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EMERGENCY ROOM STAFFING

The presence of an emergency room in a hospital gives the members of the medical staff of that hospital many legal duties. The accreditation requirements for hospitals include extensive regulations for emergency services. The medical staff as a group have responsibilities to provide certain services to the hospital and its patients. These responsibilities go beyond the care of the patients whom the individual physician has admitted. If being a staff member in the internal medicine section requires taking referrals from the emergency room, then internists have relinquished the right to choose not to accept such referrals. They have a duty to accept and care for the ER patient as though that patient was their own.

The duty to accept ER referrals is sometimes ignored by physicians who do not wish to accept emergency calls or who are on the staff of too many hospitals. A staff physician cannot refuse a call or deny care to emergency patients if this is required as a condition of medical staff privileges. If a patient with head trauma is brought to the hospital and the emergency room physician determines that a neurosurgeon is needed, the staff neurosurgeon must provide care for the patient. If the neurosurgeon refuses to attend the patient, he or she is liable for any injury to the patient that results from the delay or lack of care. If the emergency physicians and the hospital staff committees do not discipline medical staff members for refusing ER referrals, they too are liable for any resulting patient injuries. Physicians who violate their obligations to treat emergency patients also are subject to fines under federal law.

Residents who are moonlighting in an emergency room must be independently licensed and evaluated for privileges through the regular medical staff process. Their status as residents is irrelevant to their private, unsupervised practice. If residents are working in the emergency room as part of their training, they must be properly supervised. No matter how long the residency or how great the skills of a particular resident, a resident in training may not be given primary responsibility for the care of patients. There must be a qualified physician who is responsible for both the resident and the patient care. (See Chapter 15.) Supervising physicians do not have to be with the resident all the time, but they should be cautious about how much authority they delegate to the resident. A telephone consultation in the middle of the night may be adequate, but in serious situations, the supervising physician should be with the patient.

Many hospitals now contract with physician groups to provide emergency medical services. These services may be limited to the emergency room, or they may include some intensive care or resuscitation duties. Usually the contracts specify financial arrangements, confer staff appointments on the members of the group, and specify the responsibilities of the rest of the medical staff in providing specialty services and follow-up for patients seen by the emergency medicine physicians. Such contracts do not relieve the hospital or the remainder of the medical staff of responsibility for the amount or quality of care provided in the emergency room.


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