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Introduction

While only a few physicians are full-time members of medical school faculties, most physicians have to deal with students and residents, at least occasionally, when they hospitalize or refer a patient. It is important for physicians to understand the extent to which they may rely on students and residents to care for patients. Improper delegation of authority to students and residents can subject attending physicians to medical malpractice liability, license review, and criminal investigation. The case of Libby Zion is a rare but poignant reminder of the risks of improper supervision in a medical teaching situation.[88]

Libby Zion, a young woman in generally good health, was admitted to a New York hospital for an acute illness. She died several hours later, after questionable care from residents who had been on duty for an extended period. A grand jury investigation found no criminal conduct but recommended shorter hours and more supervision for residents.[89]

Most private physicians do not appreciate the risks of working with an improperly supervised teaching program. There are few large malpractice verdicts against teaching programs. There are, however, many cases in which a teaching program, protected by governmental immunity, is dropped from the case for a token settlement, leaving the private physician to fight the case alone. Improperly billing for work done by students or residents may subject the physician to civil and criminal prosecution for Medicare/Medicaid fraud.

[88]Colford JM Jr; McPhee SJ: The ravelled sleeve of care: Managing the stresses of residency training. JAMA 1989; 261:889-893.

[89]Asch DM, Parker RM: The Libby Zion case: One step forward or two steps backward? N Engl J Med 1988; 318:771-775.

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