• E-mail
• Print
• RSS

Liability issues with resident physicians

Compliance Monitor, September 1, 2006

Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!

Q:I work in a multi-specialty, free-standing ambulatory surgery center and I am concerned that our residents are not credentialed. At the beginning of the year, I receive a list of residents from our university scheduled to come in for a three-month rotation. I am also worried about liability. Should patients be aware that a resident will be participating in their procedure? Does the attending have to be physically present in the operating room while a resident is working? Can a resident write orders and prescriptions?

A: First, I am assuming these residents were credentialed by their academic medical center.

Second, I suspect your ambulatory surgery center (ASC) performs its own credentialing. If the ASC is not affiliated with the academic medical center and does not perform its own credentialing, it should start doing so immediately. Alternately, your ASC should seek contractual assurances from the academic medical center regarding the credentials of each resident assigned to the ASC.

Third, the ASC needs to be sure that the academic medical center's professional liability coverage includes coverage for events that take place outside of the academic medical center, including at the ASC. Based upon the facts presented, this is not a moonlighting activity by a resident (for which the physician would need to obtain separate coverage) but instead this appears to be part of his or her usual clinical rotation. Make sure there is sufficient liability coverage for residents.

Fourth, the informed consent form should include the name of any physician, including residents, who may treat a patient on a particular day, and include each of the potential negative occurrences that could result from the procedure.

Fifth, Medicare has certain rules for physician supervision of residents. While a physician does not have to be physically present in an operating or procedure room at all times, there are limits on how many residents a physician can supervise as well as requirements for the attending physician to be in the operating room for the critical portion of a particular procedure. An attending physician should also be immediately available to return to the procedure if necessary.

Finally, a resident is a licensed physician and therefore can write orders and prescriptions and can dictate reports. As I've just described, there are requirements that teaching physicians must adhere to for Medicare in order to get reimbursed for his or her activities. If your ASC is independent, you should immediately begin discussions with the academic medical center providing residents and ensure that these issues are addressed in contractual form. Ensuring that these steps take place will protect the ASC, the academic medical center, and the residents involved.

Thanks to Bruce D. Armon, Esq., a partner with the Philadelphia-based law firm Saul Ewing LLP, for answering this week's question on medical staff issues. Bruce specializes in healthcare law and frequently speaks to physician and healthcare audiences. He can be reached at  barmon@saul.com.

This question first appeared in Compliance Monitor's sister publication, Medical Staff Legal Advisor.

Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!

• E-mail to a Colleague
• Print
• RSS
• Archive