Section XI: Policies on Writing Orders, Medical Liability Insurance, Health Insurance and Other Health Policies

Medical Liability Insurance

It is common practice in medical education to allow third-and fourth-year students to write orders on patients they have worked with. This practice must be viewed as an educational activity and not as a service activity. As a learning experience, the teaching occurs when a supervising physician (either resident or attending); reviews the orders, discusses them with the student, provides constructive feedback, and countersigns the orders.

Under these circumstances students are covered by the university's medical liability insurance. The key conditions are that 1) the student is functioning under the direct supervision of a licensed physician, and 2) that the orders are countersigned before they are executed.

The university's medical liability insurance also covers Brown medical students when they are doing clinical electives at institutions other than Brown's affiliated hospitals, so long as the above conditions are fulfilled. Therefore, if a medical student is permitted to write orders on patients that are not countersigned or countersigned after they have been executed, the student may be personally liable for any damages that result from that action.

The medical liability insurance also covers students for any injury that results to a patient as a consequence of a student's actions in carrying out the usual and customary functions of a medical student in the course of caring for a patient. This includes taking a history, conducting a physical examination, and performing procedures of an investigatory or therapeutic nature. However, the same conditions apply, namely, that the student must be functioning under the direct supervision of a licensed physician.

Particular prudence should be exercised in the performance of procedures. It is customary for students to become proficient in certain basic procedural skills such as phlebotomy, starting IVs, inserting catheters and nasogastric tubes, doing lumbar punctures and obtaining other bodily fluids and tissues of a relatively simple nature, and minor surgical procedures. Other activities that are customarily conducted by students may include administering skin tests, relatively nontoxic medications by injection, and applying dressings, splints, and casts. Even when conducting these procedures the student should be closely and personally supervised by a licensed physician while gaining proficiency. After proficiency has been obtained, the student must perform these procedures only when they have been ordered by a supervising licensed physician. It is important for students to inform their supervising physician when they have not attained proficiency in a given procedure in order to receive close, personal supervision, even though it is the supervising physician's responsibility to ascertain the student's competence and provide appropriate supervision.

In situations that go beyond the usual and customary functions of medical students, it is imperative that the procedure is conducted under the direct, close, and personal supervision of a licensed physician. This would include such activities as major surgery, reduction of fractures, invasive procedures (e.g., bone marrow biopsies, organ biopsies, central line placement, thoracentesis, endotracheal tube insertion, etc.), and administration of relatively toxic substances (e.g., intravenous narcotics, chemotherapeutic agents, provocative tests, general anesthetics, etc.). Students should refuse to do these procedures without the direct, close, and personal supervision of a licensed physician.

Students should also refuse to obtain informed consent from patients for any procedure. This is the responsibility of the attending physician. Students are encouraged, however, to be present when the attending physician discusses the procedure with the patient as part of the informed consent process, in order to become acquainted with how this extremely important process occurs.

Students must always wear their identification name tags when dealing with patients and staff in the hospital. Students must identify themselves as medical students and sign all notations they make with the identification that they are medical students (e.g., John Smith, AMS III).

The best way to avoid being involved in a malpractice suit is to always act professionally, respect the rights of patients and treat them respectfully and kindly, act prudently, know the limits of your competence, and don't be afraid to say "I don't know," or "I'm not comfortable doing such-and-so." Listen to what staff nurses say and don't do something they don't want you to do.

If a student is involved in a medical malpractice action, legal representation is provided by the Office of the University Counsel, provided the student has acted within the guidelines specified above.

Students on Leave of Absence (LOA) or Fellow Status are not eligible for Brown's medical/professional liability insurance during their time away.

Health Services Fee and Health Services Resources

 

All medical students who are not on fellow status or LOA must pay an annual health service fee each semester.  This fee, which is separate from the charge for student health insurance, covers most general medical care at Health Services, including primary care by provider staff, use of Brown University Emergency Medical Services, nursing services and 24/7 medical advice and campus-wide health education. Also covered is access to Brown University Psychological Services, which provides assessment of problem situations, short term psychotherapy and crisis intervention. Coverage during the summer months is optional.

Waivers of the Health Services fee are available only to students who meet one of the following requirements: students who will not be in geographic residence during an entire semester (e.g., taking away electives, studying abroad, doing research at another institution, etc.). Requests for Health Service fee waivers are processed through the Office of Records & Registration (AMS-Student-Records@brown.edu) and must be submitted no later that June 15th of each year.

Student Health Insurance

Health insurance is not included in the Health Services fee.  All students must have separate health insurance to cover services not provided by the Health Services fee (such as lab, x-ray, pharmacy and hospital expenses). All active students are automatically enrolled in the Brown Student Health Insurance Plan (SHIP). This plan is designed specifically to complement the services provided by Health Services. The University's Office of Insurance and Risk is responsible for SHIP.

Students who are covered under a parent's, spouse's, or other comparable health insurance plan may complete an online form to waive them from participating in SHIP. When evaluating your plan, you must verify that your plan provides adequate coverage that is accessible in the Providence area. Information is sent to students each May with instructions on how to waive out of the plan. Students must complete an online waiver form annually at www.universityhealthplans.com. The deadline for completing the waiver is June 1st.

International Students - It is particularly important that you verify that your insurance plan provides adequate coverage that is accessible in the Providence area before waiving the Student Health Insurance.

Students on Leave of Absence (LOA) who need health insurance will need to purchase insurance directly from the Office of Insurance and Risk (OIR). Students not previously enrolled in the student health insurance program at Brown are not eligible to purchase coverage.

Students on Fellow Status who need health insurance are eligible for Brown's health insurance but must work directly with the OIR to request coverage during their time away.

Health Services records are confidential and are not released to anyone, including family, legal guardians and faculty, without written authorization from the student.  There are a few exceptions when release of specific information without a student's expressed consent is necessary in emergencies or is required by law.  Additional information can be found on the Health Services website.

More information is available at: http://brown.edu/Administration/Office_of_Insurance_and_Risk/students/.

Accidents and Injuries While in the Hospital

 

Students who are involved in an accident or who are injured while in one of the affiliated hospitals as part of their educational program should go to the hospital's Employee Health Service for attention and treatment. This is particularly important in accidents and injuries involving needle sticks or other possible contamination incidents. The Employee Health Service staff is familiar with the testing and/or treatment protocols utilized under these circumstances. Students should also notify their AMS academy director as soon after the incident as conveniently possible.

If the accident occurs outside of an affiliated hospital, such as in a doctor's office or community health center, students should obtain the needed health care in the most expeditious manner possible, and then contact their academy director. Students may also call University Health Services for advice at (401) 863-3953.

Immunizations


Rhode Island state law (R23-1-IMM/COL) and Lifespan affiliated hospitals require all medical students to have received the following vaccines and blood tests:

  • A record of two MMR vaccines and positive serological tests for immunity to Measles, Mumps and Rubella. History of disease is not acceptable. A copy of the lab report must be attached.
  • Postive serological test for immunity to Varicella (chickenpox) only if a history of chickenpox disease. History of disease alone is not acceptable. A copy of the lab report must be attached OR a record of Varicella vaccine, two doses, at least one month apart.
  • A record of Hepatitis B vaccine, three doses. If series complete, a Hepatitis B Surface Antibody titer must be done with a copy of the lab report attached.
  • Tdap (Tetanus/Diphtheria/Pertussis) booster within the past 10 years
  • PPD (Tuberculosis) skin test within the past 6 months; two-step testing will be required during the first year. The second PPD test will be performed at Brown.

In addition, all medical students are required to have an annual flu vaccine, Flu vaccines are offered at onsite clinics at the medical school each fall, and is also available at Health Services or through some of the hospital employee health departments.

Additional Resources At Brown

Dean of Chemical Dependency, Kathleen McSharry (401) 863-2536
The Dean of Chemical Dependency provides comprehensive academic and social support in non-clinical settings for Brown students, faculty and staff affected by alcohol or drug abuse. You can contact her by email at Kathleen_McSharry@brown.edu.

Health Education (401) 863-2794
Confidential appointments for drug or alcohol concerns or other health-related topics for Brown students. Located on the third floor of Health Services.

Psychological Services (401) 863-3476
Confidential appointments for psychological, alcohol or drug concerns and for adult children of alcoholics. Located on the fifth floor of J. Walter Wilson.