[NP-Clinical] CAN PA'S SUPERVISE NURSES?
Calif NP
np at c-zone.net
Wed May 9 10:14:29 PDT 2007
Here is the text of the California "Physician Assistant Practice Act", 2007
Business And Professions Code sections 3500 et seq. :
CALIFORNIA CODES (2007)BUSINESS AND PROFESSIONS CODE SECTION 3500-3503.5
The Physician Assistant Practice Act 3500. In its concern with the growing
shortage and geographicmaldistribution of health care services in
California, theLegislature intends to establish in this chapter a framework
fordevelopment of a new category of health manpower--the physicianassistant.
The purpose of this chapter is to encourage the more effectiveutilization of
the skills of physicians, and physicians andpodiatrists practicing in the
same medical group practice, byenabling them to delegate health care tasks
to qualified physicianassistants where this delegation is consistent with
the patient'shealth and welfare and with the laws and regulations relating
tophysician assistants. This chapter is established to encourage the
utilization ofphysician assistants by physicians, and by physicians and
podiatristspracticing in the same medical group, and to provide that
existinglegal constraints should not be an unnecessary hindrance to the
moreeffective provision of health care services. It is also the purposeof
this chapter to allow for innovative development of programs forthe
education, training, and utilization of physician assistants. 3500.5. This
chapter shall be known and cited as The PhysicianAssistant Practice Act.
3501. As used in this chapter: (a) "Board" means the Division of
Licensing of the Medical Boardof California. (b) "Approved program" means
a program for the education ofphysician assistants which has been formally
approved by thecommittee. (c) "Trainee" means a person who is currently
enrolled in anapproved program. (d) "Physician assistant" means a person
who meets therequirements of this chapter and is licensed by the committee.
(e) "Supervising physician" means a physician and surgeon licensedby the
board or by the Osteopathic Medical Board of California whosupervises one or
more physician assistants, who possesses a currentvalid license to practice
medicine, and who is not currently ondisciplinary probation for improper use
of a physician assistant. (f) "Supervision" means that a licensed
physician and surgeonoversees the activities of, and accepts responsibility
for, themedical services rendered by a physician assistant. (g)
"Committee" or "examining committee" means the PhysicianAssistant Committee.
(h) "Regulations" means the rules and regulations as contained inChapter
13.8 (commencing with Section 1399.500) of Title 16 of theCalifornia Code of
Regulations. (i) "Routine visual screening" means uninvasive
nonpharmacologicalsimple testing for visual acuity, visual field defects,
colorblindness, and depth perception. 3502. (a) Notwithstanding any other
provision of law, a physicianassistant may perform those medical services as
set forth by theregulations of the board when the services are rendered
under thesupervision of a licensed physician and surgeon or of physicians
andsurgeons approved by the board, except as provided in Section 3502.5.
(b) Notwithstanding any other provision of law, a physicianassistant
performing medical services under the supervision of aphysician and surgeon
may assist a doctor of podiatric medicine whois a partner, shareholder, or
employee in the same medical group asthe supervising physician. A physician
assistant who assists adoctor of podiatric medicine pursuant to this
subdivision shall do soonly according to patient-specific orders from the
supervisingphysician and surgeon. The supervising physician and surgeon
shall be physicallyavailable to the physician assistant for consultation
when suchassistance is rendered. A physician assistant assisting a doctor
ofpodiatric medicine shall be limited to performing those dutiesincluded
within the scope of practice of a doctor of podiatricmedicine. (c) No
medical services may be performed under this chapter in anyof the following
areas: (1) The determination of the refractive states of the human eye,or
the fitting or adaptation of lenses or frames for the aid thereof. (2) The
prescribing or directing the use of, or using, any opticaldevice in
connection with ocular exercises, visual training, ororthoptics. (3) The
prescribing of contact lenses for, or the fitting oradaptation of contact
lenses to, the human eye. (4) The practice of dentistry or dental hygiene
or the work of adental auxiliary as defined in Chapter 4 (commencing with
Section1600). (d) This section shall not be construed in a manner that
shallpreclude the performance of routine visual screening as defined
inSection 3501. 3502.1. (a) In addition to the services authorized in
theregulations adopted by the board, and except as prohibited by
Section3502, while under the supervision of a licensed physician andsurgeon
or physicians and surgeons authorized by law to supervise aphysician
assistant, a physician assistant may administer or providemedication to a
patient, or transmit orally, or in writing on apatient's record or in a drug
order, an order to a person who maylawfully furnish the medication or
medical device pursuant tosubdivisions (c) and (d). (1) A supervising
physician and surgeon who delegates authority toissue a drug order to a
physician assistant may limit this authorityby specifying the manner in
which the physician assistant may issuedelegated prescriptions. (2) Each
supervising physician and surgeon who delegates theauthority to issue a drug
order to a physician assistant shall firstprepare and adopt, or adopt, a
written, practice specific, formularyand protocols that specify all criteria
for the use of a particulardrug or device, and any contraindications for the
selection. Thedrugs listed shall constitute the formulary and shall include
onlydrugs that are appropriate for use in the type of practice engaged inby
the supervising physician and surgeon. When issuing a drugorder, the
physician assistant is acting on behalf of and as an agentfor a supervising
physician and surgeon. (b) "Drug order" for purposes of this section means
an order formedication which is dispensed to or for a patient, issued and
signedby a physician assistant acting as an individual practitioner
withinthe meaning of Section 1306.02 of Title 21 of the Code of
FederalRegulations. Notwithstanding any other provision of law, (1) a
drugorder issued pursuant to this section shall be treated in the samemanner
as a prescription or order of the supervising physician, (2)all references
to "prescription" in this code and the Health andSafety Code shall include
drug orders issued by physician assistantspursuant to authority granted by
their supervising physicians, and(3) the signature of a physician assistant
on a drug order shall bedeemed to be the signature of a prescriber for
purposes of this codeand the Health and Safety Code. (c) A drug order for
any patient cared for by the physicianassistant that is issued by the
physician assistant shall either bebased on the protocols described in
subdivision (a) or shall beapproved by the supervising physician before it
is filled or carriedout. (1) A physician assistant shall not administer or
provide a drugor issue a drug order for a drug other than for a drug listed
in theformulary without advance approval from a supervising physician
andsurgeon for the particular patient. At the direction and under
thesupervision of a physician and surgeon, a physician assistant mayhand to
a patient of the supervising physician and surgeon a properlylabeled
prescription drug prepackaged by a physician and surgeon,manufacturer as
defined in the Pharmacy Law, or a pharmacist. (2) A physician assistant
may not administer, provide or issue adrug order for Schedule II through
Schedule V controlled substanceswithout advance approval by a supervising
physician and surgeon forthe particular patient. (3) Any drug order issued
by a physician assistant shall besubject to a reasonable quantitative
limitation consistent withcustomary medical practice in the supervising
physician and surgeon'spractice. (d) A written drug order issued pursuant
to subdivision (a),except a written drug order in a patient's medical record
in a healthfacility or medical practice, shall contain the printed
name,address, and phone number of the supervising physician and surgeon,the
printed or stamped name and license number of the physicianassistant, and
the signature of the physician assistant. Further, awritten drug order for
a controlled substance, except a written drugorder in a patient's medical
record in a health facility or a medicalpractice, shall include the federal
controlled substancesregistration number of the physician assistant. The
requirements ofthis subdivision may be met through stamping or otherwise
imprintingon the supervising physician and surgeon's prescription blank to
showthe name, license number, and if applicable, the federal
controlledsubstances number of the physician assistant, and shall be signed
bythe physician assistant. When using a drug order, the physicianassistant
is acting on behalf of and as the agent of a supervisingphysician and
surgeon. (e) The medical record of any patient cared for by a
physicianassistant for whom the supervising physician and surgeon's
ScheduleII drug order has been issued or carried out shall be reviewed
andcountersigned and dated by a supervising physician and surgeon
withinseven days. (f) All physician assistants who are authorized by
theirsupervising physicians to issue drug orders for controlled
substancesshall register with the United States Drug
EnforcementAdministration (DEA). (g) The committee shall consult with the
Medical Board ofCalifornia and report during its sunset review required by
Division1.2 (commencing with Section 473) the impacts of exempting
ScheduleIII and Schedule IV drug orders from the requirement for a
physicianand surgeon to review and countersign the affected medical record
ofa patient. 3502.5. Notwithstanding any other provision of law, a
physicianassistant may perform those medical services permitted pursuant
toSection 3502 during any state of war emergency, state of emergency,or
state of local emergency, as defined in Section 8558 of theGovernment Code,
and at the request of a responsible federal, state,or local official or
agency, or pursuant to the terms of a mutual aidoperation plan established
and approved pursuant to the CaliforniaEmergency Services Act (Chapter 7
(commencing with Section 8550) ofDivision 1 of Title 2 of the Government
Code), regardless of whetherthe physician assistant's approved supervising
physician is availableto supervise the physician assistant, so long as a
licensedphysician is available to render the appropriate
supervision."Appropriate supervision" shall not require the personal
orelectronic availability of a supervising physician if thatavailability is
not possible or practical due to the emergency. Thelocal health officers
and their designees may act as supervisingphysicians during emergencies
without being subject to approval bythe board. At all times, the local
health officers or theirdesignees supervising the physician assistants shall
be licensedphysicians and surgeons. Supervising physicians acting pursuant
tothis section shall not be subject to the limitation on the number
ofphysician assistants supervised under Section 3516. No responsible
official or mutual aid operation plan shall invokethis section except in the
case of an emergency that endangers thehealth of individuals. Under no
circumstances shall this section beinvoked as the result of a labor dispute
or other dispute concerningcollective bargaining. 3503. No person other
than one who has been licensed to practice asa physician assistant or
authorized to practice on interim approvalunder Section 3517 shall practice
as a physician assistant or in asimilar capacity to a physician and surgeon
or podiatrist or holdhimself or herself out as a "physician assistant," or
shall use anyother term indicating or implying that he or she is a
physicianassistant. 3503.5. (a) A person licensed under this chapter who in
good faithrenders emergency care at the scene of an emergency that
occursoutside both the place and course of that person's employment shallnot
be liable for any civil damage as a result of any acts oromissions by that
person in rendering the emergency care. (b) This section shall not be
construed to grant immunity fromcivil damages to any person whose conduct in
rendering emergency careis grossly negligent. (c) In addition to the
immunity specified in subdivision (a), theprovisions of Article 17
(commencing with Section 2395) of Chapter 5shall apply to a person licensed
under this chapter when actingpursuant to delegated authority from an
approved supervisingphysician. * * * * * * * * *
----- Original Message -----
From: "Conrad Rios" <conrad.rios at ucdmc.ucdavis.edu>
To: "NP Clinical" <np-clinical at nurse.net>
Cc: <np-clinical-bounces at nurse.net>; <ACC-Circle at listserve.com>;
<np-clinical at nurse.net>
Sent: Tuesday, May 08, 2007 10:04 PM
Subject: Re: [NP-Clinical] CAN PA'S SUPERVISE NURSES?
> Under CA codes and regulations for PAs 1399.541 I believe will suffice.
> Under the PA Business and Professional Codes 2069 Medical Assistants are
> mentioned, not LVNs as you mentioned. I presume what you mean can a PA be
> in a clinic setting alone giving orders to the LVN as part of the medical
> team vs someone the LVN sees a supervisor. When you read the first
sentence
> of 1399.541 it mentions the "PA acts as an agent for that physician, the
> orders given and tasks performed by a PA shall be considered the same as
if
> they had been given and performed by the supervising MD"
> Hope this helps.
>
> Conrad J. Rios, NP, PA, MSN
> Faculty
> UC Davis, FNP/PA Program
> 559-281-8211
>
> Email: conrad.rios at ucdmc.ucdavis.edu
> Web: http://fnppa.ucdavis.edu
> "Christine Smith"
> <chrisbsmith at mind
> spring.com> To:
> Sent by: <np-clinical at nurse.net>,
> np-clinical-bounc <ACC-Circle at listserve.com>
> es at nurse.net cc:
>
> Subject:
> 05/08/2007 04:27 [NP-Clinical] CAN PA'S SUPERVISE
> PM NURSES?
> Please respond to
> NP Clinical
> <np-clinical at nurs
> e.net>
> I need specific legalese that states in California a PA can supervise an
> LVN (LPNs in most states). I can find legitimate info stating a PA can
> supervise an MA on both the California BRN site and the California PA site
> but nothing specific saying they can supervise an LVN.
> We may make an LVN position in the hospital based clinic I run - free
> standing, no MD on site. I know that RNs (therefore NPs) can supervise
LVNs
> but I cannot find the documentation allowing PAs to do this.
> Thanks,
> Christine Smith, NP
> Antioch, CA
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