(A) A licensee who supervises another practitioner shall hold a permanent, active, unrestricted authorization to practice in this State and be currently engaged in the active practice of their respective profession or shall hold an active unrestricted academic license to practice medicine in this State.

(B) Pursuant to this chapter, only licensed physicians may supervise another practitioner who performs delegated medical acts in accordance with the practitioner's applicable scope of professional practice authorized by state law. It is the supervising physician's responsibility to ensure that delegated medical acts to other practitioners are performed under approved written scope of practice guidelines or approved written protocol in accordance with the applicable scope of professional practice authorized by state law. A copy of approved written scope of practice guidelines or approved written protocol, dated and signed by the supervising physician and the practitioner, must be provided to the board by the supervising physician within seventy-two hours of request by a representative of the department or board.

(C) In evaluating a written guideline or protocol, the board and supervising physician or medical staff shall consider the:

(1) training and experience of the supervising physician;

(2) nature and complexity of the delegated medical acts being performed;

(3) geographic proximity of the supervising physician to the supervised practitioner; when the supervising physician is not located at the same site as the supervised practitioner, special consideration must be given to the manner in which the physician intends to monitor the practitioner, and prior board approval must be received for this practice unless otherwise provided in this chapter; and

(4) number of other practitioners the physician or medical staff supervises. Reference must be given to the number of supervised practitioners, as prescribed by law. When the supervising physician assumes responsibility for more than the number of practitioners prescribed by law, special consideration must be given to the manner in which the physician intends to monitor, and prior board approval must be received for this practice.

(D)(1) A physician or medical staff who are engaged in practice with a PA, NP, CNM, or CNS must:

(a)(i) hold permanent, active, and unrestricted authorization to practice medicine in this State and be actively practicing medicine within the geographic boundaries of this State; or

(ii) hold an active, unrestricted academic license to practice medicine in this State and be actively practicing medicine within the geographic boundaries of this State;

(b) have in place prior to beginning practice and during its continuation a practice agreement as defined in Section 40-47-20(35) or scope of practice guidelines as defined in Section 40-47-20(5), a copy of which the physician must make available to the board within seventy-two hours of a request;

(c) not enter into scope of practice guidelines or practice agreements with more than the equivalent of six full-time PAs, NPs, CNMs, or CNSs and must not practice in a situation in which the number of NPs, CNMs, or CNSs providing clinical services with whom the physician is working, combined with the number of PAs providing clinical services whom the physician is supervising, is greater than six individuals at any one time, provided, however, that the board may approve an exception to these requirements upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained;

(d) not enter into a practice agreement with a PA, NP, CNM, or CNS performing a medical act, task, or function that is outside the usual practice of that physician or outside of the physician's training or experience, provided, however, that the board may approve an exception to this requirement upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained; and

(e) maintain responsibility in the practice agreement for the health care delivery team pursuant to rules and regulations of the Board of Medical Examiners.

(2) The board is authorized to conduct random audits of scope of practice guidelines and practice agreements.

HISTORY: 2006 Act No. 385, Section 1; 2018 Act No. 234 (S.345), Section 6, eff July 1, 2018; 2019 Act No. 32 (S.132), Section 1, eff August 11, 2019.

Effect of Amendment

2018 Act No. 234, Section 6, in (B), in the second sentence, deleted "the APRN (NP, CNM, or CNS) or" following "delegated medical acts to"; in (C), inserted "or medical staff" following "supervising physician", in (3), substituted "not located at the same site as" for "to be more than forty-five miles from", and in (4), in the first sentence, inserted "or medical staff" following "the physician"; and added (D), providing licensure qualifications and practice agreement requirements for physicians and medical staff who engage in practice with NPs, CNMs, or CNSs.

2019 Act No. 32, Section 1, in (C), in (3), inserted "unless otherwise provided in this chapter"; in (D)(1), substituted "are engaged in practice with a PA" for "is engaged in practice with an NP", in (b), inserted "or scope of practice guidelines as defined in Section 40-47-20(5)", in (c), inserted "scope of practice guidelines or" and "PAs," following "six full-time", and substituted "PAs" for "physician assistants", in (d), substituted "a PA, NP" for "an NP"; and in (D)(2), inserted "scope of practice guidelines and".