On a busy Monday, two triage nurses at a pediatric clinic call in sick, and the office manager pulls two medical assistants (MAs) to cover the phones for a few hours. The MAs have been with the clinic for many years and are quite experienced. One of the triaged calls is from the parent of a 2-week-old who has a fever of 39 degrees Celsius (102.2 degrees Fahrenheit). The MA advises the parent to give the infant acetaminophen and call the next day if the baby is not better. The next morning, the infant suffers cardiorespiratory collapse from sepsis and meningitis. She is resuscitated but has catastrophic brain injury. A malpractice lawsuit is filed against the MA, the supervising physician and the clinic.
Medical assistants are valued members of the medical team. Many clinics and inpatient facilities use MAs to help with a variety of tasks, including patient outreach, rooming and vital signs, assisting nurses with procedures, performing lab testing and delivering immunizations. These unlicensed medical team members have training that includes basic principles of anatomy and physiology, drug dosing and calculations, infection control, nutrition, effective communication and administrative skills. Many practices also train MAs on practice-specific protocols.
State law often determines the scope of care MAs can provide, but some general principles apply to all unlicensed office personnel.
Medical assistants function under the direct supervision of a licensed medical provider (typically a physician, nurse, nurse practitioner or physician assistant) and may only render services as permitted by state law. The licensed medical provider is responsible for the care provided by the MA who is under his or her supervision.
The American Association of Medical Assistants has a list of scope of practice laws, regulations and guidance by state, https://bit.ly/3AT6NBV.
MAs may not perform tasks that require diagnostic or independent medical decision-making, including care planning, giving medical advice or making clinical decisions. This would seem to impact phone or other medical triage systems in the absence of strict and consistently applied protocols that would eliminate individual medical decision-making for the MA. They may not perform tasks that might constitute “medical practice” outside the scope of their state-delegated duties.
Liability for negligent action by the MA when within their scope of practice is not confined to the MA but also would come back on the supervising provider. This typically would constitute malpractice action.
MAs performing a task outside their scope of practice may put themselves and their supervisor at risk for civil and criminal liability when the care rendered was negligent. In some cases, the care rendered may have been appropriate, but civil or criminal liability still may be possible.
In most states, MAs may deliver oral medication or start/monitor IVs, though a few states place restrictions on these actions (typically requiring documentation of education or competence). Some states may require co-signature for routine medication administration.
The amount of direct supervision needed may depend on the complexity of the procedure and the relative danger of the medication or infusion. Even if state law does not mandate additional direct supervision for oral drugs with potential toxicity, it is prudent for the supervising provider to provide additional oversight.
Most states consider administration of vaccines and other injectable medications within MAs’ scope of practice. Again, supervising providers might provide more oversight for the use of more toxic drugs or products, including double-checking dosing and patient identification prior to administration.
- Check your state laws, regulations and guidance on scope of practice and tasks that can be delegated appropriately to MAs.
- Do not put MAs in a position where they need to make independent medical decisions or direct clinical care.
- Liability for care provided by MAs will fall on the MAs and the supervising physician. This may include potential criminal liability if the MA is negligent and working outside scope of care.
- Verify that liability actions brought against MAs and their medical supervisors would be covered by malpractice insurance for hospitals, clinics and individual physicians.
- Make sure the educational program an MA graduated from is accredited by the Commission on Accreditation of Allied Health Education Programs or the Accrediting Bureau of Health Education Schools, https://bit.ly/3AVy46P.
Dr. Scibilia is chair of the AAP Committee on Medical Liability and Risk Management.
- Information on medical assistant certification from the American Association of Medical Assistants
- Pediatric Telephone Protocols, 17th Edition