Physician Responsibility, Risk, and Professional Obligations

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Written By: Traci Pritchard, MD, FACR

Picture this…

You are an employed physician seeing patients in an outpatient office setting. It is a busy, single-physician office. Your employer is not another physician. Instead, it is a non-medical corporate entity that sets up physician practices and owns the practice. Maybe you are a W-2 employee, or perhaps you are a 1099 subcontractor. In either case, you are contractually NOT given the title of Medical Director for the office. You become aware that a regularly used piece of equipment for diagnosing or treating patients is not being maintained according to what you believe is standard practice. You alert your employer, and they tell you they will take care of it. But they don’t. In fact, the equipment goes further into disrepair, while you continue to alert them every day.  Your employer eventually responds that you are wrong. They represent that, according to the manufacturer, the equipment is working fine. The front desk personnel is employed by the corporate entity, who follow their instructions to keep scheduling patients. So, patients keep coming and getting exposed to faulty equipment.
Your clinical acumen knows that something is wrong. You call the manufacturer directly and find out that the equipment no longer meets the standard operating procedure for maintenance, and there is a potential chance for patient harm. What do you do?
What if you were not that experienced physician in the above scenario but a new-to-graduate, unsure, inexperienced physician? What if you have not dealt with that kind of medical equipment in your residency? What if you had no idea your employer was misleading you? What if you had no idea what to look for to determine if the equipment is properly maintained?
Importantly, what are your legal responsibilities as an employed or subcontractor physician if a patient gets hurt by the equipment you use? This is not legal advice, only a lawyer can give that, but what is your ethical duty?

Or,

The same employed-physician scenario. This time, you come to the office as usual Monday morning, and it is locked. The corporate owner of the practice was leasing the office space and fell behind in rent. The commercial owner of the building locks the entire office up until rent is paid. The corporate entity that you contract with is filing Chapter 7 and walks away because it makes the most financial sense for them.  What are your duties to those patients whose medical records are locked up in that office? …You are not a party to the building lease. You do not have employees. You do not have physical access to the office and the patients’ files. You are also suddenly out of a job. Who is responsible for those patients who need to get their records and find another place to get their care? The medical records are just sitting there, thousands of them.
Even if you think you have been relieved of all “Medical Director” duties to the corporate entity that was spelled out in your signed contract, that status may not be a decided issue. Beware of the ex-post facto Medical Director liabilities.
The world still sees us, the physician, as autonomous and in charge of everything. However, these scenarios demonstrate some inherent risk in our roles. So, as we assume job positions, even temporary ones, be aware that your responsibilities may be much greater than the limited role granted to you by your employer. Be aware of, and address, these issues before you find yourself in a position that you never expected. The last thing we want to be…is that doctor at the center of “interesting case law in Arizona”.
Physicians must follow the guiding principles of an ethical, empathic heart and mind. We need to stay organized and involved in our physician community, including through membership and engagement in ArMA. We need to maintain the confidence that even if we are called “employee” and someone else is the “boss,” particularly a non-physician, at the end of the day, no one can force us as physicians to do something that is incongruent or frankly contrary to good, safe medicine. That can be a precarious perch for those of us reading this who are employed, young, inexperienced and in a position without the older owner-physician as our employer, right out of the gate of residency.  So, before you go to work tomorrow, ask yourself now, what would I do if…….
Sincerely,
Traci Pritchard, MD, FACR

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