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General Assembly Raised Bill No. 6942
January Session, 2019
LCO No. 3474
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING A COLLABORATIVE RELATIONSHIP
BETWEEN PHYSICIAN AS SISTANTS AND PHYSICIANS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subdivision (1) of subsection (a) of section 20-8a of the 1
general statutes is repealed and the following is substituted in lieu 2
thereof (Effective October 1, 2019): 3
(1) Said board shall consist of twenty-one members, thirteen of 4
whom are physicians, one of whom is a physician assistant and seven 5
of whom are public members, all of whom are appointed by the 6
Governor, subject to the provisions of section 4-1a, as follows: Three 7
physicians of any specialty; three physicians who are specialists in 8
internal medicine; one physician who is a psychiatrist; one physician 9
who is a surgeon; one physician who is an obstetrician-gynecologist; 10
one physician who is a pediatrician; one physician who is an 11
emergency medical physician; one physician who is [a supervising 12
physician for] a collaborating physician with one or more physician 13
assistants; one physician who is a graduate of a medical education 14
program accredited by the American Osteopathic Association; one 15 Raised Bill No. 6942
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physician assistant licensed pursuant to section 20-12b, as amended by 16
this act; and seven public members. 17
Sec. 2. Subsection (b) of section 20-9 of the general statutes is 18
repealed and the following is substituted in lieu thereof (Effective 19
October 1, 2019): 20
(b) The provisions of this chapter shall not apply to: 21
(1) Dentists while practicing dentistry only; 22
(2) Any person in the employ of the United States government while 23
acting in the scope of his employment; 24
(3) Any person who furnishes medical or surgical assistance in cases 25
of sudden emergency; 26
(4) Any person residing out of this state who is employed to come 27
into this state to render temporary assistance to or consult with any 28
physician or surgeon who has been licensed in conformity with the 29
provisions of this chapter; 30
(5) Any physician or surgeon residing out of this state who holds a 31
current license in good standing in another state and who is employed 32
to come into this state to treat, operate or prescribe for any injury, 33
deformity, ailment or disease from which the person who employed 34
such physician, or the person on behalf of whom such physician is 35
employed, is suffering at the time when such nonresident physician or 36
surgeon is so employed, provided such physician or surgeon may 37
practice in this state without a Connecticut license for a period not to 38
exceed thirty consecutive days; 39
(6) Any person rendering service as (A) an advanced practice 40
registered nurse if such service is rendered in accordance with section 41
20-87a, or (B) an advanced practice registered nurse maintaining 42
classification from the American Association of Nurse Anesthetists if 43
such service is under the direction of a licensed physician; 44 Raised Bill No. 6942
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(7) Any nurse-midwife practicing nurse-midwifery in accordance 45
with the provisions of chapter 377; 46
(8) Any podiatrist licensed in accordance with the provisions of 47
chapter 375; 48
(9) Any Christian Science practitioner who does not use or prescribe 49
in his practice any drugs, poisons, medicines, chemicals, nostrums or 50
surgery; 51
(10) Any person licensed to practice any of the healing arts named 52
in section 20-1, who does not use or prescribe in his practice any drugs, 53
medicines, poisons, chemicals, nostrums or surgery; 54
(11) Any graduate of any school or institution giving instruction in 55
the healing arts who has been issued a permit in accordance with 56
subsection (a) of section 20-11a and who is serving as an intern, 57
resident or medical officer candidate in a hospital; 58
(12) Any student participating in a clinical clerkship program who 59
has the qualifications specified in subsection (b) of section 20-11a; 60
(13) Any person, otherwise qualified to practice medicine in this 61
state except that he is a graduate of a medical school located outside of 62
the United States or the Dominion of Canada which school is 63
recognized by the American Medical Association or the World Health 64
Organization, to whom the Connecticut Medical Examining Board, 65
subject to such regulations as the Commissioner of Public Health, with 66
advice and assistance from the board, prescribes, has issued a permit 67
to serve as an intern or resident in a hospital in this state for the 68
purpose of extending his education; 69
(14) Any person rendering service as [a physician assistant licensed 70
pursuant to section 20-12b,] a registered nurse, a licensed practical 71
nurse or a paramedic, as defined in subdivision (15) of section 19a-175, 72
acting within the scope of regulations adopted pursuant to section 19a-73
179, if such service is rendered under the supervision, control and 74 Raised Bill No. 6942
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responsibility of a licensed physician; 75
(15) Any person rendering service as a physician assistant, as 76
defined in section 20-12a, as amended by this act, acting in accordance 77
with the provisions of chapter 370; 78
[(15)] (16) Any student enrolled in an accredited physician assistant 79
program or paramedic program approved in accordance with 80
regulations adopted pursuant to section 19a-179, who is performing 81
such work as is incidental to his course of study; 82
[(16)] (17) Any person who, on June 1, 1993, has worked 83
continuously in this state since 1979 performing diagnostic radiology 84
services and who, as of October 31, 1997, continued to render such 85
services under the supervision, control and responsibility of a licensed 86
physician solely within the setting where such person was employed 87
on June 1, 1993; 88
[(17)] (18) Any person practicing athletic training, as defined in 89
section 20-65f; 90
[(18)] (19) When deemed by the Connecticut Medical Examining 91
Board to be in the public's interest, based on such considerations as 92
academic attainments, specialty board certification and years of 93
experience, to a foreign physician or surgeon whose professional 94
activities shall be confined within the confines of a recognized medical 95
school; 96
[(19)] (20) Any technician engaging in tattooing in accordance with 97
the provisions of section 20-266o or 20-266p and any regulations 98
adopted thereunder; 99
[(20)] (21) Any person practicing perfusion, as defined in section 20-100
162aa; 101
[(21)] (22) Any foreign physician or surgeon (A) participating in 102
supervised clinical training under the direct supervision and control of 103
a physician or surgeon licensed in accordance with the provisions of 104 Raised Bill No. 6942
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this chapter, and (B) whose professional activities are confined to a 105
licensed hospital that has a residency program accredited by the 106
Accreditation Council for Graduate Medical Education or that is a 107
primary affiliated teaching hospital of a medical school accredited by 108
the Liaison Committee on Medical Education. Such hospital shall 109
verify that the foreign physician or surgeon holds a current valid 110
license in another country; or 111
[(22)] (23) Any person practicing as a nuclear medicine technologist, 112
as defined in section 20-74uu, while performing under the supervision 113
and direction of a physician licensed in accordance with the provisions 114
of this chapter. 115
Sec. 3. Section 20-12a of the general statutes is repealed and the 116
following is substituted in lieu thereof (Effective October 1, 2019): 117
As used in sections 20-12a to 20-12g, inclusive, as amended by this 118
act: 119
(1) "Accredited physician assistant program" means a physician 120
assistant program accredited, at the time of the applicant's graduation, 121
by the Committee on Allied Health Education and Accreditation of the 122
American Medical Association, the Commission on Accreditation of 123
Allied Health Education Programs or such successor organization for 124
the accreditation of physician assistant programs as may be approved 125
by the department. 126
(2) "Board" means the Connecticut Medical Examining Board, 127
established pursuant to section 20-8a, as amended by this act. 128
(3) "Department" means the Department of Public Health. 129
(4) "National commission" means the National Commission on 130
Certification of Physician Assistants or a successor organization for the 131
certification or recertification of physician assistants that may be 132
approved by the department. 133
(5) "Physician assistant" means an individual who: (A) Functions in 134 Raised Bill No. 6942
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[a dependent relationship] collaboration with [a physician] one or 135
more physicians licensed pursuant to this chapter; and (B) is licensed 136
pursuant to section 20-12b, as amended by this act, to provide patient 137
services [under the supervision, control, responsibility and direction of 138
said physician] in collaboration with one or more physicians licensed 139
pursuant to this chapter. 140
[(6) "Supervising physician" means a physician licensed pursuant to 141
this chapter who assumes responsibility for the supervision of services 142
rendered by a physician assistant. 143
(7) (A) "Supervision" in hospital settings means the exercise by the 144
supervising physician of oversight, control and direction of the 145
services of a physician assistant. Supervision includes but is not 146
limited to: (i) Continuous availability of direct communication either in 147
person or by radio, telephone or telecommunications between the 148
physician assistant and the supervising physician; (ii) active and 149
continuing overview of the physician assistant's activities to ensure 150
that the supervising physician's directions are being implemented and 151
to support the physician assistant in the performance of his or her 152
services; (iii) personal review by the supervising physician of the 153
physician assistant's practice on a regular basis as necessary to ensure 154
quality patient care in accordance with a written delegation agreement, 155
as described in subsection (a) of section 20-12d; (iv) review of the 156
charts and records of the physician assistant on a regular basis as 157
necessary to ensure quality patient care; (v) delineation of a 158
predetermined plan for emergency situations; and (vi) designation of 159
an alternate licensed physician in the absence of the supervising 160
physician. 161
(B) "Supervision" in settings other than hospital settings means the 162
exercise by the supervising physician of oversight, control and 163
direction of the services of a physician assistant. Supervision includes, 164
but is not limited to: (i) Continuous availability of direct 165
communication either in person or by radio, telephone or 166
telecommunications between the physician assistant and the 167 Raised Bill No. 6942
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supervising physician; (ii) active and continuing overview of the 168
physician assistant's activities to ensure that the supervising 169
physician's directions are being implemented and to support the 170
physician assistant in the performance of his or her services; (iii) 171
personal review by the supervising physician of the physician 172
assistant's services at a facility or practice location where the physician 173
assistant or supervising physician performs services, in accordance 174
with a written delegation agreement, as described in subsection (a) of 175
section 20-12d, to ensure quality patient care; (iv) review of the charts 176
and records of the physician assistant on a regular basis as necessary to 177
ensure quality patient care and written documentation by the 178
supervising physician of such review at the facility or practice location 179
where the physician assistant or supervising physician performs 180
services; (v) delineation of a predetermined plan for emergency 181
situations; and (vi) designation of an alternate licensed physician in the 182
absence of the supervising physician.] 183
(6) "Collaboration" means the continuous process by which (A) a 184
physician assistant and one or more physicians licensed pursuant to 185
this chapter jointly contribute, pursuant to a written agreement as 186
described in section 20-12d, as amended by this act, to the provision of 187
health care services to a patient, (B) the physician assistant engages in 188
an appropriate level of consultation with such physician or physicians, 189
and (C) the physician assistant provides care to a patient to the fullest 190
extent of his or her education, experience and skill level. 191
(7) "Collaborating physician" means a physician licensed pursuant 192
to this chapter who works in collaboration with a physician assistant. 193
Sec. 4. Subsection (b) of section 20-12b of the general statutes is 194
repealed and the following is substituted in lieu thereof (Effective 195
October 1, 2019): 196
(b) The department may, upon receipt of a fee of one hundred fifty 197
dollars, issue a temporary permit to an applicant who (1) is a graduate 198
of an accredited physician assistant program; (2) has completed not 199 Raised Bill No. 6942
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less than sixty hours of didactic instruction in pharmacology for 200
physician assistant practice approved by the department; and (3) [if 201
applying for such permit on and after September 30, 1991,] holds a 202
baccalaureate or higher degree in any field from a regionally 203
accredited institution of higher education. Such temporary permit shall 204
authorize the holder to practice as a physician assistant only in those 205
settings where [the supervising physician] one or more collaborating 206
physicians is physically present on the premises and is immediately 207
available to the physician assistant when needed, but shall not 208
authorize the holder to prescribe or dispense drugs. Such temporary 209
permit shall be valid for a period not to exceed one hundred twenty 210
calendar days after the date of graduation and shall not be renewable. 211
Such permit shall become void and shall not be reissued in the event 212
that the applicant fails to pass a certification examination scheduled by 213
the national commission following the applicant's graduation from an 214
accredited physician assistant program. Violation of the restrictions on 215
practice set forth in this subsection may constitute a basis for denial of 216
licensure as a physician assistant. 217
Sec. 5. Section 20-12c of the general statutes is repealed and the 218
following is substituted in lieu thereof (Effective October 1, 2019): 219
(a) Each physician assistant practicing in this state or participating 220
in a resident physician assistant program shall have [a clearly 221
identified supervising physician who maintains the final responsibility 222
for the care of patients and the performance of the physician assistant] 223
one or more collaborating physicians. 224
(b) A physician may function as a [supervising physician for as 225
many physician assistants as is medically appropriate under the 226
circumstances, provided the supervision is active and direct] 227
collaborating physician for as many physician assistants as is 228
medically appropriate for the practice setting. 229
(c) Nothing in this chapter shall be construed to [prohibit the 230
employment of physician assistants in a hospital or other health care 231 Raised Bill No. 6942
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facility where such physician assistants function under the direction of 232
a supervising physician] limit an employment arrangement for a 233
physician assistant. 234
(d) Nothing in this chapter shall be construed to prohibit a licensed 235
physician assistant who is (1) part of the Connecticut Disaster Medical 236
Assistance Team or the Medical Reserve Corps, under the auspices of 237
the Department of Public Health, or the Connecticut Urban Search and 238
Rescue Team, under the auspices of the Department of Emergency 239
Services and Public Protection, and is engaged in officially authorized 240
civil preparedness duty or civil preparedness training conducted by 241
such team or corps, or (2) licensed in another state as a physician 242
assistant or its equivalent and is an active member of the Connecticut 243
Army or Air National Guard, from providing patient services [under 244
the supervision, control, responsibility and direction of a licensed 245
physician] in collaboration with one or more collaborating physicians. 246
Sec. 6. Subsection (a) of section 20-12d of the general statutes is 247
repealed and the following is substituted in lieu thereof (Effective 248
October 1, 2019): 249
(a) A physician assistant who has complied with the provisions of 250
sections 20-12b and 20-12c, as amended by this act, [may perform 251
medical functions delegated by a supervising physician when: (1) The 252
supervising physician is satisfied as to the ability and demonstrated 253
competency of the physician assistant; (2) such delegation is consistent 254
with the health and welfare of the patient and in keeping with sound 255
medical practice; and (3) such functions are performed under the 256
oversight, control and direction of the supervising physician. The 257
functions that may be performed under such delegation are those that 258
are within the scope of the supervising physician's license, within the 259
scope of such physician's competence as evidenced by such physician's 260
postgraduate education, training and experience and within the 261
normal scope of such physician's actual practice. Delegated functions 262
shall be implemented in accordance with a written delegation 263
agreement between the supervising physician and the physician 264 Raised Bill No. 6942
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assistant. A supervising physician shall establish the terms of a written 265
delegation agreement that shall include, but not be limited to: (A) A 266
description of the professional relationship between the supervising 267
physician and the physician assistant; (B) identification of the medical 268
services that the physician assistant may perform; (C) a description of 269
the manner in which the physician assistant's prescribing of controlled 270
substances shall be documented in the patient's medical record; and 271
(D) a description of the process for the supervising physician to 272
evaluate the physician assistant's performance, including, but not 273
limited to (i) the frequency with which the supervising physician 274
intends to personally review the physician assistant's practice and 275
performance of delegated medical services, and (ii) a description of the 276
manner in which, and the frequency with which, the supervising 277
physician intends to review the physician assistant's prescription and 278
administration of controlled substances in schedule II or III. A 279
supervising physician in a hospital setting shall reference or include 280
applicable hospital policies, protocols and procedures in the written 281
delegation agreement. The supervising physician shall review the 282
written delegation agreement not less than annually and shall revise 283
such written delegation agreement as the supervising physician deems 284
necessary to reflect any change in the professional relationship 285
between the supervising physician and the physician assistant, the 286
medical services that the physician assistant is authorized to perform 287
or the process for the supervising physician to evaluate the physician 288
assistant's performance. A physician assistant may, as delegated by the 289
supervising physician within the scope of such physician's license, (I) 290
prescribe and administer drugs, including controlled substances in 291
schedule IV or V in all settings, (II) renew prescriptions for controlled 292
substances in schedule II, III, IV or V in all settings, (III) prescribe and 293
administer controlled substances in schedule II or III in all settings, 294
provided in all cases where the physician assistant prescribes a 295
controlled substance in schedule II or III, the physician under whose 296
supervision the physician assistant is prescribing shall document such 297
physician's approval of the order in the patient's medical record in the 298
manner prescribed in the written delegation agreement, and (IV) 299 Raised Bill No. 6942
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prescribe and approve the use of durable medical equipment. The 300
physician assistant may, as delegated by the supervising physician 301
within the scope of such physician's license, request, sign for, receive 302
and dispense drugs to patients, in the form of professional samples, as 303
defined in section 20-14c, or when dispensing in an outpatient clinic as 304
defined in the regulations of Connecticut state agencies and licensed 305
pursuant to subsection (a) of section 19a-491 that operates on a not-for-306
profit basis, or when dispensing in a clinic operated by a state agency 307
or municipality] may perform medical and surgical functions in all 308
settings in collaboration with one or more collaborating physicians as 309
delineated by a written agreement between the physician assistant and 310
such physicians. The written agreement shall include a description of 311
(1) the professional collaborative arrangement between the physician 312
assistant and collaborating physicians, (2) the services that the 313
physician assistant may provide, (3) the ability of the physician 314
assistant to sign all forms that a physician may sign, obtain informed 315
consent, prescribe and administer durable medical equipment and 316
drugs, including, but not limited to, controlled substances in schedules 317
II to V, inclusive, and (4) the ability of the physician assistant to 318
request, sign for, receive and dispense drugs, as defined in section 20-319
14c, in the form of professional samples, as defined in section 20-14c, in 320
accordance with the provisions of sections 20-14d and 20-14e. Nothing 321
in this subsection shall be construed to allow the physician assistant to 322
request, sign for, receive or dispense any drug the physician assistant 323
is not authorized under this subsection to prescribe. 324
Sec. 7. Section 20-12h of the general statutes is repealed and the 325
following is substituted in lieu thereof (Effective October 1, 2019): 326
No person shall participate in a resident physician assistant 327
program until he has received a license or temporary permit issued 328
pursuant to section 20-12b, as amended by this act, or a training permit 329
issued by the department. The training permit shall be issued solely for 330
purposes of participation in postgraduate education as a resident 331
physician assistant in a short-term hospital, as defined in the 332
regulations of Connecticut state agencies and licensed pursuant to 333 Raised Bill No. 6942
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subsection (a) of section 19a-491, that provides a postgraduate medical 334
education program accredited by the Accreditation Council for 335
Graduate Medical Education. No person shall receive a training permit 336
until a statement has been filed with the department on his behalf by 337
the hospital administrator certifying that such person is to be 338
appointed a resident physician assistant in such hospital and that he 339
has satisfied the requirements of subdivisions (1), (2) and (5) of 340
subsection (a) of section 20-12b. Such training permit shall authorize 341
the holder to participate in clinical educational activities only when the 342
[supervising] collaborating physician is physically present on the 343
premises and is immediately available to the physician assistant when 344
needed, but shall not authorize the holder to prescribe or dispense 345
drugs. 346
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2019 20-8a(a)(1)
Sec. 2 October 1, 2019 20-9(b)
Sec. 3 October 1, 2019 20-12a
Sec. 4 October 1, 2019 20-12b(b)
Sec. 5 October 1, 2019 20-12c
Sec. 6 October 1, 2019 20-12d(a)
Sec. 7 October 1, 2019 20-12h
Statement of Purpose:
To allow for a collaborative relationship between physician assistants
and physicians.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]