Minimizing Risk When Supervising Medical Assistants and Unlicensed Staff in Utah

What risks come with the use of medical assistants or other unlicensed staff in an ambulatory setting and how can practices reduce these risks?

Generally, unlicensed staff practice under another practitioner’s license. This exposes the licensed practitioner to risk if the unlicensed individual does not perform delegated tasks properly, and the licensed practitioner does not or can correct it.

For example, medical assistants practice under a licensed physician or surgeon. Certified nurse assistants practice under the license of a Registered Nurse or Licensed Practical Nurse. Esthetician apprentices practice under the license of an esthetician. Thus, it is ultimately the licensed practitioner who bears the risk and the liability for any negligence of unlicensed personnel.

It's not just the licensed practitioner who faces risk, but also the ambulatory facilities that utilize unlicensed staff. Generally, the facilities are responsible for the training and supervision of their staff. If written policies are not implemented and education provided to the staff, the facility could face liability.

Outpatient settings that do not fulfill their obligations under the respective rules and Utah Code are subject to class A misdemeanors. See generally Utah Admin. Code 432-500-34; Utah Admin. Code 432-650-15; 58-11a-503(1).

One way to reduce a practitioner’s risk would be to eliminate the use of unlicensed personnel, but this may not be practical. Instead, physician practices and other ambulatory facilities may focus on risk reduction strategies.

Outpatient healthcare centers can reduce their risks by implementing regular trainings for unlicensed and licensed personnel. It is important to document the orientation and trainings provided. Employers should also verify the licenses of all licensed personnel hired.

Individual licensed practitioners who are supervising unlicensed staff can reduce risk with policies and procedures and job descriptions that specify the expectations, duties, and scope of practice of unlicensed staff. Frequent interaction and communication between supervisors and unlicensed staff are also important. Regular, documented reviews of charting notes and treatment provided can go a long way toward minimizing risk.

Are there Utah statutes or regulations which limit the scope of tasks delegated to unlicensed staff, impose supervisory requirements, or otherwise regulate the use of unlicensed staff?

Utah Code

Section 58 of the Utah Code Annotated contains the practice acts of healthcare practitioners throughout Utah. These each include a provision regarding which activities in each practice field are exempted for licensure requirements. Some are summarized below.

Medical Care

Utah Code Annotated 58-67-305 outlines exemptions from licensure for individuals performing certain types of medical care. Some of these include medical assistants, persons authorized to draw blood in criminal investigations, and those providing volunteer emergency medical care.

This section clarifies that medical assistants may perform supervised tasks such as:

1. administering a vaccine under the general supervision of a physician; or
   
   
2. under the indirect supervision of a physician, engaging in tasks appropriately delegated by the physician in accordance with the standards and ethics of the practice of medicine, except for:
    
   1. performing surgical procedures;
      
      
   2. prescribing prescription medications;
      
      
   3. administering anesthesia other than for a local anesthetic for minor procedural use; or
      
      
   4. engaging in other medical practices or procedures as defined by division rule in collaboration with the board;

Utah Code Annotated 58-67-305(6).

Exemptions for Emergencies

Utah Code 58-1-307 also provides general exemptions for licensure in specific instances, such as in national emergencies.

Utah Regulations

Utah Regulations clarify responsibilities for certain ambulatory facilities.

Ambulatory Surgical Centers

Specifically, Utah Admin. Code 432-500-18 outlines regulations for ambulatory surgical facilities. These require a Director of Nursing to supervise the non-medical care. “All non-medical patient services shall be under the general direction of the director of nursing, except as exempted by facility policy.” Utah Admin. Code 432-500-18(2).

Utah Admin. Code 432-500-10 outlines additional responsibilities imposed on the Director of Nursing in Ambulatory Surgical Centers. Among other things, he or she is responsible for:

1. 1. Maintaining qualified health care personnel that are available and used as needed under the supervision of a registered nurse; and
      
      
   2. Assuring a licensed nurse is on duty when patients are in the facility.

Utah Admin. Code 432-500-10(b).

Section 11 of the same section imposes responsibilities on the facility for in-service training programs for “all personnel.”

End-Stage Renal Disease (“ESRD”) Facilities

Utah Admin. Code 432-650-7 outlines responsibilities for facilities and clinical staff in ESRD Facilities. Specifically, Utah Admin. Code 432-650-7(4) states that, “Each ESRD facility must orient all employees to specific job requirements and facility policies. The facility shall document initial and on-going employee orientation and training.”

Utah Code also provides guidelines for registered nurses to delegate tasks at ESRD Facilities to other clinicians. Specifically, a registered nurse may delegate the following patient care activities to licensed practical nurses or dialysis technicians:

• • cannulation of peripheral vascular access;
    
    
  • administration of intradermal lidocaine, intravenous heparin and intravenous normal saline; and
    
    
  • initiation, monitoring and discontinuation of the dialysis process.

Utah Admin. Code 432-650-7(5).

Additionally, this section clarifies that “Each ESRD facility must ensure that all personnel are licensed, certified or registered as required by the Utah Department of Commerce.”

Utah Admin. Code 432-650-7(6).

Read the statutory prohibitions and penalties for misuse of the term “nurse” in Utah and a checklist to reduce your risk.