I have often written about the importance of doing some homework when choosing a new doctor. There are a lot of resources out there and it is foolish not to take advantage of them. A poorly-qualified doctor, or one who is just not very good, can cause you or a loved one severe injuries, including death. Unfortunately, many times when we need a doctor, we don’t get to choose. We must accept whomever the hospital has selected to provide our care. While we may technically have a say, as a practical matter we are stuck with whoever the hospital has allowed to walk into our hospital room and provide treatment.
When you call 911 and the EMTs decide you need to go to the hospital, they most often take you to the hospital that is nearest wherever you happen to be at the time. It may just happen to be the best hospital in town or it may happen to be the worst. The EMTs don’t ask a lot of questions about the hospital. They just need to know where it is and whether it accepts patients with your kind of problem.
Once you get to the emergency department, the doctor you see will almost always be the employee of a medical group the hospital has hired to staff the department. As with most business decisions, a lot of factors go into it. You certainly hope that the quality of the doctors the group hires is one of those factors, but you can’t be sure and, even if it is, the quality of care may not be very high on the list of factors being considered by the hospital administration. Certainly the cost of the contract, how much the hospital has to pay the group, is an important factor, as might be the size of the group, the ability of the physicians to create billables for the hospital, and the willingness of the group to create work for other departments of the hospital.
Things don’t get a lot better when you leave the emergency department and are admitted to the hospital. Emergency Department doctors cannot admit patients to the hospital. If the physician believes you should be admitted, she must call a doctor on the hospital’s staff, explain her decision making, and ask the doctor on staff to agree to admit you and to be primarily responsible for your care while you are there. Pretty much the only exception to this is if you are already under the care of physician for the condition which requires hospital admission and your doctor is already on the hospital’s staff. Then, and only then, can you have your own doctor take care of you in the hospital.
The admitting doctor, also called the attending physician, may call in other doctors to consult on your condition and to provide treatment in their areas of expertise. You don’t get to choose these doctors either. The hospital may also send around a doctor called a hospitalist, who takes care of you only in the hospital so the attending doctor does not need to come see you every day.
Even though you never saw any of these doctors before in your life and did not choose them to provide care for you, they are now your doctors, unless you fire them and hire someone else, who must also be on the hospital’s staff. I have never seen this happen, but it is your right.
Despite the fact that the hospital is vouching for these doctors by allowing them to have staff privileges and to practice in the hospital, the hospital has no legal responsibility for them as it takes the position they are independent contractors. The hospital has also almost certainly put language in the multi-page document you are required to sign (called Conditions of Admission), which advises you that the hospital does not employ these other doctors. No patient ever reads the Conditions of Admission and probably would not understand them, if they did. In spite of this, the courts have ruled that patients have been informed that the doctors on staff are not hospital employees, have agreed to this arrangement, and cannot sue the hospital for mistakes these doctors make. This is hugely important, if the doctor malpractices and causes more harm than his insurance policy limits can cover.
You have undoubtedly heard the old expression, “There ought to be a law.” There ought to be a law requiring hospitals which choose what doctors can practice at their hospitals and what doctors will be permitted to see and treat you to be financially responsible, if these doctors injure you. In light of all the money hospitals donate to politicians and the number of lobbyists they employ, I wouldn’t hold my breath waiting for that law to be passed. As is usually the case when money is involved, the money comes fist and the patient comes last.
