AAPA

Areas of State Law that May Require Amendment for Inclusion of Physician Assistants

All physician assistants practice with physician supervision, and with a scope of practice that includes those duties for which the PA is appropriately trained and that the physician chooses to delegate. The supervising physician and PA must comply with all provisions included in the state laws that govern physicians and physician assistants.

The PA law generally states that the physician may delegate any legal task for which the PA is appropriately trained. However, some aspects of care that the physician may choose to delegate are addressed in other sections of state law. Although it may be clear to the physician and PA that the "physician may delegate" language authorizes the doctor to delegate tasks covered by other laws, the most definitive authorization occurs when PAs are expressly mentioned in the applicable laws and regulations. The list below includes areas of state law that may require amendment to authorize PAs to participate fully in physician-directed patient care.

Checklist: Areas where PAs should be specifically included

1. Administration of Sedation / Anesthesia If authorized providers are listed, PAs should be included.
2. Apologies If state law allows health care practitioners to apologize to patients, with guaranteed immunity from any potential lawsuit that would use the apology as a basis for the suit, then PAs should be listed as covered practitioners.
3. Camp Physicals PAs should be able to perform exams and sign documents. In states that exempt physicians from needing to have a state license to provide care at a camp, PAs should be similarly exempted.
4. Confidentiality PAs should be protected from having to testify about information obtained through confidential relationships with patients in the same way physicians are exempted.
5. Cosmetic Procedures (w/o lasers) If authorized providers are listed, PAs should be included.
6. Death Certificates PAs should be able to pronounce death and sign certificates.
7. Deferral of Immunization Where immunizations are required unless a health care provider determines that immunization should be deferred, PAs should be included in the definition of "health care provider."
8. Department of Motor Vehicles PAs should be able to perform assessments and sign forms.
9. Disasters PAs should be allowed to provide care in disaster situations, even if not licensed in the state where the disaster response occurs.
10. End of Life Care If authorized providers are listed, PAs should be included. If the state enacts a Physician Order for Life Sustaining Care (POLST) law, physicians should be authorized to delegate POLST activities to PAs.
11. Good Samaritan Laws PAs should be afforded Good Samaritan immunity to the extent that it is extended to other health care providers.
12. Hospital Staffing Required staffing laws should include PAs among providers that meet appropriate staffing requirements
13. Informed Consent PAs should be authorized to provide all relevant information to patients and receive informed consent when required.
14. Lasers PAs should be allowed to use laser / pulsed light devices to perform medical procedures, if properly trained.
15. Long-Term Care If authorized providers are listed, PAs should be included.  Medicaid laws governing long term care should recognize PAs and not impose additional restrictions on PA practice.
16. Mental Health Providers In states that limit the provision of mental health services to "mental health providers," PAs should be included in the definition of "mental health providers."
17. Neonatal Intensive Care Units Required staffing laws should include PAs among providers that meet appropriate staffing requirements.
18. Ordering Restraint / Emergency Detention PAs should be able to order that a patient be restrained or detained for involuntary evaluation and treatment (generally for 72 hours) if the patient is judged to pose an imminent threat to themselves or others.
19. Organ Procurement PAs should be allowed to receive consent to procure organs, and if there is a list of practitioners who may procure organs, PAs should be included where consistent with standard of care.  If enucleation is addressed separately in law, PAs should also be authorized to become enucleators.
20. Outpatient Surgery Because the term "outpatient surgery" is so broad as to include many routine procedures, PAs should not be restricted by laws that govern outpatient surgery. Additionally, if laws specify who may administer sedation or be present during recovery, PAs should be included in any applicable list.
21. Pre-Hospital Care PAs should be able relay on-line medical direction to EMS personnel. PAs should be authorized to participate in the transport of pre-hospital patients without necessarily being certified EMTs.
22. Reporting Requirements PAs should be included in any list of health care professionals that are required to report child abuse, elder abuse, or injuries caused by firearms to the appropriate  authorities.
23. Reproductive Health If authorized providers are listed, PAs should be included.
24. Sports / School Physicals PAs should be allowed to perform exams and sign documents.
25. Supervision of Medical Assistants In states where medical assistants can only perform medical tasks when their supervising physician is on-site, physicians should be allowed to delegate such authority to PAs when the physician is off-site.
26. Transfusions PAs should be authorized to receive consent for blood transfusions, and should be authorized to order blood or blood products.
27. Workers' Compensation PAs should be allowed to serve as providers for patients covered by Worker's Compensation laws.
28. X-rays / Ionizing Radiation Procedures PAs should be allowed to take X-rays and perform other procedures that use ionizing radiation.  In laws that regulate radiologic technicians, PAs should be included in the list of providers exempted from needing rad tech licensure to utilize ionizing radiation.