A5466

An Act concerning oversight of physician assistants and amending and supplementing various parts of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 2 of P.L.1991, c.378 (C.45:9-27.11) is amended to read as follows:

2. As used in this act:

"Accredited program" means an education program for physician assistants which is accredited by the Accreditation Review Commission on Education for the Physician Assistant or its predecessor or successor agency.

"Board" means the State Board of Medical Examiners created pursuant to R.S.45:9-1.

"Committee" means the Physician Assistant Advisory Committee established pursuant to section 11 of P.L.1991, c.378 (C.45:9-27.20).

"Director" means the Director of the Division of Consumer Affairs.

"Health care facility" means a health care facility as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).

"Institution" means any of the charitable, hospital, relief and training institutions, noninstitutional agencies, and correctional institutions enumerated in R.S.30:1-7.

"Physician assistant" means a health professional who meets the qualifications under P.L.1991, c.378 (C.45:9-27.10 et seq.) and holds a current, valid license issued pursuant to section 4 of P.L.1991, c.378 (C.45:9-27.13).

"Physician" means a person licensed to practice medicine and surgery pursuant to chapter 9 of Title 45 of the Revised Statutes.

“Podiatric physician” means a person licensed to practice podiatric medicine and surgery in accordance with chapter 5 of Title 45 of the Revised Statutes.

"Veterans' home" means the New Jersey Veterans' Memorial Home - Menlo Park, the New Jersey Veterans' Memorial Home - Vineland, and the New Jersey Veterans' Memorial Home - Paramus.

(cf: P.L.2015, c.224, s.1)

2. Section 6 of P.L.1991, c.378 (C.45:9-27.15) is amended to read as follows:

6. a. A physician assistant may practice in all medical care settings, including, but not limited to, a physician's office, a podiatric physician’s office, a health care facility, an institution, a veterans' home, or a private home, provided that:

(1) the physician assistant performs medical services within the physician assistant's education, training, and experience under the supervision of a physician or a podiatric physician pursuant to section 9 of P.L.1991, c.378 (C.45:9-27.18);

(2) the practice of the physician assistant is limited to those procedures enumerated under section 7 of P.L.1991, c.378 (C.45:9-27.16), and any other procedures that are delegated to the physician assistant by the supervising physician, as authorized under subsection d. of section 7 of P.L.1991, c.378 (C.45:9-27.16) or by the supervising podiatric physician pursuant to regulations promulgated pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill);

(3) (Deleted by amendment, P.L.2015, c.224)

(4) the supervising physician, supervising podiatric physician, or physician assistant advises the patient at the time that services are rendered that they are to be performed by the physician assistant;

(5) the physician assistant conspicuously wears an identification tag using the term "physician assistant" or the designation, "PA-C" or "PA" whenever acting in that capacity; and

(6) any entry by a physician assistant in a clinical record is appropriately signed and followed by the designation, "PA-C" or "PA."

b. Any physician assistant who practices in violation of any of the conditions specified in subsection a. of this section shall be deemed to have engaged in professional misconduct in violation of subsection e. of section 8 of P.L.1978, c.73 (C.45:1-21).

(cf: P.L.2015, c.224, s.3)

3. Section 9 of P.L.1991, c.378 (C.45:9-27.18) is amended to read as follows:

9. a. A physician assistant shall be under the supervision of a physician or, pursuant to P.L. , c. (C. ) (pending before the Legislature as this bill), of a podiatric physician, at all times during which the physician assistant is working in an official capacity.

b. Supervision of a physician assistant shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician or supervising podiatric physician, provided that the supervising physician or supervising podiatric physician and physician assistant maintain contact through electronic, or other means of, communication.

(1) (Deleted by amendment, P.L.2015, c.224)

(2) (Deleted by amendment, P.L.2015, c.224)

(3) (Deleted by amendment, P.L.2015, c.224)

c. (Deleted by amendment, P.L.2015, c.224)

(1) (Deleted by amendment, P.L.2015, c.224)

(2) (Deleted by amendment, P.L.2015, c.224)

(3) (Deleted by amendment, P.L.2015, c.224)

d. (Deleted by amendment, P.L.2015, c.224)

(1) (Deleted by amendment, P.L.2015, c.224)

(2) (Deleted by amendment, P.L.2015, c.224)

(3) (Deleted by amendment, P.L.2015, c.224)

e. It is the obligation of each supervising physician or supervising podiatric physician and physician assistant to ensure that: (1) the physician assistant's scope of practice is identified; (2) delegation of medical tasks is appropriate to the physician assistant's level of competence; (3) the relationship of, and access to, the supervising physician or supervising podiatric physician is defined; and (4) a process for evaluation of the physician assistant's performance is established.

(cf: P.L.2015, c.224, s.6)

4. Section 12 of P.L.2015, c.224 (C.45:9-27.18a) is amended to read as follows:

12. a. A physician assistant licensed in this State, or licensed or authorized to practice in any other jurisdiction of the United States or credentialed as a physician assistant by a federal employer, who is responding to a need for medical care created by an emergency or a State or local disaster, excluding an emergency situation that occurs in the place of the physician assistant's employment, may render such care as the physician assistant is able to provide without supervision, or with such supervision as is available.

b. A physician or podiatric physician who supervises a physician assistant providing medical care in response to an emergency or a State or local disaster shall not be required to meet the requirements set forth for a supervising physician in P.L.1991, c.378 (C.45:9-27.10 et seq.) or for a supervising podiatric physician in P.L. , c. (C. ) (pending before the Legislature as this bill).

c. (1) A physician assistant licensed in this State, or licensed or authorized to practice in any other jurisdiction of the United States, who voluntarily and gratuitously, and other than in the ordinary course of employment or practice, renders emergency medical assistance, shall not be liable for civil damages for any personal injury that results from an act or omission by the physician assistant in rendering emergency care that may constitute ordinary negligence.

(2) A physician or podiatric physician who supervises a physician assistant voluntarily and gratuitously providing emergency care as described in this subsection shall not be liable for civil damages for any personal injury that results from an act or omission by the physician assistant rendering emergency care.

d. The immunity granted under subsection c. of this section shall not apply to an act or omission constituting gross, willful, or wanton negligence or when the medical assistance is rendered at a hospital, physician's or podiatric physician’s office, or other health care delivery entity where those services are normally rendered.

(cf: P.L.2015, c.224, s.12)

5. Section 12 of P.L.2017, c.341 (C.45:9-27.19b) is amended to read as follows:

12. a. Notwithstanding any other provision of law to the contrary, a physician assistant who is otherwise authorized to order, prescribe, and dispense controlled dangerous substances pursuant to P.L.1991, c.378 (C.45:9-27.10 et seq.) may dispense narcotic drugs for maintenance treatment or detoxification treatment if the physician assistant has met the training and registration requirements set forth in subsection (g) of 21 U.S.C. s.823. A physician assistant who is authorized to dispense such drugs may do so regardless of whether the physician assistant's supervising physician or supervising podiatric physician has met the training and registration requirements set forth in subsection (g) of 21 U.S.C. s.823, provided that the written delegation agreement between the supervising physician or supervising podiatric physician and the physician assistant executed pursuant to subsection d. of section 8 of P.L.1991, c.378 (C.45:9-27.17) included the supervising physician's or supervising podiatric physician’s written approval for the physician assistant to dispense the drugs.

b. Notwithstanding any other provision of law to the contrary, a physician assistant under the direct supervision of a licensed physician or of a podiatric physician may make the determination as to the medical necessity for services for the treatment of substance use disorder, as provided in P.L.2017, c.28 (C.17:48-6nn et al.), and may prescribe such services.

(cf: P.L.2017, c.341, s.12)

6. Section 11 of P.L.1991, c.378 (C.45:9-27.20) is amended to read as follows:

11. There is created within the State Board of Medical Examiners, a Physician Assistant Advisory Committee. The committee shall consist of [five] six members who are residents of this State, one of whom shall be a public member [and], one of whom shall be a physician licensed pursuant to chapter 9 of Title 45 of the Revised Statutes, and one of whom shall be a podiatric physician licensed pursuant to chapter 5 of Title 45 of the Revised Statutes. The remaining three members shall be, except for those first appointed, physician assistants licensed in accordance with the provisions of this act. The physician assistant members first appointed to the committee need not be licensed in this State but shall be physician assistants certified by the National Commission on Certification of Physician Assistants.

The Governor shall appoint the members of the committee for a term of three years, except that of the members first appointed, two shall be appointed for a term of one year, two shall be appointed for a term of two years and one shall be appointed for a term of three years. Each member shall serve until his successor has been qualified. Any vacancy in the membership of the committee shall be filled for the unexpired term in the same manner as the original appointments were made. No member shall serve for more than two consecutive terms in addition to any unexpired term to which he has been appointed. The Governor may remove a member of the committee for cause.

Members of the committee shall be compensated and reimbursed for actual expenses reasonably incurred in the performance of their official duties in accordance with subsection a. of section 2 of P.L.1977, c.285 (C.45:1-2.5).

(cf: P.L.1992, c.102, s.6)

7. (New section) a. As determined by the board, a physician assistant licensed pursuant to P.L.1991, c.378 (C.45:9-27.10 et seq.) and under the supervision of a podiatric physician shall perform and provide certain podiatric medical and surgical procedures and services in an office for podiatric medicine; a health care facility; an institution; a veterans' home; or a private home.

b. A podiatric physician who permits a physician assistant under the podiatric physician’s supervision to practice contrary to the provisions of P.L.1991, c.378 (C.45:9-27.10 et seq.) shall be deemed to have engaged in professional misconduct in violation of subsection e. of section 8 of P.L.1978, c.73 (C.45:1-21) and shall be subject to disciplinary action by the board pursuant to P.L.1978, c.73 (C.45:1-14 et seq.);

c. (1) In the performance of all practice-related activities, including, but not limited to, the ordering of diagnostic, therapeutic, and other podiatric medical services, a physician assistant shall be conclusively presumed to be the agent of the podiatric physician under whose supervision the physician assistant is practicing.

(2) A physician assistant under the supervision of a podiatric physician shall be authorized to prescribe controlled substances equivalent to the level at which a podiatric physician is authorized to prescribe controlled substances.

d. A podiatric physician who supervises a physician assistant may maintain a written delegation agreement with the physician assistant. A physician assistant shall sign a separate written agreement with each podiatric physician who delegates podiatric medical services pursuant to regulations as determined by the board. The agreement shall:

(1) state that the podiatric physician will exercise supervision over the physician assistant in accordance with the provisions of P.L.1991, c.378 (C.45:9-27.10 et seq.) and any rules adopted by the board;

(2) be signed and dated annually by the podiatric physician and the physician assistant, and updated as necessary to reflect any changes in the practice or the physician assistant's role in the practice; and

(3) be kept on file at the practice site, be provided to the Physician Assistant Advisory Committee, and be kept on file by the committee.

e. The delegation agreement shall include, but need not be limited to, the following provisions:

(1) The physician assistant's role in the practice, including any specific aspects of care that require prior consultation with the supervising podiatric physician;

(2) A determination of whether the supervising podiatric physician requires personal review of all charts and records of patients and countersignature by the supervising podiatric physician of all podiatric medical services performed under the delegation agreement. This provision shall state the specified time period in which a review and countersignature shall be completed by the supervising physician. If no review and countersignature is necessary, the agreement shall specifically state as much; and

(3) The locations of practice where the physician assistant may practice under the delegation agreement, including licensed facilities in which the podiatric physician authorizes the physician assistant to provide podiatric medical services.

8. The board, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act.

9. This act shall take effect on the first day of the 13th month next following the date of enactment, except that the board may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.

STATEMENT

This bill authorizes podiatric physicians to supervise physician assistants in the performance of podiatric medical services. Under the bill, podiatric physicians are incorporated into various provisions of current law regulating the oversight provided now by State-licensed physicians when supervising a physician assistant. The State Board of Medical Examiners is to determine, among other items, the podiatric medical and surgical procedures and services a physician assistant is to provide and perform in a podiatric medicine office, a health care facility, an institution, a veterans' home, or a private home. The bill further stipulates that (1) it is misconduct for a podiatric physician who permits a physician assistant under the podiatric physician’s supervision to practice contrary to the provisions of the current law governing physician assistants; and (2) in the performance of all practice-related activities, a physician assistant is to be conclusively presumed to be the agent of the podiatric physician under whose supervision the physician assistant is practicing.

The bill also provides that a podiatric physician who supervises a physician assistant is given the option to maintain a written delegation agreement with the physician assistant but a physician assistant is required to sign a separate written agreement with each podiatric physician who delegates podiatric medical services pursuant to regulations as determined by the board. The bill delineates what is to be included in the written agreement.