Liability Implications of Supervision

Liability Implications When Supervising and Collaborating With Other Licensed Health Care Practitioners

Kristen Lambert, JD, MSW, LICSW, FASHRM
Vice President, Psychiatric and Professional Liability Risk Management Group

Moira Wertheimer, JD, RN, CPHRM
Assistant Vice President, Psychiatric Risk Management Group
AWAC Services Company, a member company of Allied World

Collaboration and supervision between medical disciplines are becoming increasingly common as there are more patients and fewer psychiatrists to provide direct care. Nurse practitioners (NPs) and physician assistants (PA) are becoming more widely used in psychiatry. When supervising or collaborating with other licensed healthcare practitioners such as NPs and PAs, there are a number of factors to consider.

First, it is crucial to know what your relationship is and define your role whether you are the other provider’s supervising physician or if another physician is in that role. There are state guidelines which you must adhere to if in a supervisory role working with NPs and PAs. As such, be aware of the requirements set forth by the North Carolina Medical Board (NCMB) and the regulations set forth under North Carolina law. It is also important to be aware of your role within the agency/clinic. There may be differing liability risks if in the role as a partner/shareholder versus an independent contractor.

Second, if you are not in a supervisory role, is it a collaborative relationship where there is shared responsibility of the patient? Whether in a supervisory or collaborative relationship, this should be identified at the outset of your relationship. It is important that you have an agreement in place with your agency/hospital/other licensed healthcare provider prior to beginning. Again, it is important that you are aware of your responsibilities with respect to Collaborative Practice Agreements (CPAs) and Supervisory Arrangements (SA) as set forth under the NCMB and North Carolina law.

If either in the role as a supervisor or in a collaborative role, it is important to know if you will be requested to “sign off” on another provider’s treatment notes/plan. Even if you are not in the role as the “supervising physician” and the other provider had a bad outcome and a lawsuit is brought, you may be included in the case as a defendant by nature of your role in signing off on the note/plan. If being requested to “sign off,” this may have liability implications even if you did not have any involvement with the patient. In other words, know what you are signing off on.

Conclusion
In order to minimize liability exposure, it is important that all parties involved in the collaborative/supervisory relationship understand and abide by all aspects of North Carolina and federal law.  Prior to entering such an arrangement, it is prudent for the psychiatrist to consult with a local attorney and/or risk management professional.  

Risk Management Tips

• Understand your state and federal laws and regulations. 
• Adhere to your ethical guidelines (APA’s The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry).
• Be aware of your employment contractual obligations and the policies and procedures of your agency/clinic.
• Define your role and have a clear delineation of responsibility. Know what your responsibilities are for patient care.
• Whether in the role of supervisor or collaborator, it is important to maintain effective communication, including documentation. 
• Keep in mind you may be held liable for the acts of those you supervise. Be aware of the education, training, and experience of the other provider and ensure that sufficient supervision is provided.
• If in a supervisory or collaborative arrangement, ensure that you adhere to state regulations and have a collaboration agreement in place. It is important to have an attorney review the agreement on your behalf prior to signing to ensure you are aware of your responsibilities. Should you deviate from the agreement, ensure you are following the regulatory guidelines set forth in North Carolina. 
• If you have questions, it is important to discuss with a local attorney or your risk management professional. 

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Requirements of Supervisory Practice Agreements >>

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