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

equired by the school is not acceptable medical practice. The physician should keep in
mind that signing that school physical is saying that the child is healthy enough to
participate in the athletic activities without endangering life or health. The national
medical standards are what the physician will be judged by if the child is injured by
inadequate screening.
D. The School Doctor
There are two distinct types of school medicine practice. The more common is
practiced in nonresidential elementary and secondary schools. This practice is a
combination of pediatrics, emergency medicine, and public health. Large school
districts usually employ a physician to direct the school health programs and oversee
the nursing staff. Smaller districts rely on physicians in the community to provide these
services as paid consultants or as unpaid volunteers. The second practice type is school
medicine programs in residential schools—usually in colleges but in some elementary
and secondary boarding schools. The basic problems are the same in both settings, but
the physician’s responsibilities are greater in the residential settings.
1. Supervisory Responsibilities
Only the largest school health programs employ physicians to deliver direct patient
care. In most programs, the primary role of the school physician is to supervise
nonphysician personnel: school nurses, dietitians, coaches, and trainers. In some
smaller districts, the school physician also may need to oversee food sanitation in the
lunch room and zoonosis problems in vocational agriculture classes.
Most states require nurses, child health associates, physicians’ assistants, and other
such personnel to be supervised by a physician. If the school employs personnel (or
uses volunteers) who may not practice without physician supervision, the duty to
supervise these personnel will flow to any physician who is nearby. The legal theory
for this responsibility by proximity is called ostensible agency. This means that if it
appears to the patient that the physician is supervising the personnel, the law will
hold that physician responsible. Since ostensible agency is judged from the patient’s
perspective, a contract between the physician and the school to exclude such
supervision will not obviate the physician’s responsibility. Explicitly declining to
supervise a given activity may not be enough. The physician must not become
involved with the activity in such a way as to appear to supervise it. For this reason,
all school physicians should have their supervisory responsibilities listed and
described in a contract. The contracts should provide for the supervision of all
personnel who may require it under state law to protect both the physician and the
other personnel.
The school physician has a duty to ensure that all the medical professionals that he or
she supervises are competent, adequately trained, and practicing within the limits of
the law. Disciplining a nurse may be difficult if the nurse reports to a nursing
supervisor or other administrator who is not responsible to the physician. If a
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