Missouri Statute | Act | Code |Occupations And Professions| US Code - US Statute | Chapter 334 Physicians And Surgeons--therapists--athletic Trainers--health

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)

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.

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)

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)

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.

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.)

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)

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)

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

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

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)

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.

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

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)

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)

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.)

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)

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.)

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)

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)

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.).

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.)

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)

1. The license of a physician shall be automatically revoked at
such time as the final trial proceedings are concluded whereby a
physician 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 a physician, 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 of a physician to practice the healing arts 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 physician 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)

(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.).

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. 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)

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)

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)

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)

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)

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)

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, five of whom shall be
graduates of professional schools approved and accredited as reputable by
the American Medical Association or the Liaison Committee on Medical
Education and 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)

CROSS REFERENCE: Public member, additional duties, RSMo 620.132

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)

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)

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).

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)

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

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)

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)

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

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.

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

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)

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)

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)

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

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

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)

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

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)

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)

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)

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)

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)

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)

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 pursuant to sections
334.400 to 334.430. Pursuant to sections 334.400 to 334.430, the board
shall have the authority to negotiate reciprocal compacts with licensing
boards of other states for the admission of licensed anesthesiologist
assistants from Missouri to practice in other states.

2. The board shall issue a license to any anesthesiologist assistant, who
is licensed in another jurisdiction and who has had no violations,
suspensions, or revocations of a license, to practice as an
anesthesiologist assistant in any jurisdiction, provided that, such
person is licensed in a jurisdiction whose requirements are substantially
equal to, or greater than, the requirements for licensure of
anesthesiologist assistants in Missouri at the time the applicant applies
for licensure. (L. 2003 H.B. 390)

1. The board shall issue a certificate of registration to any
applicant that meets the qualifications for an anesthesiologist assistant
and that has paid the required fees.

2. The board shall promulgate rules and regulations pertaining to:

(1) Establishing application forms to be furnished to all persons seeking
registration pursuant to* sections 334.400 to 334.430;

(2) Accepting certification by the National Commission on Certification
of Anesthesiologist Assistants or its successor in lieu of examinations
for applicants for registration pursuant to sections 334.400 to 334.430;

(3) Determining the form and design of the registration to be issued
pursuant to sections 334.400 to 334.430;

(4) Setting the amount of the fees for registration, licensure, and
renewal pursuant to sections 334.400 to 334.430. The fees shall be set at
a level to produce revenue which shall not substantially exceed the cost
and expense of administering the provisions of sections 334.400 to
334.430;

(5) Keeping a record of all of its proceedings regarding sections 334.400
to 334.430 and of all anesthesiologist assistants registered in this
state.

No rule or portion of a rule promulgated pursuant to the authority of
sections 334.400 to 334.430 shall become effective unless it has been
promulgated pursuant to chapter 536, RSMo.

3. The board shall have the authority to:

(1) Issue subpoenas to compel witnesses to testify or produce evidence in
proceedings to deny, suspend, or revoke registration; and

(2) Establish guidelines for anesthesiologist assistants pursuant to
sections 334.400 to 334.430.

4. The board may refuse to issue, suspend, revoke, or renew any
certificate of registration or authority, permit, or license required
pursuant to sections 334.400 to 334.430 for one or any combination of
causes stated in subsection 5 of this section. The board shall notify the
applicant in writing of the reasons for the refusal, suspension, or
revocation and shall advise the applicant of the right to file a
complaint with the administrative hearing commission as provided by
chapter 621, RSMo.

5. 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 pursuant to sections 334.400 to 334.430 or against any person
who has failed to renew or has surrendered a certificate of registration
or authority, permit, or license for any one or any combination of the
following causes:

(1) Use or unlawful possession 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 an anesthesiologist
assistant;

(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 an
anesthesiologist assistant, for any offense for which an essential
element 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 sections 334.400 to 334.430 or in obtaining permission to
take any examination given or required pursuant to sections 334.400 to
334.430;

(4) Obtaining or attempting to obtain any fee, charge, tuition, or other
compensation by fraud, deception, or misrepresentation;

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation,
or dishonesty in the performance of the functions and duties of an
anesthesiologist assistant;

(6) Violation of, or assisting or enabling any person to violate any
provision of sections 334.400 to 334.430 or any lawful rule or regulation
adopted pursuant to sections 334.400 to 334.430;

(7) Impersonation of any person holding a certificate of registration or
authority, permit, or license, or allowing any person to use a
certificate of registration or authority, permit, license or diploma from
any school;

(8) Disciplinary action against the holder of a license or other right
relating to the practice of an anesthesiologist assistant granted by
another state, territory, federal agency, or country upon grounds for
which revocation or suspension is authorized in this state;

(9) Final adjudication of insanity or incompetency by a court of
competent jurisdiction;

(10) Assisting or enabling any person to practice or offer to practice as
an anesthesiologist assistant who is not registered and currently
eligible to practice pursuant to sections 334.400 to 334.430;

(11) Issuance of a certificate of registration or authority, permit, or
license based upon a material mistake of fact;

(12) Violation of any professional trust or confidence;

(13) Violation of the ethical standards for an anesthesiologist assistant
as defined by board rule; or

(14) Violation of chapter 195, RSMo, or rules and regulations of this
state, any other state, or the federal government.

6. After the filing of such complaint, 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 5 of this section, for disciplinary action are met, the board
may, singly or in combination, censure or place the person named in the
complaint on probation with such terms and conditions as the board deems
appropriate for a period not to exceed ten years, or suspend his or her
license for a period not to exceed seven years, or revoke his or her
license, certificate, or permit.

7. An individual whose license has been revoked shall wait at least one
year from the date of revocation to apply for relicensure and shall not
be eligible for a temporary license. Relicensure shall be at the
discretion of the board after compliance with all requirements of
sections 334.400 to 334.430.

8. Any person who violates any of the provisions of sections 334.400 to
334.430 is guilty of class A misdemeanor. (L. 2003 H.B. 390)

*Word "to" does not appear in original rolls.

1. Every person licensed pursuant to sections 334.400 to 334.430
shall renew his or her 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:

(1) The applicant's full name and his or her office and residence address;

(2) The date and number of his or her license;

(3) 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

(4) Information concerning the applicant's current physical and mental
fitness to practice as an anesthesiologist assistant.

2. A blank form for application for registration shall be mailed to each
person licensed in this state at his or her last known office or
residence address. The failure to receive the application form does not
relieve any person of the duty to register and pay the fee required
pursuant to sections 334.400 to 334.430 nor be exempt from the penalties
provided pursuant to sections 334.400 to 334.430 for failure to register.

3. If a person licensed, certified, or registered by the board does not
renew such license, certification, or registration for two consecutive
renewal periods, such license, certification, or registration shall be
deemed void.

4. An application for registration pursuant to sections 334.400 to
334.430 shall be accompanied with a registration fee to be payable 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. The
delinquent fee may be waived by the board based on extenuating
circumstances as defined by board rule. (L. 2003 H.B. 390)

1. Except as provided in subsection 2 of this section, no person
shall practice as an anesthesiologist assistant unless the person holds a
current, valid certificate of registration issued pursuant to sections
334.400 to 334.430 to practice as an anesthesiologist assistant.

2. The provision of subsection 1 of this section shall not apply to the
following:

(1) A person participating in a training program leading toward
certification by the National Commission for Certification of
Anesthesiologist Assistants, as long as the person is supervised by an
anesthesiologist;

(2) An individual participating in a hospital residency program in
preparation to practice as an anesthesiologist; and

(3) Any person who is otherwise authorized by subsection 2 of section
334.428 to perform any of the activities that an anesthesiologist
assistant is authorized to perform. (L. 2003 H.B. 390)

The board shall not renew any certificate of registration unless
the anesthesiologist assistant has provided satisfactory evidence that
the board's minimum requirements for continuing education have been met.
The board's minimum requirements for continuing education shall include,
but are not limited to, the successful completion of the examination for
continued demonstration of qualifications once every six years, as
authorized by the National Commission on Certification* of
Anesthesiologist Assistants (NCCAA) or its successor. At the discretion
of the board, compliance with the provision of this section may be waived
for an anesthesiologist assistant that has discontinued the practice of
an anesthesiologist assistant due to retirement. (L. 2003 H.B. 390)

*Words "on Certification" do not appear in original rolls.

1. All fees payable pursuant to the provisions of sections
334.400 to 334.430 shall be collected by the division of professional
registration, which shall transmit them to the department of revenue for
deposit in the state treasury to the credit of the board of registration
for the healing arts fund.

2. Upon appropriation by the general assembly, the money in the fund
shall be used to administer the provisions of sections 334.400 to
334.430. (L. 2003 H.B. 390)

1. An anesthesiologist assistant shall practice only under the
direct supervision of an anesthesiologist who is physically present or
immediately available. A supervising anesthesiologist shall be allowed to
supervise up to four anesthesiologist assistants consistent with federal
rules or regulations for reimbursement for anesthesia services.

2. Each anesthesiologist who agrees to act as the supervising
anesthesiologist of an anesthesiologist assistant shall adopt a written
practice protocol that is consistent with sections 334.400 to 334.430 and
delineates the services that the anesthesiologist assistant is authorized
to provide and the manner in which the anesthesiologist will supervise
the anesthesiologist assistant. The provisions of the protocol shall be
based on relevant quality assurance standards, including regular review
by the supervising anesthesiologist of the medical records of the
patients cared for by the anesthesiologist assistant.

3. The supervising anesthesiologist shall oversee the anesthesiologist
assistant in accordance with the terms of the protocol and any rules and
regulations as defined by the board for the supervision of an
anesthesiologist assistant. The board may randomly audit or inspect any
written practice protocol under which an anesthesiologist assistant
works. (L. 2003 H.B. 390)

Notwithstanding the provisions of sections 334.400 to 334.430,
or the rules of the Missouri state board of registration for the healing
arts, the governing body of every hospital shall have full authority to
limit the functions and activities that an anesthesiologist assistant
performs in such hospital. Nothing in this section shall be construed to
require any hospital to hire an anesthesiologist who is not already
employed as a physician prior to August 28, 2003. (L. 2003 H.B. 390)

1. No person shall put forth to the public any title or
description that includes the words "licensed anesthesiologist assistant"
as defined in section 334.404 unless the person is duly licensed pursuant
to the provisions of sections 334.400 to 334.430.

2. Nothing in sections 334.400 to 334.430 shall be construed as
prohibiting any individual, regardless of whether the individual is
licensed pursuant to sections 334.400 to 334.430, from providing the
services of anesthesiologist assistant, so long as those services are
lawfully performed pursuant to the individual's scope of practice as
authorized by law, regulation, and hospital or medical staff policies or
credentialing standards.

3. Notwithstanding the specified penalty in section 334.414, any person
found guilty of violating any provision of subsections 1 and 2 of this
section shall be guilty of an infraction and upon conviction thereof
shall be punished as provided by law. For purposes of this subsection,
the maximum fine for a violation of this section shall be two hundred
dollars. (L. 2003 H.B. 390)

1. There is hereby established an "Advisory Commission for
Anesthesiologist Assistants" which shall guide, advise and make
recommendations to the board. The commission shall be responsible for the
ongoing examination of the scope of practice and promoting the continuing
role of anesthesiologist assistants in the delivery of health care
services. The commission shall assist the board in carrying out the
provisions of sections 334.400 to 334.430.

2. The commission shall be appointed no later than July 1, 2005. The
commission shall be composed of five members, to be appointed by the
governor, with the advice and consent of the senate, as follows:

(1) One member of the board;

(2) One licensed anesthesiologist assistant;

(3) Two licensed, board-certified anesthesiologists; and

(4) One lay member.

3. Each licensed anesthesiologist assistant member shall be a citizen of
the United States and a resident of this state, and shall be licensed as
an anesthesiologist assistant by this state. Each physician member shall
be a United States citizen, a resident of this state and have an active
license to practice medicine in this state. The lay member shall be a
United States citizen and a resident of this state.

4. The licensed anesthesiologist assistant member shall be appointed to
serve a three-year term. The anesthesiologist members and lay member
shall each be appointed to serve three-year terms, except at the time the
commission is created, when one anesthesiologist member will be appointed
for a first term of two years while the second anesthesiologist member
will be appointed to a three-year term. This will ensure that at least
one anesthesiologist member has at least one year's experience as a
member of the commission. Neither the anesthesiologist assistant member
nor the physician members shall be appointed for more than two
consecutive three- year terms.

5. The president of the Missouri Society of Anesthesiologists or its
successor in office at the time shall, at least ninety days prior to the
expiration of a term of an anesthesiologist assistant member or an
anesthesiologist member of the commission or as soon as feasible after
such a vacancy on the commission otherwise occurs, submit to the director
of the division of professional registration a list, not to exceed five
individuals per vacancy, of qualified and willing anesthesiologists or
anesthesiologist assistants, respectively, to fill the vacancy in
question, with the request and recommendation that the governor appoint
one of the persons so listed. With the list so submitted, the president
of the Missouri Society of Anesthesiologists shall include in a letter of
transmittal a description of the method by which the names were chosen by
that association.

6. Until such time as eligible anesthesiologist assistant candidates are
identified, the anesthesiologist assistant seat may remain vacant or may
be filled by a qualified anesthesiologist candidate, at the governor's
discretion with the advice and consent of the senate. This member may
serve no more than two consecutive three-year terms or until an eligible
anesthesiologist assistant candidate selected by the governor with the
advice and consent of the senate from a list provided as outlined above
is appointed.

7. Notwithstanding any other provision of law to the contrary, any
appointed member of the commission shall receive as compensation an
amount established by the director of the division of professional
registration not to exceed seventy dollars per day for commission
business plus actual and necessary expenses. The director of the division
of professional registration shall establish by rule the guidelines for
payment. The board shall provide all staff for the commission.

8. The commission shall hold an open annual meeting at which time it
shall elect from its membership a chairman and secretary. The commission
may hold such additional meetings as may be required in the performance
of its duties, provided that notice of every meeting shall be given to
each member at least ten days prior to the date of the meeting. A quorum
of the commission shall consist of a majority of its members.

9. No licensing activity or other statutory requirements shall become
effective until expenditures or personnel are specifically appropriated
for the purpose of conducting the business as required to administer the
provisions of sections 334.400 to 334.430 and the initial rules filed
have become effective. (L. 2003 H.B. 390)

As used in sections 334.500 to 334.685, the following terms mean:

(1) "Board", the state board of registration for the healing arts in the
state of Missouri;

(2) "Physical therapist assistant", a person who is licensed as a
physical therapist assistant by the board or a person who was actively
engaged in practice as a physical therapist assistant on August 28, 1993;

(3) "Physical therapist", a person who is licensed to practice physical
therapy;

(4) "Physical therapy", the examination, treatment and instruction of
human beings to assess, prevent, correct, alleviate and limit physical
disability, movement dysfunction, bodily malfunction and pain from
injury, disease and any other bodily condition, such term includes, but
is not limited to, the administration, interpretation and evaluation of
physical therapy tests and measurements of bodily functions and
structures; the planning, administration, evaluation and modification of
treatment and instruction, including the use of physical measures,
activities and devices, for preventive and therapeutic purposes; and the
provision of consultative, educational, research and other advisory
services for the purpose of reducing the incidence and severity of
physical disability, movement dysfunction, bodily malfunction and pain
does not include the use of surgery or obstetrics or the administration
of x-radiation, radioactive substance, diagnostic x-ray, diagnostic
laboratory electrocautery, electrosurgery or invasive tests or the
prescribing of any drug or medicine or the administration or dispensing
of any drug or medicine other than a topical agent administered or
dispensed upon the direction of a physician. Physical therapists may
perform electromyography and nerve conduction tests but may not interpret
the results of the electromyography or nerve conduction test. Physical
therapists shall practice physical therapy within the scope of their
education and training as provided in sections 334.500 to 334.620. (L.
1969 H.B. 39 § 1, A.L. 1993 H.B. 564, A.L. 1995 S.B. 452, A.L. 1996 H.B.
999)

1. Nothing in this chapter shall prevent a physical therapist,
whose license is in good standing, from providing educational resources
and training, developing fitness or wellness programs for asymptomatic
persons, or providing screening or consultative services within the scope
of physical therapy practice without the prescription and direction of a
person licensed and registered as a physician and surgeon pursuant to
this chapter, as a chiropractor pursuant to chapter 331, RSMo, as a
dentist pursuant to chapter 332, RSMo, or 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, except that no physical therapist shall initiate treatment for
a new injury or illness without the prescription or direction of a person
licensed and registered as a physician and surgeon pursuant to this
chapter, as a* chiropractor pursuant to chapter 331, RSMo, as a dentist
pursuant to chapter 332, RSMo, or 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.

2. Nothing in this chapter shall prevent a physical therapist, whose
license is in good standing, from examining and treating, without the
prescription and direction of a person licensed and registered as a
physician and surgeon pursuant to this chapter, as a chiropractor
pursuant to chapter 331, RSMo, as a dentist pursuant to chapter 332,
RSMo, or 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, any person with a
recurring, self-limited injury within one year of diagnosis by a person
licensed and registered as a physician and surgeon pursuant to this
chapter, as a chiropractor pursuant to chapter 331, RSMo, as a dentist
pursuant to chapter 332, RSMo, or 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, or
any person with a chronic illness that has been previously diagnosed by a
person licensed and registered as a physician and surgeon pursuant to
this chapter, as a chiropractor pursuant to chapter 331, RSMo, as a
dentist pursuant to chapter 332, RSMo, or 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, except that a physical therapist shall contact the patient's
current physician, chiropractor, dentist, or podiatrist, within seven
days of initiating physical therapy services, pursuant to this
subsection, shall not change an existing physical therapy referral
available to the physical therapist without approval of the patient's
current physician, chiropractor, dentist, or podiatrist, and shall refer
to a person licensed and registered as a physician and surgeon pursuant
to this chapter, as a chiropractor pursuant to chapter 331, RSMo, as a
dentist pursuant to chapter 332, RSMo, or 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, any patient whose medical condition should, at the time of
examination or treatment, be determined to be beyond the scope of
practice of physical therapy. A physical therapist shall refer to a
person licensed and registered as a physician and surgeon pursuant to
this chapter, as a chiropractor pursuant to chapter 331, RSMo, as a
dentist pursuant to chapter 332, RSMo, or 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, any person whose condition, for which physical therapy services
are rendered pursuant to this subsection, has not been documented to be
progressing toward documented treatment goals after six visits or
fourteen days, whichever shall come first. If the person's condition for
which physical therapy services are rendered under this subsection shall
be documented to be progressing toward documented treatment goals, a
physical therapist may continue treatment without referral from a
physician, chiropractor, dentist or podiatrist, whose license is in good
standing. If treatment rendered under this subsection is to continue
beyond thirty days, a physical therapist shall notify the patient's
current physician, chiropractor, dentist, or podiatrist before continuing
treatment beyond the thirty-day limitation. A physical therapist shall
also perform such notification before continuing treatment rendered under
this subsection for each successive period of thirty days.

3. The provision of physical therapy services of evaluation and screening
pursuant to this section shall be limited to a physical therapist, and
any authority for evaluation and screening granted within this section
may not be delegated. Upon each reinitiation of physical therapy
services, a physical therapist shall provide a full physical therapy
evaluation prior to the reinitiation of physical therapy treatment.
Physical therapy treatment provided pursuant to the provisions of
subsection 2 of this section, may be delegated by physical therapists to
physical therapist assistants only if the patient's current physician,
chiropractor, dentist, or podiatrist has been so informed as part of the
physical therapist's seven-day notification upon reinitiation of physical
therapy services as required in subsection 2 of this section. Nothing in
this subsection shall be construed as to limit the ability of physical
therapists or physical therapist assistants to provide physical therapy
services in accordance with the provisions of this chapter, and upon the
referral of a physician and surgeon licensed pursuant to this chapter, a
chiropractor pursuant to chapter 331, RSMo, a dentist pursuant to chapter
332, RSMo, or 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. Nothing in this
subsection shall prohibit a person licensed or registered as a physician
or surgeon licensed pursuant to this chapter, a chiropractor pursuant to
chapter 331, RSMo, a dentist pursuant to chapter 332, RSMo, or 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, from acting within the scope of their
practice as defined by the applicable chapters of RSMo.

4. No person licensed to practice, or applicant for licensure, as a
physical therapist or physical therapist assistant shall make a medical
diagnosis. (L. 1999 H.B. 343 merged with S.B. 8 & 173, A.L. 2004 S.B.
1122 merged with S.B. 1181)

*Word "a" does not appear in original rolls.

Each person licensed pursuant to sections 334.500 to 334.685
shall accumulate thirty hours of continuing education every two years to
be eligible for relicensure, as follows:

(1) Continuing education shall be obtained through courses approved by
the Missouri advisory commission for physical therapists and physical
therapist assistants;

(2) Ten hours of continuing education shall be equivalent to one
continuing education unit;

(3) Adherence to the continuing education requirement shall be reviewed
for licensure renewal in each even-numbered year and shall include all
approved continuing education courses taken during the previous two
years. (L. 1998 H.B. 1601, et al.)

After October 13, 1970, no person shall hold himself or herself
out as being a physical therapist or a licensed physical therapist in
this state, unless such person is licensed and registered in accordance
with the provisions of sections 334.500 to 334.620. (L. 1969 H.B. 39 § 2,
A.L. 1995 S.B. 452)

The board shall license by examination, or otherwise as provided
in sections 334.500 to 334.620, all physical therapists in this state,
who meet the requirements of sections 334.500 to 334.620. (L. 1969 H.B.
39 § 3, A.L. 1995 S.B. 452)

1. A candidate for license to practice as a physical therapist
shall be at least twenty-one years of age. A candidate shall furnish
evidence of such person's good moral character and the person's
educational qualifications by submitting satisfactory evidence of
completion of a program of physical therapy education approved as
reputable by the board. A candidate who presents satisfactory evidence of
the person's graduation from a school of physical therapy approved as
reputable by the American Medical Association or, if graduated before
1936, by the American Physical Therapy Association, or if graduated after
1988, the Commission on Accreditation for Physical Therapy Education or
its successor, is deemed to have complied with the educational
qualifications of this subsection.

2. Persons desiring to practice as physical therapists in this state
shall appear before the board at such time and place as the board may
direct and be examined as to their fitness to engage in such practice.
Applications for examination shall be in writing, on a form furnished by
the board and shall include evidence satisfactory to the board that the
applicant possesses the qualifications set forth in subsection 1 of this
section. 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 statement,
subject to the penalties of making a false affidavit or declaration.

3. The board shall not issue a permanent license to practice as a
physical therapist or allow any person to sit for the Missouri state
board examination for physical therapists who has failed three or more
times any physical therapist licensing examination administered in one or
more states or territories of the United States or the District of
Columbia.

4. The board may waive the provisions of subsection 3 if the applicant
has met one of the following provisions:

(1) The applicant is licensed and has maintained an active clinical
practice for the previous three years 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, the District of Columbia and no license
issued to the applicant has been disciplined or limited in any state or
territory of the United States, the District of Columbia or Canada;

(2) The applicant has failed the licensure examination three times or
more and then obtains a professional degree in physical therapy at a
level higher than previously completed, the applicant can sit for the
licensure examination three additional times.

5. The examination of qualified candidates for licenses to practice
physical therapy shall include a written examination and shall embrace
the subjects taught in reputable programs of physical therapy education,
sufficiently strict to test the qualifications of the candidates as
practitioners.

6. The examination shall embrace, in relation to the human being, the
subjects of anatomy, chemistry, kinesiology, pathology, physics,
physiology, psychology, physical therapy theory and procedures as related
to medicine, surgery and psychiatry, and such other subjects, including
medical ethics, as the board deems useful to test the fitness of the
candidate to practice physical therapy. (L. 1969 H.B. 39 § 4, A.L. 1981
S.B. 16, A.L. 1995 S.B. 452, A.L. 2004 S.B. 1122 merged with S.B. 1181)

1. The board shall issue a license to any physical therapist who
is licensed in another jurisdiction and who has had no violations,
suspensions or revocations of a license to practice physical therapy in
any jurisdiction, provided that, such person is licensed in a
jurisdiction whose requirements are substantially equal to, or greater
than, the requirements for licensure of physical therapists in Missouri
at the time the applicant applies for licensure.

2. Every applicant for a license pursuant to this section, upon making
application and showing the necessary qualifications as provided in
subsection 1 of this section, shall be required to pay the same fee as
the fee required to be paid by applicants who apply to take the
examination before the board. Within the limits provided in this section,
the board may negotiate reciprocal compacts with licensing boards of
other states for the admission of licensed practitioners from Missouri in
other states.

3. Notwithstanding the provisions of subsections 1 and 2 of this section,
the board shall not issue a license to any applicant who has failed three
or more times any physical therapist licensing examination administered
in one or more states or territories of the United States or the District
of Columbia.

4. The board may waive the provisions of subsection 3 if the applicant
has met one of the following provisions:

(1) The applicant is licensed and has maintained an active clinical
practice for the previous three years 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, the District of Columbia and no license
issued to the applicant has been disciplined or limited in any state or
territory of the United States, the District of Columbia or Canada;

(2) The applicant has failed the licensure examination three times or
more and then obtains a professional degree in physical therapy at a
level higher than previously completed, the applicant can sit for the
licensure examination three additional times. (L. 1969 H.B. 39 § 5, A.L.
1974 S.B. 336, A.L. 1981 S.B. 16, A.L. 1988 H.B. 1328, A.L. 1995 S.B.
452, A.L. 2004 S.B. 1122 merged with S.B. 1181)

An applicant who has not been previously examined in another
jurisdiction and meets the qualifications of subsection 1 of section
334.530 may pay a temporary license fee and submit an agreement-to-
supervise form, which is signed by the applicant's supervising physical
therapist, to the board and obtain without examination a nonrenewable
temporary license. Such temporary licensee may only engage in the
practice of physical therapy under the supervision of a licensed physical
therapist. The board shall define the scope of such supervision by rules
and regulations. The temporary license shall expire on either the date
the applicant receives the results of the applicant's initial examination
or within ninety days of its issuance, whichever occurs first. (L. 1969
H.B. 39 § 6, A.L. 1981 S.B. 16, A.L. 1995 S.B. 452, A.L. 2004 S.B. 1122
merged with S.B. 1181)

The board shall charge each person who applies for examination
for a license to practice as a physical therapist 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
reapply and return to any meeting and be examined upon payment of a
reexamination fee; but no temporary license may be issued to such
persons. (L. 1969 H.B. 39 § 7, A.L. 1981 S.B. 16, A.L. 1995 S.B. 452)

1. Every person licensed under sections 334.500 to 334.620
shall, on or before the registration renewal date, apply to the board for
a certificate of registration for the ensuing licensing period. The
application shall be made on a form furnished to the applicant and shall
state the applicant's full name and the address at which the person
practices and the address at which the person resides and the date and
number of such person's license.

2. A blank form for application for registration shall be mailed to each
person licensed in this state at the person's last known address of
practice or residence. The failure to mail the form of application or the
failure to receive it does not, however, relieve any person of the duty
to register and pay the fee required by sections 334.500 to 334.620 nor
exempt such person from the penalties provided by sections 334.500 to
334.620 for failure to register. (L. 1969 H.B. 39 § 9, A.L. 1981 S.B. 16,
A.L. 1995 S.B. 452)

Each applicant for registration shall accompany the application
for registration with a registration fee to be paid to the director of
revenue for the licensing period for which registration is sought. (L.
1969 H.B. 39 § 10, A.L. 1981 S.B. 16)

Any person licensed to practice as a physical therapist in this
state who retires from the practice shall file with the board an
affidavit, on a form furnished by the board, which states the date on
which the person retired from the practice and such other facts as tend
to verify the retirement as the board deems necessary, and if the person
thereafter reengages in the practice, the person shall register as
provided by sections 334.500 to 334.620. (L. 1969 H.B. 39 § 12, A.L. 1981
S.B. 16, A.L. 1995 S.B. 452)

Any person who holds himself or herself out to be a physical
therapist or a licensed physical therapist within this state or any
person who advertises as a physical therapist or claims that the person
can render physical therapy services and who, in fact, does not hold a
valid physical therapist license is guilty of a class B misdemeanor and,
upon conviction, shall be punished as provided by law. Any person who, in
any manner, represents himself or herself as a physical therapist, or who
uses in connection with such person's name the words or letters "physical
therapist", "physiotherapist", "registered physical therapist", "P.T.",
"Ph.T.", "P.T.T.", "R.P.T.", or any other letters, words, abbreviations
or insignia, indicating or implying that the person is a physical
therapist without a valid existing license as a physical therapist issued
to such person pursuant to the provisions of sections 334.500 to 334.620,
is guilty of a class B misdemeanor. Nothing in sections 334.500 to
334.620 shall prohibit any person licensed in this state under chapter
331, RSMo, from carrying out the practice for which the person is duly
licensed, or from advertising the use of physiologic and rehabilitative
modalities; nor shall it prohibit any person licensed or registered in
this state under section 334.735 or any other law from carrying out the
practice for which the person is duly licensed or registered; nor shall
it prevent professional and semiprofessional teams, schools, YMCA clubs,
athletic clubs and similar organizations from furnishing treatment to
their players and members. This section, also, shall not be construed so
as to prohibit masseurs and masseuses from engaging in their practice not
otherwise prohibited by law and provided they do not represent themselves
as physical therapists. This section shall not apply to physicians and
surgeons licensed under this chapter. (L. 1969 H.B. 39 § 13, A.L. 1974
S.B. 336, A.L. 1981 S.B. 16, A.L. 1990 H.B. 1365 merged with S.B. 737,
A.L. 1995 S.B. 452)

Sections 334.500 to 334.620 shall be known as "The Physical
Therapy Practice Act". (L. 1969 H.B. 39 § 14, A.L. 1995 S.B. 452)

1. There is hereby established an "Advisory Commission for
Physical Therapists" which shall guide, advise and make recommendations
to the board. The commission shall approve the examination required by
section 334.530 and shall assist the board in carrying out the provisions
of sections 334.500 to 334.620.

2. The commission shall be appointed no later than October 1, 1989, and
shall consist of five members appointed by the governor with the advice
and consent of the senate. Each member shall be a citizen of the United
States and a resident of this state, and shall be licensed as a physical
therapist by this state. Members shall be appointed to serve three-year
terms, except that the first commission appointed shall consist of one
member whose term shall be for one year; two members whose terms shall be
for three years; and two members whose terms shall be for two years. The
president of the Missouri Physical Therapy Association in office at the
time shall, at least ninety days prior to the expiration of the term of a
commission member or as soon as feasible after a vacancy on the
commission otherwise occurs, submit to the director of the division of
professional registration a list of five physical therapists 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
Physical Therapy Association shall include in his or her letter of
transmittal a description of the method by which the names were chosen by
that association.

3. Notwithstanding any other provision of law to the contrary, any
appointed member of the commission shall receive as compensation an
amount established by the director of the division of professional
registration not to exceed seventy dollars per day for commission
business plus actual and necessary expenses. The director of the division
of professional registration shall establish by rule guidelines for
payment. All staff for the commission shall be provided by the board of
healing arts.

4. The commission shall hold an annual meeting at which it shall elect
from its membership a chairman and secretary. The commission may hold
such additional meetings as may be required in the performance of its
duties, provided that notice of every meeting must be given to each
member at least ten days prior to the date of the meeting. A quorum of
the board shall consist of a majority of its members. (L. 1989 H.B. 320 §
1, A.L. 1995 S.B. 452, A.L. 1999 H.B. 343, A.L. 2001 H.B. 567)

1. After January 1, 1997, no person shall hold himself or
herself out as being a physical therapist assistant in this state unless
the person is licensed as provided in sections 334.650 to 334.685.

2. A licensed physical therapist shall direct and supervise a physical
therapist assistant at all times. The licensed physical therapist shall
have the responsibility of supervising the physical therapy treatment
program. No physical therapist may establish a treating office in which
the physical therapist assistant is the primary care provider. No
licensed physical therapist shall have under their direct supervision
more than four physical therapist assistants. (L. 1996 H.B. 999)

1. A candidate for licensure to practice as a physical therapist
assistant shall be at least nineteen years of age. A candidate shall
furnish evidence of the person's good moral character and of the person's
educational qualifications. The educational requirements for licensure as
a physical therapist assistant are:

(1) A certificate of graduation from an accredited high school or its
equivalent; and

(2) Satisfactory evidence of completion of an associate degree program of
physical therapy education accredited by the commission on accreditation
of physical therapy education.

2. Persons desiring to practice as a physical therapist assistant in this
state shall appear before the board at such time and place as the board
may direct and be examined as to the person's fitness to engage in such
practice. Applications for examination shall be in writing, on a form
furnished by the board and shall include evidence satisfactory to the
board that the applicant possesses the qualifications provided in
subsection 1 of this section. Each application shall contain a statement
that the statement is made under oath of affirmation and that its
representations are true and correct to the best knowledge and belief of
the person signing the statement, subject to the penalties of making a
false affidavit or declaration.

3. The examination of qualified candidates for licensure to practice as
physical therapist assistants shall embrace a written examination and
which shall cover the curriculum taught in accredited associate degree
programs of physical therapy assistant education. Such examination shall
be sufficient to test the qualification of the candidates as
practitioners.

4. The board shall not issue a license to practice as a physical
therapist assistant or allow any person to sit for the Missouri state
board examination for physical therapist assistants who has failed three
or more times any physical therapist licensing examination administered
in one or more states or territories of the United States or the District
of Columbia.

5. The board may waive the provisions of subsection 4 if the applicant
has met one of the following provisions: the applicant is licensed and
has maintained an active clinical practice for the previous three years
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, the District
of Columbia and no license issued to the applicant has been disciplined
or limited in any state or territory of the United States, the District
of Columbia or Canada.

6. The examination shall include, as related to the human body, the
subjects of anatomy, kinesiology, pathology, physiology, psychology,
physical therapy theory and procedures as related to medicine and such
other subjects, including medical ethics, as the board deems useful to
test the fitness of the candidate to practice as a physical therapist
assistant.

7. The board shall license without examination any legally qualified
person who is a resident of this state and who was actively engaged in
practice as a physical therapist assistant on August 28, 1993. The board
may license such person pursuant to this subsection until ninety days
after the effective date of this section.

8. A candidate to practice as a physical therapist assistant who does not
meet the educational qualifications may submit to the board an
application for examination if such person can furnish written evidence
to the board that the person has been employed in this state for at least
three of the last five years under the supervision of a licensed physical
therapist and such person possesses the knowledge and training equivalent
to that obtained in an accredited school. The board may license such
persons pursuant to this subsection until ninety days after rules
developed by the state board of healing arts regarding physical therapist
assistant licensing become effective. (L. 1996 H.B. 999, A.L. 1997 S.B.
141, A.L. 1999 H.B. 343 merged with S.B. 8 & 173 and S.B. 225, A.L. 2004
S.B. 1122 merged with S.B. 1181)

(2002) Amendment limiting number of times licensing examination can be
taken applies retrospectively. State Board of Registration for the
Healing Arts v. Boston, 72 S.W.3d 260 (Mo.App. W.D.).

1. The board shall license without examination legally qualified
persons who hold certificates of licensure, registration or certification
in any state or territory of the United States or the District of
Columbia, who have had no violations, suspensions or revocations of such
license, registration or certification, if such persons have passed a
written examination to practice as a physical therapist assistant that
was substantially equal to the examination requirements of this state and
in all other aspects, including education, the requirements for such
certificates of licensure, registration or certification were, at the
date of issuance, substantially equal to the requirements for licensure
in this state.

2. The* board shall not issue a license to any applicant who has failed
three or more times any physical therapist assistant licensing
examination administered in one or more states or territories of the
United States or the District of Columbia.

3. The board may waive the provisions of subsection 1 if the applicant
has met one of the following provisions: the applicant is licensed and
has maintained an active clinical practice for the previous three years
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, the District
of Columbia and no license issued to the applicant has been disciplined
or limited in any state or territory of the United States, the District
of Columbia or Canada.

4. Every applicant for a license pursuant to this section, upon making
application and providing documentation of the necessary qualifications
as provided in this section, shall pay the same fee required of
applicants to take the examination before the board. Within the limits of
this section, the board may negotiate reciprocal contracts with licensing
boards of other states for the admission of licensed practitioners from
Missouri in other states. (L. 1996 H.B. 999, A.L. 1999 H.B. 343 merged
with S.B. 8 & 173, A.L. 2004 S.B. 1122 merged with S.B. 1181)

*Word "The" does not appear in original rolls.

An applicant who has not been previously examined in another
jurisdiction and meets the qualifications of subsection 1 of section
334.655 may pay a temporary license fee and submit an agreement-to-
supervise form which is signed by the applicant's supervising physical
therapist to the board and obtain without examination a nonrenewable
temporary license. Such temporary licensee may only practice under the
supervision of a licensed physical therapist. A licensed physical
therapist shall supervise no more than one temporary licensee. The board
shall define the scope of such supervision by rules and regulations. The
temporary license shall expire on either the date the applicant receives
the results of the applicant's initial examination or within ninety days
of its issuance, whichever occurs first. (L. 1996 H.B. 999, A.L. 2004
S.B. 1122 merged with S.B. 1181)

The board shall charge a person, who applies for examination for
a license to practice as a physical therapist assistant, an examination
fee. If the person does not score a passing grade on the examination, the
board may refuse to issue a license. Any applicant who fails to pass the
examination may reapply and be reexamined upon payment of a reexamination
fee. No temporary license may be issued to any person who has previously
failed the examination in Missouri or any other state or jurisdiction.
(L. 1996 H.B. 999)

1. Every person licensed pursuant to sections 334.650 to 334.685
shall, on or before the licensing renewal date, apply to the board for a
certificate of licensure for the next licensing period. The application
for renewal shall be made on a form furnished to the applicant and shall
state the applicant's full name and the address at which the applicant
practices and the address at which the applicant resides and the date and
number of the applicant's license.

2. A blank application form shall be mailed to each person licensed in
this state pursuant to sections 334.650 to 334.685 at the person's last
known address of practice or residence. The failure to mail the
application for or the failure to receive the application form does not
relieve any person of the duty to renew the person's license and pay the
renewal fee as required by sections 334.650 to 334.685 nor shall it
exempt the person from the penalties provided by sections 334.650 to
334.685 for failure to renew a license. (L. 1996 H.B. 999)

All fees authorized pursuant to the provisions of sections
334.650 to 334.685 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 to the credit of the healing
arts fund. (L. 1996 H.B. 999)

Any person licensed to practice as a physical therapist
assistant in this state who retires from the practice shall file with the
board an affidavit, on a form furnished by the board, which states the
date on which the person retired from practice and such other information
required by the board to verify such retirement. If a person reengages in
practice as a physical therapy assistant after a person submits an
affidavit of retirement required by this section, the person shall
reapply for licensure as required by sections 334.650 to 334.685. (L.
1996 H.B. 999)

Sections 334.700 to 334.725 shall be known and may be cited as
the "Missouri Athletic Trainers Act". (L. 1983 H.B. 162 & 274 § 1)

As used in sections 334.700 to 334.725, unless the context
clearly requires otherwise, the following terms mean:

(1) "Athlete", a person who participates in a sanctioned amateur or
professional sport or recreational sport activity;

(2) "Athletic trainer", a person who meets the qualifications of section
334.708 and who, upon the direction of the team physician and/or
consulting physician, practices prevention, emergency care, first aid,
treatment, or physical rehabilitation of injuries incurred by athletes in
the manner, means, and methods deemed necessary to effect care or
rehabilitation, or both;

(3) "Board", the Missouri board for the healing arts;

(4) "Committee", the athletic trainers advisory committee;

(5) "Division", the division of professional registration of the
department of economic development;

(6) "Student athletic trainer", a person who assists in the duties
usually performed by a licensed athletic trainer and who works under the
direct supervision of a licensed athletic trainer. (L. 1983 H.B. 162 &
274 § 2, A.L. 2004 H.B. 1399 merged with S.B. 962)

No person shall hold himself or herself out as an athletic
trainer in this state unless such person has been licensed as such under
the provisions of sections 334.700 to 334.725. (L. 1983 H.B. 162 & 274 §
3, A.L. 2004 H.B. 1399 merged with S.B. 962)

1. The board shall license applicants who meet the
qualifications for athletic trainers, who file for licensure, and who pay
all fees required for this licensure.

2. The board shall:

(1) Prescribe application forms to be furnished to all persons seeking
licensure pursuant to sections 334.700 to 334.725;

(2) Prepare and conduct examinations for applicants for licensure
pursuant to sections 334.700 to 334.725;

(3) Prescribe the form and design of the licensure to be issued pursuant
to sections 334.700 to 334.725;

(4) Set the fee for examination, licensure, and renewal thereof;

(5) Keep a record of all of its proceedings regarding the Missouri
athletic trainers act and of all athletic trainers licensed in this state;

(6) Annually prepare a roster of the names and addresses of all athletic
trainers licensed in this state, copies of which shall be made available
upon request to any person paying the fee therefor;

(7) Set the fee for the roster at an amount sufficient to cover the
actual cost of publishing and distributing the roster;

(8) Appoint members of the Missouri athletic trainer advisory committee;

(9) Adopt an official seal.

3. The board may:

(1) Issue subpoenas to compel witnesses to testify or produce evidence in
proceedings to deny, suspend, or revoke a license or licensure;

(2) Promulgate rules pursuant to chapter 536, RSMo, in order to carry out
the provisions of sections 334.700 to 334.725;

(3) Establish guidelines for athletic trainers in sections 334.700 to
334.725.

4. No rule or portion of a rule promulgated under the authority of
sections 334.700 to 334.725 shall become effective unless it has been
promulgated pursuant to the provisions of section 536.024, RSMo. (L. 1983
H.B. 162 & 274 §§ 4, 5, A.L. 1993 S.B. 52, A.L. 1995 S.B. 3, A.L. 2004
H.B. 1399 merged with S.B. 962)

1. Any person seeking licensure pursuant to sections 334.700 to
334.725 must be a resident or in the process of establishing residency in
this state and must meet at least one set of the following qualifications:

(1) Has met all of the National Athletic Trainers Association
certification qualifications;

(2) Holds a degree in physical therapy with at least a minor in physical
education or health which included a basic athletic training course and
has spent at least two academic years, military duty included, working
under the direct supervision of a certified athletic trainer;

(3) Can show proof acceptable to the board of experience and educational
quality equal to that in subdivision (1), and can pass the examination
for licensure pursuant to sections 334.700 to 334.725.

2. The board shall grant, without examination, licensure to any qualified
nonresident athletic trainer holding a license or licensure in another
state if such other state recognizes licenses or licensure of the state
of Missouri in the same manner. (L. 1983 H.B. 162 & 274 § 6, A.L. 2004
H.B. 1399 merged with S.B. 962)

1. All applications for initial licensure pursuant to sections
334.700 to 334.725 shall be submitted on forms prescribed by the board
and shall be accompanied by an initial licensure fee. All applications
for renewal of licensure issued pursuant to sections 334.700 to 334.725
shall be submitted on forms prescribed by the board and shall be
accompanied by a renewal fee.

2. All fees of any kind and character authorized to be charged by the
board shall be paid to the director of revenue and shall be deposited by
the state treasurer into the board for the healing arts fund, to be
disbursed only in payment for expenses of maintaining the athletic
trainer licensure program and for the enforcement of the provisions of
sections 334.700 to 334.725. (L. 1983 H.B. 162 & 274 § 7, A.L. 2004 H.B.
1399 merged with S.B. 962)

CROSS REFERENCE: Form approval required, RSMo 37.340; failure to obtain,
personal liability, RSMo 37.390

1. Any person who meets the qualifications listed in section
334.708, submits his or her application and fees in accordance with
section 334.710, and has not committed any act listed in section 334.715
shall be issued a license pursuant to sections 334.700 to 334.725.

2. Each license issued pursuant to sections 334.700 to 334.725 shall
contain the name of the person to whom it was issued, the date on which
it was issued and such other information as the board deems advisable.
All licenses issued pursuant to sections 334.700 to 334.725 shall expire
on January thirtieth of each year. (L. 1983 H.B. 162 & 274 § 8, A.L. 2004
H.B. 1399 merged with S.B. 962)

1. The board may refuse to license any applicant or may suspend,
revoke, or refuse to renew the license of any licensee for any one or any
combination of the causes provided in section 334.100, or if the
applicant or licensee:

(1) Violated or conspired to violate any provision of sections 334.700 to
334.725 or any provision of any rule promulgated pursuant to sections
334.700 to 334.725; or

(2) Has been found guilty of unethical conduct as defined in the ethical
standards of the National Athletic Trainers Association or the National
Athletic Trainers Association Board of Certification as adopted and
published by the committee and the board and filed with the secretary of
state.

2. Upon receipt of a written application made in the form and manner
prescribed by the board, the board may reinstate any license which has
expired, been suspended or been revoked or may issue any license which
has been denied; provided, that no application for reinstatement or
issuance of license or licensure shall be considered until at least six
months have elapsed from the date of denial, expiration, suspension, or
revocation when the license to be reinstated or issued was denied
issuance or renewal or was suspended or revoked for one of the causes
listed in subsection 1 of this section. (L. 1983 H.B. 162 & 274 § 9, A.L.
1997 S.B. 141, A.L. 2004 H.B. 1399 merged with S.B. 962)

1. There is hereby created the "Missouri Athletic Trainer
Advisory Committee", to be composed of five members to be appointed by
the board.

2. The athletic trainer advisory committee shall:

(1) Assist the board in conducting examinations for applicants of
athletic trainer licensure;

(2) Advise the board on all matters pertaining to the licensure of
athletic trainers;

(3) Review all complaints and/or investigations wherein there is a
possible violation of sections 334.700 to 334.725 or regulations
promulgated pursuant thereto and make recommendations to the board for
action;

(4) Follow the provisions of the board's administrative practice
procedures in conducting all official duties.

3. Each athletic trainer advisory committee member shall:

(1) Be a citizen of the United States and a resident of the state of
Missouri for five years next preceding appointment; and

(2) Be comprised of three licensed athletic trainers except for initial
appointees; and

(3) One member shall be a physician duly licensed by the Missouri state
board for the healing arts; and

(4) One member shall be a general public member.

4. Except for the initial appointees, members shall hold office for terms
of six years. The board shall designate one member for a term expiring in
1984, one member for a term expiring in 1985, one member for a term
expiring in 1986, one member for a term expiring in 1987, and one member
for a term expiring in 1988. In the event of death, resignation, or
removal of any member, the vacancy of the unexpired term shall be filled
by the board in the same manner as the other appointments. (L. 1983 H.B.
162 & 274 § 10, A.L. 2004 H.B. 1399 merged with S.B. 962)

Any person who is a resident of this state and who was actively
engaged as an athletic trainer on September 28, 1983, shall be entitled
to continue to practice as such but, within six months of that date,
comply with the provisions of section 334.708 to 334.715. For the
purposes of this section a person is actively engaged as an athletic
trainer if he is employed on a salary basis by an educational
institution, a professional athletic organization, or any other bona fide
athletic organization for the duration of the institutional year or the
athletic organization's season, and one of his job responsibilities
requires him to perform the duties of an athletic trainer. (L. 1983 H.B.
162 & 274 § 11)

Notwithstanding any other provision of law to the contrary, any
appointed member of the board shall receive as compensation an amount
established by the director of the division of professional registration
not to exceed seventy dollars per day for board business plus actual and
necessary expenses. The director of the division of professional
registration shall establish by rule guidelines for payment. (L. 2001
H.B. 567)

1. Nothing in sections 334.700 to 334.725 shall be construed to
authorize the practice of medicine by any person not licensed by the
state board of registration for the healing arts.

2. The provisions of sections 334.700 to 334.725 shall not apply to the
following persons:

(1) Physicians and surgeons licensed by the state board of registration
for the healing arts;

(2) Dentists licensed by the Missouri dental board who confine their
practice strictly to dentistry;

(3) Optometrists licensed by the state board of optometry who confine
their practice strictly to optometry, as defined in section 336.010, RSMo;

(4) Nurses licensed by the state board of nursing who confine their
practice strictly to nursing;

(5) Chiropractors licensed by the state board of chiropractic examiners
who confine themselves strictly to the practice of chiropractic, as
defined in section 331.010, RSMo;

(6) Podiatrists licensed by the state board of chiropody or podiatry who
confine their practice strictly to that of a podiatrist, as defined in
section 330.010, RSMo;

(7) Professional physical therapists licensed by the state board of
registration for the healing arts who confine their practice strictly to
professional physical therapy, as defined in section 334.500;

(8) Coaches and physical education instructors in the performance of
their duties;

(9) Apprentice athletic trainers who confine themselves strictly to their
duties as defined in sections 334.700 to 334.725;

(10) Athletic trainers from other nations, states, or territories
performing their duties for their respective teams or organizations if
they restrict their duties only to their teams or organizations and only
during the course of their teams' or organizations' stay in this state.
(L. 1983 H.B. 162 & 274 § 12)

Any person who violates any provision of sections 334.700 to
334.725 is guilty of a misdemeanor and, upon conviction thereof, shall be
punished as for a class C misdemeanor. (L. 1983 H.B. 162 & 274 § 13)

1. As used in sections 334.735 to 334.749, the following terms
mean:

(1) "Applicant", any individual who seeks to become licensed as a
physician assistant;

(2) "Certification" or "registration", a process by a certifying entity
that grants recognition to applicants meeting predetermined
qualifications specified by such certifying entity;

(3) "Certifying entity", the nongovernmental agency or association which
certifies or registers individuals who have completed academic and
training requirements;

(4) "Department", the department of economic development or a designated
agency thereof;

(5) "License", a document issued to an applicant by the department
acknowledging that the applicant is entitled to practice as a physician
assistant;

(6) "Physician assistant", a person who has graduated from a physician
assistant program accredited by the American Medical Association's
Committee on Allied Health Education and Accreditation or by its
successor agency, who has passed the certifying examination administered
by the National Commission on Certification of Physician Assistants and
has active certification by the National Commission on Certification of
Physician Assistants who provides health care services delegated by a
licensed physician. A person who has been employed as a physician
assistant for three years prior to August 28, 1989, who has passed the
National Commission on Certification of Physician Assistants examination,
and has active certification of the National Commission on Certification
of Physician Assistants;

(7) "Recognition", the formal process of becoming a certifying entity as
required by the provisions of sections 334.735 to 334.749;

(8) "Supervision", control exercised over a physician assistant working
within the same office facility of the supervising physician except a
physician assistant may make follow-up patient examinations in hospitals,
nursing homes and correctional facilities, each such examination being
reviewed, approved and signed by the supervising physician. The board
shall promulgate rules pursuant to chapter 536, RSMo, for the proximity
of practice between the physician assistant and the supervising physician
and documentation of joint review of the physician assistant activity by
the supervising physician and the physician assistant.

2. The scope of practice of a physician assistant shall consist only of
the following services and procedures:

(1) Taking patient histories;

(2) Performing physical examinations of a patient;

(3) Performing or assisting in the performance of routine office
laboratory and patient screening procedures;

(4) Performing routine therapeutic procedures;

(5) Recording diagnostic impressions and evaluating situations calling
for attention of a physician to institute treatment procedures;

(6) Instructing and counseling patients regarding mental and physical
health using procedures reviewed and approved by a licensed physician;

(7) Assisting the supervising physician in institutional settings,
including reviewing of treatment plans, ordering of tests and diagnostic
laboratory and radiological services, and ordering of therapies, using
procedures reviewed and approved by a licensed physician;

(8) Assisting in surgery;

(9) Performing such other tasks not prohibited by law under the
supervision of a licensed physician as the physician's assistant has been
trained and is proficient to perform;

(10) Physician assistants shall not perform abortions.

3. Physician assistants shall not prescribe nor dispense any drug,
medicine, device or therapy independent of consultation with the
supervising physician, nor prescribe lenses, prisms or contact lenses for
the aid, relief or correction of vision or the measurement of visual
power or visual efficiency of the human eye, nor administer or monitor
general or regional block anesthesia during diagnostic tests, surgery or
obstetric procedures. Prescribing and dispensing of drugs, medications,
devices or therapies by a physician assistant shall be pursuant to a
physician assistant supervision agreement which is specific to the
clinical conditions treated by the supervising physician and the
physician assistant shall be subject to the following:

(1) A physician assistant shall not prescribe controlled substances;

(2) The types of drugs, medications, devices or therapies prescribed or
dispensed by a physician assistant shall be consistent with the scopes of
practice of the physician assistant and the supervising physician;

(3) All prescriptions shall conform with state and federal laws and
regulations and shall include the name, address and telephone number of
the physician assistant and the supervising physician;

(4) A physician assistant or advanced practice nurse as defined in
section 335.016, RSMo, may request, receive and sign for noncontrolled
professional samples and may distribute professional samples to patients;

(5) A physician assistant shall not prescribe any drugs, medicines,
devices or therapies the supervising physician is not qualified or
authorized to prescribe; and

(6) A physician assistant may only dispense starter doses of medication
to cover a period of time for seventy-two hours or less.

4. A physician assistant shall clearly identify himself or herself as a
physician assistant and shall not use or permit to be used in the
physician assistant's behalf the terms "doctor", "Dr." or "doc" nor hold
himself or herself out in any way to be a physician or surgeon. No
physician assistant shall practice or attempt to practice without
physician supervision or in any location where the supervising physician
is not immediately available for consultation, assistance and
intervention, except in an emergency situation, nor shall any physician
assistant bill a patient independently or directly for any services or
procedure by the physician assistant.

5. For purposes of this section, the licensing of physician assistants
shall take place within processes established by the state board of
registration for the healing arts through rule and regulation. The board
of healing arts is authorized to establish rules pursuant to chapter 536,
RSMo, establishing licensing and renewal procedures, supervision,
supervision agreements, fees, and addressing such other matters as are
necessary to protect the public and discipline the profession. An
application for licensing may be denied or the license of a physician
assistant may be suspended or revoked by the board in the same manner and
for violation of the standards as set forth by section 334.100, or such
other standards of conduct set by the board by rule or regulation.
Persons licensed pursuant to the provisions of chapter 335, RSMo, shall
not be required to be licensed as physician assistants.

6. "Physician assistant supervision agreement" means a written agreement,
jointly agreed-upon protocols or standing order between a supervising
physician and a physician assistant, which provides for the delegation of
health care services from a supervising physician to a physician
assistant and the review of such services.

7. When a physician assistant supervision agreement is utilized to
provide health care services for conditions other than acute self-limited
or well-defined problems, the supervising physician or other physician
designated in the supervision agreement shall see the patient for
evaluation and approve or formulate the plan of treatment for new or
significantly changed conditions as soon as practical, but in no case
more than two weeks after the patient has been seen by the physician
assistant.

8. At all times the physician is responsible for the oversight of the
activities of, and accepts responsibility for, health care services
rendered by the physician assistant. (L. 1989 S.B. 217 § 1, A.L. 1996
H.B. 999, A.L. 1997 S.B. 141, A.L. 1998 H.B. 1601, et al., A.L. 2005 S.B.
177)

Notwithstanding any other provision of sections 334.735 to
334.749, the board may issue without examination a temporary license to
practice as a physician assistant. Upon the applicant paying a temporary
license fee and the submission of all necessary documents as determined
by the board, the board may grant a temporary license to any person who
meets the qualifications provided in section 334.735 which shall be valid
until the results of the next examination are announced. The temporary
license may be renewed at the discretion of the board and upon payment of
the temporary license fee. (L. 1995 S.B. 452, A.L. 1998 H.B. 1601, et al.)

1. Any certifying entity desiring recognition shall register
with the department the following information:

(1) The standards governing such certification or registration, which
shall include requirements for a baccalaureate or postbaccalaureate
degree, with a major course of study recognized by the certifying entity,
from a recognized educational institution accredited by the Council on
Post-Secondary Accreditation and the United States Department of
Education or a program accredited by the Committee on Allied Health,
Education and Accreditation of the American Medical Association;

(2) The nature and duration of any education including, but not limited
to, whether the education included a substantial amount of supervised
field experience; whether education programs exist in this state; if
there is an experience requirement and what the requirement entails;
whether the experience must be acquired under the direction or
supervision of another certified or registered person; whether there is
an alternative method of receiving certification or registration; whether
all applicants will be required to pass an examination for certification
or registration; and, if an examination is required, by whom the
examination was developed;

(3) The term of certification or registration;

(4) The manner in which certified or registered personnel must
demonstrate continuing maintenance of competence;

(5) Procedures for renewal of certification or registration including
fees, reexamination, and all other requirements;

(6) The code of ethics for certified or registered personnel, if any;

(7) Grounds for suspension or revocation of certification or registration
whether temporary or permanent, and justification for reinstatement, if
any;

(8) A description of the certifying entity, the service or practice being
evaluated and a list of associations, organizations or other groups
representing the service or practice;

(9) Other information which may be required by the department.

2. The department shall determine a fee to be charged to certifying
entities that register their certification or registration procedures.
The fee shall cover the cost of filing such applications for recognition.

3. The certifying entity, as a condition for recognition pursuant to
sections 334.735 to 334.748, shall certify compliance with its standards
to the department for all applicants seeking a certificate of
registration pursuant to sections 334.735 to 334.748 and may be required
to recertify compliance to the department upon request by the department.

4. The department shall approve or disapprove certifying entities for any
of the professions included in the scope of sections 334.735 to 334.748
following review of the application submitted and following a public
hearing on the application for recognition of such certifying entity.

5. The department may terminate its recognition of any certifying entity
for any of the professions included in the scope of sections 334.735 to
334.748 following a subsequent review of the certification or
registration procedures of the certifying entity and following a public
hearing. (L. 1989 S.B. 217 § 2)

1. Each person desiring a license pursuant to sections 334.735
to 334.749 shall make application to the department upon such forms and
in such manner as may be prescribed by the department and shall pay the
required application fee as set by the department. 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 same, subject to the
penalties of making a false declaration or affidavit. Such application
shall include proof of certification or registration by a certifying
entity, date the certification or registration process was completed with
the certifying entity, the name of the certifying entity, any
identification numbers and any other information necessary for the
department to verify the certification or registration.

2. The department, 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 annually by filing an application for renewal with the department
and paying the required renewal fee as set by the department. The
department shall notify each licensee in writing of the expiration date
of the person's license at least thirty days before that date, and shall
issue a license to any registrant who returns a completed application
form and pays a renewal fee before the person's license expires.

4. 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 department upon the payment of a reasonable fee. (L. 1989 S.B. 217 §
3, A.L. 1998 H.B. 1601, et al.)

1. No person shall hold himself or herself out to the public by
any title or description including the words licensed physician assistant
or physician assistant as defined in section 334.735 unless the person is
duly licensed pursuant to the provisions of sections 334.735 to 334.749,
if a certifying entity has been recognized by the department.

2. Nothing in sections 334.735 to 334.749 shall be construed as
prohibiting any individual whether licensed pursuant to sections 334.735
to 334.749 or not from providing the services of physician assistant.

3. Any person found guilty of violating any provision of subsections 1
and 2 of this section is guilty of an infraction and upon conviction
thereof shall be punished as provided by law. For purposes of this
subsection, the maximum fine for a violation of this section shall be one
thousand dollars. (L. 1989 S.B. 217 §§ 4, 8, A.L. 1995 S.B. 452, A.L.
1996 H.B. 999, A.L. 1997 S.B. 141, A.L. 1998 H.B. 1601, et al.)

1. Certifying entities shall notify the department of any
temporary or permanent revocation or suspension imposed by them.

2. The department, upon receipt of notification by a certifying entity of
any temporary or permanent revocation or suspension imposed by that
entity, shall notify the licensee within thirty days that such license is
revoked. The licensee shall immediately surrender the person's license to
the department.

3. The department shall maintain a list of individuals who hold a valid
license for the provision of a given service or practice for public
inspection and shall respond to public inquiries concerning licensees who
have received a license. (L. 1989 S.B. 217 § 5, A.L. 1998 H.B. 1601, et
al.)

Any nonresident of Missouri who enters the state and intends to
provide a service or practice for which a license is required pursuant to
sections 334.735 to 334.749 may apply for a license, provided that the
applicant meets the requirements imposed by the certifying entity. (L.
1989 S.B. 217 § 6, A.L. 1998 H.B. 1601, et al.)

Any rule or portion of a rule, as that term is defined in
section 536.010, RSMo, that is promulgated to administer and enforce
sections 334.735 to 334.749, shall become effective only if the agency
has fully complied with all of the requirements of chapter 536, RSMo,
including but not limited to, section 536.028, RSMo, if applicable, after
August 28, 1998. All rulemaking authority delegated prior to August 28,
1998, is of no force and effect and repealed as of August 28, 1998,
however nothing in this act* shall be interpreted to repeal or affect the
validity of any rule adopted and promulgated prior to August 28, 1998. If
the provisions of section 536.028, RSMo, apply, the provisions of this
section are nonseverable and if any of the powers vested with the general
assembly pursuant to section 536.028, RSMo, to review, to delay the
effective date, or to disapprove and annul a rule or portion of a rule
are held unconstitutional or invalid, the purported grant of rulemaking
authority and any rule so proposed and contained in the order of
rulemaking shall be invalid and void, except that nothing in this act*
shall affect the validity of any rule adopted and promulgated prior to
August 28, 1998. (L. 1989 S.B. 217 § 7, A.L. 1993 S.B. 52, A.L. 1995 S.B.
3, A.L. 1998 H.B. 1601, et al.)

*"This act" (H.B. 1601, et al., 1998) contains numerous sections. Consult
Disposition of Sections table for definitive listing.

1. All fees payable pursuant to the provisions of sections
334.735 to 334.748 shall be collected by the division of professional
registration, which shall transmit them to the department of revenue for
deposit in the state treasury to the credit of the board of registration
for the healing arts fund.

2. Upon appropriation by the general assembly, the money in the fund
shall be used to administer the provisions of sections 334.735 to
334.749. (L. 1989 S.B. 217 § 9, A.L. 1996 H.B. 999, A.L. 1997 S.B. 141)

All staff for the health care providers certification and
registration program shall be provided by the director of the department
of economic development through the director of the division of
professional registration. (L. 1989 S.B. 217 § 10)

1. No physician assistant shall be used in any office of a
physician or in a clinic or hospital unless a notice stating that a
physician assistant is utilized is posted in a prominent place in such
office, clinic or hospital.

2. Notwithstanding the provisions of sections 334.735 to 334.748, or the
rules of the Missouri state board of registration for the healing arts,
the governing body of every hospital shall have full authority to limit
the functions and activities of any physician assistants performed in
such hospital. (L. 1989 S.B. 217 § 11, 12)

1. There is hereby established an "Advisory Commission for
Physician Assistants" which shall guide, advise and make recommendations
to the board. The commission shall also be responsible for the ongoing
examination of the scope of practice and promoting the continuing role of
physician assistants in the delivery of health care services. The
commission shall assist the board in carrying out the provisions of
sections 334.735 to 334.749.

2. The commission shall be appointed no later than October 1, 1996, and
shall consist of five members, one member of the board, two licensed
physician assistants, one physician and one lay member. The two licensed
physician assistant members, the physician member and the lay member
shall be appointed by the governor with the advice and consent of the
senate. Each licensed physician assistant member shall be a citizen of
the United States and a resident of this state, and shall be licensed as
a physician assistant by this state. The physician member shall be a
United States citizen, a resident of this state, have an active Missouri
license to practice medicine in this state and shall be a supervising
physician, at the time of appointment, to a licensed physician assistant.
The lay member shall be a United States citizen and a resident of this
state. The licensed physician assistant members shall be appointed to
serve three-year terms, except that the first commission appointed shall
consist of one member whose term shall be for one year and one member
whose term shall be for two years. The physician member and lay member
shall each be appointed to serve a three-year term. No physician
assistant member nor the physician member shall be appointed for more
than two consecutive three-year terms. The president of the Missouri
Academy of Physicians Assistants in office at the time shall, at least
ninety days prior to the expiration of a term of a physician assistant
member of a commission member or as soon as feasible after such a vacancy
on the commission otherwise occurs, submit to the director of the
division of professional registration a list of five physician assistants
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
Academy of Physicians Assistants shall include in his or her letter of
transmittal a description of the method by which the names were chosen by
that association.

3. Notwithstanding any other provision of law to the contrary, any
appointed member of the commission shall receive as compensation an
amount established by the director of the division of professional
registration not to exceed seventy dollars per day for commission
business plus actual and necessary expenses. The director of the division
of professional registration shall establish by rule guidelines for
payment. All staff for the commission shall be provided by the state
board of registration for the healing arts.

4. The commission shall hold an open annual meeting at which time it
shall elect from its membership a chairman and secretary. The commission
may hold such additional meetings as may be required in the performance
of its duties, provided that notice of every meeting shall be given to
each member at least ten days prior to the date of the meeting. A quorum
of the commission shall consist of a majority of its members.

5. On August 28, 1998, all members of the advisory commission for
registered physician assistants shall become members of the advisory
commission for physician assistants and their successor shall be
appointed in the same manner and at the time their terms would have
expired as members of the advisory commission for registered physician
assistants. (L. 1996 H.B. 999, A.L. 1998 H.B. 1601, et al., A.L. 1999
H.B. 343, A.L. 2001 H.B. 567)

1. Sections 334.800 to 334.930 shall be known and may be cited
as the "Respiratory Care Practice Act".

2. For the purposes of sections 334.800 to 334.930, the following terms
mean:

(1) "Board", the Missouri board for respiratory care, established in
section 334.830;

(2) "Certified respiratory therapist" or "CRT", a person meeting
entry-level qualifying educational requirements, having passed the
certification examination and having been certified by the certifying
entity;

(3) "Certifying entity", the cognitive competency testing organization as
authorized by the board;

(4) "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 respiratory care;

(5) "CRT" and "RRT", abbreviations for certified respiratory therapist
and registered respiratory therapist and are registered trademarks of a
certifying entity of the National Board for Respiratory Care but does not
include certified clinical perfusionists;

(6) "Direct clinical supervision", availability of a licensed respiratory
care practitioner for purposes of immediate communication and
consultation with, and the assistance of, the permit holder;

(7) "Division", the division of professional registration of the
department of economic development;

(8) "Practice of respiratory care", as provided in section 334.810;

(9) "Protocol", a written agreement of medical care plan delegating
professional responsibilities to a person who is qualified by training,
competency, experience or licensure to perform such responsibilities. A
protocol is a defined response to a specific clinical situation and shall
be written, signed and dated by a physician prior to its implementation;

(10) "Registered respiratory therapist" or "RRT", a person meeting
advanced-level qualifying professional educational requirements, having
passed the registry examination and having been registered by the
certifying entity;

(11) "Respiratory care", the allied health profession whose practitioners
function under the supervision of a physician or in accordance with
clinical protocols accepted by the physician in the administration of
pharmacologic, diagnostic and therapeutic agents related to respiratory
care necessary to implement or modify diagnostic regimes, treatment,
disease prevention or pulmonary rehabilitation of patients with
deficiencies and abnormalities associated with the cardiopulmonary system;

(12) "Respiratory care practitioner", a person:

(a) Duly licensed by the board;

(b) Employed in the practice of respiratory care who has the knowledge
and skill necessary to administer respiratory care as defined in this
section;

(c) Who is able to function in situations of unsupervised patient contact
requiring individual judgment; and

(d) Who is capable of serving as a resource to the physician in relation
to the technical aspects of respiratory care as to safe and effective
methods for administering respiratory care modalities;

(13) "Special training":

(a) Is a deliberate systematic educational activity in the affective,
psychomotor and cognitive domains;

(b) Is intended to develop new proficiencies with an application in mind;

(c) Is presented with an attention to needs, objectives, activities and a
defined means of evaluation. (L. 1996 H.B. 999 § 1, A.L. 1999 H.B. 343)

1. The "practice of respiratory care" includes, but is not
limited to:

(1) The administration of pharmacologic, diagnostic and therapeutic
agents related to respiratory care to implement a disease prevention,
diagnostic, treatment or pulmonary rehabilitative regimen prescribed by a
physician or by clinical protocols pertaining to the practice of
respiratory care;

(2) Observing, examining, monitoring, assessment and evaluation of signs,
symptoms and general physical response to respiratory care procedures,
including whether such are abnormal, and implementation of changes in
procedures based on observed abnormalities, appropriate clinical
protocols or pursuant to a prescription by a physician licensed under
chapter 334, or a person acting under a collaborative practice agreement
as authorized by section 334.104; or

(3) The initiation of emergency procedures under the regulations of the
board or as otherwise permitted in sections 334.800 to 334.930.

2. The practice of respiratory care is not limited to the hospital
setting but shall always be performed under the prescription, order or
protocol of a licensed physician and includes the diagnostic and
therapeutic use of the following:

(1) Administration of medical gases, except for the purpose of anesthesia;

(2) Administration of pharmacologic agents related to, or in conjunction
with, respiratory care procedures;

(3) Aerosolized medications and humidification;

(4) Arterial blood gas puncture or sample collection;

(5) Bronchopulmonary hygiene;

(6) Cardiopulmonary resuscitation;

(7) Environmental control mechanisms and therapy;

(8) Initiation, monitoring, modification of ventilator controls, and
discontinuance or withdrawal of continuous mechanical ventilation;

(9) Intubation/extubation of endotracheal tubes, tracheostomy tubes and
transtracheal catheters;

(10) Insertion of artificial airways and the maintenance of natural and
artificial airways;

(11) Mechanical or physiological ventilatory support;

(12) Point-of-care diagnostic testing;

(13) Specific diagnostic and testing techniques employed in the medical
management of patients to assist in diagnosis, monitoring, treatment and
research of pulmonary abnormalities, including measurement of ventilatory
volumes, pressures, flows, collection of specimens of blood and mucus,
measurement and reporting of blood gases, expired and inspired gas
samples and pulmonary function testing;

(14) Diagnostic monitoring or therapeutic intervention for oxygen
desaturation, aberrant ventilatory patterns and related sleep disorders
including obstructive and central apnea; and

(15) Other related physiologic measurements of the cardiopulmonary system.

3. The practice of respiratory care may also include, with special
training, the following:

(1) Insertion and maintenance of peripheral arterial or venous lines and
hemodynamic monitoring;

(2) Assistance with diagnostic or performing therapeutic bronchoscopy;

(3) Extracorporeal Membrane Oxygenation (ECMO), limited to the intensive
care setting, and delivered under the supervision of a Certified Clinical
Perfusionist (CCP, as defined by the American Board of Cardiovascular
Perfusion, an allied medical professional whose expertise is the science
of extracorporeal life support) and a licensed physician;

(4) Air or ground ambulance transport;

(5) Hyperbaric oxygenation therapy;

(6) Electrophysiologic monitoring; or

(7) Other diagnostic testing or special procedures.

4. The state board of registration for the healing arts pursuant to
section 334.125, and the board of respiratory care, created pursuant to
section 334.830, may jointly promulgate rules defining additional
procedures recognized as proper to be performed by respiratory care
practitioners. 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 respiratory care may
separately promulgate rules relating to the practice of respiratory care.
(L. 1996 H.B. 999 § 2)

1. No person in the state of Missouri, unless such person holds
a current and valid license issued pursuant to sections 334.800 to
334.930, shall:

(1) Provide the services of a respiratory care practitioner, unless such
person is otherwise exempt pursuant to section 334.900; and

(2) Represent himself or herself as, or hold himself or herself out, to
the public by any title or description including the words, respiratory
therapist, respiratory therapy technician, or inhalation therapist, or as
having any similar description; and

(3) Advertise as, or take any action that would imply or lead the public
to believe that such person is, a legitimate provider of respiratory care.

2. Nothing in sections 334.800 to 334.930 shall be construed to authorize
or permit a respiratory care practitioner to practice medicine. (L. 1996
H.B. 999 § 3)

1. There is hereby created within the division of professional
registration a board to be known as the "Missouri Board for Respiratory
Care". The board shall consist of seven members, all of whom shall be
citizens of the United States, eighteen years of age or older and
residents and registered voters of the state of Missouri for at least one
year. The governor shall appoint the members of the board with the advice
and consent of the senate for terms of three years except as provided in
subsection 2 of this section. No more than four members on the board may
be from the same political party. No member of the board shall serve more
than two consecutive three-year terms. The members of the boards shall
consist of one physician, one public member, one hospital administrator
and four respiratory care practitioners.

2. The terms of the first board shall be:

(1) The physician and one registered respiratory therapist for one year;

(2) The public member, the certified respiratory therapy technician and
one registered respiratory therapist for two years; and

(3) The hospital administrator and one registered respiratory therapist
for three years.

3. The physician member of the board shall be licensed pursuant to
chapter 334, have an interest and knowledge in the diagnosis and
treatment of the deficiencies, abnormalities and diseases of the
cardiopulmonary or respiratory systems.

4. The public member of the board shall be a registered voter and a
person who is not, and never has been, a member of the profession
regulated by the provisions of sections 334.800 to 334.930, or the spouse
of any 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 the provisions of sections 334.800 to 334.930 or an
activity or organization directly related to the profession regulated
pursuant to sections 334.800 to 334.930. The duty 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 the technical competence or technical judgment of a licensee or a
candidate for licensure.

5. The hospital administrator member shall be employed as a hospital
administrator in this state.

6. The certified respiratory therapy technician and registered
respiratory therapists shall each have at least five years of active
experience as a provider or teacher of respiratory care as the person's
principal livelihood and shall be licensed, or in the case of the first
board, registered, with the state of Missouri as a respiratory care
practitioner.

7. Any member of the board may be removed from the board by the governor
for neglect of duty required by law, for incompetency, or for unethical
or dishonest conduct. Upon the death, resignation, disqualification or
removal of any member of the board, the governor shall appoint a
successor, within sixty calendar days after the vacancy occurs, to fill
the vacancy for the remainder of the unexpired term. (L. 1996 H.B. 999 §
4)

1. The board shall elect annually a chairperson, vice
chairperson and a secretary from among its members. In even-numbered
years, the chairperson shall be elected from the respiratory care members
and the vice chairperson from the nonrespiratory care members and in odd-
numbered years the chairperson shall be from nonrespiratory care members
and the vice chairperson from the respiratory care members.

2. The board shall adopt, implement, rescind, amend and administer such
rules and regulations as may be necessary to carry out the provisions of
sections 334.800 to 334.930, including, but not limited to, rules
relating to professional conduct, continuing education requirements for
renewal of licenses, approval or sanction of continuing education
programs, the amount of continuing education hours required and to the
establishment of ethical standards of practice for persons holding a
license or permit to practice respiratory care in this state. The board
shall meet with the division at least twice a year and advise the
division on matters within the scope of sections 334.800 to 334.930. The
board may convene at the request of the chairperson or as the board may
determine for such other meetings as may be necessary. A presence of a
majority of the members of the board constitutes a quorum at any meeting.

3. Each member of the board shall receive as compensation, an amount set
by the division not to exceed fifty dollars per day, for each day devoted
to the affairs of the board and may be reimbursed for actual and
necessary expenses incurred in the performance of the member's official
duties. (L. 1996 H.B. 999 § 5)

No rule or portion of a rule promulgated under the authority of
sections 334.800 to 334.930 shall become effective unless it has been
promulgated pursuant to the provisions of section 536.024, RSMo. (L. 1996
H.B. 999 § 7)

An applicant for a license to practice respiratory care may be
issued a license which is valid until the expiration date as determined
by the board after the following requirements have been met:

(1) The applicant submits to the board:

(a) A completed application for licensure;

(b) Written evidence of:

a. Credentials from the certifying entity; or

b. Current licensure or registration as a respiratory care practitioner
in another state, the District of Columbia or territory of the United
States which requires standards for licensure or registration determined
by the board to be equivalent to, or exceed, the requirements for
licensure under sections 334.800 to 334.930;

(c) Payment of any required fees;

(2) The board requests and receives a complete background check and other
information as may be deemed necessary to fulfill sections 334.800 to
334.910;

(3) An applicant who has completed the requirements of subdivision (1) of
this section and has submitted the necessary information for the
background check pursuant to subdivision (2) of this section may obtain a
conditional license to practice as a respiratory care practitioner
pending the outcome of the background check subject to the following
restrictions:

(a) The conditional license shall only be issued if the applicant has
made a prima facie showing that he or she meets all of the requirements
for full licensure;

(b) The conditional license shall only be effective until the board has
had an opportunity to investigate the applicant's qualifications for
licensure pursuant to subdivisions (1) and (2) of this section and to
notify the applicant that his or her application for licensure has been
granted or denied;

(c) If the applicant provides false or misleading information to the
board, the board may automatically terminate the conditional license. If
the board automatically terminates a conditional license, the board shall
notify the holder of the board's decision by certified mail or personal
service;

(d) In no event shall such conditional license be in effect for more than
twelve months after the date of its issuance;

(e) A conditional license shall not be eligible for renewal; and

(f) No fee shall be charged for issuing a conditional license. (L. 1996
H.B. 999 § 8, A.L. 2001 H.B. 567)

1. A license issued pursuant to sections 334.800 to 334.930
shall be renewed biennially, except as provided in sections 334.800 to
334.930. The board shall mail a notice to each person licensed during the
preceding licensing period at least thirty calendar days prior to the
expiration date of the license. The board shall not renew any license
unless the licensee shall provide satisfactory evidence of having
complied with the board's minimum requirements for continuing education.

2. Failure of a licensee to renew his or her license prior to the
expiration of the license shall result in the lapse of the license. A
lapsed license may be reinstated by the board as provided by rule.

3. Each licensee may, in lieu of submitting proof of the completion of
the required continuing education course, apply for an inactive license
at the time of renewal and pay the required inactive fee. An inactive
license shall be renewed biennially. An inactive license may be
reactivated by the board as provided by rule.

4. Any person who practices as a respiratory care practitioner during the
time his or her license is inactive or lapsed shall be considered an
illegal practitioner and shall be subject to the penalties for violation
of the respiratory care practice act. (L. 1996 H.B. 999 § 9, A.L. 1999
H.B. 343, A.L. 2001 H.B. 567)

1. If an applicant submits an application, pays the required
fees and provides documentation that the applicant is enrolled in a
nationally accredited respiratory care educational program and the board
completes a background check, an applicant may be issued an educational
permit to practice respiratory care during the applicant's course of
study and up to a period of six months after the date the applicant
graduates from the program. If the holder of an educational permit issued
pursuant to this section discontinues courseware in the program prior to
graduation, such holder's educational permit shall be automatically
revoked.

2. If an applicant graduates from a nationally accredited respiratory
care educational program but does not obtain an educational permit during
his or her course of study, then upon graduation the applicant may apply
to the board for a temporary permit. If an applicant submits an
application to the board, pays the required fees and the board completes
a background check, the board may issue a one-time temporary permit to
practice respiratory care for a period of six months from the date the
applicant graduated from a nationally accredited respiratory care
educational program. Temporary permits issued to applicants pursuant to
this section shall automatically expire six months after the date the
applicant graduated from a nationally accredited respiratory care
education program or upon issuance or denial of a respiratory care
practitioner license by the board, whichever first occurs.

3. If an applicant submits an application to the board, pays the required
fees and the board completes a background check, the board may issue a
one-time temporary permit to practice respiratory care for a period of
six months from the date the temporary permit is issued by the board.
Such temporary permit shall automatically expire at the end of the six-
month period or upon issuance of a denial of a respiratory care
practitioner license by the board, whichever first occurs. The board may
issue the temporary permit provided by this section if the applicant:

(1) Is a veteran of the United States military services and such
applicant has a minimum of six months' respiratory care experience during
the previous eighteen months as a member of the military and such
experience is verified; or

(2) Is duly licensed as a respiratory care practitioner pursuant to the
laws of another state, the District of Columbia or territory of the
United States, and submits an application for licensure as a respiratory
care practitioner in this state.

4. The holder of an educational or a temporary permit may only perform
and provide such services of a respiratory care practitioner, as defined
in section 334.800, under the direct clinical supervision of a person
licensed as a respiratory care practitioner in this state as set forth by
rule. The holder of a current and valid educational permit or temporary
permit may not represent himself or herself as a respiratory care
practitioner, use the title respiratory care practitioner or use the
abbreviation "R.C.P.". Any holder of an educational permit or a temporary
permit shall show such permit upon request.

5. An applicant who completes the requirements of subsections 1 to 3 of
this section and submits the necessary information for the background
check required by this section may obtain a conditional permit to
practice respiratory care in accordance with the provisions of sections
334.800 to 334.910 pending the outcome of the background check subject to
the following restrictions:

(1) The conditional permit shall only be issued if the applicant has made
a prima facie showing that he or she meets all of the requirements for an
educational permit or temporary permit;

(2) The conditional permit shall only be effective until the board has
had an opportunity to investigate the applicant's qualifications to hold
a permit pursuant to subsections 1 to 3 of this section and to notify the
applicant that his or her application for an educational or temporary
permit has been granted or denied;

(3) If the applicant provides false or misleading information to the
board, the board may automatically terminate the conditional permit. If
the board automatically terminates a conditional permit, the board shall
notify the holder of the board's decision by certified mail or personal
service;

(4) In no event shall such conditional permit be in effect for more than
twelve months after the date of its issuance;

(5) A conditional permit shall not be renewed; and

(6) No fee shall be charged for issuing a conditional permit. (L. 1996
H.B. 999 § 10, A.L. 1999 H.B. 343, A.L. 2001 H.B. 567)

So long as the person involved does not represent or hold
himself or herself out as a respiratory care practitioner as defined in
subdivision (12) of subsection 2 of section 334.800, nothing in sections
334.800 to 334.930 is intended to limit, preclude or otherwise interfere
with:

(1) Self-care by a patient or gratuitous care by a friend or family
member;

(2) Respiratory care rendered, by any provider in the course of emergency
care;

(3) Persons in the military services or working in federal facilities
from performing any activities as described in sections 334.800 to
334.930 during the course of their assigned duties in the military
service or a federal facility;

(4) Persons from engaging in cardiopulmonary research;

(5) Respiratory care rendered in the course of transporting a patient
into or out of the state of Missouri;

(6) The services rendered by state-certified aides, assistants or
technicians as defined in the long-term care facility and licensure law;
or

(7) The practice of respiratory care by:

(a) A licensed health care provider performing a respiratory care
procedure that is within the scope of practice of the licensee;

(b) A licensed health care provider performing a respiratory care
procedure that is not within the scope of practice of the licensee, so
long as the licensee has received special training deemed sufficient by
the board for respiratory care;

(c) A health care provider who is not licensed but is certified or
registered, so long as the provider has received special training or
passed an examination approved by the board for respiratory care;

(8) A person pursuing an accredited course of study leading to a degree
or certificate in respiratory care at an accredited or approved
educational program so long as such person does not provide respiratory
care services outside the educational program. Such person shall be
designated by a title that clearly indicates the person's status as a
student. (L. 1996 H.B. 999 § 11, A.L. 1999 H.B. 343)

Any complaint received by the board concerning a person who is
the holder of a license or permit issued pursuant to sections 334.800 to
334.930 or any complaint regarding any professional practice regulated by
sections 334.800 to 334.930 shall be recorded as received and the date
received. The board:

(1) Shall investigate all complaints concerning alleged violations of the
provisions of sections 334.800 to 334.930 or if there are grounds for the
suspension, revocation or refusal to issue any license or permit. The
board may employ investigators who shall investigate complaints and make
inspections and any inquiries as, in the judgment of the board, are
appropriate to enforce the provisions of sections 334.800 to 334.930;

(2) May issue subpoenas and subpoena duces tecum in order to cause any
licensee, permit holder or any other person to produce records or to
appear as a witness pursuant to any investigation or proceeding conducted
pursuant to the provisions of sections 334.800 to 334.930;

(3) May, in lieu of or in addition to any remedy provided in this
section, file a petition in the name of the state asking a court to issue
a restraining order, an injunction or a writ of mandamus against any
person who is, or has been, violating any of the provisions of sections
334.800 to 334.930 or any lawful rule, order or subpoena of the
department or the board;

(4) May, if the evidence supports such action, cause a complaint to be
filed with the administrative hearing commission as provided in chapter
621, RSMo, against any holder of any license or permit issued pursuant to
sections 334.800 to 334.930. (L. 1996 H.B. 999 § 12, A.L. 1999 H.B. 343)

1. The board may refuse to issue or renew any certificate of
registration or authority, permit or license required pursuant to
sections 334.800 to 334.930 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
his or her right to file a complaint with the administrative hearing
commission as provided by chapter 621, RSMo.

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 sections 334.800 to 334.930 or any person who has failed to
renew or has surrendered his or her certificate of registration or
authority, permit or license for any one or any combination of the
following causes:

(1) Use or unlawful possession 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 a respiratory care
practitioner;

(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 a respiratory care
practitioner, for any offense an essential element 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 sections 334.800 to 334.930 or in obtaining permission to
take any examination given or required pursuant to sections 334.800 to
334.930;

(4) Obtaining or attempting to obtain any fee, charge, tuition or other
compensation by fraud, deception or misrepresentation;

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation
or dishonesty in the performance of the functions and duties of a
respiratory care practitioner;

(6) Violation of, or assisting or enabling any person to violate, any
provision of sections 334.800 to 334.930 or any lawful rule or regulation
adopted pursuant to sections 334.800 to 334.930;

(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) Disciplinary action against the holder of a license or other right to
practice any profession regulated by sections 334.800 to 334.930 granted
by another state, territory, federal agency or country upon grounds for
which revocation or suspension is authorized in this state;

(9) A person if finally adjudged insane or incompetent by a court of
competent jurisdiction;

(10) Assisting or enabling any person to practice or offer to practice as
a respiratory care practitioner who is not registered and currently
eligible to practice pursuant to sections 334.800 to 334.930;

(11) Issuance of a certificate of registration or authority, permit or
license based upon a material mistake of fact;

(12) Violation of any professional trust or confidence;

(13) Use of any advertisement or solicitation which is false, misleading
or deceptive to the general public or persons to whom the advertisement
or solicitation is primarily directed;

(14) Committing unethical conduct as defined in the ethical standards for
respiratory care practitioners adopted by the division and filed with the
secretary of state; or

(15) Violation of the drug laws or rules and regulations of this state,
any other state or the federal government.

3. After the filing of such complaint, 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, censure or place the person named in the
complaint on probation with such terms and conditions as the board deems
appropriate for a period not to exceed five years, or may suspend, for a
period not to exceed three years, or may revoke the license, certificate
or permit.

4. An individual whose license has been revoked shall wait at least one
year from the date of revocation to apply for relicensure. Relicensure
shall be at the discretion of the board after compliance with all
requirements of sections 334.800 to 334.930 relative to the licensing of
the applicant for the first time.

5. Any person who violates any of the provisions of sections 334.800 to
334.930 is guilty of class A misdemeanor. (L. 1996 H.B. 999 § 13, A.L.
1999 H.B. 343)

A respiratory care practitioner may:

(1) In good faith render emergency care or assistance, without
compensation, at the scene of an emergency or accident, and shall not be
liable for any civil damages, for acts or omissions other than damages
occasioned by negligence or by willful or wanton acts or omissions by
such person in rendering such emergency care;

(2) In good faith render emergency care or assistance, without
compensation, to any minor involved in an accident, or in competitive
sports, or other emergency at the scene of an accident, without first
obtaining the consent of the parent or guardian of the minor, and shall
not be liable for any civil damages other than damages occasioned by
negligence or by willful or wanton acts or omissions by such person in
rendering the emergency care. (L. 1996 H.B. 999 § 14)

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