Physician Assistant License Defense in Massachusetts

A complaint against a physician assistant often turns on someone else’s decisions: a supervising physician who wasn’t available, a practice that set up prescribing guidelines poorly, an employer that put you in a role the rules don’t allow. The Board still holds you accountable for your own judgment. You generally have 21 days from the day you receive the Board’s request to respond in writing. Call (978) 273-8337 before you do.

A lawyer who has worked inside the hospital care team.

I’ve been a registered respiratory therapist since 2005 and a registered nurse since 2010. As a respiratory therapist I spent many years at the bedside providing hands-on respiratory care. As a nurse I’ve worked in critical care and the intensive care unit of an acute care hospital, and I’ve held management roles in that setting. I’ve worked inside an acute care team where orders, protocols and supervision decide who may do what, which helps me show the Board where your responsibility began and ended.

— Richard Alan Gaudet, JD, RN, RRT

Who regulates physician assistants in Massachusetts

The Massachusetts Board of Registration of Physician Assistants licenses PAs under G.L. c. 112, §§ 9E through 9J. Its complaint and discipline procedures are in 263 CMR 6.00, and its rules on scope of practice, supervision, prescribing and standards of conduct are in 263 CMR 5.00.

A PA matter often involves two boards. Your supervising physician is licensed by the Board of Registration in Medicine, and the same event can lead to complaints before both. Board staff and investigators handle complaints, a prosecuting counsel brings formal charges, and an administrative hearings counsel usually presides at hearings.

The supervision and prescribing rules behind most PA complaints

Many PA complaints come down to whether the rules in 263 CMR 5.00 were followed, by you, by your supervising physician, or by the practice:

Rule	What it requires
Supervision (5.04(1))	All of a PA’s professional activities must be supervised by a physician with an unrestricted Massachusetts license. The physician doesn’t need to be physically present every time.
Decision-making (5.04(2))	A PA may not replace a licensed physician as the principal medical decision-maker.
Disclosure (5.04(3)(b), (c))	Except in life-threatening emergencies, tell each patient you are a PA working under a physician’s supervision, and wear a name tag that says so.
Coverage (5.04(3)(g))	When the supervising physician is unavailable, another physician must be designated, and that designation must be readily found in the practice’s records.
Prescribing guidelines (5.06(4))	Prescribe under written guidelines developed and agreed on with your supervising physician, covering drug classes, quantities, refills and review frequency.
Schedule II (5.06(3))	Every Schedule II prescription must be reviewed by the supervising physician within 96 hours.
Billing (5.05)	A PA doesn’t bill separately; services are billed as the supervising physician’s.
Staffing (5.08(2))	A facility may not use a PA as the sole medical professional in charge of a service where no physician is regularly available.

The practice or facility that employs you is legally responsible for your acts (5.08). But that doesn’t shield your license: before the Board, you remain responsible and accountable for your own judgment, actions and competency (5.09(6)).

Other common grounds for complaints

The grounds for Board action are listed in 263 CMR 6.03. Besides the supervision and prescribing rules, the most common are:

Standard of care, including missed diagnoses and inadequate follow-up: PAs must practice in line with accepted standards of medical practice (5.04(3)(a)), and conduct likely to harm the public is a ground for action (6.03(1)(w))
Scope of practice and competency: taking on duties beyond your scope or your training (6.03(1)(h); 5.09(4), (5))
Documentation: incomplete, inaccurate, altered or destroyed records (6.03(1)(r); 5.09(7)–(9))
Controlled substances: violating G.L. c. 94C or the Drug Control Program rules (6.03(1)(a), (g))
Impairment or unlawful drug use (6.03(1)(u), (v))
Criminal convictions (6.03(1)(s))
Misrepresenting credentials or practicing under a different name (5.09(1)–(3))
Discipline in another state for similar conduct (6.03(1)(q))

The 21-day deadline for your written response

If the Board asks for your response, it is due within 21 days of the day you receive the request, and you must sign it yourself (263 CMR 6.02(2)). Failing to respond without cause is itself a ground for discipline (6.03(1)(p)). The Board can treat a letter as received when it’s delivered to your address of record, or when delivery was attempted if you moved without updating it.

Gather your prescribing guidelines, the supervision and coverage records, and the chart before you write. A PA’s response is often strongest when it shows exactly what the supervising physician reviewed and approved.

The investigation, and how a matter can end early

Staff may request documents and gather information from the practice, the supervising physician and others (6.02(1)). Before a formal complaint is opened, the Board can close the investigation (6.02(3)). After one is opened, it can still dismiss the complaint for lack of jurisdiction or insufficient evidence, or because the conduct, even if proven, doesn’t warrant action (6.04(1)). Closure or dismissal may come with an advisory letter, which is not discipline but is a public record.

Summary suspension

The Board, or its Chair between meetings, can suspend a license before any hearing if affidavits or documents show your continued practice is a serious, or an immediate and serious, threat to public health, safety or welfare (263 CMR 6.05). In a “serious threat” case you get three business days to file opposing evidence first. A post-suspension hearing must be held within seven business days. Call a lawyer the same day you receive an order.

When your supervising physician is involved

Supervision problems usually have two sides. The supervising physician may face a parallel complaint before the Board of Registration in Medicine, and the practice may have its own lawyer. Their interests and yours may not match: a physician may say they were never consulted, while you say the guidelines allowed what you did. Have your own lawyer, keep your own copies of guidelines and coverage designations, and be careful about joint statements.

Consent agreements

Most formal complaints that aren’t dismissed end in a consent agreement (263 CMR 6.04(4)). It can include any action the Board could order after a hearing, an agreement to stop practicing, or other terms such as education, practice monitoring, prescribing limits, or a revised supervision arrangement. Consent agreements are public records (6.04(6)). The terms, and the description of the facts, are negotiable before you sign.

Permanent surrender

You can offer to permanently surrender your license to resolve a complaint (6.04(3)). An accepted surrender counts as discipline, and the Board may treat the allegations as true. Don’t offer one without advice.

The Order to Show Cause and the hearing

If the matter doesn’t settle, prosecuting counsel can issue an Order to Show Cause requiring you to show why the Board should not act against your license (6.04(2)). From then on it is a formal adjudicatory proceeding under G.L. c. 30A and 801 CMR 1.01, with a written answer due within 21 days of receipt unless a statute or Board rule says otherwise (801 CMR 1.01(6)(d)(2)). Both sides present evidence and witnesses, and an administrative hearings counsel usually presides.

Possible outcomes

After a hearing, if the Board finds a 6.03 ground exists, it can order:

Outcome	Is it discipline?	Can you practice?
Stayed probation	No	Yes, with temporary conditions
Reprimand	Yes, a formal public rebuke	Yes, with no conditions
Probation	Yes	Yes, with temporary conditions
Suspension	Yes	No, for a set period or until conditions are met
Revocation	Yes	No

An order can set conditions you must meet before asking to lift restrictions or reinstate your license, and the Board may impose a fine where the law allows (6.04(7)). Any action also applies to your right to renew (6.04(5)).

Appealing a Board decision

If the Board suspends or revokes your license after a hearing, you can generally petition the Supreme Judicial Court for review under G.L. c. 112, § 64. The court reviews the hearing record and doesn’t retry the case, so the record built at the hearing is what any appeal depends on.

What I do at each stage

Before you respond: review the complaint, the chart, your prescribing guidelines and the supervision and coverage records, and identify where responsibility actually lay.
The response: draft a 21-day response that explains your clinical reasoning and documents what your supervising physician reviewed and approved.
Two-board matters: coordinate your defense with any parallel Board of Medicine complaint against the physician, while protecting your own interests.
Negotiation: negotiate consent agreement terms, including prescribing limits, monitoring or a new supervision arrangement, and the wording of what becomes public.
Summary suspension and hearings: prepare evidence and witnesses, and build the record for any appeal.
Afterward: guide you through probation conditions, employer and credentialing disclosures, and petitions to lift restrictions.

What to do when the Board’s letter arrives

Write down the date you received it, and count 21 days.
Get copies of your written prescribing guidelines and any supervision or coverage designations now, before access changes.
Don’t agree to a joint response with the practice or your supervising physician until you’ve talked with your own lawyer.
Don’t change, add to or “complete” any record.
Don’t contact the patient or family about the complaint.
Tell your lawyer about any related employer investigation, malpractice claim, criminal charge, or out-of-state matter.

Facing a Physician Assistants Board complaint?

Call or text (978) 273-8337, or send a message. I represent physician assistants across Massachusetts, in person at my Middleton office or by video.

Frequently asked questions

How long do I have to respond to the Board of Physician Assistants? Generally 21 days from the day you receive the Board’s request, under 263 CMR 6.02(2). You must sign the response yourself, and failing to respond without cause is a separate ground for discipline.

My employer is legally responsible for my work. Does that protect my license? No. The employing physician or facility is legally responsible for a PA’s acts, but before the Board you remain responsible and accountable for your own judgments, actions and competency (263 CMR 5.08 and 5.09(6)).

How quickly must a Schedule II prescription be reviewed? A PA’s Schedule II prescription must be reviewed by the supervising physician, or a designated temporary supervising physician, within 96 hours after it is issued (263 CMR 5.06(3)).

Do I have to tell patients I’m a physician assistant? Yes. Except in life-threatening emergencies, you must tell each patient that you are a PA working under a licensed physician’s supervision, and wear a name tag identifying you as a PA (263 CMR 5.04(3)(b) and (c)).

Is an advisory letter discipline? No. An advisory letter makes no finding and is not a formal Board action against your license, but it is a public record.