As physicians increasingly leverage their practices by using physician assistants (PAs) and other physician extenders, those activities are coming under significantly more scrutiny than ever before. Supervising physicians should be ever vigilant in executing their duties respecting PA oversight: the regulators are watching.

On March 13, 2008, physician James I. Honda's stipulation for the surrender of his California physicians and surgeons license became effective. By entering into the stipulation, Dr. Honda admitted to the numerous allegations lodged by the Medical Board of California that he was responsible for substandard care rendered by the PA he was supervising. California Business and Professions Code Section 3502 provides that medical services performed by a PA must be performed “under the supervision of a licensed physician and surgeon...” Section 3501 (f) provides further that “supervision means that a licensed physician and surgeon oversees the activities of, and accepts responsibility for, the medical services rendered by a physician assistant.” Section 1399.545 (g) of the California Code of Regulations, Title 16, states that a supervising physician has a “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.” Under California law, therefore, substandard care provided by a PA is imputed to the supervising physician.

Hospitals, physician supervisors and allied health professionals have a tremendous amount at stake when a physician extender practices beyond the scope of his or her license or certification. In addition to actions against the involved practitioners’ license or other legal credentials, criminal charges for the unauthorized practice of medicine, and for aiding and abetting the unauthorized practice of medicine, professional malpractice, and even Medicare false claims violations are potential consequences for inadequate supervision and control over the physician extender's practice.

The Medical Board of California Physician Assistant Committee (PA Committee) recently increased its monitoring activities by soliciting voluntary information about the use of physician delegation agreements from hospitals across the state. The PA Committee also just launched its "Disciplinary Actions" page on the PA Committee Web site. Disciplinary Actions against PAs can be tracked online here. Information will be added to the Web site quarterly.

Human resources departments should query this Web site when employing PAs, and medical staff offices should query this site when credentialing PAs. Hospitals can monitor PA enforcement activities by registering for monthly e-mail updates about disciplinary actions at the PA Committee Web site, which can be found here.

If you have any questions about the information in this alert or the legal ramifications of the allied health practitioner services at your hospital, please contact:

Patricia M. Kosich
kosich.patricia@arentfox.com
213.443.7521

Lowell C. Brown
brown.lowell@arentfox.com
213.443.7516

Sarah G. Benator
benator.sarah@arentfox.com
213.443.7518