Proposed Ohio PA Regulations

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April 5, 2007

 

Richard A. Whitehouse, Executive Director

State Medical Board of Ohio

77 South High Street, 17th Floor

Columbus, OH 43215-6127

Dear Mr. Whitehouse:

The American Academy of Physician Assistants (the Academy) is the national professional society for physician assistants (PAs.)  In this capacity the Academy represents nearly 70,000 physician assistants in clinical practice.

The Academy appreciates the opportunity to comment on the Proposed Ohio State Medical Board’s Physician Assistant Rules. We would like to make a very general comment, and then address some of the specific provisions in the proposed rules.

The role of regulations is to interpret and clarify provisions in statute. In states where the statute authorizing PA practice is very brief the regulations are more extensive (Alaska, Pennsylvania and North Dakota, for example). In states with extensive statutory provisions the regulations are quite brief. Kentucky, South Dakota and Indiana are in this category. The statute authorizing and governing PA practice in Ohio is the most extensive in the country. We were surprised by the length of the proposed regulations.

The goal of all professional regulation is public protection. Health care professionals are more able to comply with the requirements of statue and regulations when they are clear, non-redundant and consistent. Our specific comments are based on these principles.

4730-1-01 Definitions

 The definitions of (H), setting in which the physician routinely practices and (I) local anesthesia are already delineated in statute and should be deleted from the proposed rule.

4730-1-02 Physician Assistant Practice

Again, it is our view that the statute describes, in great detail, the requirements of the physician, PA, facility and board in the authorization, performance, and practice of physician assistants. It is our recommendation that this entire section be deleted.

4730-1-03 Duties of a Supervising Physician

With the exception of the regulations on termination of the supervision contained in subsection A the language is all a restatement of statute and we recommend its deletion.

4730-1-05 Quality Assurance System

This section gives the board opportunity to offer specific guidance on the requirements of the statutorily imposed quality assurance system, particularly as it applies to groups of physicians who supervise physician assistants. We recommend that the language that restates statue be deleted, and that this section be redrafted to state that the supervisory plan must describe to the board’s satisfaction how any applicable group will meet the statutory requirement.

4730-1-05 Certificate to Practice as a Physician Assistant

The word “period” is missing from the end of subsection (I)(2).

4730-1-07 Miscellaneous Provisions

The request to assist at surgery in out-patient surgery should be included in the “special services portion” of a “supervisory plan.”

4730-1-08 Special Services Plan

Again, the statute does not include nor the proposed regulation define a “special services plan.”  Rather the statute refers to a “special services portion” of a supervisory plan. We suggest that this wording be changed to be consistent with the intent and the wording of the statute. We believe that “peer review” is misused in subsection (B)(4). Subsection (D)(2A) suggests that the board should determine the number of patients a PA may see per day. This is not done anywhere else in the country, and to our knowledge has not even been contemplated. It is our firm belief that this determination is best left to the supervising physician-PA team.

4730-2-07 Standards for Prescribing

Subsection (B) requires the PA to perform all of these tasks prior to prescribing. On occasion a prescriber may refill a prescription made initially by another prescriber or authorize a very short term prescription while on call. We recommend the subsection be changed to assure that these requirements have been met, but not require that the PA has personally performed them.

The Academy appreciates the opportunity to provide these comments.

Sincerely,

Ann Davis, PA-C

Director of State Government Affairs