Being on call when resources are limited An article for physicians by physicians
Originally published March 2008 IL0810-1-E
Physicians may be expected to
provide appropriate advice to
referring physicians even
when their facility cannot
accept the patient.
Of interest to all physicians
On-call consultants frequently respond to
calls from within their own hospital or
from other institutions in or outside their
normal referral area wanting to arrange care
or transfer of a patient. Some CMPA members
have voiced concern about providing advice when
they are unable to accept the patient due to lack of
resources and therefore cannot directly provide the
investigation or therapy the patient may require. The
concern stems from a possible misunderstanding
that, by accepting the call and providing advice, the
liability of the on-call consultant may be greater than
refusing the call in the first place.
When physical and human resources are
limited or lacking, the level of service the consultant
can reasonably provide may also be affected.
Nevertheless, such circumstances do not generally
mean the consultant should avoid providing advice
to physicians in other institutions or participating in
the care of patients within their own hospital. Some
recent examples of the concerns raised to the CMPA
from our members may help illustrate the medico-legal
A chief of staff contacted the CMPA concerned
that on-call physicians in his hospital were
refusing to speak with referring physicians when
a shortage of beds precluded admitting the
patient. The concern stemmed from a belief that,
by accepting the call and providing advice, and if
the direction and advice could not be provided at
the referring physician’s site, the on-call consultant might risk increased liability. When the chief of staff contacted the regulatory
authority (College) about this matter, the College
expressed concern that on-call consultants were
refusing to provide advice to other physicians,
and indicated that such consultants should at
least provide direction to the referring physician,
regardless of whether a transfer of the patient
The director of an
reported that on-call
refusing to assist in the
critically ill patients in
their own emergency
department when ICU
beds were unavailable.
The director of a critical-care patient placement
service contacted the CMPA, concerned that
on-call specialists in urban centres had refused
to provide advice for the management and/or
transport of critically ill patients residing in areas
where specialist expertise did not exist. This had
apparently occurred under circumstances where
the specialists’ hospital could provide neither the
ICU bed nor the operating theatre needed for the
appropriate care of the patient.
Based on judgments to date, the Courts might
consider that, once contacted about a potentially
emergent patient, the on-call consultant owes a
duty of care to that patient. Should an adverse event
result from the failure to either take the call or
provide advice, the risk of liability may be as great
or greater than if appropriate advice and direction
had been provided to the referring physician.
Under circumstances such as those described
earlier, on-call consultants should accept calls
from referring physicians. During these calls,
consider the following:
Have you gathered sufficient clinical
information on which to base your professional
Have you documented the information provided
by the referring physician and the advice you
gave, including any suggestions you offered
about alternative referral centres?
Information provided and advice given should
both be documented and retained. Your advice
will be judged based on your understanding of
the situation at the time.
Has the administrator on call for your
institution been contacted to see if the
needed resource could be made available?
If your hospital does not currently provide
specific guidance on how to deal with such
situations, you may also consider approaching
the appropriate authority at your hospital to
request the development of guidelines for the
management of referred patients in situations
where resources are limited or lacking.
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