Jerry McCall Dr. Williams Office Assistant Licensed Practical Nurses and Medical Assistants: Legal and Ethical Implications

According to recent reports from the U.S. Bureau of Labor Statistics, medical assistants and licensed practical nurses (LPN) are two of the fastest growing jobs in the country (Bureau of Labor Statistics, 2010). In an effort to save costs, the demand for these professionals is increasing in both in-hospital and outpatient settings. The licenses and registrations, however, remain unstandardized; while LPNs are required to receive a license, some medical assistants receive a one or two-year degree and still others are only trained on the job. The responsibilities and restrictions of the profession are likewise only loosely regulated and vary between states. This has both ethical and legal implications for patient care. The following case scenario illustrates these ramifications and discusses the appropriate course of action for medical assistants working in a clinical setting.

The Case:

Jerry McCall is an office assistant in an outpatient physician's office. He has received professional training as both a medical assistant and LPN. He is the only person in the office when a patient calls and says he must have a prescription refill for Valium called in immediately to his pharmacy. He says that he is leaving for the airport in thirty minutes and that the physician, a close friend of his, customarily gives him a small supply of Valium when he has to fly.

Qualifications of the Profession:

The qualifications of LPNs and medical assistants are variable and often vague in interpretation. This is especially the case with respect to authorizing prescription refills. Based on Jerry's medical training alone, he is not qualified to independently issue this refill order. According to the American Association of Medical Assistants, however, medical assistants are permitted to authorize...

In this case, this definition is vague. While direct supervision is not present, the patient's chart may have a note that specifically attends to this situation. Jerry may have spoken to the physician about this patient in the past and come to an agreement that a refill of the prescription for this particular patient is appropriate. A study that reviews the management of prescription refills in primary care has shown that LPNs and medical assistant commonly perform this task and are capable of making accurate decisions with respect to medical refill requests (Ferrell, Aspy & Mold, 2006). This, however, is the product of continuing on-the-job education not provided by their professional education.
Critical Circumstances:

Critical circumstances do not change Jerry's medical job qualifications. If the patient requested medication for controlling high blood pressure that he critically needs on a daily basis, Jerry may have a more difficult ethical dilemma, but nonetheless has no authority to authorize the refill. This is based on the assumption that the situation is precisely the same as described in the case scenario. If the high blood pressure is a critical problem, the patient is likely to have an extensive medical history with the physician. In that case, the patient chart will have the name, and dose of the medication as well as the date of the last prescription refill. This scenario along with a standing permission from the physician to authorize drug refills may permit Jerry to make the authorization.

Legal Implications: Rule Respondent Superior

Medical assistants and LPNs working in a physician's office generally fall under the Rule Respondent Superior, which states that the physician holds liability for any damages incurred to a third party by any of his "servants" or "inferiors"…