JAAPA Podcast: PAs in Legal Medicine – Part 2

Date: October 2, 2025
Host: JAAPA
Guests: Adam Broughton, Chris Knell, Amanda Mallory Spillman, Susan Ferrero
Theme: Malpractice Prevention, Risk Management, and the Legal Landscape for PAs

Episode Overview

This episode builds on Part 1, continuing the vital conversation about malpractice prevention and risk management for Physician Assistants (PAs). The hosts and a panel of seasoned PAs with expertise in both clinical and medico-legal realms unpack the complexities of legal medicine: from the evolving role of AI in documentation, to the nuances of state-specific law, to actionable strategies for patient communication and error disclosure. The focus is on practical risk reduction for PAs in diverse practice environments, with candid insights and advice from experienced practitioners.

Key Discussion Points & Insights

1. Embracing AI in Medical Documentation

(02:25 – 03:49)

• Chris Knell highlights the potential efficiencies AI offers, especially with ambient listening, but notes current limitations.
  • Importance of collaborating with risk management teams and ensuring informed consent from patients when using AI, due to privacy concerns (e.g., background noise capture).
  • Quote: "A lot of facilities are embracing it... it will help out for wellness. But make sure that we're aligned with those key areas of informed consent and risk management." – Chris (03:33)

2. State Laws, Scope of Practice & Credentialing

(03:49 – 10:47)

• Amanda Mallory Spillman: PA practice laws vary widely; understanding supervision requirements, hospital bylaws, and credentialing criteria is essential.
  • Example: The number of charts requiring physician co-signature may differ by state/hospital.
  • Quote: "Just understanding your, not only your state laws, but also your local laws, your hospital bylaws, there's really a lot that can go into it..." – Amanda (04:26)
• Susan Ferrero: State and facility regulations may change without notice; PAs are responsible for staying current.
  • Quote: "It's really your job to know what your scope is and make sure that you're staying in it, because that's your responsibility." – Susan (06:18)
• Adam Broughton emphasizes joining state PA organizations for updates and networking.
  • Quote: "...joining my state association... was excellent as far as just keeping up to date..." – Adam (06:52)
• Chris Knell: Hospital or system policies may conflict with state law; always clarify what is required at every level.
  • Quote: "It's up to us to know our supervisory and collaborative agreements... because it can come back and bite you." – Chris (08:15)
• Host/Group discussion: Credentialing and scope of practice may differ even within the same health system.

3. Communication as a Risk Reduction Tool

(10:47 – 16:24)

• Chris Knell: Emphasizes informed consent, plain language, read-back techniques, and ensuring patients know how/when to seek follow-up care.
  • Quote: "...if you are kind, you are compassionate, you are empathetic, you are a good communicator, patients are less apt to approach the provider in a malpractice lawsuit." – Chris (11:44)
• Amanda: Conducts discharge instructions in patient’s presence and documents everything discussed, including diagnosis, medication, and follow-up.
  • Quote: "...speak what you want them to do, but you also write it down as well. And then I would also document." – Amanda (12:38)
• Susan: Stresses use of certified interpreters and documentation at a patient-appropriate reading level.
  • Quote: "You want to make sure that you're explaining things in terms that they can understand." – Susan (13:38)
• Adam: Building rapport and welcoming follow-up; setting clear expectations.
  • Quote: "I try to make it seem like we're welcoming you back rather than like... we're done with you." – Adam (14:26)
• Chris: Importance of follow-up mechanisms and that attorneys focus on this aspect in litigation.

4. Delegation, Supervision, and Preventing Legal Exposure

(16:24 – 20:38)

• Chris: Delegation must align with state laws and specific agreements with collaborating/supervising physicians.
  • Advice for young PAs: Learn from experienced colleagues, and utilize resources from professional organizations.
  • Quote: "Just make sure what you are doing in clinical practice that aligns with who your supervising physician is on paper..." – Chris (17:08)
• Amanda: Encourage open communication—update supervising or collaborating physicians about challenging or complicated cases.
• Susan: Value of mentoring relationships; lack of support from supervisors can be a red flag for job fit.
  • Quote: "If you don't have that relationship and you don't have that support, it's probably not the right job." – Susan (20:01)
• Adam: Self-check: just because you are allowed to do something doesn’t always mean you should.

5. Handling Medical Errors & Disclosure

(20:38 – 25:18)

• Susan: Transparency and empathy are essential in disclosing errors; be aware of your state's apology laws.
  • Quote: "You should know your state's apology laws... so that if you are doing that, the last thing you want to do is... have it used against you in court." – Susan (21:10)
• Chris: Follow your healthcare system’s reporting process; don't act independently before consulting risk management/legal. Learn from process improvement models.
  • Quote: "...listen to the advice of your healthcare system." – Chris (22:37)
• Amanda: Avoid amending charts post-event; everything is timestamped and tracked. Only discuss with appropriate professionals.
• Susan: Even simply reopening a chart post-event can be misinterpreted during legal review. If necessary, make addendums clearly labeled and justified.
  • Quote: "It's tempting to open that chart again, but... if you have closed it... just leave it alone." – Susan (23:58)
• Adam: Document and report near-misses; they are vital for system-wide improvement and prevention of future errors.

6. Best Practices for Patient Handoffs

(26:01 – 32:34)

• Susan: Both parties should have undivided attention. Document handoffs clearly, specifying who assumed care. Always assess a patient yourself, even if handed off.
  • Quote: "If you're taking the patient, then you need to document that you're seeing the patient and you're dispoing them..." – Susan (27:18)
• Amanda: Ensure your documentation is complete before sign-out to facilitate the next provider’s ability to take over care safely.
• Chris: Use checklists like SBAR to structure sign-outs, especially when fatigued or covering high volume.
  • Quote: "The more tired I get... the more I need to lean on that and say, I really need to be systematic about this." – Chris (29:36)
• Susan: Applies handoff principles even in non-ER settings—good documentation allows for continuity regardless of who picks up the patient’s care in the future.
  • Quote: "That's essentially a good, I guess you'd call it like a ghost handoff." – Susan (30:51)
• Amanda: For incidental findings (e.g., on MRIs), communicate with appropriate specialists/PCPs and document those communications. Use reminders ("sticky notes") to verify high-stakes follow-ups.

Memorable Quotes

• "Just communicate and document. That's your best defense." – Amanda (33:25)
• "Don't be afraid to practice or even make a mistake... lean on your education and your experience." – Susan (33:40)
• "You can't practice medicine constantly thinking about getting sued... Do your best." – Adam (34:06)
• "Lean on your colleagues, lean on your supervising physician... and just be as kind as possible to every patient." – Chris (33:00)

Final Thoughts & Sage Advice

(32:34 – 34:35)

• Lean on experienced colleagues and mentors; seek guidance and build strong communication practices.
• Empathy, communication, and proper documentation are the pillars of risk reduction.
• Don’t practice medicine in constant fear—do your best and do what’s right for the patient.
• Maintain awareness but don’t let fear of litigation paralyze you.

Notable Segments & Timestamps

• [02:25] – AI in documentation: benefits, risks, and informed consent
• [04:00] – Importance of understanding state & facility-specific laws
• [10:47] – Actionable communication strategies for malpractice prevention
• [20:38] – How to handle disclosure of medical errors and apology laws
• [26:01] – Best practices for safe patient handoffs
• [32:34] – Summary advice: communication, documentation, and supportive practice

For more CME resources, visit: cme.aapa.org
Episode essentials: Stay updated, communicate clearly, document thoroughly, and don’t hesitate to seek help when needed—protection comes from proactive, compassionate practice.