Supervising Medical Students and Residents
Although 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. [Colford JM Jr, McPhee SJ. The ravelled sleeve of care: managing the stresses of residency training. JAMA. 1989;261:889–893.]
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. [Asch DM, Parker RM. The Libby Zion case: one step forward or two steps backward? N Engl J Med. 1988;318:771–775.]
Most private physicians do not appreciate the risks of working with an improperly supervised teaching program. Improperly billing for work done by students or residents may subject the physician to civil and criminal prosecution for Medicare/Medicaid fraud. In addition, teaching programs are increasingly the target of medical malpractice litigation and the courts have held that staff can be liable for the actions of the residents they supervise:
[m]edical professionals may be held accountable when they undertake to care for a patient and their actions do not meet the standard of care for such actions as established by expert testimony. Thus, in the increasingly complex modern delivery of medical care, a physician who undertakes to provide on- call supervision of residents actually treating a patient may be held accountable to that patient, if the physician negligently supervises those residents and such negligent supervision proximately causes the patient’s injuries. [Mozingo by Thomas v. Pitt County Mem’l. Hosp., Inc., 415 S.E.2d 341, 345 (N.C. 1992).]