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PA Legal Handbook

  • Legal Handbook 4th Edition


    Your knowledge of and adherence to the laws that govern PA practice in California are as important to your career as your knowledge of medicine is to patient care.

    You worked hard for your license and it doesn’t make any sense to put yourself in a position to be cited for a violation of the PA Practice Act or charged for Medicare or Medi-Cal fraud and/or abuse. All PA supervisors should also be aware of the laws which regulate PA practice.

    Check with you supervising physician and/or practice/clinic administrator to see if they would purchase this book for the practice. It is an invaluable resource to have at your fingertips.

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    Announcing The Fourth, New and EXPANDED Edition Of
    California Physician Assistant’s and Supervising Physician’s Legal Handbook
    - Hot Off The Presses and Available Now!

    The first edition of this book was published in 2007 and was intended to meet a pressing need among PAs and their supervising physicians. While physician assistants emerge from their academic programs and preceptorships well equipped for the clinical challenges they will face, many are not as knowledgeable regarding the laws and regulations that govern PA practice. Many supervising physicians also lack information regarding the rules applicable to the physician-PA relationship. Failure to know and understand these rules can have dangerous, even career ending consequences, particularly as licensing agencies and government reimbursement programs become increasingly vigilant in policing professional misconduct.

    The second edition was authored in 2008 to incorporate changes in the law resulting from AB 3. AB 3 expanded Medi-Cal coverage for PA services to make it commensurate with the coverage of physician and nurse practitioner services; eliminated the requirement for patient-specific authority for a PA to write drug orders for controlled substances if the PA has met certain educational requirements; doubled the number of PAs a supervising physician may supervise from two to four; and reduced the percentage of charts a supervising physician must review when a PA functions pursuant to protocols from 10% to 5%.

    The third edition of the Legal Handbook was published in 2011 to cover new legislation sponsored and passed by CAPA in 2009 and 2010 and other new legal developments of interest to PAs. To summarize, the new information in the third edition covers the following:

    • A new law that permits PAs to obtain fluoroscopy permits and to perform fluoroscopy procedures by taking a course and passing an exam administered by the California Department of Public Health.
    • Amendments to the Education Code permitting PAs to examine and certify school district and community college district employees as being free form Tuberculosis and otherwise fit for duty, and to examine and certify students as being fit for participation in school athletics.
    • The impact on PAs of the medical marijuana law.
    • An amendment to the Physician Assistant Practice Act permitting PAs to order durable medical equipment and make arrangements for home health and personal care services.
    • An amendment to the Public Utility Code authorizing PAs to certify the need for special telecommunications equipment by disabled individuals. 
    • Updated information regarding the requirements for PAs to receive reimbursement from Medicare and Medi-Cal.
    • Information about reports of adverse peer review actions and insurance payments to the National Practitioner Data Bank.
    • An expanded discussion of how a PA obtains a DEA number.
    • Updated information regarding the HIPAA patient privacy requirements, and new state laws that make it illegal to “snoop” into the records of patients for whom a practitioner has no clinical responsibility.
    • Beginning with the third edition, case studies intended to illustrate how the laws governing PA practice work in “real life” were also added at the end or each chapter, at the suggestion of PA educators, some of whom have made this Handbook “required reading” in their classes. 
    • This fourth edition was published in November 2014 and includes, but is not limited to, new or updated discussions of the following:
    • Revisions to the PA regulations governing PAs’ ability to serve as first or second assistants in surgical procedures under general anesthesia.
    • The requirements for PAs to perform abortions by aspiration techniques.
    • Changes in the requirements for PAs to perform physical examinations for certain commercial motor vehicle drivers under state and federal law.
    • The regulations enacted by the Radiologic Health Branch of the California Department of Public Health governing the use by PAs of fluoroscopy.
    • A major statutory change permitting PAs to supervise medical assistants when the supervising physician is not on site, as was required under prior law.
    • The requirements PAs must meet in order to perform abortions using aspiration.

    The Legal Handbook helps CAPA perform its mission, which includes keeping PAs and their supervising physicians up to date and educated in legal as well as clinical matters. CAPA has performed that role over the last thirty years by responding to countless questions from PAs on a wide range of issues, such as:


    • What risk do my supervising physician and I face if he/she does not comply with the requirements for delegating services, establishing protocols, reviewing charts, etc.?
    • Can PAs own, or share ownership of, a medical practice?
    • What should be included in an employment agreement?
    • What are the requirements to bill Medicare for “incident to” services?
    • Are PAs exempt employees, or do they have to be paid overtime?
    • Does the supervising physician have to be present when I “close” a surgical patient?
    • Can PAs give orders to nurses or medical assistants?
    • What kind of insurance should I have?
    • How do I protect myself from malpractice claims?

    In answering these and other questions, for twenty five years CAPA and its members have often looked to attorney Mike Scarano, CAPA’s general counsel. Mike has not only provided CAPA and its members with guidance on a myriad of issues, he has helped shape the legal face of the PA profession by writing most of the statutes that CAPA has sponsored over the years to enhance PAs’ ability to treat their patients. Mike has authored issues and position papers for the American Academy of Physician Assistants, as well as for CAPA, and is nationally recognized in the area of physician assistant law.

    As PAs have grown in number, and the laws governing the profession have become increasingly complex, there is a need for a “one stop” authoritative source for legal information regarding the PA profession and other basic health law concepts every PA should know. This Legal Handbook meets that need.

    Gaye Breyman, CAE                Robert Miller, PA
    CAPA Executive Director Chair CAPA Professional Practice Committee

    This publication is intended as a general summary of the law for educational purposes only. It does not constitute professional advice and should not be relied on as such.

    About the Author

    ScaranoR. Michael Scarano, Jr., has served as General Counsel to the California Academy of Physician Assistants since 1989. In that capacity, Mike has advised CAPA, its members and their employers on a wide range of legal issues. He has also played a major role in the evolution of PA law in California by authoring a number of bills successfully sponsored by CAPA which have enhanced the ability of PAs to serve their patients. Mike has authored issues and position papers for the American Academy of Physician Assistants, as well as for CAPA, and is nationally recognized in the area of physician assistant law.

    Mike is a partner in the national law firm of Foley & Lardner LLP, where he is Vice Chair of the Health Care Industry Team. He was also Co-Chair of the Health Care Law Committee of the California Bar Association for 2006-2007 and is listed in the 2007 and 2008 editions of the Best Lawyers in America®. Mike is a 1984 graduate of Boalt Hall School of Law at the University of California, Berkeley, where he also received his BA in 1979.

    In addition to CAPA and numerous individual PAs, Mike represents health facilities, medical groups, emergency medical services providers and other types of health care organizations in a wide range of issues.