(1) LEGISLATIVE INTENT.

(a) The purpose of this section is to encourage the more effective utilization of the skills of osteopathic physicians by enabling them to delegate health care tasks to qualified assistants when such delegation is consistent with the health and welfare of patients.

(b) In order that maximum skills may be obtained within a minimum time period of education, the physician assistant shall be specialized to the extent that he can operate efficiently and effectively in the specialty areas in which he has been trained or is experienced.

(c) This section is established to encourage the utilization of physician assistants by osteopathic physicians and to allow for innovative development of programs for the education of physician assistants.

(2) DEFINITIONS. As used in this section:

(a) "Agency" means the Agency for Health Care Administration.

(b) "Approved program" means a program for the education of physician assistants which has been formally approved by the boards.

(c) "Boards" means the Board of Medicine and the Board of Osteopathic Medicine.

(d) "Council" means the Council on Physician Assistants.

(e) "Trainee" means a person who is currently enrolled in an approved program.

(f) "Physician assistant" means a person who is a graduate of an approved program or its equivalent or meets standards approved by the boards and is certified to perform medical services delegated by the supervising osteopathic physician.

(g) "Supervision" means responsible supervision and control. Except in cases of emergency, supervision requires the easy availability or physical presence of the licensed osteopathic physician for consultation and direction of the actions of the physician assistant. For the purposes of this definition, the term "easy availability" includes the ability to communicate by way of telecommunication by means and under circumstances approved by the boards by rule. The boards shall further establish rules as to what constitutes reasonable supervision of the physician assistant.

(h) "Proficiency examination" means an entry-level examination approved by the boards, including, but not limited to, those examinations administered by the National Commission on Certification of Physician Assistants.

(i) "Continuing medical education" means courses recognized and approved by the boards, the American Academy of Physician Assistants, the American Medical Association, the American Osteopathic Association, or the Accreditation Council on Continuing Medical Education.

(3) PERFORMANCE OF SUPERVISING OSTEOPATHIC PHYSICIAN. Every osteopathic physician or group of osteopathic physicians who supervise certified physician assistants must be qualified in the medical areas in which the physician assistant is to perform and shall be individually or collectively responsible and liable for the performance and the acts and omissions of the physician assistant. An osteopathic physician may not supervise more than four currently certified physician assistants at any one time.

(4) PERFORMANCE OF PHYSICIAN ASSISTANTS.

(a) The boards shall adopt, by rule, the general principles osteopathic supervising physicians shall use in developing the scope of practice of a physician assistant under both direct and indirect supervision. These principles shall recognize the diversity of both specialty and practice settings in which physician assistants are utilized.

(b) This chapter does not prevent third-party payors from reimbursing employers of physician assistants for services rendered by certified physician assistants.

(c) Certified physician assistants may not be denied clinical hospital privileges, except for cause, so long as the supervising physician is a staff member in good standing.

(d) A supervisory osteopathic physician may delegate to a certified physician assistant, pursuant to a written protocol, the authority to act according to s. 154.04(1)(d). Such delegated authority is limited to the supervising osteopathic physician's practice in connection with a county public health unit as defined and established pursuant to chapter 154. The boards shall adopt rules governing the supervision of physician assistants by osteopathic physicians in county public health units.

(e) A supervisory osteopathic physician may delegate to a fully certified physician assistant the authority to prescribe any medication used in the supervisory osteopathic physician's practice, if such medication is listed on the formulary created pursuant to s. 458.347. A fully certified physician assistant may only prescribe such medication under the following circumstances: 1. A physician assistant must clearly identify to the patient that he is a physician assistant. Furthermore, the physician assistant must inform the patient that the patient has the right to see the osteopathic physician prior to any prescription being prescribed by the physician assistant. 2. The supervisory osteopathic physician must notify the agency of his intent to delegate, on an agency-approved form, before delegating such authority and with each certification renewal application filed by the physician assistant. 3. The physician assistant must file with the agency, before commencing to prescribe, evidence that he has completed a continuing medical education course of at least 3 classroom hours in prescriptive practice, conducted by an accredited program approved by the boards, which course covers the limitations, responsibilities, and privileges involved in prescribing medicinal drugs or evidence that he has received education comparable to the continuing education course as part of an accredited physician assistant training program. Evidence of having completed an additional 3-hour continuing education course, or having received comparable education, during the certificate period must be submitted by a physician assistant with each certification renewal application. 4. The physician assistant must file with the [Footnote 1] agency, before commencing to prescribe, evidence that the physician assistant has a minimum of 3 months of clinical experience in the specialty area of the supervising osteopathic physician. 5. The physician assistant must file with the agency evidence that he has completed a minimum of 10 continuing medical education hours in the specialty practice in which the physician assistant has prescriptive privileges with each certification renewal application. 6. The agency shall issue certification and a prescriber number to the physician assistant granting authority for the prescribing of medicinal drugs authorized within this paragraph upon completion of the foregoing requirements. 7. The prescription must be written in a form that complies with chapter 499 and must contain, in addition to the supervisory osteopathic physician's name, address, and telephone number, the physician assistant's prescriber number. The prescription must be filled in a pharmacy permitted under chapter 465, and must be dispensed in that pharmacy by a pharmacist licensed under chapter 465. The appearance of the prescriber number creates a presumption that the physician assistant is authorized to prescribe the medicinal drug and the prescription is valid. 8. The physician assistant must note the prescription in the appropriate medical record, and the supervisory osteopathic physician must review and sign each notation. For dispensing purposes only, the failure of the supervisory osteopathic physician to comply with these requirements does not affect the validity of the prescription. 9. This paragraph does not prohibit a supervisory osteopathic physician from delegating to a physician assistant the authority to order medication for a hospitalized patient of the supervisory osteopathic physician. The boards shall adopt the formulary required by s. 458.347 by rule. Notwithstanding any provision of chapter 120 to the contrary, the formulary rule shall be effective 60 days after the date it is filed with the Secretary of State. Upon adoption of the formulary required by s. 458.347, and upon each addition, deletion, or modification to the formulary by the committee, the agency shall mail a copy of such formulary to each fully certified physician assistant licensed pursuant to this chapter. The boards shall establish, by rule, a fee not to exceed $200 to fund the provisions of this paragraph. This paragraph does not apply to facilities licensed pursuant to chapter 395.

(5) PERFORMANCE BY TRAINEES. Notwithstanding any other law, a trainee may perform medical services when such services are rendered within the scope of an approved program.

(6) PROGRAM APPROVAL.

(a) The boards shall approve programs for the education and training of physician assistants which meet standards established by rule of the boards.

(b) The boards shall adopt and publish standards to ensure that such programs operate in a manner that does not endanger the health and welfare of the patients who receive services within the scope of the program. The council shall review the quality of the curricula, faculties, and facilities of such programs and take whatever other action is necessary to determine that the purposes of this section are being met.

(7) PHYSICIAN ASSISTANT CERTIFICATION.

(a) Any person desiring to be certified in this state as a physician assistant shall apply to the agency. The agency shall issue a certificate to any person whom one of the boards certifies has met the following requirements: 1. Is at least 18 years of age. 2. Has satisfactorily passed a proficiency examination by an acceptable score established by the National Commission on Certification of Physician Assistants. 3. Has completed the application form and remitted an application fee not to exceed $250 as set by the boards. An application for certification made by a physician assistant must include: a. A certificate of completion of an approved physician assistant training program. b. A sworn statement of any prior felony convictions. c. A sworn statement of any previous revocation or denial of licensure or certification in any state. d. Two letters of recommendation.

(b) The certification must be renewed biennially. Each renewal must include: 1. A renewal fee not to exceed $250 as set by the boards. 2. A sworn statement of no felony convictions in the previous 2 years.

(c) Each certified physician assistant shall biennially complete 100 hours of continuing medical education or shall hold a current certificate issued by the National Commission on Certification of Physician Assistants.

(d) Upon employment as a physician assistant, any certified physician assistant must notify the agency in writing within 30 days after such employment or after any subsequent changes in the supervising osteopathic physician. The notification must include the full name, Florida medical license number, specialty, and address of the supervising osteopathic physician.

(e) The board may impose any of the penalties specified in ss. 455.227 and 459.015(2) upon a physician assistant if the physician assistant or the supervising osteopathic physician is found guilty or is being investigated for any act that constitutes a violation of this chapter.

(f) Notwithstanding subparagraph (a)2., the boards may grant temporary certification to a recent graduate of an approved program to expire upon receipt of scores of the proficiency examination administered by the National Commission on Certification of Physician Assistants. Between meetings of the council, the agency may grant temporary certification to practice to physician assistant applicants based on the completion of all temporary certification requirements. All such issued certifications shall be reviewed and acted on at the next regular meeting of the council and one of the boards. The recent graduate may be certified prior to employment but must comply with paragraph (d). An applicant who has passed the proficiency examination may be granted permanent certification. An applicant failing the proficiency examination is no longer temporarily certified but may reapply for a 1-year extension of temporary certification. An applicant may not be granted more than two temporary certificates and may not be certified as a physician assistant until he passes the examination administered by the National Commission on Certification of Physician Assistants. As prescribed by board rule, the boards may require an applicant who does not pass the licensing examination after five or more attempts to complete additional remedial education or training. The boards shall prescribe the additional requirements in a manner that permits the applicant to complete the requirements and be reexamined within 2 years after the date the applicant petitions the boards to retake the examination a sixth or subsequent time.

(8) COUNCIL ON PHYSICIAN ASSISTANTS. The Council on Physician Assistants is created within the Agency for Health Care Administration.

(a) The council shall consist of five members appointed as follows: 1. The chairperson of the Board of Medicine shall appoint three members who are physicians and members of the Board of Medicine. One of the physicians must supervise a physician assistant in the physician's practice. 2. The chairperson of the Board of Osteopathic Medicine shall appoint one member who is a physician, supervises a physician assistant in the physician's practice, and is a member of the Board of Osteopathic Medicine. 3. The head of the agency or his designee shall appoint a fully certified physician assistant licensed under chapter 458 or this chapter.

(b) Two of the members appointed to the council must be physicians who supervise physician assistants in their practice. Members shall be appointed to terms of 4 years, except that of the initial appointments, two members shall be appointed to terms of 2 years, two members shall be appointed to terms of 3 years, and one member shall be appointed to a term of 4 years, as established by rule of the boards. Council members may not serve more than two consecutive terms. The council shall annually elect a chairperson from among its members.

(c) The council shall: 1. Recommend to the agency the certification of physician assistants. 2. Develop rules regulating the use of physician assistants by physicians under chapter 458 and this chapter, except for rules relating to the formulary developed under s. 458.347(4)(f). The council shall also develop rules to ensure the continuity of supervision is maintained in each practice setting. The boards shall consider adopting a proposed rule developed by the council at the regularly scheduled meeting immediately following the submission of the proposed rule by the council. A proposed rule submitted by the council may not be adopted by either board unless both boards have accepted and approved the identical language contained in the proposed rule. The language of all proposed rules submitted by the council must be approved by both boards pursuant to each respective board's guidelines and standards regarding the adoption of proposed rules. If either board rejects the council's proposed rule, that board must specify its objection to the council with particularity and include any recommendations it may have for the modification of the proposed rule. 3. Make recommendations to the boards regarding all matters relating to physician assistants. 4. Address concerns and problems of practicing physician assistants in order to improve safety in the clinical practices of certified physician assistants.

(9) PENALTY. Any person who has not been certified by the boards and approved by the agency and who holds himself out as a physician assistant or who uses any other term in indicating or implying that he is a physician assistant commits a felony of the third degree, punishable as provided in s. 775.082 or s. 775.084 or by a fine not exceeding $5,000.

(10) DENIAL, SUSPENSION, OR REVOCATION OF CERTIFICATION. The boards may deny, suspend, or revoke a physician assistant certification if a board determines that the physician assistant has violated this chapter.

(11) RULES. The boards shall adopt rules necessary for the administration of the physician assistant process. Further, the boards shall adopt rules detailing the contents of the application for certification and notification pursuant to subsection (7). The boards shall adopt rules to ensure both the continued competency of physician assistants and the proper utilization of them by osteopathic physicians or groups of physicians.

(12) EXISTING PROGRAMS. This section does not eliminate or supersede existing laws relating to other paramedical professions or services. It is the intent of this section to supplement, and be in addition to, all such existing programs relating to the certification and practice of paramedical professions, as authorized by law.

(13) LIABILITY. All osteopathic physicians or physician groups utilizing physician assistants are liable for any acts or omissions of physician assistants acting under their supervision and control.

(14) LEGAL SERVICES. The Department of Legal Affairs shall provide legal services to the council as authorized in s. 455.221(1).