West Virginia Proposed Rulemaking on Definition of Surgery

June 27, 2008

 

Mr. Robert C. Knittle, M.S.

Executive Director

West Virginia Board of Medicine

101 Dee Drive Suite 103

Charleston, WV  25311 

Dear Mr. Knittle:

The American Academy of Physician Assistants is the national professional society for physician assistants (PAs). In this capacity, the Academy represents over 60,000 physician assistants in the United States. The Academy would like to comment on the West Virginia Board of Medicine (Board) proposed rule entitled, “Definition of Surgery, 11 CSR 10.”

 

 

A physician assistant’s scope of practice is that of providing medical services with the supervision of a physician. An essential element of providing medical services is a clearly defined level of supervision. AAPA is concerned that the Board’s new proposed rules will create a new standard of supervision for physician assistants by mandating that the supervising physician be physically present on the premises, within the office suite, and immediately available at all times when the PA is utilizing lasers and other similar devices.

The statute and rules that govern PA practice in West Virginia require supervision by licensed physicians (M.D.s or D.P.M.s). The physician is required to supervise and assume legal responsibility for the work or training of any PA under his or her supervision. The constant physical presence of the physician is not required so long as so long as the supervising physician and the physician assistant are or can easily be in contact with each other via telecommunication. The relevant rule, §11-1B-2.1, states: 

f. “Supervision” means the opportunity or ability of the physician to provide or exercise control and direction over the services of physician assistants. Constant physical presence of the supervising physician of a physician assistant certified by the NCCPA is not required so long as the supervising physician and the physician assistant are or can easily be in contact with each other by radio, telephone or telecommunication. Supervision requires the availability of the supervising physician. An appropriate degree of supervision includes:

1. The active and continuing overview of the physician assistant's activities to determine that the supervising physician's directions are being implemented;

2. The availability of the supervising physician to the physician assistant for all necessary consultations;

3. Personal and regular (at least monthly) review by the supervising physician of selected patient records upon which entries are made by the physician assistant. The supervising physician shall select patient records for review on the basis of written criteria established by the supervising physician and the physician assistant and shall be of sufficient number to assure adequate review of the physician assistant's scope of practice, and;

4. Periodic (at least monthly) education and review sessions discussing specific conditions, protocols, procedures and specific patients, held by the supervising physician for the physician assistant under his or her supervision.

These rules clearly require physician supervision of PA practice.

The physician assistant profession is enduringly committed to the tenet that PAs practice with physician supervision. To quote from Academy Policy:

The AAPA believes that the physician-PA team relationship is fundamental to the PA profession and enhances the delivery of high quality health care. As the structure of the health care system changes, it is critical that his essential relationship be preserved and strengthened.1

The PA profession has not sought nor promoted independent practice by PAs. Physician assistants are licensed to practice in all fifty states, the District of Columbia, several U.S. territories, and are authorized to practice by federal employers (i.e., the Department of Defense, Department of Veterans Affairs, and the Public Health Service). In all of these jurisdictions practice with physician supervision is required.

The AAPA readily acknowledges that the utilization of lasers and related technology by non-physicians requires supervision by a supervising physician. We would hold that these safeguards are already required by law for physician assistants. Any practice by a physician assistant requires that a supervising physician delegate, supervise, and take responsibility for care provided by a physician assistant.

If the proposed rules are adopted, we fear they will add an element of undue rigidity to the health care delivery system. The current rules allow the physician greater flexibility to organize their own practice based on the education, skill, and experience of the physician assistant, the acuity of patients seen in the setting, and the physician’s preferences.

We are also concerned about the proposed definition of the term “surgery.”  It appears that its intent is to clarify that only trained persons should be authorized to perform tasks included in the definition. While we would agree that this should be the case, as currently written the rule could have the effect of prohibiting physician assistants from performing tasks routine to PA practice such as suturing, incision and draining of abscesses, and removal of superficial foreign bodies.

If an amendment to this proposed rule were to be considered, it could use the following language:

The Academy appreciates the opportunity to address the Board on this important issue.

Sincerely,

Ann Davis, PA-C

Director of State Government Affairs

 

1. American Academy of Physician Assistants 2007-2008 Policy Manual. Alexandria, VA.

 

Sincerely,

Ann Davis, PA-C

Director of State Government Affairs


 

 

Last Revised: 6/30/08