Problem
Dr. Allison Jones and Emily Johnson have a practice in Jerrold, which is located in south St. Louis County. Both Drs. Jones and Johnson are board-certified internists with a rather broad family practice. They would like to expand their practice to Jackson County, a primarily rural area about seventy miles south of Jerrold. They are especially interested in Tesson, a town of approximately 6,000 that is centrally located among the four or five small towns in the area. They are interested in Tesson because it has a small community hospital and is located close to the interstate highway. They also believe the town is underserved by physicians. There is no pediatrician in Tesson, although there is one thirty miles away. The town has one internist. It has no obstetricians, although Joan Mayo, a certified nurse midwife, has an office in a small town about eighteen miles distant from Tesson.
Ms. Mayo has been providing childbirth, family planning, and other women's health services. She has an agreement with an obstetrician in Jerrold through which protocols and standing orders for her practice were established and are maintained. She can consult with this OB by phone at any time, and they make it a practice to meet once a month to discuss Ms. Mayo's patients. Ms. Mayo refers patients who require special services to this OB or to the internist in Tesson. Ms. Mayo has clinical privileges for childbirth services at the community hospital, although her patients must be admitted by the internist.
Mariah Ellis works as a physician assistant in the Jones/Johnson office in Jerrold. She is not separately licensed, but the doctors are impressed with her handling of routine patients. In most cases, Ms. Ellis examines the patient, decides on a course of treatment, and prescribed medication using blank prescription slips that are signed by the doctors. In more difficult cases, she asks for advice from one of the doctors. There is a high patient satisfaction with her work.
Drs. Jones and Jonson would like to open an office in Tesson and employ a physician assistant and a pediatric nurse practitioner to staff the office full-time. Either Dr. Jones or Dr. Jonson would have office hours at that office once a week. They are also interested in establishing an affiliation with Ms. Mayo because they see room for growth in that area. They hope to serve the needs of Tesson by establishing active obstetrical and pediatric practices working with the pediatric nurse practitioner and Ms. Mayo.
For their Tesson office, they would like to find a physician assistant with extensive experience in trauma so that the assistant could care for the high incidence of farming and hunting injuries expected in that area. This PA, then, would complement the doctors' own skills because the doctors have had little experience with such injuries.
Task
Dr. Jones and Jonson have come to you for advice concerning their plans for a new Tesson office. They have many questions, including whether their plans are consistent with the laws regulating practice in Allstate. Specify how they might comply with the law while maintaining a lower cost practice. If for some reason the Board decides to take action against them, what is the likelihood of the physicians' success in challenging the Board's action?