Required Reading |
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Excerpts from the Laws and Regulations
For complete PA regulations click here The Physician Assistant Practice Act Excerpted from the CHAPTER 7.7. PHYSICIAN ASSISTANTS Section
Legislative Intent The purpose of this chapter is to encourage the more effective utilization of the skills of physicians, and physicians and podiatrists practicing in the same medical group practice, by enabling them to delegate health care tasks to qualified physician assistants where this delegation is consistent with the patient’s health and welfare and with the laws and regulations relating to physician assistants. This chapter is established to encourage the utilization of physician assistants
by physicians, and by physicians and podiatrists practicing in the same medical
group, and to provide that existing legal constraints should not be an unnecessary
hindrance to the more effective provision of health care services. It is
also the purpose of this chapter to allow for innovative development of programs
for the education, training, and utilization of physician assistants. Title Definitions (a) ‘‘Board’’ means the Division of Licensing of the Medical Board of California. (b) ‘‘Approved program’’ means a program for the education of physician assistants which has been formally approved by the committee. (c) ‘‘Trainee’’ means a person who is currently enrolled in an approved program. (d) ‘‘Physician assistant’’ means a person who meets the requirements of this chapter and is licensed by the committee. (e) ‘‘Supervising physician’’ means a physician and surgeon licensed by the board or by the Osteopathic Medical Board of California who supervises one or more physician assistants, who possesses a current valid license to practice medicine, and who is not currently on disciplinary probation for improper use of a physician assistant. (f) ‘‘Supervision’’ means that a licensed physician and surgeon oversees the activities of, and accepts responsibility for, the medical services rendered by a physician assistant. (g) ‘‘Committee’’ or ‘‘examining committee’’ means the Physician Assistant Committee. (h) ‘‘Regulations’’ means the rules and regulations as contained in Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the California Code of Regulations. (i) ‘‘Routine visual screening’’ means uninvasive
nonpharmacological simple testing for visual acuity, visual field defects,
color blindness, and depth perception. Services those medical services as set forth by the regulations of the board when the services are rendered under the supervision of a licensed physician and surgeon or of physicians and surgeons approved by the board, except as provided in Section 3502.5. (b) Notwithstanding any other provision of law, a physician assistant performing medical services under the supervision of a physician and surgeon may assist a doctor of podiatric medicine who is a partner, shareholder, or employee in the same medical group as the supervising physician. A physician assistant who assists a doctor of podiatric medicine pursuant to this subdivision shall do so only according to patient-specific orders from the supervising physician and surgeon. The supervising physician and surgeon shall be physically available to the physician assistant for consultation when such assistance is rendered. A physician assistant assisting a doctor of podiatric medicine shall be limited to performing those duties included within the scope of practice of a doctor of podiatric medicine. (c) No medical services may be performed under this chapter in any of the following areas: (1) The determination of the refractive states of the human eye, or the fitting or adaptation of lenses or frames for the aid thereof. (2) The prescribing or directing the use of, or using, any optical device in connection with ocular exercises, visual training or orthoptics. (3) The prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the human eye. (4) The practice of dentistry or dental hygiene or the work of a dental auxiliary as defined in Chapter 4 (commencing with Section 1600). (d) This section shall not be construed in a manner that shall preclude
the performance of routine visual screening as defined in Section 3501. Prescription Transmittal Authority (1) A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions. (2) Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. The drugs listed shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon. (b) ‘‘Drug order’’ for purposes of this section means an order for medication which is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. -Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to ‘‘prescription’’ in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code. (c) A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician before it is filled or carried out. (1) A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist. (2) A physician assistant may not administer, provide or issue a drug order for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for the particular patient. (3) Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeon’s practice. (d) A written drug order issued pursuant to subdivision (a), except a written drug order in a patient’s medical record in a health facility or medical practice, shall contain the printed name, address, and phone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patient’s medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant. The requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeon’s prescription blank to show the name, license number, and if applicable, the federal controlled substances number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon. (e) The medical record of any patient cared for by a physician assistant for whom the supervising physician and surgeon’s Schedule II drug order has been issued or carried out shall be reviewed and countersigned and dated by a supervising physician and surgeon within seven days. (f) All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA). (g) The committee shall consult with the Medical Board of California and
report during its sunset review required by Division 1.2 (commencing with
Section 473) the impacts of exempting Schedule III and Schedule IV drug orders
from the requirement for a physician and surgeon to review and countersign
the affected medical record of a patient. State of Emergency No responsible official or mutual aid operation plan shall invoke this
section except in the case of an emergency that endangers the health of individuals.
Under no circumstances shall this section be invoked as the result of a labor
dispute or other dispute concerning collective bargaining. Limitation Immunity from Liability (b) This section shall not be construed to grant immunity from civil damages to any person whose conduct in rendering emergency care is grossly negligent. (c) In addition to the immunity specified in subdivision (a), the provisions of Article 17 (commencing with Section 2395) of Chapter 5 shall apply to a person licensed
under this chapter when acting pursuant to delegated authority from an approved
supervising physician. California Code of Regulations NOTE: Authority cited: Section 3510, Business and Professions Code. Reference: Sections 3509 and 3513, Business and Professions Code.HISTORY: 1. Renumbering and amendment of former section 1399.528 to section 1399.539 filed 9-20-83; effective thirtieth day thereafter (Register 83,No. 39). Article 4. Practice of Physician Assistants
1399.540. Limitation on Medical Services. 1399.541. Medical Services Performable. (a) Take a patient history; perform a physical examination and make an assessment and diagnosis therefrom; initiate, review and revise treatment and therapy plans including plans for those services described in Section 1399.541(b) through Section 1399.541(i) inclusive; and record and present pertinent data in a manner meaningful to the physician. (b) Order or transmit an order for x-ray, other studies, therapeutic diets, physical therapy, occupational therapy, respiratory therapy, and nursing services. (c) Order, transmit an order for, perform, or assist in the performance of laboratory procedures, screening procedures and therapeutic procedures. (d) Recognize and evaluate situations which call for immediate attention of a physician and institute, when necessary, treatment procedures essential for the life of the patient. ( e) Instruct and counsel patients regarding matters pertaining to their physical and mental health. Counseling may include topics such as medications, diets, social habits, family planning, normal growth and development, aging, and understanding of and long-term management of their diseases. (f) Initiate arrangements for admissions, complete forms and charts pertinent to the patient’s medical record, and provide services to patients requiring continuing care, including patients at home. (g) Initiate and facilitate the referral of patients to the appropriate health facilities, agencies, and resources of the community. (h) Administer medication to a patient, or transmit orally, or in writing on a patient’s record, a prescription from his or her supervising physician to a person who may lawfully furnish such medication or medical device. The supervising physician’s prescription, transmitted by the physician assistant, for any patient cared for by the physician assistant, shall be based either on a patient-specific order by the supervising physician or on written protocol which specifies all criteria for the use of a specific drug or device and any contraindications for the selection. A physician assistant shall not provide a drug or transmit a prescription for a drug other than that drug specified in the protocol, without a patient-specific order from a supervising physician. At the direction and under the supervision of a physician supervisor, a physician assistant may hand to a patient of the supervising physician a properly labeled prescription drug prepackaged by a physician, a manufacturer, as defined in the Pharmacy Law, or a pharmacist. In any case, the medical record of any patient cared for by the physician assistant for whom the physician’s prescription has been transmitted or carried out shall be reviewed and countersigned and dated by a supervising physician within seven (7) days. A physician assistant may not administer, provide or transmit a prescription for controlled substances in Schedules II through V inclusive without patient-specific authority by a supervising physician. (i) (1) Perform surgical procedures without the personal presence of the supervising physician which are customarily performed under local anesthesia. Prior to delegating any such surgical procedures, the supervising physician shall review documentation which indicates that the physician assistant is trained to perform the surgical procedures. All other surgical procedures requiring other forms of anesthesia may be performed by a physician assistant only in the personal presence of an approved supervising physician. (2) A physician assistant may also act as first or second assistant in
surgery under the supervision of an approved supervising physician. 1399.542. Delegated Procedures. 1399.543. Training to Perform Additional Medical
Services. (a) In the physical presence of an approved supervising physician who is directly in attendance and assisting the physician assistant in the performance of the procedure; (b) In an approved program; (c) In a medical school approved by the Division of Licensing under Section 1314; (d) In a residency or fellowship program approved by the Division of Licensing under Section 1321; (e) In a facility or clinic operated by the Federal government; (f) In a training program which leads to licensure in a healing arts profession
or is approved as Category I continuing medical education or continuing nursing
education by the Board of Registered Nursing. 1399.545. Supervision Required. (b) A supervising physician shall delegate to a physician assistant only those tasks and procedures consistent with the supervising physician’s specialty or usual and customary practice and with the patient’s health and condition. (c) A supervising physician shall observe or review evidence of the physician assistant’s performance of all tasks and procedures to be delegated to the physician assistant until assured of competency. (d) The physician assistant and the supervising physician shall establish in writing transport and back-up procedures for the immediate care of patients who are in need of emergency care beyond the physician assistant’s scope of practice for such times when a supervising physician is not on the premises. e) A physician assistant and his or her supervising physician shall establish in writing guidelines for the adequate supervision of the physician assistant which shall include one or more of the following mechanisms: (1) Examination of the patient by a supervising physician the same day as care is given by the physician assistant; (2) Countersignature and dating of all medical records written by the physician assistant within thirty (30) days that the care was given by the physician assistant; (3) The supervising physician may adopt protocols to govern the performance of a physician assistant for some or all tasks. The minimum content for a protocol governing diagnosis and management as referred to in this section shall include the presence or absence of symptoms, signs, and other data necessary to establish a diagnosis or assessment, any appropriate tests or studies to order, drugs to recommend to the patient, and education to be given the patient. For protocols governing procedures, the protocol shall state the information to be given the patient, the nature of the consent to be obtained from the patient, the preparation and technique of the procedure, and the follow-up care. Protocols shall be developed by the physician, adopted from, or referenced to, texts or other sources. Protocols shall be signed and dated by the supervising physician and the physician assistant. The supervising physician shall review, countersign, and date a minimum of 10% sample of medical records of patients treated by the physician assistant functioning under these protocols within thirty (30) days. The physician shall select for review those cases which by diagnosis, problem, treatment or procedure represent, in his or her judgment, the most significant risk to the patient; (4) Other mechanisms approved in advance by the committee. (f) In the case of a physician assistant operating under interim approval, the supervising physician shall review, sign and date the medical record of all patients cared for by that physician assistant within seven (7) days if the physician was on the premises when the physician assistant diagnosed or treated the patient. If the physician was not on the premises at that time, he or she shall review, sign and date such medical records within 48 hours of the time the medical services were provided. (g) The supervising physician has continuing responsibility to follow the
progress of the patient and to make sure that the physician assistant does
not function autonomously. The supervising physician shall be responsible
for all medical services provided by a physician assistant under his or her
supervision . 1399.546. Reporting of Physician Assistant
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