PURPOSE: This rule provides information regarding the requirements for professional conduct as referenced in section 334.100, RSMo and the Code of Ethics of the American Academy of Physician Assistants. PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

1. (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. (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:

   1. (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;
   2. (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;
   3. (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;

   4. (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. 1. Obtaining or attempting to obtain any

fee, charge, tuition or other compensation by fraud, deception or misrepresentation; willfully and continually overcharging or overtreating 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;

1. 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;

1. 3. Willfully and continually performing

inappropriate or unnecessary treatment, diagnostic tests or medical or surgical services;

1. 4. Delegating professional responsibili-

ties to a person who is not qualified by training, skill, competency, age, experience, licensure, registration or certification to perform them;

1. 5. Misrepresenting that any disease, ail-

ment or infirmity can be cured by a method, procedure, treatment, medicine or device;

1. 6. Performing or prescribing medical

services which have been declared by board rule to be of no medical or osteopathic value;

1. 7. Final disciplinary action by any pro-

fessional 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;

1. 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, except as authorized in section 334.104, RSMo;

1. 9. Exercising influence within a physi-

cian assistant-patient relationship for purposes of engaging a patient in sexual activity;

1. 10. Terminating the medical care of a

patient without adequate notice or without making other arrangements for the continued care of the patient;

1. 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;

1. 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;

1. 13. Failure to comply with any subpoe-

na or subpoena duces tecum from the board or an order of the board;

1. 14. Failure to timely pay license renew-

al fees specified in this chapter;

1. 15. Violating a probation agreement

with this board or any other licensing or regulatory agency;

1. 16. Failing to inform the board of the

physician assistant’s current residence and business address;

1. 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;

1. 18. Violation of one (1) or any combi-

nation of the standards listed in the American Academy of Physician Assistants’ Code of Ethics. The board adopts and incorporates by reference the American Academy of Physician Assistants’ Code of Ethics. A copy of the American Academy of Physician Assistants’ Code of Ethics is retained at the office of the board and is available to any interested person, upon written request, at a cost not to exceed the actual cost of reproduction; and

1. 19. Loss of national certification, for

any reason, shall result in the termination of licensure;

1. (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;
2. (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;
3. (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;
4. (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;
5. (I) A person is finally adjudged incapacitated or disabled by a court of competent jurisdiction;
6. (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;
7. (K) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact;
8. (L) Failure to display a valid license as required by this chapter;
9. (M) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;
10. (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; 20 CSR 2150-7
11. (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;
12. (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;
13. (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;
14. (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;
15. (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 supervising 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;
16. (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;
17. (U) Practicing outside the scope of practice of the physician assistant as referenced in the physician assistants’ supervision agreement;
18. (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 FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

such facility has failed to obtain or renew a license as an ambulatory surgical center; and

1. (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. 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.

1. 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.

1. 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.

1. 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.

1. 5. In any proceeding under this para-

graph 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.

1. 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.

1. (3) After the filing of such complaint, before the Administrative Hearing Commission, the proceedings shall be conducted in accordance with the provisions of Chapter 621, RSMo. Upon a finding by the Administrative Hearing Commission that the grounds, provided in section (2) of this rule, for disciplinary action are met, the board may, singly or in combination, warn, censure or place the person named in the complaint on probation on such terms and conditions as the board deems appropriate for a period not to exceed ten
2. (10) years, or may suspend license, certificate or permit for a period not to exceed ten (10) years, or restrict or limit his/her license, certificate or permit for an indefinite period of time, or revoke his/her license, certificate, or permit for an indefinite period of time, or revoke his/her license, certificate or permit, or administer a public or private reprimand, or deny his/her application for licensure, or permanently withhold issuance of licensure or require the physician assistant to submit to the care, counseling or treatment of physicians designated by the board at the expense of the individual to be examined, or require the physician assistant to attend such continuing educational courses and pass such examinations as the board may direct.
3. (4) In any order of revocation, the board may provide that the person may not apply for reinstatement of licensure for a period of time ranging from two to seven (2–7) years following the date of the order of revocation. All stay orders shall toll this time period.
4. (5) Before restoring to good standing a license, certificate or permit issued under this chapter which has been in a revoked, suspended or inactive state for any cause for more than two (2) years, the board may require the applicant to attend such continuing education courses and pass such examinations as the board may direct.
5. (6) In any investigation, hearing or other proceeding to determine a licensed physician assistant’s or applicant’s fitness to practice, any record relating to any patient of the licensed physician assistant or applicant shall be discoverable by the board and admissible into evidence, regardless of any statutory or common law privilege which such licensee, applicant, record custodian or patient might otherwise invoke. In addition, no such licensed physician assistant, applicant, or record custodian may withhold records or testimony bearing upon a licensee’s or applicant’s fitness to practice on the ground of privilege between such physician assistant licensee, applicant or record custodian and a patient.

AUTHORITY: sections 334.100, 334.125, 334.735, 334.736, 334.741 and 334.743, RSMo Supp. 1999.* This rule originally filed as 4 CSR 150-7.140. Emergency rule filed Sept. 15, 1992, effective Sept. 25, 1992, expired Jan. 22, 1993. Original rule filed April 2, 1992, effective Dec. 3, 1992. Amended: Filed Jan. 3, 1997, effective July 30, 1997. Amended: Filed July 25, 2000, effective Dec. 30, 2000. Moved to 20 CSR 2150-7.140, effective Aug. 28, 2006. *Original authority: 334.100, RSMo 1939, amended 1945, 1959, 1963, 1974, 1976, 1979, 1981, 1983, 1984, 1986, 1987, 1989, 1990, 1993, 1997; 334.125, RSMo 1959, amended 1993, 1995; 334.735, RSMo 1989, amended 1996, 1997, 1998; 334.736, RSMo 1995, amended 1998; 334.741, RSMo 1989, amended 1998; 334.743, RSMo 1989, amended 1993, 1995, 1998. Appendix A Code of Ethics of The Physician Assistant Profession The American Academy of Physician Assistants recognizes its responsibility to aid the profession in maintaining high standards in the provision of quality and accessible health care services. The following principles delineate the standards governing the conduct of physician assistants in their professional interactions with patients, colleagues, other health professionals and the general public. Realizing that no code can encompass all ethical responsibilities of the physician assistant, this enumeration of obligations in the Code of Ethics is not comprehensive and does not constitute a denial of the existence of other obligations, equally imperative, though not specifically mentioned. Physician Assistants shall be committed to providing competent medical care, assuming as their primary responsibility the health, safety, welfare and dignity of all humans. Physician Assistants shall extend to each patient the full measure of their ability as dedicated, empathetic health care providers and shall assume responsibility for the skillful and proficient transactions of their professional duties. Physician Assistants shall deliver health care services to health consumers without regard to sex, age, race, creed, socio-economic and political status. Physician Assistants shall adhere to all state and federal laws governing informed consent concerning the patient’s health care. Physician Assistants shall seek consultation with their supervising physician, other health providers, or qualified professionals having special skills, knowledge or experience whenever the welfare of the patient will be safeguarded or advanced by such consultation. Supervision should include ongoing communication between the physician and the physician assistant regarding the care of all patients. Physician Assistants shall take personal responsibility for being familiar with and adhering to all federal/state laws applicable to the practice of their profession. Physician Assistants shall provide only those services for which they are qualified via education and/or experiences and by pertinent legal regulatory process. Physician Assistants shall not misrepresent in any manner, either directly or indirectly, their skills, training, professional credentials, identity, or services. Physician Assistants shall uphold the doctrine of confidentiality regarding privileged patient information, unless required to release such information by law or such information becomes necessary to protect the welfare of the patient or the community. Physician Assistants shall strive to maintain and increase the quality of individual health care service through individual study and continuing education. Physician Assistants shall have the duty to respect the law, to uphold the dignity of the physician assistant profession and to accept its ethical principles. The physician assistant shall not participate in or conceal any activity that will bring discredit or dishonor to the physician assistant profession and shall expose, without fear or favor, any illegal or unethical conduct in the medical profession. Physician Assistants, ever cognizant of the needs of the community, shall use the knowledge and experience acquired as professionals to contribute to an improved community. Physician Assistants shall place service before material gain and must carefully safeguard against conflicts of professional interest. Physician Assistants shall strive to maintain a spirit of cooperation with their professional organizations and the general public. FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION