A Brief History of Legislation


  • Attorney General’s Opinion (requested by the Board of Nursing) states that independent prescribing or dispensing medications may not be delegated, however, in general, a nurse should acknowledge the order or direction of a PA as a valid exercise of duty delegated by the physician.


·         Legislation Title 15, enabling the Maryland Medical Practice Act of 1986 (entitling Physician Assistants to practice) was passed.

1991 – House Bill #1199 fails.

  • Delegate David Valderrama, M.D. introduced a bill, which would allow International Medical Graduates to practice as Physician Assistants. The bill was defeated by a MAPA led coalition of physicians, PAs and PA students.

1991 – Senate Bill #501 passes.

  • Senator Mary Boergers sponsored a bill which lengthened the required co-signature on PA diagnostic orders from 24 to 48 hours.

1992 – House Bill #1023 fails.

  • Delegate Valderrama, M.D. again introduces a bill to allow International Medical Graduates to practice as Physician Assistants. MAPA leads a coalition against it. The bill is narrowly defeated.

  • Attorney General Advice of Counsel Memorandum to Health Care states that prescribing activities comprise a subset of medical care and is a therapeutic task which may be legally delegated by a licensed physician to a qualified PA, subject to BPQA approvals.

1993 – House Bill #1136 fails.

  • House Bill was again introduced allowing IMGs to practice as Physician Assistants. The bill failed.

1993 – House Bill #1369 stalls.

  • Emergency legislation was introduced into the Environmental Matters Committee by the BPQA to give PAs limited prescriptive authority. 33 states and DC had prescriptive practice at that time. The legislation made it out of the Committee and the House; it was amended by the Senate to include all practice settings. The House and Senate could not agree and the bill went on to summer study session.

1993 – Senate Bill #513 passes.

·         Nurse Practitioners were given the authority to dispense prescription medications.

 1994 – House Bill #1039 fails.

·         Introduced by delegate David Valderrama, M.D., it allows IMGs to practice as Physician Assistants. The bill did not pass.

1994 – House Bill #1527 fails.

  • The Bill was introduced as a result of the Environmental Matters Committee workgroup to allow PA prescribing in inpatient settings only along with several other restrictions, which MAPA and supervising physicians opposed. MAPA testimony successfully argued for the removal of the restrictions but the bill did not pass.


  • Attorney General Opinion, among the services a PA may perform are “interpreting and evaluating patient data as authorized by the supervising physician for the purpose of determining management and treatment of patients” and “other medical acts permitted to be delegated under an approved job description.” A “medical act” unquestionably includes prescribing medications. A “medical act” refers to acts that are within the scope of the practice of medicine. BPQA has the authority to adopt a regulation specifying the circumstances under which the job descriptions of PAs may include prescribing. After discussions with MAPA, the BPQA-PAAC agreed to discuss the inpatient setting/correctional facilities/health department clinics first, to be followed in approximately nine months after the regulations are in place by the out-patient setting.

  • After an application was submitted applying for the privilege to do telephone screening, the BPQA developed the following policy – “telephone triage may be performed by a PA only for established patients, during regular office hours, when the supervising physician is on site.”


  • Regulations were put together by the BPQA, approved by the AELR committee, published and during the waiting period Med Chi decided that they had not had the opportunity for input into the regulations and went to the Governor’s Office. The Governor’s Office instructed the BPQA to inform Med Chi of the process, but the BPQA renegotiated with Med Chi, which ultimately resulted in a task force comprised of BPQA, MAPA, Med Chi, DHMH and the Attorney General’s Office. These regulations also covered telephone screening. The first meeting of the Task Force to put together legislation for medication order writing in the inpatient setting, correctional facilities and health department clinics.  Emergency regulations were put into effect by the AELR while negotiations continued. Regulations regarding telephone screening were withheld at this time because of continued disagreement over the issue.

1997 – House Bill #1323 passes.

  • An interim on in-patient prescribing bill, HB 1323 was termed Medication Order Writing; it essentially wrote into law the accepted practice of ordering medications in hospitals by PAs that had been taking place for over 20 years (greater than 85% of PAs in Maryland work in hospital settings at that time).

·        Amendments to COMAR 10.07.02 entitled “Comprehensive Care Facilities and Extended Care Facilities” were proposed.

·        Amendments to COMAR 10.07.02 were adopted without opposition. The only changes were those suggested by MAPA.

1998 – House Bill #1094 fails.

  • The companion bill to 1323: authorizing out-patient physician delegated prescriptive authority. This bill did not give blanket prescriptive authority but gave the supervising physician(s) the right to apply for this privilege for their PA.

1998 – Senate Bill #316 passes.

  • This Bill affects the makeup of the BPQA PA Advisory Committee: requiring physicians on that committee to be currently supervising PAs and giving the committee the right to elect its own chairperson, making it possible that a Physician Assistant could chair the committee.

1999 – House Bill #674 passes.

  • Physician delegated prescriptive authority available to physician assistants in the state of Maryland

2000 – House Bill #1324 fails.

·         Required on-site supervision and essentially prevented alternate supervision of physician assistants in the out-patient setting.

2001 – House Bill #1068 fails.

  • Amendments to this bill forced MAPA to “pull the plug” rather than let it pass. Originally a “technical corrections bill”, in its amended form, it severely limited scope of practice and set back recent gains.

House Bill #473 passes but is vetoed by the Governor.

  • While not a PA bill, this legislation gave Nurse Practitioners in HMOs independent practice.

2002 – House Bill #533 passes.

  • The MAPA technical corrections bill passes on its third attempt. It further clarifies questions raised following the passage of HB674.    

2003 – Senate Bill #500 passes.

  • It changes the name and makeup of the Board of Physician Quality Assurance and mandates that a physician assistant will be a voting member of the Board.

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