CHAPTER 147

FORMERLY

SENATE BILL NO. 162

AS AMENDED BY SENATE AMENDMENT NO. 1 AND HOUSE AMENDMENT NOS. 1 AND 3

AN ACT TO AMEND TITLE 24, CHAPTER 17, RELATING TO THE RECOGNITION, REGULATION, AND LICENSURE OF PHYSICIAN’S ASSISTANTS AND TO PROVIDE FOR THE MAXIMUM UTILIZATION OF QUALIFIED PHYSICIAN’S ASSISTANTS IN THE PROVISION OF HEALTH CARE TO THE CITIZENS OF DELAWARE IN ANY HEALTH CARE PRACTICE SETTING, UNDER THE SUPERVISION OF PHYSICIANS LICENSED UNDER CHAPTER 17 OF THIS TITLE.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE (Three-fifths of all members elected to each House thereof concurring therein):

Section 1. Amend §1703, Chapter 17, Title 24 of the Delaware Code by adding a new Subsection (g) to read as follows:

"(g) Physician’s Assistant Regulatory Council, To assist the Board of Medical Practice in the performance of its duty relating to the regulation of physician’s assistants the president, with advice and approval of the Board, shall appoint a Regulatory Council for Physician’s Assistants. The Regulatory Council shall be chaired by a member of the Board appointed by the president and shall have four other members. Each of those four other members shall be physician’s assistants and shall meet the same requirements and be subject to the same limitations and causes for removal as a physician member of the Board, the requirement for medical licensure being replaced by that for full and unrestricted authorization to practice as a physician’s assistant. Terms and limitations of service on the Physician’s Assistant Regulatory Council shall be the same as for the Board. The Chairman of the Regulatory Council shall be compensated and reimbursed as a Board member. The other four members of the Regulatory Council shall be compensated at an appropriate and reasonable level as determined by the Board and shall be reimbursed for meeting-related travel and expenses at the State’s current approved rate. The Physician’s Assistant Regulatory Council shall meet at least once each year to review the regulation of physician’s assistants and to advise the Board of policy and rules relating to that regulation. The Board shall also consult Council members for advice on particular issues or disciplinary matters. The Board shall determine the specific functions of the Physician’s Assistant Regulatory Council in keeping with this statute."

Section 2. Amend Chapter 17, Title 24 of the Delaware Code by adding a new §1770 to read as follows:

"§1770 Physician’s Assistants (P.A.’s). (a) As used in this section:

(1) A ‘Physician’s Assistant’ Is defined as an individual who has graduated from a physician’s or surgeon’s assistant program which has been accredited by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association (AMA), has passed a national certifying examination acceptable to the Physician’s Assistant Advisory Council of the Board and approved by the full Board, and who is licensed under this Chapter to practice as a physician’s assistant. Physician’s assistants who are currently registered in the State but who are not graduates of an approved program of the type outlined above may be licensed to practice as, and use the title ‘Physician’s Assistant’, provided the individual has successfully passed one of the national certifying examinations developed and administered by the National Board of Medical Examiners (NBME) or the National Commission on Certification of Physician’s Assistants (NCCPA) on or prior to October 1987, and has maintained Continuing Medical Education (CME) credits as required by Rules and Regulations developed under this Chapter.

(1) ‘Supervision of Physician’s Assistants’ means the ability of
the supervising physician to provide or exercise control and direction over the services of physician’s assistants as follows:

a. Any physician who delegates medical responsibility to a
physician’s assistant is responsible for that individual’s medical activities and must provide adequate supervision. No function may be delegated to a physician’s assistant who by statute or professional regulation is prohibited from performing that
function. Supervision may be direct or indirect depending upon the type of medical responsibility delegated. The delegating physician cannot be involved in patient care in name only. A physician’s assistant shall not maintain or manage an office separate and apart from the supervising physician. No regulation of the Board shall purport to authorize physician’s assistants to engage in diagnosis, to prescribe or dispense legend drugs or therapeutics, to practice medicine or surgery or refractions or to pronounce a patient dead in any setting. Such licensed physician’s assistants shall not delegate an assigned task to any other individual, nor shall they independently bill a patient for services rendered at the request of the physician.

b. For the purpose of clarification, the terms ‘guidelines’,
‘standing orders’, ‘protocols’, and ‘algorithms’ are synonymous in their application under these regulations. Hereafter, the term
‘standing orders’ will be used. Standing orders must not be used to make a medical diagnosis or to prescribe or dispense medication or other ‘therapeutics’. Non-prescription medications, however,
may be initiated by standing orders if these standing orders have been approved by the responsible delegating physician. Emergency care as defined in the Medical Practice Act is exempted from these regulations.

a. Direct supervision requires the delegating physician to be physically on the premises and to perform an evaluation or give a consultation. Direct supervision is required if a medical diagnosis is rendered or a treatment plan involving prescription medications is to be instituted.

b. Indirect supervision requires the physician to be either
physically present on the premises or readily available by an electronic device. Readily available necessitates the ability to
become physically present within thirty minutes of notification if the situation warrants such action. Indirect supervision is required whenever a physician’s assistant evaluates a patient, initiates a non-prescription medication or therapeutic, or renews a previously prescribed medication or therapeutic. Direct supervision (as defined above) is required whenever a controlled substance is renewed. A physician’s assistant may follow a physician-initiated standing order under the indirect supervision of the physician, providing the standing order does not call for the initiation of a prescription drug or therapeutic.

c. It is appropriate and good medical procedure for all responsible physicians who choose to have their patients followed by physician’s assistants to personally re-evaluate at least every three months any patient receiving controlled substances or at least every six months any patient receiving other prescription medications or therapeutics.

a. A supervising physician may not delegate responsibilities in assisting the physician to a physician’s assistant which exceed the physician’s specialty.

b. A supervising physician who fails to adhere to these regulations would be considered to be permitting the unauthorized practice of medicine (as defined under §1703, subsection (6) of the Medical Practice Act) and would be subject to disciplinary action by the Board of Medical Practice.

(3) The phrase ‘Delegated Medical Acts’ means the performance of health care activities and duties by a physician’s assistant under the delegation and control of a supervising physician.

(b) The Board in conjunction with the Physician’s Assistant Regulatory Council shall:

(1) Adopt regulations regarding activities which may be undertaken by physician’s assistants and shall license all certified physician’s assistants with the Board.

(2) Define the scope of practice of physician’s assistants including:

3. Issuance of license to physician’s assistant to allow:

1. performance of delegated medical acts within the education and experience of the physician’s assistant; and

1. performance of services customary to the practice of the
supervising physician(s);

3. Delegated medical services provided by a physician’s assistant to include but not limited to:

1. performance of complete histories and physical examinations;

2. recording of patient progress notes in an outpatient setting;

1. relaying, transcribing, or executing specific diagnostic or
therapeutic orders so long as all such notes, orders and other writings shall be reviewed and countersigned by the supervising physician within 24 hours, barring extraordinary events or circumstances.

3. Nothing in this Chapter may be construed to authorize a

physician’s assistant to practice independent of a supervising physician.

d. Except as otherwise provided in this Chapter or in a medical emergency, a physician’s assistant may not perform any medical act which has not been delegated by a supervising physician.

(3) Suspend or revoke the license of a physician’s assistant or otherwise discipline a physician’s assistant for engaging in unprofessional conduct as defined in §1731(b) of this Chapter or for inability to render medical services with reasonable skill or safety to patients because of mental illness or mental incompetence, physical illness or excessive use of drugs, including alcohol. Any disciplinary action undertaken against a physician’s assistant shall be in accordance with those procedures applicable to disciplinary actions against physicians as set out in Subchapter V of this Chapter. An appeal of disciplinary action imposed by the Board shall be taken in accordance with Subchapter V of this Chapter.

(c) The Department of Administrative Services with the concurrence of the Board may, by regulation, establish reasonable fees not to exceed $100.00 for licensing physician’s assistants and renewing the licensure of physician’s assistants on a biennial basis.

(d) The maximum number of physician’s assistants who may be supervised by a physician is two.

(e) Hospitals, clinics, and other health care facilities may employ physician’s assistants; however, no more than two physician’s assistants may be employed and supervised for each physician practicing in the same facility. Physician’s assistants employed by health care facilities must work under protocols approved by the Board.

(f) A physician’s assistant shall not practice as a member of any other health profession as authorized under this Title unless the physician assistant is duly authorized to practice that other profession under the respective Chapter and Title of this code.

Approved July 10, 1991.