Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 27 Second Substitute (2021GS)

Sponsor

Sen. Bramble, C.

Final action

Governor Signed 3/17/2021

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• amends the scope of practice for a physician assistant;
• removes the requirement that a physician assistant maintain a specific relationship with a physician or any other health care provider;
• enacts and amends provisions relating to practice as a physician assistant;
• creates requirements for newly graduated physician assistants;
• permits a physician assistant to respond during a health care emergency or disaster; and
• makes technical and corresponding changes.

Every vote on this bill

Bill text

PHYSICIAN ASSISTANT ACT AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Curtis S. Bramble
House Sponsor: 
James A. Dunnigan
LONG TITLE
General Description:
This bill amends provisions relating to the practice of a physician assistant.
Highlighted Provisions:
This bill:
▸ amends the scope of practice for a physician assistant;
▸ removes the requirement that a physician assistant maintain a specific relationship
with a physician or any other health care provider;
▸ enacts and amends provisions relating to practice as a physician assistant;
▸ creates requirements for newly graduated physician assistants;
▸ permits a physician assistant to respond during a health care emergency or disaster;
and
▸ makes technical and corresponding changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
58-70a-102
, as last amended by Laws of Utah 2017, Chapter 309
58-70a-201
, as last amended by Laws of Utah 2010, Chapter 37
58-70a-302
, as last amended by Laws of Utah 2020, Chapter 339
58-70a-305
, as last amended by Laws of Utah 2019, Chapter 349
58-70a-306
, as last amended by Laws of Utah 2020, Chapter 339
58-70a-501
, as last amended by Laws of Utah 2017, Chapter 309
58-70a-502
, as last amended by Laws of Utah 2014, Chapter 72
58-70a-503
, as last amended by Laws of Utah 2020, Chapter 25
ENACTS:
58-70a-307
, Utah Code Annotated 1953
58-70a-507
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
58-70a-102
 is amended to read:
58-70a-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) "Board" means the Physician Assistant Licensing Board created in Section
58-70a-201
.
[
(2) (a) "Delegation of services agreement" means written criteria jointly developed by
a physician assistant's supervising physician and substitute supervising physicians and the
physician assistant, that permits a physician assistant, working under the direction or review of
the supervising physician, to assist in the management of common illnesses and injuries.
]
[
(b) The agreement defines the working relationship and delegation of duties between
the supervising physician and the physician assistant as specified by division rule and shall
include:
]
[
(i) the prescribing of controlled substances;
]
[
(ii) the degree and means of supervision;
]
[
(iii) the frequency and mechanism of quality review, including the mechanism for
review of patient data and documentation of the review, as determined by the supervising
physician and the physician assistant;
]
[
(iv) procedures addressing situations outside the scope of practice of the physician
assistant; and
]
[
(v) procedures for providing backup for the physician assistant in emergency
situations.
]
[
(3) "Direct supervision" means the supervising physician is:
]
[
(a) physically present at the point of patient treatment on site where the physician
assistant he is supervising is practicing; and
]
[
(b) immediately available for consultation with the physician assistant.
]
(2) "Competence" means possessing the requisite cognitive, non-cognitive, and
communicative abilities and qualities to perform effectively within the scope of practice of the
physician assistant's practice while adhering to professional and ethical standards.
(3) "Health care facility" means the same as that term is defined in Section 
26-21-2
.
(4) "Physician" means the same as that term is defined in Section 
58-67-102
.
(5) "Physician assistant" means an individual who is licensed to practice under this
chapter.
[
(4)
] 
(6)
 "Practice as a physician assistant" means[
:(a) 
] the professional activities and
conduct of a physician assistant, also known as a PA, in diagnosing, treating, advising, or
prescribing for any human disease, ailment, injury, infirmity, deformity, pain, or other
condition[
, dependent upon and under the supervision of a supervising physician or substitute
supervising physician in accordance with a delegation of services agreement; and
] 
under the
provisions of this chapter.
[
(b) the physician assistant acts as the agent of the supervising physician or substitute
supervising physician when acting in accordance with a delegation of services agreement.
]
[
(5) "Substitute supervising physician" means an individual who meets the
requirements of a supervising physician under this chapter and acts as the supervising physician
in the absence of the supervising physician.
]
[
(6) "Supervising physician" means an individual who:
]
[
(a) is currently licensed to practice under Title 58, Chapter 67, Utah Medical Practice
Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
]
[
(b) acts as the primary supervisor of a physician assistant and takes responsibility for
the professional practice and conduct of a physician assistant in accordance with this chapter;
and
]
[
(c) is not an employee of the physician assistant whom the individual supervises.
]
[
(7) "Supervision" means the supervising physician is available for consultation with
the physician assistant, either personally or by other means permitting direct verbal
communication between the physician and the physician assistant.
]
[
(8)
] 
(7)
 "Unlawful conduct" 
means the same as that term
 is [
as
] defined in Sections
58-1-501
 and 
58-70a-502
.
[
(9)
] 
(8)
 "Unprofessional conduct" [
is
] 
means "unprofessional conduct":
(a)
 as defined in Sections 
58-1-501
 and 
58-70a-503
;
 and [
as may be further defined by
rule.
]
(b) as further defined by the division by rule.
Section 2. Section 
58-70a-201
 is amended to read:
58-70a-201.
Board.
(1) There is created the Physician Assistant Licensing Board, which consists of seven
members:
(a) three licensed physicians[
, at least two of whom are individuals who are supervising
or who have supervised a physician assistant
] 
who currently work or have previously worked
collaboratively with a physician assistant
;
(b) three physician assistants, one of whom is involved in the administration of an
approved physician assistant education program within the state; and
(c) one person from the general public.
(2) The board shall be appointed and serve in accordance with Section 
58-1-201
.
(3) 
(a)
 The duties and responsibilities of the board are in accordance with Sections
58-1-202
 and 
58-1-203
. [
In addition, the
]
(b) The
 board shall designate one of its members on a permanent or rotating basis to:
[
(a)
] 
(i)
 assist the division in reviewing complaints concerning the unlawful or
unprofessional conduct of a licensee; and
[
(b)
] 
(ii)
 advise the division in [
its
] 
the division's
 investigation of these complaints.
(4) 
(a)
 A board member who has, under Subsection (3), reviewed a complaint or
advised in its investigation may be disqualified from participating with the board when the
board serves as a presiding officer in an adjudicative proceeding concerning the complaint.
(b)
 The board member 
described in Subsection (4)(a)
 may be disqualified:
[
(a)
] 
(i)
 on the member's own motion, due to actual or perceived bias or lack of
objectivity; or
[
(b)
] 
(ii)
 upon challenge for cause raised on the record by any party to the adjudicative
proceeding.
Section 3. Section 
58-70a-302
 is amended to read:
58-70a-302.
Qualifications for licensure.
Each applicant for licensure as a physician assistant shall:
(1) submit an application in a form prescribed by the division;
(2) pay a fee determined by the department under Section 
63J-1-504
;
(3) have successfully completed a physician assistant program accredited by [
the
]:
(a) 
the
 Accreditation Review Commission on Education for the Physician Assistant; or
(b) if prior to January 1, 2001, either the:
(i) Committee on Accreditation of Allied Health Education Programs; or
(ii) Committee on Allied Health Education and Accreditation;
(4) have passed the licensing examinations required by division rule made in
collaboration with the board; 
and
(5) meet with the board and representatives of the division, if requested, for the
purpose of evaluating the applicant's qualifications for licensure[
; and
]
.
[
(6) (a) if the applicant desires to practice in Utah, complete a form provided by the
division indicating:
]
[
(i) the applicant has completed a delegation of services agreement signed by the
physician assistant and the supervising physician; and
]
[
(ii) the agreement is on file at the Utah practice sites; or
]
[
(b) complete a form provided by the division indicating the applicant is not practicing
in Utah and, prior to practicing in Utah, the applicant will meet the requirements of Subsection
(6)(a).
]
Section 4. Section 
58-70a-305
 is amended to read:
58-70a-305.
Exemptions from licensure.
(1)
 In addition to the exemptions from licensure in Section 
58-1-307
,[
 the following
persons
] 
an individual described in Subsection (2)
 may engage in acts included within the
definition of practice as a physician assistant, subject to the stated circumstances and
limitations, without being licensed under this chapter[
:
]
.
[
(1)
] 
(2) Subsection (1) applies to
 a student enrolled in an accredited physician
assistant education program while engaged in activities as a physician assistant:
(a) that are a part of the education program;
(b) that are conducted at an affiliated medical facility under the direct supervision of a:
(i) physician associated with the program; or
(ii) licensed physician assistant associated with the medical faculty; 
and
(c) for which the program accepts in writing the responsibility for the student[
; and
]
.
[
(2) a "medical assistant," as defined in Sections 
58-67-102
 and 
58-68-102
, who:
]
[
(a) does not diagnose, advise, independently treat, or prescribe to or on behalf of any
person; and
]
[
(b) for whom the supervising physician accepts responsibility.
]
Section 5. Section 
58-70a-306
 is amended to read:
58-70a-306.
Temporary license.
(1) An applicant for licensure as a physician assistant who has met all qualifications for
licensure except passing an examination component as required in Section 
58-70a-302
, may
apply for and be granted a temporary license to practice under Subsection (2).
(2) (a) The applicant shall submit to the division evidence of completion of a physician
assistant program as defined in Subsection 
58-70a-302
(3).
(b) (i) The temporary license shall be issued for a period not to exceed 120 days to
allow the applicant to pass the Physician Assistant National Certifying Examination.
(ii) The temporary license may not be renewed or extended.
[
(c) A physician assistant holding a temporary license may work only under the direct
supervision of an approved supervising or substitute supervising physician in accordance with
a delegation of services agreement, and all patient charts shall be reviewed and countersigned
by the supervising or substitute supervising physician.
]
(c) A temporary license holder shall work under the direct supervision of a physician.
Section 6. Section 
58-70a-307
 is enacted to read:
 58-70a-307.
Collaboration requirements -- Clinical practice experience --
Requirements for independent practice in a new specialty.
(1) As used in this section, "collaboration" means the interaction and relationship that a
physician assistant has with one or more physicians in which:
(a) the physician assistant and physician are cognizant of the physician assistant's
qualifications and limitations in caring for patients;
(b) the physician assistant, while responsible for care that the physician assistant
provides, consults with the physician or physicians regarding patient care; and
(c) the physician or physicians give direction and guidance to the physician assistant.
(2) A physician assistant with less than 10,000 hours of post-graduate clinical practice
experience shall:
(a) practice under written policies and procedures established at a practice level that:
(i) describe how collaboration will occur in accordance with this section and
Subsections 
58-70a-501
(2) and (3);
(ii) describe methods for evaluating the physician assistant's competency, knowledge,
and skills;
(b) provide a copy of the written policies and procedures and documentation of
compliance with this Subsection (2) to the board upon the board's request; and
(c) engage in collaboration with a physician for the first 4,000 hours of the physician
assistant's post-graduate clinical practice experience.
(3) (a) A physician assistant who has more than 4,000 hours of practice experience and
less than 10,000 hours of practice experience shall enter into a written collaborative agreement
with:
(i) a physician; or
(ii) a licensed physician assistant with more than 10,000 hours of practice experience in
the same specialty as the physician assistant.
(b) The collaborative agreement described in Subsection (3)(a) shall:
(i) describe how collaboration under this section and Subsections 
58-70a-501
(2) and
(3) will occur;
(ii) be kept on file at the physician assistant's practice location; and
(iii) be provided by the physician assistant to the board upon the board's request.
(4) A physician assistant who wishes to change specialties to another specialty in
which the PA has less than 4,000 hours of experience shall engage in collaboration for a
minimum of 4,000 hours with a physician who is trained and experienced in the specialty to
which the physician assistant is changing.
Section 7. Section 
58-70a-501
 is amended to read:
58-70a-501.
Scope of practice.
(1) A physician assistant may provide any medical services that are not specifically
prohibited under this chapter or rules adopted under this chapter, and that are[
:(a) 
] within the
physician assistant's skills and scope of competence[
;
]
.
[
(b) within the usual scope of practice of the physician assistant's supervising
physician; and
]
[
(c) provided under the supervision of a supervising physician and in accordance with a
delegation of services agreement.
]
(2) A physician assistant shall consult, collaborate with, and refer to appropriate
members of the health care team:
(a) as indicated by the patient's condition;
(b) based on the physician assistant's education, experience, and competencies;
(c) the applicable standard of care; and
(d) if applicable, in accordance with the requirements described in Section 
58-70a-307
.
(3) Subject to Section 
58-70a-307
, the degree of collaboration under Subsection (2):
(a) shall be determined at the physician assistant's practice, including decisions made
by the physician assistant's:
(i) employer;
(ii) group;
(iii) hospital service; or
(iv) health care facility credentialing and privileging system; and
(b) may also be determined by a managed care organization with whom the physician
assistant is a network provider.
(4) A physician assistant may only provide healthcare services:
(a) for which the physician assistant has been trained and credentialed, privileged, or
authorized to perform; and
(b) that are within the physician assistant's practice specialty.
(5) A physician assistant may authenticate through a signature, certification, stamp,
verification, affidavit, or endorsement any document that may be authenticated by a physician
and that is within the physician assistant's scope of practice.
(6) A physician assistant is responsible for the care that the physician assistant
provides.
(7) (a) As used in this Subsection (7):
(i) "ALS/ACLS certification" means a certification:
(A) in advanced life support by the American Red Cross;
(B) in advanced cardiac life support by the American Heart Association; or
(C) that is equivalent to a certification described in Subsection (7)(a)(i)(A) or (B).
(ii) "Minimal sedation anxiolysis" means creating a drug induced state:
(A) during which a patient responds normally to verbal commands;
(B) which may impair cognitive function and physical coordination; and
(C) which does not affect airway, reflexes, or ventilatory and cardiovascular function.
(b) Except as provided in Subsections (c) through (e), a physician assistant may not
administer general anesthetics.
(c) A physician assistant may perform minimal sedation anxiolysis if the procedure is
within the physician assistant's scope of practice.
(d) A physician assistant may perform rapid sequence induction for intubation of a
patient if:
(i) the procedure is within the physician assistant's scope of practice;
(ii) the physician assistant holds a valid ALS/ACLS certification and is credentialed
and privileged at the hospital where the procedure is performed; and
(iii) (A) a qualified physician is not available and able to perform the procedure; or
(B) the procedure is performed by the physician assistant under supervision of or
delegation by a physician.
(e) Subsection (7)(b) does not apply to anesthetics administered by a physician
assistant:
(i) in an intensive care unit of a hospital;
(ii) for the purpose of enabling a patient to tolerate ventilator support or intubation; and
(iii) under supervision of or delegation by a physician whose usual scope of practice
includes the procedure.
[
(2)
] 
(8) (a)
 A physician assistant[
, in accordance with a delegation of services
agreement,
] may prescribe or administer an appropriate controlled substance 
that is within the
physician assistant's scope of practice
 if[
: (a) 
] the physician assistant holds a Utah controlled
substance license and a DEA registration[
; and
]
.
[
(b) the prescription or administration of the controlled substance is within the
prescriptive practice of the supervising physician and also within the delegated prescribing
stated in the delegation of services agreement.
]
(b) A physician assistant may prescribe, order, administer, and procure a drug or
medical device that is within the physician assistant's scope of practice.
(c) A physician assistant may dispense a drug if dispensing the drug:
(i) is permitted under Title 58, Chapter 17b, Pharmacy Practice Act; and
(ii) is within the physician assistant's scope of practice.
(9) A physician assistant practicing independently may only perform or provide a
health care service that:
(a) is appropriate to perform or provide outside of a health care facility; and
(b) the physician assistant has been trained and credentialed or authorized to provide or
perform independently without physician supervision.
[
(3)
] 
(10)
 A physician assistant [
shall
], while practicing as a physician assistant[
,
]
:
(a) shall
 wear an identification badge showing the physician assistant's license
classification as a physician assistant[
.
]
;
[
(4) A physician assistant may not:
]
[
(a) independently charge or bill a patient, or others on behalf of the patient, for
services rendered;
]
[
(b) identify himself or herself
]
(b) shall identify themselves to a patient as a physician assistant; and
(c) may not identify themselves
 to any person in connection with activities allowed
under this chapter other than as a physician assistant[
;
] or 
PA.
[
(c) use the title "doctor" or "physician," or by any knowing act or omission lead or
permit anyone to believe the physician assistant is a physician.
]
Section 8. Section 
58-70a-502
 is amended to read:
58-70a-502.
Unlawful conduct.
[
"Unlawful conduct" includes engaging in practice as a licensed physician assistant
while not under the supervision of a supervising physician or substitute supervising physician.
]
Reserved.
Section 9. Section 
58-70a-503
 is amended to read:
58-70a-503.
Unprofessional conduct.
(1) "Unprofessional conduct" includes:
(a) violation of a patient confidence to any person who does not have a legal right and a
professional need to know the information concerning the patient;
(b) knowingly prescribing, selling, giving away, or directly or indirectly administering,
or offering to prescribe, sell, furnish, give away, or administer any prescription drug except for
a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
prescribed or provided;
(c) prescribing prescription drugs for oneself or administering prescription drugs to
oneself, except those that have been legally prescribed for the physician assistant by a licensed
practitioner and that are used in accordance with the prescription order for the condition
diagnosed;
[
(d) failure to maintain at the practice site a delegation of services agreement that
accurately reflects current practices;
]
[
(e) failure to make the delegation of services agreement available to the division for
review upon request;
]
[
(f)
] 
(d)
 in a practice that has physician assistant ownership interests, failure to allow
[
the supervising
] 
a
 physician the independent final decision making authority on [
patient
]
treatment decisions[
, as set forth in the delegation of services agreement or as defined by rule
]
for the physician's patient
;
[
(g)
] 
(e)
 violating the dispensing requirements of Chapter 17b, Part 8, Dispensing
Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable; [
or
]
and
[
(h)
] 
(f)
 falsely making an entry in, or altering, a medical record with the intent to
conceal:
(i) a wrongful or negligent act or omission of an individual licensed under this chapter
or an individual under the direction or control of an individual licensed under this chapter; or
(ii) conduct described in Subsections (1)(a) through [
(g)
] 
(e)
 or Subsection
58-1-501
(1).
(2) 
(a)
 "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, as that term
is defined in Section 
26-61a-102
, recommending the use of medical cannabis.
[
(3)
] 
(b)
 Notwithstanding Subsection (2)
(a)
, the division, in consultation with the board
and in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall
define unprofessional conduct for a physician assistant described in Subsection (2)
(a)
.
Section 10. Section 
58-70a-507
 is enacted to read:
 58-70a-507.
Volunteer health care services.
(1) A physician assistant may provide health care services as a volunteer for a
charitable organization or at a public or private event, including a religious event, youth camp,
community event, or health fair, if the physician assistant:
(a) receives no compensation for such services; and
(b) provides the health care services in a manner that is consistent with the physician
assistant's education, experience, and scope of practice.
(2) Notwithstanding Subsection 
58-70a-501
(8), a physician assistant who is providing
volunteer health services under this section may not issue a prescription to a patient for a
controlled substance.