Disclaimer: Practice guidelines provide licensees with general guidance to promote good practice. Law, rules and regulations, not guidelines, specify the requirements for practice and what may constitute professional misconduct.
Introduction
The State Board for Clinical Laboratory Technology and the State Education Department have developed the attached Practice Alerts to provide useful information on good and recommended practices in the professions by Clinical Laboratory Technologists, Cytotechnologists, Certified Clinical Laboratory Technicians, and Certified Histological Technicians. This information about good practices explains and clarifies what can be found in law, rules, and regulations, and other guidelines, such as the Q and A’s found on the OP website for the professions. This information is not a substitute for an understanding of the laws, rules, and regulations governing the practice of these professions in New York State, but can help clinical laboratory technology professionals better understand what might lead to professional practice complaints and to take steps to eliminate or minimize those situations. Practice guidelines and practice alerts can benefit licensees and consumers by broadening their understanding of the statutes and regulations that define professional practice, including professional misconduct and unprofessional conduct.
These Practice Alerts focus on the issues of professional responsibility and conduct and do not address matters of civil liability, which are outside the jurisdiction of the Regents and the Department.
Practice alerts can help practitioners comply with the Rules of the New York State Board of Regents to promote good practice.
Practice alerts do not have the force of law. Therefore, while the Practice Alerts may be a resource in assessing conduct that underlies a violation, they may not be used as the basis for a charge of or defense against a charge of professional misconduct. A licensee can only be charged with professional misconduct if there is a violation of the Education Law or Regents Rules. Determinations of which complaints lead to professional misconduct charges are made on a case-by-case basis by the Professional Conduct Officer in accordance with Section 6510 of the Education Law.
Ethical Practice
When laboratory practitioners make professional judgments, their decisions are based on a reflection on consequences and on universal moral principles. A respect for individuals as unique persons is the most fundamental of these principles. Other principles deriving from this core principle are: upholding ethical practices, avoiding harm, honesty, maintaining professional responsibility, treating persons fairly, respecting privileged data, confidentiality, self-determination as to professional competency, and personal and professional integrity.
The primary goals and values of the profession indicate a profession’s acceptance of the trust and responsibility with which it has been empowered by society and serve to inform both laboratory practitioners and society of the profession’s expectations and requirements in ethical matters. An ethical code provides a framework within which laboratory practitioners can make ethical decisions and fulfill their responsibilities to the public, to other members of the health team, and to the profession and to adhere to the laws, rules and regulations governing the practice of the professions.
Laboratory practitioners strive to protect the health, safety and rights of their patients. They are individually responsible and professionally accountable for the test results that they produce and provide to the patient’s authorized health care practitioners to aid in detection, diagnosis, and treatment of disease. They are also responsible to preserve their own safety and integrity.
To respect the legal and ethical obligation of clinical laboratory practitioners to protect the safety of patients, those licensees who are serving in managerial positions or in supervisory positions should make adequate provisions for competent staffing to ensure necessary patient care in routine situations.
Voluntary Overtime/Multiple Employers/Objection to Work Assignments
Literature from broadly based research from many professions shows the direct correlation between numbers of hours worked and the effects on job function and rates of error. Laboratory practitioners, who are mandated to work beyond their normally scheduled hours or who work for multiple employers, should know and be able to demonstrate that they are competent to perform their professional responsibilities.
The decision to accept a work assignment must be based upon a critical judgment by the laboratorian of the laboratorian’s ability to provide competent patient care. When a laboratorian is given an assignment that is beyond the clinical laboratory practitioner’s level of physical or professional competence, the laboratory practitioner should immediately notify the first-line supervisor in writing of the objections and reasons for not being able to accept the assignment.
Patient Confidentiality
Privacy is a patient right. Under various laws, rules and regulations, laboratory practitioners have a legal responsibility to safeguard patient information, including personal data, medical history, diagnosis, treatment and financial situation, and to ensure that access to information is denied to any unauthorized person or entity.
Unless disclosure is required or permitted by law, patient information should not be shared with any other person without the patient’s written permission.
Patient information, written or electronic, must be kept secure from loss, theft or unauthorized access, use or disclosure. Confidential information should be kept out of unauthorized view and stored in a secure environment. Care should be taken not to discuss patient information within the range of hearing of unauthorized persons.
Some tests, such as HIV and genetic tests, have additional disclosure protections found in the New York State Public Health Law or New York State Civil Rights Law. Practitioners working with HIV or genetic tests should know what the confidentiality requirements are and make sure that all of the staff are aware of the requirements.
Under section 29.1(b)(8) of the Regents’ Rules, it is unprofessional conduct to reveal personally identifiable facts, data or information obtained in a professional capacity without the prior consent of the patient or client, except as authorized or required by law. Violators of this rule may be subject to charges of unprofessional conduct.
Confidentiality of patient information has a central role in the practice of the professions, but in some instances laboratory results must be reported without requiring the consent of the patient, such as, for some court orders or subpoenas obtained for investigations by the Office of Professional Discipline. The disclosure of patient information also is permitted by many laws, rules and regulations, such as some provisions of the federal HIPAA law, provisions related to insurance reimbursement, and provisions related to mandatory reporting for public health purposes, e.g., pesticide poisoning, blood lead levels, communicable diseases, cancer, occupational lung disease, and heavy metal registries. Clinical laboratory technology practitioners may not be directly responsible for reporting this information, but should be aware of these mandates to ensure privacy of patient information and accuracy in reporting at those times when they have this responsibility.
References
- Section 29.1(b)(8) of the Rules of the Board of Regents on Unprofessional Conduct
- HIV (Article 27 of the Public Health Law)
- Genetic test results (§79-L. of the New York State Civil Rights Law)
- www.wadsworth.org/regulatory/clep/laws
- www.health.ny.gov/professionals/reportable_conditions/cancer/index.htm
- www.health.ny.gov/regulations/nycrr/title_10/part_22/#s224
- www.health.ny.gov/regulations/nycrr/title_10/part_22/index.htm#s226
- www.health.ny.gov/regulations/nycrr/title_10/part_67/#sec6
Supervisors and Supervision
Definitions. As used in this section, the term “supervisor” would have the following meaning: a person within an authorized clinical laboratory who has the authority to direct and control the work performance of a licensed clinical laboratory practitioner or unlicensed persons.
There are several situations in which clinical laboratory technology practitioners serve as supervisors. Laboratory supervisors may be responsible for supervising:
- clinical laboratory technologists
- cytotechnologists
- certified histological technicians
- certified clinical laboratory technicians
- phlebotomists
- laboratory assistants and other unlicensed persons
- persons gaining experience for licensure purposes
- persons in training situations
The supervisor is ultimately responsible for quality control and may, in some instances, be held accountable for the professional services being provided by the person being supervised. While there are differences in the various forms of supervision, clinical laboratory technologists who provide clinical supervision are engaged in the practice of clinical laboratory technology.
When a clinical laboratory technologist agrees to serve as a supervisor, specific areas should be addressed before entering into the supervisory role so that all parties understand their duties and obligations. The nature and terms of the relationship should be spelled out in advance, including the supervisor’s ultimate responsibility to the person receiving supervision, issues of confidentiality, etc. This ensures efficiency and accuracy of results and timely and safe services to the public.
Supervisors should recognize that they could, in some instances, be held accountable for the services provided by the employee. The inappropriate action or incompetency of an employee could be the basis for charges brought against the supervisor where supervision was not adequate.
Section 6509(7) of Education Law states that “permitting, aiding or abetting an unlicensed person to perform activities requiring a license” constitutes professional misconduct. Accordingly, laboratory testing may only be delegated to persons who are authorized by law to perform the delegated test. The fact that an unlicensed person may know how to perform the test does not confer the legal authorization to engage in an activity that is restricted to licensed persons. Licensed professionals who delegate a professional task to a person who is not legally authorized to perform such a task may be guilty of professional misconduct. Such tasks must be performed by licensed persons who, by virtue of their education and licensure, possess the level of professional judgment and assessment skills that will ensure safe practice.
A licensed clinical laboratory technology practitioner may be asked to perform supervisory duties, and you should be aware that the New York State Department of Health has requirements for supervisors and supervision. Subdivision (a) and (d) of 10 NYCRR 58-1.3 (Clinical laboratory supervision), provide as follows:
(a) A clinical laboratory shall have one or more supervisors who, under the general direction of the laboratory director, supervise technical personnel and reporting of findings, perform tests requiring special scientific skills, and, in the absence of the director, are responsible for the proper performance of all laboratory procedures.
(d) The supervisor shall be on the laboratory premises during all hours in which tests are performed. An exception to the on-premises requirement shall be applicable with respect to the performance of procedures required for emergency purposes; provided, that the person performing the test qualifies as a medical technologist, the results of his work are reviewed by the supervisor or director during his or her next duty period, and a record is maintained to reflect the actual review.