Healthcare Licensing Board discusses PA autonomy, upcoming FSMB visit

The Healthcare Professionals Licensing Board had a rather healthy discussion on proposed amendments to physician assistant regulations, particularly the issue of independent practice, during its board meeting last Dec. 17 at its office building on Capitol Hill.

Board chair Theodor R. Parker and vice chair Dr. Martin P. Rohringer led a discussion on recommendations submitted by physician assistants seeking greater autonomy. Rohringer criticized proposed language on “collaborative providers” and “optimal practice agreements,” arguing that such terms are legally meaningless and could obscure accountability in malpractice or regulatory cases.

“This whole language about optimum practice and collaborative providers is really just political nonsense. If you drill down on it, the collaborative provider really doesn't mean anything. It's supposed to appease people who say, ‘What, there's no supervision? There's nothing.’ No, there's a collaborative provider, which really has no authority whatsoever over the person. It's a name. And the optimum practice agreement is also just a name. Legally, they mean nothing, and I certainly don't want to sign off on nonsense,” said Rohringer.

He then presented alternative draft language that would allow the board discretion to grant independent practice status to qualified PAs, while keeping others under the existing supervised model.

Under the proposal, the board would evaluate experience, prescribing patterns, and supervisor feedback, with the authority to revoke independent status if concerns arise. Parker and board member Dr. Angelica Sabino acknowledged this would effectively create two tiers of PAs—independent and supervised—requiring clear designation and regulatory language.

No action was taken, as members agreed to allow more time for review and to solicit input from absent board members, including Dr. Glenda S. George and Dr. Tiffany L. Willis, as well as legal counsel Robert Glass.

“I would say I'd prefer just to let this lie and let—and make sure that we have Dr. Willis and Dr. George's comments come in. So that we can make sure that everyone's involved. And then we can kind of move forward with that. I don't think we should do anything today,” said Parker.

The board also received administrative updates on an upcoming visit by officials from the Federation of State Medical Boards, scheduled for early January. The delegation will meet with the governor, hospital leadership, and the board, and discussions will include logistics, scheduling, and participation in FSMB meetings focused on trauma-informed regulation and licensure issues.

Board director Esther Fleming reported on coordination efforts for the visit and on travel concerns related to FSMB meetings, emphasizing the challenges of long-distance travel for island-based board members.

In other business, Fleming said the board is exploring the possibility of securing investigative support through an agreement with the Attorney General’s Office, potentially funded by increased licensing fees, to handle complaints more efficiently.

The board also discussed the possibility of streamlining enforcement by issuing notices of violation for minor infractions rather than requiring full hearings in every case, with legal guidance to be addressed in executive session.