Two Clinics, One Aide, and a New Patient
Dr. Alvarez is the only physical therapist at a clinic that also employs Mei, a physical therapist assistant with six years of experience, and Jordan, an unlicensed aide. On Tuesday, Alvarez is scheduled at a satellite clinic 25 minutes away from 8 a.m. until 1 p.m. Mei is scheduled to see four follow-up patients for gait training and therapeutic exercise. At 9:10 a.m., a new patient, Mr. Reyes, arrives with neck pain and numbness in both hands that began after a fall from a ladder. The front desk asks Mei to “start him” because Alvarez will not return until 1 p.m. Jordan is asked to apply a hot pack to Mr. Reyes’s neck while Mei finishes another patient. Mr. Reyes asks whether he can just keep coming for “a few weeks” without seeing the physical therapist again.
1. May Mei perform Mr. Reyes's initial evaluation and establish a plan of care? Explain the supervision and delegation limits that apply.
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No. Under Oregon law, a physical therapist assistant may provide physical therapy services only under the supervision of a physical therapist and may not perform initial evaluations, establish diagnoses or prognoses, develop or modify a plan of care, or make discharge decisions. Mei's six years of experience do not change the statutory scope. The initial visit for a new patient with neurological symptoms after trauma requires the physical therapist's clinical judgment. The physical therapist must personally evaluate, document, and establish the plan before delegating interventions. The fact that Alvarez is 25 minutes away also matters: the physical therapist must provide the required level of supervision and remains responsible for the patient. A schedule that leaves the assistant to “start” a new patient is not compliant. The correct step is to reschedule the new evaluation or have Alvarez return.
2. May Jordan, the aide, apply the hot pack? What tasks could Jordan lawfully perform in this situation?
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No. An unlicensed aide may not perform skilled physical therapy interventions. Applying a hot pack is not merely setup: it requires assessment of skin integrity, sensation, pain response, and the patient's reaction to the modality, and it is part of the plan of care. Jordan could perform non-skilled support tasks such as transporting the patient, preparing the treatment area, or retrieving equipment, but not applying the modality independently. Even if a physical therapist or physical therapist assistant is nearby, the aide's role is limited to non-clinical assistance. Letting the aide apply the hot pack would create both a delegation violation and a patient-safety risk, especially with reported numbness in both hands.
3. How should Alvarez respond to Mr. Reyes's request to continue for 'a few weeks' without seeing the physical therapist again?
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Alvarez must personally evaluate the patient before any plan is established and cannot allow a standing series of visits without physical therapist involvement. The physical therapist must reassess, document progress, and modify the plan as needed. More importantly, bilateral hand numbness after a ladder fall is a red flag for cervical spine or neurological involvement. Alvarez should screen for serious pathology and refer to an appropriate physician or emergency setting if indicated. Direct access does not permit the physical therapist to treat a condition outside the physical therapy scope or to skip medical evaluation when warning signs are present. The patient should be told that continuing without assessment is not safe, and the advice and any refusal should be documented.