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.

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.

Vaccine Administration under Utah Medical Assisting Law

On March 10, 2022, the Utah legislature amended Section 58-67-102 of the Utah statutes to permit medical assistants to administer vaccines under general physician supervision rather than indirect supervision. Note the following definitions from the Utah Administrative Code:

(b) “Indirect supervision” means the supervising licensee:

 (i) has given either written or verbal instructions to the person being supervised;

 (ii) is present within the facility in which the person being supervised is providing services; and

 (iii) is available to provide immediate face-to-face communication with the person being supervised as necessary.

(c) “General supervision” means that the supervising licensee:

(i) has authorized the work to be performed by the person being supervised;

(ii) is available for consultation with the person being supervised by personal face-to-face contact, or direct voice contact by telephone, radio or some other means, without regard to whether the supervising licensee is located on the same premises as the person being supervised; and

(iii) can provide any necessary consultation within a reasonable period of time and personal contact is routine.

COVID-19 Vaccination in the District of Columbia

The District of Columbia Department of Health (DC Health) clarified the legality of medical assistants administering COVID-19 vaccinations by adding the following section to its regulations:

223 SARS-CoV-2 VACCINE ADMINISTRATION

223.1 An individual, including a medical assistant [emphasis added] or a health technician, who is not licensed, registered, or certified to practice a health occupation pursuant to Chapter 12 of Subtitle I of Chapter 3 of the District of Columbia Official Code, is authorized to administer a SARS-CoV-2 vaccine provided that:

(a) The individual has successfully completed training, provided by a licensed health professional authorized by an existing scope of practice of a health profession to administer a vaccination in the District of Columbia, on the administration of the SARS-CoV-2 vaccine;

(b) A licensed health professional authorized by an existing scope of practice of a health profession to administer a vaccination in the District of Columbia must supervise the individual at the vaccination site;

(c) The licensed health professional reasonably determines that the individual is able to administer the SARS-CoV-2 vaccine under appropriate supervision;

(d) The individual administers the SARS-CoV-2 vaccine at the vaccination site under the general supervision of a licensed health professional supervising the unlicensed person at the vaccination site; and

(e) The training, authorization, and supervision are appropriately documented in the records maintained by the vaccination site.

This rule is similar to rules and executive orders in other American jurisdictions that recognize the importance of empowering knowledgeable and competent medical assistants to administer COVID-19 vaccinations under appropriate supervision.

Delegation of COVID-19 Vaccinations in Oregon: Part II

In part I of this topic, I responded to a registered nurse (RN) who questioned whether language in the regulations of the Oregon Board of Nursing might prevent RNs from delegating to medical assistants the administration of COVID-19 vaccinations. The RN followed up with an additional question:

What language in the Oregon nursing law permits RNs to delegate to medical assistants the administration of intramuscular injections—including COVID-19 vaccinations?

Medical assistants are classified as unregulated assistive personnel (UAP) under the Oregon nursing law. Division 45 of the regulations of the Oregon Board of Nursing, “Standards and Scope of Practice for the Licensed Practical Nurse and the Registered Nurse,” contains the key information on medical assistants’ scope of practice:

(11) Standards related to the RN who delegates the performance of a nursing procedure to a UAP.

…

(e) The RN’s authorization of a UAP to perform a nursing procedure shall only occur when the following delegation process steps are met:

(A) Based on nursing judgment, the RN determines that:

(i) The procedure does not require interpretation or independent decision making during its performance on the client;

(ii) The results of performing the procedure are reasonably predictable;

…

(B) The RN teaches the nursing procedure to the UAP and competency validates the UAP in the safe and accurate performance of the procedure on the client.

…

(f) The RN shall provide clinical supervision of the UAP to whom the procedure has been delegated.  The clinical supervision shall include:

(A) Monitoring of the UAP’s performance of the procedure to verify the UAP’s adherence to written directions; and

(B) Engaging in ongoing evaluation of the client and associated data to determine the degree to which client outcomes related to performance of the procedure are being met.

My legal opinion is that Division 45—not Division 47, which was discussed in Part I—is the applicable Oregon nursing law for determining what tasks may be delegated by RNs to UAP such as medical assistants in outpatient settings, including vaccination clinics. Division 45 states that RNs are permitted to delegate to UAP nursing procedures as long as all of the conditions delineated in Division 45 are satisfied.

An intramuscular injection such as a COVID-19 vaccination is a nursing procedure. Therefore, my legal conclusion is that Oregon nursing law allows RNs to delegate to knowledgeable and competent medical assistants working under direct or on-site RN supervision the administration of COVID-19 vaccinations in outpatient vaccination clinics as long as all the requirements of nurse delegation in Division 45 are met.