Wyo. Code R. 052-0001-5
Medicine, Board of
Chapter 5: Rules of Practice and Procedure for the Licensure of and for the Conduct of Disciplinary Proceedings Against Physicians Assistants
Effective Date: 08/11/2009 to 06/24/2014
Rule Type: Superceded Rules & Regulations
Reference Number: 052.0001.5.08112009
RULES OF PRACTICE AND PROCEDURE FOR THE LICENSURE OF AND FOR THE CONDUCT OF DISCIPLINARY PROCEEDINGS AGAINST PHYSICIAN ASSISTANTS
These rules are promulgated pursuant to authority granted W.S. 33-26-503(b)(iv) and by the Wyoming Administrative Procedure Act, W.S. 16-3-101 through 16-3-115 (A.P.A.).
These rules have been adopted to set forth the procedures of the Wyoming board of medicine in the licensure and regulation of the practice of physician assistants in the state of Wyoming.
The definitions contained in the Wyoming Administrative Procedure Act and W.S. 33-26-501 are incorporated herein by this reference. In addition, the following definitions of terms used in these rules shall apply:
(i) “Complainant” means any identified person, persons, association, or entity including the Board of Medicine or an individual member of the board, who communicates to the board in writing, alleging facts which, if proven, would constitute a violation of W.S. 33-26-508 by a physician assistant.
(j) “Complaint” means a written communication received by the board which alleges sufficient facts by which the board can determine the identity of the physician assistant, whether the alleged conduct falls within the board’s jurisdiction and whether the alleged conduct, if proven, would constitute a violation of W.S. 33-26-508 or these rules.
(k) “Condition” means a specific requirement or prohibition imposed by any medical licensing board of any jurisdiction that must be fulfilled by an applicant or licensee in order to obtain or continue to hold a license in that jurisdiction.
(l) “Contested case” means a formal evidentiary proceeding conducted pursuant to W.S. 16-3-107 to 16-3-114.
(m) “Costs” means those expenses incurred in a hearing to deny, refuse to renew, reactivate, reinstate, revoke, restrict, place conditions upon, or suspend a license pursuant to W.S. 33-26-405(a)(viii) and includes, but is not limited to, reasonable attorneys’ fees incurred by the board, hearing officer fees, service fees, subpoena fees, reporter fees, lay and expert witness fees, travel and per diem expenses, deposition costs and other costs and expenses incurred in the investigation, discovery, preparation and hearing of any disciplinary matter.
(n) “Docket” means a continuous, permanent, confidential record of each and every board action pertaining to a complaint or a denial, and the reasons and grounds for each and every step in the disciplinary or appeal process, commencing with the first notice of complaint by any complainant or final order in a denial action. The docket shall reflect each and every incident in any complaint or denial proceeding against any respondent or applicant, including initial, oral, anonymous inquiries and complaints, whether or not such complaints or inquiries are rendered in writing and whether the board takes further action on such complaint.
(o) “Errant conduct” means conduct which may constitute grounds for denial, revocation, suspension or restriction of a license to practice as a physician assistant as set forth in W.S. 33-26-508.
(p) Deleted.
(q) “Executive director” means a non-board member hired by the board pursuant to W.S. 33-26-203(a) and authorized to coordinate and direct board functions.
(r) “Hearing officer” means an attorney experienced in administrative law who may be appointed by the board to perform those functions set forth in W.S. 16-3-112(b) in a contested case.
(s) “Informal interview” means a confidential meeting with the respondent and the interviewers, one of whom shall be a member of the advisory council, pursuant to W.S. 33-26-202(b)(iii) and 33-26-401(b) in which the specification of charges, defenses and responses are discussed after initial screening of the complaint and prior to a contested case hearing.
(t) “Interviewers” are members of the board and/or a member of the advisory council appointed by a majority of the board officers to investigate the complaint against the respondent and where circumstances warrant, conduct an informal interview with the respondent and make recommendation to the board officers for further board action.
(u) “Ledger” means a continual, permanent, public record maintained by the board. The ledger shall commence with the entry of the initial complaint or final order in a denial action and shall contain the date of the action or complaint, the section(s) of W.S. 33-26-508 relied upon the board as a basis for its action, the disposition of the matter, the disciplinary action taken, if any, and the date of final disposition. Notwithstanding the foregoing requirements, no information reasonably likely to disclose the identity of the complainant, applicant, or respondent shall be included in the ledger.
(v) “Legal custodian” means the executive director.
(w) “Licensee” means a physician assistant licensed by the board in this state.
(x) “Medical Specialty Consultants” means persons who consult with the board or members of the board and advisory council serving as interviewers in a disciplinary action who provide specialized expertise on medical issues.
(y) “National certification” means certification through the NCCPA or such other certification examination recognized by the board through examination and continuing medical education hours.
(z) “Party” means the board, the applicant or the respondent.
(aa) “Respondent” means the physician assistant named in a complaint.
(bb) “Restriction” means a limitation placed by any medical licensing board of any jurisdiction on an applicant’s or licensee’s scope of practice in that jurisdiction.
(cc) “Screening” means a preliminary review by the board officers as soon as practicable, but not later than thirty (30) days, after a written complaint is received by the board to determine whether the alleged conduct falls within the board’s jurisdiction and whether the allegations, if proven, would constitute a violation of W.S. 33-26-508 or these rules. If the majority of the board officers can determine such questions from the information provided in the complaint, they shall appoint interviewers and direct the executive director to docket the complaint. If a majority of the board officers cannot determine such questions from the information provided in the complaint, they may authorize and direct the board’s employees and/or agents to investigate the complaint to provide sufficient information for them to complete the screening process.
(dd) “Unprofessional conduct” means:- (i) Failure to conform to the applicable standards of care; - (ii) Willful or careless disregard for the health, welfare or safety of a patient; - (iii) Engaging in any conduct or practice that is harmful or dangerous to the health of a patient or the public; - (iv) Using any false, fraudulent or deceptive statement in any document connected with the practice of medicine as a physician assistant including the intentional falsification or fraudulent alteration of a patient or health care facility record; - (v) Failing to prepare and maintain legible and complete written medical records that accurately describe the medical services rendered to the patient, including the patient’s history, pertinent findings, examination, results, test results and all treatment provided; - (vi) Practicing outside the scope of the licensee’s expertise and training; - (vii) Repeatedly engaging in harassing, disruptive or abusive behavior directed at staff, co-workers a patient or a patient’s relative or guardian or that interferes with the provision of health care; - (viii) Engaging in conduct that constitutes moral turpitude, including but not limited to conviction of or pleading guilty or nolo contendere to domestic abuse, stalking, sexual assault, sexual abuse or unlawful exploitation of a minor, indent exposure, incest or distribution of pornography; - (ix) Failing or neglecting to attempt to inform a patient within a reasonable time, not to exceed thirty (30) days from the receipt, of the result of a laboratory test indicating the need for further clinical review; - (x) Improperly terminating a physician assistant patient relationship; - (xi) Representing that a manifestly incurable disease or condition can be permanently cured or that any disease or condition can be cured by a secret method, procedure, treatment, medicine or device if the representation is untrue; - (xii) Intentionally or negligently releasing or disclosing confidential patient information. This restriction shall not apply to disclosures required by state or federal law or when disclosure is necessary to prevent imminent risk of harm to the patient or others; - (xiii) Failing or refusing to transfer a copy of patient records to the patient or to the patient’s legally designated representative within thirty (30) days after
receipt of a written request;
(xiv) Utilization of experimental forms of therapy without proper informed consent from the patient, without conforming to generally accepted criteria or standard protocols, without keeping detailed, eligible records or without having periodic analysis of the study and results reviewed by a committee of peers;
(xv) Except in emergency situations where the consent of the patient or the patient’s legally designated representative cannot be reasonably obtained, assisting the care or treatment of a patient without the consent of the patient, the attending physician or the patient’s legal representative;
(xvi) Using or engaging fraud or deceit to obtain third party reimbursement;
(xvii) Upon proper request by the board, failure or refusal to produce documents or other information relevant to any investigation conducted by the board, whether the complaint is filed against the licensee or another licensee;
(xviii) Violation of any board rule or regulation;
(xix) Acquiring or attempting or conspiring to acquire any drug classified as a narcotic, addicting or scheduled drug by fraud or deception;
(xx) Initially prescribing any controlled substance for any person through the Internet, the World Wide Web or a similar proprietary or common carrier electronic system absent a documented physician assistant-patient relationship or
(xxi) Violating any final order, consent decree or stipulation between the board and the licensee.
(ee) “Petition” means a formal disciplinary action filed with the Executive Director by the Board Prosecutor against one or more licensees on behalf of one or more petitioners.
(ff) “Petitioner” means a board member or advisory council member who is appointed by the board officers to act as a prosecuting party in a formal disciplinary action against one or more licensees.
“Board officers” means the president, vice president and secretary of the board.
(a) A physician assistant assists in the practice of medicine under the supervision of a licensed physician. Within the physician/physician assistant relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic, therapeutic and health promotion and disease prevention services. The physician assistant may perform those duties and responsibilities delegated to him by the supervising physician when the duties and responsibilities are provided under the supervision of a licensed physician approved by the board, are within the scope of the physician's practice and expertise and within the skills of the physician assistant.
(b) The physician assistant may work in the office of the supervising physician where primary practice is maintained and at sites outside that office as directed by the physician.
(c) The physical presence of the supervising physician is not required if the supervising physician and the physician assistant are or can easily be in contact with each other by telephone, radio, or other telecommunications. A back-up physician shall be utilized when the supervising physician is, for any reason, not fully able to properly supervise the physician assistant in his or her professional duties, or is outside a reasonable geographic proximity to the physician assistant's practice location.
(d) The board does not recognize or bestow any level of competency upon a physician assistant to carry out a specific task. Such recognition of skill is the responsibility of the supervising physician. However, a physician assistant is expected to perform with similar skill and competency and to be evaluated by the same standards as the physician in the performance of assigned duties.
(e) Nothing in the act shall be construed to prohibit the employment of a physician assistant by a medical care facility, institution or corporation where such physician assistant functions under the supervision and direction of a physician or group of physicians.
(f) Neither the board nor the advisory council shall deny an application due to the number of physician assistants supervised up to three (3), except for good cause specific to the circumstances of the individual physician supervisor. The board and the advisory council may allow a physician to supervise more than three (3) physician assistants, subject to a showing by the supervising physician that it is appropriate in the circumstances, that all physician assistants under his supervision will have adequate, documented supervision, and that patient care and safety will be protected.
(a) Pursuant to W.S. 33-26-503(b)(v), the board of medicine shall appoint an advisory council to the board. This council shall consist of at least two (2) members who shall be licensed physician assistants and two (2) members who shall be physicians. Additional members may be appointed at the discretion of the board. The advisory council is responsible to and will serve at the pleasure of the board.
(b) The advisory council shall review and make recommendations to the board on matters relating to physician assistants that come before the council, including:
(i) Applications for licensure (ii) Physician assistant education (iii) Requirements for licensure (iv) Professional conduct; and (v) Scope of practice
(c) The advisory council shall meet in conjunction with the board for the purpose of interviewing candidates for recommendation to the board for licensure and other matters as directed by the board.
(d) The advisory council may recommend conditions, denial, suspension or revocation of licensure when it finds that the medical practice act and/or these rules are not being followed.
Section 6. License required, application, qualifications, consideration of applications and temporary licenses for physician assistants.
(a) No person may practice as a physician assistant or represent that he or she is a physician assistant without a license granted by the board.
(b) Application forms must be submitted to the advisory council and board. They must be complete in every detail, including all supporting documents and required fees. Applications shall include:
(i) A statement of qualifications and related experience of the physician assistant; (ii) A statement of the professional background of the supervising physician, including specialty; (iii) Identification by name, business address, and telephone number of the back-up supervising physician; (iv) A description of the practice and the way in which the physician assistant will be utilized; and (v) A proposed method of supervision of the physician assistant by the supervising physician.
Section 7. Qualifications.
The board may grant a physician assistant license to an applicant who:
(a) Is not less than 21 years of age or older;
(b) Has graduated from a physician assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or its predecessor or successor organization;
(c) Has satisfactorily completed a certification examination administered by the National Commission on the Certification of Physician Assistants (NCCPA) or other national certifying agency established for such purposes which has been reviewed and approved by the board and is currently certified;
(d) Physician assistants approved by the board prior to July 1, 1995 are not required to be currently certified by the NCCPA and are not required to provide proof of current NCCPA certification with any of the applications submitted to the board described in Section 8 below.
(e) The board may recognize specialty classifications of training of physician assistants. These classifications shall reflect the training and experience of the physician assistant.
(f) The board may grant an emeritus license to practice as a physician assistant under the supervision of a physician which may be used for the provision of uncompensated physician assistant services. Such license may issue to an applicant who provides an application by a supervising physician, proof that the applicant is retired from the active practice as a physician assistant, proof that the applicant has maintained a physician assistant license in good standing in another jurisdiction of the United States or Canada for a period of not less than ten (10) years prior to applying for the emeritus physician assistant license and signs a notarized statement he/she will not accept any form of remuneration for physician assistant services rendered while in the possession of an emeritus license. As part of the application process, an applicant for an emeritus physician assistant license who does not hold a current Wyoming physician assistant license shall complete to the satisfaction of a majority of the board members a personal interview consisting of inquiry and oral response to medical knowledge, personal and professional history and intentions for practicing as a physician assistant in this state. Such interview may be conducted by one (1) board member and, if deemed appropriate by a majority of the board officers, may be conducted by telephonic means.
(i) Physician assistants possessing an emeritus medical license shall:
(A) Annually sign an affidavit affirming that their physician assistant practice continues to be without remuneration; and
(B) Obtain and certify continuing medical education as required by these rules.
(ii) The board shall set no fees for the application of renewal of an emeritus physician assistant license.
(g) The board may issue a volunteer physician assistant license to a physician assistant who is in good standing in at least one (1) jurisdiction other than the state of Wyoming for the purpose of assisting in the practice of medicine as a volunteer, without compensation. An applicant for a volunteer physician assistant license must complete and submit a form and documentation prescribed by the board, meet the requirements of W.S. 33-26-504, agree to comply with the Act and these rules, agree to be subject to the jurisdiction of the board, provide proof of licensure in good standing in at least one (1) jurisdiction other than the state of Wyoming, and pay the fee set by the board. A licensure interview is not required for issuance of a volunteer physician assistant license. A volunteer physician assistant license shall be valid for not more than twenty-one (21) consecutive days in any calendar year, and may not be renewed.
(a) The applicant for physician assistant licensure is required to appear before the advisory council for initial licensure.
(b) The supervising physician shall complete and submit an application describing his/her willingness to undertake full responsibility for the physician assistant's professional actions and such other actions as may effect patients;
(c) Physicians who have conditions or restrictions upon their license or privileges issued by the board or other state medical licensing board or health care facility may apply to supervise a physician assistant. All applications submitted by physicians with restrictions or conditions on their license or clinical privileges shall be reviewed by the board. The board may, in its discretion, require an interview with an applicant under this subsection.
(d) The council may, in its discretion, require a physician supervisor to interview in person before the council if they have cause to believe that the physician does not understand or accept the ramifications of supervision of a physician assistant.
(e) If a physician assistant changes primary physician sponsorship, but remains in the same practice situation and location, the PA shall submit an application on a form approved by the board explaining the change and, provide proof of current NCCPA certification. The physician supervisor shall also complete and submit an application describing his/her willingness to undertake full responsibility for the physician assistant's professional actions and such other actions as may effect patients. Under these circumstances, an interview may be required if deemed appropriate by the council and the board. If initial licensure fees have been paid, no further fees will be assessed.
(f) If a physician assistant changes job situations or locations within the state under new physician sponsorship, submit an application on a form approved by the board explaining the change, provide proof of current NCCPA certification and pay a fee in the same amount as the initial application fee. The physician supervisor shall also complete and submit an application describing his/her willingness to undertake full responsibility for the physician assistant's professional actions and such other actions as may effect patients. A subsequent interview may be required. This may be at the discretion of the advisory council. (g) If a physician assistant leaves the state for employment and returns, a new application, fees and interviews shall be required.
(h) Following review of the application documents and, where appropriate an interview, the advisory council shall make its recommendations to the board regarding licensure of a physician assistant to practice in Wyoming. The final decision remains with the board.
(a) A physician assistant may be issued a temporary license until the next meeting of the advisory council and board provided:
(i) The application is complete in every detail;
(ii) All fees are paid;
(iii) The physician supervisor shall also complete and submit an application describing his/her willingness to undertake full responsibility for the physician assistant’s professional actions and for such other actions as may effect patients and
(iv) The application is approved by the advisory council and the board.
(b) The board may extend the temporary license at its discretion upon a showing of good cause.
(c) A temporary license may be issued to a physician assistant who meets all requirements for licensure except the certification examination. A temporary license may be issued to allow the physician assistant an opportunity to sit for the next available examination, such time period not to exceed one (1) year.
(d) When completed, a physician assistant’s application for licensure shall be sent to the advisory council for review. Upon the recommendation of the council, the application shall be sent to the board for review and final determination.
(e) All applications for physician assistants licensure shall be recommended by at least three (3) members of the advisory council and approved by a majority of the board officers.
(a) License Renewal and Deadline. All physician assistant licenses, other than temporary licenses, expire annually at the close of business, December 31. A physician assistant may renew his/her license by sending a signed renewal questionnaire and renewal fee to the board prior to expiration of current license.
(i) License Renewal Form. A physician assistant may renew a license by submitting an application for renewal each year in a format or form provided by the board. The board may utilize paper or electronic forms, or a combination of both.
(ii) License Renewal Grace Period. Licensees who provide, in writing and not more than sixty (60) days after the license renewal deadline, good cause for failure to submit their application for renewal in a timely manner may be granted an extension for submitting their application, and the requisite renewal fee and license renewal grace period surcharge, of not greater than thirty (30) days by the executive director. Any request for an extension of the renewal application deadline received by the board more than sixty (60) days after the deadline may be granted an extension for submitting their application of not greater than thirty (30) days at the discretion of a majority of the board officers. Nothing herein imposes a duty on the Board of Medicine or the executive director to grant an extension to any licensee.
(b) The board may reactivate a lapsed license if the applicant pays reactivation fee and meets the requirements for granting of an initial license.
(c) A physician assistant may apply for a duplicate license if his/her license is lost, stolen, or destroyed.
(d) A physician assistant may offer to voluntarily relinquish his/her license at any time, however the board may, at its discretion, refuse to accept such offer.
(a) Pursuant to W.S. 33-26-507(a) the board shall collect the following fees:
| Application for license | $200.00 |
|---|---|
| On-line application convenience fee | $20.00 |
| Annual renewal of license | $100.00 |
| On-line license renewal convenience fee | $10.00 |
| License renewal grace period surcharge | $50.00 |
| Replacement of lost license | $ 25.00 |
| Reactivation of license | $100.00 |
| Reinstatement of license | $200.00 |
| Temporary license | $100.00 |
| Extension of temporary license | $50.00 |
| Volunteer license | $50.00 |
Certified copies First page: $10.00; Additional pages: $.50
Photocopies (except certified copies), including cost of duplication of transcript(s) and administrative record in appeals from contested case hearings [Ch. 5 §15(i)(xvi)]
First page: $2.00; Additional pages: $.10
(b) Application fees shall be paid to the board in the form of cashier’s check or money order. All other fees shall be paid to the board in the form of a check, cashier’s check or money order; provided, however, if the board establishes a system for on-line renewal of licenses, the fee for renewal may be paid by credit card.
(c) Fees are not refundable.
(a) The board shall have the authority to refuse, revoke or suspend the license of a physician assistant for, but not limited to, those grounds set forth in W.S. 33-26-508 and any of the following reasons if the physician assistant:
(i) Has held himself or herself out or permitted another to represent him or her as a licensed physician;
(ii) Is a habitual user of intoxicants or drugs to the extent he or she is unable to safely and skillfully perform as a physician assistant;
(iii) Has been adjudicated mentally incompetent or whose mental condition, in the opinion of the board, renders him or her unable to safely and skillfully perform as a physician assistant;
(iv) The supervising physician’s right to employ a physician assistant has been withdrawn; or
(v) Has failed to comply with any portion of the Act and/or these rules.
(b) If the board denies the license or grants the license with restrictions, it shall issue a final order reflecting such action supported by findings of fact and conclusions of law.
(c) On the date of issuance of such final order, the executive director shall send a copy of such order to the applicant by certified mail at the address shown on the application or at the most recent address provided by the licensee.
An applicant who is denied a license, reinstatement or reactivation of a physician assistant license may appeal such final order to the district court pursuant to W.S. 16-3-
(i) Proceedings under these rules shall commence when a complainant, who may be a member of the board, notifies the board in writing of conduct which falls within the board’s jurisdiction and which, if proven, would constitute a violation of W.S. 33-26-508. Such complaint shall clearly identify the complainant by name, address and telephone number (if any).
(ii) All complaints shall be deemed received on the date of actual receipt by the executive director.
(iii) A copy of every written complaint, and every writing in the general nature of a complaint, as well as a report of every oral communication in the nature of a complaint received by the board shall be filed and maintained in the board’s permanent files and docket.
(iv) A copy of every written complaint and every writing in the nature of a complaint, as well as a report of every oral communication in the nature of a complaint received by the board shall, upon receipt, be sent to the board’s attorney.
(v) Within thirty (30) days after the receipt of a complaint, the board officers shall screen the complaint and, if they determine that the complaint alleges conduct by a licensee which falls within the board’s jurisdiction and which, if proven, would constitute a violation of W.S. 33-26-508, shall appoint two members of the board and one member of the advisory council as interviewers. Whenever reasonably possible, the interviewers shall include at least one (1) lay board member. If such inclusion is not reasonably possible, the executive director shall note that finding in the docket together with the grounds and reasons for said finding. If a majority of the board officers cannot determine whether the complaint alleges conduct by a licensee which falls within the board’s jurisdiction and/or which, if proven, would constitute a violation of W.S. 33-26-508, they may authorize and direct the board’s agents and/or employees to investigate the complaint to provide sufficient information for them to complete the screening process.
(i) Immediately upon receipt of a complaint, the executive director of the board shall notify the complainant in writing of said receipt.
(ii) The notification of the complainant required by this section shall clearly advise the complainant as follows:
(A) Pursuant to W.S. 33-26-408(a)(ii), the complainant and the complainant’s witnesses incur no civil liability for information provided to the board in good faith, without malice, and in reasonable belief that the information is accurate.
(B) Any effort by the licensee named in the complaint to discourage, intimidate, or otherwise impede a full and vigorous pursuit of the complaint constitutes, under board rules, a separate and distinct reportable instance of unprofessional conduct.
(c) Notice to the respondent.
(i) Within fifteen (15) working days after a majority of the board officers have appointed interviewers and the board’s prosecutor has completed a petition, notice shall be sent to the respondent.
(ii) When the board prosecutor has completed the petition and delivered it to the board executive director, record of such petition shall be entered in the board’s docket and ledger.
(iii) The notification of respondent required by this section shall clearly advise the respondent as follows:
(A) The nature and particular subject matter of the petition, when it was filed, the board’s appointment of interviewers;
(B) A date by which the respondent is requested to submit a written response to the allegations in the petition;
(C) Notice to the respondent shall advise that counsel may be present at the informal interview, describe the interview process, and enumerate a range of potential sanctions that may be available to the board as a result of the interviewers’ recommendations.
(D) That any effort by the licensee named in the complaint to discourage, intimidate or otherwise impede a full and vigorous pursuit of the complaint constitutes, under board rules, a separate and reportable instance of unprofessional conduct.
(E) If a majority of the president, the vice president, and board secretary determine that the name of the complainant should not be disclosed to the respondent or if the complainant requests that his or her identity not be revealed to the respondent, the notice provided for in this subsection shall not identify the complainant. The board may, however, disclose the particular patient care in question, including the name of the patient.
(F) The notice described herein shall also be sent to the complainant.
(d) Emergency suspension. In cases where the board determines that emergency action is required for the protection of the public health, safety or welfare, the president may call a special meeting of the board which shall occur as soon as possible after receipt of the complaint and appropriate supporting evidence. Prior to convening such special meeting, the board officers shall screen the complaint and any additional information to determine whether such special meeting is appropriate. If deemed appropriate for emergency suspension, a copy of the complaint and any additional evidence may be made available to each member of the board prior to the special meeting. Such meeting may occur via telephone conference call, when necessary. If temporary emergency suspension pursuant to W.S. 33-26-404(c) is indicated, the board may so order, pursuant to the requirements of W.S. 16-3-113(c).
(i) The interviewers shall investigate the allegations of errant conduct against the respondent and where circumstances warrant, conduct an informal interview.
(ii) The informal interviewers may, at their discretion, conduct the interview where circumstances warrant without assistance of board counsel and/or by telephone. If the interviewee notifies the board of representation by counsel, the board counsel shall participate in the interview. Notice by the interviewee of intent to be represented by counsel shall be sent to the board, in writing, not later than fourteen (14) days prior to the interview.
(iii) The interviewers are the duly appointed agents and representatives of the board. After the informal interview and at other appropriate points in the proceedings, their recommendations shall be considered by the president and board secretary.
(iv) No part or aspect of the interviewers' investigation or recommendation shall be divulged to another member of the board prior to a contested case hearing, except as may be otherwise required by these rules. However, final board orders, general information and procedural updates concerning disciplinary matters pertaining to physician assistants shall be disseminated to board and council members and board counsel by the executive director on a routine basis. This shall include private reprimands, censures and other actions that may not be subject to public disclosure.
(v) At any time after appointment by a majority of the board officers, the interviewers may seek to use or employ investigators, the offices of the attorney general, the state department of criminal investigation or any other investigatory or fact finding agency they deem necessary. The interviewers may employ, at their discretion, medical specialty consultants to assist them in the investigation and evaluation of the complaint. Pursuant to W.S.33-26-408(a), these individuals shall be deemed agents of the board and there shall be no liability on the part of and no action for damages based on their actions and conduct relevant and/or material to the conduct of the investigation undertaken at the direction of the board.
(i) Following notification to the complainant and the respondent of the board's appointment of the interviewers, and where circumstances warrant, the interviewers shall conduct the informal interview.
(ii) The purpose of the informal interview is to determine whether the allegations, if proven, would constitute a violation of W.S. 33-26-508, whether a mental or physical examination of the respondent is warranted, whether a further investigation is warranted, whether additional charges should be brought, whether there exists a possibility of resolution of the complaint without further proceedings and whether a contested case disciplinary hearing should be pursued.
(iii) Review of the complaint by the interviewers may include, but are not limited to:
occurred;
(D) Whether there appears a likelihood that the facts and circumstances alleged, if proven, would constitute a violation of W.S. 33-26-508;
(E) The factual basis for the complainant's allegations;
(F) Whether the matter is outside the board's jurisdiction and should be referred to another state agency;
(G) Where appropriate notice of the informal interview shall be given to respondent and shall contain time, date and location of the interview and a statement of the action the interviewers are authorized to take following such interview.
(H) The interviewers shall make every reasonable attempt to conduct the informal interview within forty-five (45) days after their appointment. If special circumstances prevent the conduct of the informal interview by such date, the informal interview may proceed at the earliest possible date.
(I) The informal interview may be conducted by conference telephone call if the interviewers determine that the purpose of the interview can be achieved in such manner.
(J) The interviewers may request that the respondent submit documents and/or a written narrative response to the allegations of the complaint prior to the informal interview if they determine that such information would assist them in their investigation and in their conduct of the informal interview.
(K) The interviewers, board counsel, respondent and/or respondent's counsel may discuss stipulation, dismissal, the consent decrees, restrictions or any other pertinent procedural or substantive information.
(L) An electronic or stenographic record may be made and shall, if made, become part of the permanent confidential files of the board.
(M) An informal interview is not subject to strict legal procedural or evidentiary rules. Informal interviews are not open to the public nor is their occurrence a matter of public record.
(N) After reviewing their own findings based upon the investigation and the record made of the informal interview, the interviewers shall report, in writing, to the president and board secretary. Such report shall be made within thirty (30) days after completion of the investigation unless circumstances beyond the control of the interviewers shall prevent the report from being submitted within such time period.
(O) The interviewers shall recommend dismissal of the case, continuation of the investigation, that a medical, mental or physical examination be ordered for the respondent or the placing of restrictions or conditions on the respondent’s license or suspension or voluntary relinquishment or any other combination of actions designed to specifically redress the complaint, or to proceed with a contested case.
(P) The board officers shall accept the interviewers’ recommendations on behalf of the board. This determination shall occur within fifteen (15) working days of receipt by the board officers of the interviewers’ report or as soon thereafter as practicable.
(Q) The executive director of the board shall then note the date and disposition on the ledger, and the date, disposition and the written findings and basis therefor in the docket and notify all board and council members and counsel of the disposition of the matter.
(R) The board shall notify the complainant and the respondent of its actions and in a statement in concise and plain language note the reasons and basis therefor.
(iv) Investigation and examination of physician assistants.
(A) Following the informal interview and before report to the president and board secretary, the interviewers may further investigate the complaint in order to more fully inform themselves about the allegations contained in the complaint.
(B) The investigation may include the taking of depositions as authorized in W.S. 33-26-401(c), interviews with the complainant, interviews with witnesses, and such other investigation as the interviewers deem necessary.
(C) As a part of their investigation, or any time after their appointment, the interviewers, with the prior approval of a majority of the board officers, may order a mental, physical or medical competency exam of the respondent pursuant to W.S. 33-26-403.
(D) Notice of the interviewers’ order requiring respondent to submit to a medical, mental or physical examination shall include notice of a respondent's right to designate another physician to be present at the examination and make an independent report to the board.
(E) The interviewers shall also notify the respondent that he may request a mental, physical or medical examination for himself, pursuant to the terms of W.S. 33-26-403(a-d).
(F) The interviewers shall consider the recommendation of the examination committee and shall consider the substantive findings of the committee.
(G) The results of any board ordered mental, physical competency or medical competency examination shall be provided to the respondent and the interviewers prior to any further board action.
(g) Waiver of informal interview.
(i) Following notice by the board of its intent to conduct an informal interview pursuant to section 15(e), respondent may, at any time, waive the right to an informal interview and proceed directly to a contested case proceeding pursuant to section 15(i).
(ii) Waiver of the informal interview process must be made in writing, signed by the respondent and sent to the board of Medicine.
(iii) Respondent's waiver of the informal interview process shall not, in and of itself, constitute grounds for additional charges of unprofessional conduct pursuant to W.S. 33-26-402(a)(xxvii).
(h) Settlement or stipulation.
(i) Nothing in these rules shall preclude the respondent and the board from entering into a consent decree, nor shall these rules preclude a voluntary request by the respondent for the suspension, relinquishment or restriction of respondent's license, provided, however that the board may, but is not required, to accept or reject such a request.
(ii) The reasons, grounds, conditions and other provisions of any such consent decree, voluntary relinquishment, suspension or restriction or other board action taken in lieu of a contested case hearing shall be recorded on the docket and become a permanent part of the board's confidential files.
(iii) Such consent decree or other action may occur at any time prior to the announcement of a final decision after a contested case hearing.
(iv) In the case of stipulation, relinquishment or consent decree, the ledger shall note only the disciplinary action taken and the date.
(v) The complainant and respondent shall not enter into settlement negotiations nor exchange of offers of settlement or compromise without the express written permission of the board.
(i) Contested case.
(i) Any contested case before the board in a disciplinary action or denial appeal shall be conducted pursuant to these rules and the Wyoming Administrative Procedure Act (W.S. 16-3-101 et. seq.).
(ii) Disciplinary actions shall be initiated by a petition by the board on relation by the complainant or by the interviewers, as petitioners, against the licensee, as respondent.
(A) At least ten (10) days prior to service of the petition, written communication shall be sent to respondent requiring indication whether respondent will accept service of the petition by United States certified mail, return receipt requested, or if respondent desires personal service at his place of business. Failure to return written election of choice of service to the board within ten (10) days of receipt shall mandate personal service.
(B) The petition shall contain the following information:
(I) The respondent’s name and address;
(II) The time, manner and place of the hearing. The board shall notify the respondent at least forty-five (45) days before holding a contested case hearing. The board and respondent may waive this requirement by written agreement entered into the record.
(III) The docket number assigned to the case;
(IV) The legal authority and jurisdiction under which the hearing is to be held;
(V) The particular sections of the statutes and rules involved;
(VI) A statement in ordinary and concise language setting forth the grounds for the petition. If the board is unable to state the matters in detail at the time the petition is served, the petition may be limited to a statement of issues involved. Within thirty (30) days after a respondent’s request, the board shall amend the petition to provide a more definite and detailed statement. The hearing officer shall allow amendment of the petition upon a showing of good cause and lack of prejudice to the respondent.
(iii) Answer. The respondent may file an answer within twenty (20) days after receiving the petition.
(iv) Informal disposition. Subject to board approval, a disciplinary proceeding may be resolved by mutual agreement at any time prior to the hearing. In addition, the board may, on its own motion, dismiss a disciplinary proceeding or petition. All settlements, agreements, or stipulations, dismissals, and consent decrees shall be in writing and entered into record. Following such a resolution, the board shall issue findings and a final order dismissing the case unless the board, by specific action, finds that a final order should not be issued in the case. Any such finding shall be reduced to writing and set forth the specific reasons for not issuing a final order. A copy of such writing shall be placed and retained in the respondent's file maintained by the board.
(v) Hearing officer.
(A) The board shall appoint a hearing officer to preside over each contested case. The appointed hearing officer shall not have participated in the preliminary investigation or case preparation.
(B) The hearing officer shall withdraw from the case if he or she deems himself or herself to be disqualified. The hearing officer shall provide a written explanation of such withdrawal to the board before withdrawing.
(C) A party may make a written request for the removal of a hearing officer. The request shall be made as soon as the party has reasonable grounds to believe that the hearing officer is subject to disqualification. The written request shall explain the reasons for the requested disqualification and shall be accompanied by affidavits. If the hearing officer denies the request, he or she shall issue a written explanation of such denial and enter the explanation into the record. If the hearing officer grants the request, the board shall appoint a new hearing officer as soon as possible.
(vi) Duties and powers of hearing officer. The hearing officer shall have those powers set forth in W.S. 16-3-112(b) and all such other powers as may be necessary to conduct a fair and impartial contested case hearing, including but not limited to, the power to provide for and determine the scope of discovery and assist the board in the development of proposed findings of fact and conclusions of law.
(vii) Discovery. Discovery in a board disciplinary proceeding shall be governed by W.S. 16-3-107. All records of discovery shall be filed with the board or its hearing officer.
(viii) Subpoenas. Pursuant to W.S. 16-3-107, the board or its hearing officer may order by subpoena the attendance of witnesses or require the production of books, papers or other evidence. A respondent may apply for a subpoena. However, pursuant to W.S. 33-26-408(c), a respondent may not discover board records other than final orders nor may a respondent seek discovery from any board member, employee or agent.
(ix) Pre-hearing conference.
(A) Upon request of either respondent or board, and at any time before the hearing date, the hearing officer may hold a pre-hearing conference to consider simplifying the issues, amending the pleadings, clarifying or limiting the evidence, formulating procedures to govern the hearing and any other matters which will aid in the disposition of the case.
(B) An order reflecting the action taken at the pre-hearing conference shall be written and entered into the record. The pre-hearing order shall control the course of the hearing unless modified to prevent manifest injustice. A party may request a modified order if the order is ambiguous or does not fully cover the issues presented at the pre-hearing conference.
(x) Evidence and testimony.
(A) Admissibility of evidence. Admissibility is governed by W.S. 16-3-108. Parties shall have the right to present evidence, submit rebuttal evidence, and conduct cross examinations. Irrelevant, immaterial, and unduly repetitious information shall be excluded. All documentary or physical evidence shall be marked as exhibits. The board's exhibits shall be marked by letters of the alphabet beginning with 'A'. The respondent's exhibits shall be marked with numbers beginning with '1'.
(B) Objections. The grounds for objections to evidentiary rulings shall be briefly stated. All objections and rulings shall be entered into the record.
(C) Witnesses. A testifying witness shall identify himself by stating his name and address. All witnesses shall stand and be administered the following oath: 'Do you swear (or affirm) to tell the truth, the whole truth, and nothing but the truth.'
(D) Privileged and confidential information. The hearing officer shall recognize any privilege at law.
(E) Official notice. Official notice may be taken of any information in the nature of traditional matters of judicial notice or within the board's special technical knowledge or files.
(xi) Representation. All parties have a right to represent themselves or be represented by counsel at every stage of any disciplinary proceeding including the informal interview.
(xii) Order of procedure.
(A) To the extent practicable, contested case hearings shall be conducted in accordance with the following procedure:
(I) The hearing officer shall conduct the hearing in closed session pursuant to W.S. 16-4-405(a)(ii) and (a)(ix), unless the respondent requests a public hearing. The hearing officer may sequester witnesses upon appropriate request by any party.
(II) The hearing officer shall commence the hearing by calling the docket number and title of the case to be heard. The hearing officer shall ask if the parties are ready to proceed. The hearing officer may also allow the parties to dispose of preliminary matters. The hearing officer shall allow the parties a reasonable time to voir dire the board on the grounds that a board member has a conflict of interest or is biased.
(III) If the respondent or his or her representative fails to appear, the hearing officer may:
(1.) Grant a continuance;
(2.) Conduct the proceeding in the absence of the respondent or his or her representative; or,
(3.) Declare the respondent in default and accept all matters in the complaint as true.
(IV) The hearing officer shall administer the oath to all witnesses at the beginning of the hearing or before each witness testifies.
(V) The hearing officer may allow all parties to give an opening statement to briefly explain their position and outline the evidence they propose to offer.
(VI) The hearing officer may recess the proceedings as appropriate.
(VII) The board shall present its evidence first, followed by the respondent. The board may submit rebuttal evidence. Witnesses may be cross-examined by an opposing party or by the board.
(VIII) No testimony shall be received unless given under oath or affirmation.
(IX) Closing statements shall be made after all evidence has been received with the board going first followed by the respondent.
(X) Following the closing statements, the hearing officer may dismiss and excuse all witnesses and declare the hearing closed.
(XI) No evidence shall be taken after the hearing unless requested and upon a showing of good cause.
(XII) All parties may submit legal briefs and proposed findings of fact and conclusions of law within thirty (30) days after the transcript is made available. The time limit may be extended upon agreement between the parties and with the approval of the hearing officer.
(B) All hearings shall be recorded verbatim stenographically or by other appropriate means. Within ten (10) days after the transcript is available, the hearing officer may allow all parties to submit written proposed corrections of the transcript pointing out errors that have been made in transcribing the testimony.
(xiii) Decision.
(A) After consulting with the board, the hearing officer shall assist the board in drafting findings of fact and conclusions of law within thirty (30) days after receiving proposed findings from the board and the respondent.
(B) The board shall serve a copy of the decision upon all parties. The decision shall include:
(I) A statement of the findings of fact and conclusions of law, separately stated and supported by concise and explicit statements, and
(II) An order setting forth the action taken, including costs, if any, assessed against respondent.
(xiv) Record. The record in contested cases shall consist of those items set forth in W.S. 16-3-107(o) and the transcript of all recorded proceedings if one is prepared.
(xv) Appeal. Pursuant to W.S. 16-3-114 the board’s final decision may be appealed to the district court.
(xvi) Transcript in case of appeal. If the board’s decision is appealed to the district court, the appealing party shall pay the costs of copying the transcripts and duplicating the record for submission to the court and the parties to the appeal.
Any person whose license has been relinquished or revoked may petition for reinstatement pursuant to W.S. 33-26-509. The petitioner shall have the burden to prove, by a preponderance of the evidence, that he is of good moral character and able to safely and skillfully practice as a physician assistant.
(a) As the agent of the supervising physician, a physician assistant may prescribe, administer and dispense medications, including schedule II-V as defined in W.S. 35-7-1015 through 35-7-1022. Dispensing shall be limited to rural clinics in which pharmacy services are not physically available.
(b) A physician assistant shall not prescribe schedule I and schedule drugs as defined by W.S. 35-7-1013 through 35-7-1016.
(c) Use of pre-signed prescription pads is prohibited.
(a) The supervising physician shall notify the board of any change of practice location or supervisory status of a physician assistant licensed in the state of Wyoming, and working under the physician’s supervision, within thirty (30) days of the effective date of such change.
(b) A physician assistant shall clearly identify himself or herself by a name tag or other means to differentiate himself/herself from a physician.
(c) Except as otherwise provided in these rules and regulations, a physician may be a supervising physician for three (3) physician assistants and act as a back-up physician for an additional three (3) physician assistants on duty at any given time. Physicians whose specific practice circumstances indicate the need to supervise and/or back-up more than a total of six (6) physician assistants may submit a written request for approval of the supervisory arrangement, along supporting documentation, for review by the Board of Medicine, as provided in these rules and regulations
(d) Provisions for “back-up supervision” shall be in writing and on file with and approved by the board prior to the physician assistant beginning work.
(e) Medical supervision of a physician assistant by other than a licensed physician is prohibited.
If one or more parts of these rules are found to be invalid or unenforceable, the remainder shall continue in full force and effect.
All physician assistant supervision arrangements formed or submitted to the Board on or after October 1, 2009, shall comply with the following requirements:
(a) A supervising physician or back-up supervising physician and any physician assistant under his or her supervision shall maintain on file with the Board a current supervision plan approved pursuant to section 8(h) of this chapter.
(b) The supervision plan shall be submitted as part of any application by a supervising physician, back-up supervising physician, or group of supervising physicians.
(c) Before a supervising physician, back-up supervising physician or physician assistant may change a supervision plan previously approved by the Board, they shall submit a revised supervision plan on an application form published by the Board. The revised supervision plan application shall be reviewed by the advisory council and the Board pursuant to section 8(h) of this chapter.
(d) Supervising physicians, back-up supervising physicians, and physician assistants shall maintain documentation to demonstrate compliance with the elements of the supervision plan.
(e) A supervising physician, back-up supervising physician or physician assistant shall, upon written request from the Board, produce within twenty (20) days of receipt of the Board’s request any documentation maintained pursuant to subsection (d).
(f) In addition to the ability to request documentation pursuant to subsection (e) the Board may, from time to time, conduct an audit of approximately ten (10) percent of then-active supervisory relationships, selected by random means, by requesting from the selected supervising physician, back-up supervising physician and the physician assistant any documentation from the past three (3) years maintained pursuant to subsection (d).