Clarification of Medication Administration Delegation to Medical Assistants in Oklahoma

I had the opportunity to present at the Medical Group Management Association (MGMA) Medical Practice Excellence: Leaders Conference in October 2021. The title of my presentation was “Utilizing Medical Assistants to the Top of Their Training: How Recent Law Changes Have Expanded Their Scope of Work.” After this presentation, I received the following question from an osteopathic physician practicing in Oklahoma:

I am writing to you to get a follow-up opinion on the delegatory ability of advanced practice registered nurses (APRNs) to medical assistants under Oklahoma law. I have seen your opinion letter on the AAMA website about the delegatory role of physicians to medical assistants and understand that you believe that the verbiage from the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act authorizes physicians (both MDs [doctors of medicine] and DOs [doctors of osteopathic medicine]) to delegate tasks to a medical assistant through licensed nonphysician providers, such as physician assistants and nurse practitioners.

How can your opinion be reconciled with the Oklahoma Board of Nursing (BON) statement on delegation of tasks by licensed nurses (including APRNs) to unlicensed allied health professionals such as medical assistants? Section F of the Oklahoma BON statement specifically mentions the administering of medications as not eligible for delegation by nurses to unlicensed persons.

The physician’s understanding of my legal opinion letter is correct. The relevant language I cite from the Oklahoma Medical and Surgical Licensure and Supervision Act is as follows:

E. Nothing in the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act shall prohibit:

1. The service rendered by a physician’s unlicensed trained assistant [which would include a medical assistant] if such service is rendered under the supervision and control of a licensed physician pursuant to Board rules, provided such rules are not in conflict with the provisions of any other healing arts licensure act or rules promulgated pursuant to such act

I am familiar with the statement of the Oklahoma BON regarding delegation to unlicensed persons. I agree that the position of the Oklahoma BON is that nurses are not permitted to delegate to unlicensed professionals such as medical assistants the administration of medication.

In terms of reconciling my letter and the position of the Oklahoma Board of Nursing, my legal opinion is that a physician is permitted to assign to a registered nurse (as well as an APRN such as a nurse practitioner) the supervision of a medical assistant who is administering medication as delegated to the medical assistant by the physician as long as the delegating/overseeing physician is on the premises and immediately available, although not necessarily in the same room. However, my opinion is also that—based on the policy of the Oklahoma BON—a nurse practitioner is not permitted to delegate to an unlicensed professional such as a medical assistant the administration of medication.