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AUTHORITY IN THE CCU

A common problem in CCU care is determining who has the duty to care for a patient and who has the authority to direct the patient's care. The admitting physicians and their associates may write orders and make care decisions, the CCU nurses make many medical decisions using standing orders, residents and fellows may be responsible for the patient's care between visits by the attending physician, and specialty consultants may write orders for specific problems. In some CCUs there is no single person with the sole responsibility for the patient's care or the authority to coordinate all of the care rendered to the patient.

Unlike this medical model of "the more the merrier," the law uses the "too many cooks spoil the broth" model. The basic premise of tort law is that legal liability must be vested in specific individuals in relation to their duty to the patient. When a patient is injured, the patient's attorney will sue all of the persons involved with the aspect of the patient's care that went wrong.

The court must sort out the tangle of overlapping authority and hold one or more persons liable for the patient's injuries. The problem is that the court may see responsibility for the patient's care in different terms than the CCU team. For example, members of the medical staff committee who approve CCU standing orders could be liable for patient injuries caused by the nursing staff's inability to apply the protocols properly.

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