Minimizing Liability Risk When Supervising Medical Assistants in Arizona (1)
  • Practice Management

Minimizing Liability Risk When Supervising Medical Assistants in Arizona

Running a practice requires support but it is important to understand the liability for the actions of your medical assistants on staff in Arizona.

Paul J. Giancola and Claudia E. Stedman from the Law Offices of Snell & Wilner

03/06/2023

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

A: Unlicensed staff include front and back office personnel as well as medical assistants (MAs). Although MAs are unlicensed, as will be discussed below, they must satisfy certain education requirements and adhere to their scope of practice. MAs play an important role in today’s marketplace as these individuals, when used correctly, can optimize the efficiency of a practice in the increasingly value-based healthcare environment.

The Bureau of Labor Statistics has estimated that between 2020 and 2030, the job market for MAs will grow at a rate of 18 percent.1 In the face of health care staffing shortages, especially during the pandemic, physician practices often wonder how they can best utilize MAs and other unlicensed staff to help shoulder the daily workload.

Unlicensed staff with great customer service skills can improve patient-practice relationships while they answer telephone calls, conduct patient outreach, perform patient intakes, and assist with scheduling, insurance, and payment.

However, these advantages can go hand-in-hand with risk if physicians and practices fail to properly supervise these individuals and/or permit them to perform duties outside their scope. In medical professional liability lawsuits, the medical practice and supervising clinician can be held legally responsible (vicariously liable) if the MA is negligent (for example, administering the wrong type or dose of medication) or exceeds the scope of practice. In addition, supervising clinicians can be disciplined by their licensing boards for failure to appropriately supervise MAs.

Scope of Practice for Medical Assistants

MAs are not permitted to make independent medical assessments or give medical advice to patients. They cannot interpret test results, give IV medications, administer conscious sedation, prescribe or refill medications independently, or perform any treatment that would constitute the practice of medicine. Physicians, physician assistants (PAs), and nurse practitioners (NPs) must provide direct supervision of medical tasks and monitor the quality of the MA’s work. The Arizona statutes and regulations that govern a MA’s scope of practice are described in further detail below.

Physicians, PAs, and NPs are responsible for evaluating the skill level and capabilities of each MA they supervise. Supervisors must ensure that any task delegated to a MA is within the MA’s scope of practice and appropriate for his/her skill level. It is important that supervisors not delegate duties if the individual is not trained or qualified to perform the task. Additionally, there should be constant communication between the supervisor and the MA about expectations, quality control, and duties. Close supervision and frequent communication are essential to ensure that MAs stay within their scope of practice and provide safe, appropriate care.

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

A: Unlicensed front office and back office personnel, even if trained, should not perform any medical procedures unless they also meet the statutory requirements for being a medical assistant. A.R.S. § 32-1401(16) defines “medical assistant” as an unlicensed person who has completed an education program approved by the Arizona Medical Board, assists in a medical practice under the supervision of a physician, PA, or NP and performs delegated procedures commensurate with the assistant’s education and training. The statute further specifies that a MA “does not diagnose, interpret, design, or modify established treatment programs or perform any functions that would violate any statute applicable to the practice of medicine.” 

Prior to employing a MA, physicians and PAs who will be responsible for direct supervision of the MA are legally required to ensure that the MA completed one of the following training requirements:

    • an “approved MA training program;”

    • an unapproved MA training program and pass the MA examination administered by either the American Association of Medical Assistants or the American Medical Technologists;

    • a U.S. Armed Forces medical services training program;

    • prior to February 2, 2000, completed an unapproved MA training program and subsequently was employed as a MA; or

    • prior to February 2, 2000, was directly supervised by the same physician, physician group, or physician assistant for a minimum of 2000 hours.2

An “approved MA training program” is:

In addition, Arizona law limits the medical procedures a MA can perform and requires “direct supervision” by a physician, PA, or NP. “Direct supervision” means that the physician, PA, or NP must be available for consultation regarding the delegated task by remaining in the same room or office suite as the MA.4

Tasks for Medical Assistants

MAs can perform the following under the direct supervision of a physician, PA, or NP5:

    • take bodily fluid specimens;6
    • administer injections.7
    • whirlpool treatments;8
    • diathermy treatments;9
    • electronic galvation stimulation treatments;10
    • ultrasound therapy;11
    • massage therapy;12
    • traction treatments;13
    • Transcutaneous Nerve Stimulation unit treatments;14
    • hot and cold pack treatments;15
    • small volume nebulizer treatments;16
    • perform venipuncture and blood draw;17
    • perform capillary puncture;18
    • conduct pulmonary function testing;19
    • electrocardiography;20
    • conduct patient screening;21
    • perform dosage calculations;22
    • apply pharmacology principles to prepare and administer medications;23
    • maintain medication and immunization records;24
    • perform CLIA waived hematology, chemistry, urinalysis, microbiological and immunology testing;25
    • screen test results;26
    • obtain specimens for microbiology testing;27
    • obtain patient history;28
    • document patient care;29 and
    • render first aid.30

MAs can perform the following tasks without direct supervision by a physician, PA, or NP:

    • billing and coding;
    • verify insurance;
    • make patient appointments;
    • perform scheduling;
    • record physician findings and transcribe materials in patient charts and records;
    • perform visual acuity screening as part of a routine physical; and
    • take and record patient vital signs and medical history.31

A person using the title “medical assistant” or similar abbreviation is guilty of a class 3 misdemeanor if that person does not work under the direct supervision of a physician, PA, or NP or does not provide written verification of successful completion of a training program.32

Risk Management Takeaways

To reduce the risk of liability and licensing board discipline when working with medical assistants, clinicians and practices should:

    • ensure direct supervision of MAs performing medical tasks;

    • limit medical tasks delegated to MAs to those permitted by statutes and rules;

    • limit medical tasks delegated to MAs to those within the particular MA’s competency;

    • maintain written documentation of the MA’s training and education;

    • test and document the MA’s competencies at the time of hire and annually;

    • document annual performance reviews for unlicensed staff; and

    • develop written MA job descriptions that incorporate statutory limits on MA scope of practice.

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

[1] https://www.bls.gov/ooh/healthcare/medical-assistants.htm.

[2] A.A.C. R9-16-401(A); R4-22-403. The Arizona Board of Nursing also requires that a Registered Nurse Practitioner who delegates patient care to a MA in an office or outpatient setting verify that the MA meets one of these same qualifications. A.A.C. R4-19-509(A)(1)-(5).

[3] A.A.C. R4-22-401(A)(1), (2), & (4); R4-16-101(3); A.R.S § 32-1456(D)(1)-(4). In addition, under Rules applicable to osteopathic physicians, an approved training program includes one accredited by any accrediting agency recognized by the U.S. Department of Education. A.A.C. R4-22-401(A)(3).

[4] A.R.S. § 32-1401(8).

[5] When a RNP delegates any of these tasks to a MA, the MA must first demonstrate competency in that particular task. A.A.C. R4-19-509(B).

[6] A.R.S. § 32-1456(A).

[7] Id.

[8] A.A.C. R4-19-509(B); R4-22-402(B); R4-16-402(B).

[9] Id.

[10] Id.

[11] Id.

[12] Id.

[13] Id.

[14] Id.

[15] Id.

[16] Id.

[17] A.A.C. R4-19-509(B); R4-22-402(B); R4-16-402(A).

[18] A.A.C. R4-19-509(B); R4-22-402(A); R4-16-402(A).

[19] Id.

[20] A.A.C. R4-19-509(B); R4-22-401(B); R4-16-402(A).

[21] A.A.C. R4-19-509(B); R4-22-402(A); R4-16-402(A).

[22] A.A.C. R4-19-509(B); R4-22-401(B); R4-16-402(A).

[23] Id.

[24] A.A.C. R4-19-509(B); R4-22-402(A); R4-16-402(A).

[25] Id.

[26] Id.

[27] Id.

[28] Id.

[29] Id.

[30] Id.

[31] A.R.S § 32-1456(C).

[32] A.R.S. §32-1456(E)