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Referrals and Consultations

Consulting and referrals with midwives are complicated because the tort law generally assumes that physicians are in charge whenever they work with nonphysician personnel in medical settings. A physician who consults on a case for a midwife is in a very different legal position than if the consultation were for another physician. If the consulting physician determines that physician procedures or prescription medications are necessary, carrying out these recommendations is the responsibility of the attending physician. With no attending physician, the responsibility remains with the consultant because the midwife cannot deliver the necessary care. The physician must ensure that the patient appreciates the limitations of the midwife's authority and understands the necessity for the recommended care and that it can be delivered only by a physician. Since a consultation, even for limited tasks such as ordering screening blood tests, creates a physician-patient relationship, the physician may have a duty to render the needed treatment if requested by the patient.

Referrals from midwives are less problematic than consultations because the physician will assume responsibility for the patient's ongoing care. There must be a good working relationship that ensures that referrals are made before the patient's medical condition deteriorates. In the ideal medical arrangement, the midwife and the physician discuss each new patient to evaluate future medical needs. The midwife then confers with the physician whenever something unusual develops in the patient's condition. Legally, such close cooperation would result in the physician's being found liable for the patient's medical care. If the physician is confident of the midwife's skills and judgment, assuming liability for the care is preferable to not being involved in the prereferral care.

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