LRB-2237/1
MED:jld:rs
2013 - 2014 LEGISLATURE
February 7, 2014 - Introduced by Representative Severson, cosponsored by
Senator Vukmir. Referred to Committee on Health.
AB742,1,11
1An Act to repeal 448.04 (1) (b) 2., 448.04 (1) (c), 448.065, 448.10 (1), (4) and (5),
2448.10 (2m) and 448.10 (3m);
to renumber 448.10 (1m);
to amend 440.08 (2)
3(a) (intro.), 448.02 (1), 448.02 (3) (a), 448.02 (3) (b), 448.02 (3) (c), 448.02 (3) (e),
4448.02 (3) (h), 448.02 (4) (a), 448.02 (4) (b), 448.02 (5), 448.02 (6), 448.02 (8) (a),
5448.02 (8) (b), 448.02 (8) (c), 448.05 (1) (c), 448.05 (1) (d), 448.05 (6) (a), 448.06
6(title), 448.06 (1), 448.06 (1), 448.07 (1) (d), 448.08 (1) (a), 448.08 (1) (a) and
7462.01 (4);
to repeal and recreate 448.05 (2); and
to create 448.04 (1) (ac),
8448.04 (1) (bg) and (bm), 448.05 (2c), 448.05 (6) (at), 448.063 and 448.10 (1m),
9(2m) and (3m) of the statutes;
relating to: licensure of physicians; providing
10an exemption from emergency rule procedures; and granting rule-making
11authority.
Analysis by the Legislative Reference Bureau
Under current law, physicians are licensed under the authority of the Medical
Examining Board (MEB), a credentialing board attached to the Department of
Safety and Professional Services. A physician's credential to practice is known as a
license to practice medicine and surgery. This bill makes various changes regarding
the licenses to practice medicine and surgery and related credentials issued by the
MEB. Significant changes in the bill are described as follows:
Regular licenses to practice medicine and surgery
Current law
Current law provides that an applicant for any class of license to practice
medicine and surgery must supply evidence satisfactory to the MEB that the
applicant is a graduate of and possesses a diploma from a medical or osteopathic
college approved by the MEB and has completed postgraduate training of 12 months
in a facility approved by the MEB. Current law also contains provisions for issuing
licenses to practice medicine and surgery to graduates of foreign medical schools that
are not approved by the MEB. Such a graduate of a foreign medical school may be
admitted to examination for a license to practice medicine and surgery if he or she
satisfies certain requirements.
The bill — licensure of accredited medical and osteopathic college
graduates
The bill repeals the provisions described above and replaces them with the
following requirements that an applicant other than a graduate of a foreign medical
college must satisfy in order to be eligible for a regular license to practice medicine
and surgery:
1. That the applicant is a graduate of and possesses a diploma from a medical
or osteopathic college that is accredited by the Liaison Committee on Medical
Education, the American Osteopathic Association, or a successor organization and
that is approved by the MEB.
2. That the applicant either: a) has successfully completed and received credit
for 24 months of postgraduate training in one or more programs accredited by the
Accreditation Council for Graduate Medical Education, the American Osteopathic
Association, or a successor organization; or b) be currently enrolled in a postgraduate
training program accredited by the Accreditation Council for Graduate Medical
Education, the American Osteopathic Association, or a successor organization; has
successfully completed and received credit for 12 consecutive months of
postgraduate training in that program; and has received an unrestricted
endorsement from the postgraduate training program director that includes
confirmation that the applicant is expected to continue in the program and complete
at least 24 months of postgraduate training.
3. That the applicant satisfies any other requirement established by the MEB
by rule.
The bill — licensure of graduates of foreign medical colleges
The bill repeals the provisions described above and replaces them with the
following requirements that an applicant who is a graduate of a foreign medical
college must satisfy in order to be eligible for a regular license to practice medicine
and surgery:
1. That the applicant be a graduate of and possess a diploma from a foreign
medical college credentialed by an agency approved by the MEB.
2. That the applicant has obtained certification by the Educational Council for
Foreign Medical Graduates or a successor organization.
3. That the applicant has passed all steps of the United States Medical
Licensing Examination administered by the National Board of Medical Examiners
and the Federation of State Medical Boards, or their successor organizations.
4. That the applicant has successfully completed and received credit for 24
months of postgraduate training in one or more programs accredited by the
Accreditation Council for Graduate Medical Education or the American Osteopathic
Association or a successor organization, the last 12 months of which were completed
in a single program.
5. That the applicant satisfies any other requirement established by the MEB
by rule for issuing the license.
The bill — exceptions
The bill allows the MEB to promulgate rules specifying circumstances in which
the MEB, in cases of hardship or in cases in which the applicant possesses a medical
license issued by another jurisdiction, may grant a waiver from any requirement
described above for a regular license to practice medicine and surgery. The MEB may
grant such a waiver only in accordance with those rules.
The bill also grandfathers existing holders of a regular license to practice
medicine and surgery so that they may retain and continue to renew their licenses
notwithstanding the requirements in the bill described above.
Credentials for medical residents
Current law — temporary educational permits
Under current law, the MEB may grant a temporary educational permit to
practice medicine and surgery (TEP) to a person who meets the requirements for a
license to practice medicine and surgery, other than required examinations. A TEP
may be issued for a period not to exceed one year and may be renewed annually for
not more than four years. A TEP permits the holder to take postgraduate
educational training in a facility approved by the MEB, and the holder of a TEP may,
under the direction of a licensed physician, perform services requisite to that
training, but must confine training and practice to the facility in which the holder
is taking the training.
The bill — resident educational licenses
The bill repeals the provisions for granting a TEP and replaces them with
provisions allowing the MEB to grant a resident educational license (REL). An
applicant must, under the bill, satisfy the following requirements in order to be
granted an REL:
1. Provide proof that he or she has been accepted into a postgraduate training
program accredited by the Accreditation Council for Graduate Medical Education,
the American Osteopathic Association, or a successor organization.
2. Provide written confirmation from the institution sponsoring the
postgraduate training program into which he or she has been accepted confirming
the appointment to that program.
3. Provide proof that he or she is a graduate of and possesses a diploma from
a medical or osteopathic college that is approved by the MEB.
The bill provides that an REL is valid for one year and may be renewed for
additional one-year terms while the REL holder is enrolled in his or her
postgraduate training program. The bill also provides that an REL remains valid
only while the REL holder is actively engaged in the practice of medicine and surgery
in his or her postgraduate training program and is lawfully entitled to work in the
United States. Finally, the bill provides that the holder of an REL may engage in the
practice of medicine and surgery only in connection with his or her duties under his
or her postgraduate training program.
The bill grandfathers existing TEP holders so that they may retain and renew
their TEPs for up to three years following enactment of the bill.
Licenses for visiting physicians
Current law — temporary licenses for visiting professors
Under current law, an applicant who is a graduate of a foreign medical school
and who, because of noteworthy professional attainment, is invited to serve on the
academic staff of a medical college in this state as a visiting professor, may be granted
a temporary license to practice medicine and surgery (visiting professor license). A
visiting professor license remains in force only while the holder is serving full time
on the academic staff of a medical college and the license holder's practice is limited
to the duties of the academic position.
The bill — restricted licenses to practice as a visiting physician
The bill repeals the provisions for granting a visiting professor license and
replaces them with provisions allowing the MEB to grant a restricted license to
practice medicine and surgery as a visiting physician (visiting physician license). An
applicant must, under the bill, satisfy the following requirements in order to be
granted a visiting physician license:
1. Provide proof that he or she is a graduate of and possesses a diploma from
a medical or osteopathic college that is approved by the board.
2. Provide proof that he or she teaches medicine, engages in medical research,
or practices medicine and surgery outside this state.
3. Provide proof that the applicant is licensed to practice medicine and surgery
outside this state.
4. Provide documentation that he or she intends to teach, research, or practice
medicine and surgery at a medical education facility, medical research facility, or
medical college in this state, which must include a signed letter from the dean or
president of the facility or college.
5. Provide proof that he or she satisfies any other requirement established by
the MEB by rule for issuing the license.
The bill provides that the holder of a visiting physician license may engage in
the practice of medicine and surgery only at the medical education facility, medical
research facility, or medical college where he or she is teaching, researching, or
practicing, and only in accordance with the terms and restrictions established by the
MEB. The bill provides that a visiting physician license is valid for one year and may
be renewed at the discretion of the MEB. Finally, the bill provides that a visiting
physician license remains valid only while the license holder is actively engaged in
teaching, researching, or practicing medicine and surgery and is lawfully entitled to
work in the United States.
The bill grandfathers existing visiting professor license holders so that they
may retain and renew their visiting professor licenses for up to three years following
enactment of the bill.
Administrative physician license
The bill allows the MEB to grant a new type of license known under the bill as
an administrative physician license (APL). The MEB may grant an APL to an
applicant who satisfies the requirements for a regular license to practice medicine
and surgery, other than any requirement established by the MEB relating to the
active practice of medicine and surgery.
The bill provides that the holder of an APL may not, under that APL, take any
action that constitutes the practice of medicine and surgery.
Examinations for a license to practice medicine and surgery
The bill provides that, when examining an applicant for a license to practice
medicine and surgery or an APL, the MEB may only use examinations prepared,
administered, and scored by national examining agencies, subject to the exception
that the MEB may interview an individual applicant as needed to determine
information specific to that applicant.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB742,1
1Section
1. 440.08 (2) (a) (intro.) of the statutes is amended to read:
AB742,5,42
440.08
(2) (a) (intro.) Except as provided in par. (b) and in ss. 440.51, 442.04,
3444.03, 444.11, 447.04 (2) (c) 2.,
448.065, 449.17 (1m) (d), and 449.18 (2) (d)
and
4subch. II of ch. 448, the renewal dates for credentials are as follows:
AB742,2
5Section
2. 448.02 (1) of the statutes is amended to read:
AB742,5,96
448.02
(1) License. The board may grant licenses, including various classes
7of temporary licenses, to practice medicine and surgery,
to practice as an
8administrative physician, to practice perfusion, to practice as an anesthesiologist
9assistant, and to practice as a physician assistant.
AB742,3
1Section
3. 448.02 (3) (a) of the statutes is amended to read:
AB742,6,202
448.02
(3) (a) The board shall investigate allegations of unprofessional conduct
3and negligence in treatment by persons holding a license
, or certificate
or limited
4permit granted by the board. An allegation that a physician has violated s. 253.10
5(3), 448.30 or 450.13 (2) or has failed to mail or present a medical certification
6required under s. 69.18 (2) within 21 days after the pronouncement of death of the
7person who is the subject of the required certificate or that a physician has failed at
8least 6 times within a 6-month period to mail or present a medical certificate
9required under s. 69.18 (2) within 6 days after the pronouncement of death of the
10person who is the subject of the required certificate is an allegation of unprofessional
11conduct. Information contained in reports filed with the board under s. 49.45 (2) (a)
1212r., 50.36 (3) (b), 609.17 or 632.715, or under
42 CFR 1001.2005, shall be
13investigated by the board. Information contained in a report filed with the board
14under s. 655.045 (1), as created by
1985 Wisconsin Act 29, which is not a finding of
15negligence or in a report filed with the board under s. 50.36 (3) (c) may, within the
16discretion of the board, be used as the basis of an investigation of a person named in
17the report. The board may require a person holding a license
, or certificate
or limited
18permit to undergo and may consider the results of one or more physical, mental or
19professional competency examinations if the board believes that the results of any
20such examinations may be useful to the board in conducting its investigation.
AB742,4
21Section
4. 448.02 (3) (b) of the statutes is amended to read:
AB742,7,1722
448.02
(3) (b) After an investigation, if the board finds that there is probable
23cause to believe that the person is guilty of unprofessional conduct or negligence in
24treatment, the board shall hold a hearing on such conduct. The board may use any
25information obtained by the board or the department under s. 655.17 (7) (b), as
1created by
1985 Wisconsin Act 29, in an investigation or a disciplinary proceeding,
2including a public disciplinary proceeding, conducted under this subsection and the
3board may require a person holding a license
, or certificate
or limited permit to
4undergo and may consider the results of one or more physical, mental or professional
5competency examinations if the board believes that the results of any such
6examinations may be useful to the board in conducting its hearing. A unanimous
7finding by a panel established under s. 655.02, 1983 stats., or a finding by a court that
8a physician has acted negligently in treating a patient is conclusive evidence that the
9physician is guilty of negligence in treatment. A finding that is not a unanimous
10finding by a panel established under s. 655.02, 1983 stats., that a physician has acted
11negligently in treating a patient is presumptive evidence that the physician is guilty
12of negligence in treatment. A certified copy of the findings of fact, conclusions of law
13and order of the panel or the order of a court is presumptive evidence that the finding
14of negligence in treatment was made. The board shall render a decision within 90
15days after the date on which the hearing is held or, if subsequent proceedings are
16conducted under s. 227.46 (2), within 90 days after the date on which those
17proceedings are completed.
AB742,5
18Section
5. 448.02 (3) (c) of the statutes is amended to read:
AB742,8,519
448.02
(3) (c) Subject to par. (cm), after a disciplinary hearing, the board may,
20when it determines that a panel established under s. 655.02, 1983 stats., has
21unanimously found or a court has found that a person has been negligent in treating
22a patient or when it finds a person guilty of unprofessional conduct or negligence in
23treatment, do one or more of the following: warn or reprimand that person, or limit,
24suspend or revoke any license
, or certificate
or limited permit granted by the board
25to that person. The board may condition the removal of limitations on a license
, or
1certificate
or limited permit or the restoration of a suspended or revoked license
, or 2certificate
or limited permit upon obtaining minimum results specified by the board
3on one or more physical, mental or professional competency examinations if the
4board believes that obtaining the minimum results is related to correcting one or
5more of the bases upon which the limitation, suspension or revocation was imposed.
AB742,6
6Section
6. 448.02 (3) (e) of the statutes is amended to read:
AB742,8,157
448.02
(3) (e) A person whose license
,
or certificate
or limited permit is limited
8under this subchapter shall be permitted to continue practice upon condition that the
9person will refrain from engaging in unprofessional conduct; that the person will
10appear before the board or its officers or agents at such times and places as may be
11designated by the board from time to time; that the person will fully disclose to the
12board or its officers or agents the nature of the person's practice and conduct; that
13the person will fully comply with the limits placed on his or her practice and conduct
14by the board; that the person will obtain additional training, education or
15supervision required by the board; and that the person will cooperate with the board.
AB742,7
16Section
7. 448.02 (3) (h) of the statutes is amended to read:
AB742,8,2117
448.02
(3) (h) Nothing in this subsection prohibits the board, in its discretion,
18from investigating and conducting disciplinary proceedings on allegations of
19unprofessional conduct by persons holding a license
,
or certificate
or limited permit 20granted by the board when the allegations of unprofessional conduct may also
21constitute allegations of negligence in treatment.
AB742,8
22Section
8. 448.02 (4) (a) of the statutes is amended to read:
AB742,9,923
448.02
(4) (a) The board may summarily suspend any license
, or certificate
, or
24limited permit granted by the board when the board has in its possession evidence
25establishing probable cause to believe that the holder of the license
, or certificate
, or
1limited permit has violated the provisions of this subchapter and that it is necessary
2to suspend the license
, or certificate
, or limited permit immediately to protect the
3public health, safety, or welfare. The holder of the license
, or certificate
, or limited
4permit shall be granted an opportunity to be heard during the determination of
5probable cause. The board chair and 2 board members designated by the chair or,
6if the board chair is not available, the board vice-chair and 2 board members
7designated by the vice-chair, shall exercise the authority granted by this paragraph
8to suspend summarily a license
, or certificate
, or limited permit in the manner
9provided under par. (b).
AB742,9
10Section
9. 448.02 (4) (b) of the statutes is amended to read:
AB742,9,2511
448.02
(4) (b) An order of summary suspension shall be served upon the holder
12of the license
, or certificate
, or limited permit in the manner provided in s. 801.11 for
13service of summons. The order of summary suspension shall be effective upon service
14or upon actual notice of the summary suspension given to the holder of the license
, 15or certificate
, or limited permit or to the attorney of the license
, permit, or
limited
16permit certificate holder, whichever is sooner. A notice of hearing commencing a
17disciplinary proceeding shall be issued no more than 10 days following the issuance
18of the order of summary suspension. The order of summary suspension remains in
19effect until the effective date of a final decision and order in the disciplinary
20proceeding against the holder or until the order of summary suspension is
21discontinued by the board following a hearing to show cause. The holder of the
22license
, or certificate
, or limited permit shall have the right to request a hearing to
23show cause why the order of summary suspension should not be continued and the
24order of summary suspension shall notify the holder of the license
, or certificate
, or
25limited permit of that right. If a hearing to show cause is requested by the holder
1of the license
, or certificate
, or limited permit, the hearing shall be scheduled on a
2date within 20 days of receipt by the board of the request for the hearing to show
3cause.
AB742,10
4Section
10. 448.02 (5) of the statutes is amended to read:
AB742,10,105
448.02
(5) Voluntary surrender. The holder of any license
, or certificate
or
6limited permit granted by the board may voluntarily surrender the license
, or 7certificate
or limited permit to the secretary of the board, but the secretary may
8refuse to accept the surrender if the board has received allegations of unprofessional
9conduct against the holder of the license
, or certificate
or limited permit. The board
10may negotiate stipulations in consideration for accepting the surrender of licenses.
AB742,11
11Section
11. 448.02 (6) of the statutes is amended to read:
AB742,10,1512
448.02
(6) Restoration of license, or certificate or limited permit. The board
13may restore any license
, or certificate
or limited permit which that has been
14voluntarily surrendered or revoked under any of the provisions of this subchapter,
15on such terms and conditions as it may deem appropriate.
AB742,12
16Section
12. 448.02 (8) (a) of the statutes is amended to read:
