Latest news with #PhysicianAssistants
The Independent
16-07-2025
- Health
- The Independent
Physician associates should ‘never be used to replace doctors'
Patient safety will be at the forefront of changes to the roles of NHS physician associates (PAs), who should 'never be used to replace doctors', the Health Secretary has said. Wes Streeting pledged to implement in full the findings of a review which said PAs must not diagnose patients when they come into A&E or GP practices and must be renamed as 'physician assistants'. Mr Streeting ordered the review into PAs and anaesthesia associates (AAs) after concerns were raised over whether they were safe and the impact on the training of junior doctors. The review, chaired by Professor Gillian Leng, who is president of the Royal Society of Medicine, made 18 recommendations. Mr Streeting said: ' Patients should always know who they are being treated by and should always receive appropriate care. 'Legitimate concerns about patient safety have been ignored for too long – that's why I sought out the very best clinical advice to review physician associates and anaesthesia associates' roles in the NHS. 'We're accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we've got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so. 'Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.' Prof Leng's review suggested a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training. More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number. But a general lack of support for both roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led to the review. Presenting her findings, Prof Leng said: 'Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients. 'If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.' She said more detail was needed on which patients can be seen by PAs and national clinical protocols will now be developed in this area. She added: 'Let's be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.' Newly qualified PAs will also now work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts. The study said safety concerns in relation to PAs were 'almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms'. It added: 'It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important. 'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.' Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, 'the easy option in some cases was simply to fill gaps in medical rotas with PAs', the report went on. When it comes to the safety of PAs and AAs, Prof Leng said the 'evidence is poor', with 'no compelling evidence' in published research 'that PAs were safe to work as doctor substitutes in primary care'. Prof Leng concluded there were 'no convincing reasons to abolish the roles of AA or PA' but there is also no case 'for continuing with the roles unchanged'. She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also should have the opportunity to become an 'advanced' PA or AA. Six patient deaths linked to contact with PAs have been recorded by coroners in England. One high-profile death involved Emily Chesterton, 30, who died from a pulmonary embolism. She was misdiagnosed by a PA on two occasions and told she had anxiety. NHS England has written to NHS trusts setting out the new changes, saying PAs currently working in primary care, emergency departments or any other setting must not triage patients or see undifferentiated patients without a diagnosis.
Yahoo
16-07-2025
- Health
- Yahoo
Physician associates should ‘never be used to replace doctors'
Patient safety will be at the forefront of changes to the roles of NHS physician associates (PAs), who should 'never be used to replace doctors', the Health Secretary has said. Wes Streeting pledged to implement in full the findings of a review which said PAs must not diagnose patients when they come into A&E or GP practices and must be renamed as 'physician assistants'. Mr Streeting ordered the review into PAs and anaesthesia associates (AAs) after concerns were raised over whether they were safe and the impact on the training of junior doctors. The review, chaired by Professor Gillian Leng, who is president of the Royal Society of Medicine, made 18 recommendations. Mr Streeting said: 'Patients should always know who they are being treated by and should always receive appropriate care. 'Legitimate concerns about patient safety have been ignored for too long – that's why I sought out the very best clinical advice to review physician associates and anaesthesia associates' roles in the NHS. 'We're accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we've got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so. 'Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.' Prof Leng's review suggested a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training. More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number. But a general lack of support for both roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led to the review. Presenting her findings, Prof Leng said: 'Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients. 'If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.' She said more detail was needed on which patients can be seen by PAs and national clinical protocols will now be developed in this area. She added: 'Let's be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.' Newly qualified PAs will also now work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts. The study said safety concerns in relation to PAs were 'almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms'. It added: 'It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important. 'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.' Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, 'the easy option in some cases was simply to fill gaps in medical rotas with PAs', the report went on. When it comes to the safety of PAs and AAs, Prof Leng said the 'evidence is poor', with 'no compelling evidence' in published research 'that PAs were safe to work as doctor substitutes in primary care'. Prof Leng concluded there were 'no convincing reasons to abolish the roles of AA or PA' but there is also no case 'for continuing with the roles unchanged'. She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also should have the opportunity to become an 'advanced' PA or AA. Six patient deaths linked to contact with PAs have been recorded by coroners in England. One high-profile death involved Emily Chesterton, 30, who died from a pulmonary embolism. She was misdiagnosed by a PA on two occasions and told she had anxiety. NHS England has written to NHS trusts setting out the new changes, saying PAs currently working in primary care, emergency departments or any other setting must not triage patients or see undifferentiated patients without a diagnosis.
Yahoo
06-05-2025
- Health
- Yahoo
Board suspends license of physician assistant charged with sexual assault
Bluebell Road Health Plaza in Cedar Falls. (Photo via Google Earth) The Iowa Board of Physician Assistants has suspended the license of a practitioner who is currently facing multiple criminal charges alleging he sexually assaulted female patients. Late last year, the board issued an emergency order suspending the license of James Haag, who was practicing occupational medicine at MercyOne's Bluebell Road Family Medicine in Cedar Falls. As part of his work there, Haag performed job-related physicals for individuals who worked at a local business. The board alleges that in July 2024, Haag examined four patients for purposes of their employment. In each case, the patients were allegedly instructed to disrobe and Haag conducted the initial portion of the exams without the presence of a nurse or other observer. During the course of each examination, the board alleges, Haag removed each patient's robe and 'made physical contact' with the patients' genitals. In some instances, the board alleges, he used his hands, while in others he 'pressed his fully clothed pelvic area into the patient's genitals or backside.' The board alleges Haag also made 'inappropriate contact with multiple patients' breasts' during the course of their examinations. 'In multiple instances, where the patients attempted to cover themselves, (Haag) swatted their hands away,' the board alleges. Haag was charged by the board with knowingly engaging in unethical conduct or a practice harmful or detrimental to the public, and with willful or repeated violations of state regulations. In issuing its emergency order, the board cited Haag's 'predatory actions towards his patients (that) constitute a threat to public health.' In its order, the board alleged Haag 'sexually assaulted multiple patients in his care' and that he posed 'an immediate danger to the public health, safety and welfare.' Earlier this year, Haag was criminally charged in connection with the alleged assaults. He is currently facing two counts of sexual abuse, two counts of assault with intent to commit sexual abuse, and three counts of simple assault. Haag has pleaded not guilty, and a trial is scheduled for Sept. 30, 2025. When a board investigator asked Haag about the allegations, the board says, Haag replied with one word: 'Lies.' He denied all of the allegations, including touching the women's breasts, pushing their hands away when they tried to hold their gowns closed or retie their gowns, and touching the women's vaginal area. Board records indicate it is MercyOne's policy that clinic patients disrobe and wear a gown during employment physicals, but are allowed to wear bras, underwear and socks underneath the gown. Board: 'Haag used his position of power' At a February hearing on the licensing board charges, Haag testified that he always requests a chaperone be in the room during a female hernia exam for his own 'protection' since the procedure involves touching a woman's lower pelvic area. Board records indicate that after one employee of Cedar Stone Senior Living in Cedar Falls had an employment physical performed by Haag, she called a colleague in tears, stating that she believed she had been sexually assaulted. The colleague also received an employment physical from Haag and later told a co-worker that she, too, felt she had been sexually assaulted. Eventually, two Cedar Falls police officers spoke to the women. Cedar Stone Senior Living then asked all of its employees to report whether they had experienced anything unusual during their exams. Two additional women came forward, saying they felt uncomfortable or violated during their physicals by Haag. Hearing testimony indicated that while a chaperone entered the room during the four women's physicals, it was typically after Haag had already performed the portion of the exam that was most concerning to the women. The board concluded that the four women were credible and consistent in their allegations. As for Haag, the board said that 'by his own admission, Haag spent several minutes alone in an exam room with female patients' prior to requesting a chaperone's presence. 'It is not lost on the board that Haag's meticulous documentation of a chaperone's presence is in stark contrast to his careless documentation of a medical exam itself,' the board noted in its ruling. 'Haag testified about his careless approach to documenting a physical, stating that he at times checks a box on a medical form indicating that he has performed a certain part of a medical exam even though he has not. Haag also received low marks on performance evaluations for his documentation practices. On the other hand, Haag was meticulous about obtaining chaperone signatures on his medical forms, even writing the word 'chaperone' next to a signature if the chaperone forgot to write it herself.' Having determined that Haag had inappropriately touched the four patients, the board concluded Haag's conduct was unethical and warranted a three-year suspension of his license. 'Haag used his position of power as a medical professional to inappropriately touch vulnerable female patients, patients that were required to undergo a physical in order to maintain employment,' the board stated in its ruling. Prior to any reinstatement of his physician assistant's license, Haag will have to undergo a clinical competence assessment at the Center of Personalized Education for Professionals.
