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They Must Be Golden...
As in many states, in California it has not been clear that PAs can utilize fluoroscopy for visualization while performing procedures. Until last week...
During the 2009 legislative session, the California Academy of PAs supported AB 356, sponsored by Nathan Fletcher (R-San Diego). Some of you will remember Assemblyman Fletcher from the State Legislative Coordinators Meeting in San Diego. He gave an engaging and candid presentation on life as an Assemblyman and discussed effective advocacy strategies. The legislation allows a PA working with a supervising physician who holds, or is exempt from holding (i.e. a radiologist), a fluoroscopy permit, to also obtain a fluoroscopy permit in the state of California (a fluoroscopy permit being the key to the fluoroscopic kingdom). To be eligible to take the exam for the permit, the PA must complete a 40 hour course in radiation safety and fluoroscopy. This type of course is held primarily at radiologic technology schools.
The end of the legislative session brought some typical and some completely idiosyncratic events. Through it all, and after a few amendments over the summer, the CAPA fluoroscopy bill kept progressing steadily. It was approved by all the relevant committees and passed the Senate in August.
But then, The Governator decided to hold all bills needing his signature hostage until a deal was made on water. Mark Twain (may have - this is one of those quotes that lacks conclusive attribution) said, "Whiskey is for drinking and water is for fighting over." No place is this more true than in California.
In the end, the governor blinked. He declared that sufficient progress had been made in the water negotiations to allow him to start signing bills, and moments before the deadline, he signed AB 356.
California joins Connecticut and Hawaii in successfully passing bills authorizing PAs to utilize ionizing radiation in the 2009 legislative session.
State Action on Medical Homes
Although most of the action we are hearing about on the medical home is related to federal reform, at last count 23 states had demonstration projects or Medicaid models that include medical home concepts. PAs are included, and increasingly are uniquely named in state medical home language. Academy staff monitors legislation and regulations for developments on medical home projects. If you have questions or would like summary information on medical home provisions in state law, contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
Last-Minute Amendment Includes PAs
On a Thursday afternoon earlier this month, the Massachusetts Legislature was set to vote on a bill that would protect certain health care workers providing vaccine injections from liability. The bill expressly protected physicians and nurses, as well as other health care professionals who "assisted" in vaccinations. The Massachusetts Association of Physician Assistants (MAPA), always tuned in to unfolding events on Beacon Hill, correctly concluded that the current language would exclude PAs, because they were not specifically listed and because PAs do not "assist" in providing vaccinations, they provide the service
itself. The authors of the bill argued that PAs did not need to be included, because they incorrectly believed that PAs would be protected from liability if their supervising physicians were protected.
Springing into action, MAPA's lobbyist worked with AAPA staff over the course of about an hour to gather information showing that the bill as drafted would leave PAs vulnerable to civil action. Academy staff presented data on liability payments made on behalf of PAs going back to 1996. Staff provided information on the general trend of laws explicitly including PAs, rather than lumping them in with general terms such as "other health care professionals." This information was collected and sent to MAPA's lobbyist at around 2:45 pm. By 3:15 pm, the word came down that an amendment to include PAs had been adopted, and the bill passed with PAs protected.
Nip, Tuck
The AAPA Model State Legislation for Physician Assistants has received a minor facelift. Archaic "optional replacement parts" have been excised and other language has been tightened up and clarified.
Something for Everyone
Attention program directors, regulators, and chapter leaders: the question of what to do about PAs who have been out of clinical practice, and how to advise PAs who are planning a break from clinical practice, is generating discussion, policy and regulation. Adapted from a presentation from the AAPA Annual Conference in San Diego, a power point presentation entitled, "Mapping Your Career: What the PA Who Takes a Break from Clinical Practice Needs to Know" is now available as a resource on the AAPA Web site.
All Hands on Deck
As states contemplate the impact of potential federal health care reform, they are concerned about having adequate numbers of health professionals available to see the expanded number of patients who will have access to care.
With that in mind, states are looking at streamlining licensure processes. The Federation of State Medical Boards is playing a role by promoting license portability and a common license application for physicians.
According to the Federation's task force on the issue, regulatory authorities should remove archaic licensing requirements that slow down the process without adding any public protection. For PA licensing, three key changes can get PAs licensed and working more quickly. Check your state law for these three - and if you find them, get rid of them:
- Requirement for undergraduate transcripts to accompany the application: This is the program's responsibility, right? The accredited PA program evaluates an applicant's pre-requisites. No need for the licensing authority to repeat the process.
- Letters of recommendation: Recommenders do these s-l-o-w-l-y. And they are of questionable value.
- NCCPA scores: Of course verification of passage of the PANCE exam is required, but no statute or regulation requires scores - so the application needn't require them either.
Legislative Watch is a monthly state government newsletter written for PA leaders, educators, and regulators by Ann Davis, PA-C, AAPA Director of State Government Advocacy and Outreach (
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
; 703-836-2272 ext 3201). It's goal: To provide those involved in PA state government affairs with up-to-date information, advocacy tools and resources. Newsletter editors may reprint non-sensitive items if they credit the source as "The American Academy of Physician Assistants' Legislative Watch." Failure to do so will cause the goblins to get'cha!
