vector40 Posted January 18, 2015 Share Posted January 18, 2015 Hi all, I was looking at the PA statutes for CA (I'm planning a move after graduating and Cali's on the short list), and noticed this -- [regarding supervision] "PA and supervising physician must establish written guidelines for adequate supervision, which include one or more of the following: (1) same day examination of patient by physician; (2) countersignature and dating of all medical records within 30 days; (3) adoption of protocols to govern PA performance. Protocols must include symptoms, signs and other data needed to diagnose, appropriate tests to order, drugs to recommend, education of patient, etc. Protocols must be developed by physician or adopted from texts; signed and dated by supervising physician and PA. " [regarding prescribing] "Supervising physicians who delegate authority to issue a drug order must first adopt a written practice-specific formulary and protocols that specify criteria for the use of a particular drug or device and contraindications" To me that sounds as though all care by PAs functions essentially within the limits of a cookbook written by your supervising physician (unless you go with supervisory option #1 or #2 which are both very onerous, and I can't imagine very common except maybe for new grads). Simply put, this sounds awful. Can anybody practicing in the state comment on how this usually works? Are the "protocols" typically very general and liberal, or what? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 19, 2015 Moderator Share Posted January 19, 2015 notice is says ONE or more of the following, not all. most docs just do #2, countersign charts. I practiced as a PA in CA as my first job out of school and we had no "treatment protocols" in place. #2 is what is common in most practices in most states. that's what "supervision" entails and is the standard for pa practice. in many places that means a doc has a stamp that says "PA care reviewed" which they then initial by whether or not they actually read the whole chart. Link to comment Share on other sites More sharing options...
vector40 Posted January 19, 2015 Author Share Posted January 19, 2015 Countersigning 100% of charts? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 19, 2015 Moderator Share Posted January 19, 2015 Countersigning 100% of charts? I believe that has been updated recently so folks who are not new grads after some period of time only need to submit 10% of charts and charts for which a cat 2 narcotic has been written. Link to comment Share on other sites More sharing options...
Timon Posted January 19, 2015 Share Posted January 19, 2015 I remember it as 10% as well.. but I just looked up California Assembly Bill 3 which lowered the cosignature requirements at which it states: "The supervising physician and surgeon shall review, countersign, and date a sample consisting of, at a minimum, 5 percent of the medical records of patients treated by the physician assistant functioning under the protocols within 30 days of the date of treatment by the physician assistant. The physician and surgeon shall select for review those cases that by diagnosis, problem, treatment, or procedure represent, in his or her judgment, the most significant risk to the patient." http://www.leginfo.ca.gov/pub/07-08/bill/asm/ab_0001-0050/ab_3_bill_20071010_chaptered.html I think the CAPA website has more information when you purchase a membership. Link to comment Share on other sites More sharing options...
vector40 Posted January 19, 2015 Author Share Posted January 19, 2015 Yes, it sounds as if the 5% applies to protocol-based care (i.e. it's on top of, not instead of). Here's what seems to be current on the CA website: "(e) A physician assistant and his or her supervising physician shall establish in writing guidelines for the adequate supervision of the physician assistant which shall include one or more of the following mechanisms: (1) Examination of the patient by a supervising physician the same day as care is given by the physician assistant; (2) Countersignature and dating of all medical records written by the physician assistant within thirty (30) days that the care was given by the physician assistant; (3) The supervising physician may adopt protocols to govern the performance of a physician assistant for some or all tasks. The minimum content for a protocol governing diagnosis and management as referred to in this section shall include the presence or absence of symptoms, signs, and other data necessary to establish a diagnosis or assessment, any appropriate tests or studies to order, drugs to recommend to the patient, and education to be given the patient. For protocols governing procedures, the protocol shall state the information to be given the patient, the nature of the consent to be obtained from the patient, the preparation and technique of the procedure, and the followup care. Protocols shall be developed by the physician, adopted from, or referenced to, texts or other sources. Protocols shall be signed and dated by the supervising physician and the physician assistant. The supervising physician shall review, countersign, and date a minimum of 5% sample of medical records of patients treated by the physician assistant functioning under these protocols within thirty (30) days. The physician shall select for review those cases which by diagnosis, problem, treatment or procedure represent, in his or her judgment, the most significant risk to the patient; (4) Other mechanisms approved in advance by the board. (f) The supervising physician has continuing responsibility to follow the progress of the patient and to make sure that the physician assistant does not function autonomously. The supervising physician shall be responsible for all medical services provided by a physician assistant under his or her supervision." Link to comment Share on other sites More sharing options...
JustaPA Posted February 4, 2015 Share Posted February 4, 2015 Docs also have to sign 100% of the charts when we order controlled drugs. Link to comment Share on other sites More sharing options...
SoCalPA Posted February 4, 2015 Share Posted February 4, 2015 Wow. I didn't know this. I hope we are moving towards more independence after a certain # of supervised hours. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 4, 2015 Moderator Share Posted February 4, 2015 Docs also have to sign 100% of the charts when we order controlled drugs. just sch 2, right? Link to comment Share on other sites More sharing options...
Guest Paula Posted February 4, 2015 Share Posted February 4, 2015 California seems really restrictive. Ugh. Link to comment Share on other sites More sharing options...
LESH Posted February 5, 2015 Share Posted February 5, 2015 Simply put, this sounds awful. Can anybody practicing in the state comment on how this usually works? Are the "protocols" typically very general and liberal, or what? It's not as bad as it reads. If you decide to use protocols ( remember there are other options) you can adopt/or reference current text or other sources as your protocols. Other states have the "P" word connected to PA practices. Medical organizations use the "P" word. If you look hard enough you will see that the definition of the "P" word varies. What some states call Protocols others are calling delegation of services. http://www.ksbha.org/forms/padrugprot.pdf The protocols' minimal content is described in section 3502(c )(1). I have referenced medical texts as my protocols and had no problems. I have seen other practices with very specific protocols or they adopted practice protocols from other organizations. Here's a few examples of how general or specific protocols can be; https://www.thehealthplan.com/providers_us/clinicalguidelines.cfm https://www.armedicalboard.org/Professionals/pdf/PAProExpER.pdf http://providers.kaiserpermanente.org/oh/clinicalguidelines.html http://www.tiopa.org/assets/PA_Protocol_1340803445_6762.pdf https://play.google.com/books/reader?id=dgNyDHydaTAC&printsec=frontcover&output=reader&hl=en&pg=GBS.PT20 http://notebook.lausd.net/pls/ptl/docs/PAGE/CA_LAUSD/FLDR_ORGANIZATIONS/STUDENT_HEALTH_HUMAN_SERVICES/SHHS/MEDICAL/SMS_PUBLICATIONS/SMS_REF_MANUALS/STANDARDIZED%20PROCEDURES(FINAL).PDF www.tnpa.com/protocol http://www.pg2pa.org/Assets/Official_AAPA_pdfs/PAs%20and%20Protocols%20-%202010.pdf You might want to pick up Michael Scarano, Jr's book California Physician Assistant's and Supervising Physician's Legal Handbook. Michael served as General Counsel for the California Academy of Physician Assistants for many years and his book is really good explaining the PA Practice Act and regulations. Good luck in your future PA endeavors. I hope this helps. LESH Link to comment Share on other sites More sharing options...
fyrelight74 Posted February 6, 2015 Share Posted February 6, 2015 Here is a sample delegation of services agreement: http://www.capanet.org/uploadedFiles/Content/Resources/DSA2008.pdf There are different guidelines for those of us who have taken the controlled substances class than for those who have not. PAs who have not have to have preapproval for certain scheduled drugs, etc. If you take the class, only your schedule 2 drugs need to be countersigned within 7 days. Link to comment Share on other sites More sharing options...
LESH Posted February 6, 2015 Share Posted February 6, 2015 Just a point point of clarification, in California the DSA (while required to practice as a PA) does not meet the criteria of a protocol as defined in Section 3502 (c ) (1) of the Business and Professions Code. Link to comment Share on other sites More sharing options...
vector40 Posted February 7, 2015 Author Share Posted February 7, 2015 Great info, thank you LESH. Link to comment Share on other sites More sharing options...
LESH Posted February 8, 2015 Share Posted February 8, 2015 Hope this link works because it is the most up to date version of a DSA http://www.pac.ca.gov/forms_pubs/delegation.pdf Link to comment Share on other sites More sharing options...
CByersPAC Posted February 10, 2015 Share Posted February 10, 2015 I worked in CA for many years, used standard-of-care medical texts/references as "protocols" with no problems, as LESH said. Link to comment Share on other sites More sharing options...
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