3 Colo. Code Regs. § 712-1.11
Current through Register Vol. 47, No. 22, November 25, 2024
Section 3 CCR 712-1.11 - [Effective until 12/30/2023] [Effective 1/6/2024] SUPERVISION OF AND PRACTICE BY PHYSICIAN ASSISTANTS (PAs)This Rule is promulgated pursuant to sections 12-20-204, 12-290-106(1)(a), and 12-290-117(1) and (2), C.R.S. This rule governs the licensure and conduct of licensed physician assistants and not persons performing delegated podiatric tasks pursuant to section 12-290-116(6)(c), C.R.S.
A. REQUIREMENTS In order to engage in practice as a physician assistant under the personal and responsible direction of a licensed podiatrist pursuant to the provisions of section 12-290-117, C.R.S., a physician assistant must hold a current license to practice issued by the Colorado Medical Board.
B. EXTENT AND MANNER IN WHICH A PA MAY PERFORM DELEGATED TASKS CONSTITUTING THE PRACTICE OF PODIATRY UNDER PERSONAL AND RESPONSIBLE DIRECTION AND SUPERVISION 1. Mandatory standards to be applied in the direction and supervision of (PAs): a. Direction and supervision of PAs must be personally rendered by a licensed podiatrist practicing in the State of Colorado and not through intermediaries.b. The licensed podiatrist is responsible for the performance of delegated podiatric services by PAs. That responsibility requires that the licensed podiatrist assure that those delegated services are performed with a degree of care and skill that would be expected of the licensed podiatrist. The licensed podiatrist is accountable legally for the performance of such supervised persons operating under the podiatrist's direction and supervision.c. The licensed podiatrist must provide direction to PAs in order to specify what podiatric services should be provided under the circumstances of each case. ... The licensed podiatrist shall provide appropriate directions and confirm such directions are reasonably understood by the supervised person.d. The licensed podiatrist must provide adequate supervision of the performance of delegated podiatric services. Supervision is intended to assure that the directions given are carried out properly. Supervision may include constant over-the-shoulder inspection of the performance of the podiatric services, after-the-fact review through viewing the patient or his chart or conferring with the PA rendering the delegated podiatric services. In determining whether such supervision is adequate, under the circumstances of each case, the licensed podiatrist and the Board shall consider the following factors: (i) the complexity of the task, (ii) the risk to the patient, (iii) the background, training and skill of the person performing the podiatric services, (iv) the adequacy of the direction in terms of its form, (i.e., written or oral) and its specificity, (v) the setting in which the podiatric services are performed (e.g., office, hospital, nursing home, rural clinic or other remote sites), (vi) the availability of the licensed responsible podiatrist or other licensed podiatrists, and (vii) the necessity for immediate attention. Thus, depending on the circumstances of each case, the degree of supervision necessary may vary within the above constraints. It should be noted, however, there is a presumption that the supervising podiatrist shall routinely be present at the location where the PA practices. In circumstances where on-site supervision is not provided, the burden shall be on the podiatrist or the PA or both to establish that the lack of such supervision was reasonable under the circumstances. Specific exemption from this presumption is made for facilities operated by the State Departments of Institutions and Corrections.2. Identification of PAs: The licensed podiatrist, as part of his supervisory duties, must assure that the PA under his or her supervision (i) is identified as a non-physician to his or her patients by wearing an identification plate upon his or her person setting forth his or her name and non-abbreviated title, and (ii) is not advertised or represented in any manner which would mislead his or her patients or the public generally.
C. PRESCRIPTION AND DISPENSING OF DRUGS 2. A licensed physician assistant may issue a prescription order: a. The supervising podiatrist has issued written protocols which may be prescribed by the PA on both a case-by-case and per patient visit basis. For purposes of this rule, "written protocol on a case-by-case basis" means instructions for prescribing by a PA for a new patient or a returning patient who presents new, different or additional signs or symptoms from those previously diagnosed and treated. For purposes of this rule, "written protocol on a per patient visit basis" means instructions for prescribing or refilling a prescription by a PA when a patient returns with recurrent signs or symptoms which have been previously diagnosed; and b. The order is written, not verbal; and c. Each and every prescription and refill order is entered on the patient's chart; and d. Each written prescription order is on the supervising podiatrist's prescription order form and signed by the PA and contains in printed form the name, address and telephone number of the supervising podiatrist and the name of the PA.3. All drugs dispensed or administered by PAs to third parties shall be prepackaged in a unit-of-use package by the supervising podiatrist, or by a pharmacist acting on the written order of the supervising podiatrist, and shall be labeled to show the name of the supervising podiatrist and the PA.4. PA's shall not write or sign prescriptions or perform any services which the supervising podiatrist is not qualified or authorized to prescribe or perform.5. No drug which a PA is authorized to prescribe, dispense, administer or deliver shall be obtained by said PA from a source other than a supervising podiatrist, pharmacist, or pharmaceutical representative.D. REPORTING REQUIREMENTS Each licensed supervising podiatrist shall file with the Board information required on the forms provided by the Board within thirty days of the employment of such PA, and shall notify the Board of the termination of employment of any such supervised persons previously registered within seven days of such termination. The filing of such information shall not be deemed as an approval by the Board of the job descriptions of such supervised persons or the adequacy of their direction and supervision by the licensed podiatrist. However, such information will be maintained by the Board for the purposes of (i) investigating complaints against licensed podiatrists supervising such PAs and (ii) maintaining a registry of the licensed podiatrists and PAs.
E. DISCIPLINE Physician assistants are subject to the disciplinary procedures set forth in section 12-240-125, C.R.S., of the Medical Practice Act.
42 CR 14, July 25, 2019, effective 8/14/201945 CR 13, July 10, 2022, effective 7/30/202245 CR 22, November 25, 2022, effective 10/26/202245 CR 23, December 10, 2022, effective 11/11/202246 CR 02, January 25, 2022, effective 1/9/202346 CR 01, January 10, 2023, effective 1/30/202346 CR 19, October 10, 2023, effective 9/8/2023 exp. 1/6/2024 (Emergency)