Although Physician Assistants (PAs) have been involved in providing medical care since the late 1960's they are still a relatively unknown medical entity in the legal community. The purpose of this article is to familiarize this community with the physician assistant profession and the utilization of the PA as an expert witness.
Physician Assistants provide medical care, including physical examinations, the ordering of appropriate tests and the treatment of patients, with the supervision of a licensed physician.
PAs are licensed, registered, or certified to practice in every state (as well as the District of Columbia) with the exception of Mississippi. Although state laws and regulations differ to some degree these medical providers are authorized to practice medicine with the supervision of a licensed physician. This permits the PA to examine and treat patients within the laws of their particular jurisdiction. In 39 states, the District of Columbia and Guam, PAs are permitted to prescribe medications. In 31 states they are permitted to prescribe controlled substances.
There are more than 29,000 practicing physician assistants in the United States. The U.S. Bureau of Labor Statistics (BLS) projected that total employment in the country would grow by fourteen percent between 1994 and 2005, and the growth in PA positions is projected to increase by twenty three percent during the same time period.
Significant progress has been made in standardizing the regulation of PAs. All jurisdictions, except Mississippi and 9 others, have enacted detailed statutes that define PAs, describe their scope of practice, discuss supervision, designate the agency that will administer the law, set application and renewal criteria and establish disciplinary measures for specific violations of the law. In general, statutes in the remaining 9 states authorize the medical licensing board to regulate PAs according to standards established by the board in regulation.
Physician assistants practice in all clinical settings (solo or group practice 49.5%; hospital based practice 29%; HMO's 7%; and other settings including nursing homes, correctional facilities; rural and inner city clinics). They practice in all areas of clinical medicine from family practice (39.8%) to geriatrics (0.1%) and their roles are expanding within the medical arena at a rapid pace.
There are no exact figures available to date concerning malpractice cases levied against physician assistants4. The available information does reveal that in 1990 there were two malpractice cases reported to the National Practitioner Data Bank (with 17,500 practicing PA's). In 1995 there were thirty-eight cases reported (with 25,360 practicing PA's). Malpractice reports on PA's by type of allegation (all years) indicate that the majority of cases involved diagnosis (51.4%) and treatment (28.8%) with the remaining ranging from medication errors (9.6%) to anesthesia malpractice (0.6%).
An informal survey of physician assistants who have given expert testimony, whether in a malpractice case or any other area, has revealed a great deal of confusion on the part of legal counsel concerning the role of the physician assistant. Many of these attorneys erroneously address them as "doctor" while others simply align them to medical assistants and assume that their role is restricted to obtaining blood pressures and calling in medication refills for patients.
Physician Assistants all over the nation see patients on a daily basis (The average PA sees 94.6 outpatients weekly), PAs write 154 million prescriptions yearly, and they first assist in all forms of surgery. These practitioners reduce fractures, apply casts, perform cardiac stress tests, suture lacerations, and make daily hospital rounds and numerous other functions previously performed solely by physicians.
There are presently 5,520 students enrolled in PA programs this year, 411 more than last year. There are now 96 accredited physician assistant programs. The accrediting organization is the Commission on Accreditation of Allied Health Education Programs.
Graduates of accredited physician assistant programs have the option of attending a post graduate training program in surgery, cardiothoracic surgery, orthopedics, pediatrics, emergency medicine, obstetrics and gynecology as well as others. In 1971, Montefiore Medical Center became the first hospital to use PAs as house officers when it began its surgical residency program and today has one of the largest PA staffs (more than 200 PAs) of any institution. These are optional unaccredited programs attended by 5.3 percent of PAs. Most PAs upon graduation directly enter the workforce.
As their numbers continue to grow it would be expected that the number of malpractice claims would increase. It is important for the legal community to become aware of the exact role of the PA and to evaluate the role of the physician assistant expert witness.
What factors should legal counsel consider when looking for a PA as an expert witness? The following guidelines are suggested:
The PA expert witness:
Should have experience and knowledge in the area for which they have been asked to render a professional opinion.
Should have a good knowledge of the PA profession as well as its philosophy and code of ethics.
Should have a clear understanding of what constitutes "standard of care".
Should have evaluated potential cases for both defense and plaintiff counsel.
Should be certified by the National Commission on the Certification of Physician Assistants and be currently licensed to practice without restriction.
Should be a member of the American Academy of Physician Assistants as well as his or her state physician assistant organization.
The physician assistant community is still relatively small in numbers and young in years, however, the growth and achievements of the profession over the past 30 years speaks strongly for its members and its mission.
PAs serving as expert witnesses have an ethical responsibility to the profession. The expert witness PA must be thorough and objective and base his or her opinions and interpretations on sound professional knowledge, remembering that a deviation from a practice standard is not always causally related to a bad outcome. In addition, the PA should make a clear distinction between medical malpractice and the occurrence of unavoidable complications that do not arise from negligence.
1. The American Academy of Physician Assistants 1996 Census.
2. The American Academy of Physician Assistants, Facts At A Glance, May 1997.
3. The American Academy of Physician Assistants, State Regulation of Physician Assistant Practice.
4. Danielsen, RD. The PA as an expert witness. JAAPA 1997; 10:87-100.
5. APAP Update and Statistics April 1997.
6. AAPA News, May 30 1997.
7. Cornell, S. PA Surgical Residencies. Advance for Physician Assistants 1997; 5:48-57.
8. Guidelines For The Physician Assistant Serving as an Expert Witness, American Academy of Physician Assistants, 1991.
9. Guidelines For The Physician Assistant Serving as an Expert Witness, American Academy of Physician Assistants, 1991.
* Mr. Mooney is a practicing Physician Assistant active in the areas of Family & Emergency medicine.
!! IMPORTANT !! This file is over 10 years old and contains some outdated & incorrect information. An update is in the works, but please be careful and check with other reliable sources before relying on any particular facts. - The Library Staff