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Q: physican assistant ( Answered,   0 Comments )
Subject: physican assistant
Category: Health > Medicine
Asked by: ranger75-ga
List Price: $75.00
Posted: 07 Aug 2002 11:01 PDT
Expires: 06 Sep 2002 11:01 PDT
Question ID: 51814
1-legal decisions for use of physican assistant in radiation oncology
 2-federal law in regards to physican assistant services
 3- pennsylvania law with regards to physican assistant services

Request for Question Clarification by historybuff-ga on 07 Aug 2002 13:07 PDT
Pennsylvania state law addresses physician assistants in  subchapter
D. Physician Assistants.   Specifically applicable are items

in subsection 18, Physician Assistant Utilization.  Item 18.161,
Physician assistant employed by medical care facility may also be

of interest.

18.151.    Role of physician assistant. 
18.152.    Prohibitions. 
18.153.    Executing and relaying medical regimens. 
18.154.    Substitute physician assistant supervisor. 
18.155.    Satellite locations. 
18.156.    Monitoring and review of physician assistant utilization. 
18.157.    Administration of controlled substances and whole blood and
blood components.
18.158.    Prescribing and dispensing drugs. 
18.159.    Medical records. 

Here is the original document.  Each of the topics listed above is a
link to the full legal text.

Federal law applies in Medicare reimbursement, meaning what the
federal government will and will not pay for.  But in actual

scope and use of physician assistants you will see in reading the
following document that it defers to state regulations.  "Our

analysis found that the State scopes of practice are broad and as a
result provide little guidance that carriers can use to process

claims.  Scopes [meaning state scopes of practice regulations], as
well as Medicare, call for collaboration with with a physician

which may have the effect of either limiting or expanding the services
that non-physician practitioners may perform....State Medical

Boards set the physician assistant scope."

Find the entire US government report here, with emphasis on page 13
and beyond:

The national  guidance  about practices, and even suggested state
policy guidelines come from physician assitant organizations

such as National Commission on Certification of Physician Assistants:

Their suggestions for state guidelines are here:

National Commission on Certification of Physician Assistants  full web
site is here:

and the American Academy of Physician Assistants:

Occasionally HICVA will produce a document with recommendations
related to physician assistants.

Additional information could be found in this publication from Apollo
Healthcare.  It's possible that your hospital has this or similar:

This 315-page manual is heavily focused on criteria for the granting
of core and delineated privileges for primary and specialty

physicians and non-physician clinicians (often called physician
extenders, allied health professionals or midlevel practitioners)

such as Nurse Practitioners, Nurse Anesthetists, Nurse Midwives,
Surgical Assistants, Psychologists and Podiatrists.. Extensive

and detailed example lists of privileges for each specialty are
included in an easy-to-use checklist format. Link to the contents list

for more information. References, Web sites. Continuously updated as
new privileging recommendations become available from

specialty societies and other resources.                              

As you can see, as with physicians, the laws relating to scope of
practice reside with the state.  Even if federal laws exist in some

cases, the are less restrictive than the state laws.  My comments are
strictly based on reading the applicable laws as a layman,

not a legal expert.  An article from Physicians's News Digest by a
legal expert from Pittsburg, "Using physician assistants

properly" written By Daniel B. Vukmer, Esq.

I will post this as a clarification, and will continue to search for
part one, the specific legal court rulings.  I would appreciate

on whether parts two and three of your question have been answered.



Request for Question Clarification by historybuff-ga on 07 Aug 2002 16:30 PDT
You may find this helpful:

Liability Insurance for a Physician Assistant. (Brief Article), Lee J.
JohnsonMedical Economics,  August 6, 2001 v78i15 p116 states, "In
almost every malpractice suit involving a PA, his employer will also
be named as a defendant, whether the employer is a physician,
hospital, clinic, or health plan. Plaintiffs typically allege that the
employer is liable for providing inadequate supervision. So you should
be integrally involved in all aspects of treatment. Although you may
delegate certain duties to the PA, you haven't delegated the
liability. "

I was unable to find the specific legal cases you require.  Hopefully
another researcher with access to a database of case law will be able
to help you.

Subject: Re: physican assistant
Answered By: historybuff-ga on 10 Aug 2002 21:36 PDT
Hello Ranger75,

With the help of another Google researcher, it looks like we've dug up
a relevant Pennsylvania case for you involving radiology, oncology and
a physician assistant.

and JOSEPH L. CHAPMAN, M.D., Appellees
No. 1846 Philadelphia, 1994 
441 Pa. Super. 146; 656 A.2d 1385; 1995 Pa. Super. LEXIS 282 
October 27, 1994, Argued   
February 21, 1995, FILED 

The case involved a physician assistant who failed to refer a patient
to a physician, although she ordered seemingly appropriate tests.  The
tests did not show abnormality but the patient was much later
diagnosed and treated for cancer.  It was clear that detecting the
cancer earlier would have been of great benefit to the patient, but it
was not clear whether referring the patient to a physician would have
resulted in earlier detection.  "There also was evidence that, despite
this complaint, the plaintiff had not been referred to a physician.
There was no evidence, however, of the presence of any lump or mass;
and a mammogram showed no abnormality.  [**1393]  Thus, there was no 
[***23]  evidence that an examination by a physician would have
disclosed anything more than was discovered by the physician's

The case also contains quite a bit of dispute about who is qualified
to render an opinion on whether the physian assistant provided
adequate care.  "...(physician who was not a radiologist but who was
knowledgeable of the risks of x-ray treatment could testify as an
expert in an action against a radiologist). It would seem that
knowledge as to the treatment and care of patients which may be
possessed by a physician's assistant is also knowledge generally
possessed by a medical doctor. Therefore, the Court's reasoning in
Taylor v. Spencer Hosp., supra, applies with equal force when a 
[*154]  qualified physician has been called to testify as an expert
regarding the standard of care owed to a patient by a physician's
assistant. "

The outcome of the case was that although the patient had been cared
for by a physician assistant, which would have fallen below the
standard of care, the outcome would not have been any different had
the patient been cared for by the physician. "Thus, there was no 
[***23]  evidence that an examination by a physician would have
disclosed anything more than was discovered by the physician's
assistant. The time when the tumor could first have been detected does
not appear. Was it detectable a year earlier or only a short time
before it was discovered by Dr. Seidman? Although Dr. Karp testified
that the failure to refer plaintiff to a physician fell below the
standard of care required of a physician's assistant, he was either
unable or unwilling to say that the risk of harm had been increased

In sum, the physician and physician assistant were not held liable
because even if the physician had taken care of the patient, the
outcome would have been the same.  It  does make clear however the
point mentioned in my earlier excerpts that the physician is
ultimately held liable.  Had the physician assistant failed in some
way to provide the same care that a physician would have under the
same circumstances, the legal case may have ended differently.

I came across another case about physician liability in using a
physician assistant, though not directly related to oncology or
radiology.  The analysis of the case appeared in Hospital Law's Regan
Report, Feb 2000 v40 i9 p4.  David Tammelleo, JD,  a nationally
recognized authority on health care law states, "There are limits to a
physician's ability to delegate authority to a PA. Generally, a PA may
perform tasks specified in his job description after the job
description has been approved by the Composite State Board of Medical
Examiners (Board). Here, however, the PA's job description did not
specify that he had authority to harvest saphenous veins. Thus, the
only section of the PAA which might authorize the PA to harvest the
patient's vein is one which provides, in pertinent part, as follows:
Nothing in this Code section shall make unlawful the performance of a
medical task by the physician's assistant, whether or not such task is
specified in the general job description, when it is performed under
the direct supervision and in the presence of the physician utilizing
him. This language could be read as giving a physician the authority
to delegate any "medical task" to a PA so long as the physician is
present and supervises the procedure. However, the court did not
believe that the provision in question contained such a broad grant of
authority. The court concluded that the statute could not be construed
to give a physician carte blanche to delegate any and all tasks to a
PA. To hold otherwise would allow a brain surgeon to delegate brain
surgery, or a neurosurgeon to delegate a spinal fusion, or a plastic
surgeon to delegate rhinoplasty, all with impunity. This can not be
the case. Hospitals must scrutinize the conduct of PAs as well as
their supervising physicians.   The case itself is Gillis v. Cardio
TVP Surgical Associates, 520 S.E. 2d 767 - GA (1999) [state of

My standard disclosure:  I'm not a legal expert, and this is not legal

In sum, the Pennsylvania laws are pretty explicit about the role of a
physician assistant, and the setting of guidelines by the institution
employing him. The state laws are more specific than federal laws, so
are really what guides medical practitioners.  The federal laws come
into play with Medicare reimbursement.  Everything I read was also
pretty clear that physicians are held responsible for the physician
assistant's performance.  They're free to delegate, but if something
goes wrong it quickly becomes the physician's fault.

Please feel free to ask for clarification about what I've explained. 
I hope you find the information useful.



search strategy:

"physician assistant" liability
"physician assistant" legal
"physician assistant" court ruling
"physician assistant" malpractice
"physician assistant" oncology
"physician assistant" radiology
federal law "physician assistant"
regulations "physician assistant"
radiation oncology "physician assistant"
legal radiation oncology "physician assistant"
malpractice radiation oncology "physician assistant"
legal requirements oncology Pennsylvania "physician assistant"
I also did some searches substituting "assistants" for "assistant" and
"physicians" for "physician"
There are no comments at this time.

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