Understanding medical assistant practice liability issues

Dermatology Nursing, August, 2008 by Carolyn Buppert

A nurse practitioner wrote: "I'm worried about the way the medical assistant in my office gives out telephone advice. I heard him tell a patient not to worry about the symptom the patient was calling about. It seems to me that this would be a form of diagnosing, which is the practice of medicine. Boards of nursing come down hard on registered nurses who exceed their scope of practice, but it seems that medical assistants do it all the time. Am I at risk for getting sued if I work with a medical assistant who goes out on a limb and a patient is harmed?"

There are two legal issues here. Liability for malpractice and exceeding scope of practice. If a medical assistant negligently or incompetently advises a patient and the patient suffers an injury because he or she relied on the advice, the medical assistant and his employer probably will be sued. It is unlikely that a nurse or nurse practitioner working at the practice would be sued, but if a nurse or nurse practitioner had supervisory responsibilities, then it is possible that the nurse would be named. It is the medical assistant's employer/supervisor's responsibility to monitor the medical assistant and make sure he or she is acting within the standard of care.

Scope of Practice

What is the scope of practice of a medical assistant? In some states medical assistants have a clearly stated scope of practice, but in some states there is no law on the matter. Several Web sites for medical assistants state that a medical assistant can:

* Perform clinical and administrative tasks to keep the workflow going, if supervised by a physician or other health care practitioner.

* Determine the acuity of a visit and the visit length for appointment scheduling purposes using an office protocol provided by the supervising physician.

* Measure and record vital signs.

* Record patient demographics and basic information about the presenting and previous conditions.

* Use medical terminology and accepted charting abbreviations.

* Escort patients to the exam room and prepare them for an exam.

* Use scientific methods to solve problems and choose a mathematical method or formula to solve problems.

* Convey clinical information on behalf of the physician.

* Arrange examining-room instruments and equipment.

* Change wound dressings and obtain wound cultures.

* Remove sutures or staples from superficial incisions or lacerations.

* Operate diagnostic equipment but cannot interpret tests.

* Provide patient information and instructions.

* Provide a single dose of oral medication as ordered by the physician to a patient for immediate self-administration under observation.

* Administer medications topically, sublingually, vaginally, rectally, and by injection.

* Perform CPR and render First Aid in an emergency.

* Prepare patients for examination, including draping, shaving, and disinfecting treatment sites.

* Perform aseptic procedures such as wound care.

* Collect blood specimens via capillary and venipuncture technique.

* Obtain specimens by noninvasive techniques, such as wound cultures.

* Perform simple laboratory and screening tests customarily performed STAT in a medical office, such as urinalysis.

* Administer different types of cryotherapy to reduce pain or swelling.

* Filing and bookkeeping.

* Process insurance claims.

* Transcribe medical dictation for medical records. Call in prescription orders or refills to the pharmacy, but only as ordered and approved by physician, nurse practitioner, or physician assistant.

The sites warns that medical assistants cannot:

* Independently perform telephone triage (medical assistants are not legally authorized to interpret data or diagnose symptoms!).

* Independently diagnose or treat patients.

* Independently prescribe medications.

* Independently give out medication samples.

* Independently refill prescription requests.

* Independently do triage.

* Inject medications into a vein (most states) unless permitted by state law.

* Start, flush, or discontinue IVs (most states) unless permitted by state law.

* Provide medical treatment, analyze, or interpret test results.

* Advise patients about their condition or treatment regimen.

* Make assessments or perform any kind of medical care decision making.

* Administer any anesthetic agent (except topical numbing agents such as EMLA cream).

* Perform tests that involve the penetration of human tissues except for skin tests and drawing blood as provided by law.

* Interpret the results of blood or skin tests.

* Operate laser equipment.

A Look at California Law

Of course, a list on a Web site is not law, but, in general, this list accurately describes the law in several states. Let's look at California law, which specifically addresses the scope of practice of a medical assistant. California law defines a medical assistant as "a person who may be unlicensed, who performs basic administrative, clerical and technical supportive services in compliance with this section ... for a licensed physician and surgeon or a licensed podiatrist, or group thereof, for a medical or podiatry corporation, for a physician assistant, a nurse practitioner, or a nurse-midwife ... or for a health care services plan, who is at least 18 years of age, and who has had at least the minimum amount of hours of appropriate training pursuant to standards established by the Division of Licensing." (Source: California Business and Professions Code, Section 2069 b[1]).