291 Physician Assistant Scope of Practice 2015
or functions at the direction and under the supervision of physicians.40 Additionally, the services that the PA provided had to be within the field or
fields for which the PA had been trained, approved, and registered by the
North Carolina Board.41
At the close of 1972, PA legislation had been enacted in twenty-four
states and contemplated in fifteen additional states.42 The remaining eleven
state legislatures had yet to examine any PA measures.43 The bills at that
time typically took one of two distinct forms: delegatory—those that merely altered the state medical practice act and allowed PAs to provide care
with physician supervision, or regulatory—those that authorized a particular regulatory agency, typically the state board of medical examiners, to
promulgate rules and regulations regarding the academic and employment
qualifications of PAs.44 The sole exception to these approaches was Colorado, which incorporated both types of provisions.45 Colorado’s regulatory
statute delineated specified conditions for PAs employed by physicians who
worked chiefly in pediatrics, and at the time, the statute was the only PA
law to institute licensure requirements.46 Proponents lauded general delegatory statutes for their flexibility because they facilitated the utilization of
PAs for a wide variety of tasks.47 Those supporting delegatory legislation
opined that the statutes ensured optimal patient safety by holding the physician liable for any and all PA wrongdoings.48 This absolute and significant
threat was more than enough motivation for a physician to invariably hire
competent PAs, provide sufficient supervision, and assure adequate patient
safeguards.49 However, these types of laws did have some disadvantages.50
For instance, the laws lacked formal identification or acknowledgement of
the PA profession, and the absence of provisions for approving PA educational programs was starkly evident.51 The latter facet was objectionable because it ran afoul of patient safety concerns and gave physicians vast discretion to employ and delegate a plethora of medical duties to anyone,
40. Id. § 90-18(14)(a)(b).
41. Id. § 90-18(14)(c).
42. Winston J. Dean, State Legislation for Physician’s Assistants: A Review and Analysis, 88 HEALTH SERV. REP. 3, 3 (1973), available at http://www.ncbi.nlm.nih.gov/pmc
/articles/PMC1616054/pdf/healthservrep00027-0005.pdf Legislation considered in the 15
other states was ultimately rejected.
44. Id. at 3, 6.
45. Id. at 6.
46. Id. Colorado’s statute is commonly known as the Child Health Associate Law.