The proposed rule amendments are intended to clarify the disciplinary guidelines for physician assistants and to address comments submitted by the staff of the Joint Administrative Procedures Committee.

DEPARTMENT OF HEALTH
Board of Osteopathic Medicine

RULE NO.: RULE TITLE:
64B15-6.011: Disciplinary Guidelines
PURPOSE AND EFFECT: The proposed rule amendments are intended to clarify the disciplinary guidelines for physician assistants and to address comments submitted by the staff of the Joint Administrative Procedures Committee.
SUMMARY: The proposed rule amendments set forth violations and the range of disciplinary guidelines for the violations with regard to physician assistants.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:
The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.
The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: During discussion of the economic impact of this rule at its Board meeting, the Board, based upon the expertise and experience of its members, determined that a Statement of Estimated Regulatory Costs (SERC) was not necessary and that the rule will not require ratification by the Legislature. No person or interested party submitted additional information regarding the economic impact at that time.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
RULEMAKING AUTHORITY: 456.079, 459.015(5) FS.
LAW IMPLEMENTED: 456.072, 456.079, 459.015(5), 459.022(4)(e)1., (7)(f) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Anthony Jusevitch, Executive Director, Board of Osteopathic Medicine/MQA, 4052 Bald Cypress Way, Bin #C06, Tallahassee, Florida 32399-3256

THE FULL TEXT OF THE PROPOSED RULE IS:

64B15-6.011 Disciplinary Guidelines.

(1) No change.

(2) Violations and Range of Penalties. In imposing discipline upon physician assistant applicants and licensees, in proceedings pursuant to Sections 120.57(1) and (2), F.S., the Board shall act in accordance with the following disciplinary guidelines and shall impose a penalty within the range corresponding to the violations set forth below. The verbal identification of offenses are descriptive only; the full language of each statutory provision cited must be consulted in order to determine the conduct included.

 

 

 

 

VIOLATIONS		RECOMMENDED PENALTIES
		First Offense	Subsequent Offenses
(a) Attempting to obtain a license or certificate by bribery, fraud or through an error of the Department or the Board. (Section 459.015(1)(a), F.S.); (Section 456.072(1)(h), F.S.)
1. No change.
2. Attempting to renew a license by bribery or fraud.	2. Revocation of the license and payment of a $5,000.00 fine to revocation and a $10 ,000.00 fine.		2. Revocation and a $10,000.00 fine.
3. Obtaining or renewing a license by bribery or fraud.	3. Revocation of the license and payment of a $5,000.00 fine to revocation and a $10 ,000.00 fine.		3. Revocation and a $10,000.00 fine.
4. Obtaining or renewing a license through error of the Department or the Board.	4. Revocation.		4. Revocation.
(b) Action taken against license by another jurisdiction. (Section 459.015(1)(b), F.S.); (Section 456.072(1)(f), F.S.)		(b) From imposition of discipline comparable to the discipline which would have been imposed if the substantive violation had occurred in Florida to reprimand through suspension or denial of the license until the license is unencumbered in the jurisdiction in which disciplinary action was originally taken and an administrative fine ranging from $1,000.00 to $2,500.00.	(b) From imposition of discipline comparable to the discipline which would have been imposed if the substantive violation had occurred in Florida to suspension and revocation or denial of the license until the license is unencumbered in the jurisdiction in which disciplinary action was originally taken, and an administrative fine ranging from $2,500.00 to $5,000.00.
1. Action taken against license by another jurisdiction relating to healthcare fraud in dollar amounts in excess of $5,000.00.		1. Revocation and an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, or in the case of application for licensure, denial of licensure.	1. From revocation and an administrative fine ranging from $2,500.00 to $5,000.00, or in the case of application for licensure, denial of licensure.
2. Action taken against license by another jurisdiction relating to healthcare fraud in dollar amounts of $5,000.00 or less.		2. From an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, 100 hours of community service, and a reprimand through suspension of the license, or in the case of application for licensure, denial of licensure.	2. From an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, 200 hours of community service, and suspension of the license, followed by a period of probation to revocation, or in the case of application for licensure, denial of licensure.
(c) Guilt of crime directly relating to practice or ability to practice. (Section 459.015(1)(c), F.S.); (Section 456.072(1)(c), F.S.)		(c) From reprimand to revocation or denial of license, and an administrative fine of $1,000.00 to $5,000.00, and 50 to 100 hours of community service.	(c) From probation to revocation or denial of the license, and an administrative fine ranging from $2,500.00 to $5,000.00, and from 100 to 200 hours of community service.
1. Involving a crime directly related to healthcare fraud in dollar amounts in excess of $5,000.00.		1. Revocation and an administrative fine of $10,000.00 ranging from $5,000.00 to $10,000.00, or in the case of application for licensure, denial of licensure.
2. Involving a crime directly related to healthcare fraud in dollar amounts of $5,000.00 or less.		2. From an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, 100 hours of community service, and a reprimand through suspension of the license, or in case of application for licensure, denial of licensure.	2. From an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, 200 hours of community service, and suspension of the license, followed by a period of probation to revocation, or in case of application for licensure, denial of licensure.
(d) False, deceptive, or misleading advertising. (Section 459.015(1)(d), F.S.)		(d) From a letter of concern to reprimand, or denial of licensure, and an administrative fine ranging from $1,000.00 to $2,500.00, and 50 to 100 hours of community service.	(d) From a letter of concern to reprimand or denial of licensure, and an administrative fine ranging from $1,000.00 to $2,500.00, and 100 to 200 hours of community service.
(e) Failure to report another licensee in violation. (Section 459.015(1)(e), F.S.); (Section 456.072(1)(i), F.S.)		(e) From a letter of concern to probation, an administrative fine ranging from $1,000.00 to $2,500.00, 25 to 50 hours of community service, or denial of licensure.	(e) From reprimand to suspension or denial of licensure, and an administrative fine from $2,500.00 to $5,000.00 and 50 to 100 hours of community service.
(f) Aiding unlicensed practice. (Section 459.015(1)(f), F.S.); (Section 456.072(1)(j), F.S.)		(f) From reprimand to suspension, followed by probation, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00.	(f) From probation to revocation or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00.
(g) Failure to perform legal obligation. (Section 459.015(1)(g), F.S.); (Section 456.072(1)(k), F.S.)		(g) For any offense not specifically listed herein, based upon the severity of the offense and the potential for patient harm, from a reprimand to revocation or denial of licensure, 50 hours of community service, and an administrative fine from $1,000.00 to $5,000.00.	(g) For any offense not specifically listed herein, based upon the severity of the offense and the potential for patient harm, from a reprimand to revocation or denial, from 50 to 100 hours of community service, and an administrative fine from $2,500.00 to $5,000.00.
1. Continuing medical education (CME) violations. (Section 456.072(1)(e), F.S.); (Section 456.072(1)(s), F.S.); (Section 456.033(9), F.S.)		1. Document compliance with the CME requirements for the relevant period; AND:	1. Document compliance with the CME requirements for the relevant period; AND:
a. Failure to document required HIV/ AIDS, or end of life care, or palliative health care.		a. An administrative fine ranging from $250.00 to $500.00.	a. An administrative fine ranging from $500.00 to $1,000.00.
b. Failure to document required domestic violence CME or substitute end-of-life-care CME.		b. An administrative fine ranging from $250.00 to $500.00.	b. An administrative fine of $500.00 to $1,000.00.
c. Failure to document required HIV/AIDS, or end-of-life-care, or palliative health care, and failure to document domestic violence CME.		c. An administrative fine ranging from $500.00 to $1,000.00.	c. An administrative fine ranging from $1,000.00 to $2,000.00.
2. No change.
3. Failing to disclose financial interest to patient. (Section 456.052, F.S.)		3. A refund of fees paid by or on behalf of the patient and from an administrative fine of $1,000.00, 50 hours of community service to a reprimand, 100 hours of community service and an administrative fine of $2,500.00.	3. A refund of fees paid by or on behalf of the patient and from a reprimand, 100 hours of community service and an administrative fine of $2,500.00 to a reprimand, 200 hours of community service and an administrative fine of $5,000.00.
(h) No change.
1. Relating to healthcare fraud in dollar amounts in excess of $5,000.00.		1. Revocation and an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, or in the case of application for licensure, denial of licensure.
2. Relating to healthcare fraud in dollar amounts of $5,000.00 or less.		2. An From an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, 50 to 100 hours of community service, and a reprimand through suspension of the license, or in case of application for licensure, denial of licensure.	2. An From an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, 100 to 200 hours of community service, and suspension of the license, followed by a period of probation to revocation, or in case of application for licensure, denial of licensure.
(i) Kickbacks or split fee arrangements. (Section 459.015(1)(j), F.S.)		(i) A refund of fees paid by or on behalf of the patient from a reprimand and an administrative fine of $1,000.00, 25 to 50 hours of community service to a reprimand and an administrative fine of $5,000.00, or denial of licensure.	(i) A refund of fees paid by or on behalf of the patient, 50 to 100 hours of community service, from suspension to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(j) Sexual Misconduct. (Section 459.015(1)(l), F.S.); (Section 456.072(1)(v), F.S.)		(j) From probation to revocation, or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00.	(j) From suspension, to be followed by a period of probation to revocation, 100 to 200 hours of community service or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(k) Deceptive, untrue, or fraudulent representations in the practice of osteopathic medicine. (Section 459.015(1)(m), F.S.); (Sections 456.072(1)(a), (m), F.S.)		(k) From a letter of concern, and 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00.	(k) From probation or denial of licensure, 50 to 100 hours of community service, and an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00 to revocation.
1. Deceptive, untrue, or fraudulent representations in the practice of osteopathic medicine relating to healthcare fraud in dollar amounts in excess of $5,000.00.		1. From revocation with leave to reapply in three (3) years, and an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, or in the case of application for licensure, denial of licensure.	1. From permanent revocation and an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, or in the case of application for licensure, denial of licensure.
2. Deceptive, untrue, or fraudulent representations in the practice of osteopathic medicine relating to healthcare fraud in dollar amounts of $5,000.00 or less.		2. An From an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, 50 to 100 hours of community service, and a reprimand through suspension of the license, or in case of application for licensure, denial of licensure.	2. An From an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, and suspension of the license, followed by a period of probation to revocation, 100 to 200 hours of community service, or in case of application for licensure, denial of licensure.
(l) Improper solicitation of patients. (Section 459.015(1)(n), F.S.)		(l) From an administrative fine ranging from $1,000.00 to $5,000.00, 100 to 200 hours of community service, and a reprimand to probation, or denial of licensure.	(l) From suspension, to be followed by a period of probation, 50 to 100 hours of community service, to revocation or denial of licensure, and an administrative fine from $2,500.00 to $5,000.00.
(m) Failure to keep legible written medical records. (Section 459.015(1)(o), F.S.)		(m) From letter of concern, 25 to 50 hours of community service to a reprimand, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00.	(m) From a reprimand to suspension followed by probation, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00, or denial of licensure.
1. Failure to keep legible written medical records relating to healthcare fraud in dollar amounts in excess of $5,000.00.		1. From revocation with leave to reapply in three (3) years, and an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, or in the case of application for licensure, denial of licensure.	1. From permanent revocation and an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, or in the case of application for licensure, denial of licensure.
2. Failure to keep legible written medical records relating to healthcare fraud in dollar amounts of $5,000.00 or less.		2. An From an administrative fine of $10,000.00 ranging from $1,000.00 to $5,000.00, and a reprimand, 50 to 100 hours of community service to suspension of the license, or in case of application for licensure, denial of licensure.	2. An From an administrative fine of $10,000.00 ranging from $2,500.00 to $5,000.00, and suspension of the license, followed by a period of probation, 100 to 200 hours of community service, to revocation, or in case of application for licensure, denial of licensure.
(n) Exercising influence on patient for financial gain. (Section 459.015(1)(q), F.S.); (Section 456.072(1)(n), F.S.)		(n) Payment of fees paid by or on behalf of the patient and from a reprimand, 20 to 50 hours of community service to probation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.	(n) Payment of fees paid by or on behalf of the patient and from probation, 50 to 100 hours of community service, to suspension, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(o) Improper advertising of pharmacy. (Section 459.015(1)(r), F.S.)		(o) From a letter of concern to probation, or a denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $250.00 to $2,500.00.		(o) From a reprimand, 50 to 100 hours of community service, and an administrative fine of $2,500.00 to probation, and an administrative fine from $2,500.00 to $5,000.00, or denial of licensure.
(p) Performing professional services not authorized by patient. (Section 459.015(1)(s), F.S.)		(p) From a letter of concern, 25 to 50 hours of community service, to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00.		(p) From a reprimand, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(q) Inappropriate or excessive prescribing. (Section 459.015(1)(t), F.S.)		(q) From reprimand to probation, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00, or denial of licensure.		(q) From probation, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(r) Prescribing, dispensing, administering of a scheduled drug by the physician assistant to himself or herself. (Section 459.015(1)(u), F.S.)		(r) From probation to suspension or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $2,500.00.		(r) From suspension, 50 to 100 hours of community service, to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(s) Use of amygdalin (laetrile). (Section 459.015(1)(v), F.S.)		(s) From a reprimand to probation, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $2,500.00.		(s) From suspension to be followed by a period of probation to revocation or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00.
(t) Inability to practice osteopathic medicine with skill and safety. (Section 459.015(1)(w), F.S.)		(t) From reprimand to suspension, which may be stayed to allow a period of probation with supervision, and a demonstration by the licensee of the ability to practice with reasonable skill and safety, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $2,500.00.		(t) From probation to revocation, until the licensee is able to demonstrate ability to practice with reasonable skill and safety, followed by probation, or denial of licensure, 50 to 100 hours of community service, and an administrative fine from $2,500.00 to $5,000.00.
(u)1. Malpractice: practicing below acceptable standard of care. (Section 459.015(1)(x), F.S.)		(u)1. From a letter of concern, 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00.		(u)1. From reprimand, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
2. Gross Malpractice		2. From a probation, 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $2,500.00.		2. From suspension followed by probation to revocation or denial, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00.
3. No change.
(v) Performing of experimental treatment without informed consent. (Section 459.015(1)(y), F.S.)		(v) From a letter of concern to suspension, to be followed by a period of probation, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00		(v) From suspension to be followed by a period of probation, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(w) No change.
(x) Delegation of professional responsibilities to unqualified person. (Section 459.015(1)(aa), F.S.); (Section 456.072(1)(p), F.S.)		(x) From reprimand to suspension, followed by probation, 25 to 50 hours of community service, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00.		(x) From probation, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(y)1. Violation of law, rule, or failure to comply with subpoena. (Section 459.015(1)(bb), F.S.); (Sections 456.072(1)(b), (q), F.S.)		(y)1. For any offense not specifically listed herein, based upon the severity of the offense and the potential for patient harm, from a reprimand to revocation, or denial of licensure, 25 to 100 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00.		(y)1. From probation, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
2. Violation of an order of the Board.		2. From a reprimand and suspension followed by a period of probation, 25 to 50 hours of community service, and an administrative fine of $1,000.00 to a reprimand and suspension followed by a period of probation and an administrative fine of $5,000.00.		2. From a reprimand and suspension followed by a period of probation, 50 to 150 hours of community service, and an administrative fine of $2,500.00 to a reprimand and suspension followed by a period of probation and an administrative fine of $5,000.00 and probation.
(z) Conspiring to restrict another from lawfully advertising services. (Section 459.015(1)(cc), F.S.)		(z) From a letter of concern to a reprimand, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $2,500.00.		(z) From a reprimand, 50 to 100 hours of community service, and an administrative fine of $2,500.00 to a reprimand and an administrative fine of $5,000.00.
(aa) Aiding an unlawful abortion. (Section 459.015(1)(dd), F.S.)		(aa) From probation, 25 to 50 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $1,000.00 to $5,000.00.		(aa) From suspension, to be followed by a period of probation, 50 to 100 hours of community service, to revocation or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(bb) Presigning prescription forms. (Section 459.015(1)(ee), F.S.)		(bb) From a letter of concern to a reprimand and an administrative fine of $1,000.00 to a letter of concern and an administrative fine of $2,500.00.		(bb) From a reprimand to probation, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00.
(cc) Improperly interfering with an investigation or a disciplinary procedure. (Section 459.015(1)(kk), F.S.); (Section 456.072(1)(r), F.S.)		(cc) From a reprimand to probation, 25 to 50 hours of community service, or denial of licensure, and an administrative fine ranging from $1,000.00 to $2,500.00.		(cc) From probation, 50 to 100 hours of community service to revocation, or denial of licensure without ability to re-apply, and an administrative fine ranging from $2,500.00 to $5,000.00.
(dd) Failing to report any M.D., D.O., or PA, who is in violation of law. (Section 459.015(1)(ll), F.S.); (Section 456.072(1)(i), F.S.)		(dd) From a letter of concern to probation, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $2,500.00.		(dd) From probation to revocation or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00.
(ee) Failure to adequately supervise assisting personnel. (Section 459.015(1)(hh), F.S.)		(ee) From a reprimand to probation, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $2,500.00.		(ee) From probation to suspension followed by probation, or denial of licensure, 50 to 100 hours of community service, and an administrative fine ranging from $2,500.00 to $5,000.00.
(ff) Improper use of substances for muscle building or enhancement of performance. (Section 459.015(1)(ii), F.S.)		(ff) From a reprimand to suspension, or denial of licensure, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00.		(ff) From suspension to be followed by a period of probation, to revocation or denial of licensure, 50 to 100 hours of community service and an administrative fine ranging from $1,000.00 to $5,000.00.
(gg) Misrepresenting or concealing a material fact during disciplinary or licensure procedure. (Section 459.015(1)(jj), F.S.)		(gg) From a reprimand to probation, and an administrative fine ranging from $500.00 to $2,500.00, 25 to 50 hours of community service, or the denial of licensure with the ability to reapply, upon payment of a $500.00 fine.		(gg) From probation, 50 to 100 hours of community service to revocation, or denial of licensure without the ability to reapply, and an administrative fine ranging from $500.00 to $5,000.00.
(hh) No change.
(ii) Violating Chapters 459, 456, F.S., or any rules adopted pursuant thereto. (Section 459.015(1)(pp), F.S.)	(ii) From a reprimand, 25 to 100 hours of community service, to revocation or denial and an administrative fine from $1,000.00 to $5,000.00.			(ii) From probation, 100 to 200 hours of community service; to revocation or denial and an administrative fine from $5,000.00 to $10,000.00.
(jj) No change.
(kk) Performing or attempting to perform health care services on the wrong patient, a wrong site procedure, a wrong procedure, or an unauthorized procedure or a procedure that is medically unnecessary or otherwise unrelated to the patient’s diagnosis or medical condition. (Section 456.072(1)(bb), F.S.)	(kk) From a $1,000.00 fine, a letter of concern, a minimum of five (5) hours of risk management education, and one (1) hour lecture on wrong-site surgery in the State of Florida to a $5,000.00 fine, a letter of concern, a minimum of five (5) hours of risk management education, 50 to 100 hours of community service, undergo a risk management assessment, a one (1) hour lecture on wrong-site surgery, and suspension to be followed by a term of probation.			(kk) From a $7,500.00 fine, a reprimand, 100 to 200 hours of community service, and probation or denial to a $10,000.00 fine and revocation.
(ll) Leaving a foreign body in a patient, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures. (Section 456.072(1)(cc), F.S.)	(ll) From a $1,000.00 to a $5,000.00 fine, a letter of concern, a minimum of five (5) hours of risk management education, 50 to 100 hours of community service, and a one hour lecture to the staff of a Florida licensed healthcare facility on retained foreign body objects to revocation.			(ll) From a $7,500.00 fine, a reprimand and probation, 100 to 200 hours of community service, or denial to revocation.
(mm) Engaging in a pattern of practice when prescribing medicinal drugs or controlled substances which demonstrates a lack of reasonable skill or safety to patients. (Section 456.072(1)(gg), F.S.)	(mm) From reprimand to probation, 25 to 50 hours of community service, and an administrative fine ranging from $1,000.00 to $5,000.00, or denial of licensure.			(mm) From probation, 50 to 100 hours of community service to revocation, or denial of licensure, and an administrative fine ranging from $2,500.00 to $5,000.00.
(nn) through (rr) No change.

(3) through (4) No change.

Rulemaking Authority 456.079, 459.015(5) FS. Law Implemented 456.072, 456.079, 459.015(5), 459.022(4)(e)1., (7)(f) FS. History– New 4-18-89, Formerly 21R-6.011, Amended 11-4-93, Formerly 61F9-6.011, 59W-6.011, Amended 6-7-98, 4-9-01, 7-13-03, 5-16-10, ________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Council on Physician Assistants
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Osteopathic Medicine
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 4, 2011
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: January 6, 2012