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When a patient claims that they were treated negligently in the operating room, it raises the issue of who was responsible for providing the alleged negligent care.  In Lauro v. Knowles, the Supreme Court of Rhode Island considered whether the attending surgeon could be held responsible for an alleged negligence by the anesthesiologist based on the fact that the surgeon was in charge of the case.   

            On May 24, 1988, Dr. Kenneth Knowles operated on Lou Ann Lauro, to alleviate carpal tunnel syndrome in her right wrist.  Dr. Saluja was the anesthesiologist for the procedure he was assisted by Judith Baker, a student-registered nurse anesthetist.  When the plaintiff awoke from the procedure, she noticed an abrasion to her right eye.  The plaintiff claimed that she sustained this injury during as a result of the administration of anesthesia. 

            The plaintiff filed a complaint against Dr. Knowles, the surgeon, and the hospital where the operation took place.  She later amended her complaint and added Dr. Saluja and Ms. Baker as defendants.  However, the counts against Dr. Saluja and Ms. Baker were dismissed because the plaintiff missed the statute of limitations.  Dr. Knowles then filed a motion for summary judgment, seeking to have the case against him dismissed to, and the trial court granted his motion.   

            On appeal, the plaintiff argued that under the “captain of the ship doctrine” Dr. Knowles was responsible as the operating-room surgeon for any negligence that occurred in the operating room which caused harm to the patient.  The captain of the ship doctrine dictates that the attending surgeon in charge of the operative procedure can be held accountable for the negligence of other members of the surgical team based solely upon the fact that he was serving as the attending physician.  Under this doctrine, it does not matter whether the physician provided appropriate supervision over the other health care providers during the surgical procedure.  Since the captain of the ship doctrine had never been formally adopted in Rhode Island, the plaintiff cited cases from other jurisdictions to support her argument that Dr. Knowles should be held vicariously liable for the alleged negligence of the anesthesiologist. 

The appeals court rejected the plaintiff’s argument and distinguished the cases she relied upon to support it.  In the cases from the other jurisdictions, there was a question of fact regarding whether the defendant surgeons had authority or control over the anesthesiology teams in the operating room.  In this case, Dr. Knowles testified at his deposition that he assumed the plaintiff was prepped and had already been given anesthesia when he walked into the operating room.  In fact, the plaintiff’s attorney even admitted that Dr. Knowles had no direct control over the applications of anesthesia to this patient. 

            The plaintiff failed to introduce any evidence that Dr. Knowles had any actual control over the administration of anesthesia in the operating room or over the conduct of the anesthesiology team members who were present.  The Rhode Island Supreme Court upheld the lower court’s decision to dismiss the plaintiff’s claims for negligence that were based upon the captain of the ship doctrine.

The Massachusetts Supreme Judicial Court has likewise rejected the captain of the ship doctrine.  In a recent superior court case, the plaintiff claimed that a supervising attending physician should be held responsible for the alleged negligence of the physician’s assistant he was assigned to supervise.  In that case, the plaintiff also brought a claim for negligent supervision against the attending physician. The defendant physician moved for summary judgment on both counts of the plaintiff’s complaint. The Court held that the supervising physician could not be held vicariously liable for the physician assistant’s alleged negligence based solely upon the fact that he was assigned to supervise her.    

However, the Court denied the defendant’s motion for summary judgment regarding the negligent supervision claim on the grounds that there was an issue of fact remaining as to whether the physician provided adequate supervision of the physician’s assistant.  Therefore, in that case, even if the physician’s assistant is found to be negligent, her supervising physician will be held liable for her negligence only if the plaintiff can prove that such negligence was the result of the physician’s failure to provide adequate supervision.  

           In light of these recent rulings, physicians should be aware of what their duties are when they are providing patient care as part of a team of providers.  An attending physician cannot be held vicariously liable for the negligent acts of a fellow health care provider with whom they are working based solely on the fact that they are the attending physician.  However, a physician’s duty to provide care may also encompass a duty to supervise the care provided by others.  Attending physicians who work with residents and physician’s assistants should establish policies the ensure they are providing adequate supervision. 

          For example, when an attending physician is not available to consult with a resident or a physician’s assistant, they should designate a temporary supervisor who is available to assist the individual in need of guidance.  By providing proper supervision and guidance over other providers, a physician can protect themselves from being added to a medical malpractice lawsuit brought against the resident or physician’s assistant they were assigned to supervise.

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Negligence in the Operating Room

by Attorney Frank E. Reardon

December 1999