Managed Care
(These are actual questions asked by physicians at risk management seminars. The answers are general guidelines only and are not intended to be a comprehensive treatment of very complex subjects.)

"I have a contract with a managed care organization which requires me to supervise two physician assistants. They work independently; have prescriptive authority; and function autonomously. In fact, I've only seen them twice in the past several months. If something goes wrong because of something they did, is there any way I could be held liable for their actions?"

Absolutely! Check the wording of that contract. It probably says that you will directly supervise their activities. If they do it wrong, you're liable. Either delete that part of the contract next time you renegotiate, or make a point of keeping close tabs on everything the physician assistants do.

"I am an employee of a home health care company who is being asked to administer chemotherapy. I was not trained in this specialized area during my nursing training. What are the legal risks to the practitioner and to the company?"

There is always potential liability if it can be shown that you owed a duty of care to your patient, were negligent in providing that care, and your negligence proximately caused injury to the patient. If there is a level of nursing that specializes in chemotherapy, you will be judged by those same standards. If it can be proven that the standard of care is for a practitioner to use special methods to administer chemotherapy, and the practitioner did not do so (either for lack of training or lack of care), then the practitioner probably will be negligent. As the employer, the company will also be held accountable.

"Managed care organizations dictate to doctors how to practice medicine, telling them what to prescribe, what tests to run, etc. If something goes wrong because of the managed care organization's decisions, they should be held liable for the consequences of their decisions! Why can't they be sued for malpractice?"

Simply put, because most states have a ban on "the corporate practice of medicine." Only physicians may practice medicine. The managed care organizations are not telling doctors what to do; they're only saying what they'll pay for. Of course, in reality, payment decisions usually govern what treatment is provided. That's why many states have pending legislation that would permit HMOs to be sued for malpractice when their treatment decisions adversely affect patients and when certain criteria are met. Texas is the only state where such a law has actually been passed, but more are sure to follow.

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