delegation, Scope of Practice

The Relationship between Scope and Competence

Medical assistants are under a legal duty to not exceed the legal scope of practice in their state.  Medical assistants are also under a legal duty to perform all tasks competently.  It is important to understand the relationship between these two legal duties.

Even if a medical assistant performs a task competently, and meets or exceeds the standard of care that is required of a medical assistant, the medical assistant could face legal sanctions if the task is beyond the legal scope of practice for medical assistants in the state.

Similarly, if a medical assistant performs a task that is permitted under state law, the medical assistant (and, most likely, the medical assistant’s delegating provider) could be sued for negligence if the task is not performed competently.

Medical assistants must make sure they perform all tasks competently.  They must also make sure that the tasks they perform do not exceed the legal scope of practice in the state (or other American jurisdiction) in which they are working. Of course, the best way to do so is by remaining informed about the laws in your own state. To help health care professionals navigate this issue, the AAMA website has a large collection of documents relating to different states’ scope of practice laws. Any medical assisting scope of practice questions that are not covered by these materials can be emailed to me at dbalasa@aama-ntl.org.

delegation, On the Job, Professional Identity, Scope of Practice

Medical Assistants and Limited Scope Radiography

I receive fewer questions than I did seven or 10 years ago about the legalities of medical assistants performing limited scope radiography. However, in some states medical assistants are called upon to expose patients to ionizing radiation, as specifically directed by the overseeing/delegating provider.

The legality of this task is governed by state law. In some states unlicensed professionals such as medical assistants are forbidden from doing any limited scope radiography. Only licensed radiologic technologists are permitted to perform radiography. In other states medical assistants are required to complete a short course and pass a test in order to be delegated limited scope radiography. In other states limited scope radiography under direct/on-site provider supervision is not regulated. Physicians are permitted to delegate limited scope radiography to knowledgeable and competent employees.

delegation, On the Job, Professional Identity, Scope of Practice

Can Medical Assistants Oversee and Perform Physical Therapy?

Recently I fielded a question from a chiropractor in New Jersey looking to expand his practice to include services such as physical therapy. In conducting research into this matter, he had been told that in New Jersey, state law allows MDs to delegate to medical assistants full oversight and performance of physical therapy activities, as prescribed by the MD. He asked whether this was true.

In my response, I cited a recent CMA Today article that addresses this very topic:

An example of [procedures that can be delegated only to certain health professionals other than medical assistants] is physical therapy. Although some states—explicitly or implicitly—permit physicians to delegate very minor physical therapy modalities to competent and knowledgeable medical assistants working under the physician’s direct supervision, no state allows a physician to delegate the full range of physical therapy to anyone other than a licensed physical therapist.

In addition, I recommended contacting the New Jersey Board of Chiropractic Medicine to inquire whether New Jersey statutes, regulations, and policies permit doctors of chiropractic medicine to assign to unlicensed professionals such as medical assistants the overseeing of patients performing exercises assigned by an MD, and whether there are any legal limitations on this. (Similarly, I would recommend such action to chiropractors in other states, as well.)

Scope of Practice

Forging Ahead in Washington State

Greetings, everyone! Key health care leaders in the state of Washington conducted a sunrise hearing regarding continuing confusion over the “health care assistant” category in Washington law and the medical assisting profession.

Dr. Dean Martz, president of the Washington State Medical Association stated that “Medical assistants are the vital glue that keeps medical practices running smoothly.” He stated that “the association has heard a loud and clear message statewide to fix the current situation.” Dr. Martz enumerated the strongest reasons that the roles of medical assistants need to be better defined in practices and the government. With impending health care reform and increasing demand for health care services, medical assistants will need to continue to fill an important role for health care delivery teams.

I was able to second this urgent call for improved legislation in the state. There is no other state that has a health care assistant type of regulation. Health care assisting is not a profession, but a statutorily created category from the early 1980s to address a specific problem. However, the issue is that because the health care assistant law just addresses blood withdrawal and injections, the interpretation by the department has been that no other duties that can be delegated to medical assistants. There is no other state with that type of regulatory system.

There is a great need for recognizing the abilities of medical assistants. States have taken that action to ensure medical assistants will be able to work to the top of their training and education and will free up other health care professionals to concentrate on their areas of concern.

Stay tuned for further developments. I will share more thoughts in the AAMA’s upcoming Nov/Dec 2011 CMA Today magazine.

Scope of Practice

Success in Nevada State Senate!

Good afternoon, everyone! I hope your summers are going splendidly. I have some fantastic news to share with you all. The Nevada State Senate recently passed into law the bill allowing medical assistants to administer medications under the supervision of a physician. You’ll remember that Nevada State Society President Carol Cohen and I worked on such matters earlier this spring (See “Right-to-practice Issues in Nevada“). We were hopeful that the bill would pass the Senate, and that hope proved justified. You can review the final text of the bill at http://www.leg.state.nv.us/Session/76th2011/Bills/SB/SB294_EN.pdf. Thank you again for all of your support!