Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 2150 - State Board of Registration for the Healing Arts › Chapter 7 - Licensing of Physician Assistants › Section 20 CSR 2150-7.140 - Grounds for Discipline, Procedures

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates the grounds for
				  discipline.
(1) The board may
				refuse to issue or renew any physician assistant license required pursuant to
				this chapter for one (1) or any combination of causes stated in section (2) of
				this rule. The board shall notify the physician assistant in writing of the
				reasons for the refusal and shall advise the physician assistant of their right
				to file a complaint with the Administrative Hearing Commission as provided by
				Chapter 621, RSMo.
(2) The board
				may cause a complaint to be filed with the Administrative Hearing Commission as
				provided by Chapter 621, RSMo, against any holder of any certificate of
				registration or authority, permit, or license required by this chapter or any
				person who has failed to renew or has surrendered a certificate of registration
				or authority, permit, or license for any one (1) or any combination of the
				following causes:
(A) Use of any controlled
				substance, as defined in Chapter 195, RSMo, or alcoholic beverage to an extent
				that such use impairs a person's ability to perform the work of any profession
				licensed or regulated by this chapter;
(B) The person has been finally adjudicated
				and found guilty, or entered a plea of guilty or
nolo
				contendere
, in a criminal prosecution under the laws of any state or
				of the United States, for any offense reasonably related to the qualifications,
				functions or duties of any profession licensed or regulated under this chapter,
				for any offense an essential element of which is fraud, dishonesty or an act of
				violence, or for any offense involving moral turpitude, whether or not sentence
				is imposed;
(C) Use of fraud,
				deception, misrepresentation or bribery in securing any certificate of
				registration or authority, permit or license issued pursuant to this chapter or
				in obtaining permission to take any examination given or required pursuant to
				this chapter;
(D) Misconduct, fraud,
				misrepresentation, dishonesty, unethical conduct, or unprofessional conduct in
				the performance of the functions or duties of any profession licensed or
				regulated by this chapter, including, but not limited, to the following:
1. Obtaining or attempting to obtain any fee,
				charge, tuition, or other compensation by fraud, deception, or
				misrepresentation; willfully and continually overcharging or over-treating
				patients; or charging for services which did not occur unless the services were
				contracted for in advance, or for services which were not rendered or
				documented in the patient's records;
2. Attempting, directly or indirectly, by way
				of intimidation, coercion, or deception, to obtain or retain a patient or
				discourage the use of a second opinion or consultation;
3. Willfully and continually performing
				inappropriate or unnecessary treatment, diagnostic tests, or medical or
				surgical services;
4. Delegating
				professional responsibilities to a person who is not qualified by training,
				skill, competency, age, experience, licensure, registration, or certification
				to perform them;
5. Misrepresenting
				that any disease, ailment, or infirmity can be cured by a method, procedure,
				treatment, medicine, or device;
6.
				Performing or prescribing medical services which have been declared by board
				rule to be of no medical or osteopathic value;
7. Final disciplinary action by any
				professional physician assistant association or society or licensed hospital or
				medical staff of such hospital in this or any other state or territory, whether
				agreed to voluntarily or not, and including, but not limited to, any removal,
				suspension, limitation, or restriction of his/her registration, license, or
				staff or hospital privileges, failure to renew such privileges of registration
				or license for cause, or other final disciplinary action, if the action was in
				any way related to unprofessional conduct, professional incompetence,
				malpractice, or any other violation of any provision of this chapter;
8. Signing a blank prescription form; or
				dispensing, prescribing, administering or otherwise distributing any drug,
				controlled substance, or other treatment without sufficient examination, or for
				other than medically accepted therapeutic or experimental or investigative
				purposes duly authorized by a state or federal agency, or not in the course of
				professional practice, or not in good faith to relieve pain and suffering, or
				not to cure an ailment, physical infirmity, or disease;
9. Exercising influence within a physician
				assistant-patient relationship for purposes of engaging a patient in sexual
				activity;
10. Terminating the
				medical care of a patient without adequate notice or without making other
				arrangements for the continued care of the patient;
11. Failing to furnish details of a patient's
				medical records to other treating physician assistants, physicians, or
				hospitals upon proper request; or failing to comply with any other law relating
				to medical records;
12. Failure of
				any physician assistant or applicant, other than the physician assistant
				subject of the investigation, to cooperate with the board during any
				investigation;
13. Failure to
				comply with any subpoena or subpoena duces tecum from the board or an order of
				the board;
14. Failure to timely
				pay license renewal fees specified in this chapter;
15. Violating a probation agreement with this
				board or any other licensing or regulatory agency;
16. Failing to inform the board of the
				physician assistant's current residence and business address;
17. Advertising by an applicant or licensed
				physician assistant which is false or misleading, or which violates any rule of
				the board, or which claims without substantiation the positive cure of any
				disease, or professional superiority to or greater skill than that possessed by
				any other physician assistant. An applicant or licensed physician assistant
				shall also be in violation of this provision if s/he has a financial interest
				in any organization, corporation, or association which issues or conducts such
				advertising; and
18. Loss of
				national certification, for any reason, shall result in the termination of
				licensure;
(E) Any
				conduct or practice which is or might be harmful or dangerous to the mental or
				physical health of a patient or the public; or incompetency, gross negligence
				or repeated negligence in the performance of the functions or duties of any
				profession licensed or regulated by this chapter. For the purposes of this
				subsection, "repeated negligence" means the failure, on more than one (1)
				occasion, to use that degree of skill and learning ordinarily used under the
				same or similar circumstances by the member of the applicant's, registrant's or
				licensee's profession;
(F)
				Violation of, or attempting to violate, directly or indirectly, or assisting or
				enabling any person to violate, any provision of this chapter, or of any lawful
				rule or regulation adopted pursuant to this chapter;
(G) Impersonation of any person holding a
				certificate of registration or authority, permit or license or allowing any
				person to use his/her certificate of registration or authority, permit, license
				or diploma from any school;
(H)
				Revocation, suspension, restriction, modification, limitation, reprimand,
				warning, censure, probation or other final disciplinary action against the
				holder of or applicant for licensure or other right to practice any profession
				regulated by this chapter by another state, territory, federal agency or
				country, whether or not voluntarily agreed to by the physician assistant or
				applicant, including, but not limited to, the denial of licensure or
				registration, surrender of the license or registration, allowing physician
				assistant license or registration to expire or lapse, or discontinuing or
				limiting the practice of the physician assistant while subject to an
				investigation or while actually under investigation by any licensing authority,
				medical facility, branch of the armed forces of the United States of America,
				insurance company, court, agency of the state or federal government, or
				employer;
(I) A person is finally
				adjudged incapacitated or disabled by a court of competent
				jurisdiction;
(J) Assisting or
				enabling any person to practice or offer to practice any profession licensed or
				regulated by this chapter who is not licensed and currently eligible to
				practice under this chapter; or knowingly performing any act which in any way
				aids, assists, procures, advises, or encourages any person to practice who is
				not licensed and currently eligible to practice under this chapter;
(K) Issuance of a certificate of registration
				or authority, permit or license based upon a material mistake of
				fact;
(L) Failure to display a
				valid license as required by this chapter;
(M) Violation of the drug laws or rules and
				regulations of this state, any other state or the federal government;
(N) Knowingly making, or causing to be made,
				or aiding, or abetting in the making of, a false statement in any birth, death
				or other certificate or document executed in connection with the practice of
				his/her profession;
(O) Soliciting
				patronage in person or by agents or representatives, or by any other means or
				manner, under his/her own name or under the name of another person or concern,
				actual or pretended, in such a manner as to confuse, deceive, or mislead the
				public as the need or necessity for or appropriateness of health care services
				for all patients, or the qualifications of an individual person(s) to diagnose,
				render or perform health care services;
(P) Using, or permitting the use of, his/her
				name under the designation of "physician assistant," "licensed physician
				assistant," "physician assistant-certified," or any similar designation with
				reference to the commercial exploitation or product endorsement of any goods,
				wares or merchandise;
(Q) Knowingly
				making, or causing to be made, a false statement or misrepresentation of a
				material fact, with intent to defraud, for payment under the provisions of
				Chapter 208, RSMo, or Chapter 630, RSMo, or for payment from Title XVIII or
				Title XIX of the federal Medicare program;
(R) Failure or refusal to properly guard
				against contagious, infectious or communicable diseases or the spread thereof;
				maintaining an unsanitary office or performing professional services under
				unsanitary conditions; or failure to report the existence of an unsanitary
				condition in the office of a physician or in any health care facility to the
				board, in writing, within thirty (30) days after the discovery
				thereof;
(S) Any person licensed to
				practice as a physician assistant, requiring, as condition of the physician
				assistant-patient relationship, that the patient receive prescribed drugs,
				devices, or other professional services directly from facilities of that
				physician assistant's office or other entities under the collaborating
				physician's or physician assistant's ownership or control. A physician
				assistant shall provide the patient with a prescription which may be taken to
				the facility selected by the patient;
(T) A pattern of personal use or consumption
				of any controlled substance unless it is prescribed, dispensed or administered
				by a physician who is authorized by law to do so;
(U) Practicing outside the scope of practice
				of the physician assistant as referenced in the physician assistants'
				collaborative practice arrangement;
(V) For a physician assistant to operate,
				conduct, manage, practice or establish an abortion facility, or for a physician
				assistant to perform an abortion in an abortion facility, if such facility
				comes under the definition of an ambulatory surgical center pursuant to
				sections
				197.200 to
				197.240,
				RSMo, and such facility has failed to obtain or renew a license as an
				ambulatory surgical center; and
(W)
				Being unable to practice as a physician assistant or with a specialty with
				reasonable skill and safety to patients by reasons of medical or osteopathic
				incompetency, or because of illness, drunkenness, excessive use of drugs,
				narcotics, chemicals, or as a result of any mental or physical condition.
1. In enforcing this paragraph the board
				shall, after a hearing by the board, upon a finding of probable cause, require
				a physician assistant to submit to a reexamination for the purpose of
				establishing his/her competency to practice as a physician assistant or with a
				specialty conducted in accordance with rules adopted for this purpose by the
				board, including rules to allow the examination of the pattern and practice of
				said physician assistant's professional conduct, or to submit to a mental or
				physical examination or combination thereof by at least three (3) physician
				assistants, one (1) selected by the physician assistant compelled to take the
				examination, one (1) selected by the board, and one (1) selected by the two (2)
				physician assistants so selected who are graduates of a professional school
				approved and accredited by the Commission for the Accreditation of Allied
				Health Education Programs and has active certification by the National
				Commission on Certification of Physician Assistants.
2. For the purpose of this paragraph, every
				physician assistant licensed under this chapter is deemed to have consented to
				submit to a mental or physical examination when directed in writing by the
				board and further to have waived all objections to the admissibility of the
				examining physician's testimony or examination reports on the ground that same
				is privileged.
3. In addition to
				ordering a physical or mental examination to determine competency, the board
				may, notwithstanding any other law limiting access to medical or other health
				data, obtain medical data and health records relating to a physician assistant
				or applicant without the physician assistant's or applicant's
				consent.
4. Written notice of the
				reexamination or the physical or mental examination shall be sent to the
				physician assistant, by registered mail, addressed to the physician assistant
				at his/her last known address. Failure of a physician assistant to designate an
				examining physician to the board or failure to submit to the examination when
				directed shall constitute an admission of the allegations against him/her, in
				which case the board may enter a final order without the presentation of
				evidence, unless the failure was due to circumstances beyond his/her control. A
				physician assistant whose right to practice has been affected under this
				paragraph shall, at reasonable intervals, be afforded an opportunity to
				demonstrate that s/he can resume competent practice as a physician assistant
				with reasonable skill and safety to patients.
5. In any proceeding under this paragraph
				neither the record of proceedings nor the orders entered by the board shall be
				used against a physician assistant in any other proceeding. Proceedings under
				this paragraph shall be conducted by the board without the filing of a
				complaint with the Administrative Hearing Commission.
6. When the board finds any person
				unqualified because of any of the grounds set forth in this paragraph, it may
				enter an order imposing one (1) or more of the disciplinary measures set forth
				in section (4) of this rule.