HB1273: HB1273 Professions and businesses; authorize physician assistants to receive certain delegated authorities from podiatric physicians

26 LC 46 1294 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 Co de of Georgia Annotated,1 relating to physician assistants, so as to authorize physician assistants to receive certain2 delegated authorities from podiatri c physicians; to provide for definitions; to amend3 Chapter 35 of Title 43 of the Official Code of Georgia Annotate d, relating to podiatry4 practice, so as to authorize podiatric physicians to delegate certain authorities to physician5 assistants; to provide for definitions; to provide for supervis ing and alternate supervising6 podiatric physicians; to make conforming changes; to provide fo r new authorities for the7 State Board of Podiatry Examiners; to provide for administrativ e hearings; to provide for8 certain procedures and notifications; to provide for job descri ptions; to provide for9 conforming changes; to provide for related matters; to repeal conflicting laws; and for other10 purposes.11 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12 SECTION 1.13 Article 4 of Chapter 34 of Title 43 of the Official Code of Geo rgia Annotated, relating to14 physician assistants, is amended by revising Code Section 43-34-102, relating to definitions,15 as follows:16 H. B. 1273 - 1 - 26 LC 46 1294 "43-34-102.17 As used in this article, the term:18 (1) 'Alternate supervising physician' means a physician to who m a board approved19 primary supervising physician has delegated the responsibility of supervising a physician20 assistant who is licensed to that primary supervising physician and who agrees to21 supervise the physician assistant for the primary supervising p hysician and who is on22 record with the board.23 (2) 'Alternate supervising podiatric physician' means a podiat ric physician to whom a24 State Board of Podiatry Examiners approved primary supervising podiatric physician has25 delegated the responsibility of supervising a physician assistant who is supervised by that26 primary supervising podiatric physician and who agrees to super vise the physician27 assistant for the primary supervising podiatric physician and who is on record with the28 State Board of Podiatry Examiners.29 (1)(3) 'Applicant' means an individual seeking licensure as a physician assistant pursuant30 to this article.31 (2) 'Alternate supervising physician' means a physician to who m a board approved32 primary supervising physician has delegated the responsibility of supervising a physician33 assistant who is licensed to that primary supervising physician and who agrees to34 supervise the physician assistant for the primary supervising p hysician and who is on35 record with the board.36 (3)(4) 'Board' means the Georgia Composite Medical Board.37 (4)(5) 'Job description' means a document, signed by the primary supervising physician38 or supervising podiatric physician and the physician assistant, in which the primary39 supervising physician or supervising podiatric physician delegates to that physician40 assistant authority to perform certain medical or podiatric med ical acts and which41 describes the professional background and specialty of the primary supervising physician42 or supervising podiatric physician and the qualifications including related experience of43 H. B. 1273 - 2 - 26 LC 46 1294 the physician assistant; and includes a general description of how the physician assistant44 will be utilized in the practice. A job description shall not be required to contain every45 activity the physician or podiatric physician deems the physician assistant qualified to46 perform but shall confine the activities of the physician assistant to those in the scope of47 practice of the primary supervising physician or supervising podiatric physician.48 (5)(6) 'Order' means to prescribe pursuant to a job description whic h drug, medical49 device, medical or podiatric treatment, or diagnostic study is appropriate for a patient and50 to communicate the same in writing, orally, via facsimile, or electronically.51 (6)(7) 'Physician' means a person lawfully licensed in this state to practice medicine and52 surgery pursuant to Article 2 of this chapter.53 (7)(8) 'Physician assistant' means a skilled person who is licensed to a supervising54 physician or supervising podiatric physician and who is qualified by academic and55 practical training to provide patients' services not necessarily within the physical presence56 but under the personal direction or supervision of the supervis ing physician or57 supervising podiatric physician.58 (9) 'Podiatric physician' means a physician and surgeon of the human foot and leg who59 is licensed in this state pursuant to Chapter 35 of this title.60 (8)(10) 'Prescription drug order' means a written or oral order of a physician assistant for61 a drug or medical device for a specific patient. Such term includes an electronic visual62 image prescription drug order and an electronic data prescription drug order.63 (9)(11) 'Primary supervising physician' means the physician to whom the board licenses64 a physician assistant pursuant to a board approved job descript ion and who has the65 primary responsibility for supervising the practice of a physician assistant pursuant to that66 physician assistant's job description.67 (12) 'Primary supervising podiatric physician' means the podiatric physician who has the68 primary responsibility for supervising the practice of a physician assistant pursuant to that69 physician assistant's job description."70 H. B. 1273 - 3 - 26 LC 46 1294 SECTION 2.71 Said article is further amended by revising Code Section 43-34-103, relating to application72 for licensure as a physician assistant, authorized delegating a uthority, and prohibited acts,73 as follows:74 "43-34-103.75 (a)(1) In order to obtain licensure as a physician assistant, an applicant shall submit an76 application to the board. Such application shall include:77 (A) Evidence submitted by the applicant of his or her good moral character; and78 (B) Evidence of his or her competency in a health care area re lated to the job79 description which, as a minimum, shall include:80 (i) Evidence of satisfactory completion of a training program approved by the board. 81 If the applicant is not a graduate of an accredited school approved by the board, he or82 she shall be required to receive board approved refresher training and testing; and83 (ii) Evidence that the applicant has passed the Physician Assi stant National84 Certification Examination (PANCE) administered by the National Commission for85 the Certification of Physician Assistants (NCCPA), or its successor, or the National86 Association for the Certification of Anesthesia Assistants, (NACAA), or its successor.87 The board may issue a temporary permit to any applicant for licensure who has satisfied88 the provisions of division (i) of this subparagraph and who is an applicant for the next89 available board approved or administered examination or who has completed this90 examination and is awaiting the results of such examination. The temporary permit shall91 expire upon notification of the applicant's failure to achieve a satisfactory score on the92 board approved or administered examination. A physician assistant licensed pursuant to93 this paragraph shall not be authorized to perform any medical or podiatric acts of any sort94 except as approved for utilization by a physician or podiatric physician, respectively, in95 a job description pursuant to paragraph (2) of this subsection. The board may grant an96 inactive licensure status to a physician assistant who is licensed pursuant to this article97 H. B. 1273 - 4 - 26 LC 46 1294 but who is not practicing with the supervision of a board approved primary supervising98 physician or a State Board of Podiatry Examiners approved primary supervising podiatric99 physician.100 (2) In order to obtain approval for the utilization of a physi cian assistant, whether the101 utilization is in a private practice or through a public or private health care institution or102 organization, the licensed physician or podiatric physician who will be responsible for103 the performance of such physician assistant shall submit an app lication to the board or104 State Board of Podiatry Examiners, respectively, which shall include:105 (A) Evidence that the physician assistant is licensed pursuant to paragraph (1) of this106 subsection;107 (B) A job description meeting the requirements of paragraph (4) (5) of Code Section108 43-34-102; and109 (C) A fee, established by the board or State Board of Podiatry Examiners, respectively;110 provided, however, that no fee will be required if the physician assistant is an employee111 of the state or a county government.112 (b)(1) No primary supervising physician or supervising podiatric physician shall enter113 into a job description with a physician assistant pursuant to this Code section or, in the114 case of a physician, a nurse protocol agreement with an advanced practice registere d115 nurse pursuant to Code Section 43-34-25, with more than the combined equivalent of116 eight physician assistants or advanced practice registered nurses or supervise more than117 the combined equivalent of eight physician assistants or, in th e case of a physician,118 advanced practice registered nurses at a time except as provided in paragraph (3) or (4)119 of this subsection.120 (2) A primary supervising physician or supervising podiatric physician shall designate121 in writing to the board such other physicians who may serve as an alternate supervising122 physician or supervising podiatric physician for each physician assistant with which such123 primary supervising physician or supervising podiatric physician has entered into a job124 H. B. 1273 - 5 - 26 LC 46 1294 description. The board shall have authority to approve or deny such designations in125 whole or in part; provided, however, that a physician or podiatric physician may be listed126 as an alternate supervising physician or supervising podiatric physician for any number127 of physician assistants so long as he or she only supervises as many physician assistants128 at any one time as allowed by paragraph (1) of this subsection in the case of a podiatric129 physician or paragraphs (1) and (3) of this subsection in the case of a physician.130 (3) No primary supervising physician shall have more than eigh t physician assistants131 who have completed a board approved anesthesiologist assistant program licensed to him132 or her at a time or supervise more than four physician assistants who have completed a133 board approved anesthesiologist assistant program at any one time.134 (4) Except for physician assistants who have completed a board approved135 anesthesiologist assistant program, the limitation in paragraph (1) of this subsection shall136 not apply to a physician assistant who is practicing:137 (A) In a hospital licensed under Title 31;138 (B) In any college or university as defined in Code Section 20-8-1;139 (C) In the Department of Public Health;140 (D) In any county board of health;141 (E) In any community service board;142 (F) In any free health clinic;143 (G) In a birthing center;144 (H) In any entity:145 (i) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal146 Revenue Code, as defined in Code Section 48-1-2, and primarily serves uninsured or147 indigent Medicaid and Medicare patients; or148 (ii) Which has been established under the authority of or is receiving funds pursuant149 to 42 U.S.C. Section 254b or 254c of the United States Public Health Service Act; or150 H. B. 1273 - 6 - 26 LC 46 1294 (I) In a health maintenance organization that has an exclusive contract with a medical151 group practice and arranges for the provision of substantially all physician services to152 enrollees in health benefits of the health maintenance organization.153 (c)(1) At all times while providing patient services, a physic ian assistant shall have a154 signed job description submitted by his or her primary supervis ing physician or155 supervising podiatric physician and approved by the board or State Board of Podiatry156 Examiners, respectively.157 (2) Nothing in this article shall prevent a primary supervising physician or supervising158 podiatric physician from submitting to the board or State Board of Podiatry Examiners,159 respectively, a new or amended physician assistant job description.160 (3) If a medical or podiatric practice has an existing approved job description and an161 alternate supervising physician or supervising podiatric physic ian or a change in the162 supervising physician or supervising podiatric physician within the same or similar163 specialty, such new job description for the new alternate super vising physician or164 supervising podiatric physician or a change in the supervising physician or supervising165 podiatric physician, upon submission, shall be automatically deemed approved by th e166 board.167 (4) If a primary supervising physician or supervising podiatric physician submits a job168 description for a new physician assistant and such job descript ion has substantially the169 same terms and provisions as a job description previously submi tted by such primary170 supervising physician or supervising podiatric physician for another physician assistant171 and approved by the board or State Board of Podiatry Examiners, respectively, the job172 description for the new physician assistant, upon submission, s hall be automatically173 deemed approved by the board or State Board of Podiatry Examiners.174 (d) Nothing in this article shall prohibit the rendering of se rvices to a patient by a175 physician assistant who is not in the physical presence of the supervising physician or176 supervising podiatric physician or preclude a physician assistant from making house calls,177 H. B. 1273 - 7 - 26 LC 46 1294 performing hospital duties, serving as an ambulance attendant, or performing any functions178 authorized by the supervising physician or supervising podiatri c physician w h i c h t h e179 physician assistant is qualified to perform and is in the scope of practice of the supervising180 physician or supervising podiatric physician.181 (e) A physician assistant may not be utilized to perform the duties of a pharmacist licensed182 under Chapter 4 of Title 26, relating to pharmacists.183 (e.1)(1)(A) In addition to and without limiting the authority granted by Code Section184 43-34-23 or 43-35-3.1, respectively, a physician or podiatric physician may delegate185 to a physician assistant, in accordance with a job description, the authority to issue a186 prescription drug order or orders for any device as defined in Code Section 26-4-5 or187 to issue any dangerous drug as defined in Code Section 16-13-71 , hydrocodone,188 oxycodone, or compounds thereof in accordance with subparagraph ( B ) o f t h i s189 paragraph, or any Schedule III, IV, or V controlled substance a s defined in Code190 Section 16-13-21 on a prescription drug order or prescription d evice order form as191 specified in paragraph (3) of this subsection. Delegation of s uch authority shall be192 contained in the job description required by this Code section. T h e d e l e g a t i n g193 physician or podiatric physician shall remain responsible for the medical or podiatric194 acts of the physician assistant performing such delegated acts and shall adequately195 supervise the physician assistant. If an existing job description for a physician assistant196 does not contain such authority to order a prescription drug or device order as provided197 by this subsection, that physician assistant may not issue any such prescription drug or198 device order until a new job description delegating such authority is submitted to and199 approved by the board. Nothing in this Code section shall be construed to authorize the200 written prescription drug order of a Schedule I or II controlle d substance, except as201 authorized pursuant to subparagraph (B) of this paragraph.202 (B) A physician or podiatric physician may delegate to a physician assistant who has203 at least one year of post-licensure clinical experience and is in good standing with the204 H. B. 1273 - 8 - 26 LC 46 1294 board the authority to issue prescription drug orders for hydrocodone, oxycodone, or205 compounds thereof in emergency situations pursuant to the following requirements:206 (i) The authorization is specifically included in the job description;207 (ii) The physician assistant has directly evaluated the patient;208 (iii) The drug order is limited to an initial prescription not to exceed a five-day209 supply; and210 (iv) The prescription drug order is for an individual 18 years of age or older.211 (2) Nothing in this subsection shall be construed to create a presumption of liability,212 either civil or criminal, on the part of a pharmacist who is du ly licensed under Title 26213 and who in good faith fills a prescription drug or device order presented by a patient214 pursuant to this subsection. The pharmacist shall presume that the prescription drug or215 device order was issued by a physician assistant duly licensed under this article who has216 qualified under this Code section to prescribe pharmaceutical a gents. The pharmacist217 shall also presume that the pharmaceutical agent prescribed by the physician assistant is218 an approved pharmaceutical agent, unless the pharmacist has act ual or constructive219 knowledge to the contrary.220 (3) The physician assistant shall only be authorized to exercise the rights granted under221 this subsection using a prescription drug or device order form which includes the name,222 address, and telephone number of the prescribing supervising or alternate supervising223 physician or supervising podiatric physician, the patient's name and address, the drug or224 device prescribed, the number of refills, and directions to the patient with regard to the225 taking and dosage of the drug. A prescription drug order which is transmitted either226 electronically or via facsimile shall conform to the requirements set out in paragraphs (1)227 and (2) of subsection (c) of Code Section 26-4-80, respectively . Any form containing228 less information than that described in this paragraph shall not be offered to or accepted229 by any pharmacist who is duly licensed under Title 26.230 H. B. 1273 - 9 - 26 LC 46 1294 (4) Nothing in this Code section shall be construed to authorize a physician assistant to231 authorize refills of any drug for more than 12 months from the date of the original232 prescription drug or device order.233 (5) A supervising physician or supervising podiatric physician or alternate supervising234 physician or supervising podiatric physician shall evaluate or examine, at least every235 three months, any patient receiving controlled substances.236 (6) In addition to the copy of the prescription drug or device order delivered to the237 patient, a record of such prescription shall be maintained in t he patient's medical or238 podiatric record in the following manner:239 (A) The physician assistant carrying out a prescription drug o r device order shall240 document such order either in writing or by electronic means; and241 (B) The supervising physician or supervising podiatric physici an shall periodically242 review patient records. Such review may be achieved with a sampling of such records243 as determined by the supervising physician or supervising podiatric physician.244 (7) A physician assistant is not permitted to prescribe drugs or devices except as245 authorized in the physician assistant's job description and in accordance with this article.246 (8) The board and State Board of Podiatry Examiners shall adopt rules establishing247 procedures to evaluate an application for a job description con taining the authority to248 order a prescription drug or device and any other rules the boa rd or State Board of249 Podiatry Examiners deem deems necessary or appropriate to regulate the practice of250 physician assistants working in the field of medicine or podiatry, respectively, to carry251 out the intent and purpose of this article, or to protect the public welfare.252 (9) A physician assistant authorized by a primary supervising physician or supervising253 podiatric physician to order controlled substances pursuant to this Code section i s254 authorized to register with the United States Drug Enforcement Administration.255 (10)(A) A physician assistant delegated the authority by the p rimary supervising256 physician or supervising podiatric physician to issue a prescription drug or device order257 H. B. 1273 - 10 - 26 LC 46 1294 shall be required to complete a minimum of three hours of conti nuing education258 biennially in practice specific pharmaceuticals in which the ph ysician assistant has259 prescriptive order privileges.260 (B) A physician assistant delegated the authority by the primary supervising physician261 or supervising podiatric physician to issue a prescription drug or device order for262 hydrocodone, oxycodone, or compounds thereof shall be required to complete one263 additional hour of continuing education biennially in the appropriate ordering and use264 of hydrocodone, oxycodone, or compounds thereof.265 (11) A managed care system, health plan, hospital, insurance company, or other similar266 entity shall not require a physician or podiatric physician to be a party to a job description267 as a condition for participation in or reimbursement from such entity.268 (e.2) A physician assistant may be delegated the authority to request, receive, and sign for269 professional samples and may distribute professional samples to patients so long as270 delegation of such authority is contained in a job description and the professional samples271 are within the specialty of the supervising physician or superv ising podiatric physician. 272 The office or facility at which the physician assistant is working must maintain a general273 list of professional samples approved by the supervising physician or supervising podiatric274 physician for request, receipt, and distribution by the physician assist ant as well as a275 complete list of the specific number and dosage of each profess ional sample received. 276 Professional samples that are distributed by a physician assistant shall be so noted in the277 patient's medical record. In addition to the requirements of t his Code section, all278 professional samples shall be maintained as required by applica ble state and federal law279 and regulations. As used in this subsection, the term 'profess ional samples' means280 complimentary doses of a drug, medication vouchers, or medical devices provided by the281 manufacturer for use in patient care.282 (f) A physician or podiatric physician employed by the Department of Public Health or by283 any institution thereof or by a local health department whose duties are administrative in284 H. B. 1273 - 11 - 26 LC 46 1294 nature and who does not normally provide health care to patients as such employee shall285 not be authorized to apply for or utilize the services of any physician assistant employed286 by the Department of Public Health or by any institution thereo f or by a local health287 department.288 (g) Nothing in this article shall be construed to prohibit a p hysician assistant from289 performing those acts the performance of which have been delega ted to that physician290 assistant pursuant to and in conformity with Code Section 43-34-23 or 43-35-3.1.291 (h) A physician or podiatric physician and a physician assistant may enter into a temporary292 practice agreement exempt from any filing fees with the board b y which agreement the293 physician or podiatric physician supervises the services provided by the physician assistant294 to patients at a specific facility or program that provides medical services only to indigent295 patients in medically underserved or critical need population a reas of the state, as296 determined by the board, or pursuant to Article 8 of Chapter 8 of Title 31, provided that:297 (1) Such services are provided primarily to financially disadvantaged patients;298 (2) Such services are free or at a charge to the patient based solely on the patient's ability299 to pay and provided, further, that such charges do not exceed the actual cost to the facility300 or program;301 (3) The supervising physician or supervising podiatric physici an and the physician302 assistant voluntarily and gratuitously donate their services;303 (4) Prior to providing any patient services, a copy of the temporary practice agreement,304 signed by both the supervising physician or supervising podiatr ic physician and the305 physician assistant, is on file at the facility or program and is sent to the board or State306 Board of Podiatry Examiners;307 (5) The temporary practice agreement is for a specified period of time, limits the services308 of the physician assistant to those within the usual scope of p ractice of the supervising309 physician or supervising podiatric physician , and is signed by both the supervising310 H. B. 1273 - 12 - 26 LC 46 1294 physician or supervising podiatric physician and the physician assistant prior to the311 physician assistant providing patient services; and312 (6) The facility or program has notified the board of its intent to provide patient services313 and utilize licensed physicians or podiatric physicians and physician assistants under the314 conditions set out in this subsection.315 (i)(1) Notwithstanding any provision of this article to the contrary, a physician assistant316 licensed pursuant to this article or licensed, certified, or otherwise authorized to practice317 in any other state or federal jurisdiction and whose license, certification, or authorization318 is in good standing who responds to a need for medical or podia tric care created by319 conditions which characterize those of a state of emergency or public health emergency320 may render such care that the physician assistant is able to provide with such supervision321 as is available at the immediate scene or at the local site where such need for medical or322 podiatric care exists or at a relief site established as part of a state or local safety plan323 established pursuant to Chapter 3 of Title 38. Such services s hall be provided by a324 physician assistant in response to the request of an appropriat e state or local official325 implementing a state or local emergency management plan or program, and in accordance326 with applicable guidelines established by such officials or plans. The authority granted327 by this Code section shall last no longer than 48 hours or such time as the board or State328 Board of Podiatry Examiners may establish under guidelines for supervision of the329 physician assistant rendering medical or podiatric care.330 (2) For the purposes of this subsection, the term 'public health emergency' has the same331 meaning as in paragraph (6) of Code Section 38-3-3, and the ter m 'state of emergency'332 has the same meaning as in paragraph (7) of Code Section 38-3-3.333 (j) A physician assistant shall be allowed to make a pronouncement of death pursuant to334 authority delegated by the supervising physician of the physician assistant and to certify335 such pronouncement in the same manner as a physician, including by signing death336 H. B. 1273 - 13 - 26 LC 46 1294 certificates. A selection box shall be added to death certific ates to be checked off by337 nonphysicians completing the form.338 (k) It shall be unlawful for a physician or podiatric physicia n to be an employee of a339 physician assistant, alone or in combination with others, if th e physician or podiatric340 physician is required to supervise the physician assistant; provided, however, that this shall341 not apply to arrangements of this nature which were approved by the board or State Board342 of Podiatry Examiners on or before July 1, 2009. Arrangements approved prior to suc h343 date are nontransferable. Such conduct shall be subject to sanctions by the board as to the344 physician and the physician assistant and by the State Board of Podiatry Examiners as to345 the podiatric physician and the physician assistant.346 (l) Except for assigning a percentage of a disability rating, a physician assistant may be347 delegated the authority to sign, certify, and endorse all documents relating to health care348 provided to a patient within his or her scope of authorized pra ctice, including, but not349 limited to, documents relating to physical examination forms of all state agencies and350 verification and evaluation forms of the Department of Human Services, the State Board351 of Education, local boards of education, the Department of Comm unity Health, and the352 Department of Corrections."353 SECTION 3.354 Said article is further amended by revising Code Section 43-34- 104, relating to notice of355 application approval or disapproval and issuance of license, as follows:356 "43-34-104.357 (a) Within a reasonable time after receipt of the documents re quired by this article, the358 board or State Board of Podiatry Examiners shall give to the applicant written notice of359 approval or disapproval of the physician assistant's applicatio n; and, if approval of the360 application is given, the board or State Board of Podiatry Exam iners, respectively, shall361 issue to the assistant a license authorizing the assistant to perform medical tasks under the362 H. B. 1273 - 14 - 26 LC 46 1294 direction and supervision of the physician or podiatric tasks u nder the direction and363 supervision of the podiatric physician.364 (b) The board or State Board of Podiatry Examiners shall not approve an application365 unless it finds from the information forwarded with the application that the applicant has366 complied with the requirements in this article."367 SECTION 4.368 Said article is further amended by revising Code Section 43-34-105, relating to performance369 of tasks in accordance with job description, as follows:370 "43-34-105.371 On receipt of notice of approval by the board or State Board of Podiatry Examiners the372 board's approval, a physician assistant, under the direction of the applying ph ysician or373 podiatric physician, may perform the tasks described in the job description, provided that374 nothing in this Code section shall make unlawful the performance of a medical or podiatric375 task by the physician assistant, whether or not such task is sp ecified in the general job376 description, when it is performed under the direct supervision and in the presence of the377 physician or podiatric physician utilizing him or her."378 SECTION 5.379 Said article is further amended by revising Code Section 43-34-106, relating to posting notice380 that assistants are being utilized, as follows:381 "43-34-106.382 Any physician, podiatric physician, clinic, or hospital using a physician assistant shall post383 a notice to that effect in a prominent place."384 H. B. 1273 - 15 - 26 LC 46 1294 SECTION 6.385 Said article is further amended by revising Code Section 43-34-107, relating to termination386 of approval and revocation of license, notice and hearing, and sanctions, as follows:387 "43-34-107.388 (a) The approval of a physician's or podiatric physician's utilization of a physician assistant389 may be terminated or suspended by the board or State Board of P odiatry Examiners,390 respectively, and the license revoked or suspended by the board or State Board of Podiatry391 Examiners, respectively, when, after due notice and a hearing, in accordance with this Code392 section, it and other relevant law, the board or the State Board of Podiatry Examiners shall393 find that the assistant is incompetent or has committed unethical or immoral acts, including,394 but not limited to, holding himself or herself out or permitting another to represent him or395 her as a licensed physician or podiatric physician ; performing otherwise than at the396 direction of a physician or podiatric physician approved by the board or State Board of397 Podiatry Examiners to utilize the assistant's services; habitually using intoxicants or drugs398 to such an extent that he or she is unable safely to perform as an assistant to the physician399 or podiatric physician; or being convicted in any court, state or federal, of any fel ony or400 other criminal offense involving moral turpitude.401 (b) Before the board or State Board of Podiatry Examiners shall give written notice to the402 physician assistant of termination of approval granted by it to an assistant, it will give to403 the assistant a timely and reasonable written notice indicating the general nature of the404 charges, accusation, or complaint preferred against him or her and stating that the assistant405 will be given an opportunity to be heard concerning such charges or complaints; and it shall406 hold a public hearing within a reasonable time. Following such hearing, the board or State407 Board of Podiatry Examiners shall determine, on the basis of its respective regulations and408 other relevant law , whether the approval of the assistant shall be terminated and , with409 regard to the board, whether the assistant's license shall also be revoked or suspended.410 H. B. 1273 - 16 - 26 LC 46 1294 (c) In hearings held pursuant to this Code section, the board and the State Board of411 Podiatry Examiners shall apply the rules of evidence as prescribed in Chapter 13 of Title412 50, the 'Georgia Administrative Procedure Act.'413 (d) The State Board of Podiatry Examiners may also issue a private reprimand letter to a414 physician assistant working in the field of podiatry. The issuance of such letter shall not415 be considered a contested case within the meaning of Chapter 13 of Title 50, the 'Georgia416 Administrative Procedure Act'; notice and hearing within the meaning of said chapter shall417 not be required, but the assistant shall be allowed to appear b efore the State Board of418 Podiatry Examiners if he or she so requests. Such letter shall not be considered a419 disciplinary action or a contested case under Chapter 13 of Tit le 50, the 'Georgia420 Administrative Procedure Act,' and shall not be disclosed to an y person except the421 physician's assistant.422 (e) In the event that the State Board of Podiatry Examiners te rminates or suspends the423 approval described in subsection (a) this Code section of a physician assistant working in424 the field of podiatry, the State Board of Podiatry Examiners shall notify the board of such425 action.426 (e)(f) The board may impose on a physician assistant any sanction au thorized under427 subsection (b) of Code Section 43-34-8 upon a finding of any co nduct specified in428 subsection (a) of Code Section 43-34-8."429 SECTION 7.430 Said article is further amended by revising Code Section 43-34-108, relating to powers and431 duties of the board, as follows:432 "43-34-108.433 In addition to the powers specifically delegated to it in this article, the board and the State434 Board of Podiatry Examiners shall have the authority to perform all acts which are435 necessary, proper, or incidental to the efficient development of the category of health care436 H. B. 1273 - 17 - 26 LC 46 1294 established by this article and with regard to the State Board of Podiatry Examiners, such437 category of health care as it may relate to the field of podiat ry. The board and the State438 Board of Podiatry Examiners shall have the authority to promulgate rules and regulations439 governing the definitions of delegation by physicians and podia tric physicians,440 respectively, to qualified persons other than physician assistants of any ac ts, duties, or441 functions which are permitted by law or established by custom. Any power vested by law442 in the board or the State Board of Podiatry Examiners , but not implemented by specific443 provisions for the exercise thereof, may be executed and carrie d out by the board or the444 State Board of Podiatry Examiners in a reasonable manner, pursuant to such rules,445 regulations, and procedures as the board or the State Board of Podiatry Examiners may446 adopt and subject to such limitations as may be provided by law. The board shall cooperate447 with the State Board of Podiatry Examiners to ensure the protec tion of the public and448 compliance with state law governing the conduct of physician as sistants working in the449 field of podiatry."450 SECTION 8.451 Said article is further amended by revising Code Section 43-34-109, relating to involvement452 of supervising physician in patient's care, as follows:453 "43-34-109.454 When a patient receives medical or podiatric services from a physician assistant, the455 supervising physician's or podiatric physician's involvement in the patient's care, including456 patient evaluation and follow-up care by the supervising physician or supervising podiatric457 physician, shall be appropriate to the nature of the practice and the acuity of the patient's458 medical or podiatric issue, as determined by the supervising physician or supervisi ng459 podiatric physician."460 H. B. 1273 - 18 - 26 LC 46 1294 SECTION 9.461 Chapter 35 of Title 43 of the Official Code of Georgia Annotate d, relating to podiatry462 practice, is amended by revising Code Section 43-35-3, relating to definitions, as follows:463 "43-35-3.464 As used in this chapter, the term:465 (1) 'Administer' means to give a unit dose of any drug or to p erform any podiatric466 medical treatment or diagnostic study.467 (1)(2) 'Board' means the State Board of Podiatry Examiners.468 (3) 'Controlled substance' means any controlled substance, as defined in Code Section469 16-13-21, except any Schedule I controlled substance listed in Code Section 16-13-25.470 (4) 'Dangerous drug' means any dangerous drug, as defined in Code Section 16-13-71,471 but does not include any controlled substance, as defined in Code Section 16-13-21, or472 Schedule I controlled substance listed in Code Section 16-13-25.473 (5) 'Dispense' means to issue one or more doses of any drug in a suitable container with474 appropriate labeling for subsequent administration to, or use by, a patient.475 (6) 'Dispensing procedure' means a written document that is si gned by a licensed476 pharmacist and a licensed physician and that establishes the ap propriate manner under477 which drugs may be dispensed pursuant to this Code section.478 (7) 'Drug' means any dangerous drug or controlled substance.479 (8) 'Job description' means a document, signed by the primary supervising podiatric480 physician and the physician assistant, in which the primary sup ervising podiatric481 physician delegates to that physician assistant authority to perform certain podiatric acts482 and which describes the professional background and specialty of the primary supervising483 podiatric physician and the qualifications including related experience of the physician484 assistant; and includes a general description of how the physician assistant will be utilized485 in the practice. A job description shall not be required to co ntain every activity the486 podiatric physician deems the physician assistant qualified to perform but shall confine487 H. B. 1273 - 19 - 26 LC 46 1294 the activities of the physician assistant to those in the scope of practice of the primary488 supervising podiatric physician.489 (2)(9) 'License' means a valid and current certificate of registration issued by the division490 director on behalf of the board which shall give the person to whom it is issued authority491 to engage in the practice prescribed thereon.492 (3)(10) 'Licensee' means one who holds a license under this chapter.493 (11) 'Order' means to select a drug, medical treatment, or dia gnostic study through494 podiatric physician delegation in accordance with a physician assistant's job description. 495 Ordering under such delegation shall not be construed to be prescribing nor shall ordering496 of a drug be construed to authorize the issuance of a written prescription.497 (4)(12) 'Person' means a human person only.498 (13) 'Physician assistant' means a skilled person who is:499 (A) Licensed as a physician assistant pursuant to Article 4 of Chapter 34 of this title,500 the 'Physician Assistant Act';501 (B) Approved by the board to work under a supervising podiatric physician; and502 (C) Qualified by academic and practical training to provide pa tient services not503 necessarily within the physical presence but under the personal direction or supervision504 of the supervising podiatric physician.505 (5)(14) 'Podiatric medicine,' which includes chiropody, podiatry, and podiatric medicine506 and surgery, means that portion of the practice of medicine ide ntified by the acts507 described in any one or more of the following:508 (A) Charging a fee or other compensation, either directly or indirectly, for any history509 or physical examination of a patient in a person's office or in a hospital, clinic, or other510 similar facility prior to, incident to, and necessary for the diagnosis and treatment, by511 primary medical care, surgical or other means, of diseases, ailments, injuries, cosmetic512 conditions, or abnormal conditions of the human foot and leg. As used in this513 subparagraph, the term 'cosmetic' means a surgical or medical p rocedure intended to514 H. B. 1273 - 20 - 26 LC 46 1294 enhance the physical appearance or function of the foot, ankle, or leg, including, but not515 limited to, skin problems such as blemishes, spider veins, and scar revisions;516 (B) Holding oneself out to the public, either directly or indirectly, as being engaged in517 the practice of podiatric medicine;518 (C) Displaying or using a title or abbreviation such as 'Doctor of Podiatric Medicine,'519 'D.P.M.,' 'Foot Doctor,' 'Foot Specialist,' 'Foot Surgeon,' 'Foot and Ankle Surgeon,' or520 other letters, designations, or symbols or signs of any type which expressly or implicitly521 indicate to the general public that the user renders treatment to the foot, ankle, and leg522 under the provisions of this chapter;523 (D) Performing surgery on the foot or leg of a patient, except that when such surgery524 is performed under general anesthesia it shall be permissible only when said surgery is525 performed at a facility permitted and regulated as a hospital o r ambulatory surgical526 treatment center under Article 1 of Chapter 7 of Title 31 and w hen said general527 anesthesia is administered under the direction of a duly licensed physician;528 (E) Performing amputations of the toe; or529 (F) Performing amputations distal to and including the tarsometatarsal joint but only530 when performed in a facility permitted and regulated as a hospi tal or ambulatory531 surgical treatment center under Article 1 of Chapter 7 of Title 31.532 (15) 'Podiatric physician' means a physician and surgeon of the human foot and leg who533 is subject to this chapter.534 (6)(16) 'Podiatric resident' means a person who is engaged in a postgraduate program of535 study or practice within this state approved by the board.536 (7) 'Podiatrist' means a physician and surgeon of the human foot and leg who is subject537 to this chapter.538 (17) 'Prescription drug order' means a written or oral order of a physician assistant for539 a drug or medical device for a specific patient. Such term includes an electronic visual540 image prescription drug order and an electronic data prescription drug order.541 H. B. 1273 - 21 - 26 LC 46 1294 (18) 'Primary supervising podiatric physician' means the podiatric physician to whom the542 Georgia Composite Medical Board licenses a physician assistant pursuant to a board543 approved job description and who has the primary responsibility for supervising the544 practice of a physician assistant pursuant to that physician assistant's job description."545 SECTION 10.546 Said chapter is further amended by adding a new Code section to read as follows:547 "43-35-3.1.548 (a)(1)(A) A podiatric physician may delegate the authority contained in subparagraph549 (B) of this paragraph to a physician assistant in accordance with a job description.550 (B) A podiatric physician may delegate to an authorized physician assistant:551 (i) The authority to order controlled substances selected from a formulary of such552 drugs established by the board and the authority to order dangerous drugs, podiatric553 treatments, and diagnostic studies;554 (ii) The authority to request, receive, and sign for professio nal samples and to555 distribute professional samples to patients. The office or fac ility at which the556 physician assistant is working shall maintain a general list of the professional samples557 approved by the delegating podiatric physician for request, receipt, and distribution558 by the podiatric physician as well as a complete list of the specific number and dosage559 of each professional sample and medication voucher received. Professional samples560 that are distributed by such physician assistant shall be so no ted in the patient's561 podiatric medical record. In addition to the requirements of t his Code section, all562 professional samples shall be maintained as required by applicable state and federal563 laws and regulations; and564 (iii) The authority to sign, certify, and endorse all document s relating to podiatric565 healthcare provided to a patient within his or her scope of authorized practice.566 H. B. 1273 - 22 - 26 LC 46 1294 (2) A podiatric physician may delegate to a physician assistan t the authority to order567 dangerous drugs, podiatric treatments, or diagnostic studies and a physician assistant is568 authorized to dispense dangerous drugs, in accordance with a dispensing procedure and569 under the authority of an order issued in conformity with a job description:570 (A) As an agent or employee of any organization:571 (i) Which is exempt from federal taxes pursuant to Section 501(c)(3) of the Internal572 Revenue Code, as defined in Code Section 48-1-2, other than an organization which573 is a hospital, preferred provider organization, health maintena nce organization, or574 similar organization; or575 (ii) Established under the authority of or a community health center receiving funds576 pursuant to 42 U.S.C. Section 330 of the United States Public Health Service Act, if577 such center has determined that podiatric services qualify as a n additional health578 service needed to meet the community's needs,579 which organization provides that those services and dangerous drugs which are ordered580 or dispensed by its physician assistants will be provided at no cost to the patient or at581 a cost based solely upon the patient's ability to pay; and582 (B) In conformity with subsection (b) of Code Section 26-4-130 and the rules and583 regulations established pursuant thereto by the State Board of Pharmacy.584 (3) In addition, a podiatric physician may delegate to a physician assistant the authority585 to order dangerous drugs, medical treatments, or diagnostic stu dies and a physician586 assistant is authorized to dispense dangerous drugs, in accorda nce with a dispensing587 procedure and under the authority of an order issued in conformity with a job description,588 if that physician assistant orders or dispenses such drugs, tre atments, or studies to a589 patient of an outpatient clinic:590 (A) Which is owned or operated by a licensed hospital;591 H. B. 1273 - 23 - 26 LC 46 1294 (B) Which provides such drugs, treatments, or studies free or at a charge to the patient592 based solely upon the patient's ability to pay; provided, however, that such charge shall593 not exceed the actual cost to the outpatient clinic; and594 (C) Whose services are primarily provided to the medically disadvantaged595 and that physician assistant orders or dispenses such drugs in conformity with596 subsection (b) of Code Section 26-4-130 and the rules and regul ations established597 pursuant thereto by the State Board of Pharmacy.598 (4) Delegation of authority to a physician assistant pursuant to this subsection shall be599 authorized only if that delegation is contained in the job desc ription approved for that600 physician assistant by the board.601 (b) The board is authorized to promulgate rules and regulation s governing podiatric602 physicians and physician assistants to carry out the intents an d purposes of this Code603 section, including, but not limited to, establishing criteria and standards governing podiatric604 physicians, physician assistants, and job descriptions. The bo ard shall be authorized to605 require that job descriptions not falling within such establish ed criteria and standards be606 submitted to the board for review and approval or rejection.607 (c) Notwithstanding any other provision of law to the contrary, a physician assistant may608 perform any act authorized to be performed by that person pursuant to and in conformity609 with this chapter without such act constituting the practice of podiatry or medicine.610 (d) Nothing in this Code section shall be construed to limit or repeal any Code section in611 Chapter 34 of this title, relating to physicians, osteopathic physicians, physician assistants,612 and others.613 (e) Nothing in this Code section shall be construed to limit or repeal any existing authority614 of a licensed physician to delegate to a physician assistant an y acts, duties, or functions615 which are otherwise permitted by law or established by custom.616 (f) Nothing in this Code section shall be construed to authorize or permit the issuance of617 a United States Drug Enforcement Administration license to a physician assistant who does618 H. B. 1273 - 24 - 26 LC 46 1294 not meet the qualifications described in division (i) or (ii) of subparagraph (b)(2)(A) of this619 Code section.620 (g) Nothing in this Code section shall be construed to limit or repeal the authority of any621 organization established under the authority of or receiving fu nds pursuant to 42 U.S.C.622 Section 330 of the United States Public Health Service Act, to supervise its agents or623 employees or interfere with the employer and employee relationship of any such agents or624 employees.625 (h) Notwithstanding any other provision of law to the contrary, a physician assistant may626 perform any act deemed necessary to provide treatment to a hosp ital or nursing home627 patient in a life-threatening situation when such act is authorized by standing procedures628 established by the medical staff of the hospital or nursing home."629 SECTION 11.630 Said chapter is further amended by adding a new Code section to read as follows:631 "43-35-11.1.632 (a) The authority of a podiatric physician to delegate tasks to a physician assistant shall not633 become effective until the Georgia Composite Medical Board has licensed a person in634 accordance with Code Section 43-34-103 and the requirements of this chapter are met.635 (b) The board shall cooperate with the Georgia Composite Medic al Board to ensure the636 protection of the public and compliance with state law governing the conduct of physician637 assistants working in the field of podiatry."638 SECTION 12.639 All laws and parts of laws in conflict with this Act are repealed.640 H. B. 1273 - 25 -