Delegation of Medical Tasks
May 13, 1998
Delegation is defined as the transfer of authority by one in whom such authority is vested to another person who does not have that authority. Delegation by physicians is done on a daily basis. Although the practice of medicine, as defined in Chapter 4731., Ohio Revised Code, never can be delegated, there are many specific tasks within medicine that may be safely and appropriately delegated. This position paper is intended to give guidance to the medical practitioner in making decisions concerning delegation of medical tasks.
First, the task to be delegated must be within the authority of the delegator, here, the physician. If the task is not within the physician’s authority, then no delegation can occur. Further, if the task is not within the physician’s usual scope of practice, training or expertise, it is inappropriate to delegate that task to another. The physician retains responsibility at all times for the manner in which the delegated task is carried out; if the task is not within his or her area of expertise, then it could be a violation of minimal standards of care to attempt to supervise another performing the task.
Second, the physician must determine that the task is indicated for the patient; i.e., the physician has, after an appropriate assessment, determined that under the circumstances, the given task needs to be performed. This initial determination cannot be delegated.
Third, the level of supervision must be appropriate for the specific circumstances. For unlicensed personnel to whom a physician is delegating specific medical tasks, some will require direct, on-site supervision.
Fourth, the physician must be certain that no other law prohibits the delegation. Specifically, in the health care field there are many regulatory entities and regulated activities. If only a licensed or registered person can perform the function, then the physician cannot delegate that function to an unlicensed person; he must assign the function to an appropriately licensed or registered person. For example, Chapter 4773. of the revised code regulates radiation technicians, including general x-ray machine operators. The statutes require that general x-ray machine operators be licensed and work under a specified level of supervision. Although the statutes allow a licensed physician to perform the functions of a general x-ray machine operator, delegation to an unlicensed person is not permitted. Further, if the physician assigns the function to a licensed general x-ray machine operator, the physician must also provide the level of supervision required by the statutes. There are many statutes that affect a physician’s ability to delegate medical tasks; the physician is responsible for knowing what those statutes require.
Fifth, the physician must be assured that the person to whom the task will be delegated is competent to perform that task. Appropriate training (and documentation of that training) must be provided before any delegation is made. It should also be noted that there is no authority to sub-delegate, i.e., if the physician delegates a specific task to one person, that person cannot delegate it to someone else. This is clear from the nature of delegation, in that if the person does not have the authority to perform a certain task himself, he cannot delegate it. It also is practical; if the physician is responsible for ascertaining that the person to whom the task is delegated is properly trained, then the physician must be assured that no further delegation can take place.
Finally, if all the above requirements are met, then the physician must decide if the task itself is one that can be appropriately delegated. Considerations in deciding whether a given task, under the specific circumstances present, can be delegated include the following:
1. The task can be performed without requiring the exercise of judgment based on medical knowledge.
2. The results of the task are reasonably predictable.
3. The task can safely be performed according to exact, unchanging directions; this would preclude delegation of performance of such tasks as needle EMG tests.
4. The task can be performed without a need for complex observations or critical decisions; this would preclude delegating the administration of anesthesia. Only the assignment to persons authorized by law to perform the tasks would be acceptable.
5. The task can be performed without repeated medical assessments.
6. The task, if performed improperly, would not present life threatening consequences.
If all those conditions are met, then the task may be appropriate for delegation.
The physician always retains full responsibility for the actions of the personnel to whom the task has been delegated. Inappropriate delegation, whether or not it results in actual harm to a patient, may subject the delegating physician to disciplinary action by the State Medical Board for violation of the minimal standards of care, for aiding and abetting the unlicensed practice of medicine, or for violating other applicable statutes. Therefore, it is advised that decisions concerning delegation not be made lightly, but with serious consideration for the possible ramifications.
Delegation of Medical Tasks