The legal doctrine of informed consent is directed at physicians. The courts have not found a duty for hospitals or other providers to get informed consent, holding that this always flows to the physician. [ Ward v. Lutheran Hosp. & Homes Soc’y of Am, Inc., 963 P.2d 1031 (Alaska 1998).] This has interesting ramifications as MCOs increasingly provide care without direct physician involvement. From the court decisions, it is clear that any failures in informing the patients of the risks of such treatment will be charged against either the supervising physician, or, in the absence of a clearly identified supervising physician, against the medical director.

In a great irony, the courts have not extended the duty of informed consent to alternative healers or chiropractors. Many states impose only a limited duty on them to inform the patient of the risks of their treatments or the advisability of seeking medical care for conditions that cannot be treated by the modalities offered by the alternative healer.