South Carolina Law Allows Physician Assistants to Refer Patients to Hospice

South Carolina Gov. Henry McMaster (R), has signed legislation expanding the scope of practice for physician assistants in that state, including granting them authority to refer patients to hospice. The law will become effective Aug. 11.

The new law also streamlines the licensure process to ensure that trained physician assistants can get to work more quickly, reducing the amount of time that elapses between temporary and permanent licensure, and expediting board review required for some specialties. This is designed to help South Carolina health care providers remain competitive with neighbors Georgia and North Carolina as they vie for potential employees.

“We had to make sure that the scope of practice mirrored what is really going on now in South Carolina and probably in a lot of other areas,” State Sen. Brad Hutto, (D-Orangeburg) told Hospice News. “We don’t have doctors in rural communities anymore. The need is clearly there, and physician assistants are trained to perform functions that in the past were done by doctors, so we needed to make sure they wouldn’t run into roadblocks due to scope of practice.”


Hospice providers nationwide are facing widespread staff shortages across all disciplines. Legislators on the state and federal levels have been working to find solutions. The U.S. Congress is currently considering bills that would expand palliative care and hospice medical education and expand access to these services in rural areas.

The United States has 13.35 hospice and palliative care specialists for every 100,000 adults 65 and older, research shows. By 2040 the patient population will need 10,640 to 24,000 specialists; supply is expected to range between 8,100 and 19,000 nationwide. This is in addition to staff shortages in other disciplines such as nursing and social work.

“There is definitely a shortage in hospice and palliative care,” Hutto said. “South Carolina is a growing state, and it’s a big retiree state. A lot of people move here in their later years, so we are going to have a growing need no matter what, just as a matter of population growth.”


In addition to hospice and palliative care referrals, the legislation allows physician assistants in South Carolina to pronounce death, certify the manner and cause of death, sign death certificates, execute a do-not-resuscitate order, prescribe Schedule 2 narcotic medications, and sign certain documents on behalf of the supervising physician.

“This is becoming more and more important as we develop palliative care overall. We have a number of groups working on this in our state,” Hutto told Hospice News. “We encourage all medical professions to be aware of palliative care, how do we refer to palliative and hospice care, and make sure that people have access to these services.”