LRB-4339/1
CTS:nwn:rs
2009 - 2010 LEGISLATURE
April 16, 2010 - Introduced by Senators Kreitlow, Taylor and Schultz,
cosponsored by Representatives
Schneider and Benedict. Referred to
Committee on Health, Health Insurance, Privacy, Property Tax Relief, and
Revenue.
SB698,1,10
1An Act to amend 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k),
250.49 (1) (b) (intro.), 70.47 (8) (intro.), 146.82 (3) (a), 252.07 (8) (a) 2., 252.07 (9)
3(c), 252.11 (2), 252.11 (4), 252.11 (5), 252.11 (7), 252.11 (10), 252.14 (1) (ar) 14.,
4252.15 (2) (a) 7. ak., 252.15 (5) (a) 11., 252.15 (5) (a) 12. b., 252.15 (5) (a) 14.,
5252.15 (5m) (a), 252.15 (5m) (b), 252.15 (5m) (c), 252.15 (7m) (intro.), 252.15
6(7m) (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 252.18, 343.16 (5) (a),
7448.03 (5) (b), 448.56 (1), 448.56 (1m) (b), 448.67 (2), 450.11 (7) (b) and 450.11
8(8) (b); and
to create 50.01 (4p), 252.01 (5), 450.01 (15r), 450.01 (16) (h) 3. and
9450.13 (5) (c) of the statutes;
relating to: authorizing medically related actions
10by physician assistants.
Analysis by the Legislative Reference Bureau
Under current law, the Medical Examining Board grants physician assistant
licenses to individuals who meet training and examination requirements and any
other requirements established in rules promulgated by the Medical Examining
Board.
The following provisions under current law authorize physicians or other
health care professionals to act under specified circumstances and to affect
individuals by these authorized actions:
1. Unless medically contraindicated as documented by a nursing home or
community-based residential facility resident's physician in the resident's medical
record, the resident has the right to private and unrestricted communications with
his or her family, physician, attorney, and others; to share a room with his or her
spouse or domestic partner if the spouse or domestic partner is also a resident; to
participate in activities of social, religious, and community groups; and to be free
from chemical and physical restraints.
2. Home health services that are provided to an individual by a home health
agency must be those specified under a plan for furnishing the services that is
established and periodically reviewed by a physician.
3. For hearings before the local board of review concerning assessments of
property taxes, an ill or disabled person who presents to the board a letter from a
physician or osteopath confirming the illness or disability may present testimony by
telephone.
4. Under laws relating to confidentiality of patient health care records, a
physician who treats a patient whose physical or mental condition, in the physician's
judgment, affects his or her ability to exercise reasonable and ordinary control over
a motor vehicle may, without the patient's informed consent, report the patient's
name and other information to the Department of Transportation. Physicians are
exempted from civil liability for reporting, or not reporting, this information in good
faith.
5. Under laws relating to communicable diseases:
a. The Department of Health Services (DHS) may order an individual who has
a confirmed diagnosis of infectious tuberculosis or symptoms indicative of
tuberculosis confined to a facility if several conditions are met, including notifying
a court of the confinement and providing to the court a physician's written statement
affirming the tuberculosis or symptoms.
b. If a court orders confinement of an individual with infectious tuberculosis
or symptoms indicative of tuberculosis, the individual must remain confined until
DHS or a local health officer, with the concurrence of a treating physician,
determines that treatment is complete or that the individual is no longer a public
health threat.
c. If, following a request by an officer of DHS or a local health officer, a person
reasonably suspected of being infected with a sexually transmitted disease refuses
or neglects examination by a physician or treatment, the DHS officer or local health
officer may have the person committed to an institution for examination, treatment,
or observation.
d. If a person with a sexually transmitted disease ceases or refuses treatment
before reaching what is in a physician's opinion the noncommunicable stage, the
physician must notify DHS and the person may be committed by a court for
examination or treatment.
e. If a physician has reported to DHS a case of sexually transmitted disease,
information regarding the disease and its treatment is not privileged before a court.
f. The State Laboratory of Hygiene must examine specimens for the diagnosis
of sexually transmitted disease for any physician or local health officer and must
report positive results to the local health officer and DHS.
g. If certain individuals, including emergency medical technicians, fire
fighters, state patrol officers, jailers, emergency care givers, and coroners, receive a
significant exposure (sustain a contact that has a potential for transmission of HIV),
the person to whom they are significantly exposed may be compelled to be tested for
the presence of HIV, and the test results may be provided to the affected individual.
One prerequisite for compulsory testing is a written determination and certification
by a physician that the individual has been significantly exposed.
h. If a test administered to a corpse indicates the presence of HIV, the deceased
person's physician may provide the results of the test to persons whom the physician
knows have had sexual contact or shared intravenous drug use paraphernalia with
the deceased person; to emergency caregivers; and to funeral directors, coroners, and
medical examiners who prepare a corpse for burial or who are significantly exposed
to HIV in the course of performing an autopsy.
i. If a local health officer or DHS officer requires it, a person who is employed
in the handling of food products or is suspected of having a disease in a form that is
communicable by food handling must submit to an examination by the officer or by
a physician.
j. Certain individuals are eligible to receive premium subsidies for health
insurance or medical leave premiums if a physician certifies that the individual has
been infected with HIV.
6. Under occupational regulation laws relating to physical therapists, a
physical therapist may practice only on the written referral of a physician,
chiropractor, dentist, or podiatrist, except under certain conditions, including
providing services to an individual for a previously diagnosed medical condition after
informing the individual's physician, chiropractor, dentist, or podiatrist.
7. Under occupational regulation laws relating to podiatrists, a podiatrist who
renders chargeable services to, among others, a patient or physician, must render a
statement of the charge directly to the person served.
8. Under laws relating to the practice of pharmacy, current law does the
following:
a. Defines the term "practice of pharmacy" to include making therapeutic
alternate drug selections in accordance with written guidelines or procedures
approved by a hospital and by a physician for his or her patients for a hospital stay.
b. Provides that information communicated to a physician in an effort
unlawfully to procure a prescription drug is not privileged communication.
c. Requires the enforcement of prescription drug laws that apply to physicians
to be the responsibility of the Department of Regulation and Licensing and the
Medical Examining Board.
d. Exempts pharmacists from requirements that they provide certain
information when dispensing a drug product equivalent, if the patient is in a hospital
and the drug product equivalent is dispensed in accordance with guidelines
approved by, among others, the patient's physician.
Currently, an advanced practice nurse prescriber may act in the same manner
physicians may act in the instances specified above.
This bill expands the current laws described above that authorize physicians
to act under specified circumstances and to affect individuals by these authorized
actions, by similarly authorizing individuals licensed as physician assistants.
For further information see the state and local 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:
SB698, s. 1
1Section
1. 50.01 (4p) of the statutes is created to read:
SB698,4,22
50.01
(4p) "Physician assistant" has the meaning given in s. 448.01 (6).
SB698, s. 2
3Section
2. 50.09 (1) (a) (intro.) of the statutes is amended to read:
SB698,4,104
50.09
(1) (a) (intro.) Private and unrestricted communications with the
5resident's family, physician,
physician assistant, advanced practice nurse prescriber,
6attorney, and any other person, unless medically contraindicated as documented by
7the resident's physician
, physician assistant, or advanced practice nurse prescriber
8in the resident's medical record, except that communications with public officials or
9with the resident's attorney shall not be restricted in any event. The right to private
10and unrestricted communications shall include, but is not limited to, the right to:
SB698,4,1713
50.09
(1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses
14or both domestic partners under ch.770 are residents of the same facility, the spouses
15or domestic partners shall be permitted to share a room unless medically
16contraindicated as documented by the resident's physician
, physician assistant, or
17advanced practice nurse prescriber in the resident's medical record.
SB698, s. 4
1Section
4. 50.09 (1) (h) of the statutes is amended to read:
SB698,5,52
50.09
(1) (h) Meet with, and participate in activities of social, religious, and
3community groups at the resident's discretion, unless medically contraindicated as
4documented by the resident's physician
, physician assistant, or advanced practice
5nurse prescriber in the resident's medical record.
SB698, s. 5
6Section
5. 50.09 (1) (k) of the statutes is amended to read:
SB698,5,187
50.09
(1) (k) Be free from mental and physical abuse, and be free from chemical
8and physical restraints except as authorized in writing by a physician
, physician
9assistant, or advanced practice nurse prescriber for a specified and limited period of
10time and documented in the resident's medical record. Physical restraints may be
11used in an emergency when necessary to protect the resident from injury to himself
12or herself or others or to property. However, authorization for continuing use of the
13physical restraints shall be secured from a physician
, physician assistant, or
14advanced practice nurse prescriber within 12 hours. Any use of physical restraints
15shall be noted in the resident's medical records. "Physical restraints" includes, but
16is not limited to, any article, device, or garment that interferes with the free
17movement of the resident and that the resident is unable to remove easily, and
18confinement in a locked room.
SB698, s. 6
19Section
6. 50.49 (1) (b) (intro.) of the statutes is amended to read:
SB698,6,220
50.49
(1) (b) (intro.) "Home health services" means the following items and
21services that are furnished to an individual, who is under the care of a physician
,
22physician assistant, or advanced practice nurse prescriber, by a home health agency,
23or by others under arrangements made by the home health agency, that are under
24a plan for furnishing those items and services to the individual that is established
25and periodically reviewed by a physician
, physician assistant, or advanced practice
1nurse prescriber and that are, except as provided in subd. 6., provided on a visiting
2basis in a place of residence used as the individual's home:
SB698, s. 7
3Section
7. 70.47 (8) (intro.) of the statutes is amended to read:
SB698,6,94
70.47
(8) Hearing. (intro.) The board shall hear upon oath all persons who
5appear before it in relation to the assessment. The board shall hear upon oath, by
6telephone, all ill or disabled persons who present to the board a letter from a
7physician, osteopath,
physician assistant, as defined in s. 448.01 (6), or advanced
8practice nurse prescriber certified under s. 441.16 (2) that confirms their illness or
9disability. The board at such hearing shall proceed as follows:
SB698, s. 8
10Section
8. 146.82 (3) (a) of the statutes is amended to read:
SB698,6,1711
146.82
(3) (a) Notwithstanding sub. (1), a physician
, physician assistant, as
12defined in s. 448.01 (6), or advanced practice nurse prescriber certified under s.
13441.16 (2) who treats a patient whose physical or mental condition in the physician's
,
14physician assistant's, or advanced practice nurse prescriber's judgment affects the
15patient's ability to exercise reasonable and ordinary control over a motor vehicle may
16report the patient's name and other information relevant to the condition to the
17department of transportation without the informed consent of the patient.
SB698, s. 9
18Section
9. 252.01 (5) of the statutes is created to read:
SB698,6,1919
252.01
(5) "Physician assistant" has the meaning given in s. 448.01 (6).
SB698, s. 10
20Section
10. 252.07 (8) (a) 2. of the statutes is amended to read:
SB698,6,2321
252.07
(8) (a) 2. The department or local health officer provides to the court a
22written statement from a physician
, physician assistant, or advanced practice nurse
23prescriber that the individual has infectious tuberculosis or suspect tuberculosis.
SB698, s. 11
24Section
11. 252.07 (9) (c) of the statutes is amended to read:
SB698,7,7
1252.07
(9) (c) If the court orders confinement of an individual under this
2subsection, the individual shall remain confined until the department or local health
3officer, with the concurrence of a treating physician
, physician assistant, or advanced
4practice nurse prescriber, determines that treatment is complete or that the
5individual is no longer a substantial threat to himself or herself or to the public
6health. If the individual is to be confined for more than 6 months, the court shall
7review the confinement every 6 months.
SB698, s. 12
8Section
12. 252.11 (2) of the statutes is amended to read:
SB698,7,199
252.11
(2) An officer of the department or a local health officer having
10knowledge of any reported or reasonably suspected case or contact of a sexually
11transmitted disease for which no appropriate treatment is being administered, or of
12an actual contact of a reported case or potential contact of a reasonably suspected
13case, shall investigate or cause the case or contact to be investigated as necessary.
14If, following a request of an officer of the department or a local health officer, a person
15reasonably suspected of being infected with a sexually transmitted disease refuses
16or neglects examination by a physician
, physician assistant, or advanced practice
17nurse prescriber or treatment, an officer of the department or a local health officer
18may proceed to have the person committed under sub. (5) to an institution or system
19of care for examination, treatment
, or observation.
SB698, s. 13
20Section
13. 252.11 (4) of the statutes is amended to read:
SB698,8,221
252.11
(4) If a person infected with a sexually transmitted disease ceases or
22refuses treatment before reaching what in a physician's
, physician assistant's, or
23advanced practice nurse prescriber's opinion is the noncommunicable stage, the
24physician
, physician assistant, or advanced practice nurse prescriber shall notify the
25department. The department shall without delay take the necessary steps to have
1the person committed for treatment or observation under sub. (5), or shall notify the
2local health officer to take these steps.
SB698, s. 14
3Section
14. 252.11 (5) of the statutes is amended to read:
SB698,8,204
252.11
(5) Any court of record may commit a person infected with a sexually
5transmitted disease to any institution or may require the person to undergo a system
6of care for examination, treatment, or observation if the person ceases or refuses
7examination, treatment, or observation under the supervision of a physician
,
8physician assistant, or advanced practice nurse prescriber. The court shall summon
9the person to appear on a date at least 48 hours, but not more than 96 hours, after
10service if an officer of the department or a local health officer petitions the court and
11states the facts authorizing commitment. If the person fails to appear or fails to
12accept commitment without reasonable cause, the court may cite the person for
13contempt. The court may issue a warrant and may direct the sheriff, any constable,
14or any police officer of the county immediately to arrest the person and bring the
15person to court if the court finds that a summons will be ineffectual. The court shall
16hear the matter of commitment summarily. Commitment under this subsection
17continues until the disease is no longer communicable or until other provisions are
18made for treatment that satisfy the department. The certificate of the petitioning
19officer is prima facie evidence that the disease is no longer communicable or that
20satisfactory provisions for treatment have been made.
