House Healthcare panel weighs adding physician assistants to Patient Bill of Rights

The House Healthcare Committee on March 25 heard testimony on S163, a bill to amend the Vermont Patient Bill of Rights to add advanced practice providers as potential clinicians of record in hospitals, and witnesses urged lawmakers to include physician assistants (PAs) alongside advanced practice registered nurses (APRNs).

Matt Greenberg, chair of the Vermont Board of Medical Practice and an emergency physician, told the committee the Board had not yet taken a formal position on the measure but outlined how PAs are trained, licensed and supervised in Vermont. "The leap from physician to non-physician is probably a much bigger leap," Greenberg said, arguing that once that statutory change is made, it would be logical to treat physician assistants and APRNs similarly for inpatient responsibilities.

Lee Marsett, president of the PA Association and an emergency-medicine PA in rural Vermont, said PAs routinely perform examinations, order and interpret tests, prescribe medications and coordinate inpatient care. He told the committee that Act 123 of 2020 already allows PAs to function as admitting providers and clinician of record in practice, and that Vermont statutes and hospital bylaws should permit hospitals to credential PAs based on training and experience rather than exclude them by name. "The Vermont Patient Bill of Rights creates a barrier to this by specifying only physician can be designated as a clinician of record," Marsett said.

Leah Sky Peck, a critical-care physician assistant and ICU medical director at Rutland Regional Medical Center, described a 24/7 APP–physician hybrid model the hospital uses to maintain patient coverage and safety. Peck recounted overnight scenarios where APPs perform time-critical procedures and manage transfers, saying, "I am going to provide that patient with the same care" when intensivists are not immediately available. She emphasized that hospital credentialing and privileging committees vet applicants and should determine which providers may serve as clinician of record.

Committee members asked about practical details: Greenberg described Vermont's PA practice agreements and the requirement that a collaborating physician be available (not necessarily on-site), and witnesses noted that hospitals independently credential and privilege clinicians and that Joint Commission standards set baseline expectations. Members also raised billing questions and the recent Medicare coding changes that affect how APP services are reported.

A representative of the Vermont Medical Society reiterated a neutral position: the Society acknowledged the argument to align statute with day-to-day practice but flagged that the bill touches both the Patient Bill of Rights and hospital licensure statutes and may have patient-safety implications. The committee did not vote; chair closed the session and recessed to caucus while asking members whether additional testimony or information was needed.

The hearing centered on whether statutory language should be updated to reflect inpatient staffing realities and whether hospitals' credentialing processes provide adequate safeguards. The committee will consider further testimony and legal detail before moving forward.