In the Medical Laboratory Technology Act, 1991, controlled acts authorized to medical laboratory technologists are defined as follows:
4. In the course of engaging in the practice of medical laboratory technology, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to take blood samples from veins or by skin pricking. 1991, c. 28, s. 4.
Additional requirements for authorized acts
5. (1) A member shall not perform a procedure under the authority of section 4 unless the procedure is ordered by a member of the College of Physicians and Surgeons of Ontario or the Royal College of Dental Surgeons of Ontario or by a prescribed person. 1991, c. 28, s. 5 (1); 1997, c. 9, s. 5.
Controlled Acts and Scopes of Practice
In their scope of practice, health professionals may be authorized to perform one or more controlled act. Some professions are not authorized to perform any controlled acts.
Controlled acts may only be performed by health professionals in their practice if: the controlled act is authorized to them; or the controlled act is delegated to them by a health professional who is authorized to perform it; or an exemption exists.
1. Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.
2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.
3. Setting or casting a fracture of a bone or a dislocation of a joint.
4. Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.
5. Administering a substance by injection or inhalation.
6. Putting an instrument, hand or finger, beyond the external ear canal, beyond the point in the nasal passages where they normally narrow, beyond the larynx, beyond the opening of the urethra, or beyond the labia majora, or beyond the anal verge, or into an artificial opening into the body.
7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act.
8. Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.
9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.
10. Prescribing a hearing aid for a hearing impaired person.
11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.
12. Managing labour or conducting the delivery of a baby.
13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response.
Under the RHPA, no profession has a monopoly over any of the controlled acts. This regulatory structure allows for evolution in professional scopes of practice, and is emulated in other provinces in Canada and other jurisdictions around the world.
MLT Scope of Practice
The practice of medical laboratory technology is the performance of laboratory investigations on the human body or on specimens taken from the human body and the evaluation of the technical sufficiency of the investigations and their results.
MLTs are authorized in the practice of their profession (subject to any restrictions that may have been imposed on his or her certificate of registration) to take blood samples from veins or by skin pricking, which is a part of the controlled act of performing a procedure on tissue below the dermis.
The CMLTO receives numerous inquiries from MLTs regarding scope of practice and it has developed resources about delegation and medical directives and Frequently Asked Questions-MLT scope of practice.
Although performing a procedure below the dermis is a controlled act, there are a number of exemptions in the RHPA and other legislation. Specifically, regulations under the RHPA exempt acupuncture, ear or body piercing for jewellery, electrolysis, cosmetic tattooing and male circumcision for religious tradition. In addition, regulations under the RHPA exempt taking of a blood sample from a vein or by skin pricking if done by an employee of a lab or specimen collection centre licensed under the Laboratory and Specimen Collection Centre Licensing Act, 1990
This exemption allows medical laboratory assistants and medical laboratory technicians (MLA/Ts) to perform phlebotomy in licensed laboratories.
In addition to the 13 specific controlled acts under the RHPA, a harm clause applies generally to the provision of health care:
“No person, other than a member treating or advising within the scope of practice of his or her profession, shall treat or advise a person with respect to his or her health in circumstances in which it is reasonably foreseeable that serious physical harm may result from the treatment or advice or from an omission from them.”
This clause applies to those aspects of treatment and care that may not be otherwise covered by the controlled acts. For example, performing laboratory tests on human specimens is not one of the controlled acts under the RHPA. However, it is reasonably foreseeable that serious physical harm could result if this were done by someone other than a regulated health professional working within his or her scope of practice.