House Bill 1273
By: Representatives O’Steen of the 169th, Greene of the 154th, Mathiak of the 82nd, Powell
of the 33rd, and Taylor of the 173rd
A BILL TO BE ENTITLED
AN ACT
To amend Article 4 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated,
relating to physician assistants, so as to authorize physician assistants to receive certain
delegated authorities from podiatric physicians; to provide for definitions; to amend
Chapter 35 of Title 43 of the Official Code of Georgia Annotated, relating to podiatry
practice, so as to authorize podiatric physicians to delegate certain authorities to physician
assistants; to provide for definitions; to provide for supervising and alternate supervising
podiatric physicians; to make conforming changes; to provide for new authorities for the
State Board of Podiatry Examiners; to provide for administrative hearings; to provide for
certain procedures and notifications; to provide for job descriptions; to provide for
conforming changes; to provide for related matters; to repeal conflicting laws; and for other
purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 4 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to
physician assistants, is amended by revising Code Section 43-34-102, relating to definitions,
as follows:
"43-34-102.
As used in this article, the term:
<ins>(1) 'Alternate supervising physician' means a physician to whom a board approved
primary supervising physician has delegated the responsibility of supervising a physician
assistant who is licensed to that primary supervising physician and who agrees to
supervise the physician assistant for the primary supervising physician and who is on
record with the board.
(2) 'Alternate supervising podiatric physician' means a podiatric physician to whom a
State Board of Podiatry Examiners approved primary supervising podiatric physician has
delegated the responsibility of supervising a physician assistant who is supervised by that
primary supervising podiatric physician and who agrees to supervise the physician
assistant for the primary supervising podiatric physician and who is on record with the
State Board of Podiatry Examiners.
</ins> <del>(1)(3)</del> 'Applicant' means an individual seeking licensure as a physician assistant pursuant
to this article.
<del>(2) 'Alternate supervising physician' means a physician to whom a board approved
primary supervising physician has delegated the responsibility of supervising a physician
assistant who is licensed to that primary supervising physician and who agrees to
supervise the physician assistant for the primary supervising physician and who is on
record with the board.
(3)(4)</del> 'Board' means the Georgia Composite Medical Board.
<del>(4)(5)</del> 'Job description' means a document, signed by the primary supervising physician
<ins>or supervising podiatric physician</ins> and the physician assistant, in which the primary
supervising physician <ins>or supervising podiatric physician</ins> delegates to that physician
assistant authority to perform certain medical <ins>or podiatric medical</ins> acts and which
describes the professional background and specialty of the primary supervising physician
<ins>or supervising podiatric physician</ins> and the qualifications including related experience of
the physician assistant; and includes a general description of how the physician assistant
will be utilized in the practice. A job description shall not be required to contain every
activity the physician <ins>or podiatric physician</ins> deems the physician assistant qualified to
perform but shall confine the activities of the physician assistant to those in the scope of
practice of the primary supervising physician <ins>or supervising podiatric physician.
</ins> <del>(5)(6)</del> 'Order' means to prescribe pursuant to a job description which drug, medical
device, medical <ins>or podiatric</ins> treatment, or diagnostic study is appropriate for a patient and
to communicate the same in writing, orally, via facsimile, or electronically.
<del>(6)(7)</del> 'Physician' means a person lawfully licensed in this state to practice medicine and
surgery pursuant to Article 2 of this chapter.
<del>(7)(8)</del> 'Physician assistant' means a skilled person who is licensed to a supervising
physician <ins>or supervising podiatric physician</ins> and who is qualified by academic and
practical training to provide patients' services not necessarily within the physical presence
but under the personal direction or supervision of the supervising physician <ins>or
supervising podiatric physician.
(9) 'Podiatric physician' means a physician and surgeon of the human foot and leg who
is licensed in this state pursuant to Chapter 35 of this title.
(8)(10)</ins> 'Prescription drug order' means a written or oral order of a physician assistant for
a drug or medical device for a specific patient. Such term includes an electronic visual
image prescription drug order and an electronic data prescription drug order.
<ins>(9)(11)</ins> 'Primary supervising physician' means the physician to whom the board licenses
a physician assistant pursuant to a board approved job description and who has the
primary responsibility for supervising the practice of a physician assistant pursuant to that
physician assistant's job description.
<ins>(12) 'Primary supervising podiatric physician' means the podiatric physician who has the
primary responsibility for supervising the practice of a physician assistant pursuant to that
physician assistant's job description."
</ins>
SECTION 2.
Said article is further amended by revising Code Section 43-34-103, relating to application
for licensure as a physician assistant, authorized delegating authority, and prohibited acts,
as follows:
"43-34-103.
(a)(1) In order to obtain licensure as a physician assistant, an applicant shall submit an
application to the board. Such application shall include:
(A) Evidence submitted by the applicant of his or her good moral character; and
(B) Evidence of his or her competency in a health care area related to the job
description which, as a minimum, shall include:
(i) Evidence of satisfactory completion of a training program approved by the board.
If the applicant is not a graduate of an accredited school approved by the board, he or
she shall be required to receive board approved refresher training and testing; and
(ii) Evidence that the applicant has passed the Physician Assistant National
Certification Examination (PANCE) administered by the National Commission for
the Certification of Physician Assistants (NCCPA), or its successor, or the National
Association for the Certification of Anesthesia Assistants, (NACAA), or its successor.
The board may issue a temporary permit to any applicant for licensure who has satisfied
the provisions of division (i) of this subparagraph and who is an applicant for the next
available board approved or administered examination or who has completed this
examination and is awaiting the results of such examination. The temporary permit shall
expire upon notification of the applicant's failure to achieve a satisfactory score on the
board approved or administered examination. A physician assistant licensed pursuant to
this paragraph shall not be authorized to perform any medical <ins>or podiatric</ins> acts of any sort
except as approved for utilization by a physician <ins>or podiatric physician, respectively,</ins> in
a job description pursuant to paragraph (2) of this subsection. The board may grant an
inactive licensure status to a physician assistant who is licensed pursuant to this article
but who is not practicing with the supervision of a board approved primary supervising
physician or <ins>a State Board of Podiatry Examiners approved primary supervising podiatric
physician.
</ins> (2) In order to obtain approval for the utilization of a physician assistant, whether the
utilization is in a private practice or through a public or private health care institution or
organization, the licensed physician <ins>or podiatric physician</ins> who will be responsible for
the performance of such physician assistant shall submit an application to the board or
<ins>State Board of Podiatry Examiners, respectively,</ins> which shall include:
(A) Evidence that the physician assistant is licensed pursuant to paragraph (1) of this
subsection;
(B) A job description meeting the requirements of paragraph <del>(4)</del> <ins>(5)</ins> of Code Section
43-34-102; and
(C) A fee, established by the board or <ins>State Board of Podiatry Examiners, respectively;
</ins> provided, however, that no fee will be required if the physician assistant is an employee
of the state or a county government.
(b)(1) No primary supervising physician <ins>or supervising podiatric physician</ins> shall enter
into a job description with a physician assistant pursuant to this Code section or, <ins>in the
case of a physician,</ins> a nurse protocol agreement with an advanced practice registered
nurse pursuant to Code Section 43-34-25, with more than the combined equivalent of
eight physician assistants or advanced practice registered nurses or supervise more than
the combined equivalent of eight physician assistants or, <ins>in the case of a physician,
</ins> advanced practice registered nurses at a time except as provided in paragraph (3) or (4)
of this subsection.
(2) A primary supervising physician <ins>or supervising podiatric physician</ins> shall designate
in writing to the board such other physicians who may serve as an alternate supervising
physician <ins>or supervising podiatric physician</ins> for each physician assistant with which such
primary supervising physician <ins>or supervising podiatric physician</ins> has entered into a job
description. The board shall have authority to approve or deny such designations in
whole or in part; provided, however, that a physician <ins>or podiatric physician</ins> may be listed
as an alternate supervising physician <ins>or supervising podiatric physician</ins> for any number
of physician assistants so long as he or she only supervises as many physician assistants
at any one time as allowed by <ins>paragraph (1) of this subsection in the case of a podiatric
physician or</ins> paragraphs (1) and (3) of this subsection <ins>in the case of a physician.
</ins> (3) No primary supervising physician shall have more than eight physician assistants
who have completed a board approved anesthesiologist assistant program licensed to him
or her at a time or supervise more than four physician assistants who have completed a
board approved anesthesiologist assistant program at any one time.
(4) Except for physician assistants who have completed a board approved
anesthesiologist assistant program, the limitation in paragraph (1) of this subsection shall
not apply to a physician assistant who is practicing:
(A) In a hospital licensed under Title 31;
(B) In any college or university as defined in Code Section 20-8-1;
(C) In the Department of Public Health;
(D) In any county board of health;
(E) In any community service board;
(F) In any free health clinic;
(G) In a birthing center;
(H) In any entity:
(i) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal
Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or
indigent Medicaid and Medicare patients; or
(ii) Which has been established under the authority of or is receiving funds pursuant
to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act; or
(I) In a health maintenance organization that has an exclusive contract with a medical
group practice and arranges for the provision of substantially all physician services to
enrollees in health benefits of the health maintenance organization.
(c)(1) At all times while providing patient services, a physician assistant shall have a
signed job description submitted by his or her primary supervising physician <ins>or
supervising podiatric physician</ins> and approved by the board or <ins>State Board of Podiatry
Examiners, respectively.
</ins> (2) Nothing in this article shall prevent a primary supervising physician <ins>or supervising
podiatric physician</ins> from submitting to the board <ins>or State Board of Podiatry Examiners,
respectively,</ins> a new or amended physician assistant job description.
(3) If a medical <ins>or podiatric</ins> practice has an existing approved job description and an
alternate supervising physician <ins>or supervising podiatric physician</ins> or a change in the
supervising physician <ins>or supervising podiatric physician</ins> within the same or similar
specialty, such new job description for the new alternate supervising physician <ins>or
supervising podiatric physician</ins> or a change in the supervising physician <ins>or supervising
podiatric physician,</ins> upon submission, shall be automatically deemed approved by the
board.
(4) If a primary supervising physician <ins>or supervising podiatric physician</ins> submits a job
description for a new physician assistant and such job description has substantially the
same terms and provisions as a job description previously submitted by such primary
supervising physician <ins>or supervising podiatric physician</ins> for another physician assistant
and approved by the board <ins>or State Board of Podiatry Examiners, respectively,</ins> the job
description for the new physician assistant, upon submission, shall be automatically
deemed approved by the board <ins>or State Board of Podiatry Examiners.
</ins> (d) Nothing in this article shall prohibit the rendering of services to a patient by a
physician assistant who is not in the physical presence of the supervising physician <ins>or
supervising podiatric physician</ins> or preclude a physician assistant from making house calls,
performing hospital duties, serving as an ambulance attendant, or performing any functions
authorized by the supervising physician <ins>or supervising podiatric physician</ins> which the
physician assistant is qualified to perform <ins>and is in the scope of practice of the supervising
physician or supervising podiatric physician.
</ins> (e) A physician assistant may not be utilized to perform the duties of a pharmacist licensed
under Chapter 4 of Title 26, relating to pharmacists.
(e.1)(1)(A) In addition to and without limiting the authority granted by Code Section
43-34-23 <ins>or 43-35-3.1, respectively,</ins> a physician <ins>or podiatric physician</ins> may delegate
to a physician assistant, in accordance with a job description, the authority to issue a
prescription drug order or orders for any device as defined in Code Section 26-4-5 or
to issue any dangerous drug as defined in Code Section 16-13-71, hydrocodone,
oxycodone, or compounds thereof in accordance with subparagraph (B) of this
paragraph, or any Schedule III, IV, or V controlled substance as defined in Code
Section 16-13-21 on a prescription drug order or prescription device order form as
specified in paragraph (3) of this subsection. Delegation of such authority shall be
contained in the job description required by this Code section. The delegating
physician <ins>or podiatric physician</ins> shall remain responsible for the medical <ins>or podiatric
</ins> acts of the physician assistant performing such delegated acts and shall adequately
supervise the physician assistant. If an existing job description for a physician assistant
does not contain such authority to order a prescription drug or device order as provided
by this subsection, that physician assistant may not issue any such prescription drug or
device order until a new job description delegating such authority is submitted to and
approved by the board. Nothing in this Code section shall be construed to authorize the
written prescription drug order of a Schedule I or II controlled substance, except as
authorized pursuant to subparagraph (B) of this paragraph.
(B) A physician <ins>or podiatric physician</ins> may delegate to a physician assistant who has
at least one year of post-licensure clinical experience and is in good standing with the
board the authority to issue prescription drug orders for hydrocodone, oxycodone, or
compounds thereof in emergency situations pursuant to the following requirements:
(i) The authorization is specifically included in the job description;
(ii) The physician assistant has directly evaluated the patient;
(iii) The drug order is limited to an initial prescription not to exceed a five-day
supply; and
(iv) The prescription drug order is for an individual 18 years of age or older.
(2) Nothing in this subsection shall be construed to create a presumption of liability,
either civil or criminal, on the part of a pharmacist who is duly licensed under Title 26
and who in good faith fills a prescription drug or device order presented by a patient
pursuant to this subsection. The pharmacist shall presume that the prescription drug or
device order was issued by a physician assistant duly licensed under this article who has
qualified under this Code section to prescribe pharmaceutical agents. The pharmacist
shall also presume that the pharmaceutical agent prescribed by the physician assistant is
an approved pharmaceutical agent, unless the pharmacist has actual or constructive
knowledge to the contrary.
(3) The physician assistant shall only be authorized to exercise the rights granted under
this subsection using a prescription drug or device order form which includes the name,
address, and telephone number of the prescribing supervising or alternate supervising
physician <ins>or supervising podiatric physician,</ins> the patient's name and address, the drug or
device prescribed, the number of refills, and directions to the patient with regard to the
taking and dosage of the drug. A prescription drug order which is transmitted either
electronically or via facsimile shall conform to the requirements set out in paragraphs (1)
and (2) of subsection (c) of Code Section 26-4-80, respectively. Any form containing
less information than that described in this paragraph shall not be offered to or accepted
by any pharmacist who is duly licensed under Title 26.
(4) Nothing in this Code section shall be construed to authorize a physician assistant to
authorize refills of any drug for more than 12 months from the date of the original
prescription drug or device order.
(5) A supervising physician <ins>or supervising podiatric physician</ins> or alternate supervising
physician <ins>or supervising podiatric physician</ins> shall evaluate or examine, at least every
three months, any patient receiving controlled substances.
(6) In addition to the copy of the prescription drug or device order delivered to the
patient, a record of such prescription shall be maintained in the patient's medical <ins>or
podiatric</ins> record in the following manner:
(A) The physician assistant carrying out a prescription drug or device order shall
document such order either in writing or by electronic means; and
(B) The supervising physician <ins>or supervising podiatric physician</ins> shall periodically
review patient records. Such review may be achieved with a sampling of such records
as determined by the supervising physician <ins>or supervising podiatric physician.
</ins> (7) A physician assistant is not permitted to prescribe drugs or devices except as
authorized in the physician assistant's job description and in accordance with this article.
(8) The board <ins>and State Board of Podiatry Examiners</ins> shall adopt rules establishing
procedures to evaluate an application for a job description containing the authority to
order a prescription drug or device and any other rules the board <ins>or State Board of
Podiatry Examiners deem</ins> <del>deems</del> necessary or appropriate to regulate the practice of
physician assistants <ins>working in the field of medicine or podiatry, respectively,</ins> to carry
out the intent and purpose of this article, or to protect the public welfare.
(9) A physician assistant authorized by a primary supervising physician <ins>or supervising
podiatric physician</ins> to order controlled substances pursuant to this Code section is
authorized to register with the United States Drug Enforcement Administration.
(10)(A) A physician assistant delegated the authority by the primary supervising
physician <ins>or supervising podiatric physician</ins> to issue a prescription drug or device order
shall be required to complete a minimum of three hours of continuing education
biennially in practice specific pharmaceuticals in which the physician assistant has
prescriptive order privileges.
(B) A physician assistant delegated the authority by the primary supervising physician
<ins>or supervising podiatric physician</ins> to issue a prescription drug or device order for
hydrocodone, oxycodone, or compounds thereof shall be required to complete one
additional hour of continuing education biennially in the appropriate ordering and use
of hydrocodone, oxycodone, or compounds thereof.
(11) A managed care system, health plan, hospital, insurance company, or other similar
entity shall not require a physician <ins>or podiatric physician</ins> to be a party to a job description
as a condition for participation in or reimbursement from such entity.
(e.2) A physician assistant may be delegated the authority to request, receive, and sign for
professional samples and may distribute professional samples to patients so long as
delegation of such authority is contained in a job description and the professional samples
are within the specialty of the supervising physician <ins>or supervising podiatric physician.
</ins> The office or facility at which the physician assistant is working must maintain a general
list of professional samples approved by the supervising physician <ins>or supervising podiatric
physician</ins> for request, receipt, and distribution by the physician assistant as well as a
complete list of the specific number and dosage of each professional sample received.
Professional samples that are distributed by a physician assistant shall be so noted in the
patient's medical record. In addition to the requirements of this Code section, all
professional samples shall be maintained as required by applicable state and federal law
and regulations. As used in this subsection, the term 'professional samples' means
complimentary doses of a drug, medication vouchers, or medical devices provided by the
manufacturer for use in patient care.
(f) A physician <ins>or podiatric physician</ins> employed by the Department of Public Health or by
any institution thereof or by a local health department whose duties are administrative in
nature and who does not normally provide health care to patients as such employee shall
not be authorized to apply for or utilize the services of any physician assistant employed
by the Department of Public Health or by any institution thereof or by a local health
department.
(g) Nothing in this article shall be construed to prohibit a physician assistant from
performing those acts the performance of which have been delegated to that physician
assistant pursuant to and in conformity with Code Section 43-34-23 <ins>or 43-35-3.1.
</ins> (h) A physician <ins>or podiatric physician</ins> and a physician assistant may enter into a temporary
practice agreement exempt from any filing fees with the board by which agreement the
physician <ins>or podiatric physician</ins> supervises the services provided by the physician assistant
to patients at a specific facility or program that provides medical services only to indigent
patients in medically underserved or critical need population areas of the state, as
determined by the board, or pursuant to Article 8 of Chapter 8 of Title 31, provided that:
(1) Such services are provided primarily to financially disadvantaged patients;
(2) Such services are free or at a charge to the patient based solely on the patient's ability
to pay and provided, further, that such charges do not exceed the actual cost to the facility
or program;
(3) The supervising physician <ins>or supervising podiatric physician</ins> and the physician
assistant voluntarily and gratuitously donate their services;
(4) Prior to providing any patient services, a copy of the temporary practice agreement,
signed by both the supervising physician <ins>or supervising podiatric physician</ins> and the
physician assistant, is on file at the facility or program and is sent to the board <ins>or State
Board of Podiatry Examiners;
</ins> (5) The temporary practice agreement is for a specified period of time, limits the services
of the physician assistant to those within the usual scope of practice of the supervising
physician <ins>or supervising podiatric physician,</ins> and is signed by both the supervising
physician <ins>or supervising podiatric physician</ins> and the physician assistant prior to the
physician assistant providing patient services; and
(6) The facility or program has notified the board of its intent to provide patient services
and utilize licensed physicians <ins>or podiatric physicians</ins> and physician assistants under the
conditions set out in this subsection.
(i)(1) Notwithstanding any provision of this article to the contrary, a physician assistant
licensed pursuant to this article or licensed, certified, or otherwise authorized to practice
in any other state or federal jurisdiction and whose license, certification, or authorization
is in good standing who responds to a need for medical <ins>or podiatric</ins> care created by
conditions which characterize those of a state of emergency or public health emergency
may render such care that the physician assistant is able to provide with such supervision
as is available at the immediate scene or at the local site where such need for medical <ins>or
podiatric</ins> care exists or at a relief site established as part of a state or local safety plan
established pursuant to Chapter 3 of Title 38. Such services shall be provided by a
physician assistant in response to the request of an appropriate state or local official
implementing a state or local emergency management plan or program, and in accordance
with applicable guidelines established by such officials or plans. The authority granted
by this Code section shall last no longer than 48 hours or such time as the board or <ins>State
Board of Podiatry Examiners</ins> may establish under guidelines for supervision of the
physician assistant rendering medical <ins>or podiatric</ins> care.
(2) For the purposes of this subsection, the term 'public health emergency' has the same
meaning as in paragraph (6) of Code Section 38-3-3, and the term 'state of emergency'
has the same meaning as in paragraph (7) of Code Section 38-3-3.
(j) A physician assistant shall be allowed to make a pronouncement of death pursuant to
authority delegated by the supervising physician of the physician assistant and to certify
such pronouncement in the same manner as a physician, including by signing death
certificates. A selection box shall be added to death certificates to be checked off by
nonphysicians completing the form.
(k) It shall be unlawful for a physician <ins>or podiatric physician</ins> to be an employee of a
physician assistant, alone or in combination with others, if the physician <ins>or podiatric
physician</ins> is required to supervise the physician assistant; provided, however, that this shall
not apply to arrangements of this nature which were approved by the board or <ins>State Board
of Podiatry Examiners</ins> on or before July 1, 2009. Arrangements approved prior to such
date are nontransferable. Such conduct shall be subject to sanctions by the board as to the
physician and the physician assistant <ins>and by the State Board of Podiatry Examiners as to
the podiatric physician and the physician assistant.
</ins> (l) Except for assigning a percentage of a disability rating, a physician assistant may be
delegated the authority to sign, certify, and endorse all documents relating to health care
provided to a patient within his or her scope of authorized practice, including, but not
limited to, documents relating to physical examination forms of all state agencies and
verification and evaluation forms of the Department of Human Services, the State Board
of Education, local boards of education, the Department of Community Health, and the
Department of Corrections."
SECTION 3.
Said article is further amended by revising Code Section 43-34-104, relating to notice of
application approval or disapproval and issuance of license, as follows:
"43-34-104.
(a) Within a reasonable time after receipt of the documents required by this article, the
board <ins>or State Board of Podiatry Examiners</ins> shall give to the applicant written notice of
approval or disapproval of the physician assistant's application; and, if approval of the
application is given, the board <ins>or State Board of Podiatry Examiners, respectively,</ins> shall
issue to the assistant a license authorizing the assistant to perform medical tasks under the
direction and supervision of the physician <ins>or podiatric tasks under the direction and
supervision of the podiatric physician.
</ins> (b) The board <ins>or State Board of Podiatry Examiners</ins> shall not approve an application
unless it finds from the information forwarded with the application that the applicant has
complied with the requirements in this article."
SECTION 4.
Said article is further amended by revising Code Section 43-34-105, relating to performance
of tasks in accordance with job description, as follows:
"43-34-105.
On receipt of notice of <ins>approval by the board or State Board of Podiatry Examiners</ins> <del>the
board's approval,</del> a physician assistant, under the direction of the applying physician <ins>or
podiatric physician,</ins> may perform the tasks described in the job description, provided that
nothing in this Code section shall make unlawful the performance of a medical <ins>or podiatric
</ins> task by the physician assistant, whether or not such task is specified in the general job
description, when it is performed under the direct supervision and in the presence of the
physician <ins>or podiatric physician</ins> utilizing him or her."
SECTION 5.
Said article is further amended by revising Code Section 43-34-106, relating to posting notice
that assistants are being utilized, as follows:
"43-34-106.
Any physician, <ins>podiatric physician,</ins> clinic, or hospital using a physician assistant shall post
a notice to that effect in a prominent place."
SECTION 6.
Said article is further amended by revising Code Section 43-34-107, relating to termination
of approval and revocation of license, notice and hearing, and sanctions, as follows:
"43-34-107.
(a) The approval of a physician's <ins>or podiatric physician's</ins> utilization of a physician assistant
may be terminated <ins>or suspended by the board or State Board of Podiatry Examiners,
respectively,</ins> and the license revoked <ins>or suspended</ins> by the board <ins>or State Board of Podiatry
Examiners, respectively,</ins> when, after due notice and a hearing, in accordance with this Code
section, <del>it</del> <ins>and other relevant law, the board or the State Board of Podiatry Examiners</ins> shall
find that the assistant is incompetent or has committed unethical or immoral acts, including,
but not limited to, holding himself or herself out or permitting another to represent him or
her as a licensed physician <ins>or podiatric physician;</ins> performing otherwise than at the
direction of a physician <ins>or podiatric physician</ins> approved by the board <ins>or State Board of
Podiatry Examiners</ins> to utilize the assistant's services; habitually using intoxicants or drugs
to such an extent that he or she is unable safely to perform as an assistant to the physician
<ins>or podiatric physician;</ins> or being convicted in any court, state or federal, of any felony or
other criminal offense involving moral turpitude.
(b) Before the board <ins>or State Board of Podiatry Examiners</ins> shall give written notice to the
physician assistant of termination of approval granted by it to an assistant, it will give to
the assistant a timely and reasonable written notice indicating the general nature of the
charges, accusation, or complaint preferred against him <ins>or her</ins> and stating that the assistant
will be given an opportunity to be heard concerning such charges or complaints; and it shall
hold a public hearing within a reasonable time. Following such hearing, the board <ins>or State
Board of Podiatry Examiners</ins> shall determine, on the basis of its <ins>respective</ins> regulations <ins>and
other relevant law,</ins> whether the approval of the assistant shall be terminated <ins>and, with
regard to the board, whether the assistant's license shall also be revoked or suspended.
</ins>
(c) In hearings held pursuant to this Code section, the board <ins>and the State Board of
Podiatry Examiners</ins> shall apply the rules of evidence as prescribed in Chapter 13 of Title
50, the 'Georgia Administrative Procedure Act.'
<ins>(d) The State Board of Podiatry Examiners may also issue a private reprimand letter to a
physician assistant working in the field of podiatry. The issuance of such letter shall not
be considered a contested case within the meaning of Chapter 13 of Title 50, the 'Georgia
Administrative Procedure Act'; notice and hearing within the meaning of said chapter shall
not be required, but the assistant shall be allowed to appear before the State Board of
Podiatry Examiners if he or she so requests. Such letter shall not be considered a
disciplinary action or a contested case under Chapter 13 of Title 50, the 'Georgia
Administrative Procedure Act,' and shall not be disclosed to any person except the
physician's assistant.
(e) In the event that the State Board of Podiatry Examiners terminates or suspends the
approval described in subsection (a) this Code section of a physician assistant working in
the field of podiatry, the State Board of Podiatry Examiners shall notify the board of such
action.
</ins> <del>(e)(f)</del> The board may impose on a physician assistant any sanction authorized under
subsection (b) of Code Section 43-34-8 upon a finding of any conduct specified in
subsection (a) of Code Section 43-34-8."
SECTION 7.
Said article is further amended by revising Code Section 43-34-108, relating to powers and
duties of the board, as follows:
"43-34-108.
In addition to the powers specifically delegated to it in this article, the board <ins>and the State
Board of Podiatry Examiners</ins> shall have the authority to perform all acts which are
necessary, proper, or incidental to the efficient development of the category of health care
established by this article <ins>and with regard to the State Board of Podiatry Examiners, such
category of health care as it may relate to the field of podiatry.</ins> The board <ins>and the State
Board of Podiatry Examiners</ins> shall have the authority to promulgate rules and regulations
governing the definitions of delegation by physicians <ins>and podiatric physicians,
respectively,</ins> to qualified persons other than physician assistants of any acts, duties, or
functions which are permitted by law or established by custom. Any power vested by law
in the board <ins>or the State Board of Podiatry Examiners,</ins> but not implemented by specific
provisions for the exercise thereof, may be executed and carried out by the board or <ins>the
State Board of Podiatry Examiners</ins> in a reasonable manner, pursuant to such rules,
regulations, and procedures as the board <ins>or the State Board of Podiatry Examiners</ins> may
adopt and subject to such limitations as may be provided by law. <ins>The board shall cooperate
with the State Board of Podiatry Examiners to ensure the protection of the public and
compliance with state law governing the conduct of physician assistants working in the
field of podiatry."
</ins> SECTION 8.
Said article is further amended by revising Code Section 43-34-109, relating to involvement
of supervising physician in patient's care, as follows:
"43-34-109.
When a patient receives medical <ins>or podiatric</ins> services from a physician assistant, the
supervising physician's <ins>or podiatric physician's</ins> involvement in the patient's care, including
patient evaluation and follow-up care by the supervising physician <ins>or supervising podiatric
physician,</ins> shall be appropriate to the nature of the practice and the acuity of the patient's
medical <ins>or podiatric</ins> issue, as determined by the supervising physician <ins>or supervising
podiatric physician."
</ins>
SECTION 9.
Chapter 35 of Title 43 of the Official Code of Georgia Annotated, relating to podiatry
practice, is amended by revising Code Section 43-35-3, relating to definitions, as follows:
"43-35-3.
As used in this chapter, the term:
<ins>(1) 'Administer' means to give a unit dose of any drug or to perform any podiatric
medical treatment or diagnostic study.
</ins> <del>(1)(2)</del> 'Board' means the State Board of Podiatry Examiners.
<ins>(3) 'Controlled substance' means any controlled substance, as defined in Code Section
16-13-21, except any Schedule I controlled substance listed in Code Section 16-13-25.
(4) 'Dangerous drug' means any dangerous drug, as defined in Code Section 16-13-71,
but does not include any controlled substance, as defined in Code Section 16-13-21, or
Schedule I controlled substance listed in Code Section 16-13-25.
(5) 'Dispense' means to issue one or more doses of any drug in a suitable container with
appropriate labeling for subsequent administration to, or use by, a patient.
(6) 'Dispensing procedure' means a written document that is signed by a licensed
pharmacist and a licensed physician and that establishes the appropriate manner under
which drugs may be dispensed pursuant to this Code section.
(7) 'Drug' means any dangerous drug or controlled substance.
(8) 'Job description' means a document, signed by the primary supervising podiatric
physician and the physician assistant, in which the primary supervising podiatric
physician delegates to that physician assistant authority to perform certain podiatric acts
and which describes the professional background and specialty of the primary supervising
podiatric physician and the qualifications including related experience of the physician
assistant; and includes a general description of how the physician assistant will be utilized
in the practice. A job description shall not be required to contain every activity the
podiatric physician deems the physician assistant qualified to perform but shall confine
</ins>
<ins>the activities of the physician assistant to those in the scope of practice of the primary
supervising podiatric physician.
</ins> <del>(2)(9)</del> 'License' means a valid and current certificate of registration issued by the division
director on behalf of the board which shall give the person to whom it is issued authority
to engage in the practice prescribed thereon.
<ins>(3)(10)</ins> 'Licensee' means one who holds a license under this chapter.
<ins>(11) 'Order' means to select a drug, medical treatment, or diagnostic study through
podiatric physician delegation in accordance with a physician assistant's job description.
Ordering under such delegation shall not be construed to be prescribing nor shall ordering
of a drug be construed to authorize the issuance of a written prescription.
(4)(12)</ins> 'Person' means a human person only.
<ins>(13) 'Physician assistant' means a skilled person who is:
(A) Licensed as a physician assistant pursuant to Article 4 of Chapter 34 of this title,
the 'Physician Assistant Act';
(B) Approved by the board to work under a supervising podiatric physician; and
(C) Qualified by academic and practical training to provide patient services not
necessarily within the physical presence but under the personal direction or supervision
of the supervising podiatric physician.
(5)(14)</ins> 'Podiatric medicine,' which includes chiropody, podiatry, and podiatric medicine
and surgery, means that portion of the practice of medicine identified by the acts
described in any one or more of the following:
(A) Charging a fee or other compensation, either directly or indirectly, for any history
or physical examination of a patient in a person's office or in a hospital, clinic, or other
similar facility prior to, incident to, and necessary for the diagnosis and treatment, by
primary medical care, surgical or other means, of diseases, ailments, injuries, cosmetic
conditions, or abnormal conditions of the human foot and leg. As used in this
subparagraph, the term 'cosmetic' means a surgical or medical procedure intended to
enhance the physical appearance or function of the foot, ankle, or leg, including, but not
limited to, skin problems such as blemishes, spider veins, and scar revisions;
(B) Holding oneself out to the public, either directly or indirectly, as being engaged in
the practice of podiatric medicine;
(C) Displaying or using a title or abbreviation such as 'Doctor of Podiatric Medicine,'
'D.P.M.,' 'Foot Doctor,' 'Foot Specialist,' 'Foot Surgeon,' 'Foot and Ankle Surgeon,' or
other letters, designations, or symbols or signs of any type which expressly or implicitly
indicate to the general public that the user renders treatment to the foot, ankle, and leg
under the provisions of this chapter;
(D) Performing surgery on the foot or leg of a patient, except that when such surgery
is performed under general anesthesia it shall be permissible only when said surgery is
performed at a facility permitted and regulated as a hospital or ambulatory surgical
treatment center under Article 1 of Chapter 7 of Title 31 and when said general
anesthesia is administered under the direction of a duly licensed physician;
(E) Performing amputations of the toe; or
(F) Performing amputations distal to and including the tarsometatarsal joint but only
when performed in a facility permitted and regulated as a hospital or ambulatory
surgical treatment center under Article 1 of Chapter 7 of Title 31.
<ins>(15) 'Podiatric physician' means a physician and surgeon of the human foot and leg who
is subject to this chapter.
(6)(16)</ins> 'Podiatric resident' means a person who is engaged in a postgraduate program of
study or practice within this state approved by the board.
<del>(7) 'Podiatrist' means a physician and surgeon of the human foot and leg who is subject
to this chapter.
</del> <ins>(17) 'Prescription drug order' means a written or oral order of a physician assistant for
a drug or medical device for a specific patient. Such term includes an electronic visual
image prescription drug order and an electronic data prescription drug order.
</ins>
<ins>(18) 'Primary supervising podiatric physician' means the podiatric physician to whom the
Georgia Composite Medical Board licenses a physician assistant pursuant to a board
approved job description and who has the primary responsibility for supervising the
practice of a physician assistant pursuant to that physician assistant's job description."
</ins> SECTION 10.
Said chapter is further amended by adding a new Code section to read as follows:
<ins>"43-35-3.1.
(a)(1)(A) A podiatric physician may delegate the authority contained in subparagraph
(B) of this paragraph to a physician assistant in accordance with a job description.
(B) A podiatric physician may delegate to an authorized physician assistant:
(i) The authority to order controlled substances selected from a formulary of such
drugs established by the board and the authority to order dangerous drugs, podiatric
treatments, and diagnostic studies;
(ii) The authority to request, receive, and sign for professional samples and to
distribute professional samples to patients. The office or facility at which the
physician assistant is working shall maintain a general list of the professional samples
approved by the delegating podiatric physician for request, receipt, and distribution
by the podiatric physician as well as a complete list of the specific number and dosage
of each professional sample and medication voucher received. Professional samples
that are distributed by such physician assistant shall be so noted in the patient's
podiatric medical record. In addition to the requirements of this Code section, all
professional samples shall be maintained as required by applicable state and federal
laws and regulations; and
(iii) The authority to sign, certify, and endorse all documents relating to podiatric
healthcare provided to a patient within his or her scope of authorized practice.
</ins>
<ins>(2) A podiatric physician may delegate to a physician assistant the authority to order
dangerous drugs, podiatric treatments, or diagnostic studies and a physician assistant is
authorized to dispense dangerous drugs, in accordance with a dispensing procedure and
under the authority of an order issued in conformity with a job description:
(A) As an agent or employee of any organization:
(i) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal
Revenue Code, as defined in Code Section 48-1-2, other than an organization which
is a hospital, preferred provider organization, health maintenance organization, or
similar organization; or
(ii) Established under the authority of or a community health center receiving funds
pursuant to 42 U.S.C. Section 330 of the United States Public Health Service Act, if
such center has determined that podiatric services qualify as an additional health
service needed to meet the community's needs,
which organization provides that those services and dangerous drugs which are ordered
or dispensed by its physician assistants will be provided at no cost to the patient or at
a cost based solely upon the patient's ability to pay; and
(B) In conformity with subsection (b) of Code Section 26-4-130 and the rules and
regulations established pursuant thereto by the State Board of Pharmacy.
(3) In addition, a podiatric physician may delegate to a physician assistant the authority
to order dangerous drugs, medical treatments, or diagnostic studies and a physician
assistant is authorized to dispense dangerous drugs, in accordance with a dispensing
procedure and under the authority of an order issued in conformity with a job description,
if that physician assistant orders or dispenses such drugs, treatments, or studies to a
patient of an outpatient clinic:
(A) Which is owned or operated by a licensed hospital;
</ins>
<ins>(B) Which provides such drugs, treatments, or studies free or at a charge to the patient
based solely upon the patient's ability to pay; provided, however, that such charge shall
not exceed the actual cost to the outpatient clinic; and
(C) Whose services are primarily provided to the medically disadvantaged
and that physician assistant orders or dispenses such drugs in conformity with
subsection (b) of Code Section 26-4-130 and the rules and regulations established
pursuant thereto by the State Board of Pharmacy.
(4) Delegation of authority to a physician assistant pursuant to this subsection shall be
authorized only if that delegation is contained in the job description approved for that
physician assistant by the board.
(b) The board is authorized to promulgate rules and regulations governing podiatric
physicians and physician assistants to carry out the intents and purposes of this Code
section, including, but not limited to, establishing criteria and standards governing podiatric
physicians, physician assistants, and job descriptions. The board shall be authorized to
require that job descriptions not falling within such established criteria and standards be
submitted to the board for review and approval or rejection.
(c) Notwithstanding any other provision of law to the contrary, a physician assistant may
perform any act authorized to be performed by that person pursuant to and in conformity
with this chapter without such act constituting the practice of podiatry or medicine.
(d) Nothing in this Code section shall be construed to limit or repeal any Code section in
Chapter 34 of this title, relating to physicians, osteopathic physicians, physician assistants,
and others.
(e) Nothing in this Code section shall be construed to limit or repeal any existing authority
of a licensed physician to delegate to a physician assistant any acts, duties, or functions
which are otherwise permitted by law or established by custom.
(f) Nothing in this Code section shall be construed to authorize or permit the issuance of
a United States Drug Enforcement Administration license to a physician assistant who does
</ins>
<ins>not meet the qualifications described in division (i) or (ii) of subparagraph (b)(2)(A) of this
Code section.
(g) Nothing in this Code section shall be construed to limit or repeal the authority of any
organization established under the authority of or receiving funds pursuant to 42 U.S.C.
Section 330 of the United States Public Health Service Act, to supervise its agents or
employees or interfere with the employer and employee relationship of any such agents or
employees.
(h) Notwithstanding any other provision of law to the contrary, a physician assistant may
perform any act deemed necessary to provide treatment to a hospital or nursing home
patient in a life-threatening situation when such act is authorized by standing procedures
established by the medical staff of the hospital or nursing home."
</ins> SECTION 11.
Said chapter is further amended by adding a new Code section to read as follows:
<ins>"43-35-11.1.
(a) The authority of a podiatric physician to delegate tasks to a physician assistant shall not
become effective until the Georgia Composite Medical Board has licensed a person in
accordance with Code Section 43-34-103 and the requirements of this chapter are met.
(b) The board shall cooperate with the Georgia Composite Medical Board to ensure the
protection of the public and compliance with state law governing the conduct of physician
assistants working in the field of podiatry."
</ins> SECTION 12.
All laws and parts of laws in conflict with this Act are repealed.