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What medical care can physician assistants provide in Texas?

Texas doesn't allow physician assistants to have a totally independent scope of practice

Physician assistants (PAs) are mid-level providers who are a valuable part of team-oriented health care.

Sometimes the question comes up of how PAs and nurse practitioners (NPs) are different. Baylor College of Medicine explains that the main difference is education. Both PAs and NPs have graduate-level education, usually a master’s degree. Nurse practitioners attend nursing school, where there’s an emphasis on the patient, including mental and emotional needs. PAs attend a medical school or medical center, where the focus is more on the pathology and biology of disease.

In some states, nurse practitioners are able to practice independently—meaning independent of physician delegation or supervision. Texas is not one of those states, though. In the Lone Star State, there are similar legal requirements in place for physician oversight of both PAs and NPs. For NPs, those rules come from the Texas Board of Nursing, while for PAs they’re issued by the Texas Medical Board.

Texas Medical Board Rules for PAs

Rule 185.10 sets forth two important points to bear in mind for all physician assistants working in Texas.

• PAs may only provide medical services that are delegated by a supervising physician.

• Even with proper physician delegation in place, PAs are only allowed to perform those medical services within his or her education, training, and experience.

Texas law places a clear responsibility on both the delegating/supervising physician and the physician assistant to assess and be familiar with the PA’s competence and experience before the PA provides medical services. Rule 185.14 requires the doctor and PA to share the responsibility of:

• Identifying the PAs scope of practice.

• Making sure that the only medical tasks delegated are appropriate to the PAs level of competence.

The next question that naturally follows is what level of physician supervision is required for PAs. Rule 185.14 explains that supervision “shall be continuous,” but that doesn’t mean it necessarily requires the constant physical presence of the supervising physician at a place where the PA is performing medical services.

Prescriptive agreements

Physician assistants aren’t allowed to prescribe or order drugs or devices with complete independence in Texas. Instead, Rule 185.30 requires a prescriptive authority agreement to be in place.

A prescriptive authority agreement is between the supervising/delegating physician and the PA, and allows a physician assistant to make prescription drug and medical device orders while the PA is acting under adequate physician supervision.

Rule 185.31 requires a prescriptive authority agreement to meet certain requirements, including:

• Being in writing and signed and dated by the parties to the agreement.

• Stating the nature of the practice, practice locations, or practice settings.

• Identifying the types or categories of drugs or devices that may and/or may not be prescribed by the PA.

• Describing a general plan for addressing consultation, referral, inpatient emergencies.

• Stating the general process for communication and sharing of information between the PA and physician.

• Scheduling periodic quality assurance and improvement activities, including chart review and at least monthly periodic meetings.

What you can do

When receiving medical care from a physician, nurse practitioner, or physician assistant, it’s based on the patient giving informed consent. It’s certainly within a patient’s rights to be adequately informed.

When considering physician assistant care, a patient may want to investigate or ask questions about:

• The PA’s specific training. Was the graduate training in person or online?

• What certification does the PA have? How many hours of advanced practice clinical training were required to obtain the certification?

• What physician signed off on the PA’s prescriptive authority agreement? What’s the background of that doctor?

If you’ve been seriously injured because of inadequate or poor care by a Texas PA, then contact a top-rated experience Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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