Permissible Venipuncture Delegation to Kentucky Medical Assistants

I recently received the following request for information:

In the state of Kentucky, can a medical assistant or phlebotomist perform venipuncture blood draws and specimen collection in a medical facility when they have standard orders or orders from a physician when a physician is not on the premises?

[For example,] if … there are orders for specimens to be obtained but the physician is physically not there that day, can these procedures still be done? [In this scenario,] the physician has put these orders in to be collected and will be signing off on the results.

I tried to find this information online. I have also tried to call Kentucky [Board] of Nursing with no luck of obtaining this information.

To answer this question, first see my Kentucky scope of practice analysis for medical assistants working under physician supervision. Although the Kentucky law does not set forth the physician supervision requirements for medical assistants performing phlebotomy/venipuncture, my legal opinion is that the delegating/overseeing physician must be on the premises and immediately available when a medical assistant is performing venipuncture. The only exception to this interpretation of the Kentucky law is if another licensed provider (e.g., a nurse practitioner or physician assistant) or a registered nurse is on the premises and immediately available.

Medical assistants are classified as unlicensed personnel under the Kentucky nursing law. See the Kentucky Board of Nursing advisory opinion statement, especially the last two pages that contain the delegation chart approved by the Kentucky Board of Nursing. My legal opinion is that Kentucky nursing law, based on the delegation chart, permits registered nurses (RNs) to monitor venipuncture delegated by a physician (even if the physician is not on the premises) to a knowledgeable and competent unlicensed employee (such as a medical assistant). In such a case the delegating physician would not be on the premises, but the RN would be supervising the medical assistant who is performing venipuncture.

I also recommend that someone contact the malpractice insurance carrier for the office/clinic/health system to see whether it would cover any negligence by a medical assistant performing venipuncture supervised by an RN when a physician or another licensed provider is not on the premises.

I received a follow-up question:

What about a certified phlebotomist? Can they perform these tasks when a physician is out of the office?

Kentucky law does not require phlebotomists to be certified. The certification for phlebotomists, as I understand it under Kentucky law, is voluntary—not mandatory. Therefore, they are also classified as unlicensed personnel. Everything that I have written above about delegation to medical assistants applies to delegation to phlebotomists. 

Two State Nursing Boards Recognize Educated and Credentialed Medical Assistants

Earlier this year, Connecticut and South Carolina enacted legislation that empowered medical assistants in these states to perform tasks for which they are educated, credentialed, and competent. Recently, nursing boards in Delaware and South Dakota have similarly revised existing legislation to differentiate duties delegable to educated and credentialed medical assistants from tasks delegable to all other medical assistants.

Specifically, the Delaware Board of Nursing and the South Dakota Board of Nursing issued proposed regulations that allow licensed nurses to delegate to formally educated and credentialed medical assistants the administration of medications by speci­fied routes. Like the Connecticut and South Carolina legislation, these newer revisions speak to the ongoing demand for knowledgeable and competent medical assistants to perform a greater number of advanced functions.

Learn more about this trend and read supporting documentation in the November/December 2022 Public Affairs article, “Two State Nursing Boards Recognize Educated and Credentialed Medical Assistants,” on the “Public Affairs Articles” webpage.

Permissible Vaccine Administration Sites in South Carolina

I recently received a question asking whether medical assistants are allowed to administer vaccines to patients in a parking lot outside a practice.

Note the italicized and bolded language in the following excerpt from the law enacted by the South Carolina legislature earlier this year:

Section 40-47-196. Delegation of tasks.

(A) Specific tasks may be delegated to a [credentialed medical assistant] by a physician, physician assistant if authorized to do so in [their] scope of practice guidelines, or advanced practice registered nurse if authorized to do so in [their] practice agreement. The scope of practice guidelines for a physician assistant and the practice agreement for an advanced practice registered nurse must address what tasks may be appropriately delegated to a [credentialed medical assistant], provided, however, that the following tasks must not be delegated to a [credentialed medical assistant] by a physician assistant or advanced practice registered nurse:

(1) administering controlled medications, intravenous medications, contrast agents, or chemotherapy agents;

(2) injecting neurotoxin products, neuro modulatory agents, or tissue fillers;

(3) using lasers or instruments that results in tissue destruction;

(4) placing sutures;

(5) taking radiographs or using any ionizing radiation unless the [credentialed medical assistant] is also a certified limited practice radiographer;

(6) analyzing, interpreting, or diagnosing symptoms or tests;

(7) triaging patients; and

(8) performing a clinical decision-making task by means of telemedicine.

(B) A physician, physician assistant, or advanced practice registered nurse may delegate specified tasks to a [credentialed medical assistant] pursuant to the following requirements:

(1) the task must be delegated directly to the [credentialed medical assistant] by the physician, physician assistant, or advanced practice registered nurse, and not through another licensed practitioner;

(2) the task must be performed when the physician, physician assistant, or advanced practice registered nurse delegating the task is in such close proximity as to be immediately available to the [credentialed medical assistant] if needed;

(3) the physician, physician assistant, or advanced practice registered nurse delegating the task must determine that the task is within the training and competency of the [credentialed medical assistant] and will not pose a significant risk to the patient if improperly performed

My legal opinion is that a physician, advanced practice registered nurse, or physician assistant would have to be present in the parking lot and immediately available when a medical assistant is administering vaccines.

The delegating/supervising licensed provider, the medical assistants, and all other health professionals must ensure that required precautions are taken and patient safety is maintained.  All necessary equipment, medication, and other resources should be immediately available in case an emergency occurs.

How to Receive Guidance on Scope of Practice from State Medical Boards

I recently received the following question:

My physician employer contacted the state medical board and asked whether she could delegate a particular task to a medical assistant. The staffer at the medical board replied that the board does not regulate medical assistants and therefore he was not able to answer the question. My physician employer wants to know how she can obtain an answer from the medical board.

Your physician employer should ask the state medical board whether the medical practice act and the regulations and policies of the medical board permit her to delegate a certain task to an unlicensed employee. The question should not contain the term “medical assistant” unless this term is found in the medical practice act and/or the regulations of the medical board. By using “unlicensed employee” instead of “medical assistant,” it is more likely that your physician employer will receive an answer to her question.

Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina

In May 2022, Connecticut and South Carolina legislatures passed two significant bills that empower medical assistants in these states to perform tasks for which they are educated, credentialed, and competent.

In Connecticut, “An Act Concerning the Department of Public Health’s Recommendations Regarding Various Revisions to the Public Health Statutes” will allow medical assistants to administer vaccinations (effective October 1, 2022).

In South Carolina, new legislation permits medical assistants to be delegated injections by not only physicians but also advanced practice registered nurses (including nurse practitioners) and physician assistants (effective July 14, 2022).   

Learn more about these legislative victories by reading the July/August 2022 Public Affairs article, “Key Scope of Practice Legislation Is Enacted in Connecticut and South Carolina,” on the “Public Affairs Articles” webpage.