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.
RENEE MONTGOMERY, Appellant vs. SOUTH PHILADELPHIA MEDICAL GROUP, INC.
and JOSEPH L. CHAPMAN, M.D., Appellees
No. 1846 Philadelphia, 1994
SUPERIOR COURT OF PENNSYLVANIA
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
assistant."
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
thereby."
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
Georgia].
My standard disclosure: I'm not a legal expert, and this is not legal
advice.
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.
Regards,
historybuff
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" |
