During a busy clinic, Dr A asks his clinic nurse to administer routine DPT first booster vaccine to an 18-month-old child. The nurse inadvertently administers MMR, which had been drawn up for another patient. The mother is unhappy as she did not want her child to have the MMR vaccine and sues the clinic. Dr A’s decision to delegate this task to his nurse is acceptable as she had the necessary qualifications and experience to do this. Hence any potential claim against Dr A for inappropriate delegation would be defensible.
On the other hand, Nurse B’s actions in administering the wrong vaccine on this occasion are indefensible and below the standard one would expect from a competent nurse. Nurse B would therefore be liable in the event of a claim in negligence against her. As her employer, Dr A could also be held vicariously liable for Nurse B’s error. In this event, it is likely that Dr A’s medical defence organisation would seek an indemnity from Nurse B’s insurer as Dr A’s own indemnity would not cover the acts or omissions of a member of his clinical staff.
Nurse B’s actions in administering the wrong vaccine on this occasion are indefensible
The Singapore Medical Council (SMC) places a professional obligation on the delegating doctor to exercise effective supervision over any member of staff to whom a task is delegated and who is not a registered medical practitioner. The delegated task must be undertaken as part of a legitimate training programme.2The Medical Council of Hong Kong (MCHK) makes similar provisions.3
Doctors in Singapore providing cosmetic and aesthetic services should be aware that the Guidelines on Aesthetic Practices for Doctors 2008 set out requirements for the minimum level of competence “to carry out the procedure and manage the anticipated serious complications” for List A and List B procedures. In consequence, as a minimum, only registered medical practitioners holding an appropriate Certificate of Competence are entitled to carry out these procedures which may not, therefore, be delegated to non-medically qualified staff members.4