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What is your opinion of Physician's Assistants? (Rx For Physicians Caveat).

CASE ON POINT: Rockefeller v. Kaiser Foundation Health Plan of GA, 554 S.E.2d 623 GA (2001)

ISSUE: Are some Physician's Assistants out of control? This was just one of the issues with which Georgia courts were confronted in this unusual case involving a Physician's Assistant. More and more physicians have come to employ Physician's Assistants to facilitate their care and treatment of more patients or to enable them to render more direct care to patients who require it. Undoubtedly, a competent physician's assistant, properly supervised by a conscientious and competent physician, can have a positive impact in providing appropriate health care and treatment. Conversely, Physician's Assistants who are not competent or who are competent but are not properly supervised can pose a danger to patients.

CASE FACTS: Kimberly Rockefeller was a member of an HMO incorporated as Kaiser Foundation Health Plan of Georgia, doing business as Kaiser Permanente. Dr. Bruce Sabin was her primary care physician. He was employed by a Kaiser subsidiary at the Gwinnett Medical Center in Duluth, Georgia. Drs. Sean Murphy and Martin Ettinger and Physician's Assistant Jimmy McPeters were also employed there. Dr. Sabin filed an application with the Board of Medical Examiners (Board) for the utilization of McPeters as a PA. Although, certain other physicians were listed as additional supervising physicians, Drs. Murphy and Ettinger were not. The PA's "basic job description" on file with the Board authorized him to "order ... a dangerous drug or controlled substance or order medical treatments or diagnostic studies in any health care setting in accordance with Board rules and ... perform ... routine medical treatments and diagnostic procedures for which he is qualified ... which fall within the normal scope of practice of the supervising physician as delegated by the supervising physician." The PA was authorized by his job description to "gather base data on all new patients or established patients with new problems. In conditions where a "life threatening emergency situation" arose when the supervising physician was not present, the PA was authorized to "initiate appropriate evaluation and treatment." Although the Board had not authorized Drs. Murphy or Ettinger to supervise the PA, Dr. Sabin maintained that he approved these doctors' supervision of the PA so that they could render service to Dr. Sabin's patients. Dr. Sabin maintained that the PA was authorized to order medications and to arrive at a provisional diagnosis when a physician countersigned the medical record concluding that clinical conditions justified the action taken. On April 21, 1997, Dr. Sabin's patient went to the Gwinnett Medical Center complaining of nasal congestion, dry cough, and fever to the extent that she was unable to sleep. Dr. Sabin was not available. The PA examined the patient, arrived at a provisional diagnosis of viral syndrome and selected ventolin inhaler, cough syrup, Motrin, and Guaifenesin for her treatment. Dr. Ettinger reviewed and countersigned the patient's medical records, noting his determination that documented clinical conditions justifying the action taken. Dr. Murphy reviewed and co-signed the prescriptions. The day after treatment, the patient experienced severe shortness of breath. She was taken to the hospital by ambulance where a chest x-ray revealed pneumonia. After admission to the hospital, the patient became comatose for two months. She suffers from permanent disabilities. She brought suit against the HMO and the employees responsible for her treatment alleging that they were negligent in misdiagnosing her condition and in failing to order an appropriate diagnostic study, i.e., a chest x-ray. The plaintiff moved for partial summary judgment on her claim of negligence per se. She argued that the defendants violated the Physicians' Assistant Act (PAA); the violation constituted negligence per se. The trial court denied the motion. Application for an interlocutory appeal was granted.

COURT'S OPINION: The Court of Appeals of Georgia held that the plaintiff was entitled to partial summary judgment on the sole issue relating to the defendants' violation of Georgia law. However, on the question of whether the PA exceeded his authority as outlined in his job description by rendering a provisional diagnosis, the court concluded that the patient was not entitled to summary judgment. The judgement of the lower court was affirmed in part and reversed in part.

LEGAL COMMENTARY: The Georgia Legislature enacted the PAA to encourage more effective utilization of physicians' skills by enabling them to delegate health care tasks to PAs where such delegation is consistent with a patient's health.

Editor's Note: The editor has encountered situations in which PAs have far exceeded their authority. In some cases, PAs were given carte blanche by supervising physicians. The editor encountered one situation in which the supervising physician was literally "out of the country" while a PA was left to diagnose and prescribe medication and treatment without any supervision whatsoever. This is a recipe for disaster!

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the Providence. R.I., firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in American law.
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Article Details
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Author:Tammelleo, A. David
Publication:Medical Law's Regan Report
Article Type:Brief Article
Geographic Code:1USA
Date:Feb 1, 2002
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