LOUISIANA ~ STATUTE. Physician Assistants: State Laws and Regulations 10th edition, 2006 American Academy of Physician Assistants

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1 LOUISIANA ~ STATUTE STATUTE Louisiana Revised Statutes 37: et seq; 37: DATE Enacted 1977 REGULATORY BODY Louisiana State Board of Medical Examiners PA DEFINED Person who is graduate of CAHEA or its successor-accredited PA program or who has successfully passed NCCPA certifying examination and who is approved by board to perform medical services under supervision of physician or group of physicians approved by board to supervise such assistant SCOPE OF PRACTICE PA may perform those duties and responsibilities that are delegated by the supervising physician. PA may have multiple supervising physicians in no more than 5 medical specialties. PA considered to be agent of the physician in performance of all practice-related activities, including but not limited to assisting in surgery and the ordering of diagnostic and other medical services. A PA may inject local anesthetic agents including digital blocks or apply topical anesthetic. However, PA may not administer local anesthetics perineurally, pericurally, epidurally, intrathecally, or intravenously, unless PA is a certified registered nurse anesthetist. PA practice shall include medical services within the PA s scope of education, training and experience which are delegated by the supervising physician. May include but not limited to: histories and physicals ordering or performing diagnostic procedures as delegated by the supervising physician developing and implementing a treatment plan in accordance with clinical practice guidelines and protocols of the supervising physician monitoring the effectiveness of therapeutic intervention suturing wounds as delegated patient counseling and education appropriate referrals These activities may be performed in any setting authorized by the supervising physician including clinics, hospitals, ambulatory surgical centers, patient homes, nursing homes, other institutional settings and health manpower shortage areas PRESCRIBING/DISPENSING PA scope of practice includes prescribing certain drugs and medical devices to extent delegated by supervising physician provided PA has completed a minimum of one year of clinical rotations during training and has practiced for a minimum of one year. PAs may prescribe legend drugs and Schedule III-V controlled medications SUPERVISION DEFINED Supervision means responsible direction and control, with the licensed physician assuming legal liability for services rendered by the PA. Such supervision does not in every case require personal presence of the supervising physician. PA and physician must have capability to be in contact via telecommunication. Supervision shall exist when the supervising physician gives informed concurrence of the action of a PA whether prior to or after the action, and when a treatment plan or action is made in accordance with written clinical practice guidelines or protocols Supervision shall be continuous but does not necessarily require the physical presence of the supervising physician at the time and place services are rendered PAs PER PHYSICIAN Approval may be given for physician to be the primary supervising physician for up to 2 PAs. Physician may act as locum tenens supervisor for additional PAs, as long as physician is not supervising more than 4 PAs at any one time APPLICATION By PA on board-approved forms for license, may include personal interview Notification of intent to practice By physician for approval to supervise, may include personal interview QUALIFICATIONS TEMPORARY PERMIT TERMINATION Graduation from CAHEA or its successor-accredited PA program Passage of NCCPA certifying examination Good moral character Mentally and physically able to engage in PA practice No disciplinary action in any jurisdiction unless board considers condition and agrees to licensure Personal interview for initial license or if discrepancies exist Board may grant working permit to PA applicant who meets qualifications for licensure except that applicant has not yet taken the national certifying exam or has taken the exam and is awaiting results. Valid until results are available or board makes final decision on application for licensure. May be renewed for one year PA shall notify the board of changes in supervising physicians within 15 days of the date of such change

2 LOUISIANA ~ STATUTE Continued CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION Person not licensed as PA guilty of misdemeanor if holds self out as PA, uses PA title, or acts as PA without being licensed. Unlicensed physician may not use PA title unless licensed as a PA. Only currently certified PAs may use PA-C designation PA shall keep license available for inspection at primary place of employment and shall wear name tag with identification as physician assistant PHYSICIAN LIABILITY Supervising physician must submit statement that physician will retain professional and legal responsibility for care rendered by PA PA employed by physician or group of physicians or professional corporation or other health care entity is the legal responsibility of the health care organization and the supervising physician. Legal responsibility for PA s patient care activities, including care provided in facilities, remains that of the supervising physician, group of physicians or medical corporation FEE/RENEWAL SCHEDULE License valid for no more than 1 year but may be renewed annually PROGRAM APPROVAL Programs accredited by CAHEA and its successors BOARD REPRESENTATION/ ADVISORY COMMITTEE BOARD POWERS Five-member PA Advisory Committee consists of 3 PAs appointed by governor from list of names submitted by the Louisiana Academy of PAs. At least 1 of the members shall be PA practicing in a municipality with fewer than 20,000 people. PA members must have 3 years experience and be in active practice at time of appointment. Two committee members shall be licensed supervising physicians appointed by governor from list submitted by the board. The advisory committee elects chair, vice chair and secretary. Committee appointed for 6 years and must meet a minimum of twice each year as determined by chairman or majority of members. Committee to advise the board on all matters dealing with licensing or discipline of PAs or the drafting and promulgating of regulations. Committee also to advise on applications for licensure. Board shall not act on any matter relating to PAs without first consulting the advisory committee Board shall have and exercise all powers and duties previously granted to it. Also the power, in consultation with advisory committee, to make rules and regulations pertaining to approval and regulation of PAs, the approval of physicians to supervise, and as necessary to carry out intent of the act DISCIPLINARY POWERS Refuse to grant a license Administer public or private reprimand Suspend, revoke, restrict or otherwise limit license Require PA to submit to care or counseling Place PA on probation VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE Fraudulently obtains or uses license Violates PA statute or regulations Felony conviction Habitual use of intoxicants or drugs to extent that PA is unable to practice safely Adjudication as mentally incompetent or has mental condition that renders PA unable to practice safely Commission of an act of moral turpitude Represents self as a physician Person practicing as a PA under the supervision of a licensed physician on June 16, 1993 shall be licensed as a PA STUDENTS Trainee is defined as a person currently enrolled in an approved PA program LOCUM TENENS OTHER PA shall not practice without supervision except in life-threatening emergencies and in emergency situations such as man-made and natural disaster relief efforts

3 LOUISIANA - REGULATIONS REGULATIONS LAC Title 46, Subpart 2: Chapter 15 and Chapter 45 DATE Revised 1/05 REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED Louisiana State Board of Medical Examiners Person possessing a current PA license issued under the act and this chapter. As members of the health care team, PAs provide a broad range of medical services that would otherwise be provided by physicians Performance of medical services that are delegated by supervising physician and within the scope of PA s education, training and licensure. PA services may include: screening patients to determine need for medical attention histories and routine physicals reviewing patient records recording pertinent patient data additional duties on illustrative list (regulations specifically state that list is illustrative and does not constitute limits or parameters of PA s practice) PA may suture lacerations only when specifically delegated to do so by supervising physician Licensed PA may not prescribe medication unless registration for prescriptive authority has been approved by the board To be registered as prescribing PA, physician assistant must have completed a minimum of one year of clinical rotations during training and one year of practice under supervising physician or two years of practice. Prescribing must be as delegated by physician. PA and physician must practice under practice guidelines or protocols that must include methods of supervision, types of medication and medical devices that PA is delegated to prescribe and a plan for emergency services and referrals. PA who prescribes controlled medications must register with DEA. PA with history of drug violations or history of drug abuse ineligible for registration for authority to prescribe controlled drugs Supervising physician must apply and register for ability to delegate prescriptive authority. PA must apply for registration to prescribe. Physician who delegates prescriptive authority for controlled substances to PA may not be employee or independent contractor to PA. Board may waive this restriction. Registrations renewed annually 1523, 1525, 1527, 1529 PA may prescribe legend drugs and Schedule III-V substances and medical devices. PA may not complete and issue prescription blanks previously signed by physician PA who is registered as a prescriber may issue prescriptions for medication or medical devices to patient of supervising physician. Prescribing PA may request, receive, sign for and deliver to a patient a medication sample. Prescription written by PA must include preprinted name, address, telephone number and prescriptive authority registration number of PA. If prescription is for controlled substance, must contain PA s DEA number. PA must prescribe within education and experience, within clinical practice guidelines and within the specialty of the supervising physician. PA may not utilize controlled substances to treat non-cancer intractable pain as defined, obesity as defined, or self or family except in life-threatening emergencies. PA may not dispense or deliver controlled substance sample PAs who are not registered as prescribing physician assistants may administer medication or transmit physician s prescription orally or in writing on patient s record. Must be based on patient-specific order. PA may hand to a patient a properly labeled prepackaged prescription drug on patient-specific order of physician. Patient record must be countersigned by supervising physician within 72 hours Supervision is defined as responsible direction and control, with the supervising physician assuming legal liability for services rendered by PA. Supervision does not require the physical presence of supervising physician, but physician and PA be able to contact each other by telecommunication. Supervision exists when physician responsible for the patient gives informed concurrence of the actions of the PA whether prior to or after the action, and when a medical treatment plan or action is made in accordance with written clinical practice guidelines or protocols set forth by the supervising physician PA and supervising physician shall insure that, with respect to each patient, all activities, functions, services and treatment measures are immediately and properly documented in written form by PA. Each and every such written entry shall be reviewed and countersigned by supervising physician within 24 hours for inpatients in acute care settings and hospital emergency departments; 48 hours for nursing home patients and other subacute settings, and 72 hours in all other cases. 4511

4 LOUISIANA REGULATIONS Continued PAs PER PHYSICIAN APPLICATION QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PHYSICIAN LIABILITY Physician may be primary supervising physician for up to 2 PAs; however, supervising physician may act as supervisor on a locum tenens basis provided that physician shall not supervise more than 4 PAs at any one time PA applies for license on board forms. Personal interview may be required if there are prior actions against license or when discrepancies exist Physician applies on board forms for approval and registration as a supervising physician. Includes information on physician s background and specialty, scope of practice and practice information, and plan for utilization of PA. Personal interview may be required To be eligible for licensure, an applicant shall: be at least 20 years of age and of good moral character present diploma from PA program accredited by CAHEA (or its successor) and evidence of passage of NCCPA certifying exam together with documentation of current NCCPA certification; or present valid, current PA license, certificate or permit from another state, provided the other state s requirements are substantially equivalent certify that applicant is mentally and physically able to engage in practice as PA not be subject to discipline in any jurisdiction for cause resulting from applicant s practice as a PA (may be waived by the board) 1507 Board may grant working permit (temporary license) to applicant who otherwise meets qualifications for licensure except that applicant has not yet taken or is awaiting results of certification exam. Expires when exam results are available if applicant has failed to pass or when board takes final action on application for licensure. PA practicing with working permit may not prescribe PA and supervising physician shall notify board in writing within 15 days of PA termination, physician retirement, withdrawal from active practice, any other change in employment, functions or activities, including delegation of prescriptive authority. 1513, 4511 [NCCPA certification must be maintained] PA registered to prescribe must complete NCCPA required CME, maintain current NCCPA certification and maintain record of CME for at least 4 years and make record available to board upon request No person may act as or undertake to perform functions of PA unless he has in his personal possession a current PA license issued to him by the board PA may not render any service to patient unless PA has clearly identified himself as PA by any method reasonably calculated to advise patient that the PA is not a physician Physician is responsible for supervision, control and direction of PA; retains responsibility to patient for competence and performance of PA FEE/RENEWAL SCHEDULE $155 fee with application for licensure 1509 PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE BOARD POWERS $75 fee with application for approval and registration as supervising physician 1510 License must be renewed annually on first day of month licensee was born. Renewal applications must contain documentation of current NCCPA certification and $100 renewal fee Advisory committee shall advise board on all matters dealing with licensing or discipline of PAs or the drafting and promulgating of regulations relating to PAs. Advisory committee shall review applications for licensure and make recommendations to the board. Board shall not act on any matter relating to PAs without first consulting with the advisory committee. Committee to meet not less than twice a year, or more frequently as necessary and approved by the board at the call of the chairman [See statute] DISCIPLINARY POWERS Refuse to issue, suspend or revoke license Impose probationary or other restrictions on any license issued Issue a private or public reprimand 4513

5 LOUISIANA REGULATIONS Continued VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE STUDENTS LOCUM TENENS OTHER Grounds for discipline include: conviction of a criminal offense fraud, deceit or perjury in obtaining a license providing false testimony before the board habitual or recurring drunkenness, use of narcotics or other addictive drugs efforts to defraud or deceive the public incompetence aiding physician in violation of medical practice act disciplinary action by another jurisdiction violation of applicable law or regulations immoral conduct in exercising privileges provided for by license persistent violation of federal or state laws relative to control of social diseases inability to perform with reasonable skill or safety due to various factors refusing to submit to board-ordered examination violation of rules or statute pertaining to PAs conviction or entry of guilty or nolo contendere plea to any crime related to manufacture, production, distribution, sale or exchange of controlled substance prescribing without legitimate medical justification Board may, as probationary condition or condition of reinstatement of certificate, require PA and/or physician to pay all costs of board proceedings and a fine not to exceed $5, PA may receive compensation, salary or wages only from employer; may neither render a statement for services directly to any patient nor receive any payment, compensation or fee for services directly from any patient. Nothing shall prohibit charges from being submitted to any governmental or private payer for services rendered by PA [See statute] PA students enrolled in accredited programs are exempted from rule that prohibits unlicensed PA from functioning as PA. Student may not prescribe Proposed supervising physician may in his application designate as locum tenens a physician who will assume his obligations and responsibilities when he is absent or unavailable as a result of illness, medical emergency or other causes. To be eligible for designation as locum tenens, physician must be licensed in the state, have practiced for 3 years since being awarded MD or DO degree, practice in same or related medical specialty. Application must include detailed information and signed statement from designated locum tenens. 4501, 4509 PA may practice outside approved job description in emergencies, disasters, or relief efforts or if PA is volunteering services to a non-profit charitable organization and performs services under supervision of physician who is physically present. 4505

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