LM: Principle of Liability in HM

Physician-Patient Relationship

• This relationship is considered contractual, involving both an offer and acceptance between physician and patient.
• The relationship can be established through an express or implied contract.
• An express contract is a formal agreement where the terms, rights, and responsibilities are agreed upon, typically in writing or orally.
• An implied contract arises from the actions of the parties and the circumstances, creating an understanding of agreement without a formal written contract.
• Informed consent is a critical aspect of this relationship, requiring a written, dated, and signed document outlining the nature, significance, implications, and risks of a procedure.
• The patient must be fully informed and capable of making a free decision to consent to the treatment.
• If a patient cannot write, oral consent may be given in exceptional circumstances with at least one witness.
• The physician-patient relationship can be terminated by either party with reasonable notice.
• Typical reasons for termination include a patient's recovery or death.
• When a physician withdraws from a contract, they must provide reasonable notice for the patient to find alternative treatment.

Hospital-Patient Relationship

• The relationship begins with a voluntary admission of the patient to the hospital.
• Patients sign forms during admission agreeing to pay for treatment, establishing an express contract.
• The relationship ends with discharge or when the patient leaves the hospital against medical advice.
• Hospitals are not obligated to treat every patient arriving at their doors, except in emergency care situations.
• Hospitals have a duty to assess whether a patient arriving at their doors can be treated at their facility or needs to be transferred for appropriate care.
• Anti-Deposit laws require hospitals and physicians to stabilize patients in active labor or experiencing an emergency medical condition.
• Upon stabilization, there are three choices: continue treatment, transfer the patient, or discharge them.
• This relationship primarily focuses on the contract between the hospital and the physician, allowing the physician to bring patients for care.

Hospital and Physician Liability

• Corporate negligence refers to the hospital's responsibility for ensuring the competency of its medical staff and evaluating the quality of care provided on its premises.
• Vicarious liability holds the hospital responsible for the actions of its employees, including physicians, under the "diligence of a good father in the family" principle.
• This means the hospital is liable for the mistakes of its doctors.
• The Respondeat Superior Doctrine (Latin for "let the master answer") makes an employer liable for the actions of an employee within the scope of employment.
• This doctrine is often applied to surgical situations, where the surgeon, considered the "captain of the ship," is directly responsible for any errors or negligence occurring during the procedure.
• Credentialing Process: this process involves a rigorous evaluation of physicians to ensure competence and quality of care for patients.
• The hospital can suspend or restrict a physician's medical privileges if there is imminent danger to patients or the integrity of care.
• Employer-Employees Relationship: This relationship is crucial in medical administrative management as it encompasses the rights, responsibilities, and interactions between the employer and employee.
• The hospital can be liable for the actions of a non-employee doctor under specific circumstances, especially if they had knowledge of the doctor's malpractice or if it was obvious and the hospital failed to address it.
• Medical error is defined as a mistake by a healthcare professional that can lead to patient injury or death, and is considered a form of medical malpractice.
• A doctor is more likely to be considered an employee rather than an Independent Contractor when the hospital controls their working hours, vacation time, sets their fees, and has policies on medical staff supervision.

Test your knowledge on the key aspects of the physician-patient relationship, focusing on contractual elements, informed consent, and termination processes. Understand the differences between express and implied contracts and the importance of patient autonomy. This quiz will help solidify your understanding of medical ethics in patient care.