Scope of Practice and HIPAA

Unit 4

Medicine and Law

(Scope of Practice and HIPAA)

ESLR Objective:

-Spell and define vocabulary terms correctly

-Achieve a basic understanding of the MA’s scope of practice.

-Have a general knowledge of HIPAA

Unit 4 packet due by Thursday 9/20/2012 _____/65 points

Name:______

Vocabulary

Instructions: Correctly provide the definition for each vocabulary word listed.

California Medical Board-

Specific authorization-

intradermal-

subcutaneous-

intramuscular-

supervision-

technical supportive services-

HIPAA-

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 healthcare 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 or podiatrist.

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 or podiatrist. "Supervision" is defined to require the licensed physician or podiatrist to be physically present in the treatment facility during the performance of those procedures. The only exception is contained in Business and Professions Code section 2069(a) and relates to clinics licensed under Health and Safety Code section 1204.

Prior to performing technical supportive services, a medical assistant shall receive training by either (1) a licensed physician and surgeon or podiatrist 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 or podiatrist.

"Specific authorization" means a specific written order prepared by the supervising physician or podiatrist 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 or podiatrist 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. 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.

During the past few years, the Board has received an increase in calls inquiring about who may perform what type of cosmetic procedure and where. There is a particular interest in those elective cosmetic procedures that are becoming very popular with our appearance-oriented population, especially baby-boomers concerned with the signs of aging. Physicians call to find out who they may hire so that they may expand their practice to capture this market, and non-physicians call to find out if they might be allowed to profit by performing various treatments. The Board believed that it might be helpful to share some of these questions and our responses with our readers.

Who may use lasers or intense pulse light devices to remove hair, spider veins and tattoos?

Physicians may use lasers or intense pulse light devices. In addition, physician assistants and registered nurses (not licensed vocational nurses) may perform these treatments under a physician's supervision. Unlicensed medical assistants, licensed vocational nurses, cosmetologists, electrologists or estheticians may not legally perform these treatments under any circumstances, nor may registered nurses or physician assistants perform them independently, without supervision.

Who may inject Botox?

Physicians may inject Botox, or they may direct licensed registered nurses, licensed vocational nurses, or physician assistants to perform the injection under their supervision. No unlicensed persons, such as medical asisstants, may inject Botox.

Who may perform microdermabrasion?

It depends. If it's a cosmetic treatment, that is to say it only affects the outermost layer of the skin or the stratum corneum, then a licensed cosmetician or esthetician may perform the treatment. If it's a medical treatment, that is to say in penetrates to deeper levels of the epidermis, then it must be performed by a physician, or by a registered nurse or physician assistant under supervision. Treatments to remove scarring, blemishes, or wrinkles would be considered a medical treatment. Unlicensed personnel, including medical assistants, may not perform any type of microdermabrasion.

I would like to provide nonmedical dermabrasion, and hire an esthetician to perform that and also cosmetic facial and skin treatments. What do I need to do?

It is legal for physicians to hire licensed cosmetologists or estheticians to perform cosmetology services, if they have obtained a facility permit from the Bureau of Barbering and Cosmetology. You may apply for a permit with the Department of Consumer Affairs, Bureau of Barbering and Cosmetology, 400 R Street, Suite 5100, Sacramento, CA95814. You may obtain application forms at the DCA Web site at All licensed cosmetologists, including estheticians, must perform their services in a facility with a permit.

Why can't I use a medical assistant instead of a nurse?

Medical assistants are not licensed professionals. While doctors have become accustomed to their assistance in medical office practices, they are not required to have any degree, nor do they have to pass an examination or be licensed. For that reason, the law only allows them to perform technical supportive services as described in sections 2069-2071 of the Business and Professions Code, and Title 16 California Code of Regulations, sections 1366-1366.4.

What is the penalty if I get caught using an unlicensed person to perform medical treatment?

The law provides a number of sanctions, ranging from license discipline to criminal prosecution, for aiding and abetting the unlicensed practice of medicine. Physicians could be charged with aiding and abetting unlicensed practice, and the employee could be charged with unlicensed practice.

I understand that all of these practices may be illegal, but I see advertisements all of the time for these kinds of illegal practices. What should I do?

2069. (a) (1) Notwithstanding any other provision of law, a medical

assistant may administer medication only by intradermal,

subcutaneous, or intramuscular injections and perform skin tests and

additional technical supportive services upon the specific

authorization and supervision of a licensed physician and surgeon or

a licensed podiatrist. A medical assistant may also perform all

these tasks and services in a clinic licensed pursuant to subdivision

(a) of Section 1204 of the Health and Safety Code upon the specific

authorization of a physician assistant, a nurse practitioner, or a

nurse-midwife.

(2) The supervising physician and surgeon at a clinic described in

paragraph (1) may, at his or her discretion, in consultation with

the nurse practitioner, nurse-midwife, or physician assistant provide

written instructions to be followed by a medical assistant in the

performance of tasks or supportive services. These written

instructions may provide that the supervisory function for the

medical assistant for these tasks or supportive services may be

delegated to the nurse practitioner, nurse-midwife, or physician

assistant within the standardized procedures or protocol, and that

tasks may be performed when the supervising physician and surgeon is

not onsite, so long as the following apply:

(A) The nurse practitioner or nurse-midwife is functioning

pursuant to standardized procedures, as defined by Section 2725, or

protocol. The standardized procedures or protocol shall be developed

and approved by the supervising physician and surgeon, the nurse

practitioner or nurse-midwife, and the facility administrator or his

or her designee.

(B) The physician assistant is functioning pursuant to regulated

services defined in Section 3502 and is approved to do so by the

supervising physician or surgeon.

(b) As used in this section and Sections 2070 and 2071, the

following definitions shall apply:

(1) "Medical assistant" means a person who may be unlicensed, who

performs basic administrative, clerical, and technical supportive

services in compliance with this section and Section 2070 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 as provided in

subdivision (a), or for a health care service 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. The medical assistant shall be issued a

certificate by the training institution or instructor indicating

satisfactory completion of the required training. A copy of the

certificate shall be retained as a record by each employer of the

medical assistant.

(2) "Specific authorization" means a specific written order

prepared by the supervising physician and surgeon or the supervising

podiatrist, or the physician assistant, the nurse practitioner, or

the nurse-midwife as provided in subdivision (a), 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 and surgeon or the supervising podiatrist, or

the physician assistant, the nurse practitioner, or the nurse-midwife

as provided in subdivision (a), 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

on the patient's medical record.

(3) "Supervision" means the supervision of procedures authorized

by this section by the following practitioners, within the scope of

their respective practices, who shall be physically present in the

treatment facility during the performance of those procedures:

(A) A licensed physician and surgeon.

(B) A licensed podiatrist.

provided in subdivision (a).

(4) "Technical supportive services" means 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 and surgeon or a licensed

podiatrist, or a physician assistant, a nurse practitioner, or a

nurse-midwife as provided in subdivision (a).

licensure of medical assistants. Nothing in this section shall be

construed as authorizing the administration of local anesthetic

agents by a medical assistant. Nothing in this section shall be

construed as authorizing the division to adopt any regulations that

violate the prohibitions on diagnosis or treatment in Section 2052.

(d) Notwithstanding any other provision of law, a medical

assistant may not be employed for inpatient care in a licensed

general acute care hospital as defined in subdivision (a) of Section

1250 of the Health and Safety Code.

(e) Nothing in this section shall be construed as authorizing a

medical assistant to perform any clinical laboratory test or

examination for which he or she is not authorized by Chapter 3

(commencing with Section 1206.5). Nothing in this section shall be

construed as authorizing a nurse practitioner, nurse-midwife, or

physician assistant to be a laboratory director of a clinical

laboratory, as those terms are defined in paragraph (7) of

subdivision (a) of Section 1206 and subdivision (a) of Section 1209.

2070. Notwithstanding any other provision of law, a medical

assistant may perform venipuncture or skin puncture for the purposes

of withdrawing blood upon specific authorization and under the

supervision of a licensed physician and surgeon or a licensed

podiatrist, or a physician assistant, a nurse practitioner, or a

nurse-midwife as provided in subdivision (a) of Section 2069, if

prior thereto the medical assistant has had at least the minimum

amount of hours of appropriate training pursuant to standards

established by the Division of Licensing. The medical assistant

shall be issued a certificate by the training institution or

instructor indicating satisfactory completion of the training

required. A copy of the certificate shall be retained as a record by

each employer of the medical assistant.

2071. The Division of Licensing shall adopt and administer

regulations that establish standards for technical supportive

services that may be performed by a medical assistant. Nothing in

this section shall prohibit the board or division from amending or

repealing regulations covering medical assistants. The board or

division shall, prior to the adoption of any regulations, request

recommendations regarding these standards from appropriate public

agencies, including, but not limited to, the State Board of

Optometry, the Board of Registered Nursing, the Board of Vocational

Nursing and Psychiatric Technicians, the Laboratory Field Services

division of the State Department of Health Services, those divisions

of the State Department of Education that pertain to private

postsecondary education and career and vocational preparation, the

Chancellor of the California Community Colleges, the California Board

of Podiatric Medicine, the Physician Assistant Examining Committee,

and the Physical Therapy Examining Committee. The Division of

Licensing shall also request recommendations regarding these

standards from associations of medical assistants, physicians,

nurses, doctors of podiatric medicine, physician assistants, physical

therapists, laboratory technologists, optometrists, and others as

the board or division finds appropriate, including, but not limited

to, the California Optometric Association, the California Nurses

Association, the California Medical Association, the California

Society of Medical Assistants, the California Medical Assistants'

Association, and the California Chapter of the American Physical

Therapy Association. Nothing in this section shall be construed to

supersede or modify that portion of the Administrative Procedure Act

which relates to the procedure for the adoption of regulations and

which is set forth in Article 5 (commencing with Section 11346) of

Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government

Code.

After reading the preceding pages, explain in your own words what a medical assistant is, what there role is in healthcare, and what they do.

Explain in your own words what HIPAA is and why it is important.