Drawing Without a License
Phlebotomists Get Little Training, Regulation
By Ranit Mishori
Special to The Washington Post
Tuesday, June 1, 2004; Page HE01
When you get your blood drawn, the person who tells you to roll up your sleeve and make a fist may have a professional manner and be dressed in medical scrubs. That doesn't mean he's been to medical school or nursing school . . . or any school at all. In most parts of the country, including the Washington area, phlebotomists -- workers who take blood in a medical setting -- are governed by few rules or none at all.
Unlike your hairdresser, your cosmetologist and even the aromatherapist down the street -- most of whom are licensed by some authority -- the person probing for a vein may have only a few days of on-the-job training.
"Most patients don't realize that the person sticking the needle in their arm today could have been flipping burgers last week," said Dennis Ernst, a veteran phlebotomist who runs a phlebotomy resource center in Ramey, Ind. The consequences -- in mistakes made and injuries to patients -- can be dire: contaminated samples that have to be redrawn, false positive results, incorrect medication doses, fractures, nerve damage and worse. And while the great majority of us will never face a blood-draw injury worse than a sore arm, the potential for harm has proven real.
The virtual absence of regulation for this field often comes as news even to people knowledgeable about the medical field. "I was a little surprised to hear [from a reporter] that phlebotomists have not been required to be licensed by states," said Carnegie Mellon University health care economist Martin Gaynor. "My impression was that most folks practicing in the health area have been required to be licensed a long time ago."
Phlebotomy -- the word is derived from the Greek for "vein cutting" -- matters because blood matters, in some ways more than it used to. The list of problems that can be identified by analyzing blood is amazingly long: cancer, diabetes, cholesterol, high lead levels, infections, anemia, kidney failure and heart attacks, for starters.
According to the American Society for Clinical Pathology, "an estimated 80 percent of physicians' decisions are based on laboratory test results," most of these involving blood tests. By one estimate, Americans underwent more than 1 billion blood draws last year.
That is why 58-year-old Ken Peloquin of Reston went back to school to learn to draw blood after being downsized out of middle management at a Virginia medical supply firm. And why he expects no trouble finding work, and why so many job-seekers are likely to follow him.
Said Frankie Harris-Lyne, who runs the medical lab technician and phlebotomy programs at Northern Virginia Community College Medical Education Center, where Peloquin is a student: "We can only accommodate 15 students per class, or 30 per year," she said. "Currently we have approximately 50 students placed in the major, and that number continues to grow."
Peloquin and his classmates will have an edge over the competition in that they have actually gone to school to learn their profession. Most phlebotomists don't. Only California and Louisiana have training and monitoring standards for phlebotomists.
Ernst knows the harm an unskilled phlebotomist can do, having served as an expert witness at dozens of lawsuits involving phlebotomy injuries. "There's a repeating pattern of errors that inflict permanent injuries," he said.
© 2004 The Washington Post Company
Blood Simple: Little Area Regulation|
There are no licensing or certification requirements for phlebotomists in the District, Virginia or Maryland. Here is how health authorities in each jurisdiction responded to phone and e-mail queries on the matter.
The District The Health Professions Licensing Administration (HPLA), which oversees health and medical licensing in the District, is planning to draft "legislation to license and regulate the profession," said Leila Abrar, a spokeswoman for the Department of Health. Abrar declined to say what prompted this step or when it might happen.
Virginia Elizabeth Carter, executive director of the Virginia Board of Health Professions, wrote in an e-mail, "Thus far, there has been no study on phlebotomists, per se."
Maryland According to public policy analyst Karen Wulff, the state's Board of Physician Quality Assurance, a subgroup of the body authorized to license some health professions, such as medical radiation technicians, respiratory care practitioners and physician assistants, "did consider whether there should be oversight/training requirements for phlebotomists, but concluded that such standards, training, etc. were not needed. The rationale was that phlebotomy is a technical act that does not require medical judgment and does not put the patient at significant risk."
-- Ranit Mishori