More Practice-Level Guidelines for Physician Assistants

The Physician Assistant Practice Act sets forth supervision requirements for licensed physician assistants (PAs) in California. These requirements set statewide standards for supervision, agreements, and protocols mostly under the delegation of physicians and surgeons.

Signed by Governor Newsom on October 9, 2019, and effective January 1, 2020, Senate Bill 697 relaxes chart review and physician signature requirements allowing decisions to be made at the practice level. All references to “delegation of services agreements” have been changed to “practice agreements”, the most notable change to recognize physician assistants as independent and capable health care workers.

Practice Agreements and Redefining Supervision

Under the new law, the practice agreement can be a collaboration among one or more physicians and one or more physician assistants, offering greater flexibility. This allows one or more physicians, instead of one under the previous law, to have an agreement supervising one or more physician assistants.

The act previously required medical records to identify the physician responsible for supervising the physician assistant, with written guidelines regarding adequate supervision. This established specific and constant supervision over physician assistants. 

SB 697 removed these requirements and instead authorized physicians and surgeons to create their own practice agreement to determine necessary levels of supervision over physician assistants. The practice agreement can establish policies, procedures, and meet any other requirements set forth between these practitioners. If these requirements are met, the physician assistant can perform any medical service authorized by the Physician Assistant Practice Act that they are competent to perform. 

The bill also redefines “supervision” to not require the supervising physician to be physically present. The bill only requires that the physician be available by an electronic communication method at the time the physician assistant examines the patient. “Adequate supervision” will be defined and agreed upon in the practice agreement as well.

Physician Assistant and Drug Administering

Physician assistants were previously required to be physically supervised by a physician and surgeon while administering medication to a patient or in a drug order.

Physician assistants may now administer medication to a patient or drug order in accordance with the practice agreement. The bill also authorizes a physician assistant to order or provide Schedule II or III controlled substances to the treated patient in accordance with the practice agreement or if approved by the treating supervising physician and surgeon. However, physician assistants must first complete a course that covers Schedule II controlled substances based on the standards developed by the licensing board.

While creating a practice agreement is more flexible for physicians and physician assistants within an organized health care system, this can also lead to complications and miscommunication. Organizations must ensure physicians and surgeons create precise practice agreements for physician assistants to have a smooth transition into greater independence. If you are a physician assistant or a supervising physician or surgeon  in need of assistance regarding practice agreements or legal issues within your practice,  contact Ray & Bishop, PLC to consult with one of our experienced medical license defense attorneys.

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