Who may be held liable when a patient in the Intensive Care Unit (ICU) develops severe complications after a junior doctor administers the wrong drug dosage due to lack of supervision by qualified senior doctors at night?

Medical-Legal Liability in ICU Medication Error Cases

Direct Answer

Both the junior doctor and the hospital are liable in this situation (Answer C). 1 The junior doctor bears direct responsibility for the medication error, while the hospital faces corporate/direct liability for failing to provide adequate supervision and safe staffing structures in the ICU.

Legal Framework for Dual Liability

Individual Physician Liability

• The junior doctor who administered the wrong drug dosage is directly liable for the medication error that caused severe patient complications 1
• Medical negligence occurs when a healthcare provider's actions fall below the accepted standard of care, resulting in patient harm 2, 3
• The physician cannot escape liability simply because errors "can happen" - this explicitly eliminates option D 1

Hospital Corporate/Direct Liability

• Hospitals have a non-delegable duty of care to patients that extends beyond vicarious liability for employee actions 4, 5
• The hospital's failure to provide qualified senior doctors for nighttime ICU supervision represents a systemic organizational failure 1
• Corporate liability arises when hospitals fail to implement adequate staffing structures, supervision systems, and safety protocols 4, 6

Systemic Factors Contributing to Liability

Inadequate Staffing and Supervision

• The absence of senior physician supervision in the ICU at night is a critical organizational deficiency that directly increases medication error risk 1
• Studies demonstrate that medication errors in ICU settings occur at rates of 74.5 events per 100 patient days, with 1% resulting in permanent harm or death 1
• Higher patient-to-nurse ratios and lack of senior oversight significantly increase odds ratios for parenteral medication errors 1

Organizational Safety Culture Failures

• The hospital failed to provide the structural safeguards necessary to prevent foreseeable errors by junior staff 1
• Effective ICU safety requires: adequate staffing ratios, senior physician presence, established protocols, and supervision systems 1
• The modern approach emphasizes that "when something goes wrong, it is usually the result of multiple systemic factors, rather than a single cause" 1

Why Both Parties Share Liability

The Junior Doctor Cannot Be Solely Liable (Eliminates Option A)

• While the junior doctor made the proximate error, the hospital created the unsafe environment that enabled it 1
• Modern patient safety principles recognize that individual blame without addressing systemic failures perpetuates unsafe conditions 1

The Hospital Cannot Escape Liability (Eliminates Option B)

• The hospital cannot delegate away its fundamental duty to provide safe care through adequate supervision and staffing 4, 5
• Direct liability attaches when hospitals fail to "adequately monitor and control the standards of medical care and treatment offered within their walls" 4
• The absence of nighttime senior supervision represents a breach of the hospital's organizational duty 1

Critical Distinctions in Liability Types

Vicarious Liability vs. Direct Liability

• Vicarious liability: Hospital responsibility for employee actions during employment scope 2, 3, 6
• Direct/corporate liability: Hospital's independent duty to maintain safe systems, adequate staffing, and proper supervision 4, 5
• In this scenario, both forms apply: vicarious liability for the junior doctor's error AND direct liability for inadequate supervision systems 4, 6

Common Pitfalls to Avoid

• Do not assume only the person who physically administered the drug bears responsibility - medication errors in critical care settings typically involve multiple systemic failures 1
• Do not accept "errors happen" as a defense - this contradicts established patient safety principles requiring proactive risk mitigation 1
• Do not overlook the hospital's duty to provide adequate supervision - this is a non-delegable organizational responsibility 4, 5

Evidence-Based Safety Requirements

What Hospitals Must Provide

• Qualified senior physician coverage in ICUs, particularly during high-risk periods like nights 1
• Established protocols for medication preparation, verification, and administration 1
• Adequate nurse-to-patient ratios to reduce medication error risk 1
• Systems for error reporting, analysis, and prevention 1

Individual Practitioner Responsibilities

• Junior doctors must recognize their limitations and seek supervision when uncertain 1
• All prescribers must verify patient identity, medication, dose, route, and timing (the "five rights") 1
• Healthcare providers cannot prescribe or administer medications without proper patient evaluation and verification 7