Delegation to an Unlicensed Assistant During the Doctor's Absence
Dr. R practices in Las Cruces with one unlicensed optometric assistant. On a busy afternoon, Dr. R leaves the office for 30 minutes to pick up lunch and is not reachable by phone. During that time, the assistant performs automated refraction and noncontact tonometry on three patients, instills tropicamide for a dilated fundus exam, and-when a patient with a red eye asks-uses a slit lamp to remove a superficial corneal foreign body. The assistant also inserts a punctal plug for a dry-eye patient. The assistant has been trained informally by Dr. R but has no certification. The office policy manual says 'assistants may perform any task the doctor delegates.' A patient later calls with pain and blurred vision after the foreign-body removal. Dr. R returns and finds the schedule backed up and the assistant documenting the procedures in the electronic record.
1. Which of the assistant's acts could lawfully be delegated under New Mexico rules, and which could not? Explain the distinction.
Read the worked answer
New Mexico permits unlicensed optometric assistants to perform certain noninvasive, delegated tasks under the optometrist's supervision, but the scope is not unlimited. Automated refraction and noncontact tonometry are typically delegable screening tests. Instilling a mydriatic is a diagnostic procedure that may be delegated only if the Board's rules and office protocol allow it and the assistant is trained; it requires appropriate supervision. Removing a corneal foreign body and inserting a punctal plug are invasive procedures within the optometrist's scope and may not be delegated to an unlicensed assistant. The office policy that 'assistants may perform any task' is invalid. Dr. R's absence also matters: delegated acts requiring direct supervision cannot be performed while the optometrist is off-site and unreachable.
2. What level of supervision was required, and how should the documentation have reflected it?
Read the worked answer
Supervision must match the task. Noninvasive testing may be performed under general supervision in some settings, but direct supervision-meaning the optometrist is physically present and available-is required for tasks that carry more risk, such as instillation of diagnostic drugs or any procedure near the eye. Dr. R was out of the office and unreachable, so even the arguably delegable tasks were performed without the required backup. The assistant should not have proceeded with the foreign-body removal or punctal plug. The documentation should identify who performed each task, under whose supervision, and what was found. A vague note signed only by the assistant is inadequate.
3. What are Dr. R's responsibilities after the patient reports pain and blurred vision?
Read the worked answer
Dr. R is responsible for the acts delegated to the assistant. The immediate priority is patient safety: examine the patient with pain and blurred vision, document the findings, treat or refer as needed, and inform the patient of the error. The office should preserve the records, revise the policy manual, retrain staff, and stop any unlicensed invasive practice. Depending on the harm and Board rules, Dr. R may need to report the incident to the Board or carrier. The Board can discipline Dr. R for aiding unlicensed practice and for inadequate supervision; the assistant may also face consequences for practicing without a license. 'The doctor delegates, the doctor owns the result' is the practical rule.