The California Court of Appeal has ruled that a physician assistant’s practice arrangement attenuated his required physician supervision so as to amount to the unauthorized practice of medicine.

Kenneth S. Bradley, MD, treats patients with chronic pain from conditions such as cancer, surgeries, and degenerative disk disease and has referral relationships with about 30 HMOs in the Los Angeles area. Most of his patients receive medical insurance through Medicare or Medi-Cal, according to the facts set out in the recent appellate opinion, Bradley v. CVS Pharmacy, Inc.

While surgical mishaps and other acute events can provide a clear set of facts to determine whether a plaintiff waited too long to file a suit, undiagnosed conditions continue to challenge California’s courts in determining how do deal with a healthcare provider’s defense based on the statute of limitations.

Nothing good can result when important information sent between a patient’s care providers is delayed. Including the patient in the communication process is not only the right thing to do, it can also help prevent an adverse event.

Though physicians may expect that staff will assist in properly instructing a patient on preparing for a procedure, the physician will still be responsible for those instructions having been carried out.