Rules & Regulations of the State of Tennessee Title 1130 - Board of Physician Assistants
I. Legal Authority and Purpose of Title 1130
Title 1130 is promulgated under the authority of:
Tenn. Code Ann. §§ 63-19-101 et seq. (Physician Assistants Act)
The Uniform Administrative Procedures Act (UAPA)
Purpose
The rules exist to:
Protect public health and safety
Regulate licensure, scope of practice, and discipline of physician assistants (PAs)
Ensure physician supervision and accountability
Provide due process to licensees
Courts consistently hold that professional licensing boards act in a quasi-judicial capacity and must strictly follow their enabling statutes and rules.
II. Organization of Title 1130
Title 1130 is divided into several major regulatory chapters:
General Provisions
Licensure Requirements
Scope of Practice & Supervision
Prescriptive Authority
Professional Conduct & Discipline
Administrative Procedures
Each section has been repeatedly upheld as a valid exercise of the State’s police power when reasonably related to public safety.
III. General Provisions (Definitions & Authority)
What the Rules Do
Define key terms such as physician assistant, supervising physician, collaborative practice, and delegated medical acts
Establish the Board’s authority to interpret and enforce rules
Case Law Interpretation
Tennessee courts apply strict statutory construction to licensing rules.
Key principle:
A licensing board has no authority beyond what the statute and rules expressly grant.
Relevant case law principle:
Martin v. Sizemore (Tenn. 2004) – Administrative agencies may not expand their authority by interpretation.
Effect on PAs:
If a PA is disciplined for conduct not clearly prohibited by statute or rule, courts may reverse the Board’s action.
IV. Licensure Requirements
Core Requirements
Graduation from an accredited PA program
Passage of the PANCE
Criminal background check
Ongoing compliance with renewal and CME requirements
Board Discretion
The Board may:
Deny licensure for fraud or misrepresentation
Impose conditions on licensure
Require additional proof of competency
Case Law
Tennessee courts hold that:
Licensure is a property interest
Denial or revocation requires procedural due process
Relevant case law principle:
Richardson v. Tennessee Board of Dentistry – Professional licenses cannot be denied without notice and an opportunity to be heard.
V. Scope of Practice & Physician Supervision
Core Rule
A PA may only perform:
Medical services delegated by the supervising physician
Acts within the PA’s education, training, and experience
Supervision:
Does not require constant physical presence
Must be continuous and documented
Common Violations
Practicing beyond delegated authority
Inadequate supervision agreements
Independent diagnosis or treatment without delegation
Case Law
Tennessee courts defer to boards on medical judgment but not on legal interpretation.
Relevant principle:
Jackson Mobilphone Co. v. Tennessee Public Service Commission – Courts defer to agency expertise only when acting within statutory limits.
Effect on PAs:
Boards may define clinical boundaries, but cannot invent new supervision requirements not found in statute or rule.
VI. Prescriptive Authority
Regulatory Requirements
Separate prescriptive authority registration
Compliance with controlled substance schedules
Physician-approved formulary or protocol
Adherence to state and federal controlled substance laws
Disciplinary Risk Areas
Prescribing without authority
Exceeding schedule limitations
Failure to document physician oversight
Case Law
Courts uphold strict regulation of prescribing due to public safety concerns.
Relevant principle:
Cooper v. Tennessee Board of Medical Examiners (administrative law principle applied across health boards) – The state may impose heightened controls on prescribing without violating due process.
VII. Professional Conduct & Discipline
Grounds for Discipline
Unprofessional conduct
Incompetence or negligence
Fraud or misrepresentation
Substance abuse
Criminal convictions related to practice
Available Sanctions
Reprimand
Civil penalties
Probation
Suspension or revocation
Due Process Requirements
The Board must provide:
Notice of charges
Opportunity for a hearing
Findings of fact and conclusions of law
Case Law
Key Tennessee rule:
Discipline must be supported by substantial and material evidence.
Relevant cases:
City of Memphis v. Civil Service Commission – Agencies must base discipline on evidence, not speculation.
Humana of Tennessee v. Tennessee Health Facilities Commission – Arbitrary or capricious decisions are reversible.
VIII. Administrative Hearings & Appeals
Governing Law
Tennessee Uniform Administrative Procedures Act
Standard of Judicial Review
Courts may reverse Board decisions if:
The Board exceeded its authority
The decision violated constitutional rights
The decision was arbitrary or capricious
Findings lacked substantial evidence
Case Law
CF Industries v. Tennessee Public Service Commission – Courts do not reweigh evidence but ensure lawful decision-making.
McEwen v. Tennessee Department of Safety – Failure to follow procedural rules invalidates agency action.
IX. Practical Legal Takeaways for Physician Assistants
Title 1130 has the force of law
The Board has broad power—but not unlimited power
Licensure and prescribing are protected property interests
Discipline must follow due process and evidence standards
Courts will intervene when boards exceed statutory authority
X. Summary
Title 1130 creates a regulated but protected professional framework for physician assistants in Tennessee. Courts generally support the Board’s role in protecting public safety but strictly enforce:
Statutory limits
Due process rights
Evidentiary standards
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