The Evolution of Advanced Practice Providers in California: Addressing the Legal Lacuna-Who Has the Duty of Informed...

California's requirements for informed consent were established in 1972 in the California Supreme Court's seminal case of Cobbs v. Grant. In that case, the court placed the burden of obtaining informed consent squarely upon the one kind of medical licensee at the time, the physician, framing it as an exclusive duty. Half a century ago, placing this responsibility solely on physicians made sense, as physicians were the sole providers of complicated medical procedures. Occurring simultaneously with this ruling, however, a new healthcare workforce was emerging. This new workforce included physician assistants, nurse practitioners, nurse anesthetists, and nurse-midwives, who are modernly referred to as advanced practice providers.At their inception, these providers practiced under the supervision of physicians who were ultimately responsible for the care that they provided. Historic clashes between these professions and the inconsistent and unpredictable legal rulings and interpretations over time have prompted legislative responses that are fragmented and iterative. In turn, this statutory and regulatory evolution culminates in pivotal legislative advances in recent years, solidifying this group as one of the most rapidly growing segments of the healthcare workforce. Their scope of practice, authority, autonomy, and now independence shape that future.By 2032, the United States is projected to face a shortage of over 124,000 physicians. As advanced practice providers move to fill this gap, with increasing autonomy, a "legal lacuna" has emerged in California. This article analyzes how advanced practice providers have the duty to obtain informed consent under Cobbs within this modern, multidisciplinary era of medicine. This article specifically evaluates whether the duty is delegable by a physician to an advanced practice provider, and whether the underlying legal obligation itself is transferable. Furthermore, while state laws explicitly impose professional obligations and mandatory disclosures on physicians, they fail to place these same requirements on advanced practice providers. This article addresses the resulting uncertainty in current state laws by determining who retains these duties when an advanced practice provider practices independently, ensuring that patients do not risk losing their fundamental rights.