SP extent of authority over and liability for their PA

[TheMuschroomKing]

How much authority does an SP have over a PA’s clinical judgment? Suppose an SP does not requires a discharge letter before treating a patient for opioid use disorder to confirm there is no multiple enrollment.  What if I as a PA feel uncomfortable with that practice and would like to require my patient to provide written documentation they have been discharged from a previous provider? Can an SP overrule me? Is the PA protected by their SP’s decision?

[iconic]

If an SP asks you to do something that is not illegal, I cannot imagine saying no to that. Ultimately, if you have disagreements about your practice philosophy, it may not be a good PA-SP match 

[rev ronin]

Ideally, the de facto PA practice should be the overlap of what the PA is comfortable with and what the SP is comfortable with.  If he or she is comfortable not requiring a discharge letter, why should that prevent you from requiring one?

Also, are you checking PMP every visit? I've caught more than a few problems that way, and in my state the lookup can be delegated to an MA.

[LT_Oneal_PAC]

Legally, you are an autonomous decision maker. They cannot make you do something that you feel uncomfortable doing. Now, you may be out to dry if there is a bad outcome from it. No different than if a cardiologist tells a generalist the patient needs an echo, but the generalist doesn’t order it, and the patient ends up dying from severe aortic stenosis, it would be bad from a liability perspective. There is also the complication of will they continue to employ you. 

[ohiovolffemtp]

Legal liability varies by state.  In some, the supervising physician is legally responsible for the care provided by any PA under their supervision.  Removing that and making the PA legally responsible for their care is an important step along the way to OTP.

[Mayamom]

You need to have a conversation with your SP.  Talk about the case & document well.  

[ventana]

Very much state by state answer 

 

If you are in a dependent state you are a bit bound to do what doc says, but imho open communication on the “why” is really important.  Docs are people.  Maybe they just got burned in this area and are being very cautious.
 

if you are lucky enough to be independent you still should talk with them but you can go your own way.  
 

after 50+ years of life and 20+ yrs practice I am more accepting of others ways to handle things based on everyone’s personal experience.  Great learning opportunity.   

[LT_Oneal_PAC]

14 hours ago, ohiovolffemtp said:

Legal liability varies by state.  In some, the supervising physician is legally responsible for the care provided by any PA under their supervision.  Removing that and making the PA legally responsible for their care is an important step along the way to OTP.

I think the question is more “am I liable if my SP makes me do something stupid” and not “is my SP liable,” though I could be wrong.

I also believe that it is rare for a physician, who met standard supervision requirements, to be held liable for an act they have no part in. For example, if I place a chest tube and accidentally perform a large liver biopsy, where the SP is notified prior, then I don’t see them being held liable if they was available and meets whatever chart review/co-sign/whatever requirements for supervision/collaboration. Now if the SP was the employer, that’s a different story because it’s well established that employers are responsible for the actions of employees. 
 

This is what I mean by autonomous in my previous post: If you choose to do something which is lower than the standard of care, it doesn’t matter if god almighty told you do it. Both SP and PA will be held liable. Maybe if you document that you believed it to be below the standard of care, but this may fry you even harder since you knew and did it anyway.

 

Physicians and PAs alike, at least younger ones, seem to think that the SP is some kind of shield from liability. It is not or we wouldn’t need liability insurance.