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

not the advice of a medical student.
It is particularly important to follow the laws of medical practice when prescribing
or ordering drugs in a teaching situation. Most boards of medical examiners tend to
be lenient toward physicians and medical students in the division of work. State
and federal drug enforcement agencies are much less understanding. The rule is
simple: only licensed persons may prescribe or dispense drugs. Those who violate
this rule may be subjected to criminal prosecution and the punishments prescribed
by law. The fact that the unlicensed prescriber is a student will only make
prosecution politically easier.
c) Nursing and Other Students
The rules that apply to medical students apply to other types of students: their work
must be supervised, and they may not do anything that requires licensure or
certification.
As a practical matter, much of what other students do does not require licensure or
is already supervised by a physician. For instance, an unlicensed individual may be
authorized to draw blood or administer medication. A medical student or a nursing
student also may be authorized to draw blood or give medicines. Caution must be
used to make sure that these students are following specific orders and not using
their own judgment. If there is an order from a physician saying that a blood
glucose should be drawn at 8 a.m., a student may do the task. If the blood is being
drawn under a protocol for registered nurses that says that the test should be done
when the patient shows signs of hyperglycemia, a nurse’s professional judgment is
required; no student should assume responsibility for doing or not doing the test
without supervision.
3. The Reality of Teaching Programs
The conflict between legal norms and medical practice is great in teaching programs.
The improper supervision and delegation of work is a perennial problem in medical
care delivery, and it is most troublesome in teaching programs. The medical-ethics
and medical-legal literature contain elaborate theories of patient autonomy and
student supervision that represent the expectations of the law. They bear little
resemblance to medical training, however. The usual practice in teaching hospitals
and medical schools has been to use medical students and residents for patient care
with little or no attention to their legal status. Patients are implicitly (and sometimes
explicitly) deceived about who is a licensed physician and about their right to refuse
to participate in teaching programs. [Asch DM, Parker RM. The Libby Zion case:
one step forward or two steps backward? N Engl J Med. 1988;318:771–775.]
This conflict between legal expectations and medical practice has persisted for two
reasons: (1) it is convenient for the physicians participating in the teaching programs,
and (2) boards of medical examiners have had little interest in enforcing the
provisions of the law that relate to patient autonomy and physician-endorsed
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