"AA state practice laws, are not competent nor allowed in any arena to render any care with out an MDA."
Thats like saying nurses are not competent nor allowed to give morphine without a doctors order.
Its a no-and-yes answer.
Any nurse should know how to push morphine and competent to do it, yet they must have a doctors order. Its not like if suddenly once a nurse obtains an doctors order they remember how to administer it, and without an order they are suddenly clueless incompetent people.
Even you must know that being competent is one thing, while being allowed to do something is another thing.