CLINICAL LAB SCIENEC

52
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
emergency medical technicians, dentists, and physical therapists, must be licensed.
But in a profession such as medical laboratory technology, with the potential to
do great harm to an individual, some states do not require licensure or even formal
education and some sort of credentialing, such as by examination. Economic
factors that are cited by higher-level administrators (CEOs of hospitals) and loss
of control cited by pathologists seem to be the crux of the arguments against
personnel licensure. This is more of an emotional statement by some than a fact,
but the argument for personnel licensure does in many cases hold some merit.
CLIA 88 as federal legislation attempted to address problems in the quality
of laboratory services as opposed to quality of personnel. CLIA is more
convinced that the laboratory director is able to judge competency and that
adequate proficiency testing would remedy poor practice in the medical laboratory.
However, results of proficiency testing for accuracy can be performed by
the best-trained and most competent personnel in the laboratory, yet do not
necessarily address incompetent and poorly trained or untrained personnel.
CLIA on the surface tended by this position to weaken (relax) staffing rules,
and this occurred at the same time that more POC testing was being performed
by untrained or ancillary health care personnel. Bedside testing with more portable
and sophisticated equipment is an area toward which medical laboratory
personnel are usually adamantly opposed as an encroachment on their territory,
particularly in light of their quest for more professional recognition and for
personnel licensure.
Through use of pressure by both influence and lobbying, special-interest
groups such as the manufacturers of these instruments designed for bedside testing
are of kindred mind with CLIA, intimating that extensive training is not
necessary for performing many of these tests. Of course, manufacturers would
like to sell more of the expensive portable machines. Although revenue would
be taken from the laboratory, and laboratory technical personnel are the experts
who calibrate and document results and perform preventive maintenance (without
any reimbursement to the laboratory), the actual procedures of this sort are
easily performed by properly trained personnel other than medical laboratory
technicians and technicians. It is not just turf protection for some professionals,
as they do not see any shifting of specialized work to other less-trained personnel
occurring to any great extent in other health care professions, such as nursing.
Current Efforts to Gain State Personnel Licensure
An example of the hurdles that must be overcome to legislate state licensure of
personnel is given by Nebraska. Nebraska does not currently have personnel
licensure regulations, but an extremely difficult and rigorous process is required
to ascertain the need for personnel licensure before a legislative bill can be proposed.
Requirements that must be met require the following proofs. There must
be sufficient potential harm to the public by the practice of procedures by unlicensed
personnel in the given profession. Practitioners must be independent and
not require strict supervision. And finally, the scope of practice must be clearly
defined so it is readily distinguishable from the scope of practice for another
profession.
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