Off-Site Health Screenings by Assistants
Q.: May a chiropractic assistant take blood pressure, use Myovision, scan for orthotics or perform other screening tasks in the community, such as at a health fair, without the doctor present?
A: The Medical Practice Act permits a physician to delegate patient care tasks to unlicensed personnel in an office or practice setting and within a physician-patient relationship; however, the Medical Practice Act does not contain a specific provision addressing delegation of tasks outside of the office. In response to a query from the ICS, the Illinois Department of Financial and Professional Regulation (IDFPR) states that it “has concerns about ‘health screenings’ being offered by unlicensed and unsupervised persons outside of medical or chiropractic practice settings.” The IDFPR has provided guidance regarding a physician’s use of unlicensed personnel for off-site activities, making a distinction between objective and subjective activities. An unlicensed assistant may provide general information or perform objective measurements off-site but may NOT perform subjective activities offsite, as defined below.
May an Unlicensed Assistant Perform Subjective Tasks Off Site?
No. – A screening that includes identifying the presence of certain conditions or making recommendations for treatment is prohibited because those activities require a license under Section 49 of the Medical Practice Act. The IDFPR states: “For an example of the latter, a spinal check would appear to be a subjective activity.” Thus, an unlicensed assistant may not perform a spinal check off-site, and the physician who directs the assistant to perform off-site spinal checks could be subject to license discipline for aiding and abetting the unlicensed practice of medicine.
Because off-site health fair screenings do not take place in the office setting, and usually do not involve the physician’s established patients, delegation of subjective tasks under this arrangement does not meet the requirements of the Medical Practice Act. However, within an office, a physician may delegate patient care tasks or duties to an unlicensed person who possesses appropriate training and experience, provided a health care professional, who is practicing within his or her legal scope, is on site to provide assistance.
May an Unlicensed Assistant Perform Objective Tasks Off Site?
Yes. – A physician may direct an unlicensed assistant to perform objective tasks out of the office. The IDFPR cites the dissemination of general information and performing of objective measurements as examples of these types of permitted activities. The ICS interprets this guidance to mean that an unlicensed assistant, located off-site and out of the presence of the employing physician, may take blood pressure, weight, height, etc., so long as the assistant provides only the numerical results.
However, the assistant may not provide any conclusion as to the meaning of the numbers, nor make a recommendation to seek medical attention as a result of the reading, because that activity would be subjective, as defined by the IDFPR, and would cross the line into the unlicensed practice of medicine. Similarly, an assistant could perform a scan for an orthotic fitting, but the assistant may only report the raw result of the scan. The assistant would cross the line if he or she provided any conclusion about the scan or the need to seek orthotics or other medical treatment based on the result.
Note: this answer is based on the IDFPR’s response to the ICS inquiry about off-site screenings by unlicensed assistants. On May 9, 2018, the IDFPR has stated that it is standing on that response and will not issue further guidance.