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LEGAL ISSUES | Stay ahead of regulatory action and improve patient care by understanding the rationale behind physician delegation of medical treatment. © ISTOCKPHOTO.COM Physician delegation of medical services began in the early 1970s. It is important to appreciate the history of delegation, because it will provide insight into acceptable delegation guidelines in the modern aesthetic medicine practice. In the early 1970's, the United States was deluged with various fl u epidemics. Vaccines were scarce, and there were literally waiting lines to see physicians. It is not in the public's best health interest to deny vac- cines to those who desire them. Accordingly, states began to develop regulations that enabled physicians to "delegate" medical procedures to staff based upon the physician's knowledge and comfort level with the staff member. Frequently, nurses or other licensed and trained medical personnel, delivered fl u shots. Very few states have modifi ed their delegation regula- tions since the 1970s. The primary reason for this is that the delegation of medical procedures is based on the physi- cian exercising his or her independent medical judgment for the benefi t of a patient. DELEGATION VS. SUPERVISION Physician delegation must be distinguished from physician supervision. We will address supervision of medical per- sonnel in a future issue of MedEsthetics. Delegation occurs when a physician assesses a patient and determines that the patient would benefi t from a medical procedure that the physician is comfortable delegating to a staff member. The delegated service is performed in the physician's offi ce or a satellite offi ce owned by the delegating physi- cian. Naturally, the staff member should be trained in the procedure, and the physician should monitor the care that the staff member provides. Ultimately, the physician is responsible for the care of the patient. There are signifi cant issues that relate to physician del- egation. First, the physician should delegate only to trained staff members. The training should come from both the physician and industry resources. For example, an em- ployee who is performing aesthetic laser treatments should be trained by the physician in the use and application of the laser for the delegated procedures. The staff member also should be trained in laser safety. This training can be obtained through industry workshops and seminars. The next signifi cant issue is that the delegated staff member who is performing the procedure must be an employee of the physician or medical facility. The theory By Padraic B. Deighan, JD, PhD Physician Delegation 30 APRIL 2014 | Med Esthetics Very few states have modifi ed their delegation regulations since the 1970s. L e g a l I s s u e s M E D 4 1 4 . i n d d 3 0 Legal Issues MED414.indd 30 3 / 1 3 / 1 4 9 : 1 8 A M 3/13/14 9:18 AM