Review Article

Improving Mental Health Services Through Physician Assistants: Legislation in Several Southern States

Authors: Matthew Buchbinder, JD, Judith Regan, MD, JD, Mirela Aldea, PhD, Denise Makowski, PsyD


A national effort to provide more expansive mental health care in the United States has been an increasing priority during the last decade. States have enacted laws that allow for the delegation of psychiatric services to physician assistants in an effort to address the shortage and geographic maldistribution of mental health services and to more efficiently use the skills of psychiatrists. This statutory scheme recognizing physician assistants has been effective in broadening access to mental health care in various southern states. It also has, however, imposed certain risks and responsibilities upon psychiatrists who choose to supervise physician assistants. Understanding the regulatory responsibilities imposed upon supervising psychiatrists and anticipating the risks associated with supervising a physician assistant are important in avoiding grave financial consequences and the difficulties associated with litigation. Here, we review the statutory responsibilities imposed upon the psychiatrists supervising physician assistants across various southern states and to discuss the risk of vicarious liability of the psychiatrists for the actions of the physician assistants.

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1. Nguyen T. Parity of disparity: the state of mental health in America. Published November 2014. Accessed January 13, 2017.
2. Cooper RA. New directions for nurse practitioners and physician assistants in the era of physician shortages. Acad Med 2007;82:827-828.
3. Sharma TR, Nicely MD. Physician assistants in mental health. South Med J 2011;104:87-88.
4. American Academy of Physician Assistants. Specialty practice: physician assistants in psychiatry. Published January 2010. Accessed January 22, 2017.
5. Pollack DA, Ford SM. Is there a role for physician assistants in community mental health? Community Ment Health J 1998;34:209-217.
6. Gore CL. A physician’ liability for mistakes of a physician assistant. J Leg Med 2000;21:125-142.
7. Moses RE, Feld AD. Physician liability for medical errors of nonphysician clinicians: nurse practitioners and physician assistants. Am J Gastroenterol 2007;102:6-9.
8. Cox v M.A. Primary & Urgent Care Clinic , 313 S.W.3d 240 (Tenn 2010).
9. Ala Code § 34-24-292(b).
10. Ark Code Ann § 17-105-107(b).
11. Ky Rev Stat Ann § 311.858(2).
12. Miss Code R § 30-026-2615(1.1).
13. Miss Code R § 30-026-2615(1.7).
14. Ark Code R § 060.00.001-24(9).
15. Ga Comp R & Regs 360-5-.11(7).
16. Ky Rev Stat Ann § 311.854(5).
17. Ky Rev Stat Ann § 311.856(9).
18. Ky Rev Stat Ann § 311.840(6).
19. Ky Rev Stat Ann § 311.860(4).
20. Ky Rev Stat Ann § 311.860(2).
21. Ky Rev Stat Ann § 311.856(10).
22. Ky Rev Stat Ann § 311.856(11).
23. Ky Rev Stat Ann § 311.856(1).
24. Ky Rev Stat Ann § 311.856(8).
25. Ky Rev Stat Ann § 311.856(2).
26. Ky Rev Stat Ann § 311.856(3-5).
27. Ky Rev Stat Ann § 311.856(12).
28. Ky Rev Stat Ann § 311.858(7).
29. Ky Rev Stat Ann § 311.856(7).
30. Ark Code Ann § 17-105-101(3).
31. Ark Code Ann § 17-105-109(a).
32. Ark Code R § 060.00.001-24(6).
33. Ark Code Ann § 17-105-116.
34. Ark Code R § 060.00.001-24(8)(B).
35. Ga Code Ann § 43-34-103(b)(1).
36. Ga Comp R & Regs 360-5-.05(4).
37. Ga Code Ann § 43-34-103(b)(2).
38. Ga Comp R & Regs 360-5-.05(5).
39. Ga Code Ann § 43-34-103(b)(2)(A).
40. Ga Comp R & Regs 360-5-.05(5)(a).
41. Ga Code Ann § 43-34-103(b)(2)(B).
42. Ga Comp R & Regs 360-5-.05(5)(b).
43. Ga Code Ann § 43-34-103(d).
44. Ga Comp R & Regs 360-5-.11(1).
45. Ga Comp R & Regs 360-5-.11(3).
46. Ga Comp R & Regs 360-5-.11(2).
47. Ga Code Ann § 43-34-103(b)(3).
48. Ga Comp R & Regs 360-5-.03(3)(b)(1).
49. Ga Comp R & Regs 360-5-.03(3)(b)(2).
50. Ga Comp R & Regs 360-5-.03(9).
51. Ga Comp R & Regs 360-5-.11(5).
52. Ga Code Ann § 43-34-106.
53. Ga Comp R & Regs 360-5-.11(6).
54. Ala Admin Code r 540-X-7-.26(2).
55. Ala Admin Code r 540-X-7-.23(2).
56. Ala Admin Code r 540-X-7-.53(5) (applying this rule to the supervision of anesthesiology assistants).
57. Ala Admin Code r 540-X-7-.23(1).
58. Ala Admin Code r 540-X-7-.25(1).
59. Ala Admin Code r 540-X-7-.53(1) (applying this requirement to the supervision of anesthesiology assistants).
60. Ala Admin Code r 540-X-7-.55(1) (applying this requirement to the supervision of anesthesiology assistants).
61. Ala Admin Code r 540-X-7-.23(3).
62. Ala Admin Code r 540-X-7-.23(4).
63. Ala Admin Code r 540-X-7-.23(6).
64. Ala Admin Code r 540-X-7-.23(8).
65. Ala Admin Code r 540-X-7-.24(1).
66. Ala Admin Code r 540-X-7-.54(1) (applying rule to anesthesiology assistants).
67. Ala Admin Code r 540-X-7-.24(2).
68. Ala Admin Code r 540-X-7-.54(2) (applying rule to anesthesiology assistants).
69. Ala Admin Code r 540-X-7-.20.
70. Ala Admin Code r 540-X-7-.50 (applying notification requirement to anesthesiology assistants).
71. Miss Code R § 30-026-2615(1.8).
72. Miss. Code Ann. § 73-26-3(6).
73. Miss Code R § 30-026-2615(1.9).
74. Miss Code R § 30-026-2615(1.12).