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An Act
ENROLLED HOUSE
BILL NO. 4430 By: Hilbert and Deck of the
House
and
Rosino of the Senate
An Act relating to medical malpractice; amending 59
O.S. 2021, Section 519.6, as amended by Section 5,
Chapter 343, O.S.L. 2025 (59 O.S. Supp. 2025, Section
519.6), which relates to license required,
supervision, and practice agreements within the
Physician Assistant Act; amending Section 2, Chapter
340, O.S.L. 2025 (59 O.S. Supp. 2025, Section
567.5b), which relates to Advanced Practice
Registered Nurse malpractice insurance requirements;
providing for compliance; and providing an effective
date.
SUBJECT: Medical malpractice
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 59 O.S. 2021, Section 519.6, as
amended by Section 5, Chapter 343, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 519.6), is amended to read as follows:
Section 519.6. A. No health care services may be performed by
a physician assistant unless a current license is on file with and
approved by the State Board of Medical Licensure and Supervision.
B. A physician assistant with six thousand two hundred forty
(6,240) or more hours of postgraduate clinical practice experience
who has reported those hours to the Board shall not be required to
practice under the supervision of a delegating physician.
ENR. H. B. NO. 4430 Page 2
1. A physician assistant may report the completion of
postgraduate clinical practice experience to the Board at any time
after completion of at least six thousand two hundred forty (6,240)
such hours.
2. Hours earned prior to the effective date of this act shall
be counted towards the six thousand two hundred forty (6,240) hours.
3. The Board shall maintain, make available, and keep updated,
on the Internet website of the Board, a list of physician assistants
who have reported completion of six thousand two hundred forty
(6,240) or more postgraduate clinical practice experience hours.
4. The Board shall prescribe a form for reporting postgraduate
clinical practice experience by a physician assistant. The Board
shall make available and keep updated on the Internet website of the
Board the prescribed form. This reporting form may be filed
electronically. The Board shall not charge a fee for reporting
hours or filing of the prescribed form.
5. Nothing in this subsection shall prohibit a physician
assistant from maintaining a practice agreement; however, such an
agreement is not required for a physician assistant with the
reported six thousand two hundred forty (6,240) hours of
postgraduate clinical practice experience, provided any practice
agreements are subject to the requirements of paragraphs 1, 2, 3,
and 4 of subsection C of this section.
6. Nothing in this subsection shall restrict the ability of the
Board to require supervision as a part of disciplinary action
against the license of a physician assistant.
C. A physician assistant with less than six thousand two
hundred forty (6,240) hours of postgraduate clinical practice
experience or who has completed six thousand two hundred forty
(6,240) hours but has not reported those hours to the Board shall
practice under the supervision of a delegating physician with the
following requirements:
1. All practice agreements and any amendments shall be filed
with the State Board of Medical Licensure and Supervision within ten
(10) business days of being executed. Practice agreements may be
filed electronically. The State Board of Medical Licensure and
Supervision shall not charge a fee for filing practice agreements or
amendments to practice agreements;
ENR. H. B. NO. 4430 Page 3
2. A physician assistant may have practice agreements with
multiple allopathic or osteopathic physicians. Each physician shall
be in good standing with the State Board of Medical Licensure and
Supervision or the State Board of Osteopathic Examiners;
3. The delegating physician need not be physically present nor
be specifically consulted before each delegated patient care service
is performed by a physician assistant, so long as the delegating
physician and physician assistant are or can be easily in contact
with one another by means of telecommunication. The delegating
physician shall provide appropriate methods of participating in
health care services provided by the physician assistant including:
a. being responsible for the formulation or approval of
all orders and protocols, whether standing orders,
direct orders or any other orders or protocols, which
direct the delivery of health care services provided
by a physician assistant, and periodically reviewing
such orders and protocols,
b. regularly reviewing the health care services provided
by the physician assistant and any problems or
complications encountered,
c. being available physically or through telemedicine or
direct telecommunications for consultation, assistance
with medical emergencies or patient referral,
d. reviewing a sample of outpatient medical records.
Such reviews shall take place at a site agreed upon
between the delegating physician and physician
assistant in the practice agreement which may also
occur using electronic or virtual conferencing, and
e. that it remains clear that the physician assistant is
an agent of the delegating physician; but, in no event
shall the delegating physician be an employee of the
physician assistant;
4. In patients with newly diagnosed complex illnesses, the
physician assistant shall contact the delegating physician within
forty-eight (48) hours of the physician assistant's initial
examination or treatment and schedule the patient for appropriate
evaluation by the delegating physician as directed by the physician.
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The delegating physician shall determine which conditions qualify as
complex illnesses based on the clinical setting and the skill and
experience of the physician assistant.
D. A physician assistant not practicing under a practice
agreement may prescribe written and oral prescriptions and orders.
The physician assistant not practicing under a practice agreement
may prescribe medical supplies, services, and drugs, including
controlled medications in Schedules III through V pursuant to
Section 2-312 of Title 63 of the Oklahoma Statutes. Physician
assistants not practicing under a practice agreement may not
dispense drugs, but may request, receive, and sign for professional
samples and may distribute professional samples to patients.
E. A physician assistant practicing under a practice agreement
may prescribe written and oral prescriptions and orders. The
physician assistant practicing under a practice agreement may
prescribe medical supplies, services, and drugs, including
controlled medications in Schedules II through V pursuant to Section
2-312 of Title 63 of the Oklahoma Statutes, written and oral
prescriptions and orders only as delegated by the delegating
physician, and prescriptions and orders for Schedule II drugs
written by such physician assistant shall be included on a written
protocol determined by the delegating physician. Physician
assistants practicing under a practice agreement may not dispense
drugs, but may request, receive, and sign for professional samples
and may distribute professional samples to patients. Provided that
a physician assistant practicing under a practice agreement may not
prescribe any controlled medications in a Schedule that the
delegating physician is not registered to prescribe.
F. Each physician assistant licensed under the Physician
Assistant Act shall keep his or her license available for inspection
at the primary place of business and shall, when engaged in
professional activities, identify himself or herself as a physician
assistant.
G. A physician assistant shall be bound by the provisions
contained in Sections 725.1 through 725.5 of this title.
H. 1. A physician assistant not practicing under a practice
agreement, or the employer of such physician assistant on his or her
behalf, shall carry malpractice insurance or demonstrate proof of
financial responsibility in a minimum amount of One Million Dollars
($1,000,000.00) per occurrence and Three Million Dollars
ENR. H. B. NO. 4430 Page 5
($3,000,000.00) in the aggregate per year. This requirement shall
not apply to a physician assistant practicing under a practice
agreement.
2. A physician assistant who is employed by or under contract
with a federal agency that carries malpractice insurance in any
amount on behalf of the physician assistant shall be deemed in
compliance with paragraph 1 of this subsection when practicing under
such federal employment or contract. However, to the extent the
physician assistant practices outside of such federal employment or
contract, the physician assistant, or his or her employer, shall
comply with paragraph 1 of this subsection.
3. A physician assistant who is employed by a state agency or
facility that is covered by or subject to The Governmental Tort
Claims Act, Section 151 et seq. of Title 51 of the Oklahoma
Statutes, shall be deemed in compliance with paragraph 1 of this
subsection when practicing under such state employment. However, to
the extent the physician assistant practices outside of such state
employment, the physician assistant shall comply with paragraph 1 of
this subsection.
SECTION 2. AMENDATORY Section 2, Chapter 340, O.S.L.
2025 (59 O.S. Supp. 2025, Section 567.5b), is amended to read as
follows:
Section 567.5b. A. An Advanced Practice Registered Nurse, or
the employer of the Advanced Practice Registered Nurse on his or her
behalf, shall carry malpractice insurance or demonstrate proof of
financial responsibility in a minimum amount of One Million Dollars
($1,000,000.00) per occurrence and Three Million Dollars
($3,000,000.00) in the aggregate per year. This requirement shall
apply only to the Advanced Practice Registered Nurse and shall not
be construed as to require the Advanced Practice Registered Nurse to
provide malpractice insurance coverage to any supervising physician.
B. An Advanced Practice Registered Nurse who is employed by or
under contract with a federal agency that carries malpractice
insurance in any amount on behalf of the Advanced Practice
Registered Nurse shall be deemed in compliance with subsection A of
this section when practicing under such federal employment or
contract. However, to the extent the Advanced Practice Registered
Nurse practices outside of such federal employment or contract, the
Advanced Practice Registered Nurse, or his or her employer, shall
comply with subsection A of this section.
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C. An Advanced Practice Registered Nurse who is employed by a
state agency or facility that is covered by or subject to The
Governmental Tort Claims Act, Section 151 et seq. of Title 51 of the
Oklahoma Statutes, shall be deemed in compliance with subsection A
of this section when practicing under such state employment.
However, to the extent the Advanced Practice Registered Nurse
practices outside of such state employment, the Advance Practice
Registered Nurse shall comply with subsection A of this section.
SECTION 3. This act shall become effective November 1, 2026.
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Passed the House of Representatives the 23rd day of March, 2026.
Presiding Officer of the House
of Representatives
Passed the Senate the 29th day of April, 2026.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________