Two Days Off-Site
A physical therapist is clinical director of a single-site Arizona clinic staffed by two physical therapist assistants, one unlicensed aide, and a front-desk coordinator. She is scheduled to attend a conference out of town for two days. Before she leaves, three requests land on her desk: (1) a PTA asks to complete the initial examination and set the plan of care for a new patient three weeks after total knee arthroplasty, because the patient "can't wait until Thursday"; (2) a PTA asks whether she can advance the resistance band in an established plan of care that reads "progress band resistance as tolerated"; (3) the aide asks to apply hot packs to two patients to keep the afternoon running on time. The office manager also offers to paste the PT's signature block into the daily notes while she is away.
1. Sort the four requests: what may be delegated to the PTA, what may go to the aide, and what must the PT do personally?
Read the worked answer
PTA - treatment, not the plan.
- Request (2) is delegable. The PTA may carry out and adjust interventions within an established plan of care and within the PTA's competence, and must report the change. Advancing resistance that the plan already authorizes "as tolerated" is treatment implementation, not a plan-of-care change.
- Request (1) is not delegable. The initial examination, clinical decision-making that establishes the diagnosis/problem list, the prognosis, and the plan of care are PT-only functions. A PTA cannot open the case. The correct answer to "the patient can't wait" is to reschedule, have another licensed PT cover, or have the PT do a limited telehealth/onsite session - not to hand the PTA the evaluation.
Aide - no treatment.
- Request (3) is not delegable. Applying a thermal agent to a patient is delivery of a physical therapy intervention, not a supportive task. Unlicensed aides may perform non-treatment support (transport, equipment setup/cleaning, clerical, scheduling) only.
Office manager - never.
- Pasting a signature is falsification of the record regardless of who does it. Notes are the treating therapist's attestation that the service occurred.
2. What supervision arrangements must the PT put in place before leaving, and how should she reason about the Board's supervision requirements?
Read the worked answer
Build the coverage first, then leave.
The Board's rules set the level of supervision owed to PTAs and the PT's continuing responsibility for the patients under her care. Rather than recite a number from memory, reason through the rule's components:
- Availability: Can the supervising PT be reached for consultation during all hours PTAs are treating her patients? If not, coverage by another licensed PT is required.
- On-site presence: Does the rule require periodic on-site observation or co-treatment for this patient population (post-surgical, complex)? If yes, the conference schedule must bend, not the rule.
- Documentation of supervision: Keep a record of who supervised whom, when, and how - the Board will ask.
- Competence and acuity: A three-week post-TKA is not a routine maintenance case; assigning it to a PTA without an established PT plan is both a rule problem and a safety problem.
Practical resolution: another licensed PT covers evaluations and discharges for the two days, the PTA continues established plans with documented access to a covering PT, and the aide sticks to setup and transport.
3. The office manager says "everyone does this" about the pasted signature. What is the actual exposure, and what should the PT do about past instances?
Read the worked answer
This is the most serious item in the scenario, not the most convenient.
- A note signed by someone who did not render or directly supervise the service is a false record. Depending on the facts, it implicates unprofessional conduct, falsification, and potentially insurance fraud if the note supports a billed claim.
- The exposure is individual (license) and institutional (clinic, billing), and "everyone does this" is not a defense - it is evidence of a pattern.
- Correct action now: refuse, remove the pasted blocks, and have the actual treating therapist document the services they provided.
- Then audit: identify notes already signed this way, determine whether any were billed, self-correct through the compliance/billing process, and document the corrective action. If the manager has done this previously without the PT's knowledge, that is a reportable compliance issue, not a paperwork preference.
- Consider whether the PT can continue in a supervisory role where the administrative structure directs falsification. Document the instruction and the PT's objection in writing.