Existing legislation calls for the work of PAs to be supervised by a qualified physician, but the law has been interpreted in a non-hospital setting to mean that the supervising physician does not have to be on site, as long as he or she could be consulted at any time. Spinner says that several months ago Public Health Commissioner Robert Galvin said he would begin requiring doctors to be on site to supervise PAs directly in all settings, including clinics.

So Spinner testified recently at a legislative hearing in favor of a bill that would, he said, “correct ambiguous language in the practice act concerning physician assistants."

The bill adds a whole section on supervision of PAs in non-hospital settings, and removes the language requiring a physician to be “in the specific location in which the physician assistant is practicing," from that section of the bill. The bill passed the House on April 20, and must be voted on by the Senate by this Wednesday when the session ends, or it's dead for this year.

“If we need a doctor on site," says Spinner, “many of our satellite clinics could not operate. He testified to “the lack of available physicians willing to work in urban settings." And, he added, even if doctors could be found, “our costs would go up substantially, and we would be no longer have the funds or the capacity to serve our current volume of patients."

The Hill Health Center provided over 160,000 patient visits in the past year at 19 sites in New Haven, Derby, Ansonia, and West Haven. PAs. provide care in the Hill's out-patient clinics, in-patient detoxification facility, mental health clinics, and substance abuse treatment programs. They also provide medical care in homeless shelters and soup kitchens.
Katrina Clark, executive director of the Fair Haven Community Health Center, also supports the bill. “We have a PA who staffs one of our school-based health centers," she said, “and if on site supervision were a requirement, it would really jeopardize the care that we could provide to students at the school." She says the center runs another small site for the elderly that doesn't currently use a PA, but could, and a stricter interpretation of the law would also be a problem there. “At some of the smaller satellites, that also serve very disadvantaged folks, I think it would be a real detriment."

Commissioner Galvin could not be reached, but department spokesman Bill Gerrish said, “Part of our job as regulators is to make sure practitioners are appropriately supervised." He added that Galvin “is not opposed to the legislation that passed the House."
Senate Majority Leader Martin Looney (D-New Haven), said on Sunday that he supports the bill, but it's up to the Senate chair of the Public Health Committee to bring it to the floor â€" something he said he would encourage. But he added that since leaders of the General Assembly and Gov. Jodi Rell reached a tentative agreement on the budget over the weekend, legislators now must spend more of the three days remaining in the session working to pass the budget bill and the budget implementation bill. “That leaves less time to take up the 50 or 60 non-budget bills still on the Senate calendar," he said. But he wouldn't rule out passage of the bill that would allow PAs to do their work as they have been for the past few decades.