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

supervising physician has reason to believe that a nurse is practicing in an
incompetent or illegal manner, the physician must stop the practices or resign. The
physician cannot defend improper supervision by blaming nonphysician
administrators.
a) School Clinics
Increasingly, acute care clinics, which provide preventive services and care for
minor illnesses, are being placed in nonresidential school facilities. Unlike the
nurse’s office, where students are sent so the nurse can call home, these clinics
establish a provider–patient relationship with the students. The physicians and
nurses in the clinic have the same legal responsibilities that they would have in a
private office. If the clinic is part of the school health program, it is the school
doctor’s responsibility. If the clinic is a separate entity, it must have its own
supervising physician.
Physicians overseeing a school clinic should ensure that there are proper protocols,
policies, and procedures for the staff of the clinic just as they would for any other
outreach clinic or physician extender. There should be formal agreements on the
scope of practice within the clinic and provision for appropriate follow up for
problems that go beyond this scope of practice. The physician should not lose sight
of the fact that he or she is assuming all the responsibilities of the physician– patient
relationship for the patients who use the clinic. This includes the duties of continued
treatment and proper referral.
b) Consent to Care
The general rules of consent to care for minors apply to school children. The
emergency exception, legally mandated care, proxy consent, and prior consent of
parents all apply in various school situations.
Parents may sign a proxy consent for medical care if it is required when the child is
at school. These often ask for information on preferred physicians and hospitals. All
residential schools with students under the age of 18 should require that a proxy
consent be part of the student’s admission materials. The extent to which the proxy
consent should be relied upon depends on the circumstances and the difficulty of
contacting the parents. A physician treating children in a neighborhood public
school should rely on proxy consent only to deliver urgent care until the children’s
parents can be contacted. (This type of care is usually sheltered under the
emergency exception anyway.) If the children are in a residential school and their
parents are out of the country, the proxy consent will have to cover all routine and
emergency medical care. Such extensive consent is best documented by a power of
attorney to consent to the child’s medical care.
If a child is seriously ill or injured, the emergency exception to the need for consent
generally applies. Reasonable attempts should be made to contact the child’s
parents and to follow their wishes in selecting caregivers, but these should not
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