Advocacy Spotlights

CAPA’s Pandemic Response

Teresa Chien
Executive Director

In 2020, COVID completely upended the world, not just CAPA. While a pandemic alone would have been enough for any organization to manage, CAPA was already addressing two other critical matters before the pandemic forced the world to shelter-in-place, converging three challenges that then CAPA President, Roy Guizado, and President-Elect, Brett Bergman, had not anticipated.

That year, CAPA was attempting to support PAs in their practice transitions, as required by the newly passed SB 697. And they were doing so under a brand new executive director who was still green to the PA profession and had not even hit her 3-month mark at CAPA.

How did 2020-2021 President, Brett Bergman, handle all that was thrown at CAPA during this unprecedented year?

Reflections from Former CAPA President, Brett Bergman

Being thrust into a global pandemic required CAPA leadership to pivot instantly from standard organizational governance to a rapid response "war room" mentality. As I transitioned from President-Elect (2019-2020) to President (2020-2021), alongside Roy Guizado (President 2019-2020), our primary focus was protecting the PA profession from being sidelined during a crisis that desperately needed us. We realized early on that without aggressive intervention, PAs across the State would be handcuffed from helping. This period completely upended CAPA’s operations; we relied heavily on our newly hired Executive Director, Teresa Chien, to manage the operational chaos and our lobbyist, Ed Howard, whose backchannel diplomacy was critical. Roy and I were the first presidents to lead in this new reality, fighting to ensure that the paradigm shift achieved in SB 697 was not rolled back by a global emergency, but rather used as the solution to the state's healthcare shortages.

Brett Bergman, President of CAPA from 2020 to 2021

Brett Bergman, CAPA President during the COVID-19 pandemic, 2020-2021.

CAPA letter to Governor Gavin Newsom, March 2020, urging the suspension of physician-to-PA ratio limits and practice agreement requirements to expand PA deployment during the COVID-19 emergency.

Some of our major advocacy efforts during this time included:

Governor Newsom’s Executive Orders

The California Health Corps

The LACDPH Battle

Governor Newsom’s Executive Orders

One of CAPA’s most significant advocacy victories was securing Executive Orders that removed barriers to PA deployment. In March 2020, under Roy Guizado’s presidency, CAPA sent a decisive letter to Governor Newsom urging him to unshackle PAs to aid in the pandemic response. We specifically requested the suspension of the 1:4 physician-to-PA ratio and to remove the requirement for new practice agreements in emergency settings. Our efforts resulted in the Department of Consumer Affairs issuing Waiver DCA-20-04, which suspended these ratio limits and practice agreement requirements during the COVID-19 response. This allowed health systems to redeploy PAs flexibly to ICUs and hospitals without fear of regulatory discipline, a move that undoubtedly saved lives. These waivers remained in effect until March 31, 2022 – two years after CAPA first obtained them for California PAs.

The California Health Corps

In December 2020, during the state’s deadliest surge, CAPA discovered that the California Health Corps, the state’s volunteer disaster response unit, had stopped accepting PA applications while continuing to recruit Nurse Practitioners and EMTs. The exclusion was based on a misunderstanding of PA supervision, leading to a rejection of qualified professionals, including myself, who had signed up to help. CAPA worked with our lobbyist, Ed Howard, to execute a measured, calculated strategy. We leveraged our stakeholders, including the California Medical Association and Hospital Association, to join in our advocacy efforts. Within days, we secured a correction from the Emergency Medical Services Authority (EMSA), reinstating PAs as eligible providers and ensuring we weren't left on the sidelines.

The LACDPH Battle

In early 2021, a similar battle erupted when the Los Angeles County Department of Public Health (LACDPH) excluded PAs from their vaccine rollout, claiming it was "not feasible" to use PAs because they "cannot practice independently" and physicians were not present at all sites. This decision ignored state law and the fact that NPs, who also required physician oversight, were being accepted. We immediately sent a letter to LA County Public Health Director Dr. Barbara Ferrer, correcting the record on PA practice. We educated the county that under SB 697 and active waivers, supervision "shall not be construed to require the physical presence of the physician," and that PAs were already successfully running vaccination sites elsewhere. CAPA's lobbyist, Ed Howard, again enacted a focused strategy engaging the LA County Board of Supervisors and State Government officials, culminating with the Department of Consumer Affairs issuing Waiver DCA-21-137, allowing PAs to independently order and administer vaccines. This advocacy was crucial in convincing LA County to recognize the PA workforce was ready to deploy.

“To every PA who served on the front lines during those dark days, CAPA stood proudly beside you then, and we continue to fight for you now.”

– Brett Bergman

Looking back on this tumultuous era, I am filled with immense gratitude for the thousands of PAs who, despite administrative hurdles and personal risk, stepped forward to serve their communities. Whether in ICUs, hospitals, clinics, or vaccination sites, California’s PAs proved they are indispensable to the state’s healthcare safety net. The pandemic demonstrated more clearly than ever that when PAs are liberated from outdated barriers, we are a powerful force. To every PA who served on the front lines during those dark days, CAPA stood proudly beside you then, and we continue to fight for you now.

Brett Bergman
MS, MPA, PA-C
CAPA President, 2020-2021

Order extending emergency waivers of Physician Assistant supervision requirements during the COVID-19 pandemic in California.

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Board Leadership During the COVID-19 Pandemic

CAPA extends its sincere gratitude to the members who served on the Board of Directors during the COVID-19 pandemic. Their leadership, dedication, and service guided the organization through an unprecedented and challenging period.