Q&A: Liability and scope of practice

June 12, 2008

Q: What are the legal implications for physicians who supervise other health care professionals – such as nurse practitioners in “minute clinics” or physicians’ assistants – whose scope of practice has changed in recent years?

“Insurers are seeing a dramatic increase in the number of claims against non-physician practitioners. Where there is a requirement of physician supervision, the supervisors are almost always part of the lawsuit. There are several approaches to reduce this kind of a claim. First, it is vital that we all advocate for clear standards and protocols that ensure patient safety. Second, the members of the care team must be certain as to their roles as team members. Finally, the supervisory relationship must provide for unfettered, open and frequent communication among the team members. Communication is so important that it should not be left to chance; rather, the team should establish a structure that provides for frequent interchange.”

—Edward J. Christiansen, Esq.

Vice President and Chief
Risk Officer, Boston
Medical Center

“Taking patients away from their ‘medical home’ takes away the continuity of care, which can end up being dangerous. I have a great nurse practitioner alongside me, and I review everything she does. I may not always be present, but I’m never more than 5 minutes away. There’s a big difference between knowing the patient very well and remotely managing a possibly critically ill patient I don’t know. Some clinics only have an off-site doctor, hired by a big corporation, who doesn’t know my patients – I’m no legal expert, but it seems like a lawsuit waiting to happen. And it would be my liability, my license on the line.”

—Katherine Atkinson, M.D.

Family practitioner,
Amherst

“It’s going to be important for physicians of the future to be more of a coach or team leader to control quality while allowing other health professionals to share their traditional scope of practice. With a shortage of physicians willing to focus on primary care, we need to delegate more to nurse practitioners and other allied health professionals. If we could move toward joint and several liability provisions where liability is apportioned rather than concentrated on the one with the greatest assets or insurance, it would go a long way to making the system fair for all. The focus has to be on delivering safe, high quality care in a timely manner.”

—Richard T. Moore

State Senator, D-Uxbridge, Chair of the Health Care Financing Committee

“Liability can arise from accusations of failure to use due care in hiring, supervising or continuously evaluating a nurse practitioner or physician’s assistant. Liability insurance and a properly drafted indemnification agreement with the ‘minute clinic’ owner can protect the physician to a large degree.
In any event, the physician remains a tempting lawsuit target as a party with insurance and a ‘deep pocket.’ The implications for medical licensure can be far more serious. The Board of Registration in Medicine takes an expansive view of physician conduct subject to its oversight. The accusation of failure to adequately supervise would fall squarely within the type of conduct the Board investigates.”