delegation, On the Job, Scope of Practice

Suicide Safety Plan Delegation

Is it appropriate for a nurse practitioner to delegate patient follow-up that will establish a suicide safety plan to a medical assistant?

My legal opinion is that nursing law of some states allows nurse practitioners to assign to knowledgeable and competent unlicensed professionals such as medical assistants the interacting by telephone with chronically suicidal patients to establish a suicide safety plan as long as both of the following conditions are met:

  1. The medical assistant adheres strictly to the information guidelines provided by the licensed therapist and approved by the nurse practitioner
  2. The medical assistant’s interaction with the patient does not require the exercise of any degree of independent clinical judgment or the making of clinical assessments or evaluations 

These principles are especially important in interacting with psychiatric patients—even more so for those who are chronically suicidal.

I would also suggest that delegating nurse practitioners check with their malpractice insurance carrier to make sure that the insurance would cover any negligence by a medical assistant in assisting a patient in establishing a suicide safety plan. The opinion from the malpractice carrier should be in writing and kept on file.

On the Job, Scope of Practice

Medical Assistants Answer the Call to Work in Acute Care Settings

Many medical assistants have been asked to work in acute care environments because of the enormous need to deploy skilled and dedicated health professionals to where they are most needed during the COVID-19 pandemic.

But because medical assistants have not typically worked in acute care settings, inevitable questions about the legal parameters of medical assisting scope of practice have arisen. Notably, answering these questions requires a close review because state laws usually address medical assistants’ scope of practice within only the typical ambulatory setting.

My analysis of three state examples was published in the July/August 2020 Public Affairs article, “Medical Assistants Answer the Call to Work in Acute Care Settings: What Is Their Scope of Practice?” on the AAMA website.

On the Job, Scope of Practice

CDC Affirms Medical Assistants’ Role in Telehealth

In a recent guidance on how to expand access to health care during the COVID-19 pandemic, the Centers for Disease Control and Prevention affirmed that medical assistants and other health care professionals are permitted to interact with patients by several means. Note the following from this guidance:

Telehealth Modalities

Several telehealth modalities allow [health care personnel] and patients to connect using technology to deliver health care:

Synchronous: This includes real-time telephone or live audio-video interaction typically with a patient using a smartphone, tablet, or computer.

In some cases, peripheral medical equipment (e.g., digital stethoscopes, otoscopes, ultrasounds) can be used by another HCP (e.g., nurse, medical assistant [italics added]) physically with the patient, while the consulting medical provider conducts a remote evaluation [emphasis added in red].

Asynchronous: This includes “store and forward” technology where messages, images, or data are collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging.

Remote patient monitoring: This allows direct transmission of a patient’s clinical measurements from a distance (may or may not be in real time) to their healthcare [sic.] provider.

Additionally, in its Telehealth Implementation Playbook, the American Medical Association listed ways in which medical assistants can use telehealth to help their overseeing physician/provider:

MEDICAL ASSISTANT (MA) OR PATIENT CARE TECH (PCT)

Be familiar with the conditions and situations that are appropriate for a telehealth visit

Educate patients on telehealth expectations

Support patient troubleshooting related to platform pre-visit and during visit

Let [the] doctor know when a patient has “checked in” for a telehealth appointment (if platform does not include this feature)

On the Job

Continuing Education Requirements for Medical Assistant-Certified Credential in WA

In 2020, a bill (HB 2351) was introduced in the Washington State House of Representatives that would establish continuing education requirements for the medical assistant-certified credential.

I teamed up with the Washington State Society of Medical Assistants to submit comments in support of the bill to the House Health Care & Wellness Committee on January 27, 2020. These comments are presented in the May/June 2020 Public Affairs article, “Continuing Education Requirements for Medical Assistant-Certified Credential in WA,” on the AAMA website.

Information on the bill’s status is available on a dedicated webpage of the Washington State Legislature website.

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.