Jerry Mccall Dr. Williams Office Assistant Licensed

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 refills given a direct supervision or permission from the physician (Couch, Minchella, Walker & Watson, 2008). 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" (Overton, 1957). This law, however, is meant to apply only to wrongful acts that are within the scope of the assistant's employment; that is, the responsibilities he is being compensated for. Here again, the legal implications of Jerry's case are vague because it is unclear whether he has the physician's permission to authorize the refill. If he does and there is a written consent in his employee contract that explicitly allows him to authorize drug refills, then Jerry is protected against a lawsuit if the patient has an adverse reaction while flying. However, if Jerry does not have permission or the supervision of the physician can be placed in doubt, Jerry is not protected.

Legal and Ethical Issues: Recommended course of action

In this specific case, it appears that the omission of treatment carries less risk than the possibility of committing an illegal action with the prescription refill authorization. It is unclear from the case description whether Jerry has permission from the physician to authorize refills. The way the request is made, however, with a special emphasis that the physician is a friend of the patient, makes this situation suspect and unlikely to be documented in an official patient chart. From a legal point-of-view, it would be recommended not to authorize the prescription in order to avoid even the suspicion or possibility of misconduct. Jerry should attempt to reach the physician by phone to ask permission. If the physician is not reachable, Jerry should not make the authorization. Granted, this case has significant ethical implications. On one hand, Jerry could be withholding medications from a patient and thereby undermine his well-being. As a medical assistant, his professional pledge is to enhance the health and well-being of the patient. Jerry would compromise this pledge by enhancing the patient's anxiety. On the other hand, he could be giving a powerful medication to a potential misuser in an uninformed and irresponsible decision.

The specific job qualifications associated with an education as medical assistant and LPN are vague with respect to authorizing medication refills. Generally, this responsibility is restricted to physicians, nurse practitioners and physicians' assistants (Hershey, 1965). However, in many states, the physician may permit the medical assistant to complete this task and takes legal liability for his decision under the doctrine of respondent superior. In the specific case presented, it is unclear whether permission or sufficient patient history exists to authorize the prescription. Jerry faces an ethical dilemma in his decision. Given the medical implications and possible consequences of a powerful drug such as Valium, and the uncertainty over the legality of authorizing a prescription refill, it is recommended that Jerry decline the request.