Bill Text: MI SB0384 | 2011-2012 | 96th Legislature | Introduced
Bill Title: Occupations; physician's assistants; physician delegating duties to physician's assistant; clarify ability to prescribe controlled substances and perform other delegatory activities, and revise contents of drug labels. Amends secs. 16104, 17048, 17049, 17076, 17078, 17548, 17549, 17745, 17757, 18048, 18049 & 20201 of 1978 PA 368 (MCL 333.16104 et seq.).
Spectrum: Partisan Bill (Republican 1-0)
Status: (Passed) 2011-11-09 - Assigned Pa 0210'11 With Immediate Effect [SB0384 Detail]
Download: Michigan-2011-SB0384-Introduced.html
SENATE BILL No. 384
May 18, 2011, Introduced by Senator MARLEAU and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 17048, 17049, 17050, 17076, 17078, 17548,
17549, 17550, 17745, 17757, 18048, 18049, 18050, and 20201 (MCL
333.17048, 333.17049, 333.17050, 333.17076, 333.17078, 333.17548,
333.17549, 333.17550, 333.17745, 333.17757, 333.18048, 333.18049,
333.18050, and 333.20201), section 17048 as amended by 2010 PA 124,
sections 17049 and 17549 as amended by 2004 PA 512, sections 17050
and 17550 as amended by 1990 PA 247, sections 17076 and 17548 as
amended by 1996 PA 355, section 17078 as amended and sections
18048, 18049, and 18050 as added by 2006 PA 161, section 17745 as
amended by 2006 PA 672, section 17757 as amended by 1986 PA 304,
and section 20201 as amended by 2006 PA 38.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 17048. (1) Except as otherwise provided in this section
and section 17049(5), a physician who is a sole practitioner or who
practices in a group of physicians and treats patients on an
outpatient basis shall not supervise more than 4 physician's
assistants or nurse practitioners. If a physician described in this
subsection supervises physician's assistants or nurse practitioners
at more than 1 practice site, the physician shall not supervise
more than 2 physician's assistants or nurse practitioners by a
method other than the physician's actual physical presence at the
practice site.
(2) A physician who is employed by, under contract or
subcontract to, or has privileges at a health facility or agency
licensed under article 17 or a state correctional facility may
supervise more than 4 physician's assistants or nurse practitioners
at the health facility or agency or state correctional facility.
(3) To the extent that a particular selected medical care
service requires extensive medical training, education, or ability
or poses serious risks to the health and safety of patients, the
board may prohibit or otherwise restrict the delegation of that
medical care service or may require higher levels of supervision.
(4) A physician shall not delegate ultimate responsibility for
the quality of medical care services, even if the medical care
services are provided by a physician's assistant or nurse
practitioner.
(5) The board may promulgate rules for the delegation by a
supervising physician to a physician's assistant or nurse
practitioner of the function of prescription of drugs. The rules
may define the drugs or classes of drugs the prescription of which
shall not be delegated and other procedures and protocols necessary
to promote consistency with federal and state drug control and
enforcement
laws. Until the rules are promulgated, a supervising
physician
may delegate the prescription of drugs other than
controlled
substances as defined by article 7 or federal law. When
delegated prescription occurs, both the physician's assistant's or
nurse practitioner's name and the supervising physician's name
shall be used, recorded, or otherwise indicated in connection with
each individual prescription.
(6) A supervising physician may delegate in writing to a
physician's assistant or nurse practitioner the ordering, receipt,
and
dispensing of complimentary starter dose drugs other than
including
controlled substances as defined by
article 7 or federal
law that
are included in schedules 2 to 5 of part 72. When the
delegated ordering, receipt, or dispensing of complimentary starter
dose drugs occurs, both the physician's assistant's or nurse
practitioner's name and the supervising physician's name shall be
used, recorded, or otherwise indicated in connection with each
order, receipt, or dispensing. As used in this subsection,
"complimentary starter dose" means that term as defined in section
17745. It is the intent of the legislature in enacting this
subsection to allow a pharmaceutical manufacturer or wholesale
distributor, as those terms are defined in part 177, to distribute
complimentary starter dose drugs to a physician's assistant or
nurse practitioner, as described in this subsection, in compliance
with section 503(d) of the federal food, drug, and cosmetic act, 21
USC 353.
(7)
Beginning on the effective date of the amendatory act that
added
this subsection July 19, 2010, if 1 or more individuals
licensed under part 170 to engage in the practice of medicine,
licensed under part 175 to engage in the practice of osteopathic
medicine and surgery, or licensed under part 180 to engage in the
practice of podiatric medicine and surgery, and 1 or more
physician's assistants organize a professional service corporation
pursuant to section 4 of the professional service corporation act,
1962 PA 192, MCL 450.224, or a professional limited liability
company pursuant to section 904 of the Michigan limited liability
company act, 1993 PA 23, MCL 450.4904, the individuals who are the
supervising physicians of the physician's assistants shall be
shareholders in the same professional service corporation or
members in the same professional limited liability company as the
physician's assistants and shall meet all of the applicable
requirements of part 170, 175, or 180. If 1 or more physician's
assistants organized a professional service corporation pursuant to
section 4 of the professional service corporation act, 1962 PA 192,
MCL 450.224, or a professional limited liability company pursuant
to section 904 of the Michigan limited liability company act, 1993
PA
23, MCL 450.4904, before the effective date of the amendatory
act
that added this subsection July
19, 2010 that has only
physician's assistants as shareholders or members, the individuals
who are the supervising physicians of the physician's assistants
shall meet all of the applicable requirements of part 170, 175, or
180.
(8) In addition to the requirements of section 17068 and
beginning
on the effective date of the amendatory act that added
this
subsection July 19, 2010, the department shall include on the
form used for renewal of licensure a space for a physician's
assistant to disclose whether he or she is a shareholder in a
professional service corporation pursuant to section 4 of the
professional service corporation act, 1962 PA 192, MCL 450.224, or
a member in a professional limited liability company pursuant to
section 904 of the Michigan limited liability company act, 1993 PA
23,
MCL 450.4904, which corporation or company was organized before
the
effective date of the amendatory act that added this subsection
July 19, 2010. A physician's assistant who is a shareholder in a
professional service corporation or a member in a professional
limited liability company described in this subsection shall
disclose all of the following in the form used for renewal of
licensure provided by the department:
(a) Whether any individuals licensed under part 170 to engage
in the practice of medicine, licensed under part 175 to engage in
the practice of osteopathic medicine and surgery, or licensed under
part 180 to engage in the practice of podiatric medicine and
surgery are shareholders in the professional service corporation or
members in the professional limited liability company.
(b) The name and license number of the individual licensed
under part 170 to engage in the practice of medicine, licensed
under part 175 to engage in the practice of osteopathic medicine
and surgery, or licensed under part 180 to engage in the practice
of podiatric medicine and surgery who supervises the physician's
assistant.
(c) Whether the individual licensed under part 170 to engage
in the practice of medicine, licensed under part 175 to engage in
the practice of osteopathic medicine and surgery, or licensed under
part 180 to engage in the practice of podiatric medicine and
surgery disclosed in subdivision (b) is a shareholder in the same
professional service corporation or member in a professional
limited liability company as the physician's assistant.
Sec. 17049. (1) In addition to the other requirements of this
section and subject to subsection (5), a physician who supervises a
physician's assistant or nurse practitioner is responsible for all
of the following:
(a) Verification of the physician's assistant's or nurse
practitioner's credentials.
(b) Evaluation of the physician's assistant's or nurse
practitioner's performance.
(c) Monitoring the physician's assistant's or nurse
practitioner's practice and provision of medical care services.
(2) Subject to section 16215 or 17048, as applicable, a
physician who supervises a physician's assistant or nurse
practitioner may delegate to the physician's assistant or nurse
practitioner the performance of medical care services for a patient
who is under the case management responsibility of the physician,
if the delegation is consistent with the physician's assistant's or
nurse practitioner's training.
(3) A physician who supervises a physician's assistant or
nurse practitioner is responsible for the clinical supervision of
each physician's assistant and nurse practitioner to whom the
physician delegates the performance of medical care service under
subsection (2).
(4) Subject to subsection (5), a physician who supervises a
physician's assistant or nurse practitioner shall keep on file in
the physician's office or in the health facility or agency or
correctional facility in which the physician supervises the
physician's assistant or nurse practitioner a permanent, written
record that includes the physician's name and license number and
the name and license number of each physician's assistant and nurse
practitioner supervised by the physician.
(5) A group of physicians practicing other than as sole
practitioners may designate 1 or more physicians in the group to
fulfill the requirements of subsections (1) and (4).
(6) Notwithstanding any law or rule to the contrary, a
physician is not required to countersign orders written in a
patient's clinical record by a physician's assistant or nurse
practitioner to whom the physician has delegated the performance of
medical care services for a patient. Notwithstanding any law or
rule to the contrary, a physician is not required to sign an
official form that lists the physician's signature as the required
signatory if that official form is signed by a physician's
assistant or nurse practitioner to whom the physician has delegated
the performance of medical care services.
Sec. 17050. In addition to its other powers and duties under
this article, the board may prohibit a physician from supervising 1
or more physician's assistants or nurse practitioners for any of
the grounds set forth in section 16221 or for failure to supervise
a physician's assistant or nurse practitioner in accordance with
this part and rules promulgated under this part.
Sec. 17076. (1) Except in an emergency situation, a
physician's assistant or nurse practitioner shall provide medical
care services only under the supervision of a physician or properly
designated alternative physician, and only if those medical care
services are within the scope of practice of the supervising
physician and are delegated by the supervising physician.
(2)
A physician's assistant shall provide medical care
services
only in a medical care setting where the supervising
physician
regularly sees patients. However, a A physician's
assistant or a nurse practitioner may make calls or go on rounds
under the supervision of a physician in private homes, public
institutions, emergency vehicles, ambulatory care clinics,
hospitals, intermediate or extended care facilities, health
maintenance organizations, nursing homes, or other health care
facilities. to
the extent permitted by the bylaws, rules, or
regulations
of the governing facility or organization, if any.
Notwithstanding any law or rule to the contrary, a physician's
assistant or a nurse practitioner may make calls or go on rounds as
provided in this subsection without restrictions on the time or
frequency of visits by the physician or the physician's assistant
or nurse practitioner.
(3) A physician's assistant or nurse practitioner may
prescribe
drugs as a delegated act of a supervising physician ,
but
shall
do so only in accordance with
procedures and protocol for the
prescription
established by rule of the appropriate board. Until
the
rules are promulgated, a A physician's assistant or nurse
practitioner
may prescribe a drug, other
than including a
controlled
substance as defined by article 7 or federal law that
is
included in schedules 2 to 5 of part 72, as a delegated act of the
supervising physician. When delegated prescription occurs, both the
physician's assistant's or nurse practitioner's name and the
supervising physician's name shall be used, recorded, or otherwise
indicated in connection with each individual prescription so that
the individual who dispenses or administers the prescription knows
under whose delegated authority the physician's assistant or nurse
practitioner is prescribing.
(4) A physician's assistant or nurse practitioner may order,
receive,
and dispense complimentary starter dose drugs, other than
including
controlled substances as defined by
article 7 or federal
law
that are included in
schedules 2 to 5 of part 72, as a
delegated act of a supervising physician. When the delegated
ordering, receipt, or dispensing of complimentary starter dose
drugs occurs, both the physician's assistant's or nurse
practitioner's name and the supervising physician's name shall be
used, recorded, or otherwise indicated in connection with each
order, receipt, or dispensing so that the individual who processes
the order or delivers the complimentary starter dose drugs or to
whom the complimentary starter dose drugs are dispensed knows under
whose delegated authority the physician's assistant or nurse
practitioner is ordering, receiving, or dispensing. As used in this
subsection, "complimentary starter dose" means that term as defined
in section 17745. It is the intent of the legislature in enacting
this subsection to allow a pharmaceutical manufacturer or wholesale
distributor, as those terms are defined in part 177, to distribute
complimentary starter dose drugs to a physician's assistant or
nurse practitioner, as described in this subsection, in compliance
with section 503(d) of the federal food, drug, and cosmetic act,
chapter
675, 52 Stat. 1051, 21 U.S.C. 21
USC 353.
Sec. 17078. (1) A physician's assistant or a nurse
practitioner
is the agent of the his or her supervising physician
under this part or part 175 or supervising podiatrist under part
180. A communication made to a physician's assistant or nurse
practitioner that would be a privileged communication if made to
the supervising physician under this part or part 175 or
supervising podiatrist under part 180 is a privileged communication
to the physician's assistant or nurse practitioner and the
supervising physician or supervising podiatrist to the same extent
as if the communication were made to the supervising physician or
supervising podiatrist.
(2) A physician's assistant or nurse practitioner shall
conform to minimal standards of acceptable and prevailing practice
for the supervising physician under this part or part 175 or
supervising podiatrist under part 180.
Sec. 17548. (1) Except as otherwise provided in this
subsection and section 17549(5), a physician who is a sole
practitioner or who practices in a group of physicians and treats
patients on an outpatient basis shall not supervise more than 4
physician's assistants or nurse practitioners. If a physician
described in this subsection supervises physician's assistants or
nurse practitioners at more than 1 practice site, the physician
shall not supervise more than 2 physician's assistants or nurse
practitioners by a method other than the physician's actual
physical presence at the practice site.
(2) A physician who is employed by or under contract or
subcontract to or has privileges at a health facility licensed
under article 17 or a state correctional facility may supervise
more than 4 physician's assistants or nurse practitioners at the
health facility or agency or state correctional facility.
(3) To the extent that a particular selected medical care
service requires extensive medical training, education, or ability
or pose serious risks to the health and safety of patients, the
board may prohibit or otherwise restrict the delegation of that
medical care service or may require higher levels of supervision.
(4) A physician shall not delegate ultimate responsibility for
the quality of medical care services, even if the medical care
services are provided by a physician's assistant or nurse
practitioner.
(5) The board may promulgate rules for the delegation by a
supervising physician to a physician's assistant or nurse
practitioner of the function of prescription of drugs. The rules
may define the drugs or classes of drugs the prescription of which
shall not be delegated and other procedures and protocols necessary
to promote consistency with federal and state drug control and
enforcement
laws. Until the rules are promulgated, a supervising
physician
may delegate the prescription of drugs other than
controlled
substances as defined by article 7 or federal law. When
delegated prescription occurs, both the physician's assistant's or
nurse practitioner's name and the supervising physician's name
shall be used, recorded, or otherwise indicated in connection with
each individual prescription.
(6) A supervising physician may delegate in writing to a
physician's assistant or nurse practitioner the ordering, receipt,
and
dispensing of complimentary starter dose drugs other than
including
controlled substances as defined by
article 7 or federal
law that
are included in schedules 2 to 5 of part 72. When the
delegated ordering, receipt, or dispensing of complimentary starter
dose drugs occurs, both the physician's assistant's or nurse
practitioner's name and the supervising physician's name shall be
used, recorded, or otherwise indicated in connection with each
order, receipt, or dispensing. As used in this subsection,
"complimentary starter dose" means that term as defined in section
17745. It is the intent of the legislature in enacting this
subsection to allow a pharmaceutical manufacturer or wholesale
distributor, as those terms are defined in part 177, to distribute
complimentary starter dose drugs to a physician's assistant, as
described in this subsection, in compliance with section 503(d) of
the
federal food, drug, and cosmetic act, chapter 675, 52 Stat.
1051,
21 U.S.C. 21 USC 353.
Sec. 17549. (1) In addition to the other requirements of this
section and subject to subsection (5), a physician who supervises a
physician's assistant or nurse practitioner is responsible for all
of the following:
(a) Verification of the physician's assistant's or nurse
practitioner's credentials.
(b) Evaluation of the physician's assistant's or nurse
practitioner's performance.
(c) Monitoring the physician's assistant's or nurse
practitioner's practice and provision of medical care services.
(2) Subject to section 16215 or 17548, as applicable, a
physician who supervises a physician's assistant or nurse
practitioner may delegate to the physician's assistant or nurse
practitioner the performance of medical care services for a patient
who is under the case management responsibility of the physician,
if the delegation is consistent with the physician's assistant's or
nurse practitioner's training.
(3) A physician who supervises a physician's assistant or
nurse practitioner is responsible for the clinical supervision of
each physician's assistant and nurse practitioner to whom the
physician delegates the performance of medical care service under
subsection (2).
(4) Subject to subsection (5), a physician who supervises a
physician's assistant or nurse practitioner shall keep on file in
the physician's office or in the health facility or agency or state
correctional facility in which the physician supervises the
physician's assistant or nurse practitioner a permanent, written
record that includes the physician's name and license number and
the name and license number of each physician's assistant and nurse
practitioner supervised by the physician.
(5) A group of physicians practicing other than as sole
practitioners may designate 1 or more physicians in the group to
fulfill the requirements of subsections (1) and (4).
(6) Notwithstanding any law or rule to the contrary, a
physician is not required to countersign orders written in a
patient's clinical record by a physician's assistant or nurse
practitioner to whom the physician has delegated the performance of
medical care services for a patient. Notwithstanding any law or
rule to the contrary, a physician is not required to sign an
official form that lists the physician's signature as the required
signatory if that official form is signed by a physician's
assistant or nurse practitioner to whom the physician has delegated
the performance of medical care services.
Sec. 17550. In addition to its other powers and duties under
this article, the board may prohibit a physician from supervising 1
or more physician's assistants or nurse practitioners for any of
the grounds set forth in section 16221 or for failure to supervise
a physician's assistant or nurse practitioner in accordance with
this part and rules promulgated under this part.
Sec. 17745. (1) Except as otherwise provided in this
subsection, a prescriber who wishes to dispense prescription drugs
shall obtain from the board a drug control license for each
location in which the storage and dispensing of prescription drugs
occur. A drug control license is not necessary if the dispensing
occurs in the emergency department, emergency room, or trauma
center of a hospital licensed under article 17 or if the dispensing
involves only the issuance of complimentary starter dose drugs.
(2) A dispensing prescriber shall dispense prescription drugs
only to his or her own patients.
(3) A dispensing prescriber shall include in a patient's chart
or clinical record a complete record, including prescription drug
names, dosages, and quantities, of all prescription drugs dispensed
directly by the dispensing prescriber or indirectly under his or
her delegatory authority. If prescription drugs are dispensed under
the prescriber's delegatory authority, the delegatee who dispenses
the prescription drugs shall initial the patient's chart, clinical
record, or log of prescription drugs dispensed. In a patient's
chart or clinical record, a dispensing prescriber shall distinguish
between prescription drugs dispensed to the patient and
prescription drugs prescribed for the patient. A dispensing
prescriber shall retain information required under this subsection
for not less than 5 years after the information is entered in the
patient's chart or clinical record.
(4) A dispensing prescriber shall store prescription drugs
under conditions that will maintain their stability, integrity, and
effectiveness and will assure that the prescription drugs are free
of contamination, deterioration, and adulteration.
(5) A dispensing prescriber shall store prescription drugs in
a substantially constructed, securely lockable cabinet. Access to
the cabinet shall be limited to individuals authorized to dispense
prescription drugs in compliance with this part and article 7.
(6) Unless otherwise requested by a patient, a dispensing
prescriber shall dispense a prescription drug in a safety closure
container that complies with the poison prevention packaging act of
1970,
Public Law 91-601, 84 Stat. 1670 15 USC 1471 to
1477.
(7) A dispensing prescriber shall dispense a drug in a
container that bears a label containing all of the following
information:
(a) The name and address of the location from which the
prescription drug is dispensed.
(b) The patient's name and record number.
(c) The date the prescription drug was dispensed.
(d) The prescriber's name and, if dispensed under the
prescriber's delegatory authority, the name of the delegatee.
(e) The directions for use.
(f) The name and strength of the prescription drug.
(g) The quantity dispensed.
(h) The expiration date of the prescription drug or the
statement required under section 17756.
(8) A dispensing prescriber who dispenses a complimentary
starter dose drug to a patient shall give the patient at least all
of the following information, either by dispensing the
complimentary starter dose drug to the patient in a container that
bears a label containing the information or by giving the patient a
written document which may include, but is not limited to, a
preprinted insert that comes with the complimentary starter dose
drug, that contains the information:
(a) The name and strength of the complimentary starter dose
drug.
(b) Directions for the patient's use of the complimentary
starter dose drug.
(c) The expiration date of the complimentary starter dose drug
or the statement required under section 17756.
(9) The information required under subsection (8) is in
addition to, and does not supersede or modify, other state or
federal law regulating the labeling of prescription drugs.
(10) In addition to meeting the requirements of this part, a
dispensing prescriber who dispenses controlled substances shall
comply with section 7303a.
(11) The board may periodically inspect locations from which
prescription drugs are dispensed.
(12) The act, task, or function of dispensing prescription
drugs
shall be delegated only as provided in section 16215 and this
part and sections 16215, 17048, 17076, 17212, and 17548.
(13) A supervising physician may delegate in writing to a
pharmacist practicing in a hospital pharmacy within a hospital
licensed under article 17 the receipt of complimentary starter dose
drugs other than controlled substances as defined by article 7 or
federal law. When the delegated receipt of complimentary starter
dose drugs occurs, both the pharmacist's name and the supervising
physician's name shall be used, recorded, or otherwise indicated in
connection with each receipt. A pharmacist described in this
subsection may dispense a prescription for complimentary starter
dose drugs written or transmitted by facsimile, electronic
transmission, or other means of communication by a prescriber.
(14) As used in this section, "complimentary starter dose"
means a prescription drug packaged, dispensed, and distributed in
accordance with state and federal law that is provided to a
dispensing prescriber free of charge by a manufacturer or
distributor and dispensed free of charge by the dispensing
prescriber to his or her patients.
Sec. 17757. (1) Upon a request made in person or by telephone,
a pharmacist engaged in the business of selling drugs at retail
shall provide the current selling price of a drug dispensed by that
pharmacy or comparative current selling prices of generic and brand
name drugs dispensed by that pharmacy. The information shall be
provided to the person making the request before a drug is
dispensed to the person. A person who makes a request for price
information under this subsection shall not be obligated to
purchase the drug for which the price or comparative prices are
requested.
(2) A pharmacist engaged in the business of selling drugs at
retail shall conspicuously display the notice described in
subsection (3) at each counter over which prescription drugs are
dispensed.
(3) The notice required under subsection (2) shall be in
substantially the following form:
NOTICE TO CONSUMERS
ABOUT PRESCRIPTION DRUGS
Under Michigan law, you have the right to find out the price
of a prescription drug before the pharmacist fills the
prescription. You are under no obligation to have the prescription
filled here and may use this price information to shop around at
other pharmacies. You may request price information in person or by
telephone.
Every pharmacy has the current selling prices of both generic
and brand name drugs dispensed by the pharmacy.
Ask your pharmacist if a lower-cost generic drug is available
to fill your prescription. A generic drug contains the same
medicine as a brand name drug and is a suitable substitute in most
instances.
A generic drug may not be dispensed by your pharmacist if your
doctor has written "dispense as written" or the initials "d.a.w."
on the prescription.
If you have questions about the drugs which have been
prescribed for you, ask your doctor or pharmacist for more
information.
To avoid dangerous drug interactions, let your doctor and
pharmacist know about any other medications you are taking. This is
especially important if you have more than 1 doctor or have
prescriptions filled at more than 1 pharmacy.
(4) The notice required under subsection (2) shall also
contain the address and phone number of the board and the
department. The text of the notice shall be in at least 32-point
bold type and shall be printed on paper at least 11 inches by 17
inches in size. The notice may be printed on multiple pages.
(5) A copy of the notice required under subsection (2) shall
be provided to each licensee by the department. Additional copies
shall be available if needed from the department. A person may
duplicate or reproduce the notice if the duplication or
reproduction is a true copy of the notice as produced by the
department, without any additions or deletions whatsoever.
(6) The pharmacist shall furnish to the purchaser of a
prescription drug at the time the drug is delivered to the
purchaser a receipt evidencing the transactions, which contains the
following:
(a) The brand name of the drug, if applicable.
(b) The name of the manufacturer or the supplier of the drug,
if the drug does not have a brand name.
(c) The strength of the drug, if significant.
(d) The quantity dispensed, if applicable.
(e) The name and address of the pharmacy.
(f) The serial number of the prescription.
(g) The date the prescription was originally dispensed.
(h) The name of the prescriber and, if prescribed under the
prescriber's delegatory authority, the name of the delegatee.
(i) The name of patient for whom the drug was prescribed.
(j) The price for which the drug was sold to the purchaser.
(7) Subsection (6)(a), (b), and (c) may be omitted by a
pharmacist only if the omission is expressly required by the
prescriber. The pharmacist shall retain a copy of each receipt for
90 days. The inclusion of subsection (6) on the prescription
container label is a valid receipt to the purchaser. Including
subsection (6) on the written prescription form and retaining the
form constitutes retention of a copy of the receipt.
(8) The board may promulgate rules to implement this section.
Sec. 18048. (1) Except as otherwise provided in this section
and section 18049(5), a podiatrist who is a sole practitioner or
who practices in a group of podiatrists and treats patients on an
outpatient basis shall not supervise more than 4 physician's
assistants or nurse practitioners. If a podiatrist described in
this subsection supervises physician's assistants or nurse
practitioners at more than 1 practice site, the podiatrist shall
not supervise more than 2 physician's assistants or nurse
practitioners by a method other than the podiatrist's actual
physical presence at the practice site.
(2) A podiatrist who is employed by or under contract or
subcontract to or has privileges at a health facility licensed
under article 17 may supervise more than 4 physician's assistants
or nurse practitioners at the health facility or agency.
(3) The department may promulgate rules for the appropriate
delegation and utilization of a physician's assistant or nurse
practitioner by a podiatrist, including, but not limited to, rules
to prohibit or otherwise restrict the delegation of certain
podiatric services or require higher levels of supervision if the
board
determines that such these
services require extensive
training, education, or ability or pose serious risks to the health
or safety of patients.
Sec. 18049. (1) In addition to the other requirements of this
section and subject to subsection (5), a podiatrist who supervises
a physician's assistant or nurse practitioner is responsible for
all of the following:
(a) Verification of the physician's assistant's or nurse
practitioner's credentials.
(b) Evaluation of the physician's assistant's or nurse
practitioner's performance.
(c) Monitoring the physician's assistant's or nurse
practitioner's practice and provision of podiatric services.
(2) Subject to section 16215 or 18048, as applicable, a
podiatrist who supervises a physician's assistant or nurse
practitioner may only delegate to the physician's assistant or
nurse practitioner the performance of podiatric services for a
patient who is under the case management responsibility of the
podiatrist, if the delegation is consistent with the physician's
assistant's or nurse practitioner's training. A podiatrist shall
only supervise a physician's assistant or nurse practitioner in the
performance of those duties included within his or her scope of
practice.
(3) A podiatrist who supervises a physician's assistant or
nurse practitioner is responsible for the clinical supervision of
each physician's assistant and nurse practitioner to whom the
physician delegates the performance of podiatric services under
subsection (2).
(4) Subject to subsection (5), a podiatrist who supervises a
physician's assistant or nurse practitioner shall keep on file in
the physician's office or in the health facility or agency in which
the podiatrist supervises the physician's assistant or nurse
practitioner a permanent, written record that includes the
podiatrist's name and license number and the name and license
number of each physician's assistant and nurse practitioner
supervised by the podiatrist.
(5) A group of podiatrists practicing other than as sole
practitioners may designate 1 or more podiatrists in the group to
fulfill the requirements of subsections (1) and (4).
Sec. 18050. In addition to its other powers and duties under
this article, the board may prohibit a podiatrist from supervising
1 or more physician's assistants or nurse practitioners for any of
the grounds set forth in section 16221 or for failure to supervise
a physician's assistant or nurse practitioner in accordance with
this part and rules promulgated under this part.
Sec. 20201. (1) A health facility or agency that provides
services directly to patients or residents and is licensed under
this article shall adopt a policy describing the rights and
responsibilities of patients or residents admitted to the health
facility or agency. Except for a licensed health maintenance
organization, which shall comply with chapter 35 of the insurance
code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580, the policy
shall be posted at a public place in the health facility or agency
and shall be provided to each member of the health facility or
agency staff. Patients or residents shall be treated in accordance
with the policy.
(2) The policy describing the rights and responsibilities of
patients or residents required under subsection (1) shall include,
as a minimum, all of the following:
(a) A patient or resident shall not be denied appropriate care
on the basis of race, religion, color, national origin, sex, age,
disability, marital status, sexual preference, or source of
payment.
(b) An individual who is or has been a patient or resident is
entitled to inspect, or receive for a reasonable fee, a copy of his
or her medical record upon request in accordance with the medical
records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except
as otherwise permitted or required under the health insurance
portability and accountability act of 1996, Public Law 104-191, or
regulations promulgated under that act, 45 CFR parts 160 and 164, a
third party shall not be given a copy of the patient's or
resident's medical record without prior authorization of the
patient or resident.
(c) A patient or resident is entitled to confidential
treatment of personal and medical records, and may refuse their
release to a person outside the health facility or agency except as
required because of a transfer to another health care facility, as
required by law or third party payment contract, or as permitted or
required under the health insurance portability and accountability
act of 1996, Public Law 104-191, or regulations promulgated under
that act, 45 CFR parts 160 and 164.
(d) A patient or resident is entitled to privacy, to the
extent feasible, in treatment and in caring for personal needs with
consideration, respect, and full recognition of his or her dignity
and individuality.
(e) A patient or resident is entitled to receive adequate and
appropriate care, and to receive, from the appropriate individual
within the health facility or agency, information about his or her
medical condition, proposed course of treatment, and prospects for
recovery, in terms that the patient or resident can understand,
unless
medically contraindicated as documented by the attending
physician
in the medical record by the attending physician or a
physician's assistant or nurse practitioner to whom the physician
has delegated the performance of medical care services.
(f) A patient or resident is entitled to refuse treatment to
the extent provided by law and to be informed of the consequences
of that refusal. If a refusal of treatment prevents a health
facility or agency or its staff from providing appropriate care
according to ethical and professional standards, the relationship
with the patient or resident may be terminated upon reasonable
notice.
(g) A patient or resident is entitled to exercise his or her
rights as a patient or resident and as a citizen, and to this end
may present grievances or recommend changes in policies and
services on behalf of himself or herself or others to the health
facility or agency staff, to governmental officials, or to another
person of his or her choice within or outside the health facility
or agency, free from restraint, interference, coercion,
discrimination, or reprisal. A patient or resident is entitled to
information about the health facility's or agency's policies and
procedures for initiation, review, and resolution of patient or
resident complaints.
(h) A patient or resident is entitled to information
concerning an experimental procedure proposed as a part of his or
her care and has the right to refuse to participate in the
experimental procedure without jeopardizing his or her continuing
care.
(i) A patient or resident is entitled to receive and examine
an explanation of his or her bill regardless of the source of
payment and to receive, upon request, information relating to
financial assistance available through the health facility or
agency.
(j) A patient or resident is entitled to know who is
responsible for and who is providing his or her direct care, is
entitled to receive information concerning his or her continuing
health needs and alternatives for meeting those needs, and to be
involved in his or her discharge planning, if appropriate.
(k) A patient or resident is entitled to associate and have
private communications and consultations with his or her physician
or a physician's assistant or nurse practitioner to whom the
physician has delegated the performance of medical care services,
attorney, or any other person of his or her choice and to send and
receive personal mail unopened on the same day it is received at
the health facility or agency, unless medically contraindicated as
documented
by the attending physician in the medical record by the
attending physician or a physician's assistant or nurse
practitioner to whom the physician has delegated the performance of
medical care services. A patient's or resident's civil and
religious liberties, including the right to independent personal
decisions and the right to knowledge of available choices, shall
not be infringed and the health facility or agency shall encourage
and assist in the fullest possible exercise of these rights. A
patient or resident may meet with, and participate in, the
activities of social, religious, and community groups at his or her
discretion,
unless medically contraindicated as documented by the
attending
physician in the medical record by the attending
physician or a physician's assistant or nurse practitioner to whom
the physician has delegated the performance of medical care
services.
(l) A patient or resident is entitled to be free from mental
and physical abuse and from physical and chemical restraints,
except those restraints authorized in writing by the attending
physician or a physician's assistant or nurse practitioner to whom
the physician has delegated the performance of medical care
services for a specified and limited time or as are necessitated by
an emergency to protect the patient or resident from injury to self
or others, in which case the restraint may only be applied by a
qualified professional who shall set forth in writing the
circumstances requiring the use of restraints and who shall
promptly report the action to the attending physician, physician's
assistant, or nurse practitioner. In case of a chemical restraint,
a physician shall be consulted within 24 hours after the
commencement of the chemical restraint.
(m) A patient or resident is entitled to be free from
performing services for the health facility or agency that are not
included for therapeutic purposes in the plan of care.
(n) A patient or resident is entitled to information about the
health facility or agency rules and regulations affecting patient
or resident care and conduct.
(o) A patient or resident is entitled to adequate and
appropriate pain and symptom management as a basic and essential
element of his or her medical treatment.
(3) The following additional requirements for the policy
described in subsection (2) apply to licensees under parts 213 and
217:
(a) The policy shall be provided to each nursing home patient
or home for the aged resident upon admission, and the staff of the
facility shall be trained and involved in the implementation of the
policy.
(b) Each nursing home patient may associate and communicate
privately with persons of his or her choice. Reasonable, regular
visiting hours, which shall be not less than 8 hours per day, and
which shall take into consideration the special circumstances of
each visitor, shall be established for patients to receive
visitors. A patient may be visited by the patient's attorney or by
representatives of the departments named in section 20156, during
other than established visiting hours. Reasonable privacy shall be
afforded for visitation of a patient who shares a room with another
patient. Each patient shall have reasonable access to a telephone.
A married nursing home patient or home for the aged resident is
entitled to meet privately with his or her spouse in a room that
assures privacy. If both spouses are residents in the same
facility, they are entitled to share a room unless medically
contraindicated
and documented by the attending physician in the
medical record by the attending physician or a physician's
assistant or nurse practitioner to whom the physician has delegated
the performance of medical care services.
(c) A nursing home patient or home for the aged resident is
entitled to retain and use personal clothing and possessions as
space permits, unless to do so would infringe upon the rights of
other patients or residents, or unless medically contraindicated as
documented
by the attending physician in the medical record by the
attending physician or a physician's assistant or nurse
practitioner to whom the physician has delegated the performance of
medical care services. Each nursing home patient or home for the
aged resident shall be provided with reasonable space. At the
request of a patient, a nursing home shall provide for the
safekeeping of personal effects, funds, and other property of a
patient in accordance with section 21767, except that a nursing
home is not required to provide for the safekeeping of a property
that would impose an unreasonable burden on the nursing home.
(d) A nursing home patient or home for the aged resident is
entitled to the opportunity to participate in the planning of his
or
her medical treatment. A The
attending physician or a
physician's assistant or nurse practitioner to whom the physician
has delegated the performance of medical care services shall fully
inform
the nursing home patient shall be
fully informed by the
attending
physician of the patient's medical
condition unless
medically
contraindicated as documented by a physician in the
medical record by a physician or a physician's assistant or nurse
practitioner to whom the physician has delegated the performance of
medical care services. Each nursing home patient shall be afforded
the opportunity to discharge himself or herself from the nursing
home.
(e) A home for the aged resident may be transferred or
discharged only for medical reasons, for his or her welfare or that
of other residents, or for nonpayment of his or her stay, except as
provided by title XVIII or title XIX. A nursing home patient may be
transferred or discharged only as provided in sections 21773 to
21777. A nursing home patient or home for the aged resident is
entitled to be given reasonable advance notice to ensure orderly
transfer or discharge. Those actions shall be documented in the
medical record.
(f) A nursing home patient or home for the aged resident is
entitled to be fully informed before or at the time of admission
and during stay of services available in the facility, and of the
related charges including any charges for services not covered
under title XVIII, or not covered by the facility's basic per diem
rate. The statement of services provided by the facility shall be
in writing and shall include those required to be offered on an as-
needed basis.
(g) A nursing home patient or home for the aged resident is
entitled to manage his or her own financial affairs, or to have at
least a quarterly accounting of personal financial transactions
undertaken in his or her behalf by the facility during a period of
time the patient or resident has delegated those responsibilities
to the facility. In addition, a patient or resident is entitled to
receive each month from the facility an itemized statement setting
forth the services paid for by or on behalf of the patient and the
services rendered by the facility. The admission of a patient to a
nursing home does not confer on the nursing home or its owner,
administrator, employees, or representatives the authority to
manage, use, or dispose of a patient's property.
(h) A nursing home patient or a person authorized by the
patient in writing may inspect and copy the patient's personal and
medical records. The records shall be made available for inspection
and copying by the nursing home within a reasonable time, not
exceeding 1 week, after the receipt of a written request.
(i) If a nursing home patient desires treatment by a licensed
member of the healing arts, the treatment shall be made available
unless it is medically contraindicated, and the medical
contraindication is justified in the patient's medical record by
the attending physician or a physician's assistant or nurse
practitioner to whom the physician has delegated the performance of
medical care services.
(j) A nursing home patient has the right to have his or her
parents, if a minor, or his or her spouse, next of kin, or
patient's representative, if an adult, stay at the facility 24
hours a day if the patient is considered terminally ill by the
physician responsible for the patient's care or a physician's
assistant or nurse practitioner to whom the physician has delegated
the performance of medical care services.
(k) Each nursing home patient shall be provided with meals
that meet the recommended dietary allowances for that patient's age
and sex and that may be modified according to special dietary needs
or ability to chew.
(l) Each nursing home patient has the right to receive
representatives of approved organizations as provided in section
21763.
(4) A nursing home, its owner, administrator, employee, or
representative shall not discharge, harass, or retaliate or
discriminate against a patient because the patient has exercised a
right protected under this section.
(5) In the case of a nursing home patient, the rights
enumerated in subsection (2)(c), (g), and (k) and subsection
(3)(d), (g), and (h) may be exercised by the patient's
representative.
(6) A nursing home patient or home for the aged resident is
entitled to be fully informed, as evidenced by the patient's or
resident's written acknowledgment, before or at the time of
admission and during stay, of the policy required by this section.
The policy shall provide that if a patient or resident is
adjudicated incompetent and not restored to legal capacity, the
rights and responsibilities set forth in this section shall be
exercised by a person designated by the patient or resident. The
health facility or agency shall provide proper forms for the
patient or resident to provide for the designation of this person
at the time of admission.
(7) This section does not prohibit a health facility or agency
from establishing and recognizing additional patients' rights.
(8) As used in this section:
(a) "Patient's representative" means that term as defined in
section 21703.
(b) "Title XVIII" means title XVIII of the social security
act,
42 USC 1395 to 1395hhh 1395kkk-1.
(c) "Title XIX" means title XIX of the social security act, 42
USC
1396 to 1396v 1396w-5.
