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.
