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

these rules vary greatly from state to state, physicians, nurses, and other NPPs should
obtain their state’s licensing laws and regulations and familiarize themselves with
them.
All states reserve some aspects of medical care to licensed physicians, such as
performing surgery. All states allow NPPs to do some activities without any
physician supervision, such as changing wound dressings and taking blood pressures.
Between these two extremes, the NPPs practice on the delegated authority of a
licensed physician. For these activities, the physician is charged with supervising the
NPP, either directly or through protocols and physician’s orders. Depending on the
activity and the state, the physician must be in the same room, in the same building,
or may supervise at a distance, so long as he or she is available by telephone in
emergencies. Physicians and NPPs who do not comply with their state’s regulations
on supervision and independent practice can lose their licenses, [Sermchief v.
Gonzales, 660 S.W.2d 683 (Mo. 1983).] be criminally prosecuted for unauthorized
practice of medicine, or be prosecuted for Medicare/Medicaid fraud if they bill the
government for improperly delegated tasks. [People v. Varas, 110 A.D.2d 646, 487
N.Y.S.2d 577 (N.Y.A.D. 2 Dept. 1985).]
There are three issues to consider when delegating authority: (1) the legality of the
delegation, (2) the proper method of delegation, and (3) the physician’s oversight
responsibilities for the delegated duties. These issues must be considered within the
context of the three classes of medical tasks. The first class is tasks that are freely
assignable; they are not unique to medical care delivery and do not require the
exercise of professional judgment. They include billing and patient accounts,
maintaining simple medical equipment, and other nonpatient care activities that
accompany the practice of medicine. The supervising physician must ensure that the
activities meet the necessary legal standards for protecting patient confidentiality and
any other statutory requirements, but they do not need to be done by licensed medical
professionals.
The tasks in the second class are those that may be assigned to a limited class of
persons. These tasks, such as nursing activities and laboratory analyses, require
professional skills and judgment. They also may include activities that require
physician supervision, such as recommending treatments to patients. Activities in the
third class of medical tasks are reserved solely to physicians; delegation may violate
criminal laws against aiding in the unauthorized practice of medicine. These
activities include performing surgery, directly supervising nonphysician personnel in
physician- only activities, and writing prescriptions for controlled substances. State
law and tradition determine which specific activities cannot be delegated.
a) Explicit Delegation of Authority
Explicit delegation of medical authority occurs when a physician uses protocols to
authorize NPPs to render medical care directly to patients. The physician is
allowing the NPP to practice medicine by following written protocols that allow
the extender to determine the physician’s judgment in the specific limited situation.
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