Safety of care
Shared care: issues you should consider
An article for physicians by CMPA General Counsel
Originally published June 2005 / Revised May 2008
In a shared care environment, consider liability issues, the scope of practice and qualifications of other team members, and the importance of good communication.
Of interest to all physicians
It is a reality of modern medicine that physicians are increasingly working with other health care providers when treating patients. Physician shortages as well as new and evolving models for delivering health care have led to this rise in shared care arrangements.
Shared care can mean treating a patient along with other physicians, with other regulated health care providers, or with unregulated health care providers.
Some members have contacted the CMPA asking about their responsibility in a shared care situation. They are often concerned about their personal liability in the event their patient is harmed by another involved health care provider.
Physicians should consider the legal issues common to all shared care arrangements. They also need to consider the legal issues unique to each arrangement, some of which may require varying degrees of supervision by the physician.
Issues to consider with shared care
You might consider the following issues when sharing the treatment of your patients with other health care providers:
- You should be familiar with the scope of practice, qualifications, experience and training of the other health care providers involved in the care of your patient. This will require a determination as to whether the health care provider is regulated or unregulated, and whether legislation specifically sets out the health care provider's scope of practice.
- You should confirm that each health care provider in the team has adequate liability protection/insurance to protect themselves and the patients they treat.
- Members of the health care team must be clear on which health care provider is responsible for which aspect of the patient's care. This information should be communicated to the patient and documented in the medical record.
- The law does not require you, as a physician, to double-check the work of other health care providers working within their scope of practice. However, you should know whether the performance of a task by another health care provider on the team falls within that provider's normal scope of practice or is being carried out subject to delegation from you. If it is a delegated act, you, as the physician, must decide on the appropriate level of supervision under the circumstances. You will want to be familiar with any relevant guidelines issued from your regulatory authority (College) or health care facility concerning delegation, as well as any relevant legislation.
- If you are in private practice and employing other health care providers, you should be alert to the potential for vicarious liability. The principle of vicarious liability holds that as an employer, you may be liable for the negligence of your employees when they are acting within the scope of their employment.
- Good patient care depends on good communication among all members of the health care team. This includes full and detailed documentation in the medical record by all team members so there is no breakdown in the chain of communication. Team members should also clearly establish who is responsible for ordering tests and who is responsible for follow-up.
If you are working in a shared care arrangement, it is important for your patients to understand the team roles and responsibilities and your place in it. Otherwise they may assume that, as the physician, you are responsible for all aspects of the care and are overseeing the work of the other health care providers.
The bottom line
- You need to consider the legal issues common to all shared care arrangements and the legal issues unique to each arrangement.
- You should be familiar with the scope of practice, qualifications, experience and training of the other health care providers involved in the care of your patient.
- You should confirm that each member of the health care team has adequate liability protection/insurance.
- If another health care provider is acting under your delegation, you should be familiar with any relevant guidelines or legislation.
- If you are employing other health care providers, you should be aware of the potential for vicarious liability.
- Good communication between members of the health care team is essential.
- Each health care team member's role and responsibilities need to be clearly defined and communicated to all members of the team and to patients.