Q: What is the level
of physician supervision for delegated medical acts? Does it depend
on the level of licensure of the person to whom the medical act is delegated?
A: For persons who are unlicensed,
the performance of a delegated medical act must be “ directed,
supervised and inspected” by the physician. The unlicensed
person presumably does not have the degree of knowledge, training or
education as licensed health care professionals, such as a nurse, physician
assistants, or advance nurse practice prescribers, therefore, the supervision
requirement is heightened. Wis. Stats. 448.03 (2)(e).
The level of supervision for
delegated medical acts performed by a RN is “ general supervision
”. However, the RN may only accept those delegated medical
acts for which there are written protocols or verbal or written orders.
Also, the RN must be competent to perform the delegated acts based upon
his or her nursing education, training or experience. Chapter N6.03(2),
Wis. Admin. Code.
The level of supervision for
delegated medical acts, performed by a LPN, which is beyond basic nursing
care, is “direct supervision ” of the physician. Chapter
N6.04(2)(b), Wis. Admin. Code.
The level of supervision for
delegated medical acts, performed by an APNP, is described as a “collaborative
relationship” with a physician. Chapter N8.10 (7), Wis.
Admin. Code. The collaborative relationship is a process in which
an APNP is working with a physician, in each other's presence when necessary,
to deliver health care services within the scope of the APNP's professional
expertise.
The supervision requirement for
delegated medical acts performed by a Physician Assistant is “general
supervision,” although limited by the scope of the PA's education,
training and experience, and the scope of practice of the supervising
physician. Chapter MED 8.07(1) and (2). Also, the supervising physician
shall be available to the PA at all times for consultation either in
person or within 15 minutes of contact by phone or electronic communication.
Chapter MED 8.10(3)
Q: Has the Wisconsin
Medical Examining Board adopted specific guidelines for physicians who
are treating chronic pain or prescribing controlled substances for the
treatment of pain?
A: No, the Board has not officially
adopted or issued any specific guidelines per se; however,
the Board has indicated that if a physician follows the Model Guidelines
for Use of Controlled Substances for Treatment of Pain adopted by the
Federation of State Medical Board (FSMB), the physician would be practicing
within the standard of care of a competent physician.
The current FSMB guidelines can
be located at:
http://www.fsmb.org/Policy%20Documents%20and%20White%20Papers/2004_model_pain_policy.asp
Q: Are there any restrictions
on a physician practicing medicine under a limited liability company
(LLC) or limited liability partnership (LLP)?
Q: Are there similar
restrictions on a respiratory care practitioner practicing under a LLC
or LLP?
A: Under Wisconsin law, physicians
are prohibited from practicing medicine under a LLC or LLP form of business.
Sec. 448.08(4), Wis. Stats., provides that two or more physicians may
enter into professional partnerships or service corporations to practice
medicine. The allowable form of business entity for physicians has been
reviewed by the Wisconsin Attorney General and it was determined that
physicians may not organize as business corporations. 75 Op. Att'y Gen.
200 (1986) Although LLC's and LLP's did not exist at the time
of the A.G.'s opinion, the rationale for the opinion would apply equally
to those business entities: Physicians are considered members of a learned
profession, and their responsibilities for patient health and safety
cannot be subordinated to the interests of shareholders or limited by
a business entity.
A respiratory care practitioner
is not a physician and cannot practice independently without supervision
of a physician. There is no prohibition against a RCP organizing
as a LLC or LLP business entity. The RCP may, therefore, practice under
a LLC or LLP, provided that they are supervised by a physician.
Q: What are the requirements
for a physician advertising as “board certified”?
A: Chapter MED 10.02(w) requires
that use of the term “board certified” (or a similar phrase of like
meaning) in advertising must include disclosure of the complete name
of the specialty board which conferred the certification. Advertising
in such a manner is prohibited if the physician is not in fact certified.
Failure to make the required disclosure or advertising in an untruthful
or inaccurate manner constitutes unprofessional conduct.
Q: What is the length
of time that a physician in Wisconsin must retain patient medical records?
A: Chapter MED 21.03 of the Wisconsin
Administrative Code, Minimum Standards for Patient Health Care Records,
requires that a physician or a physician's assistant shall maintain
patient health care records for a period of not less than five (5) years
after the date of the last entry, or for such longer period as may be
otherwise required by law. The rule also describes what type of information
that should be maintained in the patient's records.
