For Work Injuries in California, many Injured Workers are seen by Physician’s Assistants (PA), Psychological Assistants (PA), and Nurse Practitioners (NP) as part of their industrial treatment.
This article will discuss how and why these Assistants are considered as medical providers within the Workers’ Compensation System.
Is It Legal to Get Treatment From a Medical Assistant?
“Under workers’ compensation law, a licensed physician may employ a physician or psychological assistant or a nurse practitioner in the treatment of injured workers.” State of California Department of Industrial Relations Division of Workers’ Compensation Physician’s Guide to Medical Practice in the California Workers’ Compensation System Fourth Edition, 2016
What Is a Physician’s Assistant?
A Physician’s Assistant (PA) is a licensed vocation within the State of California. Per California Law, a PA can “furnish or order a drug or device subject to specified requirements, including that the furnishing or ordering be in accordance with the practice agreement and consistent with the physician assistant’s educational preparation or for which clinical competency has been established and maintained, and that the physician and surgeon be available by telephone or other electronic communication method at the time the physician assistant examines the patient.” There are additional rules which exist for PAs with respect to furnishing or ordering certain controlled substances.
Recent Laws, now provides that “supervision does not require the supervising physician and surgeon to be physically present, but does require adequate supervision as agreed to in the practice agreement and does require that the physician and surgeon be available by telephone or other electronic communication method at the time the physician assistant examines the patient.” See SB 697
What is a Psychological Assistant?
A Psychological Assistant can be employed by a licensed psychologist, Board-certified psychiatrist, medical or psychological corporation.
Per the B & P Code, their qualifications is that they have “(1) … completed a master’s degree in psychology or education with the field of specialization in psychology or counseling psychology, or (2) … been admitted to candidacy for a doctoral degree in psychology or education with the field of specialization in psychology or counseling psychology, after having satisfactorily completed three or more years of postgraduate education in psychology and having passed preliminary doctoral examinations, or (3) … completed a doctoral degree that qualifies for licensure under Section 2914.”
Only licensed psychologists and Board-certified psychiatrists can serve as the primary supervisor of a psychological assistant. There are limitations as to how many each provider-type may have. Board Certified Psychiatrists can have one and a Psychologist can have three. See B&P 2913(d.)
What is a Nurse Case Practitioner?
The nurse practitioner is a registered nurse who possesses additional preparation and skills in physical diagnosis, psychosocial assessment, and management of health and illness needs in primary health care. In certain circumstances, they can prescribe drugs and devices to patients.
Are There Limitations with Respect to These Assistants Within Workers’ Compensation?
Yes. “These “physician extenders” cannot determine disability. A licensed supervising physician must review the treatment administered by the extender and sign any report. According to California law, all care given to a patient by an extender is ultimately the responsibility of the supervising physician.” State of California Department of Industrial Relations Division of Workers’ Compensation Physician’s Guide to Medical Practice in the California Workers’ Compensation System Fourth Edition, 2016
Are There Limits to How Many Assistants a Physician May Have?
Yes. “Current law limits a physician to supervising no more than two physician assistants (PAs) at any moment in time. The immediate availability of the supervising physician is required whenever a PA or nurse practitioner is providing direct patient care. According to the regulations, the availability of the physician to provide the required supervision must be accomplished by being in the same facility with the PA or by being immediately available by electronic communications. “ State of California Department of Industrial Relations Division of Workers’ Compensation Physician’s Guide to Medical Practice in the California Workers’ Compensation System Fourth Edition, 2016.
Are There Any Requirements to Allow for An Assistant?
Before authorizing a PA to perform any medical procedure, the physician is responsible for evaluating the PA’s education, experience, knowledge, and ability to perform the procedure safely and correctly. In addition, the physician is also responsible for verifying that a PA has a current California license issued by the Physician Assistant Board. Lastly, the Delegation of Services Agreement (DSA) is a document used by supervising physicians and physician assistants to meet the requirements of CCR, Title 16, §1399.540.
What Is the Importance of a Delegation of Services Agreement?
The DSA is the foundation of the relationship between a supervising physician and the PA and specifies the names of the supervising physicians and what types of medical services the physician assistant is allowed to perform, how they are performed, how the patient charts will be reviewed and countersigned, and what type of medications the physician assistant will transmit on behalf of the supervising physician.
Are There Problems With Having Medical Assistants Within The Workers’ Compensation System?
Yes. Over the years, Injured Workers have complained that they have gone for treatment and that they never get to see their doctor. This is compounded is disabilities are extended out over 45-day increments. These increments create extended periods upon which Injured Workers do not have the opportunity to see their doctor.
What If I Need Legal Advice?
If you would like a “free” consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. for more information.