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Improper Supervision

The second major class of risks involving medical students are involves injuries resulting from improper supervision. These injuries may occur because of improper delegation of authority by the staff physicians, or they may occur because of unauthorized care rendered at the initiative of the student. In the first situation, the staff would be legally liable because they authorized the medical student's overreaching behavior. The student would also be liable if it could be shown that the student knew or should have known that the actions were improper. In the second situation, the staff would be liable for failing to supervised the student properly, and the student would be liable for failing to supervise the student properly, and the student would be liable for failing to supervise the student properly, and the student would be liable for taking unauthorized initiatives. In both situations, the student's actions would precipitate the lawsuit, but students are seldom named as defendants. The hospital and the supervising physicians are the usual defendants in these lawsuits.

Most medical malpractice suits are pieced together from the medical records after the charts have been "completed." At this point, all the student's orders will have been cosigned, and the entries will be legally attributed to the supervising physician. The supervising physician will be estopped from denying the validity of these orders because the countersignature legally shifts the liability from the student (and the nursing personnel who take the orders) to the staff member. The countersignature process is routine and often lags the execution of the student's orders by the nursing staff. This puts the hospital in the legal position of depending upon after-the-fact ratification of the student's orders. This can be very risky if the order causes immediate harm and the supervising staff member refuses to countersign it. The liability for the injury will then lie with the nurse for carrying out the unauthorized order and with the hospital for failing to supervise the nurse properly.

All nonphysician medical personnel--whether in a hospital, clinic, or individual practice--must be cautioned never to accept orders from a medical student without specific authorization by a licensed physician. If the authorization is verbal, it should be entered into the medical record as a voice order, that, "1 grain codeine by mouth, voice order Mr. Smith, confirmed by Dr. Jones." Dr. Jones will then cosign the order as required by the applicable hospital or practice protocol.

All members of the medical and nursing staffs should be apprised of the legal problems associated with the exercise of medical judgments by medical students. The students themselves should be warned that although the hospital and supervising physicians will usually be the defendants, plaintiffs' attorneys are beginning to name students as parties to lawsuits. This is especially true when the injury occurs because of an unauthorized action initiated by the student.

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