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DELEGATION OF AUTHORITY

There are three issues to consider when delegating authority: (1) the legality of the delegation, (2) the proper method of delegation, and (3) the physician's oversight responsibilities for the delegated duties. These issues must be considered within the context of the three classes of medical tasks.

The first class is tasks that are freely assignable; they are not unique to medical care delivery and do not require the exercise of professional judgment. They include billing and patient accounts, maintaining simple medical equipment, and other nonpatient care activities that accompany the practice of medicine. The supervising physician must ensure that the activities meet the necessary legal standards for protecting patient confidentiality and any other statutory requirements.

The tasks in the second class are those that may be assigned to a limited class of persons. These tasks such as nursing activities and laboratory analyses, require professional skills and judgment. They also may include activities that require physician supervision, such as taking clinical information from patients.

Activities in the third class of medical tasks are reserved solely to physicians; delegation may violate criminal laws against aiding in the unauthorized practice of medicine. These activities include performing surgery, directly supervising nonphysician personnel in physician-only activities, and writing prescriptions for controlled substances. State law and tradition determine which specific activities cannot be delegated, but generally nonassignable tasks involve the exercise of independent medical judgment.

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