OLR Bill Analysis

sHB 5515



This bill revises the supervision requirements for physician assistants (PAs). By law, each PA must have a clearly identified supervising physician who has final responsibility for patient care and the PA's performance. The functions a physician may delegate to a PA he or she supervises must be implemented in accordance with written protocols the supervising physician establishes. The bill renames the written protocols the “written delegation agreement,” and specifies their required contents.

The law requires a supervising physician's supervision of a PA to include, among other things, the physician's personal review of the PA's practice (in hospitals) or services (in other settings). The bill eliminates the requirement that the personal review be conducted at least weekly or more frequently as needed to ensure quality patient care. It also eliminates the current requirement that the personal review in non-hospital settings occur through face-to-face meetings. It instead requires the personal review, in both hospitals and other settings, to be in accordance with the written delegation agreement. For purposes of the personal review, it retains the reference to ensuring quality patient care for non-hospital settings, but not for hospitals.

Current law allows PAs to perform delegated medical functions when, among other requirements, the supervising physician is satisfied as to the PA's ability and competency. The bill specifies that the physician must be satisfied as to the PA's demonstrated competency.

The law allows PAs to prescribe and administer schedule II through V controlled substances, as delegated by their supervising physician. Under current law, when a PA issues an initial, but not renewal, prescription for a schedule II or III drug, the supervising physician must document his or her approval in the patient's medical record within one day after the prescription is issued. The bill instead requires the supervising physician to document his or her approval in the manner set forth in the written delegation agreement.

EFFECTIVE DATE: October 1, 2012


Current law requires the functions a supervising physician may delegate to a PA to be implemented in accordance with written protocols established by the physician. The bill instead refers to a written delegation agreement between the physician and PA. The agreement's terms, which the supervising physician must establish, must:

1. describe the professional relationship between the supervising physician and the PA;

2. identify the medical services the PA may perform;

3. describe how the PA's controlled substances prescriptions must be documented in patient medical records; and

4. describe how the supervising physician will evaluate the PA's performance, including how often the physician intends to (a) personally review the PA's practice and performance of delegated medical services and (b) review the PA's prescription and administration of schedule II or III controlled substances.

Under the bill, supervising physicians in hospitals must also include in their written delegation agreements applicable hospital policies, protocols, and procedures.

The bill requires supervising physicians to review their written delegation agreements at least annually. Supervising physicians must also revise the agreements as they deem necessary to reflect changes in (1) the physician's professional relationship with the PA, (2) the medical services the PA may perform, or (3) how the physician evaluates the PA.


Public Health Committee

Joint Favorable Substitute