Legal issue 6/30 on-call

[glorybrian]

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I am writing for my friend about her last day on-call.

She is transfering one hospital to another hospital.
She has on-call at 6/30, which requires to work until 7:00 am of July 1.
Her employment is effective until 6/30.

She doesn't want to work on July 1 from 12:00 AM to 7:00 AM.
One reason is that her new work place start to work 7:00 AM of July 1.
Driving distance between hospital is about 55 miles .
Another reason is that she is not legally employed at that institue for July.

What should she tell these PD and shief resident?

Any advice is appreciated.

 

[docB]

Sure. Talk to the PD. I'd say it's appropriate to ask for a letter from the PD or a copy of the relevant portion of the bylaws that says she's covered for those hours. It is important as she needs to know that she's covered for med mal, work comp, etc. There's probably a written policy about shifts beginning on a certain date extending into the next day carry the employment agreement of the first day. I would imagine that since you're being paid under the same employment agreement (it's illegal for them not to pay you) if you ever had a problem you could argue that you are entitled to coverage under the original agreement but that would be a huge pain. The fact that residents aren't paid hourly helps.

 

[Winged Scapula]

Excellent advice. This situation is exactly why "we" don't have leaving residents on call the last day. Most of them are asked to take their last week of vacation during the last week of June.

 

[jennyboo]

I called the hospital's medical education office and they consulted with the hospital's legal department.

In my case, they informed me that my limited license and my malpractice coverage for working at said hospital expires June 30 at 11:59PM. This meant that if I worked overtime and something happened, I will have no license and no malpractice coverage after 11:59pm. This would look very bad in a court of law. In fact, they even quoted me a state lawsuit in which a resident in my state was sued for an incident which occurred after 12am July 1, and found to be practicing without a license. In other words, the legal department and education office told me to clear outta there and not to come in.

I then forwarded that information to the chief (albeit, several weeks ago so they would know well in advance before determining the schedule) and reiterated to make sure they knew I am happy to work until 11:59pm, but after that I am not coming in (on advice of the hospital's legal department). After that point, my butt is not covered and neither is theirs.

All too often those determining the schedule (chief or whomever) simply don't think about whether you are in a good legal position to work past June 30 when you are a departing resident. Unfortunately, at this point it's Thursday and you have only until Saturday to sort out this scheduling problem, if it turns out you are not covered by licensing and malpractice insurance to work.

 

[LADoc00]

What completely idiotic dimwitted department has someone on call their last day?? That is beyond absurd. Call in sick the last 3 days.

Sheesh.

The only thing I can think is that your friend is so stupid/weak willed she would put up with that and the department knows it.

 

[edmadison]

All too often those determining the schedule (chief or whomever) simply don't think about whether you are in a good legal position to work past June 30 when you are a departing resident. Unfortunately, at this point it's Thursday and you have only until Saturday to sort out this scheduling problem, if it turns out you are not covered by licensing and malpractice insurance to work.

Well, then the Chief or the attending can get their butts into the hospital and take the call. They made the mistake, not you.

Ed

 

[Chezia]

let me get this right....last day of work there, starting a new job the next day and you are actually spending more than 5 minutes on this issue. First of all..pretty lame that they actually scheduled you on the last day, however tell them you will be there till 11:59 pm and you are walking out the door. period. If they don't like it???? what options do they have? you no longer work there. If they complain to your new program, tell them you consulted with legal and said you weren't covered. period....now forgettabouttit

 

[Apollyon]

I am writing for my friend about her last day on-call.

She is transfering one hospital to another hospital.
She has on-call at 6/30, which requires to work until 7:00 am of July 1.
Her employment is effective until 6/30.

She doesn't want to work on July 1 from 12:00 AM to 7:00 AM.
One reason is that her new work place start to work 7:00 AM of July 1.
Driving distance between hospital is about 55 miles .
Another reason is that she is not legally employed at that institue for July.

What should she tell these PD and shief resident?

Any advice is appreciated.

As others have said, it's Thursday, and this is for Saturday. This only came up NOW?

 

[docB]

Well, then the Chief or the attending can get their butts into the hospital and take the call. They made the mistake, not you.

Ed

More likely they'll make some lucky new intern start at 1200am June 1st.

 

[docB]

let me get this right....last day of work there, starting a new job the next day and you are actually spending more than 5 minutes on this issue. First of all..pretty lame that they actually scheduled you on the last day, however tell them you will be there till 11:59 pm and you are walking out the door. period. If they don't like it???? what options do they have? you no longer work there. If they complain to your new program, tell them you consulted with legal and said you weren't covered. period....now forgettabouttit

This is bad advice. If you walk out on a shift, even under these circumstances, you could be accused of abandonment. That's bad. I suggest that you take a copy of the legal department's opinion to your chief and your PD with a letter explaining that you will not be licensed or covered after midnight. Keep copies of all this and document that you presented these documents. I would not leave the hospital until you get relief. I would stay but don't give any orders. Everytime something comes up I would call your senior or attending and have them give verbal orders to the nurses. Yes it sucks but it will do the most toward keeping you out of trouble. Obviously this is all a last resort and your chief and PD should come up with something prior to the event.

 

[Midwest Medic]

The hospitals in our town all switch call at midnight on the last day. The outgoing class gives the pagers over the the newbies at 11:59 and run away as fast as they can!

 

[gwen]

what's all this brouhaha (love that word...probably misspelled it) about?

she can't physically be in two places at once...if her current hospital doesn't understand that, then she can call in sick. end of story...no more brouhahahaahahah.

 

[Winged Scapula]

what's all this brouhaha (love that word...probably misspelled it) about?

she can't physically be in two places at once...if her current hospital doesn't understand that, then she can call in sick. end of story...no more brouhahahaahahah.

I don't think the brouhaha is about being in two places at once - after all, if she asked to leave her shift a bit earlier (say 0600) she could be at her new residency program by the 0700 start time.

The brouhaha is asking someone to work after midnight when they will no longer be licensed or be covered by malpractice since her training license expires at that institution on 6/30/07. In my opinion, its a bit unprofessional to call in sick - everyone will see right through that one. I am a bit mystified as to why this is coming up only days before the problem rather than when the call schedule came out, but the best solution is to talk to the Chief and PD, armed with the info from Risk Mgt, and see how the schedule can be changed.

 

[LADoc00]

I don't think the brouhaha is about being in two places at once - after all, if she asked to leave her shift a bit earlier (say 0600) she could be at her new residency program by the 0700 start time.

The brouhaha is asking someone to work after midnight when they will no longer be licensed or be covered by malpractice since her training license expires at that institution on 6/30/07. In my opinion, its a bit unprofessional to call in sick - everyone will see right through that one. I am a bit mystified as to why this is coming up only days before the problem rather than when the call schedule came out, but the best solution is to talk to the Chief and PD, armed with the info from Risk Mgt, and see how the schedule can be changed.

Professionalism?? LMAO. Where was the "Professionalism" when the program chief made the schedule? F--- them, seriously. I would walk up and piss right on their desk, then leave. Today. Dont be there one minute longer.

I hate this self sacrifice bullcrap, you are an employee. You have NO stake in this department any longer. This isnt some mission with the Navy SEALS to rescue a foreign diplomat. Programs DONT depend on residents to function. The attending/fellow can pull his/her lazy butt into the hospital for one night.

 

[Winged Scapula]

We obviously don't see eye to eye on this issue.

I would prefer to assume that the Chief, when making the schedule, didn't think about this particular resident leaving, and the problems it would cause. I'm sure they're using some template which has the resident on call q whatever. You prefer to think the Chief has some nefarious agenda behind this particular scheduling.🙄

If you'll note, there is another attending on here who says the same thing that I do...don't just walk out or call in sick. I never said she should stay and sacrifice - I merely said it was unprofessional to call in sick when everyone knows that would be a lie. But thanks for singling me out in your tirade.

 

[LADoc00]

We obviously don't see eye to eye on this issue.

I would prefer to assume that the Chief, when making the schedule, didn't think about this particular resident leaving, and the problems it would cause. I'm sure they're using some template which has the resident on call q whatever. You prefer to think the Chief has some nefarious agenda behind this particular scheduling.🙄

If you'll note, there is another attending on here who says the same thing that I do...don't just walk out or call in sick. I never said she should stay and sacrifice - I merely said it was unprofessional to call in sick when everyone knows that would be a lie. But thanks for singling me out in your tirade.

Wouldnt you agree that residents leaving is a absolutely forseeable event when creating the schedule? Wouldnt having a resident disappear permenantly at the end of a shift leave any patients she admitted without continuity of care?

The creator of the schedule is blatantly guilty of incompetence. INCOMPETENCE. Assuming that the chief resident did this, both the chief and her attending would be held liable should something go wrong with one of these patients after the resident leaves, not the resident.

If the resident bails and no one steps up to the plate, the chief of the department should fire both the attending of the service and the chief resident. End of story. I wont post any further on this craphole of a pointless thread.

 

[docB]

If the resident bails and no one steps up to the plate, the chief of the department should fire both the attending of the service and the chief resident. End of story. I wont post any further on this craphole of a pointless thread.

Clearly you have an axe to grind against residency programs. That's cool. Bitterness is my middle name. But the goal of the resident here is escape with nothing on the record that will interfere with future licensure, insurability, priveledging and job prospects. It's not a servitude thing. It's a self preservation thing.

 

[Winged Scapula]

Wouldnt you agree that residents leaving is a absolutely forseeable event when creating the schedule?

Of course. No argument there from me.

Wouldnt having a resident disappear permenantly at the end of a shift leave any patients she admitted without continuity of care?

Sure. Happens all the time, or at least every month, when the team changes services.

The creator of the schedule is blatantly guilty of incompetence. INCOMPETENCE.

I think that's a pretty strong word. I'll assume he's busy, didn't think about it in depth when making the schedule. These things are pretty hard to do (call schedules and accomodating everyone's requests).

Assuming that the chief resident did this, both the chief and her attending would be held liable should something go wrong with one of these patients after the resident leaves, not the resident.

Seems to me the resident/OP had at least a modicum of responsibility to remind the Chief when making the June schedule that he would be leaving and even then if that responsibility was neglected, to let the Chief know there was a problem more than a couple of days in advance. Not only is the OP guilty of lack of consideration for others in the program (which I know you don't care about) but shows an incredible lack of self-preservation. Why wouldn't you say something the minute the June call schedule came out rather than wait until June 28th to complain about being on call June 30th?😕

But I do agree - the resident should not be held liable for any problems that occur because she has to leave duty before the schedule calls for it.

the resident bails and no one steps up to the plate, the chief of the department should fire both the attending of the service and the chief resident.

Seems a bit extreme for what probably amounts to an administrative oversight on the part of the Administrative Chief and a lack of balls on the amount of the OP to say something to said Chief. Not likely to happen (the firing) over something fairly trivial which can be easily resolved. The best answer probably is to switch whomever's on tonight with tomorrow, or for the Chief to take the call.

Anyway, I am not totally insensitive to your bitterness towards residency - heck, my posts here should show that I had and still have plenty of my own toward my program. But as docB points out, bailing out can come back to haunt the OP and self-preservation is the name of the game - ie, not taking call when you aren't licensed and covered and not leaving without discussing it with the higher ups.

It would be nice if the OP came back and updated us...

 

[Stimulate]

This same thing happened to me... I called the resident scheduled to be on-call on 07-01-07 and told him that he would be starting his call at 12:01am (luckily it is home call for him) and I notified the attendings on the service of the same. Everyone was cool about it.

You may want to consider NOT coming in on Saturday morning until there is a formal, written, plan in place for your relief at 12:01am. That should get their attention!! 🙂

Whatever happens keep the documentation.

 

[3dtp]

This same thing happened to me... I called the resident scheduled to be on-call on 07-01-07 and told him that he would be starting his call at 12:01am (luckily it is home call for him) and I notified the attendings on the service of the same. Everyone was cool about it.

You may want to consider NOT coming in on Saturday morning until there is a formal, written, plan in place for your relief at 12:01am. That should get their attention!! 🙂

Whatever happens keep the documentation.

Had it happen to me, too. I pointed out in no uncertain terms, months in advance that this was/would be an issue and the response from above was do it or else. I was in an extremely malignant program, run by not very nice people. I took exactly the approach that I was in the hospital as an observer, not a responder, this was documented in memoranda, that my contract and my residency had completed on 6/30 and my license ended 6/30. The fact is, if you do not have a license in those states that require them, you cannot participate in patient care. Even if nothing untoward happens, a crafty medmal atty will use that as a lever, make no mistake about it. "Tell me Doctor, what gave you the right to practice medicine on the morning my client died of ESRD when you knew you did not have a license?" No jury will hear this question because the hospital will settle the case and throw you to the wolves.

Or say, nothing at all happens, except some ancillary health care professional you've annoyed sees you writing orders at 7AM 7/1 and calls the licensing board and reports Dr. OP was writing orders in a patient's chart with an expired license, is that proper? Next comes the hearing, the reprimand, the fine and those pesky little questions. And let's not forget HIPAA. Are you allowed to know protected information if you are no longer a licensed professional?

I agree with LaDOC 100% on this. Kimberli, the chief is not competent, and this manifestation of this is the chief's/PD's responsibility alone. Outgoing residents happen every year. The chief/PD has through carelessness or worse, willful misconduct, placed the OP's future at risk, and placed the hospital at risk.

As you pointed out, this is no mystery. We all know this. Programs have been known to screw people they don't like, behave dishonestly and otherwise mess with people.

 

[tibor75]

Wouldnt you agree that residents leaving is a absolutely forseeable event when creating the schedule? Wouldnt having a resident disappear permenantly at the end of a shift leave any patients she admitted without continuity of care?

The creator of the schedule is blatantly guilty of incompetence. INCOMPETENCE. Assuming that the chief resident did this, both the chief and her attending would be held liable should something go wrong with one of these patients after the resident leaves, not the resident.

If the resident bails and no one steps up to the plate, the chief of the department should fire both the attending of the service and the chief resident. End of story. I wont post any further on this craphole of a pointless thread.

It's hard to type 3 paragraphs and not have any rational points to make but this did it. Making a schedule is a small part of a cheif resident's job. Firing a chief over a scheduling mistake is the height of stupidity and only a 4th grader would suggest that as a rational course of action.

 

[Annoyances]

Malignant and Bitterness? Hahaha that's my middle name I just left a very very malignant program talk about screwing people OVER my god that program was huge work of art run by a pack of hyenas. Horrible Horrible hope they one day lose acredidation. Lord knows they are being investigated for their crimes against humanity.

 

[docB]

It would be nice if the OP came back and updated us...

I agree. Why is the OP MIA?

 

[3dtp]

It's hard to type 3 paragraphs and not have any rational points to make but this did it. Making a schedule is a small part of a cheif resident's job. Firing a chief over a scheduling mistake is the height of stupidity and only a 4th grader would suggest that as a rational course of action.

May be a small part, but it is crucial. Suppose the chief forgot to schedule an ICU call team for a weekend in January and no one showed up?
Bet the fur would fly on that one, don't you think?

 

[docB]

Well, it's now 0113 7/1/07 Pacific time. Whatever is happening it's happening now.

 

[tibor75]

May be a small part, but it is crucial. Suppose the chief forgot to schedule an ICU call team for a weekend in January and no one showed up?
Bet the fur would fly on that one, don't you think?

not really. If this happened, there are plenty of checks in the system to prevent the lack of coverage. The schedule is probably posted for a particular month...nobody noticed the blank shift? What about the intern on call before the open period? "Yeah, I couldn't find anybody to sign out to so I just left the hospital." What about the attending? What about the daily rounds? "Who is on call tonight" Nobody answers "Oh, well, I guess somebody will show up"


Sorry, but if your scenario happened, the chief would be the last person to blame.

 

[glorybrian]

Thank you for your kind advice!

 

[glorybrian]

I recommend my friend cut herself any part of her foot and go to emergency room.

----------------

She went to emergency room to cure herself.
She was officially sick and had a proper document.
She called the program that she was sick.
The Chief was not happy about it and threatened to report to the new program.

The Chief knew that her employment is complete at the end of June because her employment was planned to finish due to her program closure last year December.
She is rotating at other sister county hospital.

Another episode is about family issue of one resident.
During his on-call, he received phone call of his mother's death.
He ask for permission to go his mother's home.
They refused for him to leave early during on-call.
He have to finish his on-call.
They may think his mother will not come back anyway.

Both of them are rotating County hospital in Southern California.
If their program is closed and rotated other hospital, they may not be treated nicely.

Anyway it's over and she didn't do any illegal service.

Thank you for your kind advice.

 

[Miami_med]

Is it just me, or did this turn into a slightly-shady sitcom with a little TMI if this is a real story? (Since there were so many county hospital resideny program closures in S. Cal in December).

 

[yaah]

Anyway it's over and she didn't do any illegal service.

You mean, except for the fraud.