Sen. Terry Link

Filed: 4/30/2012

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 5104

2    AMENDMENT NO. ______. Amend House Bill 5104 by replacing
3everything after the enacting clause with the following:
 
4    Section 1. The Ambulatory Surgical Treatment Center Act is
5amended by adding Section 6.6 as follows:
 
6    (210 ILCS 5/6.6 new)
7    Sec. 6.6. Clinical privileges; physician assistants. No
8ambulatory surgical treatment center (ASTC) licensed under
9this Act shall adopt any policy, rule, regulation, or practice
10inconsistent with the provision of adequate supervision in
11accordance with Section 54.5 of the Medical Practice Act of
121987 and the Physician Assistant Practice Act of 1987.
 
13    Section 3. The Hospital Licensing Act is amended by adding
14Section 10.11 as follows:
 

 

 

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1    (210 ILCS 85/10.11 new)
2    Sec. 10.11. Clinical privileges; physician assistants. No
3hospital licensed under this Act shall adopt any policy, rule,
4regulation, or practice inconsistent with the provision of
5adequate supervision in accordance with Section 54.5 of the
6Medical Practice Act of 1987 and the Physician Assistant
7Practice Act of 1987.
 
8    Section 5. The Medical Practice Act of 1987 is amended by
9changing Section 54.5 as follows:
 
10    (225 ILCS 60/54.5)
11    (Section scheduled to be repealed on December 31, 2012)
12    Sec. 54.5. Physician delegation of authority to physician
13assistants and advanced practice nurses.
14    (a) Physicians licensed to practice medicine in all its
15branches may delegate care and treatment responsibilities to a
16physician assistant under guidelines in accordance with the
17requirements of the Physician Assistant Practice Act of 1987. A
18physician licensed to practice medicine in all its branches may
19enter into supervising physician agreements with no more than 5
202 physician assistants as set forth in subsection (a) of
21Section 7 of the Physician Assistant Practice Act of 1987.
22    (b) A physician licensed to practice medicine in all its
23branches in active clinical practice may collaborate with an
24advanced practice nurse in accordance with the requirements of

 

 

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1the Nurse Practice Act. Collaboration is for the purpose of
2providing medical consultation, and no employment relationship
3is required. A written collaborative agreement shall conform to
4the requirements of Section 65-35 of the Nurse Practice Act.
5The written collaborative agreement shall be for services the
6collaborating physician generally provides to his or her
7patients in the normal course of clinical medical practice. A
8written collaborative agreement shall be adequate with respect
9to collaboration with advanced practice nurses if all of the
10following apply:
11        (1) The agreement is written to promote the exercise of
12    professional judgment by the advanced practice nurse
13    commensurate with his or her education and experience. The
14    agreement need not describe the exact steps that an
15    advanced practice nurse must take with respect to each
16    specific condition, disease, or symptom, but must specify
17    those procedures that require a physician's presence as the
18    procedures are being performed.
19        (2) Practice guidelines and orders are developed and
20    approved jointly by the advanced practice nurse and
21    collaborating physician, as needed, based on the practice
22    of the practitioners. Such guidelines and orders and the
23    patient services provided thereunder are periodically
24    reviewed by the collaborating physician.
25        (3) The advance practice nurse provides services the
26    collaborating physician generally provides to his or her

 

 

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1    patients in the normal course of clinical practice, except
2    as set forth in subsection (b-5) of this Section. With
3    respect to labor and delivery, the collaborating physician
4    must provide delivery services in order to participate with
5    a certified nurse midwife.
6        (4) The collaborating physician and advanced practice
7    nurse consult at least once a month to provide
8    collaboration and consultation.
9        (5) Methods of communication are available with the
10    collaborating physician in person or through
11    telecommunications for consultation, collaboration, and
12    referral as needed to address patient care needs.
13        (6) The agreement contains provisions detailing notice
14    for termination or change of status involving a written
15    collaborative agreement, except when such notice is given
16    for just cause.
17    (b-5) An anesthesiologist or physician licensed to
18practice medicine in all its branches may collaborate with a
19certified registered nurse anesthetist in accordance with
20Section 65-35 of the Nurse Practice Act for the provision of
21anesthesia services. With respect to the provision of
22anesthesia services, the collaborating anesthesiologist or
23physician shall have training and experience in the delivery of
24anesthesia services consistent with Department rules.
25Collaboration shall be adequate if:
26        (1) an anesthesiologist or a physician participates in

 

 

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1    the joint formulation and joint approval of orders or
2    guidelines and periodically reviews such orders and the
3    services provided patients under such orders; and
4        (2) for anesthesia services, the anesthesiologist or
5    physician participates through discussion of and agreement
6    with the anesthesia plan and is physically present and
7    available on the premises during the delivery of anesthesia
8    services for diagnosis, consultation, and treatment of
9    emergency medical conditions. Anesthesia services in a
10    hospital shall be conducted in accordance with Section 10.7
11    of the Hospital Licensing Act and in an ambulatory surgical
12    treatment center in accordance with Section 6.5 of the
13    Ambulatory Surgical Treatment Center Act.
14    (b-10) The anesthesiologist or operating physician must
15agree with the anesthesia plan prior to the delivery of
16services.
17    (c) The supervising physician shall have access to the
18medical records of all patients attended by a physician
19assistant. The collaborating physician shall have access to the
20medical records of all patients attended to by an advanced
21practice nurse.
22    (d) (Blank).
23    (e) A physician shall not be liable for the acts or
24omissions of a physician assistant or advanced practice nurse
25solely on the basis of having signed a supervision agreement or
26guidelines or a collaborative agreement, an order, a standing

 

 

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1medical order, a standing delegation order, or other order or
2guideline authorizing a physician assistant or advanced
3practice nurse to perform acts, unless the physician has reason
4to believe the physician assistant or advanced practice nurse
5lacked the competency to perform the act or acts or commits
6willful and wanton misconduct.
7    (f) A collaborating physician may, but is not required to,
8delegate prescriptive authority to an advanced practice nurse
9as part of a written collaborative agreement, and the
10delegation of prescriptive authority shall conform to the
11requirements of Section 65-40 of the Nurse Practice Act.
12    (g) A supervising physician may, but is not required to,
13delegate prescriptive authority to a physician assistant as
14part of a written supervision agreement, and the delegation of
15prescriptive authority shall conform to the requirements of
16Section 7.5 of the Physician Assistant Practice Act of 1987.
17(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)
 
18    Section 10. The Physician Assistant Practice Act of 1987 is
19amended by changing Sections 4 and 7 and by adding Section 7.7
20as follows:
 
21    (225 ILCS 95/4)  (from Ch. 111, par. 4604)
22    (Section scheduled to be repealed on January 1, 2018)
23    Sec. 4. In this Act:
24    1. "Department" means the Department of Financial and

 

 

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1Professional Regulation.
2    2. "Secretary" means the Secretary of Financial and
3Professional Regulation.
4    3. "Physician assistant" means any person not a physician
5who has been certified as a physician assistant by the National
6Commission on the Certification of Physician Assistants or
7equivalent successor agency and performs procedures under the
8supervision of a physician as defined in this Act. A physician
9assistant may perform such procedures within the specialty of
10the supervising physician, except that such physician shall
11exercise such direction, supervision and control over such
12physician assistants as will assure that patients shall receive
13quality medical care. Physician assistants shall be capable of
14performing a variety of tasks within the specialty of medical
15care under the supervision of a physician. Supervision of the
16physician assistant shall not be construed to necessarily
17require the personal presence of the supervising physician at
18all times at the place where services are rendered, as long as
19there is communication available for consultation by radio,
20telephone or telecommunications within established guidelines
21as determined by the physician/physician assistant team. The
22supervising physician may delegate tasks and duties to the
23physician assistant. Delegated tasks or duties shall be
24consistent with physician assistant education, training, and
25experience. The delegated tasks or duties shall be specific to
26the practice setting and shall be implemented and reviewed

 

 

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1under a written supervision agreement established by the
2physician or physician/physician assistant team. A physician
3assistant, acting as an agent of the physician, shall be
4permitted to transmit the supervising physician's orders as
5determined by the institution's by-laws, policies, procedures,
6or job description within which the physician/physician
7assistant team practices. Physician assistants shall practice
8only in accordance with a written supervision agreement.
9    4. "Board" means the Medical Licensing Board constituted
10under the Medical Practice Act of 1987.
11    5. "Disciplinary Board" means the Medical Disciplinary
12Board constituted under the Medical Practice Act of 1987.
13    6. "Physician" means, for purposes of this Act, a person
14licensed to practice medicine in all its branches under the
15Medical Practice Act of 1987.
16    7. "Supervising Physician" means, for the purposes of this
17Act, the primary supervising physician of a physician
18assistant, who, within his specialty and expertise may delegate
19a variety of tasks and procedures to the physician assistant.
20Such tasks and procedures shall be delegated in accordance with
21a written supervision agreement. The supervising physician
22maintains the final responsibility for the care of the patient
23and the performance of the physician assistant.
24    8. "Alternate supervising physician" means, for the
25purpose of this Act, any physician designated by the
26supervising physician to provide supervision in the event that

 

 

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1he or she is unable to provide that supervision. The Department
2may further define "alternate supervising physician" by rule.
3    The alternate supervising physicians shall maintain all
4the same responsibilities as the supervising physician.
5Nothing in this Act shall be construed as relieving any
6physician of the professional or legal responsibility for the
7care and treatment of persons attended by him or by physician
8assistants under his supervision. Nothing in this Act shall be
9construed as to limit the reasonable number of alternate
10supervising physicians, provided they are designated by the
11supervising physician.
12    9. "Address of record" means the designated address
13recorded by the Department in the applicant's or licensee's
14application file or license file maintained by the Department's
15licensure maintenance unit. It is the duty of the applicant or
16licensee to inform the Department of any change of address, and
17such changes must be made either through the Department's
18website or by contacting the Department's licensure
19maintenance unit.
20(Source: P.A. 95-703, eff. 12-31-07; 96-268, eff. 8-11-09.)
 
21    (225 ILCS 95/7)  (from Ch. 111, par. 4607)
22    (Section scheduled to be repealed on January 1, 2018)
23    Sec. 7. Supervision requirements.
24    (a) A supervising physician shall determine the number of
25physician assistants under his or her supervision provided the

 

 

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1physician is able to provide adequate supervision as outlined
2in the written supervision agreement required under Section 7.5
3of this Act and consideration is given to the nature of the
4physician's practice, complexity of the patient population,
5and the experience of each supervised physician assistant. A
6supervising physician may supervise a maximum of 5 full-time
7equivalent physician assistants; provided, however, this
8number of physician assistants shall be reduced by the number
9of collaborative agreements the supervising physician
10maintains. A No more than 2 physician assistants shall be
11supervised by the supervising physician, although a physician
12assistant shall be able to hold more than one professional
13position. A Each supervising physician shall file a notice of
14supervision of each such physician assistant according to the
15rules of the Department. However, the alternate supervising
16physician may supervise more than 2 physician assistants when
17the supervising physician is unable to provide such supervision
18consistent with the definition of alternate physician in
19Section 4. It is the responsibility of the supervising
20physician to maintain documentation each time he or she has
21designated an alternative supervising physician. This
22documentation shall include the date alternate supervisory
23control began, the date alternate supervisory control ended,
24and any other changes. A supervising physician shall provide a
25copy of this documentation to the Department, upon request.
26    Physician assistants shall be supervised only by

 

 

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1physicians as defined in this Act who are engaged in clinical
2practice, or in clinical practice in public health or other
3community health facilities.
4    Nothing in this Act shall be construed to limit the
5delegation of tasks or duties by a physician to a nurse or
6other appropriately trained personnel.
7    Nothing in this Act shall be construed to prohibit the
8employment of physician assistants by a hospital, nursing home
9or other health care facility where such physician assistants
10function under the supervision of a supervising physician.
11    Physician assistants may be employed by the Department of
12Corrections or the Department of Human Services (as successor
13to the Department of Mental Health and Developmental
14Disabilities) for service in facilities maintained by such
15Departments and affiliated training facilities in programs
16conducted under the authority of the Director of Corrections or
17the Secretary of Human Services. Each physician assistant
18employed by the Department of Corrections or the Department of
19Human Services (as successor to the Department of Mental Health
20and Developmental Disabilities) shall be under the supervision
21of a physician engaged in clinical practice and direct patient
22care. Duties of each physician assistant employed by such
23Departments are limited to those within the scope of practice
24of the supervising physician who is fully responsible for all
25physician assistant activities.
26    A physician assistant may be employed by a practice group

 

 

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1or other entity employing multiple physicians at one or more
2locations. In that case, one of the physicians practicing at a
3location shall be designated the supervising physician. The
4other physicians with that practice group or other entity who
5practice in the same general type of practice or specialty as
6the supervising physician may supervise the physician
7assistant with respect to their patients without being deemed
8alternate supervising physicians for the purpose of this Act.
9    (b) A physician assistant licensed in this State, or
10licensed or authorized to practice in any other U.S.
11jurisdiction or credentialed by his or her federal employer as
12a physician assistant, who is responding to a need for medical
13care created by an emergency or by a state or local disaster
14may render such care that the physician assistant is able to
15provide without supervision as it is defined in this Section or
16with such supervision as is available. For purposes of this
17Section, an "emergency situation" shall not include one that
18occurs in the place of one's employment.
19    Any physician who supervises a physician assistant
20providing medical care in response to such an emergency or
21state or local disaster shall not be required to meet the
22requirements set forth in this Section for a supervising
23physician.
24(Source: P.A. 95-703, eff. 12-31-07; 96-70, eff. 7-23-09.)
 
25    (225 ILCS 95/7.7 new)

 

 

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1    Sec. 7.7. Physician assistants in hospitals, hospital
2affiliates, or ambulatory surgical treatment centers.
3    (a) A physician assistant may provide services in a
4hospital or a hospital affiliate as those terms are defined in
5the Hospital Licensing Act or the University of Illinois
6Hospital Act or a licensed ambulatory surgical treatment center
7without a written supervision agreement pursuant to Section 7.5
8of this Act. A physician assistant must possess clinical
9privileges recommended by the hospital medical staff and
10granted by the hospital or the consulting medical staff
11committee and ambulatory surgical treatment center in order to
12provide services. The medical staff or consulting medical staff
13committee shall periodically review the services of physician
14assistants granted clinical privileges, including any care
15provided in a hospital affiliate. Authority may also be granted
16when recommended by the hospital medical staff and granted by
17the hospital or recommended by the consulting medical staff
18committee and ambulatory surgical treatment center to
19individual physician assistants to select, order, and
20administer medications, including controlled substances, to
21provide delineated care. In a hospital, hospital affiliate, or
22ambulatory surgical treatment center, the attending physician
23shall determine a physician assistant's role in providing care
24for his or her patients, except as otherwise provided in the
25medical staff bylaws or consulting committee policies.
26    (b) A physician assistant granted authority to order

 

 

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1medications including controlled substances may complete
2discharge prescriptions provided the prescription is in the
3name of the physician assistant and the attending or
4discharging physician.
5    (c) Physician assistants practicing in a hospital,
6hospital affiliate, or an ambulatory surgical treatment center
7are not required to obtain a mid-level controlled substance
8license to order controlled substances under Section 303.05 of
9the Illinois Controlled Substances Act.
 
10    (225 ILCS 95/8 rep.)
11    Section 15. The Physician Assistant Practice Act of 1987 is
12amended by repealing Section 8.
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.".