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).]
