PAs’ Efforts to Help Homeless in LA Stymied by Outmoded Regulations

Two PAs in California ready to offer primary care 

Behind the glitz and glamour of Los Angeles’ bustling entertainment industry lies a huge problem: homelessness. In fact, LA County has the largest number of chronically homeless people in the nation. In 2017 alone, LA County’s homeless population soared 23 percent despite growing success in placing people in housing.

Two LA PAs, Katayoun Moini, PA-C and Lindsay Kozicz, PA-C, Director and Associate Director, respectively, at the Charles R. Drew University PA program are ready to help. But because of outmoded laws in the state, many homeless adults and children are going without the medical care they need that these PAs desperately want to provide.

Currently, California law requires that a physician sign a delegation agreement making them legally responsible for the care provided by the PAs. Since PAs Moini and Kozicz have been unable to find a physician willing to volunteer for this role, they are unable to provide essential primary care — care they are trained and qualified to offer.

Instead, with the help of student volunteers, they are currently providing health and nutrition education and medical screenings. For now, they give patients a list of local primary care providers that are able to provide additional services either free of charge or based on income if the patient does not have insurance — a common reality.

The ideal scenario is one in which PAs Moini and Kozicz and their student volunteers would act as more of a one-stop-shop — providing primary care on the spot. If this were the case, they would partner with several other local facilities such as clinics, hospitals, and Federally Qualified Health Clinics when additional consultations or referrals were needed.

“Many physicians have told us that they’ll be available to consult with us, and of course we call on physicians when a consult is indicated. However, physicians are reluctant to sign a formal delegation of services agreement with us on this project,” Moini said.

One of their biggest frustrations is the reality that simply having the delegation agreement does not guarantee that the physician would be involved in providing care — that responsibility would primarily be the PAs’, however they would always consult with a physician when necessary.

Moini added, “When you have this type of outdated requirement on a profession, which has significantly evolved over fifty years, you really are not allowing PAs to use our expertise and education to the fullest extent possible. Sadly, it’s the patients that suffer most.”

Funding is already in place to support the kind of outreach that PAs Moini and Kozicz have planned. In 2016, the Charles R. Drew University PA program received a modest grant from the Office of Statewide Health Planning that would enable them to use the university’s mobile health clinic to provide health education, medical screenings, and primary care treatment at an inpatient substance use and trauma treatment facility, and homeless encampments.

This is just one example of outdated laws and regulations that can act as a barrier for patients and for the well-trained PAs who are willing and able to provide crucial healthcare to those who need it most.

When PAs, physicians, and other medical professionals can work together to provide quality care without burdensome administrative constraints, they can achieve Optimal Team Practice. One way to achieve this is to remove the requirement for PAs to have an agreement with a specific physician. This will strengthen healthcare teams, expand access to care, reduce healthcare costs, and enable PAs like Moini and Kozicz to provide much-needed primary care regardless of whether they have a formal agreement with a specific physician.

Find more information on OTP click here.