Explicit Delegation of Authority
Explicit delegation of medical authority occurs when a physician uses protocols to authorize NPPs to render medical care directly to patients. The physician is allowing the NPP to practice medicine by following written protocols that allow the extender to determine the physician’s judgment in the specific limited situation. This works well if both physicians and extenders understand that all medical judgments must be made by physicians. Under the law in many states, NPPs may not substitute their personal judgment in any decision that requires medical judgment. Even if a state allows NPPs to practice independently, any physician nominally directing their actions will be legally liable for their malpractice if it involves an error in medical judgment that relates to the physician’s supervision. For example, assume the physician is expected to perform periodic chart reviews. The physician could be liable for not discovering substandard care that injures a patient.