2010 News March/April by CA Academy of PAs

News

Official Publication of the California Academy of Physician Assistants

March/April 2010

\The Magazine

SB 1069 – CAPA’s BIG Piece of Legislation! by Beth Grivett, PA-C, Legislative Affairs Coordinator

fter planning time in the fall at the end of the 2009 session, CAPA is busy working again on the 2010 legislative year. The beginning of the year is the time when we get to introduce our own bills, but we also anxiously await bills from others to see where the priorities will lie this year. In this second year of the two-year term, we sometimes see bills which were introduced last year and were held back, get reactivated and amended for consideration this year. We also see new bills which may be similar to bills that didn’t get through last year, or which were voted upon favorably by the legislature, but vetoed by the Governor. So, we spend the early spring reading through the health care bills and deciding whether we need to support, oppose, or whether we just need to watch them. This year, CAPA’s priority is to continue to make some small changes in the laws in California which affect many PAs in the state. These are generally things that have become inconveniences in our daily work, but can unnecessarily consume a lot of our time and energy. So many PAs are working in so many different specialties; each with unique problems they face. However, nearly every PA has come across that form which they need to sign for a patient, but cannot because the law says “a physician and surgeon” must sign the form. And, sometimes it is not just the signing of the form, but performing the exam which leads up to that signature.

A prime example is the legislation that a variety of forms including school we passed last year, SB 171 (Pavley), district forms, public utility forms which became law effective January 1, and state disability forms. Because 2010. This bill allows PAs to perform of the need to change multiple areas a pre-employment physical exam and of law, this bill as introduced is quite sign the form certifying a potential lengthy at 22 pages. Despite its employee of a school district that they length, I believe this bill is fairly nonare physically capable of performing controversial. Much like the idea was their duties and do not have communi- easily accepted for SB 171, I think cable diseases which may put students most health care practitioner groups at risk. These types of exams are well agree that performing these exams and within the scope of practice of the PA completing these forms is well within and PAs perform them daily. However, our scope of practice and they agree the law previously stated that a physithat this is just being done to update cian and surgeon old laws which must perform the didn’t account exam and sign for PA prac“Because of the need to change tice. Provisions the form. CAPA successfully sponwithin the bill multiple areas of law, this bill sored legislation also reaffirm that as introduced is quite lengthy which changed our practice is that law. But, there truly dictated by at 22 pages.” are more areas the Delegation of law that have of Services similar language Agreement and are equally inconvenient, basically (DSA) which the PA and the physirequiring that the PA either reschedule cian has signed and agreed to as the patients only with a physician or restandard of practice for a particular quest that the physician sign the form setting. This means that for any parafter the exam has been completed. ticular form, if the physician feels This oftentimes, especially in smaller (s)he prefers to see the patients and offices, means a delay for the patient. complete the form, that can be stated Sometimes the patient even unknowin the DSA and the PA would remain ingly submits the form only to have it unable to provide that particular serreturned, wasting their time with the vice in that setting. This is a testimony office to get the physician signature. to CAPA’s commitment to physicianled team practice and helps other proOur attempt this year will be an vider groups to understand that we are even more comprehensive one. With not interested in expanding our scope SB 1069 (Pavley/Fletcher), we will Continued on page 5 introduce language which will cover

News

Editor Gaye Breyman, CAE Managing Editor Jennifer Deane

Editorial Board Miguel Medina, PA-C Eric Glassman, PA-C Beth Grivett, PA-C Bob Miller, PA-C Larry Rosen, PA-C Michael Scarano, Jr., Esq. Proofreaders Paula Meyer, PA-C CAPA Board Of Directors President Miguel Medina, PA-C president@capanet.org President-Elect Eric Glassman, PA-C president_elect@capanet.org Vice President Larry Rosen, PA-C vicepresident@capanet.org Secretary Cherri Penne-Myers, PA-C, MSCS secretary@capanet.org Treasurer Bob Miller, PA-C treasurer@capanet.org Directors-At-Large David Carter, PA-C dirdavid@capanet.org Beth Grivett, PA-C dirbeth@capanet.org

Your Vote Matters

he Election for the CAPA Board of Directors and Delegates to the AAPA HOD will take place soon. We will need your vote as we need a quorum for the election to be valid. The ballots will be mailed on April 5, 2010. CANDIDATES FOR THE 2010-2011 CAPA BOARD OF DIRECTORS Term July 1, 2010 – June 30, 2011 Vice President – Vote for 1 Larry Rosen, PA-C Secretary – Vote for 1 Cherri Penne-Myers, PA-C, MSCS Treasurer – Vote for 1 Robert Miller, PA-C Dennis Tankersley, PA-C

Student Representative – Students vote for 1 Jennifer Baltazar, PA-S Kerri Cisney, PA-S Stephanie Rolfo, PA-S

Greg Mennie, PA-C, MSed dirgreg@capanet.org

CAPA NEWS

Crystal Morant, PA-C, MBA, Shaun Partlow, PA-C and Assemblymember Joan Buchanan on February 25, 2010

ur sincere thanks to Lisa, Beverly, Shaun and Crystal for making time to make a difference for California PAs.

Student Representative Adam Marks, MPA, PA-S studentrep@capanet.org

The CAPA office is located at: 3100 W. Warner Ave., Suite 3 Santa Ana, CA 92704-5331 Office: (714) 427-0321 Fax: (714) 427-0324 Email: CAPA@capanet.org Internet: www.capanet.org

Beverly Lassiter, PA-C, MPH, Lisa Landry-Taylor, PA, Assemblymember Isadore Hall, III and a Physician on January 28, 2010

Director-At-Large – Vote for 4 Beth Grivett, PA-C Matthew Keane, MS, PA-C Adam Marks, MPA, PA-S Greg Mennie, PA-C, MSed

Matthew Keane, MS, PA-C dirmatt@capanet.org

The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.

PAs: Doing Their Part To Ensure That Every California Legislator Has A PA Experience!

CANDIDATES FOR THE 2011 AAPA HOUSE OF DELEGATES AAPA Members – Vote for 7 Term July 15, 2010 – July 14, 2011 Peter Aronson, PA-C Stephanie Bowlin, Ed.D., PA Beth Grivett, PA-C Matthew Keane, MS, PA-C Miguel Medina, PA-C Cherri Penne-Myers, PA-C, MSCS Larry Rosen, PA-C

Thank You For Your Service! David Carter, PA-C Director-At-Large 2008 – 2010 Mercedes Dodge, PA-C Student Representative Committee on Diversity Chair 2007 – 2010

Educate and Advocate by Miguel Medina, PA-C, President

I have been asked several times since being active with the CAPA Board if I still work at my old job. Some members believe that CAPA board members are paid for their services. I can assure you that we are all volunteers. We get reimbursed for our travel, but we do not receive a salary. We do get compensated by the knowledge that what we do improves the lives of our patients and

our fellow PA colleagues. The only salaried CAPA staff is our COO, Gaye Breyman, CAE and her office staff. In addition, we also have our Legal Counsel, Michael Scarano, Jr., Esq. on retainer. As you can see, running an organization like CAPA takes time and money. We appreciate your continued support with your CAPA dues and your participation at our conferences. The board looks forward to meeting you all and discussing issues which are pertinent to your everyday practice. I encourage all of you to help us advocate for our profession and to educate the public about our wonderful profession. 

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CAPA sponsors two conferences each year; one in Palm Springs and one in Napa. In addition, CAPA has developed the Controlled Substances Education Course to educate PAs about the proper utilization of controlled substances. All of these activities require time, planning and money. CAPA not only educates our fellow PAs but also educates the public, physicians, students and other health care colleagues. CAPA’s Board of Directors and its committees are charged with these duties. The Government Affairs Committee has the task of working on regulatory and legislative changes which will enhance the ability for PAs to practice in California. The Committee works together with a

contracted legislative advocate to assist CAPA in implementing these changes. The Government Affairs Committee is also responsible for educating legislators in California about our profession.

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o you wonder where your dues dollars go? CAPA’s Purpose Statement alludes to where a major portion of your money goes. “To develop, sponsor and evaluate continuing medical or medically related education programs for physician assistants...To sponsor and promote regulatory and legislative changes which will enhance the ability of the physician assistant to provide safe, cost-effective medical care to the citizens of California.”

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e hope you will SPREAD THE LOVE with a PA who is not a CAPA member. Let them know the importance of CAPA membership. Share with them the work we do to promote and protect PA practice here in California. As our numbers grow, our resources grow.

Help us to continue to do the work we do for California PAs; both large and small. Recruit a new member (be sure they include your name when joining) and remain a CAPA member throughout your entire career as well.

♥ www.capanet.org/recruit.cfm ♥

Inside This Issue Your Vote Matters.................................................................2 PAs Ensuring Every CA Legislator Has A PA Experience!..........2 Thank You For Your Service!..................................................2 Educate and Advocate...........................................................3 “A State of Catastrophe”.......................................................4 Are Electronic Medical Records Designed For PAs?..................6 CURES At CAPA’s Controlled Substances Education Course........6 What is on the Horizon.........................................................7 The Spirit of a Volunteer.......................................................8 Small Changes Add Up..........................................................9 Karen Bass Is Running For Congress!...................................10 States with the Most Physician Assistant Job Openings..........10

The CAPA PAC.....................................................................11 CAPA at Napa 2010............................................................12 Heard Any Great Speakers Lately?......................................12 American PA Idol................................................................13 Controlled Substances Education Course...............................13 CAPA’s 34th Annual Conference...........................................14 Welcome Home to the Renaissance Palm Springs.................15 CAPAs Notes.......................................................................16 Renew Your CAPA Membership Today..................................20 Professional Liability Insurance...........................................21 The Effect of a Criminal Case on Your Professional License . .22 CAPA Makes Its Entrance Into Social Networking..................24

The $1,000 an Hour Job!....................................................25 Student Challenge Bowl Sign Up Now...................................25 Diversity Outreach at TUSSPA..............................................26 Calling All PA Students........................................................26 Special Student Track at the CAPA Conference......................26 Faculty Profile: Rick Dehn, MPA, PA-C..................................27 Help To Shape Future PAs!..................................................27 Five Questions To Ask Your Pharmacist.................................28 Introducing Best Bones Forever!..........................................28 Special Recognition for Physician Assistant, Lise Noyes.........30 Welcome New Members......................................................31 Local Groups......................................................................31 MARCH/APRIL 2010

“A State of Catastrophe” by Larry Rosen, PA-C, Vice President and Public Relations Committee Chair

A lost child frantically looks for his family following a devastating 7.0 earthquake. The quake toppled schools, homes, government buildings, hotels and businesses, trapping untold numbers in the debris and killing tens of thousands. Witnesses described “general mayhem” leaving the population without electricity, phone service, or passable roads. “We can hear people screaming for help from every corner. The aftershocks are ongoing and making people very nervous,” said one observer. As the dust settles following the earthquake, experts expect “catastrophic” damage and loss of life. A third of the area’s nine million people may need emergency aid, according to the Red Cross.

his was the lead story in the Haitian newspaper, Haiti En Marche, on January 12, 2010 in Port-au-Prince. Imagine for a moment the newspaper banner being the Los Angeles Times and read those three paragraphs again.

recently registered to be volunteer health care providers during a disaster. Ironically, as I write, my iPhone posts an MSNBC alert: “Following an 8.8 earthquake, Chilean President, Michelle Bachelot has declared “a state of catastrophe.”

A little unsettling. It could easily be here.

The words were chilling, “a state of catastrophe.” It was all at once comforting to be at the Doubletree Inn in Commerce, surrounded by 100 people who not only cared about preparedness but had already done something important about it.

As of January 1, 2009, the population of L.A. County, the country’s largest county, numbered 10,393,185. According to the U.S. Geological Survey, the next major earthquake in California is predicted to take place before 2032; today, tomorrow, next week. As Californian’s, as physician assistants, how prepared would we be if, without warning, chaos and destruction visited 10 million or more people in our state… in one day? It’s Sunday, February 27th. I’m sitting, taking notes, in a Medical Reserve Corp (MRC) orientation. It’s being given by the Los Angeles MRC to orient new members who have 4

CAPA NEWS

The Medical Reserve Corp serves under the office of the United States Surgeon General. There are 440 MRCs in the state, all are part of an Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP). ESAR-VHP is part of a nationwide effort aimed at pre-registering and pre-screening volunteers to provide critical health services following a terrorist attack, a disaster or other public health emergencies.

I registered in mid-February. Shortly afterwards, I spoke with Sheila Martin in Sacramento. Sheila is the Disaster Healthcare Volunteers Coordinator as well as the Statewide MRC Coordinator. I asked her how many physician assistants had registered as volunteers throughout the state. “130.” 130 out of 7,000 licensed PAs in California. Not very impressive. At the Commerce orientation meeting, most of the attendees were nurses and non-medical volunteers. I was the only PA in the room. There were four physicians. Equally unimpressive numbers. “Emergency” was defined by one of the MRC staff as that time when a particular catastrophic event “overwhelms the resources available.” Contemplate such factors as no water, food supplies severely interrupted, no power or energy sources, no transportation due to roadway destruction, hospitals leveled, disease spreading, sanitation threatened, law and order under constant challenge. Frightening concepts when we read about Chile or Haiti. Even more so when it is Katrina or Red River or perhaps tomorrow in the Bay Area. Every time I read about why people go into health care, the phrase “…to help people” seems to be the number one choice. I’m not so sure it was my first choice. The science and the challenge were first in line for me. I got the “helping people” part much later when I actually did some good with what I’d learned. I get it now in my family practice in North Hollywood. I got it more on visits to Baja in small underserved towns. I got it big time in the remote villages of China where “emergency” is a way of life. “Emergency” is coming. What form? When? Where? That’s out of our hands. How we choose to

prepare for it is not. When it does come, every able-bodied health care professional will be vital to the recovery process. Disaster relief organizations will be staging and directing their resources to keep order and provide medical help to as many people as possible. 130 out of 7,000. That’s less than 2% of our physician assistant population. It’s not right. We need to change it and restate our position as medical practitioners dedicated to bringing health care to where it is needed most. And, how about bringing our docs along with us? This is the first of two articles about disaster preparedness. Should disaster strike, we have an obligation as PAs to prepare ourselves to take proper care of our families, first and foremost, our patients and our communities. As responsible clinicians, we are also obliged to instruct others in how best to prepare themselves for catastrophic events, in and outside the home. That will be the subject of the second article. This article is about getting involved, getting motivated and getting signed up. Registering is a simple process. You need only log on to the Disaster Healthcare Volunteers (DHV) website at https://www. healthcarevolunteers.ca.gov. Select “Register Now.” Check the CAPA website for more information. I know. You have a ton of questions; liability issues, where will you be called upon to serve, how long a period of time are you committed for, will you have to go to meetings and trainings? The DHV website will link you to the Emergency Medical Services Authority (EMSA) home page plus the Healthcare Volunteer

Resources page and other websites where all your questions will be answered. And, here’s another reliable link: my cell phone and email address: (818) 389-5955 doklite@ sbcglobal.net. As Vice President and Public Relations Committee Chair, I work with the board to find ways to promote our profession to our physician partners, allied health care professionals and the public. Registering with Health Care Volunteers is a natural assertion of our pride in our profession and our commitment to stepping up to the health care challenges that present themselves to us; “helping people” at its best. Election of CAPA officers is coming up. I will run again for Vice President and my “platform” will be devoted to getting as many PAs (including all of CAPA’s Board of Directors and Committee Chairs) registered in this worthy, necessary state disaster preparedness process. Talk to your colleagues. Talk with your supervising physicians. Get them involved. If you haven’t

already volunteered by October, at our conference in Palm Springs, we will have a speaker from the California Disaster Health Care Volunteers and a booth in our exhibit hall for information, sign-ups and materials. The process is uncomplicated and short. All your questions will be answered. There are no mysteries, no hidden “uh ohs” to worry about. Last weekend, I did my three-hour orientation workshop, got my certificate, lovely monogramed shirt and hat and met some wonderful, committed people who represent a movement I am proud to be a part of.

Larry Rosen, PA-C receives a certificate of completion for the MRC Los Angeles Orientation on February 27, 2010.

Please join me in this effort to keep California as ready and safe as possible when we most need her to be. 

SB 1069 – CAPA’s BIG Piece of Legislation! Continued from page 1

of practice. Rather, we are trying to update laws so that we can make the practice easier on ourselves as well as on our supervising physicians. Another provision within the bill is to define a statute of limitations for PAs in the state. All other boards of the healing arts clearly define a statute of limitations for actions against their licensees. It was recently brought to our attention that there is no statute of limitations for PAs. This means that there is no end date after which charges can be

brought forth against a PA. We crafted language within this same bill that would set the standard seven years as the statute of limitations for PAs. As this bill moves through the Senate and Assembly, we may again be calling on PAs in certain districts to call or write to their legislators to request careful review of this bill and help them understand the importance as we attempt to continue to provide cost-effective, appropriate care to our patients. 

MARCH/APRIL 2010

Are Electronic Medical Records Designed For PAs? by Jeremy Adler, MS, PA-C, Member, Professional Practice Committee

re you compliant with California law when you document or e-prescribe with an electronic medical record (EMR)? Unfortunately, the answer, is not simple. When using an EMR, PAs may not realize that their EMR might not allow them to be compliant. Regardless of the EMR systems capabilities, PAs are obligated to adhere to California’s practice laws and regulations. The California Code of Regulations establishes supervision requirements when practicing under protocols. For example, the supervising physician “…shall review, countersign and date a minimum of 5% sample of the medical records....” Additionally, the Physician Assistant Practice Act clearly states when issuing a Schedule II drug order, the medical record “… shall be reviewed and countersigned and dated by a supervising physician and surgeon within seven days.” Many PAs are e-prescribing through their EMR. The law also requires the supervising physician’s printed name,

address and phone number on drug orders. It appears that many of the current EMRs do not allow PAs to be compliant with many of these requirements. There are no current guidelines for EMR manufacturers regarding the necessary requirements specific for California PAs. The Professional Practice Committee of CAPA set out to survey California PAs to better understand how compliant they believe their EMR systems are. A total of 270 PAs were surveyed as they attended three Controlled Substance Education Courses provided by CAPA in the fall of 2009. Of those surveyed, 55% were documenting with an EMR system. Although most believed that their EMR system was compliant, 21% reported that their EMR did not allow PAs to either electronically sign the medical record or have the supervising physician co-sign the record. To complicate matters, the PAs reported the use of 49 different EMR systems. The most common reported were Epic/Healthconnect

(13%), eClinicalworks (11%) and Allscipts (10%). The use of e-prescribing was reported by 42% of the PAs surveyed, but less than half had the ability to have both their identification information and supervising physician information printed on the electronic drug order. Without clear guidelines to the designers of EMR with regard to California PA documenting requirements, the results of this survey are not surprising. Most EMR systems have been designed primarily for a single physician providing care. Additionally, state laws vary on PA documentation requirements and EMR systems are designed for a national audience. It is expected that more and more PAs will be documenting with an EMR system in the future. It is important that guidelines are established for the manufacturers of EMR systems and that PAs understand their legal documentation requirements regardless of the capabilities of their EMR system. 

CURES: Those Attending CAPA’s Controlled Substances Education Course Consistently Note CURES As The Number One Greatest Resource Provided

he state’s database known as the Controlled Substance Utilization Review and Evaluation System, CURES, contains over 100 million entries of controlled substance drugs that were dispensed in California. The online PDMP system makes it much easier for authorized prescribers and pharmacists to quickly review controlled substance information via the automated Patient Activity Report (PAR) in an effort to identify and deter drug abuse and diversion through accurate and rapid tracking of Schedule II through IV controlled substances. In order to obtain access to the PDMP system Prescribers and Pharmacists must first register

CAPA NEWS

with CURES by submitting an application form electronically at https://pmp.doj.ca.gov/pmpreg/. In addition, your registration must be followed up with a signed copy of your application and notarized copies of your validating documentation which includes: Drug Enforcement Administration Registration, State Medical License or State Pharmacy License, and a government issued identification. You can mail your application and notarized documents to: Bureau of Narcotic Enforcement (BNE) Attn: PDMP Registration P.O. Box 160447 Sacramento, CA 95816

What is on the Horizon by Eric Glassman, PA-C, President-Elect

et me start off by saying that I am not an expert in the knowledge of health care reform. I am not a politician who knows the ins and outs of government affairs and what goes on behind those closeddoor sessions when they talk about the future of health care. I am just a PA, practicing medicine everyday, taking care of patients as best I can, and as best that our current system will allow me to do. This is what we do as PAs, we practice the best we can within the system we are given. Nobody knows what is in store for the future of health care, but as a PA, I love where I am now at and think the future continues to look bright for our profession in this constantly changing health care field. We have the AAPA working hard for us everyday on the national level. They are working their way into our representative’s offices explaining the benefits of PAs to the health care industry and how we can be a big part of the solution to the current health care crisis. On the state level, we have CAPA working tirelessly, updating state laws to make our PA practices easier and helping us provide quality medical care to our patients. We are making sure our voice is heard loud and clear up in Sacramento. This is not an easy task and it takes a lot of coordination and planning. Oftentimes victories come in small steps, but in the end we are heading in the right direction and we are seeing great progress.

These days, you almost can’t have a HMO patients the right to obtain: get-together with friends without • A physician appointment health care reform being brought within 10 business days of a up as a topic of conversation. As of request; today, Congress has not passed any • A specialist appointment health care reform bill, but whatever within 15 business days of a it happens to be, I do not believe request; it will have a negative impact on • An urgent care visit within 48 the way we practice. However, hours of a request; and potentially and hopefully, it will • Telephone access to a health open doors for new opportunities care professional at all times. and create more jobs for PAs. For instance, if the new health care Hopefully, you are thinking what system gives these thousands of I am thinking and see these new individuals who currently don’t have regulations as an opportunity to insurance a new government-ran help lend a hand to decrease patient insurance plan and encourages them wait times. I believe this has always to get routine physicals and checkbeen our goal as a PA, but now with ups, who is going to see them? We new rules which will carry potential already have penalties to a shortage of physicians who physicians and do not comply, now we are this might “For example, earlier this year, have physicians increasing the numbers of seeking out a new rule was passed with patients who more help from need to be seen. more PAs to get regard to the amount of time Does anyone patients seen in else see the a more timely HMO patients must wait for same solution fashion. that I see? How physician appointments.” So this is just about a PA one example of who, along with how things are their physician partners, can slowly changing treat many more patients and ease in the health care realm and making the workload for everybody? I think health care more “consumer” driven and “patient-centric.” Our goal writing this in the CAPA News is almost like “preaching to the choir,” as PAs has always been to provide high-quality, affordable health but at the same time I am looking care in a “timely” fashion to our out on the horizon and seeing very patients. With this now being in the good things. forefront of many conversations, For example, earlier this year, a hopefully it will become a springboard for our profession to be new rule was passed with regard recognized as crucial partners and to the amount of time HMO leaders in health care.  patients must wait for physician appointments. This rule will take effect in 2011. The California Department of Managed Health Care rolled out new rules giving MARCH/APRIL 2010

The Spirit of a Volunteer by David Carter, PA-C, Director-At-Large

Diana Bautista, Field Representative for Senator Abel Maldonado meets with David Carter, PA-C in front of St. Louise Regional Hospital in Gilroy, CA

CAPA NEWS

Volunteerism. We are hearing this word more often these days. With national disasters, socio-economic discrepancies, and medical illnesses requiring research, well-intentioned volunteer organizations are popping up all over the place. Some are new but some are well-established, longstanding organizations which have begun marketing because of the stiff competition for volunteers. It is hard to watch television for even an hour without seeing several ads offering ways that we can volunteer. Why do we volunteer? Some reasons include: personal challenge and achievement, acquisition of new skills, gaining notoriety (hey, it looks good on a resume), meeting new people, networking with friends/family, easing guilt (perhaps the guilt of having so much when others do not), boredom, and the chance to advance a cause or “help people.” Several studies have looked at issues like this and chances are, as the studies I have read suggest, there is not usually just one reason. In fact, if we have been a volunteer and we are honest with ourselves, we can look at this list and pick out more than one of these reasons on our own. Oh sure, we all want to “help people.” That’s why many of us became physician assistants. But very few of us are completely altruistic. I’m not saying that we

should feel bad about the selffulfilling reasons for volunteering. These are very valid reasons. But we should be aware of our reasons and what priority we give them. Why am I talking about this? The demands on our time as physician assistants, citizens and family members are great. Most of us want to help something or some cause. We have been blessed with skills and have gained experience and knowledge which makes us excellent candidates to volunteer. But there is only so much time in a day and if we overcommit, we burn out and serve no one very well. On the other hand, if we under-commit, we are leaving a gap in a service, community or profession which needs to be filled with someone like us. We are not here to mandate what organizations for which someone should volunteer. The reasons for choosing a “cause” are many and personal. But when you consider that 40% of people who volunteer do so because they were asked and another 25% of people learn about an opportunity from a work colleague, relative or friend, according to one study, then why not appeal to one another in both ways right now? We, as physician assistants, are in a position to influence social change. We already do this on a daily basis in our own practices. So let us take our skills and get involved in a broader sense. We can debate health care reform, education reform and social responsibilities “until the cows come home.” But if we do not put ourselves in a position to influence politicians and “decision-makers” about our views or help those with a platform that will, then are we not living up to our responsibilities.

One study suggests that the number one reason volunteers stay involved with a cause is a sense of accomplishment or value in his/ her work. It also noted that these accomplishments need not be large ones to be satisfying. The Governor’s race is heating up and some major issues are in play. Let us consider, as physician assistants in California, getting involved in a candidate’s race. We are not saying which candidate, for there are many reasons to support a particular candidate. But with health care knowledge and experience as a physician assistant, why not call the volunteer center and ask, “Hey, do you need help making some calls or passing out some flyers?” It is often these seemingly “menial” tasks (which take so much of one staffer’s time but don’t take that much of ours) which can be so helpful to a candidate and which also gives us an opportunity to speak to campaign staff about causes important to us. If we don’t put ourselves in a position to influence our decision makers, someone else will. In the words of Dr. Martin Luther King, Jr., “Our lives begin to end the day we become silent about the things that matter.” Time is short for all of us. We have many demands and many volunteer opportunities. But so much of what we do, why we do it, and how we do it is tied into being a physician assistant. Doesn’t it make sense to volunteer in ways that contribute to our great profession so we can better serve our communities even when we aren’t “volunteering?” 

Small Changes Add Up by Greg Mennie, MSed, PA-C, Director-At-Large Kaizen, a Japanese word that means improvement. Commonly used in business where it takes on the meaning of continuous improvement in small increments. Small can be large if we have enough of it. I’ve written a number of articles over this last year for the CAPA News. In each of my articles, I’ve encouraged California PAs to volunteer, offer something back to their communities, mentor upcoming PAs and to get involved. In all these articles I have never really written about giving back to CAPA. Just how much does it cost to make sure you and I are able to enjoy our profession in the State of California? Where do we spend the money we earn as PAs, compared to what it costs us to make sure we have that money to spend? I’ve been on the CAPA Board of Directors for one year now and have seen firsthand the slow and steady work CAPA does for all PAs in California. The consistent and continued oversight of legislation and potential legislation which impacts each and every practicing PA in California is only one of the tasks CAPA takes on for all of us who practice in California. Looking for ways to improve PA practice is also where CAPA spends a lion’s share of its efforts. All of this takes place with the majority of PAs not even realizing that it’s happening…but not you, of course. You already know how important CAPA is to California PAs. You’re reading this, thus YOU are already, in some form, giving back to CAPA through membership. How do we reach all of the other PAs who aren’t members? The PAs who aren’t aware that everyday when they get up and head off to their practices, CAPA gets up and makes sure they have a practice to go to. Well, this is where you and I and Kaizen all come together. You already recognize the benefit of being a CAPA member, so I need YOU to take on one small task. Go out and get ONE non-member to join. ONE, a small number, but if we all do it, it will make a huge impact. You can let someone know that if they donate a little by becoming a member, not only do they get access to important information, as well as other member

benefits, but their small contribution is ensuring their practice capabilities remain intact. Let them know that CAPA, slowly and steadily, leads the charge for PA practice in California. Remind them of the small things they purchase in their everyday life that they’ll never miss if they just redirected that small amount of money…such as giving up:

= = = = If they just gave a little, they would have a membership in CAPA. They would then know that the reason they are able to afford all those things they can forego is because CAPA is watching out for their profession in California. You can also let them know the consequence of not making a small step:

= MARCH/APRIL 2010

Karen Bass Is Running For Congress!

ssemblymember Bass has served the PAs in California well during her time in the State Assembly. Now she is running for Congress and plans to make even a bigger impact nationally. Although CAPA continues to support Ms. Bass, the CAPA PAC does not make direct contributions for national elections. We encourage PAs in California to support Ms. Bass’ election in one of two ways. Assemblymember Karen Bass along with Speaker of the Assembly, Fabian Nunez and Assemblymember George Plescia, present CAPA delegation with a resolution on 6/29/05.

(1) Use the form below to send a check to CAPA so that we can bundle donations and let her know that the support came from California PAs. Please make checks payable to “Karen Bass for Congress” and fill out the required information completely. Mail to CAPA at 3100 W Warner Ave, Ste 3, Santa Ana, CA 92704. (2) Volunteer to help Ms. Bass with her election campaign by going to www.karenbass.com or by calling Stephanie Graves at (949) 270-6567. Watch her campaign video, which mentions physician assistants, at www. karenbass.com. Donations of any size will be most appreciated and will help to make a difference. 

Top 10 States with the Most Physician Assistant Job Openings

State

1. California 2. Texas 3. Florida 4. New York 5. North Carolina 6. Pennsylvania 7. Georgia 8. Arizona 9. Illinois 10. Michigan

Average Annual Job Openings

240 230 210 160 160 150 120 80 80 80

Statistics provided by CareerVoyages.gov

 Tear off and enclose check payable to “Karen Bass for Congress” Mail check with completed form to CAPA at 3100 W Warner Ave, Ste 3, Santa Ana, CA 92704.

Contributions are limited to $2,400 per individual per election. The primary and general elections are separate elections, so individuals may give up to a total of $4,800 for both elections. Name:_ _____________________________________________________________________________________________________ Address:_____________________________________________________________________________________________________ Email Address:________________________________________________________________________________________________ Phone Number:_______________________________________________________Amount donated:___________________________ Employer*:______________________________________________________________Occupation*:___________________________ *To comply with Federal law, contributors are required to provide their employment information. If you are retired, please enter N/A under Employer and Retired under Occupation; if a homemaker, please enter N/A - Homemaker; if self-employed, please enter “Self-Employed” under Employer and describe your line of work under Occupation. 10

CAPA NEWS

The CAPA PAC by Cherri Penne-Myers, PA-C, Political Action Committee Chair and Secretary

Cherri Penne-Myers, PA-C with the lucky winners of the Controlled Substances Education Course registrations, Sheri Oswald, PA-C and Rene Baquet, PA-C.

have just returned from the CAPA at Napa Conference. What a fun group of PAs in Northern California! This year I took a good friend and colleague to the conference, Marie Caserio, PA-C. We both had a good time greeting each of you who came to the CAPA PAC booth. Thank you for supporting us. We did run into a common question of “Don’t our membership dues cover the CAPA PAC too?” Legally, none of your CAPA dues money can go toward the CAPA PAC. This must be a separate donation designated for the CAPA PAC as there are strict guidelines which must be adhered to with Political Action Committee contributions. This year, we raffled off two complimentary Controlled Substances Education Course registrations at the Saturday, CAPA at Napa Conference. Rene Baquet, PA-C

and Sheri Oswald, PA-C were our all who took time to donate to the lucky winners. We had a fun time CAPA PAC. Contributions of any measuring those who opted to donate size are appreciated and will help us $25.00 to receive the number of raffle reach our goal. Just remember “It’s tickets equal to their height. Some A Jungle Out There!” I Want PAs at 6’3” garnered 38 tickets. CAPA to be Heard – To Create A Roar President, Miguel Medina, PA-C Heard Throughout the Jungle! Our donated lots of money to purchase goal is to have each and every CAPA raffle tickets and gave them away to member contribute to the CAPA those who attended the PAC each and every conference. You did not year. have to be present to win the free registration The CAPA PAC is for next year’s CAPA seeking items for the at Napa Conference CAPA PAC Silent which was announced Auction to be held at during the Controlled the 34th Annual CAPA Substances Education Conference in Palm Course the following day. Springs, October 7 – Congratulations to Maira 10, 2010. Last year we Lopez, PA, the lucky received many generous Marie Caserio, PA-C measures winner of the 2011 CAPA the height of Keith McGill, PA donations such as gift in Opportunity Drawing raffle at Napa Conference baskets, rounds of golf, tickets. registration. books, services, etc. We welcome your input! Thank you in Thank you, Miguel, for your advance for your contributions. You generous donation! We did have may contact me at ourjanuary@att. several individuals who just wanted net if you have any questions.  to contribute some funds, even one PA from out of state donated funds CAPA PAC ID #981553 to the CAPA PAC. Wow! Thanks to

I Want PAs to Be Heard – To Create A Roar Heard Throughout the Jungle  Cheetah  Leopard  Jaguar  Bengal Tiger  King/Queen of the Jungle

Up to $50 $51 to $99 _$100 to $149 _$150 to $199 _$200 or more

(Please photocopy this form and mail with donation.)

Name_____________________________________________________________________________________________ Address: _________________________________City___________________________ State_______ Zip_ ______________ Phone _ _______________________________ Email _______________________________________________________ Amount of cash/check/credit card donation: $________________

If donation is $100 or more please list employer__________________________________________________________________________________________ Please make checks payable to CAPA PAC. You may also pay by credit card. All contributions are voluntary. PAC ID # 981553 



Exp. Date______________________

Signature_ ______________________________________________________________________________________________________________________

MARCH/APRIL 2010

CAPA at Napa 2010 by Cyndy Flores, PA-C, CME Committee Chair

t’s hard to go wrong with a CAPA CME Conference in beautiful Napa, California. We sold out this year, well before the conference even started!

CAPA Presidents: Eric Glassman, PA-C, 2010; Rod Moser, PA, Ph.D., 1976-1977; Susan Potter, PA-C, 1986; Miguel Medina, PA-C, 2008-2010 and Bob Sachs, PA-C, 1988.

Just had to get a photo of many of the great, stylish and warm scarves worn by Napa attendees!

The Napa Valley Marriott has become CAPA’s Northern California home away from home. The staff knows us well and really takes care of CAPA leaders, volunteers and attendees. The Marriott recently underwent some renovations and will be doing more as 2010 goes on. We had six great speakers this year covering: Care for the Homeless, Diabetes, Cases You Don’t Want to Miss, Allergy Testing, Healthy Eating and Pharmacology. A well-rounded program full of information and delivered in a funny (and often hilarious) fashion. We had a record-breaking number of exhibitors and all attendees were able to spend quality time learning about new products, new services, and to get some great book deals. Our exhibitors continue to tell us how much they love working with the PAs of California.

d Hear eat r Any G ers k Spea ? ly Late

Lucky winners of this year’s CAPA at Napa prize drawings!!

We had lots of winners at the end of the day! Prizes included free conferences, free CAPA membership, wonderful medical educational books, and of course – fabulous Napa wine. Our Napa Conference has such a great feel, people tell us how much they love the intimate feel they get at Napa along with super CME. CAPA will continue our 15year tradition and we’ll see you at CAPA at Napa 2011! 

very year at the CAPA Conference in Palm Springs we hear it said: “You guys have the best speakers. How do you do it?” The answer is we hand pick them based on referrals, feedback and firsthand experiences.

Please help us identify the great speakers out there. Keep your ears open for interesting topics and excellent speakers. Please let us know what/who they are. You can email us, call us and/or fax us the information.

Email: capa@capanet.org Phone: (714) 427-0321 Fax: (800) 480-2272

A ve Us i G e s Plea r Send Us O l Cal mail. An E-

Thank you and we hope to see you at the CAPA Conference on October 7 – 10, 2010 at the Renaissance Palm Springs and Palm Springs Convention Center.

CAPA NEWS

National PA Week, October 6-12 American PA Idol – It’s Baaaack by Popular Demand! Sign Up Now!!

Past Winners

Friday, October 8, 2010 in Palm Springs

t the Friday night dance we will again hold everyone’s favorite American PA Idol competition. That is if we have at least 7 PAs sign up. We all love to watch, but we need you brave souls to sign up to sing. Don’t miss this fun opportunity to perform in front of hundreds of PAs. We will have fun and who knows, a star may be born. No matter what, we will have a great time. There are a lot of very talented PAs out there and the CAPA Conference in Palm Springs is the place to come and show your stuff. The PA Community wants to see you shine. (Or, at least have a really good time singing!) We will have a great host, judges who add their thoughts to the final audience vote and tons of songs from which to choose. To sign up please call the CAPA office or email us at capa@capanet.org. Complete details are on the website. 

APPLICATION FORM Name _ _________________________________________ Address _ ________________________________________ City ___________________________St _____Zip _ ________ I will be performing:  solo  as a duet

 a group of_ _______

Would you say that your voice is (don’t be modest):  Absolute perfection!  Everyone tells me I have a great voice  Just okay  Not that great, but I love to sing and can get a crowd going

Cheryl-Ann Leslie, PA-C Renton, WA 1st American PA Idol

Jodi Tarutis, PA-C Menifee, CA 2nd American PA Idol

Shalechia Hunt, PA-C Apple Valley, CA 4th American PA Idol

James Wiley, PA-S Loma Linda, CA 5th American PA Idol

Darla Kyle, PA-S Tulare, CA 6th American PA Idol

Marilyn Rodriguez, PA-S Sacramento, CA 7th American PA Idol

Which category best describes your style of singing?  Pop/Top 40  Rock  Country Western  Gospel  Easy Listening  Jazz  Rhythm and Blues  Broadway Show Tunes  Rap/Hip Hop ______________________________ Title of songs (please choose 3) which you would be interested in singing: 1) _____________________________________________ 2) _____________________________________________ 3) _____________________________________________

Controlled Substances Education Course at the CAPA Conference - Mark Your Calendar!

10/6/10

f you have not yet registered for the Controlled Substances Education Course and wish to do so, we will be holding a course on Wednesday, October 6 at the Renaissance Palm Springs.

This course will sell out quickly, so register online today at www.capanet.org! We will be holding this course on an on-going basis in various locations throughout the state. Future course dates and locations will be available on the CAPA website as soon as they have been confirmed.  MARCH/APRIL 2010

Welcome Home to the Wyndham Rena

CAPA’s 34th Annual Conference October 7-10, 2010 Optional Controlled Substances Education Course on PA Day, October 6, 2010 by Gaye Breyman, CAE, Chief Operating Officer

e’re back in Palm Springs and, yes, you will still set your GPS to 888 Tahquitz Canyon Way. But, when you For many years, Gume and Mark have been warmly greeting CAPA attendees – welcoming us home! walk into the beautiful, new Renaissance Palm Springs, it will feel a bit like a palace. It is simply beautiful. It doesn’t even seem like it could be the same place. That is until you see the friendly faces of the staff, many of whom have been there greeting CAPA Conference attendees for several years. It still has a warm and friendly feel combined with the signature Marriott Renaissance level of service. No question the renovation was sorely needed and, who doesn’t appreciate an added level of service.

The frosting on the cupcake is you get to enjoy it all at prerenovation, Wyndham rates. Years ago, the CAPA board made the decision to sign a contract through 2013 given the information that a major renovation was eminent. Their wise planning and your loyalty and patience over the years has paid off greatly. The fun and the feel of the CAPA Conference remains – the setting is more beautiful and even more perfect for us. CAPA’s first contract with the Wyndham Palm Springs was signed in the early 90’s. Then CME Committee Chair, Steve Henry and I went on a site visit and immediately knew this was a place where PAs would feel welcome and it was perfectly suited for our needs. We have been there so long we joked that CAPA is practically part of the woodwork. Well, when we were at the conference last year and the lobby was demolished and renovation was underway, we were honored to be asked to sign one of the supporting lobby pillars. It will be there

Join Us In Palm Springs During National ✲ Friendships Are Made ✲ People ✲ Dreams Are Encouraged ✲ ✲ And the CME is Fascinat 14

aissance Palm Springs Workshops, October 7 & 9

forever with CAPA logo and signatures now under the beautiful new wood. It is truly extraordinary for a group to be considered and valued the way the Renaissance values California PAs and CAPA. They like us. They really, really like us and coming home to this hotel each year is part of what makes the CAPA Conference experience so special. Thank you for being the best group there is!! Of course, I know it (I am a bit biased, I know) but I also hear it over and over again from hotel and convention center staff, speakers and exhibitors.

So, if you are a CAPA Conference “regular,” we can’t wait to see your face when you see the spectacular, new Renaissance Palm Springs. If you have never been to a Palm Springs CAPA Conference or it has been a while, this is your year!! Come join the party and enjoy the New Renaissance Palm Springs. You will want to reserve your hotel room now as it will most assuredly sell out. The CAPA room rate for a standard room is just $162. Over $100 less than the normal rate in October! Bring the family (they have added a sandbox next to the kiddie pool) and there are beautiful new cabanas at the pool as well.

CAPA memorialized forever beneath the new pillar in the Renaissance Lobby.

PA Week Where.... e Connect ✲ Ideas Are Shared ✲ History Is Honored (And Made) ting, Fun and Interactive

We have some exciting new things planned this year. We look forward to seeing you in Palm Springs!! 

✲ Fun Is Mandatory MARCH/APRIL 2010

CAPAsNotes

n a perfect world every PA would be able to recite the PA Practice Act, chapter and verse. We know the reality is that most of you have never read the entire book of PA laws and regulations. We have excerpted here the Prescription Transmittal Authority Section from Article 1 of the PA Practice Act and all of Article 4 of the California Code of Regulations pertaining to PAs. These two articles are the “meat” of the PA laws and regulations. Both have had substantial changes recently. We sincerely hope that you will thoroughly read and learn these sections. Share them with your supervising physicians and keep this information close at hand. We have taken editorial privilege here. Please keep in mind that in some cases we have added emphasis and/or text, highlighted certain sections, made notes in others. We have deleted the cited authority and history footnotes in the interest of space. You may download the complete 81 page document from the Physician Assistant Committee’s website. We encourage you to do so. For complete PA laws & regulations http://www.pac.ca.gov/about_us/ lawsregs/law-booklet.pdf

CAPA NEWS

Excerpted from The Physician Assistant Practice Act Business and Professions Code CHAPTER 7.7. PHYSICIAN ASSISTANTS

(Title amended by Stats. 1992, Ch. 427.)

Article 1. General Provisions Section 3502.1 Prescription Transmittal Authority Prescription Transmittal Authority 3502.1. (a) In addition to the services authorized in the regulations adopted by the board, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patient’s record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d). (1) A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions. (2) Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued.

Visit www.capanet.org for sample protocols and formulary The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon. (b) ‘‘Drug order’’ for purposes of this section means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to ‘‘prescription’’ in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code. (c) A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out. (1) A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without

CAPAsNotes advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist. (2) A physician assistant may not administer, provide or issue a drug order for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the committee. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the committee prior to the physician assistant’s use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.

To learn more about CAPA’s Controlled Substances Education Course visit www.capanet.org

(3) Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeon’s practice. (d) A written drug order issued pursuant to subdivision (a), except a written drug order in a patient’s medical record in a health facility or medical practice, shall contain the printed name, address, and phone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patient’s medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with the provisions of Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeon’s prescription blank to show the name, license number, and if applicable, the federal controlled substances number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon. (e) The medical record of any patient cared for by a physician assistant for whom the physician assistant’s Schedule II drug order has been issued or carried out shall be reviewed and countersigned and dated by a supervising physician and surgeon within seven days.

All Schedule II drug orders must be countersigned within 7 days (f ) All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).

If you are writing drug orders for Schedule II-V medications you must have your own DEA number. (g) The committee shall consult with the Medical Board of California and report during its sunset review required by Division 1.2 (commencing with Section 473) the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient. (Amended by Stats. 2007, Ch. 376.) Excerpted from The California Code of Regulations Article 4. Practice of Physician Assistants Section § 1399.540. Limitation on Medical Services. § 1399.541. Medical Services Performable. § 1399.542. Delegated Procedures. § 1399.543. Training to Perform Additional Medical Services. § 1399.545. Supervision Required. § 1399.546. Reporting of Physician Assistant Supervision.

MARCH/APRIL 2010

CAPAsNotes 1399.540. Limitation on Medical Services. (a) A physician assistant may only provide those medical services which he or she is competent to perform and which are consistent with the physician assistantâ&#x20AC;&#x2122;s education, training, and experience, and which are delegated in writing by a supervising physician who is responsible for the patients cared for by that physician assistant. (b) The writing which delegates the medical services shall be known as a delegation of services agreement. A delegation of services agreement may be signed by more than one supervising physician only if the same medical services have been delegated by each supervising physician. A physician assistant may provide medical services pursuant to more than one delegation of services agreement.

A Delegation of Services Agreement is required in every practice (c) The committee or division or their representative may require proof or demonstration of competence from any physician assistant for any tasks, procedures or management he or she is performing. (d) A physician assistant shall consult with a physician regarding any task, procedure or diagnostic problem which the physician assistant determines exceeds his or her level of competence or shall refer such cases to a physician. 1399.541. Medical Services Performable. Because physician assistant practice is directed by a supervising physician, and a physician assistant acts as an agent for that physician, the orders given and tasks

CAPA NEWS

performed by a physician assistant shall be considered the same as if they had been given and performed by the supervising physician. Unless otherwise specified in these regulations or in the delegation or protocols, these orders may be initiated without the prior patient specific order of the supervising physician. In any setting, including for example, any licensed health facility, out-patient settings, patientsâ&#x20AC;&#x2122; residences, residential facilities, and hospices, as applicable, a physician assistant may, pursuant to a delegation and protocols where present: (a) Take a patient history; perform a physical examination and make an assessment and diagnosis therefrom; initiate, review and revise treatment and therapy plans including plans for those services described in Section 1399.541(b) through Section 1399.541(i) inclusive; and record and present pertinent data in a manner meaningful to the physician. (b) Order or transmit an order for x-ray, other studies, therapeutic diets, physical therapy, occupational therapy, respiratory therapy, and nursing services. (c) Order, transmit an order for, perform, or assist in the performance of laboratory procedures, screening procedures and therapeutic procedures. (d) Recognize and evaluate situations which call for immediate attention of a physician and institute, when necessary, treatment procedures essential for the life of the patient. (e) Instruct and counsel patients regarding matters pertaining to their physical and mental health. Counseling may include topics such as medications, diets, social habits, family planning, normal growth and development, aging, and understanding of and long-term management of their diseases. (f ) Initiate arrangements for admissions, complete forms and charts pertinent to the patientâ&#x20AC;&#x2122;s medical record,

and provide services to patients requiring continuing care, including patients at home. (g) Initiate and facilitate the referral of patients to the appropriate health facilities, agencies, and resources of the community. (h) Administer or provide medication to a patient, or issue or transmit drug orders orally or in writing in accordance with the provisions of subdivisions (a)-(f ), inclusive, of Section 3502.1 of the Code.

Reference to protocol again. (i) (1) Perform surgical procedures without the personal presence of the supervising physician which are customarily performed under local anesthesia. Prior to delegating any such surgical procedures, the supervising physician shall review documentation which indicates that the physician assistant is trained to perform the surgical procedures. All other surgical procedures requiring other forms of anesthesia may be performed by a physician assistant only in the personal presence of an approved supervising physician. (2) A physician assistant may also act as first or second assistant in surgery under the supervision of supervising physician. 1399.542. Delegated Procedures. The delegation of procedures to a physician assistant under Section 1399.541, subsections (b) and (c) shall not relieve the supervising physician of primary continued responsibility for the welfare of the patient. 1399.543. Training to Perform Additional Medical Services. A physician assistant may be trained

CAPAsNotes to perform medical services which augment his or her current areas of competency in the following settings: (a) In the physical presence of a supervising physician who is directly in attendance and assisting the physician assistant in the performance of the procedure; (b) In an approved program; (c) In a medical school approved by the Division of Licensing under Section 1314; (d) In a residency or fellowship program approved by the Division of Licensing under Section 1321; (e) In a facility or clinic operated by the Federal government; (f ) In a training program which leads to licensure in a healing arts profession or is approved as Category I continuing medical education or continuing nursing education by the Board of Registered Nursing.

such times when a supervising physician is not on the premises. (e) A physician assistant and his or her supervising physician shall establish in writing guidelines for the adequate supervision of the physician assistant which shall include one or more of the following mechanisms: (1) Examination of the patient by a supervising physician the same day as care is given by the physician assistant; and/or (2) Countersignature and dating of all medical records written by the physician assistant within thirty (30) days that the care was given by the physician assistant; and/or

1399.545. Supervision Required. (a) A supervising physician shall be available in person or by electronic communication at all times when the physician assistant is caring for patients. (b) A supervising physician shall delegate to a physician assistant only those tasks and procedures consistent with the supervising physician’s specialty or usual and customary practice and with the patient’s health and condition. (c) A supervising physician shall observe or review evidence of the physician assistant’s performance of all tasks and procedures to be delegated to the physician assistant until assured of competency. (d) The physician assistant and the supervising physician shall establish in writing transport and back-up procedures for the immediate care of patients who are in need of emergency care beyond the physician assistant’s scope of practice for

(3) The supervising physician may adopt protocols to govern the performance of a physician assistant for some or all tasks. The minimum content for a protocol governing diagnosis and management as referred to in this section shall include the presence or absence of symptoms, signs, and other data necessary to establish a diagnosis or assessment, any appropriate tests or studies to order, drugs to recommend to the patient, and education to be given the patient. For protocols governing procedures, the protocol shall state the information to be given the patient, the nature of the consent to be obtained from the patient, the preparation and technique of the procedure, and the follow-up care. Protocols shall be developed by the physician, adopted from, or referenced to, texts or other sources. Protocols shall be signed and dated by the supervising physician and the physician assistant.

Most PAs practice using this third option: by adopting protocols.

The supervising physician shall review, countersign, and date a minimum of 5% sample of medical records of patients treated by the physician assistant functioning under these protocols within thirty (30) days. The physician shall select for review those cases which by diagnosis, problem, treatment or procedure represent, in his or her judgment, the most significant risk to the patient; (4) Other mechanisms approved in advance by the committee. (f ) In the case of a physician assistant operating under interim approval, the supervising physician shall review, sign and date the medical record of all patients cared for by that physician assistant within seven (7) days if the physician was on the premises when the physician assistant diagnosed or treated the patient. If the physician was not on the premises at that time, he or she shall review, sign and date such medical records within 48 hours of the time the medical services were provided. (g) The supervising physician has continuing responsibility to follow the progress of the patient and to make sure that the physician assistant does not function autonomously. The supervising physician shall be responsible for all medical services provided by a physician assistant under his or her supervision. 1399.546. Reporting of Physician Assistant Supervision. Each time a physician assistant provides care for a patient and enters his or her name, signature, initials, or computer code on a patient’s record, chart or written order, the physician assistant shall also enter the name of his or her supervising physician who is responsible for the patient. When a physician assistant transmits an oral order, he or she shall also state the name of the supervising physician responsible for the patient.

MARCH/APRIL 2010

Renew lly tica Automa

SAVE $15

Pay Quarterly

If You Have Not Already Done So, Please Renew Your CAPA Membership Today As you know, the California health care system is fraught with problems including turf issues. California PAs need to be strongly represented with legislators and regulators. With your continuous support, we will remain diligent in our efforts on your behalf. As the saying goes: If you are not at the table, you may very well be on the menu. CAPA must remain strong and have the means and the membership numbers necessary to effectively represent your interests. We can’t do that without YOU! You can renew your CAPA membership online or wait to receive your Dues Renewal Statement in the mail. That will arrive shortly. Either way, we hope you will continue to support the only organization working solely to promote and protect PAs in California.

Fellow and Associate Members: Save $15 This Year By Marking The Box Instructing Us To Automatically Renew Your CAPA Membership Year After Year When renewing your membership, check the box that allows us to automatically renew your yearly CAPA membership until you notify us that you would like us to stop. You will save $15 and you will no longer receive paper renewal statements in the mail*. Your commitment to support your profession will be easily fulfilled.

In Addition, Fellow and Associate Members May Pay Your CAPA Dues in Quarterly Installments With No Additional Processing Fee

itional No Add Fees ing Process

CAPA membership is an investment in your professional future. It should be automatic and easy to support the only organization working solely to promote and protect PA practice in California. You may pay your CAPA membership dues automatically on a quarterly basis. For less than 50 cents a day you can support CAPA’s efforts on your behalf*. About an hour’s pay per quarter!

For complete information regarding quarterly installments and automatic yearly renewal, visit the CAPA website or refer to the insert in the Membership Dues Renewal Statement you receive in the mail. Or, we always welcome your calls to the CAPA Office at (714) 427-0321. *Fellow and Associate Members Only

CAPA NEWS

APA C t r po $$ p u S To d Save an

Professional Liability Insurance: The Difference Between Claims-Made and Occurrence Coverage

n the world of professional liability insurance, there are two types of policies: claims-made and occurrence. One policy form is not necessarily better than the other. When purchasing professional liability insurance, a careful evaluation of insurance needs becomes even more important than the selection of coverage. Claims-made coverage is provided for claims made and reported to the insurance company while the policy remains in force. Occurrence provides coverage for an injury or damage which takes place during the policy period – regardless of when the claim is reported. E-8102-310-CAPA:E-8102-310-CAPA

Advantage of Claims-Made Policy Insurance Company Evaluation: the financial stability of the insurance company can be examined each year to determine its ability to pay claims currently, rather than in the future. Disadvantage of Claims-Made Policy Potential costs: should the policy be discontinued by the insured or the insurance company, extended reporting period endorsement, also known as tail coverage or prior acts coverage may have to be purchased. Advantage of Occurrence Policy Mobility: an occurrence policy makes it easier to change insurance companies without additional costs or potential gaps in coverage – such as the need to purchase “tail” coverage.

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1:37 PM

Disadvantage of Occurrence Policy Pricing for future costs: rates are based upon an insurance company’s projections of claim costs in future years. Inaccurate projections can severely tax an insurer’s ability to meet its future financial obligations – if the premiums charged are not adequate to fund the cost of claims. It’s important to consider the long-term financial strength and stability of the insurance company issuing the policy. Safeguarding a professional practice, protecting the financial security, and having adequate coverage in case of a claim should be the utmost concern. Clearly, where both forms of coverage are available, the decision rests in the hands of the professional buying the coverage. 

Page 1

A physician assistant’s story… My child is home sick. Barely get to the office on time. Waiting room is packed. The office manager is out on vacation. Meet with supervising physician to discuss patients. Grab stethoscope. In first room is 3-yearold Emma. Pink eyes, a cough and ear infection. “Gifts” from daycare. Record on chart. Next room. A pleasant 55-year-old woman in no acute distress. She describes a new cough and onset of chest pain. Order EKG, chest x-ray and labs. Minor emergency of the day – 16-year-old Sammy fell off his skateboard while ‘performing an Ollie.’ Suture knee and write prescription for the pain. Fifteen minute break spent getting caught up on paperwork. Supervising physician e-mailed an article titled, “In a courtroom, your documentation can be your best friend or worst enemy.” Good thing I have HPSO!

Make sure your story has a happy ending.

Professional Liability Insurance for Physician Assistants

888.273.4686 www.hpso.com/capa3

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This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA Company. Healthcare Providers Service Organization is a division of Affinity Insurance Services, Inc.; in CA (License #0795465), MN and OK, AIS Affinity Insurance Agency, Inc.; and in NY, AIS Affinity Insurance Agency. ©2010 Affinity Insurance Services, Inc. E-8102-310-CAPA

MARCH/APRIL 2010

The Effect of a Criminal Case on Your Professional License HOLDING ON TO YOUR TICKET by Robin D. Perry, Esq.

our right to practice your profession is surrounded with a “panoply of legal protections.” However, your right is not absolute. “To protect the public,” California regulates the practice of many professions through licensing and license disciplinary actions.

Regulated Professions The list of regulated professions is extensive. Medical professionals including physicians, osteopaths, podiatrists, “In fact, even conduct that physician assistants, occurs outside of a licensee’s psychologists, practice or profession is often dentists, dental assistants, dental fair game.” hygienists, chiropractors, pharmacists, optometrists, registered nurses, vocational nurses, psychiatric technicians, respiratory care practitioners, acupuncturists, occupational therapists, speechlanguage pathologists, physical therapists, veterinarians are all subject to licensing laws. Similarly, most counselors such as marriage and family therapists, license clinical social workers, licensed educational psychologists are regulated. Financial, legal, real estate and property professionals like accountants, architects, real estate brokers, engineers, geologists, geophysicists, land surveyors, attorneys and court reporters are subject to discipline. Finally, barbers and cosmetologists, electronic and appliance repair 22

CAPA NEWS

dealers and contractors, funeral directors, embalmers, and even horse jockeys can find themselves in the cross-hairs should they run a foul of the criminal laws. Licensing Agencies Frequently Discipline Based Upon Criminal Issues Discipline cases based upon criminal convictions are common. Indeed, licensing agencies frequently seek to revoke or suspend a professional license when a licensee has been convicted of a crime. As a result, a large body of case law and statutory law has developed concerning the use of criminal convictions as a basis for license discipline. This article discusses common legal issues that arise when a criminal issue is the basis for license discipline. California is permitted to regulate the practice of professions under its general police powers. Courts construe license discipline laws broadly to effectuate the protection of the public. As a rule, licensing cases are intended to prevent future harm. Actual harm to an existing patient, client or customer is generally not required to be shown as part of a licensing action. In fact, even conduct that occurs outside of a licensee’s practice or profession is often fair game. For example, a court upheld discipline of a doctor on the basis of drunk driving convictions despite a lack of evidence that the doctor’s actions ever effected his medical practice or patients. In that case, the court found the DUIs reflected on the licensee’s fitness and qualifications to practice medicine. Effect of Criminal Convictions Typically, the license agency uses a criminal conviction as a basis for

discipline. For a criminal conviction to form the basis for licensing discipline, it must be substantially related to the licensee’s fitness to practice the profession for which the license was issued. A conviction is defined as * A plea or verdict of guilty; or * A conviction following a plea of nolo contendere, commonly known as “no-contest.” However, even an acquittal in a criminal case may not mean a licensee is not subject to discipline. While it is true that criminal proceedings that results in an acquittal, cannot be the basis of license discipline, a licensing agency can bring discipline proceedings based on the conduct underlying the criminal case. A higher standard of proof exists in a criminal case than in a disciplinary case. For example, assume an accountant is acquitted of embezzlement in a criminal trial. Because the standard of proof, proof beyond a reasonable doubt, is much higher than the standard of proof in a disciplinary hearing, a licensing agency can still bring discipline proceedings under a theory that the evidence would justify discipline under the lower standard that exists in disciplinary proceedings. Similarly, while an arrest by itself is not appropriate for discipline, the conduct underlying the arrest may be the basis for license discipline. Effect of Expungement of Criminal Conviction Under certain circumstances, a criminal defendant may have his or her guilty plea set aside and dismissed. Such an occurrence is called an expungement. While a

expungement is desirable, it does not prevent a licensing agency from bringing a disciplinary action based upon the conviction, in the absence of a specific statutory provision. However, an expungement may be relevant to a license discipline case as evidence that the licensee has been rehabilitated or to otherwise mitigated the charge. Effect of Drug Diversion Many licensing disciplinary actions stem from substance abuse. Often, those criminal cases resolve as part of a drug diversion program or under the the provisions of Proposition 36. Nevertheless, a licensing agency may bring disciplinary action even if the licensee successfully completes a drug diversion program as part of a criminal case resolution. Although the conviction itself cannot form the basis for discipline, the wrongful conduct underlying the conviction may be a basis for discipline. Frequently, licensing agencies have their own drug diversion program. In substance abuse cases, it is often possible to resolve the criminal case and disciplinary case when the licensee completes the licensing agencies substance abuse program.

What to do if you have Criminal Issues Criminal cases are stressful for everyone. If you are a licensed professional, a criminal case, even a minor one, may not only effect your liberty, but your livelihood. It is important to obtain skilled counsel at the outset. The goal is to prevent the case from ever being filed. If a case is filed, the preference is often to seek an acquittal, dismissal, deferred entry of judgment or expungement. Any of those results may eliminate, reduce or mitigate a subsequent disciplinary proceeding. When a licensee is confronted with a disciplinary proceeding, it is critical to show that he or she is sufficiently rehabilitated from his or her crime to continue practicing. Evidence of rehabilitation may include character letters, volunteer work and community service, counseling and therapy, religious and community based activity, evidence of attendance in drug rehabilitation, testimony from a psychotherapist that the criminal conduct is unlikely to recur and evidence that the licensee has changed business practices to avoid a recurrence of the problem. Your attorney should also be prepared to show mitigating

evidence. Such evidence may include the length of time licensed, absence of prior discipline and convictions, employment record, the licensee’s good reputation, difficult circumstances that may have led to criminal conduct, length of time the licensee has spent free of judicial “For most licensed oversight, honesty in admitting professionals, criminal issues errors, etc.

are typically isolated instances

For most licensed that mar an otherwise good professionals, criminal issues are reputation.” typically isolated instances that mar an otherwise good reputation. With capable legal counsel and representation, it need not cost you your ticket to practice your chosen profession.  Robin Perry is an attorney whose statewide practice includes professional disciplinary matters and white collar criminal defense. He has offices in Long Beach and San Francisco, California. He may be reached at robin@lordp.net or at (562) 216-2944.

D Requires Physician Signature

o you have examples of forms, cards, certificates which have been rejected by organizations, insurance companies, state agencies, departments, school districts, etc. solely because the form was signed by a PA and not a physician? If so, please fax us a copy of the form, being careful to abide by HIPAA Privacy Rule Requirements. You may fax your examples (800) 480-2272 or email them to capa@capanet.org or call us and we can speak with you to explore the best way to share the information.

MARCH/APRIL 2010

Students Students Students Students Students Students CAPA Makes Its Entrance Into Social Networking by Adam Marks, MPA, PA-S, Student Representative

ver the last couple of years, CAPA Student Representatives have been looking for a platform which would allow those involved in the PA profession to network with each other. Various ideas have been contemplated, ranging from a CAPA online forum to Twitter. In November 2009, CAPA created a taskforce to investigate the use of Facebook and other social networking sites to help disseminate information to CAPA members, as well as provide an area where Pre-PAs and others can get information regarding upcoming CAPA events and membership information. On January 17, the CAPA board voted unanimously to create a Facebook Group. With the input of the past two Student Representatives and CAPA’s wonderful Webmaster, Linda Klompus, the CAPA Facebook group was created. The page was published on January 22 and within the first three weeks the group accumulated over 100 fans. Along with building a fan group, it has bridged information from the National Health Service Corp and the AAPA, as well as linked people to the CAPA website which allows them to learn more about CAPA. While it has been an interesting venture, the taskforce is looking 24

CAPA NEWS

to maximize Facebook by bringing up-to-date information to fans, photos from our CAPA at Napa Conference and Annual Conference in Palm Springs, provide useful links to local PA groups and California’s PA alumni groups. If you have a Facebook account or if you have not made your way into the realm of Facebook, I encourage you to become a fan of CAPA’s Facebook Group. As you know, the PA community in California is very tight and any opportunity to network with your school’s alumni or practicing PAs in your area could prove beneficial as you continue on in your studies. Facebook is just one of the many ways for PA students to connect with other students and practicing PAs. CAPA already has a list of useful links for students on their website, which can be found at www.capanet.org/studentlinks. cfm. If you are looking for a way to connect with the professional

community and have a question regarding school and/or life after school, I advise you to visit the PA Forum (www.physicianassistantforum.com/forums/forum. php). Facebook is just another tool CAPA is using with the intention of connecting students and increasing membership in CAPA. Our ultimate goal is to have the content completely driven by PAs, PA students and CAPA Facebook Fans. As the Student Affairs Committee continues to add content to the Facebook Group, we invite anyone who wishes to take part in our new Facebook project or if you have any ideas with regard to the content that you would like to see on the page, to contact us. Please email me at studentrep@capanet. org or Matthew Keane, MS, PA-C, Student Affairs Committee Chair, at dirmatt@capanet.org. We look forward to your comments and suggestions. 

Attention: PA Program Directors, Class Presidents, Student Society Leaders, Faculty and Students

et CAPA know what you are doing by submitting an article and include a photo if possible. Or, you may simply send a photo with a descriptive caption. We want to let our readers know the wonderful things that are happening at our PA programs. We will print submissions on a space available basis. Send your article/photos, etc. to capa@capanet.org. Thank you!!

Students Students Students Students Students Students The $1,000 an Hour Job! by Matthew Keane, MS, PA-C, Director-At-Large and Student Affairs Committee Chair

or most students, the logistics of getting through PA school can be as difficult to manage as learning the algorithms for treating cardiac arrhythmias. Trying to figure out how to pay for tuition, books, food, rent, gas, supplies, and so on, can seem as hard as trying to figure out the California State Budget. For many students, this may be the first time they ever had to sit down and analyze their financial standings and decide where each and every penny will go. As we sort through each penny, our minds drift and we start to daydream about the day we are PAs, making thirty, forty, fifty, or even a thousand dollars an hour. Yes, that’s right you could make a thousand dollars an hour even before you become a practicing PA and CAPA is willing to pay you! CAPA just recently paid three PA students, Louis A. Rosales and Veronica Galvan from the San Joaquin Valley College PA Program and Eric Chow from the Samuel Merritt University PA Program, a thousand dollars each for about an

hour’s worth of work. However, there’s a catch; Louis, Veronica and Eric applied for one of CAPA’s three annual student scholarships. Louis was the winner of the Ray Dale Memorial Scholarship. This scholarship goes to an individual who is in good academic standing and who has engaged in activities to promote the PA profession. Veronica was the winner of the Community Outreach Scholarship, which is awarded to a student who is in good academic standing and has demonstrated community outreach and other philanthropic activities as a student. Eric was the winner of the Ruth Webb Minority Scholarship, which is awarded to a minority student who is in good academic standing and pursuing activities to promote the PA profession. I would like to congratulate Louis, Veronica and Eric on their outstanding achievements and wish them all the best of luck in the future. Figuring out how to pay your way through PA school can be an overwhelming and sometimes

frightening thing when you sit down and add up all the numbers. However, as students, you should never stop looking for ways to add some cash to the financial investment that is PA school. Two years can come and go in a blink of an eye, but after the diplomas are handed out and the “C’s” are added to the end of our names, the time to repay our loans will soon follow. Wouldn’t it be nicer if those bills were at least a thousand dollars lighter? So, in between looking under the cushions of the couch and begging mom and dad for a little extra dough to help get through school, visit the Student Section of the CAPA website and take a few minutes to read over the requirements to earn a CAPA scholarship. Maybe you will be the next PA student to earn a thousand dollars an hour! 

Student Challenge Bowl Sign Up Now by Matthew Keane, MS, PA-C, Student Challenge Bowl Coordinator

he 14th Annual CAPA/Kaiser Student Medical Challenge Bowl will be held Saturday, October 9, 2010, poolside at the Renaissance Palm Springs from 5:30 p.m. – 7:00 p.m. There will be a cash prize for the winning team: $250 for their Student Society. CAPA will provide other prizes like t-shirts and

gift cards. The winning team will also be able to display the official Challenge Bowl Trophy at their PA program. To sign up, to go the student section of the CAPA website (www.capanet.org). We look forward to seeing you there.  MARCH/APRIL 2010

Students Students Students Students Students Students Diversity Outreach at TUSSPA by Alfred Tobias, PA-S and Anna Ngo, PA-S, Touro University MSPAS/MPH Class of 2012

TOURO UNIVERSITY

he Touro University of Student Society Physician Assistant (TUSSPA) is a student body organization which aims to promote the PA profession, community service, cultural competency, enhance curriculum, and most importantly establish rapport with other future health care professionals. TUSSPA, Class of 2012, has kicked off with a great start on all our missions during this academic year. We started out with an eyeglasses drive and collected over 33 pairs of glasses and 30 cases from students. The glasses were donated to the local Lions Club in support of their Vision Promotion Campaign. We had a funds drive to purchase Christmas gifts for needy children. We also had several outreach projects intended to familiarize students with certain populations (i.e., geriatrics, pediatrics,

homeless and Veterans) in order to promote cultural diversity and to humble ourselves. We served at a local soup kitchen which gave us an opportunity to interact with the homeless, helped build a house with the local chapter of Habitat for Humanity as a way of involvement in community development, and helped with H1N1 vaccinations in Solano County. We also presented general health information to the community via Touro University’s Student Run Health Clinic. The next big event is the Teen Life Conference in Vallejo. It is sponsored by Touro University and aims to reach out to teenagers. We have several PA students giving presentations and we also have an information booth on our PA Program and profession at this conference.

Calling All PA Students

pply today to serve as a CAPA Student Ambassador at this year’s 34th Annual Conference in Palm Springs on October 7-10, 2010. The deadline to apply is July 1, 2010. For complete information, please visit the CAPA website at: www.capanet.org /studentamb_ page.cfm. 

CAPA NEWS

Other future events include serving meals at a nursing home, volunteering hospice services at the VA Hospital, being a temporary respite at the Ronald McDonald House for terminally ill children and a feminine hygiene drive for women’s shelters. In addition, we began a monthly “Brown Bag Cultural Competency Series” for our organizations which consist of educational videos, discussion and presenters. We watched “The Culture of Emotions – A Cultural Competence and Diversity Program,” which highlights the effect of culture on the expression of symptoms, definition of illness and treatment from people of all upbringings. It was a great introductory film to addressing cultural competency with real world examples and psychological reasoning. There are more great videos and presenters to come. 

Special Student Track at the CAPA Conference

e will again have a special series of lectures and we hope a workshop for PA students. There is no additional charge for this wonderful student experience at the CAPA Conference. Mark your calendar for the CAPA Conference, October 7 – 10, 2010 and watch for more details.

Students Students Students Students Students Students What’s Going On At…University of California, Davis? Faculty Profile: Rick Dehn, MPA, PA-C by Michael J. De Rosa, MPH, Ph.D., PA-C, PA Program Relations Committee Chair

M Rick Dehn, MPA, PA-C

any in the PA profession, particularly those involved in PA education, know Rick Dehn for his unrivaled enthusiasm for research and publication as a means of elevating the PA profession. He was not always destined for this role. As Rick Dehn describes his early career, he was on the path to become a secondary school educator well before becoming a PA. After completing a baccalaureate degree in history at the University of Iowa, he met the people responsible for starting the PA training program there, “and they distracted me.” He recounted to me recently how his first job as a physician assistant was in a facility with a residency training program. Teaching clinical medicine was a requirement of his job from day one. For the duration of his career, Rick continued to intertwine his passions for clinical medicine and teaching. In 1978, Rick moved to Merced, California. Within a month, he began a long-term, off-and-on relationship with the University of

Help To Shape Future PAs!

f you would like to learn more about your place of employment becoming a clinical rotation site for one or more of the PA Programs in California, please contact CAPA. You can email us at capa@capanet.org or give us a call at (714) 427-0321. Thank you!

California, Davis (UCD) teaching family practice residency students while providing primary care to the underserved in community clinics in the Central Valley. Eventually, he was named a core faculty member for UCD’s Modesto satellite campus of the FNP/PA program in 1988. He served the UCD combined program in that capacity until 1993 when he returned to Iowa to become the Assistant Director of the University of Iowa College of Medicine’s Physician Assistant Program.

Rick also spoke of his concern that if the PA profession loses track of its mission, “maldistributing just like the physicians did,” it may miss a significant opportunity. In describing his biggest challenge as a Program Director, he reminisced about his early days as a physician assistant training other providers, “ the traditional relationship between the clinical practice of medicine and training has broken down at the same time that society is not… embracing education, particularly in funding priorities.”

In April 2008, Rick reunited with the University of California, Davis after 15 years when he was named Director of the sole remaining combined FNP/PA Program in the United States. When asked about the most rewarding aspects of the position, Rick immediately spoke of the students: “What [the students] do when they graduate is so focused on providing care to patients. The entire process focuses on selecting the right people and providing the proper training. Also, people who want to be PAs combine desire to help with great, limitless enthusiasm toward learning.” More recently, Rick discovered the gratification of becoming both a teacher and mentor to the faculty. Rick now takes pleasure in helping young faculty grow into their various roles.

So what can CAPA do for PA Programs? You guessed it… rotations. Rick sees CAPA as serving an important liaison function, potentially helping to identify clinical training opportunities. Additionally, he recognizes CAPA as the only organization well positioned and equipped to address practice legislation and “outdated educational requirements.”

Rick sees the potential for a great future for the profession because of the place PAs hold in the economic model of medicine in America today. Having said that,

Part of the only state-run university currently to house physician assistant training, the UC Davis program continues to blaze new trails. Currently, they are eagerly anticipating the opening of the Betty Irene Moore School of Nursing. Additionally, the program now offers the opportunity to combine PA training with an MPH in a 33-month curriculum. Having a widely recognized and honored leader in PA education and scholarly research at the helm will serve the UC Davis Program well over the coming years.  MARCH/APRIL 2010

Help Educate and Advocate!

his is the third in a series of articles we published to educate and inform you so you may also help to educate your patients about dangerous and growing practices. We also want you to share your patients’ stories (always abiding by HIPAA Privacy Rule Requirements) with us so we may help in the development of real-life documentation to use when these issues are discussed with policymakers and legislators. We began with Step Therapy/Fail First Practices. Then in the January/February 2010 issue of the CAPA News, we highlighted the Health Insurer Code of Conduct. This installment talks about Therapeutic Substitutions which is very different from generic substitutions. Patients should be become aware of the differences. On page 29 we have included 5 Questions To Ask Your Pharmacist (from the National Alliance on Mental

Illness), information you can hand to your patients. In the next issue of the CAPA News we will take a more in-depth look at Therapeutic Substitutions. As PAs, we are on the frontlines of medical care and these important issues affect the health and well-being of our patients. As PAs, we are advocates for our patients. We hope you will share the information below with your patients and your colleagues. And, share with us, firsthand how these practices are impacting on the care you and/or your supervising physician (s) provide. Again, always being careful to abide by HIPAA Privacy Rule Requirements, you may fax your examples (800-480-2272) or email (capa@capanet.org) or call us and we can speak with you to explore the best way to share the information.

From the National Alliance on Mental Illness

FIVE QUESTIONS TO ASK YOUR PHARMACIST

Why are you switching my prescription?

or many the trip to the pharmacy is a quick one. Most run up to the counter or use the drivethrough, pay the pharmacist, and rightfully assume that they are leaving with the medication their health care provider prescribed. It is the same situation with mail-order prescriptions; people presume the drugs in their mailbox were filled according to the doctor’s script. According to recent news reports, it has become quite common for pharmacists to switch patients’ prescriptions to generic or less expensive brand-

name drugs. A number of factors may influence these decisions, and while saving a few dollars on medications certainly sounds appealing during these tough economic times, cutting costs should never be at the expense of ones health. There are five critical questions that everyone should keep in mind each time they visit the pharmacy counter. We encourage you to photocopy the information on page 29 and hand it to your patients. Thank you.

Introducing Best Bones Forever! A Fresh and Fun Bone Health Campaign For Girls

steoporosis is a pediatric disease with geriatric consequences. In terms of bone health, the stage is set early on: girls build close to 90% of their bone mass by age 18. Once they reach adulthood, it becomes increasingly difficult for them to make it up. Unfortunately, most adolescent

CAPA NEWS

girls do not get the calcium, vitamin D, and physical activity they need to grow strong, healthy bones.

a national bone health campaign for girls ages 9-14. Best Bones Forever! focuses on friendship and fun–and encourages girls to “grow strong together, stay strong forever.”

That’s why the U.S. Department of Health and Human Services’ Office on Women’s Health (OWH) launched Best Bones Forever!,

The new campaign empowers girls and their BFFs (best friend forever) to build strong

 FIVE QUESTIONS TO ASK YOUR PHARMACIST From the National Alliance on Mental Illness

Is this the exact drug that my health care provider prescribed? This may sound like a given, but unless your health care provider specifically checks “dispense as written” on your prescription script, a pharmacist may change your prescription without knowing your full medical background as your health care provider does. Why are you switching my prescription? It is probably to keep costs down for the pharmacy. You may be pleased to learn you’re also saving money, but it’s often the pharmacy that reaps the real reward of the switch. For example, last month Walgreens agreed to pay $35 million to 42 states, including Illinois, to settle allegations that it unlawfully switched medications from tablet form to capsules to receive more money from Medicaid reimbursements. As taxpayers, this deceptive switch affected us all. Will this switch impact my health? Keep in mind that not all medications are created equal. Many people think generics always perform the same as a brand-name equivalent, but that is a common misconception. While the active ingredients may be the same, it’s the inactive components of a drug that can potentially cause adverse reactions. Additionally, certain brand name drugs don’t have a generic equivalent, so a switch means you are getting a different medication. Have you notified my health care provider of this switch? It is all too common for a patient to be switched to a different medication without the knowledge of his or her doctor. The health care provider often doesn’t find out until the patient requests another appointment because they are still sick or, in some cases, their condition has worsened. Always consult with your health care provider before a switch. After all, nobody knows what’s in a patient’s best medical interest better than his or her own health care provider. Is this the same dosage as my previous prescription? New medicines may only be available in a higher or lower dose, and can be metabolized at a different rate than the previously prescribed medicine. This can lead to confusion and non-adherence, which can affect both the safety and effectiveness of the medicine.

bones by choosing snacks and foods with calcium and vitamin D, and getting an hour of physical activity a day. Campaign materials such as journals, posters, magnets, tattoos, book covers and a Web site (www.bestbonesforever. gov) get girls excited about bone health with recipes, tips, and fun activities. Parents can get important bone health information from a brochure in both

English and Spanish, and a Web site: www. bestbonesforever.gov/parents. Help make an impact by taking just a few minutes to discuss bone health with your young patients and their parents. If you are interested in ordering our free Best Bones Forever! materials, visit http://www. bestbonesforever.gov/parents/materials.cfm and enter the partner code BBFPA914. 

MARCH/APRIL 2010

Special Delivery Nets Special Recognition for Physician Assistant, Lise Noyes

“I

can’t believe what Lise did for me,” said Karen, recalling the day when Lise Noyes came through for her – big time. The Kaiser Permanente member had phoned Noyes, asking to see her right away because of a breathing problem. “She was really

miserable,” Noyes recalled. “I told her to come right in.” By the time the physician assistant had finished treating Karen, it was late in the day. “I was exhausted and just had to get home,” Karen said. Yet she still had to go to the pharmacy for her medications. “I looked at her and knew she couldn’t do it,” Noyes said. So, she made a quick and caring decision. “She said to me, ‘please just go home and I’ll get your medicine,’” Karen said, still touched by the physician assistant’s kindness. So

after finishing a busy day at work, Noyes took the time to pick up Karen’s medications and deliver them to her home. “I’m so grateful for Lise’s help,” Karen said. “She came through for me when I needed it most.” For more information or to nominate someone you feel is an Everyday Hero, visit http://hero. kp.org/scal.  inside KP @ Southern California Posted on November 5, 2009

Doctors everyday heroes. a New Exhibitor to CAPA and Doctors areare everyday heroes. They are alsoRecruit human. Substance They abuse, depression, career burnout can impact anyone. Including are alsoandhuman. doctors. The Physicians’ and Dentists’ Conﬁdential Line is here to help.

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The Physicians’ and Dentists’ Confidential Line is a project of the California Medical Association, with additional support from the California Dental Association. Membership in these organizations is encouraged, but is not required to use the hotline.

Physician Assistants who are struggling with substance abuse and/or depression may call the Diversion Program for Physician Assistants at (800) 522-9198 30

CAPA NEWS

Palm Springs Convention Center October 8-9, 2010

Reserve Booth Space Onlin www.capa e at net.org/ exhibits. cfm

Welcome New Members

Local Groups

January 22, 2010 through March 8, 2010 James Avery, PA-C Sonia Bacchus, PA-C Barbara Ball, PA-C Ashley Bessette, PA-S Tiara Burks, PA-C Crystal Calcott, MA Zulema Carrillo, PA-C Samantha Carroll, PA-C Pamela Chan, PA-S Stephanie Choi, PA-S Alma Corvera, PA Jose Corvera, PA-C April De La Cruz, PA-C Maria DeGracia, PA Andrea DeMesquita Michelle DeWindt, PA-C Eric Esparza, PA-S Kimberly Ferguson, PA-S Salma Foroozan, PA-C Dayna Giannascoli-Freedhand, PA-C Veronica Gonzales, PA-C Stephanie Haire, PA-S Maria-Dolores Haneffant, PA-C Avon Hansen, PA-C Anna Heilig Adams, PA-S Amy Heller, PA-C Christine Hong, PA-C Jamie Huberman, PA-S Shalini Jeyakumar, PA-C Leila Jirari, PA-S Erin Klingler, PA-S

Stephanie Korb, PA-C Richard Licon, PA Linda Liu, PA-C Liberty Lomeli, PA-C Jenna Long, PA-S Justin Mallit, PA-S Juana Oralia Marquez, PA-C Elizabeth Mayer, PA-C Susan McGee, PA-C Keith McGill, PA Jeffrey Meyers, PA-C Anna Micklea, PA-C Jessica Miyashiro, PA-S Debbra Montoya, PA-C Yolanda Moore, PA-C Nancy Munoz, PA-C Brendan Murphy, PA-S Angela Murray, PA-C Matthew Olin, PA-C Bella Olson, PA-S Maisha Parnell, MPH Oliver Petalver, PA-C Annette Pizano, PA-C Rebecca Powell, PA-C William Prentice, PA-C Sadia Quidwai Millad Rashti, PA-C Shabnam Richardson, PA-C Alexandria Robles, MS, PA-C Adrian Ruelas, PA-S Sara Saunders, PA-C

Eileen Scanlon, PA-C, MPAS William Schlegel, PA-C Melissa Schreiber, PA Anita See, PA-C Thomas Seivert, PA-C Rebekah Sexton, PA-C Rina Shah, PA-C Sarah Sharp, PA-S Carolin Sherf, PA-C Natalie Shitara, PA-S Jackai Smith, PA-S Katherine Stoesz, PA-C, MPA Matthew Tate, PA-C Nasreen Taymuree, PA-C Maria Tiu, PA-S Jody Tomic, PA-C Pilar Tusa, PA Vanessa Vega, PA-C Hilda Villarreal, FNP, PA Luqiu Wang, PA-C Kathryn Whitelaw, PA-S Katherine Wilkens, PA-C Kelli Wilson, PA-S Whitney Woodward, PA-C Jessica Wright, PA-S Jonathan de Guzman, PA-C

1. Redding Area PA/NP Alliance Summer Ross, PA-C; (530) 275-5747 summerross@hughes.net 2. Physician Assistant Society of Sacramento (PASS) Carlos De Villa, PA-C, PASS President; (916) 973-6185, pasocietyofsac@yahoo.com Atul Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, pasocietyofsac@yahoo.com 3. Sacramento Area NP and PA Association A. Lynne Wittekind, PA-C; (530) 906-1238, sanppaa@sanppaa.org, lwittekind@earthlink.net, www.sanppaa.org 4. Contra Costa Clinicians Association Brian Costello, MS, PA-C, ATC; (925) 689-8853, brianpac@astound.net 5. San Francisco Bay Area Physician Assistants (SFBAPA) www.sfbapa.com, PO Box 14096, San Francisco, CA 94114-0096 Martin Kramer, PA-C; (415) 433-5359, Fax: (415) 397-6805, mkramersf@hotmail.com 6. Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251, rosepard@aol.com Matt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com 7. Bay Area Non-Docs Linda O’Keeffe, PA-C; (650) 366-2050, lindapac@aol.com 8. Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net 9. Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) 605-4966, briancor@verizon.net, www.nppanetwork.org 10. Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434, clopez875@aol.com; 2134 10th St, Sanger, CA 93657 11. Tulare/Kings NP/PA Association Steve Henry, PA-C; Pager: (559) 749-4348, msh649@sbcglobal.net

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f you haven’t received email from CAPA lately, we may have an incorrect email address or your computer may be blocking an unknown sender. Please add the following to your address book to keep from blocking our important emails: capa_action_network@capanet.org and webmaster@capanet. org. Please keep the CAPA office informed of your current email address by logging onto the CAPA website and updating your member profile by clicking on “Your Profile” in the top right hand corner.

12. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com 13. So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com 14. Orange County Hung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com 15. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com 16. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com 17. San Diego Area Jeremy Adler, MS, PA-C; (619) 829-1430, jadler@simplyweb.net

MARCH/APRIL 2010

California Academy of Physician Assistants 3100 W. Warner Avenue, Suite 3 Santa Ana, CA 92704-5331

Presorted STD US Postage PAID Torrance, CA Permit No 102

Address Service Requested

See Pag es 14 –15 Inside

CAPA’s 34th Annual Conference October 7-10, 2010

Optional Workshops, October 7 and 9

Controlled Substances Education Course

October 6, 2010 – Prior to the CAPA Conference

APA’s home away from home is looking a bit more like a palace! The renovation is complete and the Wyndham Palm Springs is no more. A new and very much improved CAPA Conference experience awaits you at the Renaissance Palm Springs. And, the special CAPA Conference Rate is just $162! You may reserve your room today.