June 2008

Fact or fiction?
State pulls together for immunization bill

A state society works relentlessly as a team, in constant communication with members, developing relationships with legislators and drug company representatives to support the medical assistant's right to practice.

Fact or fiction? All fact.

The Washington State Society of Medical Assistants successfully organized to get a bill passed that permits CMAs (AAMA) to administer oral immunizations in their state.

How did they do it?
We asked WSSMA President Tom Wolf, CMA (AAMA), and WSSMA Vice President Pat Hightower, CMA (AAMA), to share their insights about how their state accomplished such a monumental task.

What was the catalyst?
We were alerted by a broadcast fax sent to all physicians and clinics in the Seattle area from their public health department identifying two new vaccines, Gardasil (human papillomavirus vaccine) and RotaTeq (rotavirus vaccine, live, oral, pentavalen), which had recently been funded for purchase by the Washington State legislature.

The fax gave guidelines for administration with special notes referencing the RotaTeq vaccine since it was oral. What caught our eye was this last paragraph:

Please note that in Washington State, medical assistants are not authorized to administer oral medications, nor can it be delegated to them by a physician or nurse practitioner.

A few weeks later our state health officer sent a letter to all health care providers offering further clarification.

Our Health Care Assistant Law, which only addresses invasive procedures (and includes more than 12 professions), did not cover this. It was the legal opinion of the Washington State Department of Health (DOH) that only physicians and nurses had legal authority to administer the vaccine and all oral medications.

What was the progression of events?
Our state had its annual conference two weeks after receiving the notice. Our Board of Trustees addressed the matter at our post-convention meeting. A draft rebuttal letter was prepared and reviewed by AAMA Executive Director and Legal Counsel Donald A. Balasa, JD, MBA. Word went out to the chapters and their members. Within a few weeks, clinics were calling the Washington State DOH for clarification and concern that they did not have the nursing staff to support this decision.

How did you get the word out to members?
Communication with members was mainly done through e-mails to the BOT members to pass on to their chapter members. We also sent e-mails announcing the best time to blast the legislative and committee members to support the bill.

If you knew what you know now, what would you change?
If we had developed a better working relationship with the Washington State DOH, maybe they would have consulted our organization prior to coming down with their decision. Also, would have liked to have more knowledge about the legislative process. We were thrown into trying to get a bill passed, learning as we went.

What worked to your advantage?
We were lucky to have the support of the Washington State Medical Association (WSMA), which covered the expenses, including preparing the proposal, obtaining a sponsor, and lobbying. We were also fortunate to have a well maintained state legislative web page that could be monitored daily.

Besides those voting on the bill, who did you contact to support this cause, and how did you decide to engage them?
This all came down in a firestorm. The WSMA took the lead. They had physicians throughout the state complaining that children were not receiving the vaccine because they didn't have the staff (nurses) to administer it. In some cases large clinics weren't even ordering the vaccine from the state because of short-staffing.

The physicians wanted it fixed fast. The WSMA set up a meeting with the Washington State DOH and several other concerned organizations to come up with a plan.

The WSSMA sent out rebuttal letters to several county health departments and had opened up dialog with the Washington State DOH so they knew we were a "player" in the process.

Other agencies involved included the Washington Chapter of the American Academy of Pediatricians, the Immunization Action Coalition of Washington, the Washington Association of Community Migrant Workers, and even MedImmune, the manufacturer of the vaccine.

Members of the AAMA were encouraged to talk with their employers. Those who were in large clinics kept not only the MDs, but the pharmacy directors informed, and encouraged them to support the bill.

Roles of CMAs (AAMA) explained in MPM Journal

In its March 2008 issue, the Journal of Medical Practice Management published "Roles for CMAs (AAMA) Enhance Quality and Effectiveness of Care" written by AAMA Executive Director and Legal Counsel Donald A. Balasa, JD, MBA. The article describes a new frontier for the profession.

You may share the article. Greenbranch Publishing, LLC, publisher of the Journal of Medical Practice Management, has granted AAMA affiliates permission to send the article to local and state medical and specialty societies. You may write your own news story or use the following language and link:

In its March 2008 issue, the Journal of Medical Practice Management published "Roles for CMAs (AAMA) Enhance Quality and Effectiveness of Care" written by Donald A. Balasa, JD, MBA, executive director and legal counsel for the American Association of Medical Assistants. The article explains how employing the CMA (AAMA) is "proving to be a cost-effective way of providing high-quality care." The article also describes a new frontier for the profession, detailing how researchers are exploring new roles for the CMA (AAMA) that will enhance efficiency and patient compliance.

If you would like to request a free sample issue of MPM Journal, you may do so at http://www.mpmnetwork.com/forms.cfm?id=18.