Is a Physician Liable for the Negligence of Other Providers?
Landmark Case
It was a horrific case of medical malpractice. In December 1943, Dr. Philip Williams, an obstetrician, was engaged to perform a cesarean section at the Jewish Hospital in Philadelphia. During the procedure, because Mrs. McConnell was hemorrhaging, Dr. Williams requested the assistance of an intern, who was employed by the hospital, to care for the newborn. After the delivery, the intern negligently applied too much silver nitrate to the infant's eyes and then failed to flush the eyes, resulting in severe chemical burns and the subsequent loss of one eye and blindness in the other. Who is liable—the surgeon, the hospital, or the intern?
In the landmark case of McConnell v. Williams, the court emphasized that the attending surgeon had complete control over the operating room and all personnel assisting in the procedure, including the intern, and held that the attending physician was vicariously liable for the actions of those under their supervision, regardless of their employment status. This is called the Captain of the Ship Doctrine. The charity hospital’s exemption from liability played a role in this decision. At the time, hospitals were shielded by charity laws, meaning they could not be sued for the intern’s actions. The intern had no financial means to compensate the injured party. So, the court found that the obstetrician had complete control over the operating room and was therefore responsible for the intern’s negligence.
Evolving Medicine and Law
Historically, medical practice was characterized by a hierarchical structure with attending physicians holding primary responsibility for patient care. Under the principle of respondeat superior and the doctrine of Captain of the Ship, attending physicians were often held liable for the actions of their subordinates, including residents and interns. While McConnell v. Williams remains a foundational case in understanding the legal responsibilities of attending physicians for the actions of their assistants, the Captain of the Ship Doctrine has been increasingly scrutinized and limited in modern medical practice.
Modern healthcare has transitioned to a team-based approach, emphasizing collaboration among various professionals, such as physicians, nurse practitioners, physician assistants, nurses, and allied health staff. Courts have shifted toward a more nuanced analysis, considering the specific roles and responsibilities of each team member in the operating room. This evolution reflects a broader trend in medical malpractice law, moving away from blanket vicarious liability towards a more individualized assessment of liability based on control and supervision.
Many jurisdictions have now rejected or limited the application of the Captain of the Ship Doctrine. For instance, the Wisconsin Supreme Court declined to adopt the doctrine, emphasizing that it failed to reflect the emergence of hospitals as modern healthcare facilities. Similarly, the Illinois Appellate Court reaffirmed the state’s rejection of the doctrine in Forsberg v. Edward Hospital and Health Services, highlighting that a surgeon’s liability should be based on actual control over the negligent act, rather than on a presumption of control. New York courts now focus on the specific relationships and control mechanisms between healthcare professionals to determine liability in medical malpractice cases.
Liability for Other Physicians
In Kavanaugh v. Nussbaum, the New York Court of Appeals held that a covering physician was not liable for the actions of another physician, as there was no evidence of joint action or control. Subsequent cases have collectively reinforced the principle established in Kavanaugh that a physician is generally not vicariously liable for the negligence of another physician unless there is a recognized legal relationship or evidence of joint action in diagnosis or treatment.
For example, in Graddy v. New York Medical College, the New York Appellate Division held that physicians who were not in a joint venture or partnership were not liable for each other's actions, as there was no shared control over patient care. And, in Connell v. Hayden, the New York Appellate Division discussed situations where co-employees of a professional service corporation could be jointly liable without one having authority to control the other but referenced Graddy in explaining that liability for one physician’s negligence is typically limited to cases of joint action or control in diagnosis or treatment.
Liability for Nurse Practitioners
In New York, a physician’s liability for the actions of a nurse practitioner (NP) in the office depends on the nature of their professional relationship and the specific circumstances of the case. Under New York State Education Law § 6902, NPs are authorized to diagnose illnesses and perform therapeutic measures within their specialty area of practice. They must practice in collaboration with a physician, as defined by written practice agreements and protocols. Importantly, New York law does not require a physician to supervise a NP or co-sign orders or records. NPs are independently responsible for their patient care.
However, a physician may be held liable for the actions of an NP under certain limited conditions: (1) if the NP is an employee of the physician and the alleged negligence occurred within the scope of employment, the physician may be vicariously liable; (2) if the physician negligently hired or retained the NP, knowing or should have known that the NP was unfit for the role, the physician may be directly liable; and (3) even though direct supervision is not required, if the physician fails to provide adequate oversight, they may be liable for negligent supervision.
Liability for Nurses
In New York, a physician's liability for the actions of nurses in their office is contingent upon the nature of the professional relationship and the specific circumstances of the case. Generally, nurses are considered independent practitioners responsible for their own actions. Nurses in New York are licensed professionals who operate within the scope of their practice as defined by the New York State Education Law and the Nurse Practice Act. They are authorized to perform various medical tasks, including administering medications, monitoring patient conditions, and providing direct patient care. While nurses often work under the supervision of physicians, they are not typically employees of the physician unless explicitly stated in their employment agreement.
However, a physician may be held liable for the actions of a nurse under certain conditions: (1) if the nurse is an employee of the physician and the alleged negligence occurred within the scope of employment, the physician may be vicariously liable; (2) if the physician negligently hired or retained the nurse, knowing or should have known that the nurse was unfit for the role, the physician may be directly liable; and (3) even though direct supervision is not always required, if the physician fails to provide adequate oversight, they may be liable for negligent supervision.
Liability for Physician Assistants
In New York, physicians can be held liable for the actions of physician assistants (PAs) under certain conditions, primarily through vicarious liability and direct liability. Under New York law, specifically 10 NYCRR § 94.2(f), a physician remains “medically responsible” for the medical services performed by a PA whom the physician supervises or employs. This responsibility encompasses acts of negligence and medical malpractice committed by the PA during the course of their duties. For instance, in Marchisotto v. Williams, the court held that the term “medically responsible” includes legal responsibility for the PA’s actions, thereby holding the supervising physician liable for the PA’s alleged malpractice.
Physicians may also face direct liability for: (1) if a physician hires a PA without adequately verifying their qualifications or fitness for the role; (2) if a physician fails to properly supervise a PA, leading to negligent acts; and (3) if a physician continues to employ a PA despite knowledge of the PA's incompetence or unfitness. These forms of liability are assessed based on the physician’s direct actions or omissions concerning the PA’s employment and supervision. However, the employment relationship between the PA and the physician is crucial in determining liability. In Sanders v. Guida, the New York Appellate Division held that the physician defendants were not vicariously liable for the PA’s alleged negligence because the PA was employed by the medical practice, not by the individual physicians. The court emphasized that the physicians did not have direct control over the PA’s actions during the patient’s care.
In sum, a physician is no longer the captain of the ship, making him/her vicariously liable for the actions of his/her subordinates, but instead, one member of a collaborative team and, to determine liability in medical malpractice cases, New York courts focus on the specific relationships and control mechanisms between healthcare professionals.