CLINICAL LAB SCIENEC

CHAPTER 2: LABORATORY PERSONNEL CREDENTIALING AND FACILITY ACCREDITATION 49
The training and supervising of personnel, maintenance of equipment, documenting
of quality control results, and record-keeping for test procedures require a
medical technologist as the supervisor. But in some states, a laboratory with this
scope of practice may require a site license by the state agency responsible for
ensuring competence and accuracy of results produced, as well as establishing
adherence to state laws and regulations. Requirements would most likely include
a site license, which would result in periodic site visits to inspect the operations
to ensure compliance with policies and procedures for a full-scale laboratory.
Laboratory professionals at the technician level are currently legally allowed
by most states to perform only those tasks that are routine and repetitive. This
provision would also be consistent with the requirements by CLIA 88 that match
the complexity of the procedures with the level of technical personnel required
for laboratory testing. In most states, this level of worker must be supervised at
all times by a technologist. The technician is often not allowed to perform emergency
work or to do work that requires a great deal of interpretation and subjective
judgment as determined by most regulatory agencies. One argument against
this requirement preventing certain processes by a technician is that some of
the requirements are too stringent and that automation removes some of the
variables that would require troubleshooting or the interpretive skills of a highly
trained professional such as the technologist.
At one point several years ago, a dramatic attempt was initiated by certain
special interest groups to require that only the supervisor had to have formal
training or to possess any kind of credentials. He or she would then be able to
hire any applicant, regardless of the level of or lack of training, and simply vouch
for the results produced, certifying that they were accurate. It appears this would
create a dangerous precedent, and a step backward for the laboratory profession,
since an environment would be created in which the bench worker would have
little or no training, and the work would be performed in a fragmented manner,
with each person trained to perform only a few specific tests or to perform only
some of the steps of a laboratory test. Fortunately for medical laboratory professionals,
this suggestion has apparently been abandoned.
The laboratory seems to be the only allied health profession that allows so
many and varied alternate routes to credentialing. In contrast, the pharmacy
does not allow its pharmacy technicians to eventually take the pharmacy board
examinations following a certain level of experience. The ward clerks and nursing
assistants do not automatically qualify to take the registered nurse examination
with no further training by virtue of having worked in the nursing field for
a given period of time. Although they do inspect all departments and functions
within the hospitals, another important organization that is vitally interested in
the credentialing of health care professionals is TJC. TJC, as well as other agencies
that inspect and accredit health care facilities, does not certify the competence
of personnel. However, TJC usually leaves the matter of credentialing of
personnel to the local facility or the respective state governments, if there are any
regulations governing these professions in a certain locale. TJC does not mandate
any specific level of training and education but merely ensures that state
requirements for the credentialing of medical laboratory workers as well as all
of the other professionals working in the facility are met. But because there are
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