The Unlicensed Assistant Alone in the Lane
A Kansas optometrist owns a busy practice with three examination lanes. A high school graduate with three months of on-the-job training works as an optical assistant. The assistant instills proparacaine, performs applanation tonometry, obtains OCT scans, and tells patients whether the scans are "normal or abnormal." The optometrist is usually in another lane and reviews the results later. On a Saturday, the optometrist leaves the office for 30 minutes to pick up lunch; the assistant continues testing and instills a second drop in a patient with a known corneal abrasion. The assistant also fits a trial soft contact lens on a new patient. The practice has no written delegation policy. The assistant has not been certified by any board.
1. Identify which tasks may be delegated under Kansas Board rules and which may not. What level of supervision is required?
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Unlicensed assistants may perform certain mechanical or automated tests - visual acuity, keratometry, OCT image capture - under supervision, but they may not diagnose, interpret results, or independently tell patients a scan is normal or abnormal. Instilling a topical anesthetic is administration of a drug; whether an assistant may do so depends on the Board's delegation rule and the optometrist's written protocol. Applanation tonometry may be delegated if the Board permits it and the optometrist is available to supervise; an off-site lunch break is not direct supervision. Contact lens fitting is part of optometry and may not be delegated to an unlicensed person. The assistant's statements about normal or abnormal scans are especially problematic.
2. What corrective and reporting steps should the optometrist take?
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Stop the unauthorized activities immediately, provide retraining, and create a written delegation and supervision policy that lists permitted tasks, required supervision, and documentation. Review affected patient records and arrange optometrist interpretation of any tests the assistant described. If the conduct may have harmed a patient or constitutes unlicensed practice, consult the Board and legal counsel about reporting obligations. Do not simply backdate or alter records. Document the corrective action. The owner should also ensure the assistant is not held out as certified and should audit whether drug administration is occurring without proper authority.