From: James V. McDonald, MD, MPH, Chief Administrative Officer Board of Medical Licensure and Discipline. Date: 15 November 2013

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1 Rhode Island Department of Health Three Capitol Hill Providence, RI To: Members of the Community interested in the proposed: Guidelines for Minimum Standard of Conduct for Medical Assistants; Guidelines for Scope of Practice of Medical Assistants & Guidelines for Supervision of Medical Assistants From: James V. McDonald, MD, MPH, Chief Administrative Officer Board of Medical Licensure and Discipline Date: 15 November 2013 The Board of Medical Licensure and Discipline (BMLD) would appreciate your review and comment regarding the proposed Guidelines for Minimum Standard of Conduct for Medical Assistants, Guidelines for Scope of Practice of Medical Assistants and Guidelines for Supervision of Medical Assistants. The BMLD requests that comments regarding these proposed Guidelines be submitted in electronic format to Dr. McDonald: Comments are due by close of business on Friday, 6 December If you have any questions about the proposed Guidelines, they should also be directed to Dr. McDonald: James.McDonald@health.ri.gov or Please feel free to circulate additional copies of the proposed Guidelines to any interested person. Your participation is appreciated. Thank you. Attachment

2 Rhode Island Board of Medical Licensure and Discipline Guidelines Minimum Standard of Conduct for Medical Assistant Introduction The Rhode Island Board of Medical Licensure and Discipline (BMLD) acknowledges that medical assistants currently function in the workforce in a variety of roles, clinical and administrative. The purpose of this document is to provide clarity for the medical assistant and the supervising physician regarding expectations of conduct. Minimum Expectations of Conduct of Medical Assistants Medical assistants hold as their primary responsibility the health, safety, welfare, and dignity of all human beings. Medical assistants uphold the tenets of patient autonomy, beneficence, nonmaleficence, and justice. Medical assistants recognize and promote the value of diversity. Medical assistants treat equally all persons who seek their care. Medical assistants hold in strict confidence information obtained through employment unless legally authorized or required by responsible performance of duty to divulge such information. Medical assistants actively seek to expand their knowledge and skills, keeping abreast of advances in medicine. Medical assistants work with other members of the health care team to provide compassionate and effective care of patients. Medical assistants use their knowledge and experience to contribute to an improved community. Medical assistants respect their professional relationship with all members of the health care team. Medical assistants should respect the culture, values, beliefs, and expectations of the patient. Medical assistants should not discriminate against classes or categories of patients in the delivery of needed health care. Medical assistants should disclose to his or her supervising physician information about errors made in the course of caring for a patient Medical assistants should place service to patients before personal material gain and should avoid undue influence on their judgment Medical assistants should not misrepresent directly or indirectly, their skills, training, professional credentials, or identity. Medical assistants should not become sexually involved with patients Medical assistants should not engage in or condone any form of gender - 1 -

3 discrimination Medical assistants should not engage in or condone any form of sexual harassment Medical assistants should seek professional help if suffering from issues of addiction or substance abuse and should not engage in patient care while symptomatic or cleared by treating professional

4 October 2013 Rhode Island Board of Medical Licensure and Discipline Guideline Regarding for Scope of Practice of MEDICAL ASSISTANTS The Rhode Island Board of Medical Licensure and Discipline (BMLD) acknowledge that medical assistants currently function in the workforce in a variety of roles, clinical and administrative. Thus far the BMLD has not specifically directed policy regarding their scope, supervision or place on the health care team. The purpose of this document is to provide clarity for the medical assistant and the supervising physician regarding the nature and scope of the role of the medical assistant. The BMLD does not address matters pertaining to nursing and limits this policy to the relationship of medical assistant and physician. Medical Assistant: A medical assistant (MA) should be a graduate from an accredited program; yet there are other recognized paths for medical assistants to receive appropriate training. Generally a medical assistant is qualified by education and experience and performs routine administrative, clerical and clinical duties in various health care settings. A medical assistant does not diagnose, treat, or examine a patient and does not work in an autonomous manner and is under constant supervision by an appropriate licensed clinician at all times. Medical assistants should not be confused with physician assistants. Physician assistants are trained in comprehensive, multi-year educational programs to practice medicine with physician supervision. Physician assistants are trained in graduate level programs and have prescriptive authority. Education - Educational programs are accredited by Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Accrediting Bureau of Health Education Schools (ABHES). Certification or Registration: Medical assistants can be certified or registered. Certification is by accomplished by passing the American Association of Medical Assistants certifying exam. Certified Medical Assistant Registration occurs by exam or reciprocity with American Medical Technologists Registered Medical Assistant Medical assistants who are certified or registered have demonstrated a higher level of training and therefore allowed a broader scope of practice. Scope of Practice- Medical assistants may perform clinical activities only in the context of direct supervision. Medical assistants are not allowed to interpret any clinical or diagnostic test, physical or historical finding. Additionally, the medical assistant is not allowed to conduct any invasive procedure, except as noted below. It is incumbent on the

5 medical doctor to determine that the delegation of any task does not create an undue risk to the particular patient being treated. Tasks that can be performed by medical assistants should be verified by demonstrating competency and recorded in a training record (e.g., checklist or similar tool) which shall be established and maintained prior to solo performing on actual patients. Tasks that are not done routinely will be updated annually. Scope of work for a Certified Medical Assistant (or Registered Medical Assistant) will differ from a medical assistant who has not acquired certification or registration. The formal training of a medical assistant is limited. Not all medical assistants have the same skill set, and it is expected that supervisors will verify individual medical assistant s competence before allowing them to conduct their scope of practice. Skills that a medical assistant has demonstrated competence yet may not have done in a prolonged period of time should have their competence reassessed. Scope of work for a Medical Assistant (not certified or registered) secretarial work such as assembling charts or assisting with billing, measuring vital signs, assisting an authorized practitioner, under the direct and personal supervision of said practitioner, to carry out a specific task, as a "second set of hands" (e.g. authorized practitioner, after positioning a limb, asks the medical assistant to maintain the limb in the position while a bandage is applied or sutures removed. Medical assistant could not independently position the patient.) Scope of work for a Medical Assistant (certified or registered)* performing ECGs, taking laboratory specimens including blood work (by capillary or peripheral vein), administering a vaccine perform clia waived test *applying casts * An example of a task can be added to a non-certified or registered medical assistant from the above list of competency if verified and maintained in a training record. Responsibility of maintaining the training record is the physicians.

6 Forbidden Tasks Tasks that can never be performed by medical assistants or unlicensed persons include (but are not limited too): triage administering schedule medications (controlled substances) parenteral administering contrast dyes or parenteral injections of any kind placing sutures inserting a intravenous catheter obtaining blood from an artery taking x-rays or independently positioning patients for x-rays, Call in prescriptions for schedule 3-5 medications Interpret any test or clinical finding Diagnose or treat any disease

7 October 2013 Rhode Island Board of Medical Licensure and Discipline Guideline Regarding for Supervision of Medical Assistants The Rhode Island Board of Medical Licensure and Discipline (BMLD) acknowledge that medical assistants currently function in the workforce in a variety of roles, clinical and administrative. The purpose of this document is to provide clarity for the medical assistant and the supervising physician regarding supervision of medical assistants. Medical Assistant: A medical assistant (MA) should be a graduate from an accredited program; yet there are other recognized paths for medical assistants to receive appropriate training. Generally a medical assistant is qualified by education and experience and performs routine administrative, clerical and clinical duties in various health care settings. A medical assistant does not diagnose, treat, or examine a patient and does not work in an autonomous manner and is under constant supervision by an appropriate licensed clinician at all times. Medical assistants should not be confused with physician assistants. Physician assistants are trained in comprehensive, multi-year educational programs to practice medicine with physician supervision. Physician assistants are trained in graduate level programs and have prescriptive authority. Supervision- Medical assistants require direct supervision when engaged in clinical activities. The direct supervision must come from a physician (or appropriate designee). The supervisor can be a Physician Assistant as long as the supervising physician has specifically delegated supervision of the medical assistant to the physician assistant and the physician assistant has consented to supervise the medical assistant. The supervisor does not need to be in the same room as the medical assistant yet must be directly available when the medical assistant is engaged in clinical activities. (Directly available means in the same office space and immediately available) Medical assistants do not require direct supervision when engaged in administrative duties. Medical assistants are not supervised by registered nurses or licensed practical nurses. Written Supervisory agreement: Each medical assistant should have a written supervisory agreement that clearly explains who their supervisor, by name or role. Additionally, the supervisory agreement should include the medical assistant s scope of practice. It is incumbent upon the supervising physician to document or verify a medical assistant s level of competency on all clinical tasks. This verification can be done with a checklist indicating the physician has credible reason to believe through training, direct mentorship or appropriate reference that the clinical task can be competently performed. The supervisory physician shall understand that ultimately they are responsible for the actions of the medical assistant.

8 *The BMLD does not address matters pertaining to nursing and limits this policy to the relationship of medical assistant and physician.