3500. In its concern with the growing shortage and geographic
maldistribution of health care services in California, the
Legislature intends to establish in this chapter a framework for
development of a new category of health manpower--the physician
assistant.
The purpose of this chapter is to encourage the more effective
utilization of the skills of physicians, and physicians and
podiatrists practicing in the same medical group practice, by
enabling them to delegate health care tasks to qualified physician
assistants where this delegation is consistent with the patient's
health and welfare and with the laws and regulations relating to
physician assistants.
This chapter is established to encourage the utilization of
physician assistants by physicians, and by physicians and podiatrists
practicing in the same medical group, and to provide that existing
legal constraints should not be an unnecessary hindrance to the more
effective provision of health care services. It is also the purpose
of this chapter to allow for innovative development of programs for
the education, training, and utilization of physician assistants.
3500.5. This chapter shall be known and cited as the Physician
Assistant Practice Act.
3501. As used in this chapter:
(a) "Board" means the Medical Board of California.
(b) "Approved program" means a program for the education of
physician assistants that has been formally approved by the
committee.
(c) "Trainee" means a person who is currently enrolled in an
approved program.
(d) "Physician assistant" means a person who meets the
requirements of this chapter and is licensed by the committee.
(e) "Supervising physician" means a physician and surgeon licensed
by the board or by the Osteopathic Medical Board of California who
supervises one or more physician assistants, who possesses a current
valid license to practice medicine, and who is not currently on
disciplinary probation for improper use of a physician assistant.
(f) "Supervision" means that a licensed physician and surgeon
oversees the activities of, and accepts responsibility for, the
medical services rendered by a physician assistant.
(g) "Committee" or "examining committee" means the Physician
Assistant Committee.
(h) "Regulations" means the rules and regulations as set forth in
Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the
California Code of Regulations.
(i) "Routine visual screening" means uninvasive nonpharmacological
simple testing for visual acuity, visual field defects, color
blindness, and depth perception.
(j) "Program manager" means the staff manager of the diversion
program, as designated by the executive officer of the board. The
program manager shall have background experience in dealing with
substance abuse issues.
(k) "Delegation of services agreement" means the writing that
delegates to a physician assistant from a supervising physician the
medical services the physician assistant is authorized to perform
consistent with subdivision (a) of Section 1399.540 of Title 16 of
the California Code of Regulations.
(l) "Other specified medical services" means tests or examinations
performed or ordered by a physician assistant practicing in
compliance with this chapter or regulations of the board promulgated
under this chapter.
(m) A physician assistant acts as an agent of the supervising
physician when performing any activity authorized by this chapter or
regulations promulgated by the board under this chapter.
3502. (a) Notwithstanding any other provision of law, a physician
assistant may perform those medical services as set forth by the
regulations of the board when the services are rendered under the
supervision of a licensed physician and surgeon who is not subject to
a disciplinary condition imposed by the board prohibiting that
supervision or prohibiting the employment of a physician assistant.
(b) Notwithstanding any other provision of law, a physician
assistant performing medical services under the supervision of a
physician and surgeon may assist a doctor of podiatric medicine who
is a partner, shareholder, or employee in the same medical group as
the supervising physician and surgeon. A physician assistant who
assists a doctor of podiatric medicine pursuant to this subdivision
shall do so only according to patient-specific orders from the
supervising physician and surgeon.
The supervising physician and surgeon shall be physically
available to the physician assistant for consultation when such
assistance is rendered. A physician assistant assisting a doctor of
podiatric medicine shall be limited to performing those duties
included within the scope of practice of a doctor of podiatric
medicine.
(c) (1) A physician assistant and his or her supervising physician
and surgeon shall establish written guidelines for the adequate
supervision of the physician assistant. This requirement may be
satisfied by the supervising physician and surgeon adopting protocols
for some or all of the tasks performed by the physician assistant.
The protocols adopted pursuant to this subdivision shall comply with
the following requirements:
(A) A protocol governing diagnosis and management shall, at a
minimum, 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 provided to the patient.
(B) A protocol governing procedures shall set forth the
information to be provided to the patient, the nature of the consent
to be obtained from the patient, the preparation and technique of the
procedure, and the followup care.
(C) Protocols shall be developed by the supervising physician and
surgeon or adopted from, or referenced to, texts or other sources.
(D) Protocols shall be signed and dated by the supervising
physician and surgeon and the physician assistant.
(2) 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.
(3) Notwithstanding any other provision of law, the board or
committee may establish other alternative mechanisms for the adequate
supervision of the physician assistant.
(d) No medical services may be performed under this chapter in any
of 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 optical
device in connection with ocular exercises, visual training, or
orthoptics.
(3) The prescribing of contact lenses for, or the fitting or
adaptation of contact lenses to, the human eye.
(4) The practice of dentistry or dental hygiene or the work of a
dental auxiliary as defined in Chapter 4 (commencing with Section
1600).
(e) This section shall not be construed in a manner that shall
preclude the performance of routine visual screening as defined in
Section 3501.
3502.1. (a) In addition to the services authorized in the
regulations adopted by the board, and except as prohibited by Section
3502, while under the supervision of a licensed physician and
surgeon or physicians and surgeons authorized by law to supervise a
physician assistant, a physician assistant may administer or provide
medication to a patient, or transmit orally, or in writing on a
patient's record or in a drug order, an order to a person who may
lawfully furnish the medication or medical device pursuant to
subdivisions (c) and (d).
(1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
(2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt, or adopt, a written, practice specific, formulary
and protocols that specify all criteria for the use of a particular
drug or device, and any contraindications for the selection.
Protocols for Schedule II controlled substances shall address the
diagnosis of illness, injury, or condition for which the Schedule II
controlled substance is being administered, provided, or issued. The
drugs listed in the protocols shall constitute the formulary and
shall include only drugs that are appropriate for use in the type of
practice engaged in by the supervising physician and surgeon. When
issuing a drug order, the physician assistant is acting on behalf of
and as an agent for a supervising physician and surgeon.
(b) "Drug order" for purposes of this section means an order for
medication that is dispensed to or for a patient, issued and signed
by a physician assistant acting as an individual practitioner within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription or order of the supervising physician, (2)
all references to "prescription" in this code and the Health and
Safety Code shall include drug orders issued by physician assistants
pursuant to authority granted by their supervising physicians and
surgeons, and (3) the signature of a physician assistant on a drug
order shall be deemed to be the signature of a prescriber for
purposes of this code and the Health and Safety Code.
(c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician and surgeon before it is filled
or carried out.
(1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient. At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled 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 a
drug order to a patient for Schedule II through Schedule V controlled
substances without advance approval by a supervising physician and
surgeon for that particular patient unless the physician assistant
has completed an education course that covers controlled substances
and that meets standards, including pharmacological content, approved
by the committee. The education course shall be provided either by
an accredited continuing education provider or by an approved
physician assistant training program. If the physician assistant will
administer, provide, or issue a drug order for Schedule II
controlled substances, the course shall contain a minimum of three
hours exclusively on Schedule II controlled substances. Completion of
the requirements set forth in this paragraph shall be verified and
documented in the manner established by the committee prior to the
physician assistant's use of a registration number issued by the
United States Drug Enforcement Administration to the physician
assistant to administer, provide, or issue a drug order to a patient
for a controlled substance without advance approval by a supervising
physician and surgeon for that particular patient.
(3) Any drug order issued by a physician assistant shall be
subject to a reasonable quantitative limitation consistent with
customary medical practice in the supervising physician and surgeon's
practice.
(d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility 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 physician
assistant, and the signature of the physician assistant. Further, a
written drug order for a controlled substance, except a written drug
order in a patient's medical record in a health facility or a medical
practice, shall include the federal controlled substances
registration number of the physician assistant and shall otherwise
comply with the provisions of Section 11162.1 of the Health and
Safety Code. Except as otherwise required for written drug orders for
controlled substances under Section 11162.1 of the Health and Safety
Code, the requirements of this subdivision may be met through
stamping or otherwise imprinting on the supervising physician and
surgeon's prescription blank to show the name, license number, and if
applicable, the federal controlled substances number of the
physician assistant, and shall be signed by the physician assistant.
When using a drug order, the physician assistant is acting on behalf
of and as the agent of a supervising physician and surgeon.
(e) The medical record of any patient cared for by a physician
assistant for whom the physician assistant's Schedule II drug order
has been issued or carried out shall be reviewed and countersigned
and dated by a supervising physician and surgeon within seven days.
(f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
(g) The committee shall consult with the Medical Board of
California and report during its sunset review required by Division
1.2 (commencing with Section 473) the impacts of exempting Schedule
III and Schedule IV drug orders from the requirement for a physician
and surgeon to review and countersign the affected medical record of
a patient.
3502.2. Notwithstanding any other provision of law, a physician
assistant may perform the physical examination and any other
specified medical services that are required pursuant to Section 2881
of the Public Utilities Code and Sections 44336, 49406, 49423,
49455, 87408, 87408.5, and 87408.6 of the Education Code, practicing
in compliance with this chapter, and may sign and attest to any
certificate, card, form, or other documentation evidencing the
examination or other specified medical services.
3502.3. (a) Notwithstanding any other provision of law, in addition
to any other practices that meet the general criteria set forth in
this chapter or the board's regulations for inclusion in a delegation
of services agreement, a delegation of services agreement may
authorize a physician assistant to do any of the following:
(1) Order durable medical equipment, subject to any limitations
set forth in Section 3502 or the delegation of services agreement.
Notwithstanding that authority, nothing in this paragraph shall
operate to limit the ability of a third-party payer to require prior
approval.
(2) For individuals receiving home health services or personal
care services, after consultation with the supervising physician,
approve, sign, modify, or add to a plan of treatment or plan of care.
(b) Nothing in this section shall be construed to affect the
validity of any delegation of services agreement in effect prior to
the enactment of this section or those adopted subsequent to
enactment.
3502.5. Notwithstanding any other provision of law, a physician
assistant may perform those medical services permitted pursuant to
Section 3502 during any state of war emergency, state of emergency,
or state of local emergency, as defined in Section 8558 of the
Government Code, and at the request of a responsible federal, state,
or local official or agency, or pursuant to the terms of a mutual aid
operation plan established and approved pursuant to the California
Emergency Services Act (Chapter 7 (commencing with Section 8550) of
Division 1 of Title 2 of the Government Code), regardless of whether
the physician assistant's approved supervising physician is available
to supervise the physician assistant, so long as a licensed
physician is available to render the appropriate supervision.
"Appropriate supervision" shall not require the personal or
electronic availability of a supervising physician if that
availability is not possible or practical due to the emergency. The
local health officers and their designees may act as supervising
physicians during emergencies without being subject to approval by
the board. At all times, the local health officers or their designees
supervising the physician assistants shall be licensed physicians
and surgeons. Supervising physicians acting pursuant to this section
shall not be subject to the limitation on the number of physician
assistants supervised under Section 3516.
No responsible official or mutual aid operation plan shall invoke
this section except in the case of an emergency that endangers the
health of individuals. Under no circumstances shall this section be
invoked as the result of a labor dispute or other dispute concerning
collective bargaining.
3503. No person other than one who has been licensed to practice as
a physician assistant shall practice as a physician assistant or in
a similar capacity to a physician and surgeon or podiatrist or hold
himself or herself out as a "physician assistant," or shall use any
other term indicating or implying that he or she is a physician
assistant.
3503.5. (a) A person licensed under this chapter who in good faith
renders emergency care at the scene of an emergency that occurs
outside both the place and course of that person's employment shall
not be liable for any civil damage as a result of any acts or
omissions by that person in rendering the emergency care.
(b) This section shall not be construed to grant immunity from
civil damages to any person whose conduct in rendering emergency care
is grossly negligent.
(c) In addition to the immunity specified in subdivision (a), the
provisions of Article 17 (commencing with Section 2395) of Chapter 5
shall apply to a person licensed under this chapter when acting
pursuant to delegated authority from an approved supervising
physician.
3500. In its concern with the growing shortage and geographic
maldistribution of health care services in California, the
Legislature intends to establish in this chapter a framework for
development of a new category of health manpower--the physician
assistant.
The purpose of this chapter is to encourage the more effective
utilization of the skills of physicians, and physicians and
podiatrists practicing in the same medical group practice, by
enabling them to delegate health care tasks to qualified physician
assistants where this delegation is consistent with the patient's
health and welfare and with the laws and regulations relating to
physician assistants.
This chapter is established to encourage the utilization of
physician assistants by physicians, and by physicians and podiatrists
practicing in the same medical group, and to provide that existing
legal constraints should not be an unnecessary hindrance to the more
effective provision of health care services. It is also the purpose
of this chapter to allow for innovative development of programs for
the education, training, and utilization of physician assistants.
3500.5. This chapter shall be known and cited as the Physician
Assistant Practice Act.
3501. As used in this chapter:
(a) "Board" means the Medical Board of California.
(b) "Approved program" means a program for the education of
physician assistants that has been formally approved by the
committee.
(c) "Trainee" means a person who is currently enrolled in an
approved program.
(d) "Physician assistant" means a person who meets the
requirements of this chapter and is licensed by the committee.
(e) "Supervising physician" means a physician and surgeon licensed
by the board or by the Osteopathic Medical Board of California who
supervises one or more physician assistants, who possesses a current
valid license to practice medicine, and who is not currently on
disciplinary probation for improper use of a physician assistant.
(f) "Supervision" means that a licensed physician and surgeon
oversees the activities of, and accepts responsibility for, the
medical services rendered by a physician assistant.
(g) "Committee" or "examining committee" means the Physician
Assistant Committee.
(h) "Regulations" means the rules and regulations as set forth in
Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the
California Code of Regulations.
(i) "Routine visual screening" means uninvasive nonpharmacological
simple testing for visual acuity, visual field defects, color
blindness, and depth perception.
(j) "Program manager" means the staff manager of the diversion
program, as designated by the executive officer of the board. The
program manager shall have background experience in dealing with
substance abuse issues.
(k) "Delegation of services agreement" means the writing that
delegates to a physician assistant from a supervising physician the
medical services the physician assistant is authorized to perform
consistent with subdivision (a) of Section 1399.540 of Title 16 of
the California Code of Regulations.
(l) "Other specified medical services" means tests or examinations
performed or ordered by a physician assistant practicing in
compliance with this chapter or regulations of the board promulgated
under this chapter.
(m) A physician assistant acts as an agent of the supervising
physician when performing any activity authorized by this chapter or
regulations promulgated by the board under this chapter.
3502. (a) Notwithstanding any other provision of law, a physician
assistant may perform those medical services as set forth by the
regulations of the board when the services are rendered under the
supervision of a licensed physician and surgeon who is not subject to
a disciplinary condition imposed by the board prohibiting that
supervision or prohibiting the employment of a physician assistant.
(b) Notwithstanding any other provision of law, a physician
assistant performing medical services under the supervision of a
physician and surgeon may assist a doctor of podiatric medicine who
is a partner, shareholder, or employee in the same medical group as
the supervising physician and surgeon. A physician assistant who
assists a doctor of podiatric medicine pursuant to this subdivision
shall do so only according to patient-specific orders from the
supervising physician and surgeon.
The supervising physician and surgeon shall be physically
available to the physician assistant for consultation when such
assistance is rendered. A physician assistant assisting a doctor of
podiatric medicine shall be limited to performing those duties
included within the scope of practice of a doctor of podiatric
medicine.
(c) (1) A physician assistant and his or her supervising physician
and surgeon shall establish written guidelines for the adequate
supervision of the physician assistant. This requirement may be
satisfied by the supervising physician and surgeon adopting protocols
for some or all of the tasks performed by the physician assistant.
The protocols adopted pursuant to this subdivision shall comply with
the following requirements:
(A) A protocol governing diagnosis and management shall, at a
minimum, 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 provided to the patient.
(B) A protocol governing procedures shall set forth the
information to be provided to the patient, the nature of the consent
to be obtained from the patient, the preparation and technique of the
procedure, and the followup care.
(C) Protocols shall be developed by the supervising physician and
surgeon or adopted from, or referenced to, texts or other sources.
(D) Protocols shall be signed and dated by the supervising
physician and surgeon and the physician assistant.
(2) 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.
(3) Notwithstanding any other provision of law, the board or
committee may establish other alternative mechanisms for the adequate
supervision of the physician assistant.
(d) No medical services may be performed under this chapter in any
of 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 optical
device in connection with ocular exercises, visual training, or
orthoptics.
(3) The prescribing of contact lenses for, or the fitting or
adaptation of contact lenses to, the human eye.
(4) The practice of dentistry or dental hygiene or the work of a
dental auxiliary as defined in Chapter 4 (commencing with Section
1600).
(e) This section shall not be construed in a manner that shall
preclude the performance of routine visual screening as defined in
Section 3501.
3502.1. (a) In addition to the services authorized in the
regulations adopted by the board, and except as prohibited by Section
3502, while under the supervision of a licensed physician and
surgeon or physicians and surgeons authorized by law to supervise a
physician assistant, a physician assistant may administer or provide
medication to a patient, or transmit orally, or in writing on a
patient's record or in a drug order, an order to a person who may
lawfully furnish the medication or medical device pursuant to
subdivisions (c) and (d).
(1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
(2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt, or adopt, a written, practice specific, formulary
and protocols that specify all criteria for the use of a particular
drug or device, and any contraindications for the selection.
Protocols for Schedule II controlled substances shall address the
diagnosis of illness, injury, or condition for which the Schedule II
controlled substance is being administered, provided, or issued. The
drugs listed in the protocols shall constitute the formulary and
shall include only drugs that are appropriate for use in the type of
practice engaged in by the supervising physician and surgeon. When
issuing a drug order, the physician assistant is acting on behalf of
and as an agent for a supervising physician and surgeon.
(b) "Drug order" for purposes of this section means an order for
medication that is dispensed to or for a patient, issued and signed
by a physician assistant acting as an individual practitioner within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription or order of the supervising physician, (2)
all references to "prescription" in this code and the Health and
Safety Code shall include drug orders issued by physician assistants
pursuant to authority granted by their supervising physicians and
surgeons, and (3) the signature of a physician assistant on a drug
order shall be deemed to be the signature of a prescriber for
purposes of this code and the Health and Safety Code.
(c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician and surgeon before it is filled
or carried out.
(1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient. At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled 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 a
drug order to a patient for Schedule II through Schedule V controlled
substances without advance approval by a supervising physician and
surgeon for that particular patient unless the physician assistant
has completed an education course that covers controlled substances
and that meets standards, including pharmacological content, approved
by the committee. The education course shall be provided either by
an accredited continuing education provider or by an approved
physician assistant training program. If the physician assistant will
administer, provide, or issue a drug order for Schedule II
controlled substances, the course shall contain a minimum of three
hours exclusively on Schedule II controlled substances. Completion of
the requirements set forth in this paragraph shall be verified and
documented in the manner established by the committee prior to the
physician assistant's use of a registration number issued by the
United States Drug Enforcement Administration to the physician
assistant to administer, provide, or issue a drug order to a patient
for a controlled substance without advance approval by a supervising
physician and surgeon for that particular patient.
(3) Any drug order issued by a physician assistant shall be
subject to a reasonable quantitative limitation consistent with
customary medical practice in the supervising physician and surgeon's
practice.
(d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility 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 physician
assistant, and the signature of the physician assistant. Further, a
written drug order for a controlled substance, except a written drug
order in a patient's medical record in a health facility or a medical
practice, shall include the federal controlled substances
registration number of the physician assistant and shall otherwise
comply with the provisions of Section 11162.1 of the Health and
Safety Code. Except as otherwise required for written drug orders for
controlled substances under Section 11162.1 of the Health and Safety
Code, the requirements of this subdivision may be met through
stamping or otherwise imprinting on the supervising physician and
surgeon's prescription blank to show the name, license number, and if
applicable, the federal controlled substances number of the
physician assistant, and shall be signed by the physician assistant.
When using a drug order, the physician assistant is acting on behalf
of and as the agent of a supervising physician and surgeon.
(e) The medical record of any patient cared for by a physician
assistant for whom the physician assistant's Schedule II drug order
has been issued or carried out shall be reviewed and countersigned
and dated by a supervising physician and surgeon within seven days.
(f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
(g) The committee shall consult with the Medical Board of
California and report during its sunset review required by Division
1.2 (commencing with Section 473) the impacts of exempting Schedule
III and Schedule IV drug orders from the requirement for a physician
and surgeon to review and countersign the affected medical record of
a patient.
3502.2. Notwithstanding any other provision of law, a physician
assistant may perform the physical examination and any other
specified medical services that are required pursuant to Section 2881
of the Public Utilities Code and Sections 44336, 49406, 49423,
49455, 87408, 87408.5, and 87408.6 of the Education Code, practicing
in compliance with this chapter, and may sign and attest to any
certificate, card, form, or other documentation evidencing the
examination or other specified medical services.
3502.3. (a) Notwithstanding any other provision of law, in addition
to any other practices that meet the general criteria set forth in
this chapter or the board's regulations for inclusion in a delegation
of services agreement, a delegation of services agreement may
authorize a physician assistant to do any of the following:
(1) Order durable medical equipment, subject to any limitations
set forth in Section 3502 or the delegation of services agreement.
Notwithstanding that authority, nothing in this paragraph shall
operate to limit the ability of a third-party payer to require prior
approval.
(2) For individuals receiving home health services or personal
care services, after consultation with the supervising physician,
approve, sign, modify, or add to a plan of treatment or plan of care.
(b) Nothing in this section shall be construed to affect the
validity of any delegation of services agreement in effect prior to
the enactment of this section or those adopted subsequent to
enactment.
3502.5. Notwithstanding any other provision of law, a physician
assistant may perform those medical services permitted pursuant to
Section 3502 during any state of war emergency, state of emergency,
or state of local emergency, as defined in Section 8558 of the
Government Code, and at the request of a responsible federal, state,
or local official or agency, or pursuant to the terms of a mutual aid
operation plan established and approved pursuant to the California
Emergency Services Act (Chapter 7 (commencing with Section 8550) of
Division 1 of Title 2 of the Government Code), regardless of whether
the physician assistant's approved supervising physician is available
to supervise the physician assistant, so long as a licensed
physician is available to render the appropriate supervision.
"Appropriate supervision" shall not require the personal or
electronic availability of a supervising physician if that
availability is not possible or practical due to the emergency. The
local health officers and their designees may act as supervising
physicians during emergencies without being subject to approval by
the board. At all times, the local health officers or their designees
supervising the physician assistants shall be licensed physicians
and surgeons. Supervising physicians acting pursuant to this section
shall not be subject to the limitation on the number of physician
assistants supervised under Section 3516.
No responsible official or mutual aid operation plan shall invoke
this section except in the case of an emergency that endangers the
health of individuals. Under no circumstances shall this section be
invoked as the result of a labor dispute or other dispute concerning
collective bargaining.
3503. No person other than one who has been licensed to practice as
a physician assistant shall practice as a physician assistant or in
a similar capacity to a physician and surgeon or podiatrist or hold
himself or herself out as a "physician assistant," or shall use any
other term indicating or implying that he or she is a physician
assistant.
3503.5. (a) A person licensed under this chapter who in good faith
renders emergency care at the scene of an emergency that occurs
outside both the place and course of that person's employment shall
not be liable for any civil damage as a result of any acts or
omissions by that person in rendering the emergency care.
(b) This section shall not be construed to grant immunity from
civil damages to any person whose conduct in rendering emergency care
is grossly negligent.
(c) In addition to the immunity specified in subdivision (a), the
provisions of Article 17 (commencing with Section 2395) of Chapter 5
shall apply to a person licensed under this chapter when acting
pursuant to delegated authority from an approved supervising
physician.
3500. In its concern with the growing shortage and geographic
maldistribution of health care services in California, the
Legislature intends to establish in this chapter a framework for
development of a new category of health manpower--the physician
assistant.
The purpose of this chapter is to encourage the more effective
utilization of the skills of physicians, and physicians and
podiatrists practicing in the same medical group practice, by
enabling them to delegate health care tasks to qualified physician
assistants where this delegation is consistent with the patient's
health and welfare and with the laws and regulations relating to
physician assistants.
This chapter is established to encourage the utilization of
physician assistants by physicians, and by physicians and podiatrists
practicing in the same medical group, and to provide that existing
legal constraints should not be an unnecessary hindrance to the more
effective provision of health care services. It is also the purpose
of this chapter to allow for innovative development of programs for
the education, training, and utilization of physician assistants.
3500.5. This chapter shall be known and cited as the Physician
Assistant Practice Act.
3501. As used in this chapter:
(a) "Board" means the Medical Board of California.
(b) "Approved program" means a program for the education of
physician assistants that has been formally approved by the
committee.
(c) "Trainee" means a person who is currently enrolled in an
approved program.
(d) "Physician assistant" means a person who meets the
requirements of this chapter and is licensed by the committee.
(e) "Supervising physician" means a physician and surgeon licensed
by the board or by the Osteopathic Medical Board of California who
supervises one or more physician assistants, who possesses a current
valid license to practice medicine, and who is not currently on
disciplinary probation for improper use of a physician assistant.
(f) "Supervision" means that a licensed physician and surgeon
oversees the activities of, and accepts responsibility for, the
medical services rendered by a physician assistant.
(g) "Committee" or "examining committee" means the Physician
Assistant Committee.
(h) "Regulations" means the rules and regulations as set forth in
Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the
California Code of Regulations.
(i) "Routine visual screening" means uninvasive nonpharmacological
simple testing for visual acuity, visual field defects, color
blindness, and depth perception.
(j) "Program manager" means the staff manager of the diversion
program, as designated by the executive officer of the board. The
program manager shall have background experience in dealing with
substance abuse issues.
(k) "Delegation of services agreement" means the writing that
delegates to a physician assistant from a supervising physician the
medical services the physician assistant is authorized to perform
consistent with subdivision (a) of Section 1399.540 of Title 16 of
the California Code of Regulations.
(l) "Other specified medical services" means tests or examinations
performed or ordered by a physician assistant practicing in
compliance with this chapter or regulations of the board promulgated
under this chapter.
(m) A physician assistant acts as an agent of the supervising
physician when performing any activity authorized by this chapter or
regulations promulgated by the board under this chapter.
3502. (a) Notwithstanding any other provision of law, a physician
assistant may perform those medical services as set forth by the
regulations of the board when the services are rendered under the
supervision of a licensed physician and surgeon who is not subject to
a disciplinary condition imposed by the board prohibiting that
supervision or prohibiting the employment of a physician assistant.
(b) Notwithstanding any other provision of law, a physician
assistant performing medical services under the supervision of a
physician and surgeon may assist a doctor of podiatric medicine who
is a partner, shareholder, or employee in the same medical group as
the supervising physician and surgeon. A physician assistant who
assists a doctor of podiatric medicine pursuant to this subdivision
shall do so only according to patient-specific orders from the
supervising physician and surgeon.
The supervising physician and surgeon shall be physically
available to the physician assistant for consultation when such
assistance is rendered. A physician assistant assisting a doctor of
podiatric medicine shall be limited to performing those duties
included within the scope of practice of a doctor of podiatric
medicine.
(c) (1) A physician assistant and his or her supervising physician
and surgeon shall establish written guidelines for the adequate
supervision of the physician assistant. This requirement may be
satisfied by the supervising physician and surgeon adopting protocols
for some or all of the tasks performed by the physician assistant.
The protocols adopted pursuant to this subdivision shall comply with
the following requirements:
(A) A protocol governing diagnosis and management shall, at a
minimum, 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 provided to the patient.
(B) A protocol governing procedures shall set forth the
information to be provided to the patient, the nature of the consent
to be obtained from the patient, the preparation and technique of the
procedure, and the followup care.
(C) Protocols shall be developed by the supervising physician and
surgeon or adopted from, or referenced to, texts or other sources.
(D) Protocols shall be signed and dated by the supervising
physician and surgeon and the physician assistant.
(2) 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.
(3) Notwithstanding any other provision of law, the board or
committee may establish other alternative mechanisms for the adequate
supervision of the physician assistant.
(d) No medical services may be performed under this chapter in any
of 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 optical
device in connection with ocular exercises, visual training, or
orthoptics.
(3) The prescribing of contact lenses for, or the fitting or
adaptation of contact lenses to, the human eye.
(4) The practice of dentistry or dental hygiene or the work of a
dental auxiliary as defined in Chapter 4 (commencing with Section
1600).
(e) This section shall not be construed in a manner that shall
preclude the performance of routine visual screening as defined in
Section 3501.
3502.1. (a) In addition to the services authorized in the
regulations adopted by the board, and except as prohibited by Section
3502, while under the supervision of a licensed physician and
surgeon or physicians and surgeons authorized by law to supervise a
physician assistant, a physician assistant may administer or provide
medication to a patient, or transmit orally, or in writing on a
patient's record or in a drug order, an order to a person who may
lawfully furnish the medication or medical device pursuant to
subdivisions (c) and (d).
(1) A supervising physician and surgeon who delegates authority to
issue a drug order to a physician assistant may limit this authority
by specifying the manner in which the physician assistant may issue
delegated prescriptions.
(2) Each supervising physician and surgeon who delegates the
authority to issue a drug order to a physician assistant shall first
prepare and adopt, or adopt, a written, practice specific, formulary
and protocols that specify all criteria for the use of a particular
drug or device, and any contraindications for the selection.
Protocols for Schedule II controlled substances shall address the
diagnosis of illness, injury, or condition for which the Schedule II
controlled substance is being administered, provided, or issued. The
drugs listed in the protocols shall constitute the formulary and
shall include only drugs that are appropriate for use in the type of
practice engaged in by the supervising physician and surgeon. When
issuing a drug order, the physician assistant is acting on behalf of
and as an agent for a supervising physician and surgeon.
(b) "Drug order" for purposes of this section means an order for
medication that is dispensed to or for a patient, issued and signed
by a physician assistant acting as an individual practitioner within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription or order of the supervising physician, (2)
all references to "prescription" in this code and the Health and
Safety Code shall include drug orders issued by physician assistants
pursuant to authority granted by their supervising physicians and
surgeons, and (3) the signature of a physician assistant on a drug
order shall be deemed to be the signature of a prescriber for
purposes of this code and the Health and Safety Code.
(c) A drug order for any patient cared for by the physician
assistant that is issued by the physician assistant shall either be
based on the protocols described in subdivision (a) or shall be
approved by the supervising physician and surgeon before it is filled
or carried out.
(1) A physician assistant shall not administer or provide a drug
or issue a drug order for a drug other than for a drug listed in the
formulary without advance approval from a supervising physician and
surgeon for the particular patient. At the direction and under the
supervision of a physician and surgeon, a physician assistant may
hand to a patient of the supervising physician and surgeon a properly
labeled 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 a
drug order to a patient for Schedule II through Schedule V controlled
substances without advance approval by a supervising physician and
surgeon for that particular patient unless the physician assistant
has completed an education course that covers controlled substances
and that meets standards, including pharmacological content, approved
by the committee. The education course shall be provided either by
an accredited continuing education provider or by an approved
physician assistant training program. If the physician assistant will
administer, provide, or issue a drug order for Schedule II
controlled substances, the course shall contain a minimum of three
hours exclusively on Schedule II controlled substances. Completion of
the requirements set forth in this paragraph shall be verified and
documented in the manner established by the committee prior to the
physician assistant's use of a registration number issued by the
United States Drug Enforcement Administration to the physician
assistant to administer, provide, or issue a drug order to a patient
for a controlled substance without advance approval by a supervising
physician and surgeon for that particular patient.
(3) Any drug order issued by a physician assistant shall be
subject to a reasonable quantitative limitation consistent with
customary medical practice in the supervising physician and surgeon's
practice.
(d) A written drug order issued pursuant to subdivision (a),
except a written drug order in a patient's medical record in a health
facility 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 physician
assistant, and the signature of the physician assistant. Further, a
written drug order for a controlled substance, except a written drug
order in a patient's medical record in a health facility or a medical
practice, shall include the federal controlled substances
registration number of the physician assistant and shall otherwise
comply with the provisions of Section 11162.1 of the Health and
Safety Code. Except as otherwise required for written drug orders for
controlled substances under Section 11162.1 of the Health and Safety
Code, the requirements of this subdivision may be met through
stamping or otherwise imprinting on the supervising physician and
surgeon's prescription blank to show the name, license number, and if
applicable, the federal controlled substances number of the
physician assistant, and shall be signed by the physician assistant.
When using a drug order, the physician assistant is acting on behalf
of and as the agent of a supervising physician and surgeon.
(e) The medical record of any patient cared for by a physician
assistant for whom the physician assistant's Schedule II drug order
has been issued or carried out shall be reviewed and countersigned
and dated by a supervising physician and surgeon within seven days.
(f) All physician assistants who are authorized by their
supervising physicians to issue drug orders for controlled substances
shall register with the United States Drug Enforcement
Administration (DEA).
(g) The committee shall consult with the Medical Board of
California and report during its sunset review required by Division
1.2 (commencing with Section 473) the impacts of exempting Schedule
III and Schedule IV drug orders from the requirement for a physician
and surgeon to review and countersign the affected medical record of
a patient.
3502.2. Notwithstanding any other provision of law, a physician
assistant may perform the physical examination and any other
specified medical services that are required pursuant to Section 2881
of the Public Utilities Code and Sections 44336, 49406, 49423,
49455, 87408, 87408.5, and 87408.6 of the Education Code, practicing
in compliance with this chapter, and may sign and attest to any
certificate, card, form, or other documentation evidencing the
examination or other specified medical services.
3502.3. (a) Notwithstanding any other provision of law, in addition
to any other practices that meet the general criteria set forth in
this chapter or the board's regulations for inclusion in a delegation
of services agreement, a delegation of services agreement may
authorize a physician assistant to do any of the following:
(1) Order durable medical equipment, subject to any limitations
set forth in Section 3502 or the delegation of services agreement.
Notwithstanding that authority, nothing in this paragraph shall
operate to limit the ability of a third-party payer to require prior
approval.
(2) For individuals receiving home health services or personal
care services, after consultation with the supervising physician,
approve, sign, modify, or add to a plan of treatment or plan of care.
(b) Nothing in this section shall be construed to affect the
validity of any delegation of services agreement in effect prior to
the enactment of this section or those adopted subsequent to
enactment.
3502.5. Notwithstanding any other provision of law, a physician
assistant may perform those medical services permitted pursuant to
Section 3502 during any state of war emergency, state of emergency,
or state of local emergency, as defined in Section 8558 of the
Government Code, and at the request of a responsible federal, state,
or local official or agency, or pursuant to the terms of a mutual aid
operation plan established and approved pursuant to the California
Emergency Services Act (Chapter 7 (commencing with Section 8550) of
Division 1 of Title 2 of the Government Code), regardless of whether
the physician assistant's approved supervising physician is available
to supervise the physician assistant, so long as a licensed
physician is available to render the appropriate supervision.
"Appropriate supervision" shall not require the personal or
electronic availability of a supervising physician if that
availability is not possible or practical due to the emergency. The
local health officers and their designees may act as supervising
physicians during emergencies without being subject to approval by
the board. At all times, the local health officers or their designees
supervising the physician assistants shall be licensed physicians
and surgeons. Supervising physicians acting pursuant to this section
shall not be subject to the limitation on the number of physician
assistants supervised under Section 3516.
No responsible official or mutual aid operation plan shall invoke
this section except in the case of an emergency that endangers the
health of individuals. Under no circumstances shall this section be
invoked as the result of a labor dispute or other dispute concerning
collective bargaining.
3503. No person other than one who has been licensed to practice as
a physician assistant shall practice as a physician assistant or in
a similar capacity to a physician and surgeon or podiatrist or hold
himself or herself out as a "physician assistant," or shall use any
other term indicating or implying that he or she is a physician
assistant.
3503.5. (a) A person licensed under this chapter who in good faith
renders emergency care at the scene of an emergency that occurs
outside both the place and course of that person's employment shall
not be liable for any civil damage as a result of any acts or
omissions by that person in rendering the emergency care.
(b) This section shall not be construed to grant immunity from
civil damages to any person whose conduct in rendering emergency care
is grossly negligent.
(c) In addition to the immunity specified in subdivision (a), the
provisions of Article 17 (commencing with Section 2395) of Chapter 5
shall apply to a person licensed under this chapter when acting
pursuant to delegated authority from an approved supervising
physician.
