Chapter 1: Requirements for Medical Laboratory Technologists

Duty of the College Under the Medical Laboratory Technology Act

The NSCMLT is our regulatory body. The responsibilities of the NSCMLT are described in broad terms at the beginning of the Medical Laboratory Technologists Act (Section 5). The college protects public safety by ensuring that the aspects of professionalism discussed in the introduction—competence, integrity, and respect—are upheld by MLTs in Nova Scotia.

To ensure professionalism, the NSCMLT licenses all MLTs in Nova Scotia. Without a licence, no one can be employed as an MLT or use that professional designation, and the title MLT is reserved for our profession; no other profession can use it. To ensure that the licence to practise is meaningful, the college:

• Requires specific educational qualifications and a minimum level of relevant ongoing continuing education
• Provides guidance for and access to relevant continuing education resources
• Defines what tasks MLTs are competent to perform (scope of practice)
• Provides a code of professional conduct
• Ensures that the requirements of the MLT Act, by-laws, and regulations are met
• Deals with complaints and reports of professional misconduct and imposes disciplinary measures where necessary

The primary function of the College is to protect the safety of the public, who rely on MLTs for accurate test results. The MLT Act and the College specifically exist to protect the quality of laboratory testing—to ensure that our profession helps to provide exemplary health care in Nova Scotia. While this means that the College is not there to protect us, our rights, our jobs, or our salaries, the activities of the NSCMLT do protect our scope of practice and raise our public profile. It’s to our advantage and our professional responsibility to support the NSCMLT.

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Duty of the Medical Laboratory Technologist

Our designation as a self-regulated profession means that we have a formal agreement with government with a legal foundation. This agreement is based on the belief that we have the knowledge, ability, and good judgment to regulate ourselves, and indicates significant respect and trust on the part of government. While the NSCMLT is the regulatory body that does the administrative work, it is the members of the College—the licensed MLTs working in Nova Scotia—who have primary responsibility for ensuring that we keep our side of the agreement.

You may be familiar with the phrase “ignorance of the law is no excuse.” Clearly, no one can be sure of meeting the requirements of legislation and regulations without knowing what they are, and therefore this handbook and the materials available at the NSCMLT website are an important resource. It’s your responsibility to be familiar with the MLT Act and the conduct required of you by the College, and to respect those requirements.

The key purpose of all this is to ensure that every MLT is competent and fit to practise in our profession. There are a number of things that you can do to maintain your competency and keep yourself current on events in your profession:

• Support the NSCMLT and CSMLS— volunteer, attend meetings, visit the websites
• Keep current with technology that affects your work—read the literature, take continuing education courses
• Attend seminars, workshops, education days, conventions
• Share knowledge with colleagues

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Liability Insurance

It’s uncommon for an MLT to be found liable in a medical malpractice suit— uncommon, but not unheard of. We tend to think of insurance as something we buy to protect ourselves, and we weigh the cost against the likelihood of ever making a claim. From that perspective, choosing not to have professional liability insurance might seem a rational decision. The NSCMLT, however, requires that we have liability insurance in order to practise medical laboratory science in Nova Scotia. Why? Let’s compare this requirement with something we’re already familiar with in daily life

Scenario:

You have a perfect driving record. You’ve only had one accident in your entire life and it was the other driver’s fault. You have a good automobile insurance policy that includes liability insurance (mandatory) and insurance to cover your late-model car in the unlikely event that you are in a collision and are found at fault.

One day you are sitting at a red light when another vehicle hits you from behind and pushes you into oncoming traffic. The resulting three-vehicle accident leaves you with back injuries that will prevent you from working for a very long time, perhaps permanently, and your car is a write-off.

The car that hit you was what you might call a beater. Rusty, dented, and with questionable brakes, it was virtually worthless. The owner of the car did not carry collision insurance to cover his own car, but he did have liability insurance, perhaps only because we are required to by law. You’ll get a generous insurance settlement, so at least you won’t have to live in poverty, now that you’ve lost your income and have significant medical expenses. If the other driver had not had liability insurance, your predicament would be very much worse.

This is why MLTs need liability insurance in our professional practice. Your professional liability insurance is not for your protection, although it does protect you to some extent. It’s really for the protection of any person who suffers harm because of your actions as an MLT. Without liability insurance, you could be held personally financially responsible in a judgment that goes against you. This would not benefit the injured party much, however, because the average MLT could never come up with the money required to replace someone’s salary, or pay expensive medical costs for an extended period of time. That’s what professional liability insurance is for.

Scenario:

A woman is diagnosed with cervical cancer at an advanced stage despite having had a recent negative Pap smear result. Her cancer has spread to lymph nodes, she requires extensive chemotherapy, and her prognosis is poor. A review of the earlier smear reveals abnormal cells.

A lawsuit is filed, naming both the laboratory and the cytotechnologist who read the recent Pap smear. The case goes to trial and the woman is ultimately awarded damages in the hundreds of thousands of dollars for pain and suffering, and loss of income.

The woman’s prognosis cannot be changed, but she and her family are fortunate that both the laboratory and the cytotechnologist held liability insurance. She’ll receive some compensation for her ordeal.

When we recall that the College exists to protect the public, it makes sense that we are required to hold professional liability insurance. Liability insurance is available from various insurance companies; however, it can be expensive because of the potential for settlements in the millions of dollars. Fortunately, we can obtain it through the CSMLS for a very minimal cost. The most current details of professional liability insurance provided through the CSMLS, as well as contact information, are available on the CSMLS website: www.csmls.org.

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Mandatory Reporting

Have you ever found yourself in a situation where you felt you had to speak up about someone else’s actions? In the practice of medical laboratory technology, as in daily life, we may encounter inappropriate behavior by others. Some of these situations carry a legal obligation to make a report to the proper authorities such as the NSCMLT or a government agency. For example, the NSCMLT prescribes a code of professional conduct; if you observe professional misconduct by someone else, your obligation to the code requires that you report the misconduct to the College.

In virtually all instances, you’ll report incidents to your employer first, but it may not be enough to leave it there. Remember that the situations described here carry a legal requirement to report, so ensure that you have fulfilled that requirement

Scenario:

You’re working evenings in mid- December, and you’re looking forward to heading home as your replacement arrives humming Frosty the Snowman and handing out marshmallow Santa’s to everyone she meets. As you receive your treat, you catch a whiff of alcohol on her breath and you gasp as she knocks several lab coats to the floor while searching for her own. You realize that your co-worker has been drinking and is impaired. What should you do?

It’s likely that your employer has a strict policy about employees working while impaired by alcohol or drugs, but even if that isn’t the case, you must ensure that your co-worker does not work in this condition. Depending on the circumstances, you may have to remain on duty until someone is able to replace you, to ensure that urgent tests are covered.

Of course you cannot hide this incident from your employer, nor should you. You must also, however, report it to the College. This task may be onerous for you; few people relish the idea of reporting something that may cost a friend or colleague their job. However, failing to report it is also professional misconduct, because an MLT who works while impaired endangers not only patients, but also coworkers and even her- or himself. It is your professional obligation to inform the appropriate people so that it doesn’t happen again.

As health care professionals, MLTs may become aware of other types of risk or harm to others in the course of our work. Nova Scotia has various pieces of legislation aimed at protecting vulnerable individuals; any person who knows or suspects that another is in danger is required by law to report the situation.

Scenario:

You are a licensed (MLT) self- employed phlebotomist who goes to people’s homes to collect blood. Upon entering a new client’s residence, you find it in deplorable condition. Every room of the house is filled with garbage, paper, clothing, and other items; it’s infested with flies and overrun by rodents. Your client sits in a padded reclining chair, surrounded by unwashed dishes and empty food containers. You realize that because there is no clear path, he cannot possibly use the walker that sits nearby. Clearly, these surroundings are unsafe in a number of ways.

The Adult Protection Act requires us to report an adult in need of protection, and this includes an adult that is unable to care for him- or herself. We can debate the point at which someone should intervene in cases such as this, and argue that individuals have the right to live as they please; however, if you honestly think that a person is at risk, you have a duty to report it.

Similarly, if you observe what appears to be workplace abuse, abuse of a patient by another health care worker, or any other abusive or dangerous situation, you can’t choose to look the other way. You must report it. As long as you don’t make the report maliciously, there will be no negative consequences for you, even if authorities decide that no action is required.

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Situations where you have a duty to make a report

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Conclusion

Employers should always be made aware of abusive and dangerous workplace situations; however, both the NSCMLT and practising MLTs in Nova Scotia also have obligations under the MLT Act, and the by-laws and regulations. These obligations ultimately focus on safety—the safety of the public, and of ourselves and others in the workplace.

While the NSCMLT provides guidelines and standards, and deals with incidents when they occur, MLTs must try to ensure that those incidents don’t occur, and report them to the proper authorities if they do.

In addition, other legislation requires that we make reports in specific circumstances.

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