Proposed changes to the State Board of Medicine PA Regulations*
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
SUBPART A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 16. STATE BOARD OF MEDICINE GENERAL PROVISIONS
Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION
PROVISIONS
* * *
§16.11. Licenses, certificates and registration.
* * *
(c) The following registrations are issued by the Board.
(1) Registration as a [physician assistant supervisor] SUPERVISING PHYSICIAN of a physician assistant.
* * *
§16.13 Licensure, certification, examination and registration fees.
* * *
(k) The fee for registration as a [physician assistant supervisor] SUPERVISING PHYSICIAN of a physician assistant is $55. (1) The application fee for satellite location approval is $50.
CHAPTER 18 STATE BOARD OF MEDICINE PRACTITIONERS OTHER THAN
MEDICAL DOCTORS
Subchapter D. PHYSICIAN ASSISTANTS
GENERAL PROVISIONS
§18.121. Purpose
This subchapter implements Section 13 of the Act (63 P.S. § 422.13) pertaining
to physician assistants and provides for the delegation of certain medical tasks
to qualified physician assistants by THE [physician assistant supervisors] SUPERVISING
PHYSICIAN when the delegation is consistent with the written agreement.
§18. 122. Definitions.
The following words and terms, when used in this subchapter, have the following
meanings, unless the context clearly indicates otherwise:
Administration The direct application of a drug, whole blood, blood components,
diagnostic procedure or device, whether by injection, inhalation, ingestion,
skin application or any other means, into the body of a patient.
Device Instrument or tool necessary in the administration of medication and
medical care.
[Direct Supervision The physical presence of the physician assistant supervisor
on the premises so that the supervisor is immediately available to the physician
assistant when needed.]
Dispense Deliver a drug or device to or for an ultimate user for limited or
continuing use.
Drug -- A term used to describe a drug or device or agent which a physician
assistant prescribes or dispenses under §18.158 (relating to prescribing
and dispensing drugs).
Emergency Medical Care Setting – A health care setting which is established
to provide emergency medical care as its primary purpose. The term does not
include a setting, which provides general or specialized medical services that
are not routinely emergency in nature even though that setting provides emergency
medical care from time to time.
Medical Care Facility An entity licensed or approved to render health care services.
Medical Regimen – [A therapeutic, corrective or diagnostic measure ordered
by a physician assistant supervisor which is required for the management of
a specific condition and which is incorporated into the written agreement] A
THERAPEUTIC, CORRECTIVE OR DIAGNOSTIC MEASURE UNDERTAKEN OR ORDERED BY A PHYSICIAN
ASSISTANT ACTING WITHIN THEIR SCOPE OF PRACTICE AND IN ACCORDANCE WITH THE WRITTEN
PRACTICE AGREEMENT BETWEEN THE SUPERVISING PHYSICIAN AND THE PHYSICIAN ASSISTANT.
Medical Service – An activity which lies within the scope of the practice
of medicine and surgery.
NCCPA The National Commission on Certification of Physician Assistant
Physician A medical doctor or doctor of osteopathic medicine.
Physician Assistant An individual who is [certified] LICENSED as a physician
assistant by the Board.
Physician Assistant Examination – An examination to test whether an individual
has accumulated sufficient academic knowledge to qualify for certification as
a physician assistant. The Board recognizes the certifying examination of the
NCCPA.
Physician Assistant Program A program for the training and education of physician
assistants which is [approved] RECOGNIZED by the Board[.]AND ACCREDITED BY CAHEA,
CAAHEP, ARC-PA OR ANY SUCCESSOR AGENCY.
[Physician Assistant Supervisor] SUPERVISING PHYSICIAN An approved physician
who is identified as a supervising physician of a physician assistant in a written
agreement and is registered with the Board as such.
Prescription A written or oral order for a drug or device to be dispensed to
or for an ultimate user. The term does not include an order for a drug which
is dispensed for immediate administration to the ultimate user; for example,
an order to dispense a drug to a patient for immediate administration in an
office or hospital is not a prescription.
Primary [Physician Assistant Supervisor] SUPERVISING PHYSICIAN A [physician
assistant supervisor] SUPERVISING PHYSICIAN who is registered with the Board
and designated in the written agreement as having primary responsibility for
directing and supervising the physician assistant.
Satellite Location A location, other than the primary place at which the [physician
assistant supervisor] SUPERVISING PHYSICIAN provides medical services to patients,
where a physician assistant provides medical services.
Substitute [Physician Assistant Supervisor] SUPERVISING PHYSICIAN A [physician
assistant supervisor] SUPERVISING PHYSICIAN who is registered with the Board
and designated in the written agreement as assuming primary responsibility for
a physician assistant when the primary [physician assistant supervisor] SUPERVISING
PHYSICIAN is unavailable.
Supervision – [The control and personal direction exercised by the physician
assistant supervisor over the medical services provided by a physician assistant.
Constant physical presence of the physician assistant supervisor is not required
so long as the physician assistant supervisor and the physician assistant are,
or can easily be, in contact with each other by radio, telephone or telecommunications.
Supervision requires the availability of the physician assistant supervisor
to the physician assistant.] OVERSEEING THE ACTIVITIES OF, AND ACCEPTING RESPONSIBILITY
FOR, THE MEDICAL SERVICES RENDERED BY A PHYSICIAN ASSISTANT. THE CONSTANT PHYSICAL
PRESENCE OF THE SUPERVISING PHYSICIAN IS NOT REQUIRED AS LONG AS THE SUPERVISING
PHYSICIAN AND THE PHYSICIAN ASSISTANT ARE, OR CAN BE, EASILY IN CONTACT WITH
EACH OTHER BY RADIO, TELEPHONE, OR OTHER TELECOMMUNICATIONS DEVICE.
An appropriate degree of supervision includes:
(i) Active and continuing overview of the physician assistant's activities to
determine that the physician's directions are being implemented.
(ii) Immediate availability of the [physician assistant supervisor] SUPERVISING
PHYSICIAN to the physician assistant for necessary consultations.
(iii) Personal and regular – [at least weekly] review by the [physician
assistant supervisor] SUPERVISING PHYSICIAN of the patient records upon which
entries are made by the physician assistant AS DESCRIBED IN THE WRITTEN AGREEMENT.
Written Agreement – The agreement between the physician assistant and [physician assistant supervisor], SUPERVISING PHYSICIAN which satisfies the requirements of §18.142 (relating to written agreements).
PHYSICIAN ASSISTANT EDUCATIONAL PROGRAMS
§18.131. [Approved] RECOGNIZED educational programs/standards.
(a) The Board [approves] RECOGNIZES physician assistant educational programs
[developed] ACCREDITED by the [accreditation review committee for the physician
assistant, and accredited by the] ACCREDITATION REVIEW COMMISSION (ARC-PA),
COMMISSION FOR ACCREDITATION OF ALLIED HEALTH EDUCATIONAL PROGRAMS (CAAHEP),
Committee on Allied Health Education and Accreditation (CAHEA), of the American
Medical Association, OR ANY SUCCESSOR ORGANIZATION. [Information regarding approved
programs may be obtained directly from CAHEA, 515 North State Street, Chicago,
IL 60610.]
(b) The criteria for certification by the Board of physician assistant educational programs will be identical to the essentials developed by various organizations listed in this section or other accrediting agencies approved by the Board.
[CERTIFICATION] LICENSURE OF PHYSICIAN ASSISTANTS AND REGISTRATION OF [PHYSICIAN ASSISTANT SUPERVISOR] SUPERVISING PHYSICIAN (S)
§18.141. Criteria for [certification] LICENSURE as a physician assistant.
The Board will approve for [certification] LICENSURE as a physician assistant
an applicant who:
(1) Satisfies the [certification] LICENSURE requirements in §16.12 (relating
to general qualifications for licenses and certificates).
(2) Has graduated from a physician assistant program [approved] RECOGNIZED by
the Board.
(3) Has submitted a completed application together with the required fee, under
§16.13 (relating to licensure, certification, examination and registration
fees).
(4) Has passed the physician assistant examination.
§18.142. Written agreements.
(a) The written agreement required by section 13(e) of the Act (63 P.S. §422.13(e))
shall satisfy the following requirements. The agreement shall:
(1) Identify and be signed by the physician assistant and [each physician the
physician assistant will be assisting.] EACH PHYSICIAN ACTING AS A SUPERVISING
PHYSICIAN. At least one physician shall be a medical doctor.
(2) Describe the manner in which the physician assistant [will be assisting
each named physician] WORKS WITH THE SUPERVISING PHYSICIAN. The description
shall list functions to be delegated to the physician assistant, [including:
(i) selected procedures enumerated in §18.151 (relating to the role of
the physician assistant) and all other delegated tasks; (ii) instructions for
the use of the physician assistant if performance of delegated tasks; (iii)
medical regimens to be administered or relayed by the physician assistant.]
(3) Describe the time, place and manner of supervision and direction each named
physician will provide the physician assistant, including the frequency of personal
contact with the physician assistant.
(4) THE PHYSICIAN ASSISTANT SUPERVISOR SHALL COUNTERSIGN THE PATIENT RECORD
WITHIN A REASONABLE AMOUNT OF TIME. THIS TIME PERIOD SHALL NOT EXCEED TEN DAYS.
[(4)] (5) Designate one of the named physicians who shall be a medical doctor
as the primary [physician assistant supervisor] SUPERVISING PHYSICIAN.
[(5)] (6) Identify the location(s) and practice setting(s) where the physician
assistant will serve.
(b) The written agreement shall be [approved] FILED [by] WITH the Board. [as
satisfying the foregoing requirements and as being consistent with relevant
provisions of the act and regulations contained in this subchapter]
(c) A physician assistant or [physician assistant supervisor] SUPERVISING PHYSICIAN
shall provide immediate access to the written agreement to anyone seeking to
confirm the scope of the physician assistant's authority.
§18.143. Criteria for registration as [physician assistant supervisor]
A SUPERVISING PHYSICIAN.
(a) The Board will [approve] ACCEPT for registration as a [physician assistant
supervisor] SUPERVISING PHYSICIAN an applicant who:
(1) Possesses a current license without restriction to practice medicine and
surgery in this Commonwealth.
(2) Has [submitted] FILED a completed [application] NOTIFICATION accompanied
by the written agreement (see §18.142 (relating to written agreements))
and the required fee under §16.13 (relating to licensure, certification,
examination and registration fees). The [application] NOTIFICATION requires
detailed information regarding the physician's professional background and specialties,
medical education, internship, residency, continuing education, membership in
American Boards of medical specialty, hospital or staff privileges and other
information the Board may require.
(3) Includes with the [application] NOTIFICATION, a list, identifying by name
and license number, all other physicians who are serving as [physician assistant
supervisor] SUPERVISING PHYSICIAN(s) of the designated physician assistant pursuant
to other written agreements.
(b) If the [applicant] SUPERVISING PHYSICIAN plans to utilize physician assistants
in satellite locations, [he] THE SUPERVISING PHYSICIAN shall provide the Board
with supplemental information as set forth in §18.155 (relating to physician
assistants and satellite locations) and any additional information requested
by the Board directly relating to the satellite location.
(c) The Board will keep a current [register of approved] LIST OF registered
supervising physicians. The [register] LIST will include the physician's name,
the address of residence, current business address, the date of [approval] FILING,
satellite locations if applicable, the names of current physician assistants
under [his] THEIR supervision and the physicians willing to provide substitute
supervision.
§18.144. Responsibility of primary [physician assistant supervisor] SUPERVISING
PHYSICIAN.
A primary physician assistant supervisor SUPERVISING PHYSICIAN shall assume
the following responsibilities. The supervisor shall:
(1) Monitor the compliance of all parties to the written agreement with the
standards contained in the written agreement, the act and this subchapter.
(2) Advise any party to the written agreement of any failure to conform with
the standards contained in the written agreement, the act and this subchapter.
(3) Arrange for a substitute physician assistant supervisor SUPERVISING PHYSICIAN.
(See Section
§18.154 relating to substitute physician assistant supervisor SUPERVISING
PHYSICIAN.)
(4) [See each patient in his office every third visit, but at least once a year.]
RECOGNIZE THAT THE SUPERVISING PHYSICIAN INVOLVEMENT WOULD BE PREDICATED ON
THE TYPE OF PRACTICE, SITES OF SERVICE, AND CONDITION OF THE PATIENT.
(5) See each patient while hospitalized at least once.
[(6) Provide access to the written agreement upon request and provide clarification
of orders and prescriptions by the physician assistant relayed to other health
care practitioners.]
(6) SHALL SUPERVISE NO MORE THAN FOUR PHYSICIAN ASSISTANTS AT ANY ONE TIME.
THE BOARD MAY GRANT EXCEPTIONS WHERE APPROPRIATE.
(7) Accept full professional and legal responsibility for the performance of
[his] THE physician assistant and the care and treatment of [his] THE PHYSICIAN’S
patients.
§18.145. Biennial registration requirements; renewal of physician assistant
[certification] LICENSE.
(a) A physician assistant shall register biennially according to the procedure
set forth in §16.15 (relating to biennial registration; inactive status
and unregistered status).
(b) The fee for the biennial registration of a physician assistant [certificate]
LICENSE is set forth in §16. 13 (relating to licensure, certification,
examination and registration fees).
(c) To be eligible for renewal of A physician assistant [certification] LICENSE,
the physician assistant shall maintain [his] national certification by completing
current recertification mechanisms available to the profession and recognized
by the Board.
(d) The board will keep a current [register] LIST of persons [certified] LICENSED
as physician assistants. The [register] LIST will include: (1) the name of each
physician assistant (2) the place of residence (3) the current business address
(4) the date of initial [certification] LICENSURE, biennial renewal record and
current [physician assistant supervisor]SUPERVISING PHYSICIAN(S).
PHYSICIAN ASSISTANT UTILIZATION
§18.151. Role of physician assistant.
The physician assistant shall, under appropriate direction and supervision by
a physician assistant supervisor, augment the physician's data gathering abilities
in order to assist the physician in reaching decisions and instituting care
plans for the physician's patients. Physician assistants may be permitted to
perform the following functions. This list is not intended to be all inclusive.
(1) Screen patients to determine need for medical attention.
(2) Review patient records to determine health status.
(3) Take a patient history.
(4) Perform a physical examination.
(5) Perform developmental screening examination on children.
(6) Record pertinent patient data.
(7) Make decisions regarding data gathering and appropriate management and treatment
of patients being seen for the initial evaluation of a problem or the follow
up evaluation of a previously diagnosed and stabilized condition.
(8) Prepare patient summaries.
(9) Initiate requests for commonly performed initial laboratory studies.
(10) Collect specimens for and carry out commonly performed blood, urine and
stool analyses and cultures.
(11) Identify normal and abnormal findings on history, physical examination
and commonly performed laboratory studies.
(12) Initiate appropriate evaluation and emergency management for emergency
situations, for example, cardiac arrest, respiratory distress, injuries, burns
and hemorrhage.
(13) Perform clinical procedures such as:
(i) Venipuncture.
(ii) Intradermal tests.
(iii) Electrocardiogram.
(iv) Care and suturing of minor lacerations.
(v) Casting and splinting.
(vi) Control of external hemorrhage.
(vii) Application of dressings and bandages.
(viii) Administration of medications except as specified in §18.158 (relating
to prescribing and dispensing drugs), intravenous fluids, whole blood and blood
components except as specified in §18.157 (relating to administration of
controlled substances and whole blood and blood components).
(ix) Removal of superficial foreign bodies.
(x) Cardio pulmonary resuscitation.
(xi) Audiometry screening.
(xii) Visual screening.
(xiii) Carrying out aseptic and isolation techniques.
(14) Provide counseling and instruction regarding common patient problems.
(1) PHYSICIAN ASSISTANTS PRACTICE MEDICINE WITH PHYSICIAN SUPERVISION.
PHYSICIAN ASSISTANTS MAY PERFORM THOSE DUTIES AND RESPONSIBILITIES, INCLUDING
THE ORDERING, PRESCRIBING AND DISPENSING, AND ADMINISTRATION OF DRUGS AND MEDICAL
DEVICES THAT ARE DELEGATED BY THEIR SUPERVISING PHYSICIAN.
(2) PHYSICIAN ASSISTANTS MAY PROVIDE ANY MEDICAL SERVICE WHICH IS DELEGATED
BY THE SUPERVISING PHYSICIAN WHEN THE SERVICE IS WITHIN THE PHYSICIAN ASSISTANT’S
SKILLS, FORMS A COMPONENT OF THE PHYSICIAN’S SCOPE OF PRACTICE, AND IS
PROVIDED WITH SUPERVISION.
(3) PHYSICIAN ASSISTANTS MAY PRONOUNCE DEATH AND MAY AUTHENTICATE WITH THEIR
SIGNATURE ANY FORM RELATED TO PRONOUNCING DEATH.
(4) PHYSICIAN ASSISTANTS MAY AUTHENTICATE WITH THEIR SIGNATURE ANY FORM THAT
MAY OTHERWISE BE AUTHENTICATED BY A PHYSICIAN’S SIGNATURE AS PERMITTED
BY THE SUPERVISING PHYSICIAN, STATE OR FEDERAL REGULATIONS AND/OR BY FACILITY
PROTOCOL.
(5) PHYSICIAN ASSISTANTS SHALL BE CONSIDERED THE AGENTS OF THEIR SUPERVISING
PHYSICIAN IN THE PERFORMANCE OF ALL PRACTICE-RELATED ACTIVITIES INCLDING, BUT
NOT LIMITED TO, THE ORDERING OF DIAGNOSTIC, THERAPEUTIC, AND OTHER MEDICAL SERVICES.
§18.152. Prohibitions.
(a) A physician assistant may not:
(1) Provide medical services except as described in a written agreement.
(2) Prescribe or dispense drugs except as described in a written agreement.
(3) Maintain or manage a satellite location under §18.155 (relating to
physician assistants and satellite locations) unless [approved] REGISTERED WITH
[by]the Board.
(4) Independently bill patients for services provided.
(5) [Independently delegate a task specifically assigned to him by his supervising
physician to another health care provider.] INDEPENDENTLY DELEGATE TO ANOTHER
HEALTH CARE PROVIDER A TASK SPECIFICALLY ASSIGNED TO THE PHYSICIAN ASSISTANT.
(6) List [his]HIS/HER name independently in a telephone directory or other directory
for public use in a manner which indicates that [he] HE/SHE functions as an
independent practitioner.
(7) Perform acupuncture except as permitted by Section 13(k) of the Act (63
P.S. §422.13(k).
[(8) Pronounce a patient dead.]
[(9)] (8) Perform a medical service without the supervision of a [physician
assistant supervisor] SUPERVISING PHYSICIAN
(9) SEEK INDEPENDENT PRACTICE.
(b) A [physician assistant supervisor] SUPERVISING PHYSICIAN may not:
(1) Permit a physician assistant to engage in conduct proscribed in subsection
(a).
[(2) Have primary responsibility for more than two physician assistants.]
§18.153 Executing and relaying medical regimens.
(a) A physician assistant may execute a medical regimen or may relay a medical
regimen to be executed by a health care practitioner subject to the requirements
of this subsection.
(b) AS OUTLINED IN THE WRITTEN AGREEMENT, the physician assistant shall report
orally or in
writing, to a [physician assistant supervisor] SUPERVISING PHYSICIAN, [within
12 hours,] IN A TIMELY MANNER, medical regimens executed or relayed by [him]
THE PHYSICIAN ASSISTANT while the [physician assistant supervisor] SUPERVISING
PHYSICIAN was not physically present, and the basis for each decision to execute
or relay a medical regimen.
(c) The physician assistant shall record, date and authenticate the medical
regimen on the patient's chart at the time it is executed or relayed. The [physician
assistant supervisor] SUPERVISING PHYSICIAN shall countersign the patient record
within a reasonable time not to exceed [three] TEN days, unless countersignature
is required sooner by regulation, policy within the medical care facility, or
the requirements of a third party payer.
(d) A physician assistant or [physician assistant supervisor] SUPERVISING PHYSICIAN
shall provide immediate access to the written agreement to anyone seeking to
confirm the physician assistant’s authority to relay a medical regimen
or administer a therapeutic or diagnostic measure.
§18.154 Substitute physician assistant supervisor SUPERVISING PHYSICIAN.
(a) If the primary [physician assistant supervisor] SUPERVISING PHYSICIAN is
unavailable to supervise the physician assistant the primary [physician assistant
supervisor] SUPERVISING PHYSICIAN may not delegate patient care to [his] THE
physician assistant unless [he has made] appropriate arrangements for substitute
supervision ARE in the written agreement and the substitute physician is registered
as a [physician assistant supervisor] SUPERVISING PHYSICIAN with the Board.
(b) It is the responsibility of the substitute SUPERVISING physician to insure
that supervision is maintained in the absence of the primary [physician assistant
supervisor] SUPERVISING PHYSICIAN. (c) During the period of supervision by the
substitute [physician assistant supervisor] SUPERVISING PHYSICIAN, [he] THE
SUBSTITUTE SUPERVISING PHYSICIAN retains the full professional and legal responsibility
for the performance of the physician assistant and the care and treatment of
the patients treated by the physician assistant.
(d) Failure to properly supervise may provide grounds for disciplinary action
against the substitute [physician assistant supervisor] SUPERVISING PHYSICIAN.
§18.155. Satellite locations.
(a) Approval of satellite location. A physician assistant may not provide medical
services at a satellite location unless the supervising physician has [obtained
specific approval from] FILED A NOTIFICATION WITH the Board.
(b) Separate [application] NOTIFICATION requirement. A separate [application]
NOTIFICATION shall be made for each satellite location. [To obtain approval
for each satellite location a physician assistant supervisor] THE NOTIFICATION
shall demonstrate that:
(1) The physician assistant will be utilized in an area of medical need.
(2) There is adequate provision for direct communication between the physician
assistant and the
[physician assistant supervisor] SUPERVISING PHYSICIAN and that the distance
between
the location where the physician provides services and the satellite location
is not so great as to
prohibit or impede appropriate support services.
(3)[The supervisor will see each patient every third visit, but at least once
a year.] THE SUPERVISING
PHYSICIAN INVOLVEMENT WOULD BE PREDICATED ON THE TYPE OF PRACTICE,
SITE OF SERVICE, AND CONDITION OF THE PATIENT.
(4) The [supervisor] SUPERVISING PHYSICIAN will visit the satellite location
at least weekly and devote enough time on site to provide supervision and personally
review the records of [each] SELECTED patient(S) seen by the physician assistant
in this setting. THE PHYSICIAN ASSISTANT SUPERVISOR SHALL COUNTERSIGN THE PATIENT
RECORD WITHIN A REASONABLE AMOUNT OF TIME. THIS TIME PERIOD SHALL NOT EXCEED
TEN DAYS.
(c) Failure to comply with this section. Failure to maintain the standards required
for a satellite location may result not only in the loss of the privilege to
maintain a satellite location but also may result in disciplinary action against
the physician assistant and the [physician assistant supervisor] SUPERVISING
PHYSICIAN.
§ 18.156. Monitoring and review of physician assistant utilization.
(a) Representatives of the Board will be authorized to conduct scheduled and
unscheduled on site inspections of the locations where the physician assistants
are utilized, during the [physician assistant supervisors’] SUPERVISING
PHYSICIAN’S (s’) office hours to review the following:
(1) Supervision of the physician assistant. See §§18.144 and 18.154
(relating to responsibility of primary [physician assistant supervisor)] SUPERVISING
PHYSICIAN; and substitute [physician assistant supervisor] SUPERVISING PHYSICIAN).
(2) Presence of a written agreement and compliance with its terms. See Section
§18.142 (relating to written agreements).
(3) Utilization in conformity with the act, this subchapter and the written
agreement.
(4) Appropriate identification of physician assistant. See Section §18.171
(relating to physician assistant identification).
(5) Compliance with [certification] LICENSURE and registration requirements.
See Sections §§18.141 and 18.145 (relating to criteria for [certification]
LICENSURE as a physician assistant; and biennial registration requirements;
renewal of physician assistant [certification]LICENSE).
(6) Maintenance of records evidencing patient and supervisory contact by the
physician assistant
supervisor.
(b) Reports shall be submitted to the Board and become a permanent record under
the [physician assistant supervisor] SUPERVISING PHYSICIAN’S registration.
Deficiencies reported shall be reviewed by the Board and may provide a basis
for loss of the privileges to maintain a satellite location and disciplinary
action against the physician assistant and the [physician assistant supervisor.]
SUPERVISING PHYSICIAN.
(c) The Board reserves the right to review physician assistant utilization without
prior notice to either the physician assistant or the [physician assistant supervisor.]
SUPERVISING PHYSICIAN. It is a violation of this subchapter for a [physician
assistant supervisor ] SUPERVISING PHYSICIAN or a physician assistant to refuse
to comply with the request by the Board for the information in subsection (a).
(d) Additional inspections, including follow up inspections may be conducted
where the Board has reason to believe that a condition exists which threatens
the public health, safety or welfare.
§18.157. Administration of controlled substances and whole blood and blood
components.
(a) The physician assistant may ORDER AND/OR administer controlled substances
and whole blood and blood components if the authority to administer these medications
and fluids is expressly set forth in the written agreement. [and that the administration
of these medications and fluids is separately ordered by the physician assistant
supervisor and the physician assistant supervisor specifies a named drug for
a named patient.]
(b) The physician assistant shall comply with the minimum standards for ORDERING/administering
controlled substances specified in §16.92 (relating to prescribing, administering
and dispensing controlled substances).
§18.158 Prescribing and dispensing drugs[.],PHARMACEUTICAL AIDS AND DEVICES.
(a) The Board shall adopt the American Hospital Formulary Service (AHFS) Pharmacological
Therapeutic Classification to identify drugs which a physician assistant may
prescribe and dispense subject to the restrictions specified in subsection (c).
(1) Drug classifications which a physician assistant may prescribe and dispense
without limitation:
(i) Antihistamines
(ii) Anti infective Agents
(iii) Cardiovascular Drugs
(iv) Contraceptives ---for example, foams and devices
(v) Diagnostic Agents
(vi) Disinfectants---for agents used on objects other than skin
(vii) Electrolytic, Caloric and Water Balance
(viii) Enzymes
(ix) Antitussives, Expectorants, and Mucolytic Agents
(x) Gastrointestinal Drugs
(xi) Local Anesthetics
(xii) Serums, Toxoids, and Vaccines
(xiii) Skin and Mucous Membrane Agents
(xiv) Smooth Muscle Relaxants
(xv) Vitamins
(2) Categories from which a physician assistant may prescribe and dispense
subject to exclusions listed:
(i) Autonomic Drugs. Drugs excluded under this category: Sympathomimetic (adrenergic)
agents.
(ii) Blood Formation and Coagulation. Drugs excluded under this category:
(A) Anti coagulants and coagulants
(B) Thrombolytic agents
(iii) Central Nervous System Agents. Drugs excluded under this category:
(A) General anesthetics
(B) Monoamine oxidase inhibitors
(A) Pituitary hormones and synthetics
(B) Parathyroid hormones and synthetics
(3) Categories from which a physician assistant may not prescribe or dispense
are as follows:
(i) Antineoplastic Agents
(ii) Dental Agents
(iii) Gold Compounds
(iv) Heavy Metal Antagonists
(v) Oxytocics
(vi) Radioactive Agents
(vii) Unclassified Therapeutic Agents
(viii) Devices
(ix)Pharmaceutical Aids
(4) New drugs and new uses for drugs will be considered approved for prescribing and dispensing purposes by physician assistants 90 days after approval by the Federal Drug Administration unless excluded in subsections (2) and (3) above.
(b) If the physician assistant supervisor intends to authorize a physician
assistant to prescribe or dispense drugs, he shall:
(1) Establish a list of drugs, based on the classification listed in paragraph
(a) of this section, which the physician assistant may prescribe or dispense.
The physician assistant supervisor shall assure that the physician assistant
is able to competently prescribe or dispense those drugs.
(2) Submit the list of drugs to the Board, in duplicate, on a form supplied
by the Board, and signed by both physician assistant supervisor and the physician
assistant. The list will become part of the physician assistant's written agreement
if it is consistent with the approved classification.
(3) Notify the Board, in duplicate, on a form supplied by the Board, of an addition
or deletion to the list of drugs. The amendment will become part of the physician
assistant's written agreement if it is consistent with the approved classification.
(4) Assume full responsibility for every prescription issued and drug dispensed
by a physician assistant under his supervision.
(5) Maintain a copy of the list of drugs submitted to the Board in his principal
office and at all locations where the physician assistant practices under his
supervision for review or inspection without prior notice by patients, the Board
or its agents. The physician shall provide a pharmacy with a copy of the drug
list upon request by the pharmacist.
(6) Immediately advise the patient, notify the physician assistant and, in the
case of a written prescription, advise the pharmacy, if the physician assistant
is prescribing or dispensing a drug inappropriately. The physician shall advise
the patient and notify the physician assistant to discontinue using the drug,
and in the case of a written prescription, shall notify the pharmacy to discontinue
the prescription. The order to discontinue use of the drug or prescription shall
be noted in the patient's medical record by the physician.
(c) Restriction on a physician assistant's prescription and dispension practices
are as follows:
(1) A physician assistant may only prescribe or dispense a drug approved by
the Board from the classifications specified in subsection (a).
(2) A physician assistant may only prescribe or dispense a drug for a patient
who is under the care of the physician responsible for the supervision of the
physician assistant and only in accordance with the physician's instructions
and written agreement.
(3) A physician assistant shall comply with the minimum standards for prescribing
and dispensing controlled substances specified in §16.92 (relating to prescribing,
administering and dispensing controlled substances) and regulations of the Department
of Health relating to Controlled Substances, Drugs, Devices and Cosmetics, 28
Pa. Code §§25.51 25.58 (relating to prescriptions), and packaging
and labeling dispensed drugs. See §§16.93) and 16.94 (relating to
packaging; and labeling of dispensed drugs) and 28 Pa. Code §§ 25.91--25.95
(relating to labeling of drugs, devices and cosmetics).
(4) A physician assistant may not:
(i) Prescribe or dispense a pure form or combination of drugs listed in subsection
(a) unless the drug or class of drug is listed as permissible for prescription
or dispension.
(ii) Prescribe or dispense Schedules I or II controlled substances as defined
by Section 4 of the Controlled Substances, Drug, Device, and Cosmetic Act (35
P.S. §780 104).
(iii) Prescribe or dispense a drug for a use not permitted by the Federal Food
and Drug Administration.
(iv) Prescribe or dispense a generic or branded preparation of a drug that has
not been approved by the Federal Food and Drug Administration.
(v) Prescribe or dispense parenteral preparations other than Insulin, emergency
allergy kits and other approved drugs listed in subsection (a).
(vi) Dispense a drug unless it is packaged in accordance with applicable Federal
and State law pertaining to packaging by physicians. See §16.93 and §16.94.
(vii) Compound ingredients when dispensing a drug, except for adding water.
(viii)Issue a prescription for more than a 30-day supply, except in cases of
chronic illnesses where a 90-day supply may be prescribed. The physician assistant
may authorize refills up to 6 months from the date of the original prescription
if not otherwise precluded by law.
(d) The requirements for prescription blanks are as follows.
(1) Prescription blanks shall bear the certification number of the physician
assistant and the name of the physician assistant in printed format at the heading
of the blank, and a space for the entry of the Drug Enforcement Administration
registration number of the physician assistant supervisor as appropriate. The
physician assistant supervisor shall also be identified as required in §
16.91 (relating to identifying information on prescription and orders for equipment
and service).
(2) The physician assistant supervisor is prohibited from pre-signing prescription
blanks or allowing the physician assistant to use a device for affixing a signature
copy on the prescription. The signature of a physician assistant shall be followed
by the initials "PA C" or similar designation to identify the signer
as a physician assistant.
(3) The physician assistant may use a prescription blank generated by a hospital
provided the information in subsection (1) appears on the blank.
(1) THE SUPERVISING PHYSICIAN MAY DELEGATE TO THE PHYSICIAN ASSISTANT THE PRESCRIBING,
DISPENSING, AND ADMINISTERING OF DRUGS AND THERAPEUTIC DEVICES.
(2) THE WRITTEN AGREEMENT SHALL LIST THE CATEGORIES OF DRUGS WHICH THE PHYSICIAN
ASSISTANT IS NOT PERMITTED TO PRESCRIBE.
(3) A PHYSICIAN ASSISTANT SHALL COMPLY WITH THE MINIMUM STANDARDS FOR PRESCRIBING
AND DISPENSING CONTROLLED SUBSTANCES SPECIFIED IN §16.92 (RELATING TO PRESCRIBING,
ADMINISTERING AND DISPENSING CONTROLLED SUBSTANCES) AND REGULATIONS OF THE DEPARTMENT
OF HEALTH RELATING TO CONTROLLED SUBSTANCES, DRUGS, DEVICES AND COSMETICS, 28
PA. CODE §§25.51 25.58 (RELATING TO PRESCRIPTIONS), AND PACKAGING
AND LABELING DISPENSED DRUGS. (SEE §16.93 (RELATING TO PACKAGING), §16.94
(RELATING TO LABELING OF DISPENSED DRUGS) AND §§25.91 25.95 (RELATING
TO LABELING).)
(4) THE PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE SCHEDULE I CONTROLLED
SUBSTANCES AS DEFINED BY SECTION IV OF THE CONTROLLED SUBSTANCES, DRUG, DEVICE,
AND COSMETIC ACT (35 P.S. §780 104).
(5) THE PHYSICIAN ASSISTANT MAY WRITE A PRESCRIPTION FOR A SCHEDULE II CONTROLLED
SUBSTANCE FOR INTIAL THERAPY, UP TO A 72 HOUR DOSE. THE PHYSICIAN ASSISTANT
SHALL NOTIFY THE SUPERVISING PHYSICIAN OF THE PRESCRIPTION AS SOON AS POSSIBLE
BUT IN NO EVENT LONGER THAN 24 HOURS. A PHYSICIAN ASSISTANT MAY WRITE A PRESCRIPTION
FOR A SCHEDULE II CONTROLLED SUBSTANCE FOR UP TO A 30 DAY SUPPLY IF IT WAS ORIGINALLY
PRESCRIBED BY THE SUPERVISING PHYSICIAN AND APPROVED BY THE SUPERVISING PHYSICIAN
FOR ONGOING THERAPY.
(6) THE SUPERVISING PHYSICIAN WILL [I]immediately advise the patient, notify
the physician assistant and, in the case of a written prescription, advise the
pharmacy, if the physician assistant is prescribing or dispensing a drug inappropriately.
The physician shall advise the patient and notify the physician assistant to
discontinue using the drug, and in the case of a written prescription, shall
notify the pharmacy to discontinue the prescription. The order to discontinue
use of the drug or prescription shall be noted in the patient's medical record
by the physician.
(7) A physician assistant may only prescribe or dispense a drug for a patient
who is under the care of the physician responsible for the supervision of the
physician assistant and only in accordance with the physician's instructions
and written agreement.
(8) PHYSICIAN ASSISTANTS MAY REQUEST, RECEIVE, AND SIGN FOR PROFESSIONAL SAMPLES
AND MAY DISTRIBUTE PROFESSIONAL SAMPLES TO PATIENTS.
(9) PHYSICIAN ASSISTANTS AUTHORIZED TO PRESCRIBE AND/OR DISPENSE CONTROLLED
SUBSTANCES MUST REGISTER WITH THE FEDERAL DRUG ENFORCEMENT ADMINISTRATION.
(10)
PRESCRIPTION BLANKS:
(A) PRESCRIPTION BLANKS SHALL BEAR THE LICENSE NUMBER OF THE PHYSICIAN ASSISTANT
AND THE NAME OF THE PHYSICIAN ASSISTANT IN PRINTED FORMAT AT THE HEADING OF
THE BLANK. THE SUPERVISING PHYSICIAN SHALL ALSO BE IDENTIFIED AS REQUIRED IN
§16.91 (RELATINGTO IDENTIFYING INFORMATION ON PRESCRIPTION AND ORDERS FOR
EQUIPMENT AND SERVICE).
(B) THE SIGNATURE OF A PHYSICIAN ASSISTANT SHALL BE FOLLOWED BY THE INITIALS
“PA-C” OR SIMILAR DESIGNATION TO IDENTIFY THE SIGNER AS A PHYSICIAN
ASSISTANT. WHEN APPROPRIATE, THE PHYSICIAN ASSISTANT’S DEA NUMBER MUST
APPEAR ON THE PRESCRIPTION.
(C) THE SUPERVISING PHYSICIAN IS PROHIBITED FROM PRE-SIGNING PRESCRIPTION BLANKS.
(D) THE PHYSICIAN ASSISTANT MAY USE A PRESCRIPTION BLANK GENERATED BY A HOSPITAL
PROVIDED THE INFORMATION IN SUBSECTION (1) APPEARS ON THE BLANK.
(e) Recordkeeping requirements are as follows:
(1) When prescribing a drug, the physician assistant shall keep a copy of the
prescription, including the number of refills, in a ready reference file, or
record the name, amount, and doses of the drug prescribed, the number of refills,
the date of the prescription, and the physician assistant's name in the patient's
medical records.
(2) When dispensing a drug, the physician assistant shall record [his]HIS/HER
name, the name of the medication dispensed, the amount of medication dispensed,
the dose of the medication dispensed, and the date dispensed in the patient's
medical records.
(3) The physician assistant shall report, orally or in writing, to [his] THE
[physician assistant supervisor] SUPERVISING PHYSICIAN [within 12 hours] IN
A TIMELY MANNER, any drug prescribed or medication dispensed [by him] while
the [physician assistant supervisor] SUPERVISING PHYSICIAN was not physically
present, and the basis for each decision to prescribe or dispense[.] IN ACCORDANCE
WITH THE WRITTEN AGREEMENT.
(4) [The physician assistant supervisor shall countersign the prescription copy
or medical entry for each prescription or dispension within a reasonable time,
not to exceed three days, unless countersignature is required sooner by regulation,
policy within the health care facility or the requirements of a third party
payer.] THE PHYSICIAN ASSISTANT SUPERVISOR SHALL COUNTERSIGN THE PATIENT RECORD
WITHIN A REASONABLE TIME. THIS TIME PERIOD SHALL NOT EXCEED TEN DAYS.
(5) The physician assistant and the [physician assistant supervisor] SUPERVISING
PHYSICIAN shall provide immediate access to the written agreement to anyone
seeking to confirm the physician assistant's authority to prescribe or dispense
a drug.
§ 18.159. Medical records.
The [physician assistant supervisor] SUPERVISING PHYSICIAN shall timely review the medical records prepared by the physician assistant to ensure that the requirements of §16.95 (relating to medical records) have been satisfied.
MEDICAL CARE FACILITIES AND EMERGENCY MEDICAL SERVICES
§18.161. Physician assistant employed by medical care facilities.
(a) A physician assistant may be employed by a medical care facility, but shall
comply with all of the requirements of the act and this subchapter.
(b) The physician assistant shall not be responsible to more than three physician
assistant supervisors in a medical care facility.
(cB) This subchapter does not require medical care facilities to employ physician
assistants or to permit their utilization on their premises. Physician assistants
are permitted to provide medical services to the hospitalized patients of their
[physician assistant supervisor] SUPERVISING PHYSICIAN if the medical care facility
permits it.
§ l8.162 Emergency medical services.
(A) A physician assistant may only provide medical service in an emergency medical
care setting if the physician assistant has training in emergency medicine,
functions within the purview of [his] HIS/HER written agreement and is under
the [direct] supervision of the [physician assistant supervisor] SUPERVISING
PHYSICIAN.
(B) A PHYSICIAN ASSISTANT LICENSED IN THIS STATE OR LICENSED OR AUTHORIZED TO
PRACTICE IN ANY OTHER STATE OF THE UNITED STATES WHO IS RESPONDING TO A NEED
FOR MEDICAL CARE CREATED BY AN EMERGENCY OR A STATE OR LOCAL DISASTER (NOT TO
BE DEFINED AS AN EMERGENCY SITUATION WHICH OCCURS IN THE PLACE OF ONE’S
EMPLOYMENT) MAY RENDER SUCH CARE THAT THEY ARE ABLE TO PROVIDE WITHOUT SUPERVISION
AS IT IS DEFINED IN THESE REGULATIONS, OR WITH SUCH SUPERVISION AS IS AVAILABLE.
(C) ANY PHYSICIAN WHO SUPERVISES A PHYSICIAN ASSISTANT PROVIDING MEDICAL CARE
IN RESPONSE TO SUCH AN EMERGENCY OR STATE OR LOCAL DISASTER SHALL NOT BE REQUIRED
TO MEET THE REQUIREMENTS SET FORTH IN THESE REGULATIONS FOR AN APPROVED SUPERVISING
PHYSICIAN.
(D) NO PHYSICIAN ASSISTANT LICENSED IN THIS STATE OR LICENSED OR AUTHORIZED
TO PRACTICE IN OTHER STATES OF THE UNITED STATES WHO VOLUNTARILY AND GRATUITOUSLY,
AND OTHER THAN IN THE ORDINARY COURSE OF EMPLOYMENT OR PRACTICE, RENDERS EMERGENCY
MEDICAL ASSISTANCE SHALL BE LIABLE FOR CIVIL DAMAGES FOR ANY PERSONAL INJURIES
WHICH RESULT FROM ACTS OR OMISSIONS BY THOSE PERSONS IN RENDERING EMERGENCY
CARE WHICH MAY CONSTITUTE ORDINARY NEGLIGENCE. THE IMMUNITY GRANTED BY THIS
SECTION SHALL NOT APPLY TO ACTS OR OMISSIONS CONSTITUTING GROSS, WILLFUL, OR
WANTON NEGLIGENCE OR WHEN THE MEDICAL ASSISTANCE IS RENDERED AT ANY HOSPITAL,
PHYSICIAN’S OFFICE OR OTHER HEALTH CARE DELIVERY ENTITY WHERE THOSE SERVICES
ARE NORMALLY RENDERED. NO PHYSICIAN WHO SUPERVISES A PHYSICIAN ASSISTANT VOLUNTARILY
AND GRATUITOUSLYH PROVIDING EMERGENCY CARE AS DESCRIBED IN THIS SECTION SHALL
BE LIABLE FOR CIVIL DAMAGES FOR ANY PERSONAL INJURIES WHICH RESULT FROM ACTS
OR OMISSIONS BY THE PHYSICIAN ASSISTANT RENDERING EMERGENCY CARE.
IDENTIFICATION AND NOTICE RESPONSIBILITIES
§18.171. Physician assistant identification.
(a) A physician assistant may not render medical services to a patient until
the patient or the patient's legal guardian has been informed of the following:
(1) That the physician assistant is not a physician.
(2) That the physician assistant may perform the service required as the agent
of the physician and only as directed by the [physician assistant supervisor]
SUPERVISING PHYSICIAN
(3) That the patient has the right to be treated by the physician if the patient
desires.
(b) It is the [physician assistant supervisor] SUPERVISING PHYSICIAN ('s) responsibility
to be alert to patient complaints concerning the type or quality of services
provided by the physician assistant.
(c) In the [physician assistant supervisor] SUPERVISING PHYSICIAN ('s) office
and satellite locations, a notice plainly visible to patients shall be posted
in a prominent place explaining that a "physician assistant" is authorized
to assist a physician in the provision of medical care and services. The [physician
assistant supervisor] SUPERVISING PHYSICIAN shall display [his] THE registration
to supervise in [his] HIS/HER office. The physician assistant's [certificate]
LICENSE shall be prominently displayed at any location at which [he] THE PHYSICIAN
ASSISTANT provides services. Duplicate [certificates] LICENSES may be obtained
from the Board if required.
(d) The physician assistant shall wear an identification tag which uses the
term "Physician Assistant," [in 16 point type or larger]. The tag
shall be conspicuously worn.
§18.172. Notification of changes in employment.
(a) The physician assistant is required to notify the Board, in writing, of
a change in or termination of employment or a change in mailing address within
15 days. Failure to notify the Board in writing of a change in mailing address
may result in failure to receive pertinent material distributed by the Board.
The physician assistant shall provide the Board with [his] HIS/HER new address
of residence, address of employment and name of registered [physician assistant
supervisor] SUPERVISING PHYSICIAN.
(b) The [physician assistant supervisor] SUPERVISING PHYSICIAN is required to
notify the Board, in writing, of a change or termination of his OR HER supervision
of a physician assistant within 15 days.
(c) Failure to notify the Board of changes in employment or any termination
in the physician/physician assistant relationship is a basis for disciplinary
action against the physician's license, [physician assistant supervisor] SUPERVISING
PHYSICIAN ('s) registration and the physician assistant's [certificate] LICENSE.
DISCIPLINE
§18.181. Disciplinary and corrective measures.
(a) A physician assistant who engages in unprofessional conduct is subject
to disciplinary action under section 41 of the act (63 P.S. §422.41). Unprofessional
conduct includes but is not limited to, the following:
(1) Misrepresentation or concealment of a material fact in obtaining a [certificate]
LICENSE or a reinstatement thereof
(2) Commission of an offense against the statutes of the Commonwealth relating
to the practice of physician assistants or regulations adopted thereunder.
(3) Commission of an act involving moral turpitude, dishonesty, or corruption
when the act directly or indirectly affects the health, welfare or safety of
citizens of this Commonwealth. If the act constitutes a crime, conviction thereof
in a criminal proceeding may not be a condition precedent to disciplinary action.
(4) Conviction of a felony or conviction of a misdemeanor relating to a health
profession or receiving probation without verdict, disposition in lieu of trial
or an accelerated rehabilitative disposition in the disposition of felony charges,
in the courts of this Commonwealth, a Federal court or a court of any other
State, territory or country.
(5) Misconduct in practice as a physician assistant or performing tasks fraudulently,
beyond its authorized scope, with incompetence, or with negligence on a particular
occasion or negligence on repeated occasions.
(6) Performance of tasks as a physician assistant while the ability to do so
is impaired by alcohol, drugs, physical disability or mental instability.
(7) Impersonation of a licensed physician or another certified physician assistant.
(8) Offer, undertake or agree to cure or treat disease by a secret method, procedure,
treatment or medicine; the treating, prescribing for a human condition, by a
method, means or procedure which the physician assistant refuse to divulge upon
demand of the Board; or use of methods or treatment which are not in accordance
with treatment processes accepted by a reasonable segment of the medical profession.
(9) Violation of a provision of this subchapter fixing a standard of professional
conduct.
(10) Continuation of practice while the physician assistant's [certificate]
LICENSE has expired, is not registered or is suspended or revoked.
(11) Delegating a medical responsibility to a person when the physician assistant
knows or has reason to know that the person is not qualified by training, experience,
license or certification to perform the delegated tasks.
(12) The failure to notify the [physician assistant supervisor] SUPERVISING
PHYSICIAN that the physician assistant has withdrawn care from a patient.
(b) The Board will order the emergency suspension of the [certificate] LICENSE
of a physician assistant who presents an immediate and clear danger to the public
health and safety, as required by Section 40 of the act, (63 P.S. §422.40).
(c) The [certificate] LICENSE of a physician assistant shall automatically be
suspended, under conditions in section 40 of the act.
(d) The Board may refuse, revoke or suspend a physician's approval to supervise
a physician assistant for engaging in any of the conduct proscribed of Board
regulated practitioners in Section 41 of the act (63 P.S. §422.41).
*This is a copy of the proposed changes that were
presented to the State Board of Medicine on October 18, 2002 by the PSPA and
the Pennsylvania Medical Society. These are only proposed changes and currently
there is no change to the way a PA must practice within the Commonwealth. For
a copy of the current regulations, go to the Government Affairs page of the
PSPA website"