334.002. 1. Notwithstanding any law to the contrary, any person licensed pursuant to this chapter may apply to the state board of registration for the healing arts for an inactive license status on a form furnished by the board. Upon receipt of the completed inactive status application form and the board's determination that the licensee meets the requirements established by rule, the board shall declare the licensee inactive and shall place the licensee on an inactive status list. A person whose license is inactive or who has discontinued his or her practice because of retirement shall not practice his or her profession within this state, but shall be allowed to practice his or her profession on himself or herself or on his or her immediate family, however, such person shall not be allowed to prescribe controlled substances. Such person may continue to use the title of his or her profession or the initials of his or her profession after such person's name.
2. During the period of inactive status, the licensee shall not be required to comply with the board's minimum requirements for continuing education.
3. If a licensee is granted inactive status, the licensee may return to active status by notifying the board in advance of his or her intention, paying the appropriate fees, and meeting all established requirements of the board as a condition of reinstatement.
4. Any licensee allowing his or her license to become inactive may within five years of the inactive status return his or her license to active status by notifying the board in advance of such intention, paying the appropriate fees, and meeting all established licensure requirements of the board, excluding the licensing examination, as a condition of reinstatement.
(L. 2002 S.B. 1182)
334.010. 1. It shall be unlawful for any person not now a registered physician within the meaning of the law to practice medicine or surgery in any of its departments, to engage in the practice of medicine across state lines or to profess to cure and attempt to treat the sick and others afflicted with bodily or mental infirmities, or engage in the practice of midwifery in this state, except as herein provided.
2. For the purposes of this chapter, the "practice of medicine across state lines" shall mean:
(1) The rendering of a written or otherwise documented medical opinion concerning the diagnosis or treatment of a patient within this state by a physician located outside this state as a result of transmission of individual patient data by electronic or other means from within this state to such physician or physician's agent; or
(2) The rendering of treatment to a patient within this state by a physician located outside this state as a result of transmission of individual patient data by electronic or other means from within this state to such physician or physician's agent.
3. A physician located outside of this state shall not be required to obtain a license when:
(1) In consultation with a physician licensed to practice medicine in this state; and
(2) The physician licensed in this state retains ultimate authority and responsibility for the diagnosis or diagnoses and treatment in the care of the patient located within this state; or
(3) Evaluating a patient or rendering an oral, written or otherwise documented medical opinion, or when providing testimony or records for the purpose of any civil or criminal action before any judicial or administrative proceeding of this state or other forum in this state; or
(4) Participating in a utilization review pursuant to section 376.1350, RSMo.
(RSMo 1939 § 9981, A.L. 1959 S.B. 50 § 18, A.L. 1998 H.B. 1601, et al.)Prior revisions: 1929 § 9111; 1919 § 7330; 1909 § 8311
(1958) "Without holding that unlicensed medical practice constitutes a public nuisance per se", where record showed that defendant was utterly inadequate and incompetent for the role he assumed and established that his extensive unlicensed practice (as a naturopath) was in fact, a public nuisance, he would be enjoined. State ex rel. Collet v. Scopel (Mo.), 316 S.W.2d 515.
(1958) Where naturopath advertised that he was a doctor and maintained a place of business in Missouri where, for a consideration, he consulted with patients, made examinations, diagnosed their condition, prescribed for and treated them for illness, he was practicing medicine. Such practice without a license could be enjoined as public nuisance. State v. Errington (Mo.), 317 S.W.2d 326. Cert. Den. 359 U.S. 992, 79 S.Ct. 1122.
(1963) Ear drops, vitamins and placebo pills prescribed and administered by a doctor of chiropractic, in his professional capacity to a patient for which he expected to make a charge, were medicine within meaning of section 331.010, the administering and prescribing of which were beyond the scope of his chiropractic license and grounds for revocation of his license. State ex rel. Gibson v. Missouri Board of Chiropractic Examiners (A.), 365 S.W.2d 773.
(1964) Verdict finding defendant "guilty of practicing medicine without a license between March 19, 1962 and April 7, 1962 by applying certain substances and bandages to the face of * * * in treatment of a bodily infirmity, professing to cure the same * *" held sufficient. State v. Leimer (A.), 382 S.W.2d 718.
(1966) Separate sections of chapter 334 constitute a part of entire code, are pari materia, must be read and construed together, effect must be given to all provisions, and apparent conflicts must be harmonized whenever possible. Bittiker v. State Board of Registration for Healing Arts (A.), 404 S.W.2d 402.
(1986) This section is not void for vagueness on account of its failure to expressly define "practice of medicine" or "engage in the practice of midwifery". Engaging in the practice of midwifery is unlawful, but every act of midwifery engaged in without a license is not unlawful. The statute permits isolated or occasional gratuitous acts of midwifery. State ex rel. Mo. State Board v. Southworth (Mo. banc), 704 S.W.2d 219.
334.020. Whenever used in this chapter, unless expressly stated otherwise, the term "board" means the state board of registration for the healing arts in the state of Missouri.
(L. 1945 p. 1147 § 9992e, A.L. 1959 S.B. 50 § 1)
334.021. 1. Where other statutes of this state use the terms "physician", "surgeon", "practitioner of medicine", "practitioner of osteopathy", "board of medical examiners", or "board of osteopathic registration and examination" or similar terms, they shall be construed to mean physicians and surgeons licensed under this chapter or the state board of registration for the healing arts in the state of Missouri.
2. With the exception of section 197.700, RSMo, notwithstanding any other provision of law, no health facility, health benefit plan, managed care plan, or health carrier shall discriminate with respect to employment, staff, privileges, or the provision of professional services against a physician licensed to practice the healing arts in this state on the basis of whether the physician holds a "medical doctor", "M.D." or "doctor of osteopathy", "D.O." degree.
3. Any reference in an executive order, an administrative regulation, or in the Missouri revised statutes to "medical doctor", "M.D.", or "physician" shall be deemed to include a "doctor of osteopathy" or "D.O." unless any of those terms are specifically excluded by reference to this section. Similarly, any reference to an "osteopath", "D.O." or "physician" shall be deemed to include a "medical doctor" or "M.D.", unless any of those terms are specifically excluded by reference to this section. Similarly, any reference to a specialist shall be deemed to include those specialists accredited by either the Accreditation Council for Graduate Medical Education or the American Osteopathic Association unless specifically excluded by reference to this section.
4. The provisions of subsection 3 of this section do not apply to the makeup of boards and commissions on which an unequal number of medical doctors or osteopaths serve.
(L. 1959 S.B. 50 § 22, A.L. 2001 H.B. 567)
334.031. 1. Candidates for licenses as physicians and surgeons shall furnish satisfactory evidence of their good moral character, and their preliminary qualifications, to wit: a certificate of graduation from an accredited high school or its equivalent, and satisfactory evidence of completion of preprofessional education consisting of a minimum of sixty semester hours of college credits in acceptable subjects leading towards the degree of bachelor of arts or bachelor of science from an accredited college or university. They shall also furnish satisfactory evidence of having attended throughout at least four terms of thirty-two weeks of actual instructions in each term and of having received a diploma from some reputable medical college or osteopathic college that enforces requirements of four terms of thirty-two weeks for actual instruction in each term, including, in addition to class work, such experience in operative and hospital work during the last two years of instruction as is required by the American Medical Association and the American Osteopathic Association before the college is approved and accredited as reputable. Any medical college approved and accredited as reputable by the American Medical Association or the Liaison Committee on Medical Education and any osteopathic college approved and accredited as reputable by the American Osteopathic Association is deemed to have complied with the requirements of this subsection.
2. In determining the qualifications necessary for licensure as a qualified physician and surgeon, the board, by rule and regulation, may accept the certificate of the National Board of Medical Examiners of the United States, chartered pursuant to the laws of the District of Columbia, of the National Board of Examiners for Osteopathic Physicians and Surgeons chartered pursuant to the laws of the state of Indiana, or of the Licentiate of the Medical Counsel of Canada (LMCC) in lieu of and as equivalent to its own professional examination. Every applicant for a license on the basis of such certificate, upon making application showing necessary qualifications as provided in subsection 1 of this section, shall be required to pay the same fee required of applicants to take the examination before the board.
(L. 1959 S.B. 50 § 3, A.L. 1981 S.B. 16, A.L. 1997 S.B. 141)(1974) Held that determination of factual considerations used in exercising discretion of the board are subject to administrative review. State Bd. of Registration for the Healing Arts v. Finch (A.), 514 S.W.2d 608.
334.035. Every applicant for a permanent license as a physician and surgeon shall provide the board with satisfactory evidence of having successfully completed such postgraduate training in hospitals or medical or osteopathic colleges as the board may prescribe by rule.
(L. 1987 H.B. 667, et al.)
334.040. 1. Except as provided in section 334.260, all persons desiring to practice as physicians and surgeons in this state shall be examined as to their fitness to engage in such practice by the board. All persons applying for examination shall file a completed application with the board at least eighty days before the date set for examination upon blanks furnished by the board.
2. The examination shall be sufficient to test the applicant's fitness to practice as a physician and surgeon. The examination shall be conducted in such a manner as to conceal the identity of the applicant until all examinations have been scored. In all such examinations an average score of not less than seventy-five percent is required to pass; provided, however, that the board may require applicants to take the Federation Licensing Examination, also known as FLEX, or the United States Medical Licensing Examination (USMLE). If the FLEX examination is required, a weighted average score of no less than seventy-five percent is required to pass. The passing score of the United States Medical Licensing Examination shall be determined by the board through rule and regulation. The board shall not issue a permanent license as a physician and surgeon or allow the Missouri state board examination to be administered to any applicant who has failed to achieve a passing score within three attempts on licensing examinations administered in one or more states or territories of the United States, the District of Columbia or Canada. The steps one, two and three of the United States Medical Licensing Examination shall be taken within a seven-year period with no more than three attempts on any step of the examination; however, the board may grant an extension of the seven-year period if the applicant has obtained a MD/PhD degree in a program accredited by the liaison committee on medical education (LCME) and a regional university accrediting body. The board may waive the provisions of this section if the applicant is licensed to practice as a physician and surgeon in another state of the United States, the District of Columbia or Canada and the applicant has achieved a passing score on a licensing examination administered in a state or territory of the United States or the District of Columbia and no license issued to the applicant has been disciplined in any state or territory of the United States or the District of Columbia. Prior to waiving the provisions of this section, the board may require the applicant to achieve a passing score on one of the following:
(1) The American Specialty Board's certifying examination in the physician's field of specialization;
(2) Part II of the FLEX; or
(3) The Federation portion of the State Medical Board's Special Purpose Examination (SPEX).
3. If the board waives the provisions of this section, then the license issued to the applicant may be limited or restricted to the applicant's board specialty. Scores from one test administration shall not be combined or averaged with scores from other test administrations to achieve a passing score. The board shall not be permitted to favor any particular school or system of healing.
(RSMo 1939 § 9983, A.L. 1941 p. 418, A.L. 1945 p. 1147, A.L. 1951 p. 727, A.L. 1959 S.B. 50 § 3, A.L. 1981 S.B. 16, A.L. 1993 H.B. 564, H.B. 590 (H.B. 590 repealed 1996 H.B. 1473), A.L. 1997 S.B. 141, A.L. 2000 H.B. 1848)
334.043. Upon the applicant paying a fee equivalent to the required examination fee and furnishing the board with all locations of previous practice and licensure in chronological order, the board shall, under regulations prescribed by it, admit without examination qualified persons who meet the requirements of this state including, but not limited to, sections 334.031, 334.035 and 334.040, and who hold certificates of licensure in any state or territory of the United States or the District of Columbia authorizing them to practice in the same manner and to the same extent as physicians and surgeons are authorized to practice by this chapter. Within the limits of this section, the board is authorized and empowered to negotiate reciprocal compacts with licensing boards of other states for admission of licensed practitioners from Missouri in other states.
(L. 1959 S.B. 51 § 4, A.L. 1981 S.B. 16, A.L. 1983 H.B. 659, A.L. 1993 H.B. 564 merged with H.B. 590)
334.044. Notwithstanding any other provision of law to the contrary, any qualified physician who is legally authorized to practice under the laws of another state may practice as a physician and surgeon in this state, without examination by the board or payment of any fee, if such practice consists solely of the provision of gratuitous medical services provided for a summer camp for a period of not more than fourteen days in any one calendar year.
(L. 1992 S.B. 867)Effective 7-9-92
334.045. 1. Notwithstanding any other provisions of law, the board may grant a temporary license to any graduate of a reputable medical college or osteopathic college to practice as a physician and surgeon in hospitals approved by the board, who meets such other requirements as the board may prescribe by rule and regulation.
2. The temporary license provided for in subsection 1 of this section shall limit the right of the licensee to practice only in hospitals approved by the board, under the supervision of the superintendent or chief of staff of such institution, and shall be renewable in the discretion and with the approval of the board; provided, however, that no fees for services rendered shall be charged by the temporary licensee nor by the hospital where he is employed for services performed by such temporary licensee. A temporary license fee shall accompany the original application for temporary license and a similar amount shall be paid in the event the temporary license is renewed.
3. Prior to receiving all the necessary documents as required in section 334.031, the board may grant a conditional temporary license to any medical or osteopathic school graduate who is a first-time candidate in this state for temporary licensure. The conditional temporary license shall only be issued upon the board's receipt of such documentary assurances as are reasonably available from the medical or osteopathic institution to demonstrate that the candidate will fulfill the actual requirements of section 334.031, and in situations where a first-time candidate for licensure would otherwise be unable to receive a temporary license in time to begin his or her training program. The conditional temporary license shall limit the licensee to practice in the same manner as a temporary licensee and shall automatically expire either one hundred twenty days from the date of issuance or upon the issuance of a temporary license and shall not be renewed.
(L. 1963 p. 429, A.L. 1981 S.B. 16, A.L. 1987 H.B. 667, et al., A.L. 1989 S.B. 283, A.L. 1993 H.B. 564 merged with H.B. 590, A.L. 1995 S.B. 186)Effective 5-4-95
334.046. 1. Notwithstanding any other provisions of law to the contrary, the board may grant a temporary license to any otherwise qualified physician to teach or lecture in a program sponsored by an accredited medical school in the state of Missouri or any accredited hospital. The temporary license shall not extend beyond twelve months from the date of its issuance and shall terminate automatically. To be granted a temporary license pursuant to this section, a physician shall meet all requirements for permanent licensure in the state of Missouri, including those imposed by rule and regulation; except that, the board may recognize and take into account the credentials of a physician licensed in other states or in foreign countries. Nothing contained in this section shall be construed so as to permit the issuance of a temporary license for locum tenens or other itinerant practices of the healing arts.
2. Within guidelines established by rule and regulation, the board may authorize an intern or a resident who is otherwise properly enrolled and duly licensed to participate in a program of graduate medical or osteopathic education in an accredited program in a contiguous state, to act as an intern or resident in this state; provided, that such activity is a recognized part of the educational experience offered by that program.
3. Notwithstanding any other provision of law to the contrary, the board may waive the provisions of sections 334.035 and 334.040, but not section 334.031, and grant a permanent license to practice as a physician and surgeon to the holder of a temporary license issued pursuant to this section. The board shall not grant a waiver pursuant to this section unless and until the applicant has held a temporary license for a minimum of twelve months preceding the date of application and complies with all requirements the board may impose by rule or regulation. An applicant for a permanent license pursuant to this section shall present evidence to the board that the applicant holds a certificate of licensure in any state or territory of the United States, of the District of Columbia or in a foreign country, authorizing the applicant to practice in the same manner and to the same extent as physicians and surgeons are authorized to practice by this chapter.
4. Before granting a waiver pursuant to this section, the board may require the applicant to achieve a passing score on the federation portion of the state medical board's special purpose examination (SPEX).
5. If the board grants a waiver pursuant to this section, then the license issued to the applicant may be limited or restricted to the applicant's board specialty.
6. The board may not grant a waiver pursuant to this section to any applicant who has failed to achieve a passing score within three attempts on licensing examinations administered in one or more states or territories of the United States, the District of Columbia or in any foreign country.
7. Any waiver granted by the board pursuant to this section, or pursuant to section 334.040, shall be granted in the sole discretion of the board. A refusal by the board to grant such a waiver shall not be appealable to the administrative hearing commission or circuit court.
(L. 1986 H.B. 1036, A.L. 1989 S.B. 283, A.L. 1996 H.B. 1473, A.L. 1997 S.B. 141)
334.047. 1. On the licenses issued by the board, the board shall enter after the name of the licensee the degree to which the licensee is entitled by reason of his diploma of graduation from a professional school approved and accredited as reputable by the American Medical Association or the Liaison Committee on Medical Education or approved and accredited as reputable by the American Osteopathic Association.
2. A licensee under this chapter shall, in any letter, business card, advertisement, prescription blank or sign, designate the degree to which he is entitled by reason of his diploma of graduation from a professional school approved and accredited as reputable by the American Medical Association or the Liaison Committee on Medical Education or approved and accredited as reputable by the American Osteopathic Association.
3. On licenses issued by the board to foreign trained licensees, the board may enter the degree to which the licensee is entitled based upon the nature of the licensee's education and training and the licensee shall, in any writing or display, so designate this degree.
(L. 1959 S.B. 50 §§ 3, 21, A.L. 1981 S.B. 16, A.L. 2001 H.B. 567)(1964) This section held not to impose an obligation on board of election commissioners to designate on ballot the degree to which licensee is entitled where licensee is running for public office. State ex rel. Rainey v. Crowe (A.), 382 S.W.2d 38.
(1965) Board of registration for the healing arts, in applying statute that applicants for license should have shown on license their degree, had power to determine that doctor who graduated from osteopathic school with degree of Doctor of Osteopathy was not entitled to have entered on his license degree of Medical Doctor, notwithstanding fact that he had obtained M.D. degree from a California college of medicine at which he registered but never attended. Mitchem v. Perry (A.), 390 S.W.2d 600.
334.050. 1. There is hereby established in the office of the state treasurer a fund to be known as the "Board of Registration for the Healing Arts Fund". All fees of any kind and character authorized to be charged by the board shall be collected by the director of the division of professional registration and shall be transmitted to the department of revenue for deposit in the state treasury for credit to this fund, to be disbursed only in payment of expenses of maintaining the board and for the enforcement of the provisions of law concerning professions regulated by the board; and no other money shall be paid out of the state treasury for carrying out these provisions. Warrants shall be issued on the state treasurer for payment out of said fund.
2. The provisions of section 33.080, RSMo, to the contrary notwithstanding, money in this fund shall not be transferred and placed to the credit of general revenue until the amount in the fund at the end of the biennium exceeds two times the amount of the appropriation from the board's funds for the preceding fiscal year or, if the board requires by rule permit renewal less frequently than yearly, then three times the appropriation from the board's funds for the preceding fiscal year. The amount, if any, in the fund which shall lapse is that amount in the fund which exceeds the appropriate multiple of the appropriations from the board's funds for the preceding fiscal year.
3. The board shall charge each person applying to and appearing before it for examination for certificate of licensure to practice as physician and surgeon, an examination fee. Should the examination prove unsatisfactory and the board refuse to issue a license thereon, the applicant failing to pass the examination may return to any meeting and be examined upon payment of a reexamination fee.
(RSMo 1939 § 9989, A.L. 1945 p. 1147, A.L. 1951 p. 727, A.L. 1959 S.B. 50 § 5, A.L. 1963 p. 429, A.L. 1981 S.B. 16, A.L. 1985 S.B. 99)Prior revisions: 1929 § 9119; 1919 § 7335; 1909 § 8316
334.070. 1. Upon due application therefor and upon submission by such person of evidence satisfactory to the board that he is licensed to practice in this state, and upon the payment of fees required to be paid by this chapter, the board shall issue to him a certificate of registration. The certificate of registration shall contain the name of the person to whom it is issued and his office address and residence address, the expiration date, and the date and number of the license to practice.
2. Every person shall, upon receiving such certificate, cause it to be conspicuously displayed at all times in every office maintained by him in the state. If he maintains more than one office in this state, the board shall without additional fee issue to him duplicate certificates of registration for each office so maintained. If any registrant shall change the location of his office during the period for which any certificate of registration has been issued, he shall, within fifteen days thereafter, notify the board of such change and it shall issue to him without additional fee a new registration certificate showing the new location.
(L. 1945 p. 1147 § 9992b, A.L. 1959 S.B. 50 § 7, A.L. 1981 S.B. 16)
334.073. Pursuant to the requirements of 4 CSR 150-2.125, the state board of registration for the healing arts shall accept toward the fifty-hour license renewal requirement, continuing medical education courses which have an emphasis on the early diagnosis and treatment of autism in children.
(L. 2002 S.B. 1207)
334.075. The board shall not renew any certificate of registration unless the licensee shall provide satisfactory evidence that he has complied with the board's minimum requirements for continuing education. At the discretion of the board, compliance with the provisions of this section may be waived for licensed physicians who have discontinued their practice of medicine because of retirement.
(L. 1987 H.B. 667, et al.)
334.080. 1. Every person licensed under the provisions of this chapter shall renew his certificate of registration on or before the registration renewal date. The application shall be made under oath on a form furnished by the board. The application shall include, but not be limited to, disclosure of the following: the applicant's full name and his office and residence address and the date and number of his license; all final disciplinary actions taken against the applicant by any professional medical or osteopathic association or society, licensed hospital or medical staff of the hospital, state, territory federal agency or country; and, information concerning the applicant's current physical and mental fitness to practice as a physician and surgeon.
2. A blank form for application for registration shall be mailed to each person licensed in this state at his last known office or residence address. The failure to receive it does not, however, relieve any person of the duty to register and pay the fee required by the chapter nor exempt him from the penalties provided by this chapter for failure to register.
3. If a person licensed, certified, or registered by the board of healing arts does not renew such license, certification, or registration for two consecutive renewal periods, such license, certification, or registration shall be deemed void.
(L. 1945 p. 1147 § 9992a, A.L. 1947 V. I p. 374, A.L. 1959 S.B. 50 § 8, A.L. 1981 S.B. 16, A.L. 1987 H.B. 667, et al., A.L. 1997 S.B. 141)
334.090. 1. Each applicant for registration under this chapter shall accompany the application for registration with a registration fee to be paid to the director of revenue. If the application is filed and the fee paid after the registration renewal date, a delinquent fee shall be paid; but whenever in the opinion of the board the applicant's failure to register is caused by extenuating circumstances including illness of the applicant, as defined by rule and regulation, the delinquent fee may be waived by the board. Whenever any new license is granted to any person under the provisions of this chapter, the board shall, upon application therefor, issue to such licensee a certificate of registration covering a period from the date of the issuance of the license to the next renewal date without the payment of any registration fee.
2. The board shall set the amount of the fees which this chapter authorizes and requires by rules and regulations promulgated pursuant to section 536.021, RSMo. The fees shall be set at a level to produce revenue which shall not substantially exceed the cost and expense of administering this chapter.
(L. 1945 p. 1147 § 9992c, A.L. 1951 p. 727, A.L. 1959 S.B. 50 § 9, A.L. 1963 p. 429, A.L. 1981 S.B. 16, A.L. 1987 H.B. 667, et al.)
334.097. 1. Physicians shall maintain an adequate and complete patient record for each patient and may maintain electronic records provided the record-keeping format is capable of being printed for review by the state board of registration for the healing arts. An adequate and complete patient record shall include documentation of the following information:
(1) Identification of the patient, including name, birthdate, address and telephone number;
(2) The date or dates the patient was seen;
(3) The current status of the patient, including the reason for the visit;
(4) Observation of pertinent physical findings;
(5) Assessment and clinical impression of diagnosis;
(6) Plan for care and treatment, or additional consultations or diagnostic testing, if necessary. If treatment includes medication, the physician shall include in the patient record the medication and dosage of any medication prescribed, dispensed or administered;
(7) Any informed consent for office procedures.
2. Patient records remaining under the care, custody and control of the licensee shall be maintained by the licensee of the board, or the licensee's designee, for a minimum of seven years from the date of when the last professional service was provided.
3. Any correction, addition or change in any patient record made more than forty-eight hours after the final entry is entered in the record and signed by the physician shall be clearly marked and identified as such, and the date, time and name of the person making the correction, addition or change shall be included, as well as the reason for the correction, addition or change.
4. A consultative report shall be considered an adequate medical record for a radiologist, pathologist or a consulting physician.
5. The board shall not initiate disciplinary action pursuant to subsection 2 of section 334.100 against a licensee solely based on a violation of this section. If the board initiates disciplinary action against the licensee for any reason other than a violation of this section, the board may allege violation of this section as an additional cause for discipline pursuant to subdivision (6) of subsection 2 of section 334.100.
6. The board shall not obtain a patient medical record without written authorization from the patient to obtain the medical record or the issuance of a subpoena for the patient medical record.
(L. 2002 S.B. 1024)
334.098. 1. If the board finds merit to a complaint by an individual incarcerated or under the care and control of the department of corrections and takes further investigative action, no documentation may appear on file or disciplinary action may be taken in regards to the licensee's license unless the provisions of subsection 2 of section 334.100 have been violated. Any case file documentation that does not result in the board filing an action pursuant to subsection 2 of section 334.100 shall be destroyed within three months after the final case disposition by the board. No notification to any other licensing board in another state or any national registry regarding any investigative action shall be made unless the provisions of subsection 2 of section 334.100 have been violated.
2. Upon written request of the physician subject to a complaint, prior to August 28, 1999, by an individual incarcerated or under the care and control of the department of corrections that did not result in the board filing an action pursuant to subsection 2 of section 334.100, the board and the division of professional registration, shall in a timely fashion:
(1) Destroy all documentation regarding the complaint;
(2) Notify any other licensing board in another state or any national registry regarding the board's actions if they have been previously notified of the complaint; and
(3) Send a letter to the licensee that clearly states that the board found the complaint to be unsubstantiated, that the board has taken the requested action, and notify the licensee of the provisions of subsection 3 of this section.
3. Any person who has been the subject of an unsubstantiated complaint as provided in subsection 1 or 2 of this section shall not be required to disclose the existence of such complaint in subsequent applications or representations relating to their medical practice.
(L. 1999 H.B. 343)
334.100. 1. The board may refuse to issue or renew any certificate of registration or authority, permit or license required pursuant to this chapter for one or any combination of causes stated in subsection 2 of this section. The board shall notify the applicant in writing of the reasons for the refusal and shall advise the applicant of the applicant's right to file a complaint with the administrative hearing commission as provided by chapter 621, RSMo. As an alternative to a refusal to issue or renew any certificate, registration or authority, the board may, at its discretion, issue a license which is subject to probation, restriction or limitation to an applicant for licensure for any one or any combination of causes stated in subsection 2 of this section. The board's order of probation, limitation or restriction shall contain a statement of the discipline imposed, the basis therefor, the date such action shall become effective, and a statement that the applicant has thirty days to request in writing a hearing before the administrative hearing commission. If the board issues a probationary, limited or restricted license to an applicant for licensure, either party may file a written petition with the administrative hearing commission within thirty days of the effective date of the probationary, limited or restricted license seeking review of the board's determination. If no written request for a hearing is received by the administrative hearing commission within the thirty-day period, the right to seek review of the board's decision shall be considered as waived.
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 the person's certificate of registration or authority, permit or license for any one or any combination of the following causes:
(1) 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) 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 pursuant to 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) 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) 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:
(a) 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 visits to the physician's office 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;
(b) 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;
(c) Willfully and continually performing inappropriate or unnecessary treatment, diagnostic tests or medical or surgical services;
(d) Delegating professional responsibilities to a person who is not qualified by training, skill, competency, age, experience or licensure to perform such responsibilities;
(e) Misrepresenting that any disease, ailment or infirmity can be cured by a method, procedure, treatment, medicine or device;
(f) Performing or prescribing medical services which have been declared by board rule to be of no medical or osteopathic value;
(g) Final disciplinary action by any professional medical or osteopathic 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 the person's license or staff or hospital privileges, failure to renew such privileges 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;
(h) 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;
(i) Exercising influence within a physician-patient relationship for purposes of engaging a patient in sexual activity;
(j) Terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient;
(k) Failing to furnish details of a patient's medical records to other treating physicians or hospitals upon proper request; or failing to comply with any other law relating to medical records;
(l) Failure of any applicant or licensee, other than the licensee subject to the investigation, to cooperate with the board during any investigation;
(m) Failure to comply with any subpoena or subpoena duces tecum from the board or an order of the board;
(n) Failure to timely pay license renewal fees specified in this chapter;
(o) Violating a probation agreement with this board or any other licensing agency;
(p) Failing to inform the board of the physician's current residence and business address;
(q) Advertising by an applicant or licensee 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. An applicant or licensee shall also be in violation of this provision if the applicant or licensee has a financial interest in any organization, corporation or association which issues or conducts such advertising;
(5) 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 subdivision, "repeated negligence" means the failure, on more than one occasion, to use that degree of skill and learning ordinarily used under the same or similar circumstances by the member of the applicant's or licensee's profession;
(6) 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;
(7) Impersonation of any person holding a certificate of registration or authority, permit or license or allowing any person to use his or her certificate of registration or authority, permit, license or diploma from any school;
(8) Revocation, suspension, restriction, modification, limitation, reprimand, warning, censure, probation or other final disciplinary action against the holder of or applicant for a license 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 licensee or applicant, including, but not limited to, the denial of licensure, surrender of the license, allowing the license to expire or lapse, or discontinuing or limiting the practice of medicine 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;
(9) A person is finally adjudged incapacitated or disabled by a court of competent jurisdiction;
(10) Assisting or enabling any person to practice or offer to practice any profession licensed or regulated by this chapter who is not registered and currently eligible to practice pursuant to this chapter; or knowingly performing any act which in any way aids, assists, procures, advises, or encourages any person to practice medicine who is not registered and currently eligible to practice pursuant to this chapter. A physician who works in accordance with standing orders or protocols or in accordance with the provisions of section 334.104 shall not be in violation of this subdivision;
(11) Issuance of a certificate of registration or authority, permit or license based upon a material mistake of fact;
(12) Failure to display a valid certificate or license if so required by this chapter or any rule promulgated pursuant to this chapter;
(13) Violation of the drug laws or rules and regulations of this state, any other state or the federal government;
(14) 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 the person's profession;
(15) Soliciting patronage in person or by agents or representatives, or by any other means or manner, under the person's 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 to the need or necessity for or appropriateness of health care services for all patients, or the qualifications of an individual person or persons to diagnose, render, or perform health care services;
(16) Using, or permitting the use of, the person's name under the designation of "Doctor", "Dr.", "M.D.", or "D.O.", or any similar designation with reference to the commercial exploitation of any goods, wares or merchandise;
(17) Knowingly making or causing to be made a false statement or misrepresentation of a material fact, with intent to defraud, for payment pursuant to the provisions of chapter 208, RSMo, or chapter 630, RSMo, or for payment from Title XVIII or Title XIX of the federal Medicare program;
(18) 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 days after the discovery thereof;
(19) Any candidate for licensure or person licensed to practice as a physical therapist, paying or offering to pay a referral fee or, notwithstanding section 334.010 to the contrary, practicing or offering to practice professional physical therapy independent of the prescription and direction of a person licensed and registered as a physician and surgeon pursuant to this chapter, as a dentist pursuant to chapter 332, RSMo, as a podiatrist pursuant to chapter 330, RSMo, or any licensed and registered physician, dentist, or podiatrist practicing in another jurisdiction, whose license is in good standing;
(20) Any candidate for licensure or person licensed to practice as a physical therapist, treating or attempting to treat ailments or other health conditions of human beings other than by professional physical therapy and as authorized by sections 334.500 to 334.620;
(21) Any person licensed to practice as a physician or surgeon, requiring, as a condition of the physician-patient relationship, that the patient receive prescribed drugs, devices or other professional services directly from facilities of that physician's office or other entities under that physician's ownership or control. A physician shall provide the patient with a prescription which may be taken to the facility selected by the patient and a physician knowingly failing to disclose to a patient on a form approved by the advisory commission for professional physical therapists as established by section 334.625 which is dated and signed by a patient or guardian acknowledging that the patient or guardian has read and understands that the physician has a pecuniary interest in a physical therapy or rehabilitation service providing prescribed treatment and that the prescribed treatment is available on a competitive basis. This subdivision shall not apply to a referral by one physician to another physician within a group of physicians practicing together;
(22) A pattern of personal use or consumption of any controlled substance unless it is prescribed, dispensed or administered by another physician who is authorized by law to do so;
(23) Revocation, suspension, limitation or restriction of any kind whatsoever of any controlled substance authority, whether agreed to voluntarily or not;
(24) For a physician to operate, conduct, manage, or establish an abortion facility, or for a physician to perform an abortion in an abortion facility, if such facility comes under the definition of an ambulatory surgical center pursuant to sections 197.200 to 197.240, RSMo, and such facility has failed to obtain or renew a license as an ambulatory surgical center;
(25) Being unable to practice as a physician and surgeon 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. The following shall apply to this subdivision:
(a) In enforcing this subdivision the board shall, after a hearing by the board, upon a finding of probable cause, require a physician to submit to a reexamination for the purpose of establishing his or her competency to practice as a physician or surgeon 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 such physician's or surgeon's professional conduct, or to submit to a mental or physical examination or combination thereof by at least three physicians, one selected by the physician compelled to take the examination, one selected by the board, and one selected by the two physicians so selected who are graduates of a professional school approved and accredited as reputable by the association which has approved and accredited as reputable the professional school from which the licentiate graduated. However, if the physician is a graduate of a medical school not accredited by the American Medical Association or American Osteopathic Association, then each party shall choose any physician who is a graduate of a medical school accredited by the American Medical Association or the American Osteopathic Association;
(b) For the purpose of this subdivision, every physician licensed pursuant to 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 the examining physician's testimony or examination is privileged;
(c) 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 or applicant without the physician's or applicant's consent;
(d) Written notice of the reexamination or the physical or mental examination shall be sent to the physician, by registered mail, addressed to the physician at the physician's last known address. Failure of a physician 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 the physician, in which case the board may enter a final order without the presentation of evidence, unless the failure was due to circumstances beyond the physician's control. A physician whose right to practice has been affected under this subdivision shall, at reasonable intervals, be afforded an opportunity to demonstrate that the physician can resume the competent practice as a physician and surgeon with reasonable skill and safety to patients;
(e) In any proceeding pursuant to this subdivision neither the record of proceedings nor the orders entered by the board shall be used against a physician in any other proceeding. Proceedings under this subdivision shall be conducted by the board without the filing of a complaint with the administrative hearing commission;
(f) When the board finds any person unqualified because of any of the grounds set forth in this subdivision, it may enter an order imposing one or more of the disciplinary measures set forth in subsection 4 of this section.
3. Collaborative practice arrangements, protocols and standing orders shall be in writing and signed and dated by a physician prior to their implementation.
4. 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 subsection 2 of this section, 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 years, or may suspend the person's license, certificate or permit for a period not to exceed three years, or restrict or limit the person's license, certificate or permit for an indefinite period of time, or revoke the person's license, certificate, or permit, or administer a public or private reprimand, or deny the person's application for a license, or permanently withhold issuance of a license or require the person 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 person to attend such continuing educational courses and pass such examinations as the board may direct.
5. In any order of revocation, the board may provide that the person may not apply for reinstatement of the person's license for a period of time ranging from two to seven years following the date of the order of revocation. All stay orders shall toll this time period.
6. Before restoring to good standing a license, certificate or permit issued pursuant to this chapter which has been in a revoked, suspended or inactive state for any cause for more than two years, the board may require the applicant to attend such continuing medical education courses and pass such examinations as the board may direct.
7. In any investigation, hearing or other proceeding to determine a licensee's or applicant's fitness to practice, any record relating to any patient of the licensee 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 licensee, 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 licensee, applicant or record custodian and a patient.
(RSMo 1939 § 9990, A.L. 1945 p. 1147, A.L. 1959 S.B. 50 § 10, A.L. 1963 p. 429, A.L. 1974 H.B. 1328, A.L. 1976 S.B. 472, A.L. 1979 S.B. 241, A.L. 1981 S.B. 16, A.L. 1983 S.B. 44 & 45, H.B. 713 Revision, A.L. 1984 H.B. 1351, A.L. 1986 H.B. 1029, A.L. 1987 H.B. 667, et al., A.L. 1989 H.B. 320, A.L. 1990 S.B. 737, A.L. 1993 H.B. 564, A.L. 1997 S.B. 141, A.L. 2004 S.B. 1122 merged with S.B. 1181)CROSS REFERENCE:
Administrative procedure and review, Chap. 536, RSMo
(1966) Fact that the same agency, state board of registration for the healing arts, both prosecuted and decided the case does not by itself deprive appellant of right of due process of law. Rose v. State Board of Registration for the Healing Arts (Mo.), 397 S.W.2d 570.
(1970) This section is not penal in nature, being for the protection of the public in safeguarding public health, and a revocation of a physician's license under it is not an imposition of punishment. Younge v. State Bd. of Registration for Healing Arts. (Mo.), 451 S.W.2d 346.
(1974) Determination of present moral character is a function of the administrative hearing commission. St. Bd. of Reg. for Healing Arts of Mo. v. DeVore (A.), 517 S.W.2d 480.
(1991) Acting as a non-treating expert medical witness does not constitute the practice of medicine. Physician would not be subject to discipline under statute for alleged false testimony while acting as a medical expert witness. Board of Registration for the Healing Arts v. Levine, 808 S.W.2d 440 (Mo.App. W.D.).
334.101. 1. Other provisions of section 620.010, RSMo, to the contrary notwithstanding, the board shall, at least quarterly, publish a list of the names and addresses of all persons who hold licenses under the provisions of this chapter, and shall publish a list of all persons whose licenses have been suspended, revoked, surrendered, restricted, denied or withheld. The board shall mail a copy of such lists to any person, upon request.
2. Other provisions of section 620.010, RSMo, to the contrary notwithstanding, in addition, the board shall prepare and make available to the public a report upon the disciplinary matters submitted to them where the board recommends disciplinary action except in those instances when persons possessing licenses voluntarily enter treatment and monitoring programs for purposes of rehabilitation and, in these instances, only this specific action shall not be reported with any other actions taken prior to, as part of, or following voluntary entrance into such treatment programs. The report shall set forth findings of fact and any final disciplinary actions of the board. Where the board does not recommend disciplinary action, a report stating that no action is recommended shall be prepared and forwarded to the complaining party.
(L. 1987 H.B. 667, et al.)
334.102. 1. Upon receipt of information that the holder of any certificate of registration or authority, permit or license issued pursuant to this chapter may present a clear and present danger to the public health and safety, the executive secretary or director shall direct that the information be brought to the board in the form of sworn testimony or affidavits during a meeting of the board.
2. The board may issue an order suspending and/or restricting the holder of a certificate of registration or authority, permit or license if it believes:
(1) The licensee's acts, conduct or condition may have violated subsection 2 of section 334.100; and
(2) A licensee is practicing, attempting or intending to practice in Missouri; and
(3) Either a licensee is unable by reason of any physical or mental condition to receive and evaluate information or to communicate decisions to the extent that the licensee's condition or actions significantly affect the licensee's ability to practice, or another state, territory, federal agency or country has issued an order suspending or restricting the holder of a license or other right to practice a profession regulated by this chapter, or the licensee has engaged in repeated acts of life-threatening negligence as defined in subsection 2 of section 334.100; and
(4) The acts, conduct or condition of the licensee constitute a clear and present danger to the public health and safety.
3. (1) The order of suspension or restriction:
(a) Shall be based on the sworn testimony or affidavits presented to the board;
(b) May be issued without notice and hearing to the licensee;
(c) Shall include the facts which lead the board to conclude that the acts, conduct or condition of the licensee constitute a clear and present danger to the public health and safety; and
(2) The board or the administrative hearing commission shall serve the licensee, in person or by certified mail, with a copy of the order of suspension or restriction and all sworn testimony or affidavits presented to the board, a copy of the complaint and the request for expedited hearing, and a notice of the place of and the date upon which the preliminary hearing will be held.
(3) The order of restriction shall be effective upon service of the documents required in subdivision (2) of this subsection.
(4) The order of suspension shall become effective upon the entry of the preliminary order of the administrative hearing commission.
(5) The licensee may seek a stay order from the circuit court of Cole County from the preliminary order of suspension, pending the issuance of a final order by the administrative hearing commission.
4. The board shall file a complaint in the administrative hearing commission with a request for expedited preliminary hearing and shall certify the order of suspension or restriction and all sworn testimony or affidavits presented to the board. Immediately upon receipt of a complaint filed pursuant to this section, the administrative hearing commission shall set the place and date of the expedited preliminary hearing which shall be conducted as soon as possible, but not later than five days after the date of service upon the licensee. The administrative hearing commission shall grant a licensee's request for a continuance of the preliminary hearing; however, the board's order shall remain in full force and effect until the preliminary hearing, which shall be held not later than forty-five days after service of the documents required in subdivision (2) of subsection 3.
5. At the preliminary hearing, the administrative hearing commission shall receive into evidence all information certified by the board and shall only hear evidence on the issue of whether the board's order of suspension or restriction should be terminated or modified. Within one hour after the preliminary hearing, the administrative hearing commission shall issue its oral or written preliminary order, with or without findings of fact and conclusions of law, that either adopts, terminates or modifies the board's order. The administrative hearing commission shall reduce to writing any oral preliminary order within five business days, but the effective date of the order shall be the date orally issued.
6. The preliminary order of the administrative hearing commission shall become a final order and shall remain in effect for three years unless either party files a request for a full hearing on the merits of the complaint filed by the board within thirty days from the date of the issuance of the preliminary order of the administrative hearing commission.
7. Upon receipt of a request for full hearing, the administrative hearing commission shall set a date for hearing and notify the parties in writing of the time and place of the hearing. If a request for full hearing is timely filed, the preliminary order of the administrative hearing commission shall remain in effect until the administrative hearing commission enters an order terminating, modifying, or dismissing its preliminary order or until the board issues an order of discipline following its consideration of the decision of the administrative hearing commission pursuant to section 621.110, RSMo, and subsection 3 of section 334.100.
8. In cases where the board initiates summary suspension or restriction proceedings against a physician licensed pursuant to this chapter, and said petition is subsequently denied by the administrative hearing commission, in addition to any award made pursuant to sections 536.085 and 536.087, RSMo, the board, but not individual members of the board, shall pay actual damages incurred during any period of suspension or restriction.
9. Notwithstanding the provisions of this chapter or chapter 610, RSMo, or chapter 621, RSMo, to the contrary, the proceedings under this section shall be closed and no order shall be made public until it is final, for purposes of appeal.
10. The burden of proving the elements listed in subsection 2 of this section shall be upon the state board of registration for the healing arts.
(L. 1986 S.B. 663, A.L. 1990 S.B. 737)
334.103. 1. A license issued under this chapter by the Missouri State Board of Registration for the Healing Arts shall be automatically revoked at such time as the final trial proceedings are concluded whereby a licensee has been adjudicated and found guilty, or has entered a plea of guilty or nolo contendere, in a felony criminal prosecution under the laws of the state of Missouri, the laws of any other state, or the laws of the United States of America for any offense reasonably related to the qualifications, functions or duties of their profession, or for any felony offense, an essential element of which is fraud, dishonesty or an act of violence, or for any felony offense involving moral turpitude, whether or not sentence is imposed, or, upon the final and unconditional revocation of the license to practice their profession in another state or territory upon grounds for which revocation is authorized in this state following a review of the record of the proceedings and upon a formal motion of the state board of registration for the healing arts. The license of any such licensee shall be automatically reinstated if the conviction or the revocation is ultimately set aside upon final appeal in any court of competent jurisdiction.
2. Anyone who has been denied a license, permit or certificate to practice in another state shall automatically be denied a license to practice in this state. However, the board of healing arts may set up other qualifications by which such person may ultimately be qualified and licensed to practice in Missouri.
(L. 1986 H.B. 1029, A.L. 2006 S.B. 756)(2000) State Board of Registration for the Healing Arts lacks authority to stay the revocation of a license and place the licensee on probation; statute mandates single option of revocation. Cantrell v. State Board of Registration for the Healing Arts, 26 S.W.3d 824 (Mo.App.W.D.).
334.104. 1. A physician may enter into collaborative practice arrangements with registered professional nurses. Collaborative practice arrangements shall be in the form of written agreements, jointly agreed-upon protocols, or standing orders for the delivery of health care services. Collaborative practice arrangements, which shall be in writing, may delegate to a registered professional nurse the authority to administer or dispense drugs and provide treatment as long as the delivery of such health care services is within the scope of practice of the registered professional nurse and is consistent with that nurse's skill, training and competence.
2. Collaborative practice arrangements, which shall be in writing, may delegate to a registered professional nurse the authority to administer, dispense or prescribe drugs and provide treatment if the registered professional nurse is an advanced practice nurse as defined in subdivision (2) of section 335.016, RSMo. Such collaborative practice arrangements shall be in the form of written agreements, jointly agreed-upon protocols or standing orders for the delivery of health care services.
3. The state board of registration for the healing arts pursuant to section 334.125 and the board of nursing pursuant to section 335.036, RSMo, may jointly promulgate rules regulating the use of collaborative practice arrangements. Such rules shall be limited to specifying geographic areas to be covered, the methods of treatment that may be covered by collaborative practice arrangements and the requirements for review of services provided pursuant to collaborative practice arrangements. Any rules relating to dispensing or distribution of medications or devices by prescription or prescription drug orders under this section shall be subject to the approval of the state board of pharmacy. In order to take effect, such rules shall be approved by a majority vote of a quorum of each board. Neither the state board of registration for the healing arts nor the board of nursing may separately promulgate rules relating to collaborative practice arrangements. Such jointly promulgated rules shall be consistent with guidelines for federally funded clinics. The rulemaking authority granted in this subsection shall not extend to collaborative practice arrangements of hospital employees providing inpatient care within hospitals as defined pursuant to chapter 197, RSMo.
4. The state board of registration for the healing arts shall not deny, revoke, suspend or otherwise take disciplinary action against a physician for health care services delegated to a registered professional nurse provided the provisions of this section and the rules promulgated thereunder are satisfied. Upon the written request of a physician subject to a disciplinary action imposed as a result of an agreement between a physician and a registered professional nurse or registered physician assistant, whether written or not, prior to August 28, 1993, all records of such disciplinary licensure action and all records pertaining to the filing, investigation or review of an alleged violation of this chapter incurred as a result of such an agreement shall be removed from the records of the state board of registration for the healing arts and the division of professional registration and shall not be disclosed to any public or private entity seeking such information from the board or the division. The state board of registration for the healing arts shall take action to correct reports of alleged violations and disciplinary actions as described in this section which have been submitted to the National Practitioner Data Bank. In subsequent applications or representations relating to his medical practice, a physician completing forms or documents shall not be required to report any actions of the state board of registration for the healing arts for which the records are subject to removal under this section.
5. Within thirty days of any change and on each renewal, the state board of registration for the healing arts shall require every physician to identify whether the physician is engaged in any collaborative practice agreement or physician assistant agreement and also report to the board the name of each licensed professional with whom the physician has entered into such agreement. The board may make this information available to the public. The board shall track the reported information and may routinely conduct random reviews of such agreements to ensure that agreements are carried out for compliance under this chapter.
6. Notwithstanding anything to the contrary in this section, a registered nurse who has graduated from a school of nurse anesthesia accredited by the Council on Accreditation of Educational Programs of Nurse Anesthesia or its predecessor and has been certified or is eligible for certification as a nurse anesthetist by the Council on Certification of Nurse Anesthetists shall be permitted to provide anesthesia services without a collaborative practice arrangement provided that he or she is under the supervision of an anesthesiologist or other physician, dentist, or podiatrist who is immediately available if needed.
(L. 1993 H.B. 564, A.L. 2002 S.B. 1182, A.L. 2003 H.B. 390, A.L. 2006 H.B. 1515 merged with S.B. 756)
334.105. 1. Sections 334.105 to 334.107 shall be known and may be cited as the "Intractable Pain Treatment Act".
2. For purposes of sections 334.105 to 334.107, the following terms mean:
(1) "Board", the state board of registration for the healing arts;
(2) "Intractable pain", a pain state in which the cause of pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts that have been documented in the physician's medical records;
(3) "Physician", physicians and surgeons licensed pursuant to this chapter by the board;
(4) "Therapeutic purpose", the use of controlled substances in acceptable doses with appropriate indication for the treatment of pain. Any other use is nontherapeutic.
(L. 1995 S.B. 125)
334.106. 1. Notwithstanding any other provision of law to the contrary, a physician may prescribe, administer or dispense controlled substances for a therapeutic purpose to a person diagnosed and treated by a physician for a condition resulting in intractable pain, if such diagnosis and treatment has been documented in the physician's medical records. No physician shall be subject to disciplinary action by the board solely for prescribing, administering or dispensing controlled substances when prescribed, administered or dispensed for a therapeutic purpose for a person diagnosed and treated by a physician for a condition resulting in intractable pain, if such diagnosis and treatment has been documented in the physician's medical records.
2. The provisions of subsection 1 of this section shall not apply to those persons being treated by a physician for chemical dependency because of their use of controlled substances not related to the therapeutic purposes of treatment of intractable pain.
3. The provisions of subsection 1 of this section provide no authority to a physician to prescribe, administer or dispense controlled substances to a person the physician knows or should know to be using controlled substances which use is not related to the therapeutic purpose.
4. Drug dependency or the possibility of drug dependency in and of itself is not a reason to withhold or prohibit the prescribing, administering or dispensing of controlled substances for the therapeutic purpose of treatment of a person for intractable pain, nor shall dependency relating solely to such prescribing, administering or dispensing subject a physician to disciplinary action by the board.
(L. 1995 S.B. 125 § 334.106 subsecs. 1 to 4)
334.107. Nothing in section 334.106 and this section shall deny the right of the board to deny, revoke or suspend the license of any physician or otherwise discipline any physician who:
(1) Prescribes, administers or dispenses a controlled substance that is nontherapeutic in nature or nontherapeutic in the manner in which it is prescribed, administered or dispensed, or fails to keep complete and accurate ongoing records of the diagnosis and treatment plan;
(2) Fails to keep complete and accurate records of controlled substances received, prescribed, dispensed and administered, and disposal of drugs listed in the Missouri comprehensive drug control act contained in chapter 195, RSMo, or of controlled substances scheduled in the Federal Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 U.S.C. 801, et seq. A physician shall keep records of controlled substances received, prescribed, dispensed and administered, and disposal of these drugs shall include the date of receipt of the drugs, the sale or disposal of the drugs by the physician, the name and address of the person receiving the drugs, and the reason for the disposal or the dispensing of the drugs to the person;
(3) Writes false or fictitious prescriptions for controlled substances as defined in the Missouri comprehensive drug control act, chapter 195, RSMo, or for controlled substances scheduled in the Federal Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 U.S.C. 801, et seq.; or
(4) Prescribes or administers, or dispenses in a manner which is inconsistent with provisions of the Missouri drug control act contained in chapter 195, RSMo, or the Federal Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 U.S.C. 801, et seq.
(L. 1995 S.B. 125 § 334.106 subsec. 5)
334.110. Any person licensed to practice as physician and surgeon in this state who retires from such practice shall file with the board an affidavit, on a form to be furnished by the board, which states the date on which he retired from such practice and such other facts as tend to verify the retirement as the board may deem necessary; but if he thereafter reengages in the practice, he shall renew his registration with the board as provided by section 334.090.
(L. 1945 p. 1147 § 9992d, A.L. 1959 S.B. 50 § 11, A.L. 1981 S.B. 16)
334.112. 1. A person desiring to obtain a limited license to practice medicine shall:
(1) Submit to the board, with an application and fee, not to exceed twenty-five dollars, a verified affidavit stating that he has been licensed to practice medicine in Missouri or in any state or territory of the United States or the District of Columbia for at least ten years, is retired from the practice of medicine and that his license was in good standing at retirement;
(2) Meet the requirements in section 334.031 and 334.080.
2. The board shall not require more than five hours of continuing education annually as a requirement of renewal of a limited licensee's certificate of registration.
3. A physician with a limited license may only provide without compensation primary care and preventive health care services to family members or at facilities operated by city or county health departments organized under chapter 192, RSMo, or chapter 205, RSMo, city health departments operating under city charters, combined city-county health centers, public elementary or secondary schools, federally funded community health centers, or nonprofit community health centers.
4. As used in this section, primary care and preventive health care services are limited to noninvasive procedures, and shall not include obstetrical care or any specialized care or treatment, but may include injections, the suturing of minor lacerations, and incisions of boils or superficial abscesses.
5. A physician with a limited license may not prescribe controlled substances as defined in chapter 195, RSMo.
(L. 1993 H.B. 564)
334.120. 1. There is hereby created and established a board to be known as "The State Board of Registration for the Healing Arts" for the purpose of registering, licensing and supervising all physicians and surgeons, and midwives in this state. The board shall consist of nine members, including one voting public member, to be appointed by the governor by and with the advice and consent of the senate, at least five of whom shall be graduates of professional schools accredited by the Liaison Committee on Medical Education or recognized by the Educational Commission for Foreign Medical Graduates, and at least two of whom shall be graduates of professional schools approved and accredited as reputable by the American Osteopathic Association, and all of whom, except the public member, shall be duly licensed and registered as physicians and surgeons pursuant to the laws of this state. Each member must be a citizen of the United States and must have been a resident of this state for a period of at least one year next preceding his or her appointment and shall have been actively engaged in the lawful and ethical practice of the profession of physician and surgeon for at least five years next preceding his or her appointment. Not more than four members shall be affiliated with the same political party. All members shall be appointed for a term of four years. Each member of the board shall receive as compensation an amount set by the board not to exceed fifty dollars for each day devoted to the affairs of the board, and shall be entitled to reimbursement of his or her expenses necessarily incurred in the discharge of his or her official duties. The president of the Missouri State Medical Association, for all medical physician appointments, or the president of the Missouri Association of Osteopathic Physicians and Surgeons, for all osteopathic physician appointments, in office at the time shall, at least ninety days prior to the expiration of the term of the respective board member, other than the public member, or as soon as feasible after the appropriate vacancy on the board otherwise occurs, submit to the director of the division of professional registration a list of five physicians and surgeons qualified and willing to fill the vacancy in question, with the request and recommendation that the governor appoint one of the five persons so listed, and with the list so submitted, the president of the Missouri State Medical Association or the Missouri Association of Osteopathic Physicians and Surgeons, as appropriate, shall include in his or her letter of transmittal a description of the method by which the names were chosen by that association.
2. The public member shall be at the time of his or her appointment a citizen of the United States; a resident of this state for a period of one year and a registered voter; a person who is not and never was a member of any profession licensed or regulated pursuant to this chapter or the spouse of such person; and a person who does not have and never has had a material, financial interest in either the providing of the professional services regulated by this chapter, or an activity or organization directly related to any profession licensed or regulated pursuant to this chapter. All members, including public members, shall be chosen from lists submitted by the director of the division of professional registration. The duties of the public member shall not include the determination of the technical requirements to be met for licensure or whether any person meets such technical requirements or of the technical competence or technical judgment of a licensee or a candidate for licensure.
(L. 1945 p. 1145 § 1, A. 1949 H.B. 2073, A.L. 1959 S.B. 50 § 2, A.L. 1981 S.B. 16, A.L. 1988 H.B. 1573, A.L. 1999 H.B. 343, A.L. 2007 H.B. 780 merged with S.B. 308)CROSS REFERENCE:
Public member, additional duties, RSMo 620.132
334.123. The board shall elect its own president and secretary, each to serve for a term of one year, and shall maintain an office and employ an executive director and such other board personnel, as defined in section 620.010, RSMo, as the board in its discretion deems necessary. Without limiting the foregoing, the board is specifically authorized to obtain the services of specially trained and qualified persons or organizations to assist in conducting examinations of applicants for licenses and may employ legal counsel. The executive director shall have the degree of bachelor of arts or the equivalent combination of education and experience from which comparable knowledge and abilities can be acquired. The board shall meet annually in Jefferson City and at such other times and places as the members of the board may designate, and shall keep a record of its proceedings and shall cause a register to be kept of all applicants for certificates of licensure. The records and register shall be prima facie evidence of all matters recorded therein. Four members of the board shall constitute a quorum, at least one of whom shall be a graduate of a professional school approved and accredited as reputable by the American Medical Association or the Liaison Committee on Medical Education, and at least one of whom shall be a graduate of a professional school approved and accredited as reputable by the American Osteopathic Association.
(L. 1959 S.B. 50 § 2, A.L. 1981 S.B. 16, A.L. 1990 S.B. 737, A.L. 1996 H.B. 999)
334.125. 1. The board shall have a common seal and shall formulate rules and regulations to govern its actions. Provision shall be made by the division of design and construction for office facilities in Jefferson City, Missouri, where the records and register of the board shall be maintained.
2. No rule or portion of a rule promulgated under the authority of this chapter shall become effective unless it has been promulgated pursuant to the provisions of section 536.024, RSMo.
(L. 1959 S.B. 50 § 2, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3)
334.127. 1. The president or secretary of the board may administer oaths, subpoena witnesses, issue subpoenas duces tecum and require production of documents and records. Subpoenas, including subpoenas duces tecum, shall be served by a person authorized to serve subpoenas of courts of record. In lieu of requiring attendance of a person to produce original documents in response to a subpoena duces tecum, the board may require sworn copies of such documents to be filed with it or delivered to its designated representative.
2. The board may enforce its subpoenas, including subpoena duces tecum, by applying to a circuit court of Cole County, the county of the investigation, hearing or proceeding, or any county where the person resides or may be found, for an order upon any person who shall fail to obey a subpoena to show cause why such subpoena should not be enforced, which such order and a copy of the application therefore shall be served upon the person in the same manner as a summons in a civil action, and if the circuit court shall, after a hearing, determine that the subpoena should be sustained and enforced, such court shall proceed to enforce the subpoena in the same manner as though the subpoena had been issued in a civil case in the circuit court.
(L. 1959 S.B. 50 § 2, A.L. 1987 H.B. 667, et al.)(2001) As applied to licensed physician who served as medical director for administrator of employee benefits plan, section is not preempted by Employee Retirement Income Security Act; the physician's finding of medical necessity was a medical decision reviewable by State Board of Registration for the Healing Arts. State Board of Registration for the Healing Arts v. Fallon, 41 S.W.3d 474 (Mo.banc).
334.128. Any person who reports or provides information to the board, or any person who assists the board, including, but not limited to, physicians' health programs and individuals working, consulting with or staffing such physicians' health programs approved by the board for impaired physicians, applicants or licensees who are the subject of an investigation, physicians serving on competency panels, medical record custodians, consultants, attorneys, board members, agents, employees or expert witnesses, in the course of any investigation, hearing or other proceeding conducted by or before the board pursuant to the provisions of this chapter and who does so in good faith and without malice shall not be subject to an action for civil damages as a result thereof, and no cause of action shall arise against him or her as a result of his or her conduct pursuant to this section. The attorney general shall defend such persons in any such action or proceeding.
(L. 1987 H.B. 667, et al., A.L. 2001 H.B. 78)
334.150. It is not intended by sections 334.010 to 334.140 to prohibit isolated or occasional gratuitous service to and treatment of the afflicted, and sections 334.010 to 334.140 shall not apply to physicians and surgeons commissioned as officers of the armed forces of the United States or of the public health services of the United States while in the performance of their official duties, nor to any licensed practitioner of medicine and surgery in a border state attending the sick in this state, if he does not maintain an office or appointed place to meet patients or receive calls within the limits of this state, and if he complies with the statutes of Missouri and the rules and regulations of the department of social services relating to the reports of births, deaths and contagious diseases; and sections 334.010 to 334.140 shall not apply to Christian Science practitioners who endeavor to cure or prevent disease or suffering exclusively by spiritual means or prayer, so long as quarantine regulations relating to contagious diseases are not infringed upon; but no provision of this section shall be construed or held in any way to interfere with the enforcement of the rules and regulations adopted and approved by the department of health and senior services or any municipality under the laws of this state for the control of communicable or contagious diseases.
(RSMo 1939 § 9992, A.L. 1959 S.B. 50 § 13) Prior revisions: 1929 § 9122; 1919 § 7338; 1909 § 8319
334.155. 1. The provisions of this chapter shall apply to any licensee of this chapter performing tasks which education or licensure qualify him to perform, in any setting.
2. This chapter does not apply to dentists licensed and lawfully practicing their profession within the provisions of chapter 332, RSMo; to nurses licensed and lawfully practicing their profession within the provisions of chapter 335, RSMo; to optometrists licensed and lawfully practicing their profession within the provisions of chapter 336, RSMo; to pharmacists licensed and lawfully practicing their profession within the provisions of chapter 338, RSMo; to podiatrists licensed and lawfully practicing their profession within the provisions of chapter 330, RSMo; or to chiropractors licensed and lawfully practicing their profession within the provisions of chapter 331, RSMo.
3. The provisions of this chapter shall not prevent a licensed physician from referring a patient to or delegating responsibilities to the professions exempted by subsection 2 of this section.
(L. 1959 S.B. 50 § 16, A.L. 1981 S.B. 16, A.L. 1990 S.B. 737)
334.157. The state board of registration for the healing arts, in consultation with the department of health and senior services, shall promulgate rules and regulations requiring physicians to:
(1) Administer hepatitis B vaccine and immunoglobulin to neonates in keeping with standards of current medical practice in any instance in which the blood test for hepatitis B performed in accordance with section 210.030, RSMo, indicates the neonate has been exposed or is at risk of exposure to hepatitis B; and
(2) Recommend to the parents or legal guardians of any neonate who is not found to have been exposed or at risk of exposure to hepatitis B that the neonate receive hepatitis B vaccine in accordance with standards of current medical practice, upon receipt of informed written consent of the parents or legal guardians.
(L. 1993 H.B. 522 § 3)
334.160. The decision of the board to deny recognition to or withdraw recognition from a school as a reputable professional school of good standing, and the action of the board in refusing to permit an applicant to take an examination, is subject to the provisions of chapter 621, RSMo.
(RSMo 1939 § 9984, A.L. 1945 p. 1147, A.L. 1959 § 14, A.L. 1981 S.B. 16)Prior revision: 1929 § 9114
334.170. Any officer, agent or employee of any professional school or college, whether organized as a corporation, association, partnership, common law trust, or individually owned and operated, who knowingly permits the issuance of any diploma or any certificate of graduation from any such school or college as aforesaid to anyone, or anyone who knowingly accepts or receives such certificate or diploma, unless the recipient or beneficiary thereof has actually attended in good faith at least eighty percent of the minimum curriculum prescribed in this chapter for such character of schools in this or some other state, and has received instruction in and has satisfactorily passed all the courses and subjects purported* to be required by said school for completion of its course, and has actually been granted a degree by vote of the trustees of said college or school, shall be guilty of a class A misdemeanor.
(RSMo 1939 § 9985, A.L. 1959 S.B. 50 § 15, A.L. 1981 S.B. 16) Prior revision: 1929 § 9115*Word "purporting" appears in original rolls.
334.190. It is unlawful for any person licensed as a midwife only to engage in any other branch of medical practice or to advertise herself as doctor, doctress or physician or to use any letters before or after her name on a sign or otherwise, indicating that she is authorized to or does engage in any other branch of medical practice.
(L. 1939 § 9993, A.L. 1945 p. 1154, A.L. 1959 S.B. 50 § 17)Prior revisions: 1929 § 9123; 1919 § 7339; 1909 § 8320
CROSS REFERENCE:
Certified midwives, services related to pregnancy permitted, when, RSMo 376.1753
334.230. l. Upon application by the board, and the necessary burden having been met, a court of general jurisdiction may grant an injunction, restraining order or other order as may be appropriate to enjoin a person from:
(1) Offering to engage or engaging in the performance of any acts or practices for which a certificate of registration or authority, permit or license is required by this chapter upon a showing that such acts or practices were performed or offered to be performed without a certificate of registration or authority, permit or license; or
(2) Engaging in any practice or business authorized by a certificate of registration or authority, permit or license issued pursuant to this chapter upon a showing that the holder presents a substantial probability of serious danger to the health, safety or welfare of any resident of the state or client or patient of the licensee.
2. Any such action shall be commenced either in the county in which such conduct occurred or in the county in which the defendant resides.
3. Any action brought under this section shall be in addition to and not in lieu of any penalty provided by this chapter and may be brought concurrently with other actions to enforce this chapter.
(L. 1959 S.B. 50 § 20, A.L. 1981 S.B. 16)
334.240. Upon receiving information that any provision of sections 334.010, 334.190 and 334.250 has been or is being violated, the secretary of the board or other person designated by the board shall investigate, and upon probable cause appearing, the secretary shall, under the direction of the board, file a complaint with the administrative hearing commission or appropriate official or court. All such complaints shall be handled as provided by rule promulgated pursuant to subdivision (6) of subsection 16 of section 620.010, RSMo.
(L. 1959 S.B. 50 § 19, A.L. 1981 S.B. 16)
334.250. 1. Any person who violates section 334.010 shall, upon conviction, be adjudged guilty of a class C felony for each and every offense; and treating each patient is considered a separate offense.
2. Any person filing or attempting to file as his own a license of another, or forged affidavit of identification, shall be guilty of a class C felony and upon conviction thereof shall be subjected to such fine and imprisonment as is provided by the statutes of this state for the crime of forgery.
(L. 1959 S.B. 50 § 19, A.L. 1981 S.B. 16, A.L. 1990 S.B. 737)
334.252. As used in this section and section 334.253, the following terms mean:
(1) "Board", the state board of registration for the healing arts in the state of Missouri;
(2) "Entity", any individual, partnership, firm, corporation, or other business entity which provides, furnishes, or refers physical therapy services;
(3) "Fair market value", value in arms length transactions, consistent with the general market value and, with respect to rentals or leases, the value of rental property for general commercial purposes, not taking into account its intended use, and, in the case of a lease of space, not adjusted to reflect the additional value the prospective lessee or lessor would attribute to the proximity or convenience to the lessor where the lessor is a potential source of patient referrals to the lessee;
(4) "Joint venture", any ownership or investment interest or compensation arrangement between physicians and an entity providing physical therapy services;
(5) "Physician", any physician licensed under chapter 334;
(6) "Referral", any referral or prescription, written or verbal, for physical therapy service;
(7) "Remuneration" includes any remuneration, directly or indirectly, overtly or covertly, in-cash or in-kind arising out of a compensation arrangement of any kind. Remuneration does not include any payment by a lessee or lessor for the use of premises or equipment as long as all of the following five standards are met:
(a) The lease agreement is set out in writing and signed by the parties;
(b) The lease specifies the premises or equipment covered by the lease;
(c) If the lease is intended to provide the lessee with access to the premises or to the equipment for periodic intervals of time, rather than on a full-time basis for a term of the lease, the lease shall specify exactly the schedule of such intervals, their precise length, and the exact rent for such intervals;
(d) The term of the lease is not for less than one year;
(e) The aggregate rental charge is set in advance, is consistent with fair market in arms length transactions, and is not determined in a manner that takes into account the volume or value of any referrals or business otherwise generated between the parties;
(8) "Rural area", a county with a population density of no greater than one hundred persons per square mile, as defined by the latest United States Census.
(L. 1992 H.B. 1377 § 1 subsec. 1)Effective 1-1-95
334.253. 1. A physician may not make a referral to an entity for the furnishing of any physical therapy services with whom the physician, physician's employer, or immediate family member of such referring physician has a financial relationship. A financial relationship exists if the referring physician, the referring physician's employer, or immediate family member:
(1) Has a direct or indirect ownership or investment interest in the entity whether through equity, debt, or other means; or
(2) Receives remuneration from a compensation arrangement from the entity for the referral.
2. The following financial arrangements shall be exempt from disciplinary action under this section:
(1) When the entity with whom the referring physician has an ownership or investment interest is the sole provider of the physical therapy service within a rural area;
(2) When the referring physician owns registered securities issued by a publicly held corporation or publicly traded limited partnership, the shares of which are traded on a national exchange or the over-the-counter market, provided that such referring physician's interest in the publicly held corporation or publicly traded limited partnership is less than five percent and the referring physician does not receive any compensation from such publicly held corporation or publicly traded limited partnership other than as any other owner of the shares of such publicly held corporation or publicly traded limited partnership;
(3) When the referring physician has an interest in real property resulting in a landlord-tenant relationship between the physician and the entity in which the equity interest is held, unless the rent is determined, in whole or in part, by the business volume or profitability of the tenant or is otherwise unrelated to fair market value;
(4) When the indirect ownership in the entity is by means of a bona fide debt incurred in the purchase or acquisition of the entity for a price which does not in any manner reflect the potential source of referrals from the physician with the indirect interest in the entity and the terms of the debt are fair market value, and neither the amount or the terms of the debt in any manner, directly or indirectly, constitutes a form of compensating such physician for the source of his business;
(5) When such physician's employer is a health maintenance organization as defined in subdivision (6) of section 376.960, RSMo, and such health maintenance organization owns or controls other organizations which furnish physical therapy services so long as the referral is to such owned or controlled organization and the physician does not also have a direct or indirect ownership or investment interest in such organization, physical therapy services or the health maintenance organization and the referring physician does not receive any remuneration as the result of the referral;
(6) When such physician's employer is a hospital defined in section 197.020, RSMo, and such hospital owns or controls other organizations which furnish physical therapy services so long as the referral is to such owned or controlled organization and the physician does not also have a direct or indirect ownership or investment interest in such organization, physical therapy service, or the hospital and the referring physician does not receive any remuneration as the result of the referral.
3. The provisions of sections 334.252 and 334.253 shall become effective January 1, 1995.
(L. 1992 H.B. 1377 § 1 subsecs. 2, 3, § 2)Effective 1-1-95
334.260. On August 29, 1959, all persons licensed under the provisions of chapter 334, RSMo 1949, as midwives shall be deemed to be licensed as midwives under this chapter and subject to all the provisions of this chapter.
(L. 1959 S.B. 50 § 22, A.L. 1961 p. 500, A.L. 1965 p. 531)
334.265. Notwithstanding any other provision of law or rule of confidentiality to the contrary, any physician licensed under this chapter who treats a person who appears intoxicated, for injuries sustained in a motor vehicle accident, may immediately report same to a highway patrol officer or local law enforcement agency.
(L. 1987 S.B. 230 § 8)Effective 12-1-87
334.400. As used in sections 334.400 to 334.430, the following terms shall mean:
(1) "Anesthesiologist", a physician who has completed a residency in anesthesiology approved by the American Board of Anesthesiology or the American Osteopathic Board of Anesthesiology;
(2) "Anesthesiologist assistant", a person who meets each of the following conditions:
(a) Has graduated from an anesthesiologist assistant program accredited by the American Medical Association's Committee on Allied Health Education and Accreditation or by its successor agency;
(b) Has passed the certifying examination administered by the National Commission on Certification of Anesthesiologist Assistants;
(c) Has active certification by the National Commission on Certification of Anesthesiologist Assistants; and
(d) Provides health care services delegated by a licensed anesthesiologist;
(3) "Anesthesiologist assistant supervision agreement", a written agreement, jointly agreed upon protocols or standing order between a supervising anesthesiologist and an anesthesiologist assistant, which provides for the delegation of health care services from a supervising anesthesiologist to an anesthesiologist assistant and the review of such services;
(4) "Applicant", any individual who seeks to become licensed as an anesthesiologist assistant;
(5) "Continuing education", the offering of instruction or information to license holders for the purpose of maintaining or increasing skills necessary for the safe and competent practice of anesthetic care;
(6) "Department", the department of economic development or a designated agency thereof;
(7) "Immediately available", in the same physical location or facility in which the services are provided;
(8) "Physician", an individual licensed pursuant to this chapter to practice medicine and surgery or osteopathic medicine and surgery;
(9) "Supervision", medical direction by an anesthesiologist of an anesthesiologist assistant as defined in conditions of 42 CFR 415.110 which limits supervision to no more than four anesthesiologist assistants concurrently.
(L. 2003 H.B. 390)
334.402. 1. An anesthesiologist assistant may assist the supervising anesthesiologist in developing and implementing an anesthesia care plan for a patient. In providing assistance to the supervising anesthesiologist, an anesthesiologist assistant shall have the authority to:
(1) Obtain a comprehensive patient history, perform relevant elements of a physical exam and present the history to the supervising anesthesiologist;
(2) Pretest and calibrate anesthesia delivery systems and obtain and interpret information from the systems and monitors, in consultation with an anesthesiologist;
(3) Assist the supervising anesthesiologist with the implementation of medically accepted monitoring techniques;
(4) Establish basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;
(5) Administer intermittent vasoactive drugs and start and adjust vasoactive infusions;
(6) Administer anesthetic drugs, adjuvant drugs, and accessory drugs;
(7) Assist the supervising anesthesiologist with the performance of epidural anesthetic procedures, spinal anesthetic procedures, and other regional anesthetic techniques;
(8) Administer blood, blood products, and supportive fluids;
(9) Provide assistance to a cardiopulmonary resuscitation team in response to a life-threatening situation;
(10) Participate in administrative, research, and clinical teaching activities as authorized by the supervising anesthesiologist; or
(11) Perform such other tasks not prohibited by law under the supervision of a licensed anesthesiologist that an anesthesiologist assistant has been trained and is proficient to perform.
2. An anesthesiologist shall at all times accept and be responsible for the oversight of the health care services rendered by the anesthesiologist assistant.
3. Anesthesiologist assistants are prohibited from the following:
(1) An anesthesiologist assistant shall not prescribe any medications or controlled substances;
(2) An anesthesiologist assistant shall not administer any drugs, medicines, devices, or therapies the supervising anesthesiologist is not qualified or authorized to prescribe; and
(3) An anesthesiologist assistant shall not practice or attempt to practice without the supervision of a licensed anesthesiologist or in any location where the supervising anesthesiologist is not immediately available for consultation, assistance, and intervention.
4. An anesthesiologist assistant shall be clearly identified as an anesthesiologist assistant and shall not use or permit to be used in the anesthesiologist assistant's behalf the terms "doctor", "Dr.", or "doc" or in any way be identified as a physician or surgeon. An anesthesiologist assistant shall not refer to a certificate of registration or authority, permit, or license as "board-certified" or use any other terminology that may imply that the anesthesiologist assistant is a physician or surgeon.
5. A student in any anesthesiologist assistant training program shall be identified as a student anesthesiologist assistant or an anesthesiologist assistant student. Under no circumstances shall such a student use or permit to be used on the student's behalf, the terms "intern", "resident", or "fellow" or be identified in any way as a physician or surgeon.
6. The anesthesiologist members of the faculty of an anesthesiologist assistant program established in this state shall be comprised of board-certified or board-eligible anesthesiologists. No faculty member of any anesthesiologist assistants program shall concurrently supervise more than two anesthesiologist assistant students who are delivering anesthesia. Certified registered nurse anesthetists will be excluded from clinical education of anesthesiologist assistants.
(L. 2003 H.B. 390)
334.404. 1. Each person desiring a license pursuant to sections 334.400 to 334.430 shall make application to the board upon such forms and in such manner as may be prescribed by the board and shall pay the required application fee as set by the board. The application fee shall cover the cost of issuing the license and shall not be refundable. Each application shall contain a statement that it is made under oath or affirmation and that its representations are true and correct to the best knowledge and belief of the person signing the application, subject to the penalties of making a false declaration or affidavit. Such application shall include proof of certification from the National Commission on Certification of Anesthesiologist Assistants or its successor, date of the certification, any identification numbers, and any other information necessary for the board to verify the certification.
2. The board, upon approval of the application from an applicant, shall issue a license to such applicant.
3. A license is valid for two years from the date it is issued and may be renewed biennially by filing an application for renewal with the board and paying the required renewal fee as set by the board.
4. A blank form for application for renewal of licensure shall be mailed to each person licensed in this state at his or her last known office or residence address.
5. A new license to replace any license lost, destroyed, or mutilated may be issued to any applicant, subject to rules and regulations issued by the board upon the payment of a reasonable fee.
(L. 2003 H.B. 390)
334.406. Notwithstanding any of the provisions of sections 334.400 to 334.430, the board may issue a temporary license to practice as an anesthesiologist assistant to an applicant that has taken the examination and is awaiting the results. A temporary license may be granted upon the payment of a temporary license fee, the submission of all required documents, and the applicant meeting the necessary qualifications, as defined by board rule. The temporary license shall be valid until the results of the examination are announced. The temporary license may be renewed at the discretion of the board and upon payment of the temporary license fee.
(L. 2003 H.B. 390)
334.408. 1. Notwithstanding any law to the contrary, any person licensed pursuant to sections 334.400 to 334.430 may apply to the board for an inactive license status on a form furnished by the board. Upon receipt of the completed inactive status application form and a determination by the board that the licensee meets the requirements defined by board rule, the board shall declare the licensee inactive and shall place the licensee on an inactive status list. A person that has an inactive license or has discontinued the practice of an anesthesiologist assistant because of retirement shall not practice as an anesthesiologist assistant within this state.
2. During the period of inactive status, the licensee shall not be required to comply with the board's minimum requirements for continuing education.
3. If a licensee is granted inactive status, the licensee may return to active status by notifying the board of the intention to resume the practice of an anesthesiologist assistant, paying the appropriate fees, and meeting all established licensure requirements of the board as a condition of reinstatement.
4. Any licensee that allows the license to become inactive for a period of five years or less may return the license to active status by notifying the board in advance of such intention, paying the appropriate fees, and meeting all established licensure requirements of the board, excluding the licensing examination, as a condition of reinstatement.
(L. 2003 H.B. 390)
334.410. Any person licensed to practice as an anesthesiologist assistant in this state who retires from such practice shall file with the board an affidavit, on a form to be furnished by the board, which states the date of retirement and such other facts to verify the retirement as defined by board rule. Registration with the board must be renewed pursuant to section 334.414 for any person that wants to resume the practice of an anesthesiologist assistant.
(L. 2003 H.B. 390)
334.412. 1. Upon the applicant paying a fee equivalent to the required licensing fee and furnishing the board with all locations of previous practice and licensure in chronological order, the board may, subject to the prescribed rules and regulations, license, without examination or additional certification, any qualified applicant that meets the requirements of this state including any person that is licensed in any state or territory of the United States or the District of Columbia with the authority to practice in the same manner and to the same extent as an anesthesiologist assistant is authorized to practice pursu