Risk Management

Resident Supervision

By Paul Weber, JD

OMIC’s vice-president of risk management

Digest, Spring, 2002

Many OMIC insureds participate in teaching programs and supervise ophthalmology residents in the clinic, the operating room, and the emergency room. Resident supervision is an integral part of passing on the knowledge and skills of the ophthalmology profession, but it requires a delicate balance between providing adequate supervision and allowing sufficient independence for the resident’s skill to grow. Occasionally, OMIC insureds incur claims related to their supervision of residents, which raises liability issues about the adequacy of the ophthalmologist’s supervision and the resident’s qualifications to diagnose and treat patients.

Q  Can I be held liable for an injury caused by a resident whom I am supervising?

A  If a supervising physician misjudges a resident’s abilities or assigns a task that he or she knows the resident cannot carry out competently, the physician may be held liable for the resident’s actions if they result in an injury to the patient. 

Q  Aren’t residents considered “full-fledged” physicians who are licensed and qualified to provide medical care, including ophthalmic care?

A  Residents are not board certified in a specialty. They may be just weeks into their residency or nearing completion. Some courts apply an intermediate standard to residents somewhere between a general practitioner and a fully trained specialist with that degree of skill, learning, and care possessed by other medical residents under similar circumstances. Other courts have said that the duty owed to the patient does not vary according to the doctor’s individual knowledge or education and that patients have the right to expect the same quality of care found in the general medical community.

Q  Isn’t the hospital or teaching institution primarily responsible for resident supervision?

A  The employer entity may be found vicariously responsible for the actions of residents just as it would for any other employee. However, even though the hospital or teaching institution may have overall responsibility for the resident, a jury may find that the supervising physician shares responsibility for the resident’s actions. At trial, it would be up to the jury to decide how much control was assumed by the supervising physician.

Regulatory agencies provide guidelines to hospitals and universities employing residents. The Joint Commission on Accreditation of Healthcare Organizations requires hospitals participating in professional graduate education programs to establish rules and regulations specifying the “mechanisms by which house staff members are supervised by medical staff members in carrying out patient responsibilities.” The Accreditation Council for Graduate Medical Education has set forth guidelines for program directors and teaching faculty to ensure “proper supervision…and appropriate involvement of supervisory physicians in a manner appropriate for quality patient care and educational programs.”

Q  What are the rules surrounding informed consent of patients treated by residents?

A  It is the attending physician’s duty to inform patients if a resident will be responsible for any part of their care. A patient should never be misled or misinformed about anyone who participates in his or her care. Hospitals and universities that employ residents should include language in their general consent form about the role of residents in the patient’s care and treatment. The same disclosure applies to the informed consent process is a resident provides surgical assistance to a physician’s private practice patients. “Ghost surgery,” in which the physician allows another doctor to perform the surgery unbeknownst to the patient, has attracted much unfavorable attention in the press.

A contingency plan must be in place to handle situations in which a patient refuses to have a resident participate in his or her care. The physician who uses a resident despite the expressed wishes of a patient does so at his or her own risk and may be sued for battery even if there is no negligence.

Q  What can I do to protect myself against a claim of negligent supervision?

A  Apply the guiding principle of graded responsibility, whereby residents are allowed to deliver a particular kind of medical care without direct supervision only when they have achieved competence in providing that type of care as determined by criteria set forth by the training program director in accordance with the guidelines of the relevant specialty board. When your clinical experience tells you there might be a greater liability risks at hand, take a more active role in the case.

The primary resource for this article was ECRI’s Healthcare Risk Control System.