Publications

ISSUE NO. WINTER 1999

PAC UPDATE

Published by the California Physician Assistant Committee

PHYSICIAN ASSISTANT SCOPE OF PRACTICE

Due to the increasing complexity and proliferation of medical services available today, the Physician Assistant Committee (PAC) has received a number of inquiries regarding physician assistant (PA) scope of practice in the State of California. All PAs, physician supervisors, and interested others may consequently be advised of the following. 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 (ref. Title 16 CCR 1399.545(b).

A PA may only provide those medical services which: (1) she or he is competent to perform, as determined by the supervising physician; (2) are consistent with her or his education, training, and experience, and; (3) are delegated in writing by the supervising physician responsible for the patients cared for by the PA.

In accordance with these criteria and other provisions set forth in PA law and regulations, and not withstanding any other provision of law (e.g., pharmacy law), a PA may work in any setting, and may provide any medical service with the exception of certain ophthalmological and dental procedures listed in law [Business and Professions Code, Section 3502 (c)]. Please note that Section 3502.1 of the Business and Professions Code allows the written transmittal of a physician's prescription orders, but does not grant prescriptive authority to a Physician Assistant.

Specific examples of some of the medical services performable by a PA are listed in regulation (Title 16 California Code of Regulations 1399.541). However, should additional questions arise concerning PA scope of practice, the staff of the PAC may be reached at (916) 561-8780 or (800) 555-8038 to address inquiries of this nature.

FREQUENTLY ASKED QUESTIONS

Each year the staff at the Physician Assistant Committee answers thousands of questions about California physician assistant laws and regulations. In a continuing series, we will publish some of the most frequently asked questions, along with our standard replies.

QUESTION: What do I do if my supervising physician goes on vacation?

ANSWER: The Physician Assistant Committee recommends, as the most practical and safest course of action for both the consumer and the practitioner, that the physician assistant (PA) find another supervising physician available to take over the complete supervision of the PA until such time that the vacationing supervising physician resumes her or his duties.

Alternatively, the supervising physician who wishes to continue supervision of the PA while on vacation must comply with the following:

(1) The supervising physician must continue to assume responsibility for all medical services provided by the PA under her or his supervision.

(2) The supervising physician must be available through at least electronic communication at all times when the PA is caring for patients, and;

(3) The countersigning of the medical records of the patients cared for by the PA must be completed (in the manner and time frame stipulated in law and regulations) by the supervising physician.

If a PA begins work with another supervising physician for the purposes of complete supervision in the absence of a vacationing supervising physician, then all requirements for the adequate supervision of a PA must still be satisfied.

Specifically, and in accordance with regulation, every physician must, at a minimum, (1) accept responsibility for the care given by the PA, (2) in writing delegate tasks to the PA and state how the activities of the PA will be supervised, and (3) establish transport and backup procedures for the immediate care of patients in need of emergency care beyond the PA's scope of practice for such times when a supervising physician is not on the premises. (Reference: California Code of Regulations 1399.545.)

This written delegation of tasks to the PA is often referred to as a Delegation of Services Agreement. An example of this document which may utilize in whole or in part at the direction of the supervising physician, can be obtained by calling the Physician Assistant Committee at (916) 263-3670 or (800) 555-8038 and retrieved from our Fax-on Demand service.

QUESTION: How many PAs can I supervise?

ANSWER: Current California law allows an approved supervising physician to supervise no more than two physician assistants at any given time. [Reference: Business and Professions Code, Section 3516(a).]

This means that a supervising physician must be available through at least electronic means during those times in which up to two physician assistants (PAs) under the physician's supervision are caring for patients.

Conceivably, this could mean that a supervising physician may, on any given day, supervise two PAs in the morning, and then, when both PAs ceased practicing for that shift, the supervising physician could next supervise two other PAs, and so on. In short, a physician may legally serve as physician supervisor to any number of PAs, as long as the physician supervises in the manner specified above no more than two PAs at any given time.

DISCIPLINARY REPORT

The following summary indicates the administrative law actions taken against licensed physician assistants by the State of California from December 1997 through December 1998, Section numbers cited refer to California Business and Professions Code (BPC); Title 16 of the California Code of Regulations (CCR), Division 13.8; Health and Safety Code (HSC); Welfare and Institutions Code (WIC). This summary does not reflect criminal and civil actions that may also have been brought separately against the licensee, as those actions are not within the jurisdiction of the Physician Assistant Committee.

Although every effort is made to ensure that the following information is correct, before making any decision based upon this information, check with the Physician Assistant Committee to substantiate the accuracy of this listing. Specific information on these violations may be obtained by contacting the Physician Assistant Committee at 916/561-8780 or 800/555-8038, extension 204.

MELENDEZ, BERNARD J. (PA-10901)
2234, (e), 2261, 2262, 2305, 3503 BPC
Violations: Suspension of authority to practice in a federal agency, knowingly and intentionally entering false information on patient record, indicated on resume licensure as a physician assistant prior to license issue date. ALJ Decision: Revoked, stayed, 3 years probation on terms and conditions.
Effective date: 15 January 1998.

HARKIN, ROBERT L. (PA-13553)
2054, 2234, 3527(a), 3531 BPC
Violation: Conviction of criminal offense substantially related to the duties, functions, and responsibilities of a physician assistant; false representation of himself as a physician.
Stipulated Decision. Revoked, stayed, 3 years probation on terms and conditions.
Effective date: 30 March 1998.

BALTIERRA, JUAN R. (PA-10073)
726, 3531, 3527(a) BPC
Violation: Conviction of criminal offense substantially related to the duties, functions, and responsibilities of a physician assistant: sexual battery of patients.
Stipulated Decision. Surrender of license.
Effective date: 3 June 1998.

DANIELS, FRANK A. (PA-12213)
2234(a), 2238, 2239(a), 3527(a) BPC
Violation: Self use of drugs, and dishonesty
Default Decision. Revoked.
Effective date: 12 June 1998.

JOSEPH, LLOYD (PA-13828)
726, 2234(b), 2234(e), 3527 BPC
Violation: Sexual misconduct with patients.
Stipulated Decision. Surrender of license.
Effective date. 17 June 1998.

CONSIGLIO, RUSSELL E. (PA-10894)
3502.1(b) (2) BPC
Violation: Transmitted orders for controlled substances without prior patient specific authorization from a supervising physician.
Stipulating Decision: Public reproval.
Effective date: 8 July 1998

ALAVI, ALIAKBAR (PA-12223)
651, 810, 2234(a), 2234(b), 2234(d), 2261, 2262, 2273, 3527(a) BPC
Violation: Engaged telephone solicitors to lure patients into the office on the promise of cost-free examinations. Patients would be diagnosed and treated for maladies that didn't exist.
Stipulated Decision. Revoked, stayed, 3 years probation on terms and conditions.
Effective date: 4 September 1998.

GREEN, MICHAEL DEE (PA-13052)
2234, 3531BPC
Violation: Conviction of criminal offense substantially related to the duties, functions, and responsibilities of physician assistant: sexual misconduct with patients.
Stipulated Decision: Surrender of license.
Effective date. 19 August 1998.

BALDWIN, MELBOURNE (PA-12724)
2234(a) 2234(b), 2234(c), 2234(f), 3502(1), 3527 BPC; 1399.540, 1399.541, 1399.545 CCR
Violation(s): Practicing without appropriate supervision; transmitting orders for controlled substances without patient specific authorization; failed to have back-up procedures for immediate care of patients in need of emergency treatment; transmitted orders for RXs without written protocols.
Stipulated Decision: Revoked, stayed, 3 years probation on terms and conditions.
Effective date. 26 October 1998.

PHYSICIAN ASSISTANT COMMITTEE
1999 MEETING DATES*


Date Location
28 January 1999 San Diego, California
15 April 1999 San Francisco, California
8 July 1999 Burbank, California
7 October 1999 Sacramento, California

Licensees and interested others are welcome to attend. Contact the PAC office for information regarding specific sites and times.

*Subject to change