Avoiding the PA Disciplinary Review Process: Important Work, Part 3 of 3

by Katherine A. Adamson, PA-C, MMS, MA

This article is the final installment in a three-part series on the National Commission on the Certification of Physician Assistants’ (NCCPA) enforcement of the Code of Conduct for Certified and Certifying PAs. In the first, I outlined the organization’s disciplinary review process, providing background on the disciplinary policy’s development and how cases are handled. In my second column, I shared insights into the two most common triggers of the disciplinary review process: (1) the diversion and self-administration of Controlled Dangerous Substances and (2) other abuses of prescribing privileges.

Certified PAs, by and large, are very well-meaning, professional, stand-up providers who provide excellent care and make a positive difference in the lives of patients throughout the United States (and even beyond). Some of the few who wind up the subject of an NCCPA disciplinary review case knowingly made bad decisions that landed them there and others were more hapless victims that stumbled into trouble without “knowing better.” We have been working for several years to better inform PAs about the behaviors that can get them into trouble in hopes of keeping them out of that kind of professional jeopardy.

Beyond the abuse of controlled substances and the prescription pad, a number of other issues can result in a PA facing a disciplinary sanction from NCCPA (which, as I’ve mentioned in my previous articles, usually follows discipline by the state licensing board).

Falsification of Credentials: For most PAs, maintaining certification is required, if not by the state, then by employers or entities that pay for the services we provide. That makes maintenance of certification a high-stakes proposition. That said, it’s important to keep it in perspective: losing certification can cost a job, but pretending to be certified when you’re not can cost your career. If you’re not certified, never say or imply that you are or let your employer or anyone else say or imply that you are. These cases can lead to permanent revocation of eligibility for certification. NCCPA has to pursue these aggressively to protect the integrity of the PA-C credential for all who have truly earned it and all who rely upon it.

NCCPA Background Questions

1. During the period between November 17, 2002 and today’s date, have you been denied a license, or has any state board or other governmental agency taken any disciplinary action (as described above) against your license to practice as a Physician Assistant or as any other health-care provider?

2. During the period between November 17, 2002 and today’s date, have you been convicted of, or entered a plea of guilty, nolo contendere, or no contest to, a crime in any jurisdiction (including under the Uniform Code of Military Justice and/or any international jurisdiction) other than a minor traffic offense? Include all misdemeanors and felonies, even if the court withheld adjudication so that you would not have a record of conviction. Any convictions for driving under the influence or while impaired should be reported here.

3. During the period between November 17, 2002 and today’s date, have you been adjudicated as mentally incompetent by a court or other government entity?

Exam Misconduct: Almost a decade ago, NCCPA uncovered a group of graduates who had shared or received questions recounted by someone who had already taken PANCE. Through that investigation, we uncovered an astonishing truth: many of those involved didn’t realize they weren’t supposed to talk about the content of NCCPA’s exams. In response, NCCPA took several steps to make that message impossible to miss in the exam registration process and at the testing center. Also, with the NCCPA Foundation, we developed Exploring Ethics, a video and discussion guide that brings that issue and others to life for PA students. Today, it would be difficult to credibly claim that you shared information about our exams without understanding the consequences of doing so. We take this very seriously, and so should all PAs. If you didn’t realize sharing information about exam content was verboten, start reading the policies and statements you acknowledge when you register for NCCPA exams.

Boundary Issues: These cases can get pretty salacious, and thankfully they are few and far between. We all know that getting personally involved with a patient is a big no-no. When I talk to PA audiences about these issues, my advice is if you wish to pursue a personal relationship with a patient, terminate the professional relationship first and then wait. Then when you think you’ve waited long enough, wait some more. And to be on the safe side, check with your state licensing board to be sure you have waited long enough. Occasionally we will see a case that does not involve two adults in a healthy, consensual relationship; as you can imagine, those types of boundary violations are career-ending.

Gross Negligence: PAs are human, and like other humans, we do sometimes make mistakes. When medical errors result from gross negligence, however, they can trigger disciplinary sanctions. NCCPA’s allegiance is to the public, and the public’s interest is the standard we have to weigh in these and all disciplinary review cases. If you’re being asked to do things in your practice that you do not feel qualified to do, you must take a stand. If you’re being asked to work beyond the point of exhaustion, you must refuse. Your patients’ health and your career could hang in the balance.

Felonious Activity: Health care fraud and other felonious activity is serious business. But then we all know that. Enough said.

Answering NCCPA’s Background Questions

Every PA seeking initial certification or fulfilling requirements to maintain it will answer three background questions posed by NCCPA. (See box at right.) Read them carefully, and only respond affirmatively regarding incidents that occurred after or were not resolved by November 17, 2002 (the date the disciplinary policy went into effect). New graduates only need to respond affirmatively regarding incidents that occurred after or were not resolved before matriculation into their PA program. And after you’ve reported an incident to NCCPA once, you don’t have to keep reporting the same incident again and again. We need to look into it only one time. Most importantly, be honest. If you’re not sure how to answer a question, call NCCPA, and ask. Remember that state licensing boards and NCCPA are happy to objectively evaluate your story, but they are unlikely to forget or forgive an effort to cover-up the situation.

If you’ve read all three articles in this series, hopefully you’re better informed and more impressed by the effort NCCPA puts into protecting the integrity of the PA-C credential that tens of thousands of PAs have worked so hard to obtain and to maintain. And if you ever see a PA colleague about to make a mistake that could put him or her on the wrong side of a disciplinary review case, please intervene. It could save a career.

Katherine Adamson, PA-C, MMS, MA serves as medical consultant to NCCPA and as an adviser to the Appeals and Review Staff and the NCCPA Review Panel. A healthcare professional since 1973, Ms. Adamson retired from the US Air Force with the rank of lieutenant colonel in 2008.