The Vermont Statutes Online

Title 26: Professions and Occupations

Chapter 31: PHYSICIAN ASSISTANTS

§§ 1725-1729. Repealed. 1981, No. 100 § 13.

§ 1730. [Reserved for future use.].

§ 1731. Policy and purpose

The general assembly recognizes the need to provide means by which physicians in this state may increase the scope and efficiency of their practice in order to ensure that quality medical services are available to all Vermonters at reasonable cost. (Added 1981, No. 100, § 1; amended 1985, No. 208 (Adj. Sess.), § 1, eff. June 30, 1986.)

§ 1732. Definitions

As used in this chapter:

(1) "Accredited physician assistant program" means a physician assistant educational program that has been accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), or, prior to 2001, by either the Committee on Allied Health Education and Accreditation (CAHEA), or the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

(2) "Board" means the state board of medical practice established by chapter 23 of this title.

(3) "Delegation agreement" means a detailed description of the duties and scope of practice delegated by a primary supervising physician to a physician assistant that is signed by both the physician assistant and the supervising physicians.

(4) "Physician" means an individual licensed to practice medicine pursuant to chapter 23 or 33 of this title.

(5) "Physician assistant" means an individual licensed by the state of Vermont who is qualified by education, training, experience, and personal character to provide medical care with the direction and supervision of a Vermont licensed physician.

(6) "Supervising physician" means an M.D. or D.O. licensed by the state of Vermont who oversees and accepts responsibility for the medical care provided by a physician assistant.

(7) "Supervision" means the direction and review by the supervising physician of the medical care provided by the physician assistant. The constant physical presence of the supervising physician is not required as long as the supervising physician and physician assistant are or easily can be in contact with each other by telecommunication.

(8) "Disciplinary action" means any action taken against a physician assistant or an applicant by the board or on appeal therefrom, when that action suspends, revokes, limits, or conditions licensure in any way, and includes reprimands and administrative penalties. (Added 1981, No. 100, § 2; amended 1985, No. 208 (Adj. Sess.), § 2, eff. June 30, 1986; 1989, No. 250 (Adj. Sess.), § 4(a); 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1733. Licensure

(a) The state board of medical practice is responsible for the licensure of physician assistants, and the commissioner of health shall adopt, amend, or repeal rules regarding the training, practice, qualification, and discipline of physician assistants.

(b) In order to practice, a licensed physician assistant shall have completed a delegation agreement as described in section 1735a of this title with a Vermont licensed physician signed by both the physician assistant and the supervising physician or physicians. The original shall be filed with the board and copies shall be kept on file at each of the physician assistant's practice sites. All applicants and licensees shall demonstrate that the requirements for licensure are met.

(c), (d) [Deleted.]  (Added 1981, No. 100, § 3; amended 1985, No. 208 (Adj. Sess.), § 3, eff. June 30, 1986; 2003, No. 34, § 10, eff. May 23, 2003; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1734. Eligibility

(a) The board may grant a license to practice as a physician assistant to an applicant who:

(1) submits a completed application form provided by the board;

(2) pays the required application fee;

(3) has graduated from an accredited physician assistant program or has passed and maintained the certification examination by the National Commission on the Certification of Physician Assistants (NCCPA) prior to 1988;

(4) has passed the certification examination given by the NCCPA;

(5) is mentally and physically able to engage safely in practice as a physician assistant;

(6) does not hold any license, certification, or registration as a physician assistant in another state or jurisdiction which is under current disciplinary action, or has been revoked, suspended, or placed on probation for cause resulting from the applicant's practice as a physician assistant, unless the board has considered the applicant's circumstances and determines that licensure is appropriate;

(7) is of good moral character;

(8) submits to the board any other information that the board deems necessary to evaluate the applicant's qualifications; and

(9) has engaged in practice as a physician assistant within the last three years or has complied with the requirements for updating knowledge and skills as defined by board rules. This requirement shall not apply to applicants who have graduated from an accredited physician assistant program within the last three years.

(b), (c) [Deleted.]

(d) When the board intends to deny an application for licensure, it shall send the applicant written notice of its decision by certified mail. The notice shall include a statement of the reasons for the action. Within 30 days of the date that an applicant receives such notice, the applicant may file a petition with the board for review of its preliminary decision. At the hearing, the burden shall be on the applicant to show that licensure should be granted. After the hearing, the board shall affirm or reverse its preliminary denial.

(e) Failure to maintain competence in the knowledge and skills of a physician assistant, as determined by the board, shall be cause for revocation of licensure. (Added 1981, No. 100, § 4; amended 1985, No. 208 (Adj. Sess.), § 4, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1734a. Repealed. 2011, No. 61, § 9, effective June 2, 2011.

§ 1734b. Renewal of license

(a) Licenses shall be renewed every two years on payment of the required fee. At least one month prior to the date on which renewal is required, the board shall send to each licensee a license renewal application form and notice of the date on which the existing license will expire. On or before the renewal date, the licensee shall file an application for license renewal and pay the required fee. The board shall register the applicant and issue the renewal license. Within one month following the date renewal is required, the board shall pay the license renewal fees into the medical practice board special fund. Any physician assistant while on extended active duty in the uniformed services of the United States or member of the national guard, state guard, or reserve component who is licensed as a physician assistant at the time of an activation or deployment shall receive an extension of licensure up to 90 days following the physician assistant's return from activation or deployment, provided the physician assistant notifies the board of his or her activation or deployment prior to the expiration of the current license, and certifies that the circumstances of the activation or deployment impede good faith efforts to make timely application for renewal of the license.

(b) A licensee shall demonstrate that the requirements for licensure are met.

Subsection (c) effective 60 days after the adoption of the maintenance of licensure for physician assistants; see note set out below.

(c) A licensee for renewal of an active license to practice shall have practiced as a physician assistant within the last three years or have complied with the requirements for updating knowledge and skills as defined by board rules.

(d) A licensee shall promptly provide the board with new or changed information pertinent to the information in his or her license and license renewal applications at the time he or she becomes aware of the new or changed information.

(e) A license which has lapsed may be reinstated on payment of a renewal fee and a late renewal fee. The applicant shall not be required to pay renewal fees during periods when the license was lapsed. However, if a license remains lapsed for a period of three years, the board may require the licensee to update his or her knowledge and skills as defined by board rules. (Added 1985, No. 208 (Adj. Sess.), § 6, eff. June 30, 1986; amended 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1734c. Exemptions

Nothing herein shall be construed to require licensure under this chapter of:

(1) a physician assistant student enrolled in a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant;

(2) a physician assistant employed in the service of the U.S. military or national guard, including national guard in-state status, while performing duties incident to that employment; or

(3) a technician or other assistant or employee of a physician who performs physician-delegated tasks but who is not rendering services as a physician assistant or identifying himself or herself as a physician assistant. (Added 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1735. Repealed. 2011, No. 61, § 9, effective June 2, 2011.

§ 1735a. Supervision and scope of practice

(a) It is the obligation of each team of physician and physician assistant to ensure that the physician assistant's scope of practice is identified; that delegation of medical care is appropriate to the physician assistant's level of competence; that the supervision, monitoring, documentation, and access to the supervising physician is defined; and that a process for evaluation of the physician assistant's performance is established.

(b) The information required in subsection (a) of this section shall be included in a delegation agreement as required by the commissioner by rule. The delegation agreement shall be signed by both the physician assistant and the supervising physician or physicians, and a copy shall be kept on file at each of the physician assistant's practice sites and the original filed with the board.

(c) The physician assistant's scope of practice shall be limited to medical care which is delegated to the physician assistant by the supervising physician and performed with the supervision of the supervising physician. The medical care shall be within the supervising physician's scope of practice and shall be care which the supervising physician has determined that the physician assistant is qualified by education, training, and experience to provide.

(d) A physician assistant may prescribe, dispense, and administer drugs and medical devices to the extent delegated by a supervising physician. A physician assistant who is authorized by a supervising physician to prescribe controlled substances must register with the federal Drug Enforcement Administration.

(e) A supervising physician and physician assistant shall report to the board immediately upon an alteration or the termination of the delegation agreement. (Added 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1736. Unprofessional conduct

(a) The following conduct and the conduct described in section 1354 of this title by a licensed physician assistant shall constitute unprofessional conduct. When that conduct is by an applicant or person who later becomes an applicant, it may constitute grounds for denial of licensure:

(1) fraud or misrepresentation in applying for or procuring a license or in applying for or procuring a periodic renewal of a license;

(2) occupational advertising which is intended or has a tendency to deceive the public;

(3) exercising undue influence on or taking improper advantage of a person using the individual's services, or promoting the sale of professional goods or services in a manner which exploits a person for the financial gain of the practitioner or of a third party;

(4) failing to comply with provisions of federal or state statutes or rules governing the profession;

(5) conviction of a crime related to the profession;

(6) conduct which evidences unfitness to practice in the profession.

(b) Unprofessional conduct includes the following actions by a licensed physician assistant:

(1) making or filing false professional reports or records, impeding or obstructing the proper making or filing of professional reports or records, or failing to file the proper professional report or record;

(2) practicing the profession when mentally or physically unfit to do so;

(3) practicing the profession without having a delegation agreement meeting the requirements of this chapter on file at the primary location of the physician assistant's practice and the board;

(4) accepting and performing responsibilities which the individual knows or has reason to know that he or she is not competent to perform;

(5) making any material misrepresentation in the practice of the profession, whether by commission or omission;

(6) the act of holding one's self out as, or permitting one's self to be represented as, a licensed physician;

(7) performing otherwise than at the direction and under the supervision of a physician licensed by the board or an osteopath licensed by the Vermont board of osteopathic physicians and surgeons;

(8) performing or offering to perform a task or tasks beyond the individual's delegated scope of practice;

(9) administering, dispensing, or prescribing any controlled substance otherwise than as authorized by law;

(10) habitual or excessive use or abuse of drugs, alcohol, or other substances that impair the ability to provide medical services;

(11) failure to practice competently by reason of any cause on a single occasion or on multiple occasions. Failure to practice competently includes as determined by the board:

(A) performance of unsafe or unacceptable patient care; or

(B) failure to conform to the essential standards of acceptable and prevailing practice.

(c) A person aggrieved by a determination of the board may, within 30 days of the order, appeal that order to the Vermont supreme court on the basis of the record created before the board. (Added 1981, No. 100, § 6; amended 1985, No. 208 (Adj. Sess.), § 8, eff. June 30, 1986; 1989, No. 250 (Adj. Sess.), § 47; 2003, No. 34, § 13, eff. May 23, 2003; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1737. Disposition of complaints

(a) Complaints and allegations of unprofessional conduct shall be processed in accordance with the rules of procedure of the board of medical practice.

(b) Any person, firm, corporation, or public officer may submit a written complaint to the board alleging a physician assistant practicing in the state committed unprofessional conduct, specifying the grounds. The board may initiate disciplinary action in any complaint against a physician assistant and may act without having received a complaint.

(c) After giving opportunity for hearing, the board shall take disciplinary action described in subsection 1361(b) of this title against a physician assistant or applicant found guilty of unprofessional conduct.

(d) The board may approve a negotiated agreement between the parties when it is in the best interest of the public health, safety, or welfare to do so. Such an agreement may include any of the following conditions or restrictions which may be in addition to, or in lieu of, suspension:

(1) a requirement that the individual submit to care or counseling;

(2) a restriction that the individual practice only under supervision of a named person or a person with specified credentials;

(3) a requirement that the individual participate in continuing education in order to overcome specified practical deficiencies;

(4) a requirement that the scope of practice permitted be restricted to a specified extent;

(5) an administrative penalty not to exceed $1,000.00 for each act that constitutes an unprofessional conduct violation. Any money received from the imposition of an administrative penalty imposed under this subdivision shall be deposited into the board of medical practice regulatory fee fund for the purpose of providing education and training for board members and the professions regulated by the board. The commissioner shall detail in the annual report receipts and expenses from money received under this subsection.

(e) Upon application, the board may modify the terms of an order under this section and, if licensure has been revoked or suspended, order reinstatement on terms and conditions it deems proper. (Added 1981, No. 100, § 7; amended 1985, No. 208 (Adj. Sess.), § 9, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1737a. Repealed. 1989, No. 250 (Adj. Sess.), § 92.

§ 1738. Use of title

Any person who is licensed to practice as a physician assistant in this state shall have the right to use the title "physician assistant" and the abbreviation "P.A." and "PA-C." No other person may assume that title or use that abbreviation, or any other words, letters, signs, or devices to indicate that the person using them is a physician assistant. (Added 1981, No. 100, § 8; amended 1985, No. 208 (Adj. Sess.), § 11, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1739. Legal liability

(a) The supervising physician delegating activities to a physician assistant shall be legally liable for such activities of the physician assistant, and the physician assistant shall in this relationship be the physician's agent.

(b) Nothing in this chapter shall be construed as prohibiting a physician from delegating to the physician's employees certain activities relating to medical care and treatment now being carried out by custom and usage when such activities are under the control of the physician. The physician delegating activities to his or her employees shall be legally liable for such activities of such persons, and such person shall in this relationship be the physician's agent. Nothing contained in this chapter shall be construed to apply to nurses acting pursuant to chapter 28 of this title. (Added 1981, No. 100, § 9; amended 1985, No. 208 (Adj. Sess.), § 12, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1739a. Inappropriate use of services by physician; unprofessional conduct

Use of the services of a physician assistant by a physician in a manner which is inconsistent with the provisions of this chapter constitutes unprofessional conduct by the physician and such physician shall be subject to disciplinary action by the board in accordance with the provisions of chapter 23 or 33 of this title, as appropriate. (Added 1985, No. 208 (Adj. Sess.), § 13, eff. June 30, 1986; amended 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1740. Fees

Applicants and persons regulated under this chapter shall pay the following fees:

(1) Original application for licensure, $170.00; the board shall use at least $10.00 of this fee to support the cost of maintaining the Vermont practitioner recovery network which monitors recovering chemically dependent licensees for the protection of the public.

(2) Biennial renewal, $170.00; the board shall use at least $10.00 of this fee to support the cost of maintaining the Vermont practitioner recovery network which monitors recovering chemically dependent licensees for the protection of the public. (Added 1981, No. 100, § 10; amended 1985, No. 208 (Adj. Sess.), § 14, eff. June 30, 1986; 1989, No. 250 (Adj. Sess.), § 48; 1999, No. 49, § 211; 2003, No. 163 (Adj. Sess.), § 6; 2007, No. 76, § 20; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1741. Notice of use of physician assistant to be posted

A physician, clinic, or hospital that utilizes the services of a physician assistant shall post a notice to that effect in a prominent place. (Added 1981, No. 100, § 11; amended 1985, No. 208 (Adj. Sess.), § 15, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1742. Penalty

(a) Any person who, not being licensed, holds himself or herself out to the public as being licensed under this chapter shall be liable for a fine of not more than $10,000.00.

(b) In addition to the penalty provided in subsection (a) of this section, the attorney general or a state's attorney may bring a civil action to restrain continuing violations of this section. (Added 1981, No. 100, § 15; amended 1985, No. 208 (Adj. Sess.), § 16, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1743. Medicaid reimbursement

The secretary of the agency of human services shall, pursuant to the Administrative Procedure Act, promulgate rules providing for a fee schedule for reimbursement under Title XIX of the Social Security Act and 33 V.S.A. chapter 19, relating to medical assistance which recognizes reasonable cost differences between services provided by physicians and those provided by physician assistants under this chapter. (Added 1981, No. 100, § 16; amended 1985, No. 208 (Adj. Sess.), § 17, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

§ 1744. Certified physician assistants

Any person who is certified by the board as a physician assistant prior to the enactment of this section shall be considered to be licensed as a physician assistant under this chapter immediately upon enactment of this section, and shall be eligible for licensure renewal pursuant to section 1734b of this title. (Added 2011, No. 61, § 4, eff. June 2, 2011.)