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.

Clinical Assessment, On the Job, Professional Identity, Scope of Practice

Supervision in an Office Setting

I recently received the following question:

I work in a medical specialty office. We have four CMAs (AAMA) and six nurses. Is it legal for a medical assistant to supervise a nurse in an office setting?

Here is my response:

Thank you for your question. It is my legal opinion that a medical assistant is permitted to supervise a registered nurse and a licensed practical/vocational nurse in regard to non-clinical matters–such as work schedule, office attire, compliance with government regulations, and administrative protocol. A medical assistant is not permitted to supervise an RN or an LP/VN in regard to clinical matters. This is due to the fact that clinical supervision of a nurse may require the medical assistant to exercise independent professional judgment, or to make clinical assessments, evaluations, or interpretations.

On the Job, Professional Identity, Scope of Practice

Ohio Passes Senate Bill 110

I am happy to report that the Ohio Legislature has passed Senate Bill (SB) 110, which has now been signed into law by Governor John Kasich. The bill becomes effective 90 days after signing.

This bill gives nurse practitioners (NPs) and physician assistants (PAs) the ability to delegate medication administration to unlicensed allied health professionals, such as medical assistants working under their supervision in outpatient settings.

See the following relevant passages from SB 110, the first from page 20 of the attached, which is the version that has passed both Houses of the Ohio legislature:

Sec. 4723.48. (A) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner seeking authority to prescribe drugs and therapeutic devices shall file with the board of nursing a written application for a certificate to prescribe. The board of nursing shall issue a certificate to prescribe to each applicant who meets the requirements specified in section 4723.482 or 4723.485 of the Revised Code. …

(C)(1) The holder of a certificate issued under this section may delegate to a person not otherwise authorized to administer drugs the authority to administer to a specified patient a drug, other than a controlled substance, listed in the formulary established in rules adopted under section 4723.50 of the Revised Code. The delegation shall be in accordance with division (C)(2) of this section and standards and procedures established in rules adopted under division (Q) of section 4723.07 of the Revised Code.

(2) Prior to delegating the authority, the certificate holder shall do both of the following:

(a) Assess the patient and determine that the drug is appropriate for the patient;

(b) Determine that the person to whom the authority will be delegated has met the conditions specified in division (D) of section 4723.489 of the Revised Code.

Note also the following on pages 22 and 23:

Sec. 4723.489. A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met:

(A) The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a certificate to prescribe issued under section 4723.48 of the Revised Code.

(B) The drug is listed in the formulary established in rules adopted under section 4723.50 of the Revised Code but is not a controlled substance and is not to be administered intravenously.

(C) The drug is to be administered at a location other than a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department or a freestanding emergency department; or an ambulatory surgical facility, as defined in section 3702.30 of the Revised Code.

(D) The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely.

(E) The person’s employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section.Sub. S. B. No. 110 131st G.A. 23

(F) The advanced practice registered nurse is physically present at the location where the drug is administered.

Note the following from pages 36 and 37:

Sec. 4730.203. (A) Acting pursuant to a supervision agreement, a physician assistant may Sub. S. B. No. 110 131st G.A. 37

delegate performance of a task to implement a patient’s plan of care or, if the conditions in division (C) of this section are met, may delegate administration of a drug. Subject to division (D) of section 4730.03 of the Revised Code, delegation may be to any person. The physician assistant must be physically present at the location where the task is performed or the drug administered.

(B) Prior to delegating a task or administration of a drug, a physician assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.

(C) A physician assistant may delegate administration of a drug only if all of the following conditions are met:

(1) The physician assistant has been granted physician-delegated prescriptive authority.

(2) The drug is included in the formulary established under division (A) of section 4730.39 of the Revised Code.

(3) The drug is not a controlled substance.

(4) The drug will not be administered intravenously.

(5) The drug will not be administered in a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department; a freestanding emergency department; or an ambulatory surgical facility licensed under section 3702.30 of the Revised Code.

(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a physician assistant’s delegation under this section.

Scope of Practice

New Outlook for a New Year

Greetings, colleagues! I hope the first month of your year was a fantastic one. The coming year should feature some great updated information on medical assisting for the public.

Under the excellent leadership of Secretary-Treasurer Charlene B. Couch, CMA (AAMA), the Occupational Analysis Task Force met in Indianapolis during the 2011 Annual Conference and began its work on the 2012 Occupational Analysis. I attended this meeting and assisted this task force in its important charge. I drafted a request for proposal (RFP) for review by the task force. The RFP will be sent to testing and measurement companies with expertise and experience in conducting occupational analysis studies for the health and allied health professions. I’ll keep you informed as the new Occupational Analysis takes shape!

In addition, I was recently asked by a staff member of the United States Bureau of Labor Statistics to review the draft of the two-page description of the medical assisting profession that will be included in the 2012 edition of the Occupational Outlook Handbook.

As the year progresses, information about the profession will be updated on two fronts, helping to provide an accurate picture of your profession.

Scope of Practice

Speaking the Language of Medicine

Correcting errors is a fairly simple process when it involves a change to a website or some short literature. Language in government publications often proves to be a more time-consuming process.

I was contacted by Rusty Dowling, CMA (AAMA), on behalf of the Michigan State Society of Medical Assistants. Concern was expressed that the Michigan Department of Labor and Economic Growth (DLEG) had classified medical assisting as a “high-growth occupation requiring at least moderate on-the-job training” in one of its publications. I pointed out that the United States Department of Labor (DOL) also classifies medical assisting in this manner, and forwarded to Ms. Dowling letters that I had written to the Department of Labor objecting to the fact that medical assisting is so classified, and is considered an “apprenticeable occupation” by the DOL. I suggested that Ms. Dowling inform the Michigan DLEG of the formal opposition of the AAMA to these classifications of medical assisting by the United States DOL, and further suggested that the Michigan State Society also express its disagreement with this classification to the Michigan DLEG.

Because the legislative landscapes in Michigan and Washington are similar, two public policy leaders of the Michigan State Society joined me in meeting with representatives of the Washington State legislative coalition during the AAMA Board of Trustees meeting in Seattle in early June.

Working against such language is a monumental task, but it is one we must approach with energy if we hope to fix it!