The Ohio State Medical Board recently issued a statement on the ability of physician assistants (“PA”) to order the restraint and seclusion of patients. The statement is helpful given that both the Medicare Conditions of Participation (“COPs”) and The Joint Commission rules on restraint/seclusion rely heavily on what is permitted by state law.
The Medical Board’s statement reiterates that while a PA is a dependent practitioner, not a licensed independent practitioner (“LIP”), PAs practicing in a health care facility (including a hospital) may provide the services as designated in the facility’s PA policies (with a few statutory exceptions), unless restricted by the PA’s supervising physician. Thus, under these circumstances, Ohio law would permit PAs to order restraint/seclusion in a health care facility.
The Hospital COPs generally require that restraint/seclusion be ordered by a LIP. However, in statements accompanying the most recent revisions to the COPs on this issue, the Centers for Medicare and Medicaid Services (“CMS”) stated that the COPs are not to be construed “to limit the authority of a physician to delegate tasks to other qualified healthcare personnel, that is, physician assistants and advanced practice nurses, to the extent recognized under State law or a State’s regulatory mechanism, and hospital policy.” In July 2007, the Ohio Department of Health and Ohio Hospital Association received a clarification from CMS agreeing that this meant that PAs in Ohio, who are not LIPs, could be delegated the authority to order restraint/seclusion if permitted by state law and hospital policy. Thus, a PA can order restraint/seclusion in a health care facility pursuant to both the COPs and Ohio law if the facility has PA policies permitting such services and if so authorized by the PA’s supervising physician.
While the Medical Board statement does not address APNs, please note that the CMS clarification applied to both PAs and APNs. An APN also could order restraint/seclusion if such tasks were authorized in the APN’s standard care agreement.
Finally, note that while the Medical Board statement does not reference accreditation standards, The Joint Commission also requires that restraint/seclusion be ordered by a LIP. For most purposes PAs and APNs in Ohio would not meet The Joint Commission’s definition of LIP. However, in a footnote in the Patient Care Standards, The Joint Commission states, similar to the COPs, that PAs and APNs can be "delegated" the ability to order restraint/seclusion as an LIP if permitted by state law.
Accordingly, because Ohio law permits PAs (pursuant to health care facility policies and supervising physician authority) and APNs (pursuant to a standard care arrangement) to be delegated the task of ordering restraint/seclusion, such activity is consistent with both the COPs and The Joint Commission standards.