Sen. Ira I. Silverstein
Filed: 3/17/2009
 
 

 




 

 		












09600SB0318sam003

LRB096 08980 ASK 23477 a






1

AMENDMENT TO SENATE BILL 318




2
    AMENDMENT NO. ______. Amend Senate Bill 318 by replacing 
3
everything after the enacting clause with the following:

 
4
    "Section 5. The Medical Practice Act of 1987 is amended  by 
5
changing Section 54.5 and  by adding Section 54.2 as follows:
 
6
    (225 ILCS 60/54.2  new)
7
    (Section scheduled to be repealed on December 31, 2010)
8
    Sec. 54.2. Physician delegation of authority. 
9
    (a) Nothing in this Act shall be construed to limit the 
10
delegation of tasks or duties by a physician licensed to 
11
practice medicine in all its branches to a licensed practical 
12
nurse, a registered professional nurse, or other licensed 
13
person practicing within the scope of his or her individual 
14
licensing Act.
15
    (b) A physician licensed to practice medicine in all its 
16
branches may delegate tasks and duties to an appropriately 
 


 






09600SB0318sam003
- 2 -
LRB096 08980 ASK 23477 a




1
trained licensed or unlicensed person.  Any such task or duty 
2
delegated to a licensed or unlicensed person must be within the 
3
education, training, or experience of the delegating physician 
4
and within the context of a physician-patient relationship.
5
    (c) A chiropractic physician may delegate tasks and duties 
6
to an appropriately trained licensed or unlicensed person.  Any 
7
task or duty delegated to a licensed or unlicensed person by 
8
the chiropractic physician:
9
        (1) must fall within the scope of practice of the 
10
    chiropractic physician as defined by this Act; 
11
        (2) must be within the education, training, or 
12
    experience of the delegating chiropractic physician; and 
13
        (3) can only be delegated within the context of a 
14
    physician-patient relationship.
 



15
    (225 ILCS 60/54.5)


16
    (Section scheduled to be repealed on December 31, 2010)

17
    Sec. 54.5. Physician delegation of authority to physician 
18
assistants and advanced practice nurses. 

19
    (a) Physicians licensed to practice medicine in all its

20
branches may delegate care and treatment responsibilities to a

21
physician assistant under guidelines in accordance with the

22
requirements of  the Physician Assistant Practice Act of
1987.  A 
23
physician licensed to practice medicine in all its
branches may 
24
enter into supervising physician agreements with
no more than 2 
25
physician assistants.

 


 






09600SB0318sam003
- 3 -
LRB096 08980 ASK 23477 a




1
    (b) A physician licensed to practice medicine in all its

2
branches in active clinical practice may collaborate with an 
3
advanced practice
nurse in accordance with the requirements of 
4
the Nurse Practice Act.  Collaboration
is for the purpose of 
5
providing medical consultation,
and no employment relationship 
6
is required.  A
written collaborative agreement shall
conform to 
7
the requirements of Section 65-35 of the Nurse Practice Act.  
8
The written collaborative agreement shall
be for
services the 
9
collaborating physician generally provides to
his or her 
10
patients in the normal course of clinical medical practice.
 A 
11
written collaborative agreement shall be adequate with respect 
12
to collaboration
with advanced practice nurses if all of the 
13
following apply:


14
        (1) The agreement is written to promote the exercise of 
15
    professional judgment by the advanced practice nurse 
16
    commensurate with his or her education and experience. The 
17
    agreement need not describe the exact steps that an 
18
    advanced practice nurse must take with respect to each 
19
    specific condition, disease, or symptom, but must specify 
20
    those procedures that require a physician's presence as the 
21
    procedures are being performed.


22
        (2) Practice guidelines and orders are developed and 
23
    approved jointly by the advanced practice nurse and 
24
    collaborating physician, as needed, based on the practice 
25
    of the practitioners. Such guidelines and orders and the 
26
    patient services provided thereunder are periodically 
 


 






09600SB0318sam003
- 4 -
LRB096 08980 ASK 23477 a




1
    reviewed by the collaborating physician.


2
        (3) The advance practice nurse provides services the 
3
    collaborating physician generally provides to his or her 
4
    patients in the normal course of clinical practice, except 
5
    as set forth in subsection (b-5) of this Section. With 
6
    respect to labor and delivery, the collaborating physician 
7
    must provide delivery services in order to participate with 
8
    a certified nurse midwife.
9
        (4)  The collaborating physician and advanced practice 
10
    nurse meet in person at least once a month to provide 
11
    collaboration and consultation.
12
        (5) Methods of communication are available with the 
13
    collaborating physician in person or through 
14
    telecommunications for consultation, collaboration, and 
15
    referral as needed to address patient care needs.
16
        (6)  The agreement contains provisions detailing notice 
17
    for termination or change of status involving a written 
18
    collaborative agreement, except when such notice is given 
19
    for just cause.


20
    (b-5) An anesthesiologist or physician licensed to 
21
practice medicine in
all its branches may collaborate with a 
22
certified registered nurse anesthetist
in accordance with 
23
Section 65-35 of the Nurse Practice Act for the provision of 
24
anesthesia services.  With respect to the provision of 
25
anesthesia services, the collaborating anesthesiologist or 
26
physician shall have training and experience in the delivery of 
 


 






09600SB0318sam003
- 5 -
LRB096 08980 ASK 23477 a




1
anesthesia services consistent with Department rules.  
2
Collaboration shall be
adequate if:


3
        (1) an anesthesiologist or a physician
participates in 
4
    the joint formulation and joint approval of orders or

5
    guidelines and periodically reviews such orders and the 
6
    services provided
patients under such orders; and


7
        (2) for anesthesia services, the anesthesiologist
or 
8
    physician participates through discussion of and agreement 
9
    with the
anesthesia plan and is physically present and 
10
    available on the premises during
the delivery of anesthesia 
11
    services for
diagnosis, consultation, and treatment of 
12
    emergency medical conditions.
Anesthesia services in a 
13
    hospital shall be conducted in accordance with
Section 10.7 
14
    of the Hospital Licensing Act and in an ambulatory surgical

15
    treatment center in accordance with Section 6.5 of the 
16
    Ambulatory Surgical
Treatment Center Act.

17
    (b-10) The anesthesiologist or operating physician must 
18
agree with the
anesthesia plan prior to the delivery of 
19
services.

20
    (c) The supervising physician shall have access to the

21
medical records of all patients attended by a physician

22
assistant.  The collaborating physician shall have access to
the 
23
medical records of all patients attended to by an
advanced 
24
practice nurse.

25
    (d) Nothing in this Act
shall be construed to limit the 
26
delegation of
tasks or duties by a physician licensed to 
 


 






09600SB0318sam003
- 6 -
LRB096 08980 ASK 23477 a




1
practice medicine
in all its branches to a licensed practical 
2
nurse, a registered professional
nurse, or other persons in 
3
accordance with Section 54.2.

4
    (e) A physician shall not be liable for the acts or

5
omissions of a physician assistant or advanced practice
nurse 
6
solely on the basis of having signed a
supervision agreement or 
7
guidelines or a collaborative
agreement, an order, a standing 
8
medical order, a
standing delegation order, or other order or 
9
guideline
authorizing a physician assistant or advanced 
10
practice
nurse to perform acts, unless the physician has
reason 
11
to believe the physician assistant or advanced
practice nurse 
12
lacked the competency to perform
the act or acts or commits 
13
willful and wanton misconduct.

14
(Source: P.A. 95-639, eff. 10-5-07.)


 
15
    Section 99. Effective date. This Act takes effect upon 
16
becoming law.".