The PMA Identity Crisis: Where Do We Go From Here?
A Closer Look At The Existing Documentation On Assistant Duties
Susan Scanlan, DPM, the Executive Director of the Washington State Podiatric Medical Association (WSPMA), directed me to a Department of Health Web site to read WAC 246-922-100: Acts that may be delegated to an unlicensed person. This was a great start. They also utilize the common verbiage, “… duties may be performed only under the supervision of a licensed podiatric physician and surgeon.” However, they also provide a laundry list of acceptable tasks that non-licensed personnel can do which includes (but is not limited to):
• patient education in foot hygiene;
• deliver a sedative drug in a oral dosage form to the patient;
• give preoperative and postoperative instructions;
• take health histories;
• measure the patient’s blood pressure;
• perform a plethysmographic or Doppler study;
• assist in obtaining material for a C&S test;
• take scrapings from the skin or nails of the feet;
• debride keratotic tissues of the foot;
• remove and apply dressings and/or padding;
• produce impression casting of the foot;
• “prepare” the foot for anesthesia as needed;
• apply a flexible cast (e.g., unna boot);
• apply cast material for immobilization of foot and leg; and
• remove sutures, debride nails and other instructional protocols.
The aforementioned ASPMA pamphlet also lists a number of duties that focus on what a “certified” PMA could perform. Interestingly enough, while certification may pump up a sense of professionalism and self-esteem, it provides no legal status or endorsement (except for taking X-rays in less than a handful of states). In effect, the duties listed can be performed by any PMA, provided of course that the PMA’s supervising doctor feels he or she is trained and capable.
Andrew Feldman, the General Counsel to the New York State Podiatric Medical Association (NYSPMA), provided me with a document from the New York Education Department, dated 1/9/03, that specifically concerns certified assistants for a podiatrist.
This document does not recognize a “certified assistant” for a podiatrist and PMAs are referred to only as “unlicensed personnel” or “unlicensed assistant.” The document refers to PMAs in these terms “because they have met no particular qualifications” and giving them a title such as “podiatric assistant” could create a “misconception.” Essentially, without an identified scope, they are not officially recognized.
Mr. Feldman’s memo refers to the “Office of Professions” Web site which addresses what an (unlicensed) assistant may do. These duties involve helping the patient on and off the treatment chair, removing bandages, taking the patient’s history and vital signs, and performing duties “which are not considered the practice of podiatry.” It states that the podiatrist may not delegate surgical procedures or ultrasound treatment to unlicensed personnel.
However, this memo does recommend the podiatrist consider several factors including supervision, responsibility and pathology before delegating a task. As per the memo, podiatrists should:
• remain in the podiatric office where the services are being performed;
• personally diagnose the condition to be treated;
• personally authorize the procedure; and
• evaluate the services performed by the unlicensed person prior to dismissing the patient.
Since the licensed podiatrist “must assume responsibility and accountability” for the services performed by the unlicensed assistant, it is also recommended that DPMs exercise prudent judgment in assigning tasks. What is the bottom line? If an unlicensed assistant is given authority to perform tasks that (specifically) require a license, these actions could result in charges of professional misconduct.
I also contacted the PICA Group, a malpractice insurance company in Tennessee, in order to find out from PICA how a PMA with no written scope of practice fits into the risk management picture of health care. PICA cannot offer a list detailing what a PMA can and cannot do, according to Barbara Bellione, PICA’s Director of Risk Management.
However, she does say that podiatric assistants should have appropriate education and training in the tasks they are to perform and be able to demonstrate competency in those tasks prior to performing them.