Public Health Law Map - Beta 5 - Medical and Public Health Law Site

An attending physician has the legal responsibility to obtain consultations when
necessary for the patient’s well-being. Physicians must choose consultants
carefully, both as to specialty and personal competence. The attending physician
must then oversee the actions of the consultant while continuing to provide the
patient’s general care. When orders are written or accepted by the attending
physician, he or she has implicitly ratified the correctness of those orders. It is not a
defense to say that the order was written at the suggestion of a consultant.
Physicians may be held liable for substandard care if they fail to obtain a
consultation in a case that falls outside their areas of expertise or in a case in which
only a consultant can provide necessary tests or procedures. If an internist who
cannot do endoscopy is caring for a patient with occult intestinal bleeding, the
internist has a duty to consult an endoscopist to obtain the procedure for the
patient. The attending physician cannot force a patient to undergo the procedure
but must ensure that the test and the consultation are available. If the attending
physician leaves the arrangement of the consultation to the patient, the patient may
later contend that he or she had no real opportunity for this care.
A physician has a duty to choose consultants wisely. The physician should know
the consultant’s qualifications and be assured of the person’s competence before
asking for a consultation. Usually the attending physician can rely on the process of
admission to hospital staff as adequate verification of another physician’s
qualifications. This reliance assumes that the attending physician has no reason to
suspect the consultant. If a consultant does not appear to have appropriate skills or
is impaired, the attending physician has a duty to investigate before consulting that
particular physician. For example, a surgeon typically may accept as an
anesthesiologist any member of the anesthesia group that serves the hospital; the
qualifications of the individual anesthesiologists have been checked by the hospital
staff committee and the anesthesia group. If, however, the surgeon has reason to
suspect the competency of the anesthesiologist, the surgeon has a duty to protect
the patient by refusing the anesthesiologist’s services.
An attending physician is liable for negligent care that a patient receives from a
consultant because the attending physician retains responsibility for the patient’s
care. An attending physician should never simply turn over the care of the patient
to a consultant. The attending should be informed of all actions taken by the
consultant and should order all tests, medications, and other changes in the
patient’s care. If the attending physician does not wish to accept responsibility for
the patient’s care, the patient should be referred to the consultant or another
physician.
d) Documenting a Consultation
The entire process of consultation should be documented in the patient’s chart: the
request for consultation or, in the hospital, an order for the consultation; all physical
findings and test results; a clear evaluation and recommendation; the attending
physician’s evaluation of the consultation and his or her own recommendations; and
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