Liability of physicians supervising nonphysician clinicians.

Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.

The corpulent and sedentary society: epitome of a healthcare crisis.

Obesity is killing our patients and draining our healthcare resources. The First Amendment is an available tool to reverse the tragic state of our nation's health. Through educational programs, across all economic, educational, and cultural stratifications of our society, emphasizing the importance of diet and exercise, we can reverse the tragic physical, emotional, and health consequences of obesity. This must be a physician-led strategy that empowers patients across all age groups to be personally responsible for their personal health.

The challenges to transparency in reporting medical errors.

In an ideal health care environment, physicians and health care organizations would acknowledge and factually report all medical errors and "near misses" in an effort to improve future patient safety by better identifying systemic safety lapses. Truth must permeate the health care system to achieve the goal of transparency. The Institute of Medicine has estimated that 44,000 to 98,000 patients die each year as a result of medical errors. Improving the reporting of medical errors and near misses is essential for better prevention of medical errors and thus increasing patient safety. Higher rates of reporting can permit identification of the root causes of errors and create improved processes that can significantly reduce errors in future patient care. Multiple barriers exist with respect to reporting medical errors, despite the ethical and various professional, regulatory, and legislative expectations and requirements generating this obligation. As long as physicians perceive that they are at risk for sanctions, malpractice claims, and unpredictable compensation of injured patients as determined by the United States' tort law system, legislative or regulative reform is unlikely to affect the underreporting of medical errors, and patient safety cannot benefit from the lessons derived from past medical errors and near misses. A new infrastructure for creating patient safety systems, as identified in the Patient Safety and Quality Improvement Act of 2005 is needed. A patient compensation system guided by an administrative health court that includes some form of no-fault insurance must be studied to identify benefits and risks. Most urgent is the development of a reporting system for medical errors and near misses that is transparent and effectively recognizes the legitimate concerns of physicians and health care providers and improves patient safety.

Implications of Good Samaritan laws for physicians.

Good Samaritan laws are designed to encourage individuals, including physicians, to gratuitously render medical care in emergency situations. Through these laws, immunity from civil liability is provided to physicians who act in good faith to provide emergency care gratis. Historically, emergency care involved medical assistance given to persons in motor vehicle crashes or other emergency situations in which bystanders were present. Protection of physicians from allegations of negligence was a tactic of the legislative and judicial systems to encourage active clinical participation, rather than cautious nonparticipation, in emergency care. In some states and under defined circumstances, the immunity may apply in the hospital setting, as well as in the physician's office. Legislatures have continued to amend the statutes to expand the protection provided to physicians who offer emergency care. Judicial construction of the nature and scope of physician immunity has similarly expanded.