On the Job, Scope of Practice

Medical Assistants in Ambulatory Surgery Centers

A core part of the mission of the American Association of Medical Assistants® (AAMA) is to protect medical assistants’ scope of practice. Sometimes this work requires revealing facts and sharing legal interpretations that contradict others’ assessments.

For instance, I received the following email from a California physician:

Our ASC [ambulatory surgery center] has been recently inspected by the State of California Department of Public Health as a representative of CMS [Centers for Medicare & Medicaid Services]. We employ trained medical assistants and increase their specific training in the ASC with attention to specific duties unique to the ASC.

The California Department of Public Health has opined that it is “unlawful” to have medical assistants participate in the care of patients in an ambulatory surgery center as they are to practice in physicians’ offices and not to replace licensed, higher-qualified practitioners. …

I believe prohibiting medical assistants in an ASC is a disturbing, restrictive trend of the California Department of Public Health. We need to educate them to prevent this trend expanding and being enforced in other ASCs as the role of the medical assistant is important and a valuable support resource to our supervising, licensed staff.

I am unaware of any language in California statutes or regulations that forbids medical assistants from working under physician authority in ASCs. The only limitation in California law that addresses where medical assistants are permitted to work is in Section 2069 of the Medical Practice Act:

(e) Notwithstanding any other law, a medical assistant shall not be employed for inpatient care in a licensed general acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code.

Note the following from the Medical Board of California webpage “Is Your Medical Assistant Practicing Beyond His or Her Scope of Training?”:

The classification of medical assistant is defined under the provisions of the Medical Practice Act (Business and Professions Code sections 2069-2071) as a person who may be unlicensed who performs basic administrative, clerical, and technical supportive services under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife.

Under the law, “technical supportive services” are simple, routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. “Supervision” is defined to require the licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife to be physically present in the treatment facility during the performance of those procedures.

My legal opinion is that all the tasks and duties listed for an ASC medical assistant and operating room medical assistant fall within the definition of “technical supportive services” under California law.

I am unaware of any federal laws prohibiting medical assistants working under direct physician supervision in ASCs from performing tasks allowed by California law. It is also my understanding that physician delegation to medical assistants of permitted tasks in ASCs is a community standard of practice in the state of California.

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