Code of Massachusetts Regulations 263 CMR - BOARD OF REGISTRATION OF PHYSICIAN ASSISTANTS
263 CMR – Board of Registration of Physician Assistants
Authority:
Promulgated under Massachusetts General Laws Chapter 112, Sections 9F–9K, 263 CMR governs the licensure, practice, supervision, and discipline of physician assistants (PAs) in Massachusetts.
Purpose:
To regulate the profession, ensure public safety, and define professional standards for Physician Assistants in the Commonwealth.
1. Scope and Definitions (263 CMR 2.00)
Defines the term “Physician Assistant” as a licensed professional practicing medicine under supervision of a physician.
Establishes the Board’s authority to license, supervise, and discipline PAs.
Clarifies terminology, including “supervision,” “scope of practice,” “delegation,” and “competency.”
2. Licensure (263 CMR 3.00)
Requirements to become licensed:
Graduation from an accredited PA program.
Passing a nationally recognized certification exam.
Submission of background information.
Other provisions:
Temporary licenses for new graduates pending exam results.
License renewal procedures and continuing education requirements.
Consequences for lapses or failure to meet continuing education requirements.
3. Scope of Practice and Supervision (263 CMR 5.00)
Scope of Practice (263 CMR 5.03)
PAs may perform medical services within their training and under supervision.
Services may include: history-taking, physical exams, ordering tests, minor procedures, and emergency care.
Limitations:
Cannot administer general anesthesia independently.
Cannot perform major invasive procedures without explicit physician-approved protocols.
Must follow accepted medical standards and written delegation agreements.
Supervision Requirements (263 CMR 5.04)
All PA activities must be supervised by a licensed physician.
Physician must review patient care and treatment plans as required.
In emergencies, PAs may act until a physician is available.
Supervising physician assumes legal responsibility for PA actions.
Professional Responsibility (263 CMR 5.08–5.09)
PAs must use the PA title correctly and maintain licensure.
Must act within their scope, maintain confidentiality, and avoid sexual or abusive conduct with patients.
Required to report professional misconduct observed in others.
Board may sanction violations of professional standards or scope of practice.
4. Board Actions, Complaints, and Discipline (263 CMR 6.00)
Investigations and Complaints (263 CMR 6.01–6.02)
Complaints may be submitted by anyone.
Board investigates alleged violations of law or regulations.
Investigations can lead to formal complaints and hearings.
Grounds for Action (263 CMR 6.03)
The Board may discipline a PA for:
Practicing without a valid license.
Violating standards of conduct.
Practicing beyond authorized scope.
Providing false information to the Board.
Conduct harmful to public health or professional integrity.
Disciplinary Measures
Advisory letters, reprimands, probation, suspension, or revocation.
Summary suspension possible in emergencies to protect public health.
5. Case Law and Legal Context in Massachusetts
While there are relatively few published appellate decisions specifically interpreting 263 CMR for PAs, principles can be drawn from administrative law and malpractice cases:
Supervision and Liability:
Supervising physicians are legally responsible for the actions of PAs under their supervision.
If a PA acts beyond their scope, both the PA and supervising physician may be liable for malpractice.
Discipline:
Regulatory violations (e.g., practicing without a license, falsifying records, or breaching supervision rules) can trigger Board sanctions.
Massachusetts courts defer to administrative agencies’ reasonable interpretations of their regulations in disciplinary matters.
Professional Standards:
Standards of conduct in 263 CMR are often referenced in malpractice or administrative hearings to define the professional standard of care.
Example (Summarized from Public Records):
A PA practicing with an expired license was disciplined by the Board.
The case emphasized that maintaining a valid license and complying with supervision rules is a strict requirement.
Board actions typically range from reprimand to suspension depending on severity and harm.
6. Practical Takeaways for PAs
Always maintain current licensure and comply with continuing education requirements.
Practice within your authorized scope and under proper supervision.
Maintain professional conduct in all patient interactions.
Respond promptly to Board investigations or complaints.
Be aware that regulatory violations can result in disciplinary action or affect liability in malpractice suits.
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