licensed, certificated or registered by the State Board of
    19  Medicine as provided for in this act.
    20  Section 52.  Effective date.
    21     This act shall take effect January 1, 1986.






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