HISTORY OF SCAPA

Foreword

I agreed to write this after having my heart broken at the SCAPA annual meeting in 2005. The very hard working president, C.J. Parris, was looking for volunteers to write the history. "Who," he asked, "for example, is Elizabeth Gouge and why do we have a scholarship named for her?" This is dedicated to the memory of my friend, and fellow SCAPA volunteer, Elizabeth Gouge.
Cecilia Cannon, September 2006

I. The Earliest Years

SCAPA was organized in 1976 and chartered by the AAPA in 1977.   The PA profession was a very new concept.  The first national AAPA conference had just been held in 1973 in San Antonio, Texas.   SCAPA was a direct outgrowth of the first group of PA s to be trained in South Carolina.  The first PA program in the state was a Med-Ex non-degree program from 1973-1975 at MUSC-Charleston.   The program in 1976 became formally accredited as a PA certificate program.  Its funding was linked to a federal grant.   The first PAs in the state were charting new territories.  They banded together in SCAPA to promote the profession and to achieve legal recognition and certification.  The first meetings were held in a conference room at a Holiday Inn in Clemson, SC, recounts long time SCAPA member and advocate, Buck Harvey.  "We had a set of by-laws and officers.  Often, drug reps would help sponsor the meetings.  We didn’t have too many for CME, the main concern was legislative."

The earliest days of SCAPA were a time of many challenges. A group of faculty and students worked hard to try to implement legislation that would allow the vision of the PA concept to flourish in South Carolina. With the shining light of Duke just to the north, surely South Carolina would follow their lead.  Some of the earliest leaders included Gene O’Conner, Sean Irvin, Brenda Sprinkle, Henry Ramirez, Al Curtis and Buck Harvey.  (Of note, Brenda Sprinkle was a SCAPA president in both the 1970’s and the 1990’s.)

Such was not to be the case. This was a time of trial and tribulations for PA s in South Carolina. The days seemed like one step forward and two steps back. Restrictive legislation mandated by the State Board of Medical Examiners ((SBME) was implemented in 1976.  To give an illustration of how restrictive, consider Opinion No. 77-254, 5 pp.) by Assistant Attorney General A. Camden Lewis, written August 12, 1977: ...Based on the board of medical examiners application for a PA certificate (Regulation No. 1.7 ...."), the Attorney General concluded that a PA is legally prohibited from writing patient care orders. 

There were no prescriptive privileges and PAs worked under a regulatory law.  PA privileges were regulated by the SBME, not delegated to supervising physicians as in other states.

Also, the very first South Carolina Pas were required to take an exam on the "Medical Practice Act" regarding the PA laws in South Carolina.  In 1975 and 1976 this also covered scientific and clinical subjects; the failure rate was 31%.  When the test was changed to cover only the medical practice act, the pass rate zoomed to 93% in l978 and 1979.

Originally, there was no representation on the State Board of Medical Examiners for PAs.  The SCAPA president would make presentations at SBME meetings by invitation only at their meetings  3 times a year.  
 
 An early leader of SCAPA was Gene O’Conner. Gene relentlessly pushed for better legislation. He faced a completely uphill, and often adversarial, battle with the State Board of Medical Examiners.  In April 1980, as president of SCAPA, Gene requested to testify before the "Sunset Review of the Board of Medical Examiners."  This was a legislative audit every six years that reviewed every aspect of the board of medical examiners.

Gene passionately requested that state laws be amended to allow for better utilization of PA s in our state.  His requests were turned down.

In the mid-1980’s, SCAPA was in shambles. The PA program had closed in 1983 due to lack of federal funding and SCAPA’s assets were kept in a cardboard box. Gene O’Conner handed the box over to a young rising PA, Mike Taylor, and told him, "You young people better take over or this organization is going to die."

II The Vision of Mike Taylor, the 1980s

Mike Taylor was a visionary. He had a dream of revitalizing SCAPA and growing the profession in the state. By 1985, there were only  about 30 PAs total in the state. At the time of this writing in 2006, there are over 500.

Mike had three ideas for the success of SCAPA: 1. the need for representation on the medical board as a way to more favorable legislation 2. the need for an annual SCAPA CME program. 3.  the need for a newsletter.  These were the goals that he set.  Meetings were moved to Columbia, SC as a more central location. 

When the Sunset Review met again in 1986, a goal of SCAPA was to have a more cordial relationship with the SBME.   In 1986, the SC PA law was amended to require the SBME to appoint a PA representative as a nonvoting member of the SBME. SCAPA voted to recommend that the SCAPA president be designated as the PA representative.  This was a critical juncture and gave a face to SCAPA on the medical board and credible representation.  This was the result of tireless effort by Mike Taylor, Keith Stewart, Keith Didyoung, Buck Harvey and others.

Becky Miller (Charleston area) stepped forward and started organizing an annual CME program. The first one was in 1988 in Charleston.  This was before everyone had personal computers and the Internet and was quite time consuming. This was also before the ease of cell phones.  There were a group of less than 10 that made up SCAPA workers. Of that 10, everyone reached out to whoever they knew who would be willing to sponsor a speaker, moderate a lecture, work at sending out registration material, handle the registration, have AAPA sanction the CMEs offered, and on and on. At the earliest SCAPA conferences, lots of arm-twisting had to take place to get volunteers to assure the program would run and continue for the next year.  Speakers often noted how exhausted Becky looked at the event. 

With the advent of the CME program, SCAPA had to have funds and manage funds. Elizabeth Gouge(Aiken) volunteered to be the treasurer. With her husband Tony, they implemented an accounting system for SCAPA and insisted on annual audits by someone from outside SCAPA. They were also responsible for SCAPA monies from dues, donations, and newsletter awards.

Elizabeth lost a battle to a brain tumor and died in May 1996. However, she left her mark on the organization with the financial tools she implemented

The early newsletter was edited by Cecilia Cannon (Spartanburg). Cecilia was responsible for writing and editing the newsletter, typing up a copy, having it printed, then printing labels and applying them on the newsletters. The first SCAPA newsletters were written in 1988 on a quarterly basis.   The newsletters had to be sorted and prepared for bulk mailing and then taken to the post office in Spartanburg. Her children have memories of the mass production in the den of the newsletter--one child would fold the newsletters, another would staple it, and then mom would put the labels on. A big expenditure for SCAPA was purchasing an electric stapler to speed up this process. The newsletter was mailed to all the PAs in South Carolina plus pharmaceutical representatives and other interested parties. The early newsletter was funded by a grant from the Lederle Pharmaceutical Company.   In 1988 and 1990, the newsletter received awards from Lederle for best chapter newsletter.  In 1993, the AAPA awarded the newsletter the best in  the small state category and was given a monetary award of $1,000. This was a big boost to a pretty small budget for the state.

By 1989, things had improved overall for SCAPA. The newsletter was being produced quarterly, there had been one successful CME conference the previous year and another one planned for October, and the relationship with the state board of medical examiners was becoming cordial and professional.

Then came Hurricane Hugo on September 21, 1989 and its devastation. The conference was planned for Charleston, October 5-8, l989, right after Hugo struck. I remember a phone call I made to Becky Miller right after Hugo hit, asking about the conference. Her reply, "Cecilia, we don’t even have electricity here. There is no way we can have a conference." Phone calls were hastily made to all the pre-registered attendees that the conference would have to be put on hold. Just like that, it seemed all the hard work of SCAPA would be erased. Finances were very precarious and most of the funds were tied up in the conference.

And that’s when the generosity of other PAs and the AAPA and of other PA chapters ( especially North Carolina) started pouring in. SCAPA was able to recover and have an abbreviated conference in January, 1990 and to start achieving financial stability. Checks also came from PA chapters in Alaska, California, Georgia,  Alabama, New York, Texas and the membership of the Air Force PA’s.

This outpouring of support was a real financial turning point for SCAPA.  The days of the funds being kept in a cardboard box were gone.

III The 1990’s - Legislative and Organizational Accomplishments

The Sunset Review met again in 1992. SCAPA was approached by the Sunset Review legislative committee to submit proposals for legislative changes of PA regulations.  There was a growing realization that PAs  were being under-utilized in South Carolina compared to neighboring states.

By now, SCAPA had a good working relationship with the SBME.  Part of this is attributable to Brenda Eason, Administrative Assistant to the SCBME.  Ms. Eason has been involved with the licensing of PAs since 1988 and has always strived to be helpful to PAs.  SCAPA president Keith Stewart made sure that the SBME were apprised that SCAPA had been approached by  the Sunset Review legislative committee to make a presentation.  In a letter dated August 22, l992 to Stephen Seeling, executive director of the SBME,  Keith wrote, "We feel that we have a very positive relationship with the State Board....SCAPA feels that this is the most opportune time for these regulations to be brought forward.  ...By informing you at this time of our intentions through our proposals for changes of the rules and regulations governing PA s in SC, we are seeking the support of the State Board of Medical Examiners in this endeavor."

The SBME executive director, Steven Seeling, wrote in a letter in response in 1992  to the  Sunset Review legislative council that, "We have an excellent working relationship with the South Carolina Academy of Physician Assistants.  We will continue to review applicable laws regarding Physician Assistants to insure that the best interest of all our citizens are served."

So in  1992, SCAPA president Keith Stewart met with the Sunset Review committee along with Dr. Ernie Latham, president of the SBME, and Stephen Seeling, executive director.  The Sunset Review committee mandated changes be made to the restrictive laws governing PAs in SC.  South Carolina laws were to be changed  from a regulatory system to a delagatory system.

Thus the groundwork was laid for important legislative changes. In 1993, a sweeping overhaul of the PA laws were made.  South Carolina became a favorable place for new PAs to work.  The working environment of all SC PA s improved.  Protocols were established which included formularies for prescriptive privileges.  Off-site job sites were sanctioned.  It became much less cumbersome to be approved to work here.  And the numbers of PAs in the state started growing.  In 1994, Bill Jones (Upstate area)opened the first satellite clinic run by a SC PA.

Another important accomplishment was the re-opening of the MUSC-PA program in fall, 1994. The movement to re-open the PA program was spearheaded by Dr. Fred Crawford, MUSC Cardiothoracic surgeon.  Gwen Strickland and Steve Russel were appointed as PA members of the group working to re-establish the program. This was seen by SCAPA as a key element to building the number of PAs in South Carolina.    SCAPA worked with MUSC to get the program re-established without it being tied to a federal grant.  SCAPA requested a commitment from the college to support the program.  Senator Geise sponsored a bill to have the SC legislature to provide financial security and support to reinstitute the PA program.

Dr. Glenn Askins was instrumental in obtaining legislative support for the PA program.  He became the program director when the PA program reopened in fall 1994.  He is still involved with the program and serves as the Department Chair of Clinical Services in the College of Health Professions.  He is responsible for the medical education of the PA students.

 As plans for the PA program to reopen in 1994 preceded, Sean Irvin, PA (Upstate area), saw an opportunity for SCAPA to permanently contribute to the growth of the PA profession in this state and suggested an annual scholarship to the MUSC program. Through Sean’s hard work, this program was established in 1994 as the PA program reopened. As of this writing in 2006, over $2, 500 have been distributed in scholarship monies. Sean suggested, and the SCAPA board approved, naming this scholarship in memory of Elizabeth Gouge.

In 1999, the Medical Practice Act was amended to allow physicians to supervise 2 PAs and the PA advisory committee to the SBME was formed.  This is made up of 3 physicians, 3 PAs and 2 lay members who have to be citizens of South Carolina.  Lisa Sand, Arnie Metz, Buck Harvey, Keith Didyoung , Keith Stewart and Kirk Heinold along with others were instrumental in achieving this.

IV The Modern Era - 2000 and Beyond

Another visionary, Kirk Heinhold, became SCAPA president in 2001.  Gone were the days of a shoebox full of assets and a handful of members.   Kirk realized that financially, SCAPA was in a position to move ahead and become a professional organization.  He introduced the idea of using SCAPA funds to hire an executive director.   And so, with great trepidation, Janet Jordan was hired in 200l to become the first paid employee of SCAPA.  Funds were only available for a part-time position and she mainly stayed behind the scene with clerical and telephone work.  Over the last years, her stature has grown and she is a familiar face at all SCAPA CME conferences and events. In recognition of all her contributions, the SCAPA board in 2006 voted for her to be an honorary member of the board, the only non-PA. 

With the re-opening of the PA Program at MUSC, faculty members became involved with SCAPA.   Arnie Metz has been very active and has served eight years on the PA Advisory Board. Paul Jacques has been very active with SCAPA serving first as the Public Education Committee Chair and then as the Legislative Committee Chair.  Due to the improved numbers of members and financial assets, SCAPA was able to hire a lobbyist, Ted Riley, Esq.,  to help pass Bill H. 4015  in 2006  that allows supervising physicians to delegate the privilege to prescribe Schedule III-V controlled substances to PAs.  MUSC faculty member Paul Jacques spearheaded this bill with the help of Reamer Bushardt.   And Kirk Heinold credits his successor, CJ Parris, with the drive to really advance the legislation and to move forward in hiring the lobbyist and the grassroots effort that was organized in support of this bill.

V Conclusion

SCAPA has continued to grow and prosper. Many, many PAs have contributed to the modern success. Keith Stewart, Buck Harvey, Brenda Sprinkle, Sean Irvin, Elizabeth Gouge, Gwen Strickland, Janine Moseley, Keith Didyoung, Steve Russell, Judi McKay, Becky Miller,  Bill Jones, Cecilia Cannon, are just a few of the early names that laid the foundation.  This group was followed by Lisa Sand, Kirk Heinold, CJ Parris, Arnie Metz, Paul Jacques, Wanda Hancock and others.   It was the vision of Mike Taylor, who received the AAPA International Humanitarian Award in 1991, is what started this all.

Please consider this a work in progress. The author would welcome comments and additional information.  Thanks to all the contributors including Brenda Sprinkle, Sean Irvin, Keith Stewart, Buck Harvey, Kirk Heinold, Tony Gouge, Brenda Eason, Bill Jones, Paul Jacques, Janet Jordan, and Gwen Strickland.