What Tasks Are Delegable to—and Performable by—Medical Assistants? Part II

The COVID-19 pandemic has created many changes in health care. Notably, medical assistants’ roles have shifted and expanded to help ensure patients continue to receive high-quality care.

The January/February 2021 Public Affairs article—adapted from the handout for my presentation of the same title for the 2020 American Academy of Ambulatory Care Nursing Annual (Virtual) Conference— discusses medical assistants’ scope of practice in terms of state law. Specifically, I examine the legality of delegating certain tasks to medical assistants:

• Performing injections and venipuncture
• Executing verbal and standing orders from licensed providers
• Enter­ing orders under the Medicaid Promoting Interoperability Program and its meaningful use provisions for electronic order entry

Review details by reading “What Tasks Are Delegable to—and Performable by—Medical Assistants? Part II” on the AAMA website. And check out “Part I,” which was published in the November/December 2020 issue of CMA Today.

New Alaska Standards for Delegation of Certain Duties

The Alaska State Medical Board has added a new section to its regulations that establishes standards and conditions under which a licensed physician (doctor of medicine or osteopathic medicine), podiatrist, or physician assistant may delegate certain medical duties to unlicensed professionals such as medical assistants.

These regulations remove any ambiguity from the assertion that knowledgeable and competent unlicensed allied health professionals such as medical assistants can legally perform intramuscular (IM), subcutaneous (subq), and intradermal (ID) injections delegated by a licensed provider under the provider’s direct/on-site supervision.

The regulations of the Alaska State Medical Board were finalized November 25, 2019, and went into effect December 25, 2019.

You can read the regulations by either accessing the December 2019 medical statues and regulations document (Page 37) via the Alaska State Medical Board webpage or the Alaska section of the AAMA State Scope of Practice Laws webpage on the AAMA website.

This is a significant scope of practice victory in Alaska, and I congratulate the Alaska Medical Assistant Society for its excellent and diligent work on strengthening and clarifying medical assistants’ right to practice!

Medical Assistants in Camping Settings

I recently received the following question:

I was wondering whether medical assistants in my state are eligible to become overnight camp health officers and whether we are allowed to give intramuscular and subcutaneous injections as needed. No health care provider would be physically present. However, one or more providers (e.g., physicians, nurse practitioners, physician assistants) would be available by phone.

Under the laws of your state, medical assistants are not permitted to serve as camp health officers when no licensed health care provider is present and immediately available. This is because health professionals in a camping setting may be called upon to deal with situations that require the making of immediate clinical assessment and evaluations and the exercise of independent clinical judgments. Medical assistants are not taught the knowledge and skills necessary to function in this capacity.

Medical assistants are permitted to assist licensed health care providers in a camping environment, however.

Preparation and Administration of Injections by Medical Assistants

In the current ambulatory care environment, medical assistants are being delegated the preparation of injectable substances, as well as the administration of injections. I often receive questions about legal restrictions on medical assistants preparing injectable substances. In some states, there are specific laws that address this question. In general, it is my legal opinion that, if there is a likelihood of significant harm to a patient if an injectable substance is prepared improperly, the delegating provider must verify the identity and the dosage of the injectable substance before it is administered by the medical assistant.

Arkansas Legislation Gets a Shot in the Arm

Obtaining the right to administer medication is a never-ending struggle for medical assistants across the country. But, a difficult challenge makes victory that much sweeter.

After more than a decade of intense disagreement between the Arkansas Board of Medical Examiners and the Arkansas Board of Nursing, legislation was passed in 2009 to codify the fact that medical assistants are permitted to administer medication under a physician’s direct supervision. In 2010 the Board of Medical Examiners promulgated regulations pursuant to the legislation. Regaining the right to be delegated injections is a significant victory for the medical assisting profession in Arkansas!

Our work to earn medical assistants this right continues in other states, as well. In New York I have worked closely with the NYSSMA President Paula Guidozzoli, CMA (AAMA), and have been asked to write articles about the education and credentialing of CMAs (AAMA) for the Medical Society of the State of New York and the New York State Nurses Association. Ms. Guidozzoli continues to provide excellent leadership, establish important contacts, and seek the best ways to effect positive change for medical assistants in this important state.

Every state has different legislation concerning medical assistants. Be sure to educate yourself about your professional rights!