Liability of physicians supervising nonphysician clinicians.

Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.

[Legal aspects of delegation and reorganisation of medical services in the psychiatric field]. / Rechtliche Aspekte von Delegation und Neuorganisation ärztlicher Tätigkeiten im psychiatrischen Fachgebiet.

Current psychiatric-psychotherapeutic in-patient care takes place in an area of tension between increasing treatment requirements and the persistent lack of qualified staff. The optimisation of the diagnostic-therapeutic procedures in a clinic helps to reduce existing care deficits or to generate resources for future developments. The subject of delegation and substitution of medical services is considered in this context. Inadequate knowledge of the legal situation on the part of the decision makers impairs the indispensable trustful cooperation among the professions and adds to the uncertainty of all those concerned. The present paper outlines the legal, organisational and health policy aspects of delegation and the reorganisation of medical activities in the field of psychiatry.

[Definition of the core area of medical services in the psychiatric-psychotherapeutic field--the prerequisite for any delegation]. / Definition des Kernbereichs ärztlicher Tätigkeit im psychiatrisch-psychotherapeutischen Fachgebiet--Voraussetzung für jede Delegation.

Based on legal jurisdiction, knowledge of the psychiatric-psychotherapeutic field and insight into the necessity of a new allocation of responsibilities in the overall therapeutic service of a clinic, the core areas of medical activities are defined for the first time, innovative organisational approaches to the reorganisation of therapeutic service are presented and discussed against the background of qualified staff deficit, introduction of an OPS coding for inpatient psychiatry and economic constraints.

[Delegation of medical responsibilities to non-medical personnel. Options and limits from a legal viewpoint]. / Delegation ärztlicher Aufgaben auf nichtärztliche Berufsgruppen. Möglichkeiten und Grenzen aus rechtlicher Sicht.

Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. In the German health system there is no legal norm which clearly and definitively describes the field of activity of a medical doctor. Fundamental for a reform of the areas of responsibility between physicians and non-medical personnel is a terminological differentiation between instruction-dependent, subordinate, non-independent assistance and the delegation of medical responsibilities which are transferred to non-medical personnel for independent and self-determined completion under the supervision and control of a physician. The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.

Ultimate doctor liability: a myth of ignorance or myth of control?

Ultimate medical doctor responsibility for the care delivered to patients by all professionals is a myth. Legally Lord Denning dismissed the myth in the mid-20th century in England. The assumption that a medical doctor is responsible for the care delivered by nurses has not existed in English and Australian law since that time, and it has been actively refuted. Yet it is a myth that continues to circulate influencing health service, state and federal health policy. For some it is a myth of ignorance and for others it is a means of control. This paper outlines the relevant case law to debunk the myth of ultimate medical doctor control.