Understanding liability as an attending physician

Who is in charge? In healthcare, the answer is clearer than ever before in regard to treating the patient of a private attending physician who has been admitted to a hospital: the private attending physician is the one in charge.

In a New York City case (MacDonald vs. Beth Israel Medical Center) with far-reaching implications, a New York State appellate court ruled that hospital staff, even including the hospital’s attending physician, is shielded from liability if the staff defers to the private attending for all medical decisions-and exercises no independent medical judgement. 

While there is longstanding precedent in such cases involving nurses, residents or other hospital staff, the MacDonald decision was the first ruling to establish a broader standard extending immunity from liability to in-house attending physicians.

With more and more hospitals in recent years evolving their own employees into attending physician roles, this appellate decision clarifies the parameters of everyone’s responsibilities-and the need for specificity in determining duties and protocols when a private attending physician is in charge.

Price of leadership

Why did the court rule so broadly? I believe it was because the court wanted to establish beyond all reasonable doubt the relationship between private and hospital attending physicians. The ruling seemed to indicate that when a clear chain of command exists, a plaintiff unhappy with a medical outcome cannot hold liable those who were responsible for carrying out the private attending’s plan. 

From the perspective of a hospital administrator, this ruling confirms that all hospital physicians and staffers playing a supporting role to a private attending physician-and following his or her direction-cannot be held liable if the treatment plan is challenged. A physician with a different specialty would have a coordinate responsibility and therefore potentially have independent liability.

Conversely, from the perspective of private attending physicians, the ruling confirms the great burden on them, as they are expected to set a clear course of treatment with the understanding and expectation that hospital employees will not interfere.

Of course, there is one key caveat, as expressed in previous court decisions: The immunity from liability is lost if the private attending physician’s orders (and/or the patient’s situation) are so clearly contraindicated by normal practice that the hospital must intervene.

Protection for all

To ensure that all parties are protected from liability to the greatest extent possible, hospitals and private attending physicians should consider the following suggestions:

When the roles and responsibilities of the attending private physician and the hospital are clearly delineated, there will be less chance for confusion regarding decision-making.

Yes, the private attending physician is in charge. But if his or her treatment is clearly contraindicated and intervention is warranted, the hospital and its staff must take immediate and appropriate action.

In the course of monitoring and performing routine tasks in caring for the patient, the hospital staff should stay in regular contact with the private attending physician. This is especially important during complicated cases that may require frequent course changes.