What are the regulations regarding PAs (physician assistants) and writing prescriptions? Are these Federal regulations or vary by State?

They are allowed to prescribe medications. Limitations of what they can and can’t prescribe varies by state in the US although it seems that the limitations are primarily concerned with controlled drugs (i.e. Opiates etc).
The level of supervision the supervising doctor provides again varies by state but as far as I can see that wouldn’t mean they have to review every prescription.

My doctor has the two P.A. listed on his pre printed script pad with their names and registration number. I believe I have gotten Opiates from both the P.A.‘s and the MD.

My state does not allow PAs to prescribe controlled substances. The hospital I work in requires doctors to review the PAs notes and sign after them. Not all hospitals require this.

Varies by state. Laws are very similar to nurse practitioners. Some parts of the country seem to have more NP’s and some more PA’s. Probably has to do with the programs (schools) in the immediate area. I’m pretty sure there has to be an MD or DO I the practice. I don’t think a PA can just hang their own shingle. That might vary by state though. I’ve personally never seen a PA or NP have their own practice.

State by state. In some states the PA can sign his/her own scrip, in other states the PA needs to get an MD’s signature. In some states a PA can do a referral, on other states the referral needs to come from the MD.

This is to some degree based on the power power of the local medical association.

The educational, licensing, and practice standards vary significantly from state-to-state. In some places, PAs can work without a physician’s direct supervision, diagnosing conditions and prescribing medications. Elsewhere, the scope of practice is more restrictive.

I don’t care about or need any opiates but I’m still trying to figure out why the PA at the urgent care I went to last weekend refused to prescribe a simple anti emetic and told me I wouldn’t need it because the shot of Phenergan was sufficient.

Well obviously it wasn’t. It was sufficient for about 3–4 hrs and then I spent the next 12 hrs. Vomiting every 10–15 minutes all because he “thought” I wouldn’t need it or didn’t want to spend the two minutes to write a simple prescription. Needles to say, I’m furious.

By the time it was obvious the Phenergan wore off, the facility was closed. So I had another night of misery because of that jerk

PAs and all medical professionals are regulated by both state and federal laws. This can be seen in the pain clinic shutdowns in Florida over the past three years. The people who make the busts are usually feds, the indictments are both federal and state. Depending on the type of deals cut by their attorneys, the perps can be sent to federal or state time. In Florida, doing federal prison time is much preferable to doing state time. In a side note: Florida prisons are horrendous with horrible records of guards starving, torturing and killing inmates. Florida is also number one in privatized prisons. You do not want to do time there.

@Buttonstc I would be furious. My phobia is being nauseas and throwing up. When I had surgery I grilled the doctor before my surgery about drugging me for nausea.

What big deal would it have been for the doctor you saw to write a script for 3 pills? Jerk. He just never does it, so he didn’t do it. It’s especially terrible that you actually asked for it and see denied. A lot of people don’t know to ask. His only suffered is no one ever complains, so he is unaware what is happening to patients. I think you should write a letter. Your clear goal can be to give feedback to hopefully help other patients in the future.

@Buttonstc Phenergan is a simple anti-emetic. Your PA obviously determined that your symptoms were acute. Back in the day, he or she probably would have done more diagnostics to discover the root cause or your discomfort. Today, it is dependent upon the quality of your insurance, because if the diagnostics he or she performs is determined by the insurance company to be unnecessary, the PA has to pay out of pocket. And insurance companies will fight against paying even the most obviously necessary diagnostics on principle. The quality of American medicine, especially private practices and hospitals, is determined by MBAs, not doctors. So, against the old ethic, it makes them cautious to do make these diagnostics which were once routine. Shitty, huh? It’s one of the reasons I will no longer work in the profession in the US.

Nowadays, it is incumbent upon you to inform the PA that your symptoms have not abated. My guess is that he or she would prescribe Phenergan in it’s pill form (Promethazine), or some other anti-emetic. He or she should, upon your further complaint, call you in for further diagnostics. It’s the world we live in now. You are expected to—without proper knowledge of medicine—to be proactive in your own medical care. You are on your own, pal.

This was an urgent care place so I wasn’t expecting a full workup necessarily. Just simple relief from constant vomiting.

And this was right in the very beginning so assuming it was viral stomach flu was reasonable.

What was not reasonable imho was his refusal of a written prescription because it would have cost him nothing other than a few extra minutes. It cost me 12 more hours of abject misery.

Once I get some extra energy back I am going to call and speak to whomever runs this place and give them a piece of my mind.

I went to my own family practice doc the next day. But in the future I’m going to the ER (which is only about 5 mins away)

The only reason I didn’t this time is because I’ve never managed to get out of that ER in less than the typical 3–4 hours, even when I was the only patient there and only needed a fairly simple diagnostic test to rule out DVT.

But at least that ER is generally staffed by reasonably competent people.

I’m pretty sure they wouldn’t have any qualms about writing for a simple anti emetic in addition to the phenergan shot. And I likely wouldn’t have even had to ask.

Good luck on that. The last time I was in an American ER, I went in for an emergency urinary catheter change. The procedure itself took only 15 minutes max. performed by a $40/hour RN after a one minute consult with the doc. I got a bill for $4,700 and change. If they would have written me a prescription for Foley Cath outfit, which costs about $50 retail at any medical supply, I could have done it myself. They refused even though I was a licensed RN at the time and had done this on other people hundreds of times.

That is pretty damn outrageous, especially considering that you’re an RN.

@Buttonstc Did you have a stomach flu? What exactly were you sick with? I never go to the doctor for a stomach flu.