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Mythbuster:Working in Interprofessional Teams Increases Legal Liability Risks for Physicians

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By Nola Ries, MPA, LLM; Newcastle Law Schoool, University of Newcastle, Australia

December 2015

Interprofessional collaborative practice is championed as an important element of healthcare reform. The Romanow Commission, for example, advocated for interprofessional collaboration to “transform our health care ‘system’ from one in which a multitude of participants, working in silos … to one in which they work collaboratively to deliver a seamless, integrated array of services.”1 A 2014 Canadian Academy of Health Sciences report on health professional scopes of practice urged reforms to “to shift the healthcare system from one that is characteristically siloed to one that is collaborative and patient-focused.”2 Most recently, a 2015 report of the Advisory Panel on Healthcare Innovation advocates integrated collaborative care teams and more role flexibility for health professionals.3

So what is stopping system-wide adoption of interprofes-sional collaborative teams? A variety of factors influence how (or if) health professionals from different disciplines work together in collaborative teams. Fears about legal liability and confusion about scopes of practices are often identified as a key barrier to collaborative practice, especially for doctors who worry they will bear ultimate responsibility for the actions of other health professionals. But is that more myth than reality?

Legal liability rules

Interprofessional collaboration involves team approaches to the provision of care, but this does not mean team members automatically share legal responsibility if a pa-tient is harmed during the course of receiving care. A review of Canadian court decisions has found that courts are careful to examine each situation to determine if and how the actions of individual practitioners fell below the legally required standard of care. A health care profes-sional must meet the standard of a prudent practitioner of the same profession. For example, a general medical practitioner must meet the standard expected of a prudent GP and a pharmacist must meet the standard of a prudent pharmacist. A health practitioner is not held to a legal standard of care applicable to a different health pro-fessional group where that practitioner has acted reasonably within their own scope. Courts apply a standard of reasonableness, not perfection or infallibility, and recognize the complexities and pressures of health service delivery.

Some physicians worry they may be held legally responsible for the actions of other care providers, however, a doctor’s scope of practice alone does not give rise to liability for the acts of other regulated professionals. Courts recognize that each health profession has its own practices and competency standards and that these standards are a starting point for considering legal duties: “Each member of the healthcare team must carry out their role within their appropriate standard of care and each of these professionals is entitled to rely upon the others to fulfill their respective individual responsibilities.”4 It is reasonable for professionals to expect that systems will function effectively and to rely on other members of the care team.5

The Canadian Medical Protective Association, the liability insurer for physicians throughout Canada, affirms that each regulated health professional group has its standards of practice and responsibility for their own actions: “In an interprofessional model, every member of the care team is accountable for the care he or she provides and may also be held accountable for his or her role in the outcomes. As a result, each professional owes a separate duty to the patient within his or her scope of practice. There is an established legal precedent that confirms health professionals are not to be held directly liable for the acts of others.”6

Of course, health professionals must be careful not to take shortcuts and become overly reliant on others; they must make sure they fulfill the duties reasonably expected of them. With a new referral, a doctor must fulfil her legal duty to take a history, discuss the patient’s current symptoms and the reason for the consultation. She cannot simply rely on the clinical records that accompany referral.

Good practices to reduce risks

Practitioners working in collaborative teams can reduce their liability risks by ensuring they communicate clearly with one another and the patient, document their actions, and have a common understanding about the roles and responsibilities of team members. An Alberta court has pointed out that “one of the advantages of a shared-care approach for the patient is that two heads examining a problem is better than one. Such is true if the two heads communicate.”7 In a recent British Columbia court case, the judge instructed: “Where the patient is seen by a treatment team -- nurses, doctors, or other medical practitioners, all working together -- there is also a duty on each person in the team to communicate diligently with the other medical professionals. The treatment team must take care in comparing notes and make certain that things do not slip through the cracks; elements of treatment or assessment should not be overlooked because each member of the team thinks the other has completed the task.” 8

Health care organizations that implement team based care delivery models must ensure they provide appropri-ate supports to help teams function in a coordinated manner. They have a legal duty to provide safe systems of health service delivery and to “ensure that proper coordination occurs and that the treatment program operates as a unified and cohesive whole.”9

A final practical matter is to ensure that professionals who work together have adequate liability coverage. Such insurance, which may be a statutory registration requirement for regulated professionals, provides protection for practitioners and patients if allegations of patient harm and negligence arise.

References

1) Commission on the Future of Health Care in Canada, Building on Values: The Future of Health Care in Canada (Commissioner: R.J. Romanow, QC), online: http://publications.gc.ca/pub?id=237274&sl=0, xviii.
2) Canadian Academy of Health Sciences, Optimizing Scopes of Practice: New Models of Care for a New Health Care System. Report of the Expert Panel appointed by the Canadian Academy of Health Sciences (2014), online: http://www.cahs-acss.ca, 10.
3) Advisory Panel on Healthcare Innovation, Unleashing Innovation: Excellent Healthcare for Canada (July 2015), online: http://www.healthycanadians.gc.ca/publications/health-system-systeme-sante/report-healthcare-innovation-rapport-soins/alt/report-healthcare-innovation-rapport-soins-eng.pdf, 14.
4) Ferguson v Steel, 2007 ABQB 596 at para 143.
5) Bush v Friedman, 2011 ONSC 4988 at para 108.
6) Canadian Medical Protective Association, The New Reality: Expanding Scopes of Practice (March 2010), online: https://oplfrpd5.cmpa-acpm.ca/-/the-new-reality-expanding-scopes-of-practice.
7) Allen v University Hospitals Board, 2000 ABQB 509 at para 101.
8) Briante v Vancouver Island Health Authority, 2014 BCSC 1511 at para 272.
9) Lachambre v Nair [1989] 2 WWR 749 (Sask QB) p 768.

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Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.