Is Your Medical Assistant Practicing Beyond His or Her Scope of Training?

The Medical Board receives numerous inquiries concerning the use of medical assistants in a physician's office. (By law, a medical assistant may not be employed for inpatient care in a licensed general acute care hospital.)

Medical assistants are unlicensed, and may only perform basic administrative, clerical and technical supportive services as permitted by law. An unlicensed person may not diagnose or treat or perform any task that is invasive or requires assessment. The responsibility for the appropriate use of unlicensed persons in health care delivery rests with the physician.

The classification of medical assistant is defined under the provisions of the Medical Practice Act (Business and Professions Code sections 2069-2071) as a person who may be unlicensed who performs basic administrative, clerical, and technical supportive services under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife.

Under the law, "technical supportive services" are simple, routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. "Supervision" is defined to require the licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife to be physically present in the treatment facility during the performance of those procedures.

Prior to performing technical supportive services, a medical assistant shall receive training by either (1) a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife or (2) an instructor in an approved school program to assure the medical assistant's competence in performing a service at the appropriate standard of care.

A medical assistant who has completed the minimum training prescribed by regulation may administer medication by intradermal, subcutaneous, or intramuscular injections, perform skin tests, and other technical supportive services upon the specific authorization and supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife.

"Specific authorization" means a specific written order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed on a patient, which shall be placed in the patient's medical record; or a standing order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed, the duration of which shall be consistent with accepted medical practice. A notation of the standing order shall be placed in the patient's medical record.

Other technical supportive services which a medical assistant may perform have been established by regulation and include: applying and removing bandages and dressings, removing sutures, performing ear lavage, preparing patients for examinations, and shaving and disinfecting treatment sites. A medical assistant may also hand patients properly-labeled and pre-packaged prescriptions drugs (excluding controlled substances) that have been ordered by a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. The properly-labeled and pre-packaged prescription drug must have the patient’s name affixed to the package, and the physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife must verify it is the correct medication and dosage for that specific patient and provide the appropriate patient consultation regarding use of the drug prior to the medical assistant handing medication to a patient. The regulations governing medical assistants can be found in Title 16, California Code of Regulations, sections 1366-1366.4. Medical assistants who have completed the minimum training prescribed by regulation may draw blood.

Medical assistants are not allowed to perform such invasive procedures as:

• placing the needle or starting and disconnecting the infusion tube of an IV.
• administering medications or injections into the IV line.
• charting the pupillary responses.
• inserting a urine catheter.
• independently performing telephone triage.
• injecting collagen.
• using lasers to remove hair, wrinkles, scars, moles or other blemishes.
• administering chemotherapy.

Medical assistants may not interpret the results of skin tests, although they may measure and describe the test reaction and make a record in the patient's chart.

In summary, medical assistants are not licensed, and it is not legal to use them to replace highly trained, licensed professionals. The medical assistant is present to assist and perform basic supportive services in the physician's office.

Those duties must be appropriate with the medical assistant's required training.