What Is A Medical Assistant Allowed To Do?

Medical assistants are unlicensed employees in the healthcare system, and local and state laws require that a supervising physician, surgeon, or podiatrist must be present whenever clinical tasks, especially direct patient care procedures, are performed.

Employers, often doctors, who are willing to train their medical assistant directly on the job usually expect at least some prior related work experience in a professional office setting, but what if the medical assistant will be working on the clinical floors administering direct patient care as part of the daily routine?

We know that often there is confusion, because we receive many emails and forum post with questions about specific clinical duties. These questions almost always revolve  around whether a medical assistant is allowed to do a certain tasks, such as:

1. phlebotomy
2. X-rays
3. Holter Monitor and ECG/EKG
4. physical therapy
5. start IV lines
6. transcutaneous nerve stimulation
7. hot and cold pack treatments
8. nebulizer treatments

Despite of the continued absence of specific legislation and licensure requirement for medical assistants in many US states we caution each and everyone that authorized clinical procedures for medical assistants can change from state to state, and that there is NO universal answer.

There still are certain laws that regulate the medical assistant's duties, and spell out what a medical assistant can and cannot do, especially in a clinical setting, for example, some US states mandate limited licenses, or recognized certifications in certain medical technical procedures, such as phlebotomy, IV therapy, and exposing patients to x-rays, or certain therapeutic modalities.

This in turn, also strongly influences what should, and can be taught. If you are planning to pursue a medical assistant career, or are in charge of training a new medical assistant, but are unsure whether there are certain limits, or restrictions, the best source of information regarding the medical assistant's scope of practice is your state's Medical Board/Board of Medical Examiners, State Nursing Board, Department of Health, and professional membership organizations for medical assistants, such as the American Association of Medical Assistants (AAMA), or American Medical Technologists (AMT) legal department.

Can Medical Assistants Be Sued?

Laws that Govern Medical Assistants

Many working medical assistants are under the impression that when there are no specific laws and organizations that govern them then there are no liabilities. Nothing could be further from the truth.
It is NOT TRUE that Medical Assistants cannot be sued and held legally responsible for their actions!

The Tex Med Website has put it so well where they state: the term “medical assistant” has no real legal significance. Medical assistants (MAs) are not licensed, certified, or registered by any agency of the State of Texas, nor are they recognized under federal Medicare or Medicaid laws as a species of “provider.” There is no reference to medical assistants in the Medical Practice Act, or any other Texas Statute, thus, there is no specific legal regulation of medical assistants in Texas.

The same applies to many other US States, however, it doesn't mean total absence of laws and regulations for medical assistants. Fact is...

Medical Assistants Can, Have and Will Be Sued If They Cause Harm

It cannot be said often enough: although medical assistants are dependent hires working under the employ and direct supervision of the physician, or supervised by a licensed practitioner, or clinician, it does not exonerate them from direct liability, nor protect them from being sued, should anything that causes injury or losses happen to a patient--and not only injury, but any medical assistant who inadvertently oversteps their bounds and scope of practice, e.g. writes and signs a prescription, instead of the doctor, or carries out a full range of physical therapy modalities, which will constitute practicing medicine without a license, to name just one of many possible scenarios, exposes her/himself to a civil fine of at least $10,000 per violation and almost always other severe charges, penalties and consequences.

Many medical assistants falsely believe that if there are no specific laws that regulate the medical assistant profession where they work then there are no laws to be followed.

Most state laws don't specify exactly which duties medical assistants can perform, but anything they do that goes above and beyond basic low level tasks which can be delegated, such as taking patient vital signs, can be questioned in court, should a lawsuit ensue. If a medical assistant makes an error, typically the lawsuit will be filed against the doctor under whom the medical assistant works, however, the medical assistant can also be named in the suit. Listen in as Gerry Oginski, an experienced medical malpractice, wrongful death and personal injury lawyer in and around the New York City vicinity explains.
What does this mean for medical assistants?

It means to always be sure to practice only skills that you have been taught and are clearly within your discipline's scope of practice. Never act on your own without a doctor physically present in the office when providing any type of direct patient health and medical care procedures. Don't independently give any kind of medical advice, don't ever share confidential patient information with other parties unless a valid need to know exists and never venture into territory that can be viewed as "practicing medicine without a license".

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More at Medical Assistant NET website.

Avoiding Hidden Pitfalls when Delegating Tasks to Medical Assistants

With the increased need to hire medical assistants due to the rough economy and inflation also come certain pitfalls when physicians train their medical assistants on the job to delegate medical tasks and advanced health care procedures that were formerly performed by higher paid licensed nursing and allied health professionals.

With the economy down, all costs and prices increasing everywhere, and energy prices through the roof it also affects the cost of running and maintaining a medical office. Practicing physicians try to lessen the impact of the current inflation on their medical office operational cost by turning toward hiring unlicensed staff, e.g., lesser paid medical assistants or technicians, to delegate responsibilities which historically have been performed by higher-salaried nurses and mid-level providers. While this literally spurs the hiring of more medical assistants it also means that measures must be taken to avoid certain liability issues for the physician and medical assistant alike.

Medical assistants receive on-the-job training to perform administrative and clinical duties, such as patient care and medical tasks and are expected to handle advanced services such as injections, calling-in prescriptions, removing sutures and on-site laboratory screening tests. This trend of hiring medical assistants  to replace nursing staff for less pay is likely to continue as long as inflation and people seeking jobs everywhere remains high.


When a medical assistant receives on-the-job training to perform a medical task, it is good practice that the supervising physician includes a record and description of the training in the personnel file, which should also include clinical skills checklists.

Each item on the checklist should be checked off only after observing the medical assistant perform the task appropriately. Furthermore, the medical assistant's personnel file should include a written job description defining his/her scope of practice and limits of duties.

Then, the specific skills should be periodically revisited, reviewed and reevaluated by to avoid deterioration of this knowledge and prevent errors from seeping in over time. It is equally important to appropriately supervise medical assistants when they perform any kind of hands-on patient care, on site screening tests, call in prescriptions, or administer medications.

The best way to prevent liability issues for doctors who hire and train medical assistants, and medical assistants under their employ is to stay well informed and abreast with current trends.

For more information about training medical assistant students, duties, specialties, certifications and pay visit the Certified Medical Assistant website. This website addresses typical training requirements, challenges, hidden pitfalls, job market trends, future outlook and pay for medical assistants in the USA.

While the above referenced website provides unmatched information for medical assistants not found anywhere else on the Web it cannot answer all questions that may arise. Therefore, another great resource is the State Medical Board/Board of Medical Examiners which regulates the medical profession in each state and the Board of Nursing.

Learn more about medical assistants at Medical Assistant NET on the Web.

Medical Assistant Responsibilities and Limitations

Every medical office should have an organized plan that outlines the duties of every staff member in the medical office, especially their medical assistants, which should also address how to handle patient assessment and triage procedures, administration of medication, treatment procedures and emergency situations.

A good medical practice and health care facility has established policies and provides a written job description outlining responsibilities for each specialty and discipline to all their medical office staff members, including medical assistants. It is good policy to instruct their staff that they have specific responsibilities while also being subject to certain limitations while performing work related duties under their employ. These responsibilities and limitations are based on the quality and amount of their education, training and experience, as well as local and state regulations and official guidelines regulating their profession, i.e. the medical assistant's specific scope of practice.

The responsible medical assistant will recognize, accept and demand that these limitations are respected and strictly adhered to where ever they work and practice their skills. Click the link for an extensive list of what a medical assistant can and cannot do.

Medical Assistants Taking X-Rays

Medical assistants may work in a medical office or facility where x-rays are part of the daily routine. The doctor might wish for the medical assistant to handle taking the radiographic images, however, a special license is required in most states. State authorities have jurisdiction over radiology licensing for each state.

Medical Assistants Reading Laboratory Results

When it comes to reading lab or x-ray result to patients over the phone, that is permissible. Medical assistants are allowed to read x-ray and various other medical screening and laboratory results from the medical chart. When the lab printouts are read and the patient has specific questions then the medical assistant must refer them to the doctor for his/her interpretation. Once read, the medical assistant annotates the lab slip with the date, who he/she spoke to over the phone, any other brief notes, initials it and files it back into the patient's chart and brings chart to doctor. A short annotation is enough (but very important!): "05/15/2009; results read to PT, referred to doctor; SMD, CCMA (initials)."

For more info visit Medical Assistant Net: Medical Assistant Scope of Practice which provides answers to questions regarding medical assistants with limited x-ray responsibilities and their requirements.

Proper Supervision of Medical Assistants: Doctors Take Massive Risks

Little oversights, simple miscommunication, unintended slip-ups, distractions and kind favors can lead to serious consequences and repercussions for each individual medical assistant, the doctor under whom they work, the patient and everybody else involved.

Medical Assistant Charged with 10 Felonies and Unlawful Practice

A medical assistant was arrested in 2009 in Las Vegas, Nevada for administering Botox treatments in her role while under the direction of a doctor. She was under the impression that she was simply doing what all medical assistants do and it never crossed her mind that she may be practicing outside her scope of practice as legislated by the Nevada State Board of Medical Examiners. Nevada law prohibits medical assistants from administering any kind of medications, this includes giving injections. While the restriction had largely gone unenforced it wasn't until this medical assistant's arrest on 10 felony counts on allegations of "unlawful practice of medicine" received media attention. The unsuspecting medical assistant's whole world came to a crashing halt when she was charged.

UPDATE:
Betty Guerra’s nightmare is over. On October 14th the Las Vegas Review Journal reported that the 45-year-old former medical assistant learned from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed. The State Medical board reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox as long as they are under the “direct supervision” of a physician; meaning the doctor is on the premises.

Doctors Taking Massive Risks

Another medical assistant was fired in 2011 in Fort Collins, Colorado after inadvertently putting young children in harms way. She only administered half the amount of a pre-measured children's influenza vaccine to children in the pediatrics office. Assuming it was an adult dosage in the vial, she simply withdrew half the amount of the vial into the syringe and administered it, hence each child recieved only half the required dosage. In addition, after drawing up the vaccine from the vial the assistant removed the needle from the syringe and replaced it with a sterile needle, but not a new syringe, potentially exposing each child to bloodborne pathogenes and serious infections by reusing the syringe.

Safety Guidelines in the Administration of Medications

Medical assistants must never be tempted to do, or say, more than they should and never attempt procedures that they weren't adequately trained and properly supervised to do. They should administer only those medications for which the physician has written and signed the order and must always check with the ordering doctor when in doubt about any medication dosage. When dispensing medications, they must carefully check to make sure that everything on the medication order corresponds exactly with the label on the package or container and medications that are not clearly labeled should never be used, or put back into the medicine closet.

You might ask: "What are the 5 Rs?"

To learn more about the medical assisting career please visit Medical Assistant NET on the Web. 

Medical Assistant Charged with Felonies and Unlawful Practice of Medicine

An Unsuspecting Medical Assistant Was Charged with 10 Felonies and Unlawful Practice of Medicine in Nevada for Administering Botox Injection Under the Supervision of a Physician.

Nevada law prohibits medical assistants from administering any kind of medications, this includes injections. While the restriction had largely gone unenforced it wasn't until a medical assistant's arrest on 10 felony counts on allegations of "unlawful practice of medicine" received media attention.

The medical assistant was arrested in 2009 in Las Vegas for administering Botox treatments in her role as a medical assistant while under the direction of a doctor. She was under the impression that she was simply doing what all medical assistants do, and it never crossed her mind that she may be practicing outside her scope of practice as legislated by the Nevada State Board of Medical Examiners. Her whole world came to a crashing halt when she was charged with 10 felony counts on allegations of "unlawful practice of medicine".

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It is a massive risk that some medical assistants take, especially when they are trained on the job without access to current information from a professional membership organization, such as the American Association of Medical Assistants, American Medical Technologists, or National Healthcareer Association; and not having received formal training from an accredited vocational training institution where expertly trained faculty instruct future medical assistants on what they can and cannot do. This leaves them open to the assumption that as long as they work under the umbrella of the doctor who taught them what to do they are allowed to do what is asked. However, this is a  misconception.

The rule is that ALL medical assistants, regardless of the amount of education, training and experience must realize that they are subject to certain laws and limitations and can practice only within their specific scope of practice. For example, certain US states require medical assistants to have a special license from their state to expose patients to X-rays. Other states mandate special training before a medical assistant can administer certain types of needle injections, vaccinations, and screening tests such as for allergy testing, or PPD/Mantoux skin tests.

The Nevada Sate Board of Medical Examiners, in an emergency meeting on Sept. 18, 2009 adopted a regulation to stop medical assistants from performing certain services, such as administering the cosmetic drug Botox. But the regulation allowed medical assistants to give flu shots and vaccinations.

Medical Assistants to be Stationed at Rural Clinics

Friday July 9, 2010
News on thestar.com online

SEPANG: Medical assistants will be stationed at all rural clinics for the convenience of patients in the area, said China's Health Minister Datuk Seri Liow Tiong Lai.

Liow said the upgrading of the 2,000 rural clinics nationwide, currently run by community nurses, would be done in stages but it would take time to place a medical assistant in each of them.

“Having medical assistants at rural clinics would mean that patients in the area would no longer have to travel far to seek treatment for minor problems like influenza, fever or cough,” he said.

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In reading this news article I immediately wondered what the function and scope of practice for medical assistants in China might be. The article says, the rural clinics are run by community nurses. Therefore, the article seems to imply that there aren't necessarily doctors at all, if not any of the clinics, which then, if I spin this thought on further, would put the nurses in charge of the newly hired medical assistants there. Interesting, and quite a bit different from the function and supervision of medical assistants in the USA.

http://thestar.com.my/news/story.asp?file=/2010/7/9/nation/6635241&sec=nation

Cert Med Assistant: Free Guide for Working Medical Assistants

Cert Med Assistant: Free Guide for Working Medical Assistants video testimonial:

First off, it’s not often you stumble upon a website where the primary objective isn’t to sell you something. At Cert Med Assistant it seemed as if I came across someone who had my best interest at heart. When I learned that Medical Assistants have replaced Nurses in doctor’s offices, I realized the potential for working in a medical office near me (something I always wanted to achieve). After finding out which schools in my area were accredited, it didn’t take me very long to register. In 5 minutes I found every answer I was looking for. It’s almost a no-brainer. With Cert Med Assistant (.c0m) they have created a site that not only helps you along the path to getting your medical assistant career started, but also get certified, and there is an active medical assistant message board, resume help, and the scope of its practice by each state for reference what medical assistant can, and cannot, do.

Cert Med Assistant is a resource that prospective and current medical assistants can enjoy It seems like this will be a resource I’ll be using throughout my career. If you’re aspiring to be or thinking about become a medical assistant, it has tons of information on job outlook, where to find the jobs, how to get certified, where schools are in your area, and the scope of practice by state if you're looking for jobs elsewhere. If you’re already certified, it has job search resources and even resume help. If by some chance that doesn’t help, a forum to post questions that’ll be answered by other certified medical assistants is there too.

Check it out: www.certmedassistant.com

Medical Assistants Who Administer Medications

The confusion about what a medical assistant can and cannot do continues, mostly because of the wide variety of training options, differences in programs, and lack of clearly spelled out rules and regulations. Medical assistants are unlicensed health professionals with special training, which means they have the duty to abide by the rules and use ordinary care within their scope of practice. Often, the doctors and supervising nurses in the medical office wonder: "Can I delegate this, or that task to my medical assistant?". This includes the question, whether the medical assistant is allowed to administer medications.

Medical assistants are allowed to administer medications, or hand patients a measured dose for self-administration while under observation IF it has been so ordered by their medical doctor*, or licensed health care professional (*by doctor's, or licensed provider's orders, such as a physician's assistant, or an advance practice registered nurse ONLY).

Medical assistants can administer only oral, topical, or inhalant medications, suppositories, intradermal, subcutaneous, or intramuscular injections, and medications applied to mucous membranes , such as eyes, nose, mouth, and ears.

Administration means the direct application of a medication by inhalation, ingestion, or any other means to the body of a person, including by injection.

To learn more about educational requirements, and practical tips for handling emergencies, and proper documentation visit Medical Assistant Net on the Web. There is lots of additional "scope of practice for medical assistants" info at that web site.

Confusion About Medical Assistant's Scope of Practice

I am sure everybody who reads this understands concerns and questions medical assistants have, and the confusion that revolves around the medical assistant's scope of practice.

Fact is, not only are medical assistants confused, so are their supervising physicians, licensed health care practitioners, registered nurses, medical office managers. They, too are not always 100% sure of what tasks can be assigned, or delegated to the medical assistant under their employ. Post after post in our medical assistant web forum proves it!!!

Medical assistants who don't know, or disregard established professional standards and attempt to perform procedures or tasks beyond their training, capabilities, or scope of practice are in danger of exposing themselves, and possibly their employer, and supervisor to serious consequences, and possible liability issues.

When a medical assistant winds up doing tasks they aren't allowed to do, or act independently without permission, or supervision most medical office supervisors react with very harsh measures. Over the years I have seen and heard stories where medical assistants were immediately suspended and dismissed (fired!) without any further counseling, or second chances.

The fear of damaging the office's reputation and the consequences of a malpractice law suit is overwhelming. Where so much is at stake, there just rarely are any second chances, especially when it comes to new staff members where trust has not even been established yet.

Now, don't get me wrong! Often it is not the medical assistant's own fault, or fault alone. Like I said before, even the medical office managers and clinical supervisors are not always sure what the medical assistant is allowed to do.

They realize that it is important to clearly delineate and communicate the medical assistant's role and responsibilities, however, when looking for answers pertaining to the medical assistant's scope of practice in their state, they often don't know where to turn.

For example, many states mandate that anybody performing phlebotomy, EKG and X-ray must have a specific license to do so, and medical assistants who draw blood in California, and those who perform point of care testing in Georgia are required to be certified in that particular skill first.

In closing I want to remind all medical assistants and their instructors and supervisors to make it their top priority to clearly define and communicate rules and regulations that affect medical assistants and medical office staff to promote a healthy and safe work environment, and success.

Medical Assistants who Draw Blood

I was wondering if there was a way to find out whether medical assistants across the country are actually performing venipuncture once they graduated from school. It would be interesting to find out how many are drawing blood in-house.

The reason why I ask is because, as far as I know, most medical assistants do not draw venous blood samples. Yes, they do the quick test urines, finger sticks, injections, and throat swabs, but it seems, rarely do medical assistants I know perform the in-office venipuncture blood collections anymore.

It could be that they all work out of offices where there is an inhouse reference lab somewhere on the 1st floor, or a contracted hematology lab nearby, so if there is a need for blood they simply hand the patients the requisition slip and send them downstairs or across the hall to get the sample drawn.

Sometimes there is a phlebotomist who makes his/her daily rounds and takes care of all blood drawing needs. In hospitals, it's the RN or, again, the phlebotomist who obtains the venous blood samples, which leaves medical assistants relieved from this responsibility. To those medical assistant students who were not particularly happy about having to do venipunctures, not having to do them at work may seem like a good thing.

However, not practicing this valuable skill after having been taught so diligently by the clinical lab instructor means that unfortunately, sooner or later the ability to smoothly and properly obtain a venous blood sample will get lost. Yes, here goes the old adage: if you don't use it you will loose it.

So, working medical assistants, take on the challenge and put your heart in what you love. Grasp every chance you can to practice ALL your skills. Practice makes perfect, especially in phlebotomy and venipuncture.


Oh, and don't forget to add a comment, especially about whether or not you have blood drawing responsibilities at your workplace!



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