Professional Practice Issues

1
Professional Practice Issues

• Michael De Rosa MPH, Ph.D., PA-C
• Chair, SMC Physician Assistant Department
• CAPA Government Affairs/Professional Practice
  Committee

2
Legislative Issues

• AB3
• Four major goals achieved
• Expanded Medi-Cal coverage to equal physicians
  and NPs
• Eliminates Patient Specific Authority for
  controlled substances (sort of) Nov 16
• Doubles supervisory restriction to 4 PAs
• Reduces countersign requirement from 10-5

3
Patient Specific Authority

• Physician Assistant Practice Act
• 3502.1.c.2
• A physician assistant may not administer or
  provide a drug or issue a drug order to a patient
  for Schedule II through Schedule V controlled
  substances without advance approval by a
  supervising physician and surgeon for that
  particular patient
• AB3 adds unless the physician assistant has
  completed an education course that covers
  controlled substances and meets standards,
  including pharmacological content, approved by
  the committee.

4
Upcoming Courses

• Saturday, January 24, 2009 at the Marriott in
  Norwalk, CA
• Saturday, January 31, 2009 at the Marriott in
  Visalia, CA
• Sunday, February 22, 2009 at the Napa Valley
  Marriott in Napa, CA

5
Supervision of MAs

• Physician Assistant Practice Act
• 2069.a.1
• Notwithstanding any other provision of law, a
  medical assistant may administer medication only
  by intradermal, subcutaneous, or intramuscular
  injections and perform skin tests and additional
  technical supportive services upon the specific
  authorization and supervision of a licensed
  physician and surgeon or a licensed podiatrist.
• Interpretation With the exception of community
  and free clinics as defined by Section 1204 of
  the Health and Safety Code where a PA can be
  designated to supervise an MA in the absence of a
  physician, PAs may not supervise (legally) MAs in
  the practice of medicine in California.

6
Physician Identification

• California Code of Regulations
• 1399.546
• Each time a physician assistant provides care for
  a patient and enters his or her name, signature,
  initials, or computer code on a patients record,
  chart or written order, the physician assistant
  shall also enter the name of his or her approved
  supervising physician who is responsible for the
  patient. When a physician assistant transmits an
  oral order, he or she shall also state the name
  of the supervising physician responsible for the
  patient.

7
Approved Supervising Physician

• California Code of Regulations
• 1399.540.b
• A delegation of services agreement shall be
  signed and dated by the physician assistant and
  each supervising physician.

8
Grazie mille!