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SAINT ALPHONSUS REGIONAL MEDICAL CENTER 1055 NORTH CURTIS ROAD BOISE, ID 83706 April 9, 2018
VIOLATION: EMERGENCY SERVICES POLICIES Tag No: A1104
Based on staff interview, review of IDAPA state rules, and review of hospital documents, it was determined the hospital failed to ensure physicians (MDs and DOs) provided supervision of PAs, who provided care to patients in the ED, as described in their Delegation of Services Agreement. This deficient practice had the potential to directly impact the care of all patients receiving treatment in the ED. Findings include:

IDAPA 22.01.03.029.03 includes the delegation of service agreement between the PA and Supervising Physician. It states:

"03. Delegation of Services Agreement. Each licensed physician assistant and graduate physician assistant shall maintain a current copy of a Delegation of Services (DOS) Agreement between the licensee and each of his supervising physicians...(3-16-04)."

The delegation of services agreement for 4 of the 10 PAs who work in the ED was requested. The hospital provided documents titled "Delegation of Services Agreement" for each of the 4 PAs. Under the section titled "MEDICAL SERVICES REVIEW" the documents stated, " ... a daily review of Physician Assistant's care and prescribing practice will occur due to the usual customary interaction by the Physician Assistant and physician during working hours. A sampling of not less than ten patients' medical records per month are reviewed by the supervising physician on an ongoing basis."

Documentation of the medical record reviews for the 4 PAs was requested. The hospital provided documentation the Supervising Physicians completed 10 medical record reviews per quarter for each PA. The supervising physicians did not complete reviews of 10 medical records per month as required by the delegation of services agreements.

A Supervising Physician for PAs was interviewed on 4/09/18 beginning at 3:10 PM. He stated he was the Physician Liaison to the PAs, which included responsibility for education, evaluation, and reviewing of the PAs' charts. When asked how many and how often he reviewed medical records of the PAs he supervised, he stated he reviewed a total of 10 records per quarter for each PA.

The ED Medical Director was interviewed on 4/09/18 beginning at 5:14 PM. When asked how many PAs he supervised he stated he thought it was 3. When asked which PAs he supervised, he stated he would have to look because there had been recent changes. He also stated that medical record reviews were delegated to the Physician Liaison and he would look at the charts if a concern or issue was identified by the Physician Liaison.

The Supervising Physicians did not provide oversight to the PAs in the ED as required by the hospitals delegation of services agreement.