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ETHICAL PRACTICE & LEGAL ISSUES INSOCIAL WORK SUPERVISIONFIELD INSTRUCTORS TRAININGFEBRUARY 12, 2016ROBIN M. KOHN, MSW, LCSWBSW PROGRAM COORDINATOR/ASSOCIATE INSTRUCTORUCF SCHOOL OF SOCIAL [email protected]

SUPERVISION A SOCIAL WORKER/MENTAL HEALTH COUNSELOR WHO ASSUMES THEROLE OF FIELD INSTRUCTOR OR TASK SUPERVISOR HAS SPECIAL ETHICALOBLIGATIONS: RESPONSIBLE FOR THE QUALITY OF WORK DONE BY THOSE THEY SUPERVISE MUST HAVE KNOWLEDGE & SKILL IN THE AREAS THEY PROVIDE SUPERVISION EVALUATE THE PERFORMANCE BY USING HELPFUL & FAIR METHODS ASSIST SUPERVISEE’S GAIN KNOWLEDGE & SKILLS MAINTAIN PROFESSIONAL BOUNDARIES(GARTHWAIT, 2012, P. 39)

STANDARD OF CARETHE “STANDARD OF CARE” REFERS TO THEWAY AN ORDINARY, REASONABLE, ANDPRUDENT PROFESSIONAL WOULD ACTUNDER SIMILAR CIRCUMSTANCES.

WHAT SETS THE STANDARD OF CARE? STATE STATUTES NASW CODE OF ETHICS CASE LAW

SUPERVISION DEFINED SUPERVISION PROTECTS CLIENTS, SUPPORTS PRACTITIONERS, AND ENSURES THATPROFESSIONAL STANDARDS AND QUALITY SERVICES ARE DELIVERED BYCOMPETENT SOCIAL WORKERS & MENTAL HEALTH COUNSELORS. PROFESSIONAL SUPERVISION IS DEFINED AS THE RELATIONSHIP BETWEENSUPERVISOR AND SUPERVISEE IN WHICH THE RESPONSIBILITY ANDACCOUNTABILITY FOR THE DEVELOPMENT OF COMPETENCE, DEMEANOR, ANDETHICAL PRACTICE TAKE PLACE. THE SUPERVISOR IS RESPONSIBLE FOR PROVIDINGDIRECTION TO THE SUPERVISEE, WHO APPLIES SOCIAL WORK THEORY,STANDARDIZED KNOWLEDGE, SKILLS, COMPETENCY, AND APPLICABLE ETHICALCONTENT IN THE PRACTICE SETTING. THE SUPERVISOR AND THE SUPERVISEE BOTHSHARE RESPONSIBILITY FOR CARRYING OUT THEIR ROLE IN THIS COLLABORATIVEPROCESS. (NASW & ASWB BEST PRACTICE STANDARDS, 2012)

NASW CODE OF ETHICS & SUPERVISION3.01 SUPERVISION AND CONSULTATION3.01(A) SOCIAL WORKERS WHO PROVIDESUPERVISION OR CONSULTATION SHOULD HAVE THENECESSARY KNOWLEDGE AND SKILL TO SUPERVISEOR CONSULT APPROPRIATELY AND SHOULD DO SOONLY WITHIN THEIR AREAS OF KNOWLEDGE ANDCOMPETENCE.3.01(B) SOCIAL WORKERS WHO PROVIDESUPERVISION OR CONSULTATION ARE RESPONSIBLEFOR SETTING CLEAR, APPROPRIATE, AND CULTURALLYSENSITIVE BOUNDARIES.

3.01 SUPERVISION AND CONSULTATION3.01(C) SOCIAL WORKERS SHOULD NOT ENGAGE IN ANYDUAL OR MULTIPLE RELATIONSHIPS WITH SUPERVISEES IN WHICHTHERE IS A RISK OF EXPLOITATION OF OR POTENTIAL HARM TO THESUPERVISEE.3.01(D) SOCIAL WORKERS WHO PROVIDE SUPERVISIONSHOULD EVALUATE SUPERVISEES' PERFORMANCE IN A MANNER THAT ISFAIR AND RESPECTFUL.

MENTAL HEALTH COUNSELORS RELATIONSHIP WITH STUDENTS, INTERNS & EMPLOYEES MENTAL HEALTH COUNSELORS HAVE AN ETHICAL CONCERN FOR THEINTEGRITY & WELFARE OF SUPERVISEES, STUDENTS, & EMPLOYEES. THESERELATIONSHIPS TYPICALLY INCLUDE AN EVALUATIVE COMPONENT &THEREFORE NEED TO BE MAINTAINED ON A PROFESSIONAL & CONFIDENTIALBASIS RECOGNIZE INFLUENTIAL POSITION DO NOT ENGAGE IN ONGOING RELATIONSHIPS WITH CURRENT SUPERVISEE,STUDENTS OR EMPLOYEES ALL FORMS OF SEXUAL BEHAVIOR WITH SUPERVISEES, ETC. ARE UNETHICAL(AMERICAN MENTAL HEALTH COUNSELORS ASSOCIATION)

3.02 EDUCATION & TRAINING3.02 (A) SOCIAL WORKERS WHO FUNCTION AS EDUCATORS,FIELD INSTRUCTORS FOR STUDENTS, OR TRAINERS SHOULD PROVIDEINSTRUCTION ONLY WITHIN THEIR AREAS OF KNOWLEDGE &COMPETENCE AND SHOULD PROVIDE INSTRUCTION BASED ON THEMOST CURRENT INFORMATION & KNOWLEDGE AVAILABLE IN THEPROFESSION. (MENTAL HEALTH COUNSELORS #5)3.02 (B) SOCIAL WORKERS WHO FUNCTION AS EDUCATORS,FIELD INSTRUCTORS FOR STUDENTS SHOULD EVALUATE STUDENTS’PERFORMANCE IN A MANNER THAT IS FAIR & RESPECTFUL.

3.02 EDUCATION AND TRAINING3.02 (C) SOCIAL WORKERS WHO FUNCTION ASEDUCATORS OR FIELD INSTRUCTORS FOR STUDENTS SHOULDTAKE REASONABLE STEPS TO ENSURE THAT CLIENTS AREROUTINELY INFORMED WHEN SERVICES ARE BEINGPROVIDED BY STUDENTS.MENTAL HEALTH COUNSELORS – IN THE INFORMED CONSENTSTATEMENT, STUDENTS & EMPLOYEES NOTIFY THE CLIENT THEYARE IN SUPERVISION & PROVIDE THEIR CLIENTS WITH THENAME & CREDENTIALS OF THE SUPERVISOR

RESPONSIBILITIES, CHALLENGES DISCUSS EXPECTATIONS EARLY, AS OCCURS WITH CLIENTS CONDUCT OPEN & FAIR EVALUATIONS PROVIDE AMPLE TIME & OPPORTUNITY TO IMPROVE CREATE A SAFE ENVIRONMENT SO INTERN CAN SHAREFEELINGS ESTABLISH/MODEL CLEAR & APPROPRIATE BOUNDARIES &PROFESSIONAL BEHAVIOR

RESPONSIBILITIES, CHALLENGES DISTINGUISH SUPERVISION & COUNSELING ETHICAL OBLIGATION TO ENCOURAGE & CHALLENGE SUPERVISEES TO FACE& DEAL WITH POTENTIAL BARRIERS IDENTIFY LIMITATIONS OR UNRESOLVED PROBLEMS THAT INTERFERE WITHPRACTICE ENCOURAGE THERAPY IF NEEDED MAKE SUPERVISION PERSONAL BUT NOT THERAPY SUPERVISION IS TEACHING, MODELING, LEADING, GUIDING THERAPY IS THAT BUT ALSO HELPS A PERSON TO CHANGE SELF, BEHAVIOR ORRESOLVE PERSONAL PROBLEMS USING THERAPY IN SUPERVISION RESULTS IN INAPPROPRIATE DUALRELATIONSHIP WITH INTERN

RESPONSIBILITIES, CHALLENGES AVOID DUAL RELATIONSHIPS & CONFLICTING ROLES SEXUAL RELATIONSHIPS WITH CURRENT OR FORMER SUPERVISEE USING A SUPERVISEE AS A RESEARCH PARTICIPANT FRIENDSHIPS/SOCIAL RELATIONSHIPS BETWEEN SUPERVISORS &SUPERVISEES

ETHICAL PRACTICE CONFIDENTIALITY – DISCUSS CONFIDENTIALITY – WHAT WILL BESHARED AND WITH WHOM UNNECESSARY CONVERSATIONS – NEED TO KNOW STORAGE OF RECORDS INFORMED CONSENT & RELEASE OF INFORMATION INFORMING CLIENTS STUDENT IS AN INTERN AND WILL HAVE SUPERVISION DUTY TO WARN DUTY TO REPORT (AGENCY PROCESS) DUTY TO PROTECT (AGENCY PROCESS)

ETHICAL PRACTICE DOCUMENTATION OF CLIENT RECORDS ACCURATE & REFLECTS THE SERVICES PROVIDED DATED TIMELY DOCUMENTATION IN RECORDS TO FACILITATE THE DELIVERY OFSERVICES & TO ENSURE CONTINUITY DOCUMENTATION SHOULD PROTECT CLIENT’S PRIVACY & SHOULD ONLYINCLUDE INFORMATION THAT IS DIRECTLY RELEVANT TO THE DELIVERY OFSERVICES SIGNATURE OF STUDENT INTERN AND SUPERVISOR DEPENDING ON POLICYOF AGENCY DOCUMENTATION ON SUPERVISORY LOG & FIELD HOURS

STUDENT – FIELD INSTRUCTOR/TASKSUPERVISOR RELATIONSHIP SUPERVISION CAN BE DEMANDING, YET SATISFYING & INSPIRING IT IS A JOB THAT TAKES SENSITIVITY, SKILL, COMMON SENSE,COMMITMENT, GOOD SENSE OF HUMOR, INTELLIGENCE TEACHING ASPECT OF SUPERVISION SUPERVISION IS A WAY TO GIVE BACK TO THE PROFESSION – IT ISALSO BEING A “GATEKEEPER”

STUDENT-FIELD EDUCATOR INSTRUCTOR/TASKSUPERVISOR RELATIONSHIP THE VICARIOUS LIABILITY DOCTRINE PROTECTS THE RIGHTS OFCLIENTS TO RECEIVE QUALIFIED SERVICE AND THE RIGHTS OFSTUDENTS TO RECEIVE ADEQUATE AND COMPETENTSUPERVISION. THE VICARIOUS RESPONSIBILITY DOCTRINE DOES NOT RELEASESTUDENTS FROM LIABILITY BUT SPREADS THE RESPONSIBILITY TOTHE SUPERVISOR.

STUDENT-FIELD EDUCATORINSTRUCTOR/TASK SUPERVISORRELATIONSHIP THE VICARIOUS RESPONSIBILITY DOCTRINE ALSO SPREADSRESPONSIBILITY TO THE AGENCY ADMINISTRATION, FIELD STAFF,SCHOOL ADMINISTRATION, OR ANYONE INVOLVED WITH THESTUDENT. THE SUPERVISOR IS ULTIMATELY RESPONSIBLE FOR THE WORKTHAT IS ASSIGNED TO AND DELEGATED TO STUDENTS.

VICARIOUS LIABILITY SUPERVISORS CAN MANAGE VICARIOUS LIABILITY—WHILEINCREASING THE LIKELIHOOD OF A FAVORABLE RULING IN THEEVENT OF A MALPRACTICE ACTION—IN SEVERAL WAYS: CLEARLY DEFINED POLICIES AND EXPECTATIONS; AWARENESS OF HIGH-RISK AREAS; PROVISION OF APPROPRIATE TRAINING AND SUPERVISION NASW INSURANCE TRUST

VICARIOUS LIABILITY UNDERSTANDING SUPERVISEE STRENGTHS AND WEAKNESSES ASPRACTITIONERS DEVELOPING AN ADEQUATE FEEDBACK SYSTEM SUPERVISORS KNOWING THEIR OWN RESPONSIBILITIES NASW INSURANCE TRUST

ETHICAL PRACTICE & THE LAW LEGISLATION ESTABLISHES MINIMUM STANDARDS FOR CONSUMERPROTECTION LEGISLATION IS BASED ON “THOU SHALLS” & “THOU SHALL NOTS” MOST ETHICAL DECISIONS ARE MORE COMPLICATED THAN “THOUSHALLS” MANY COURTS OF LAW RELY UPON PROFESSIONAL CODES OFETHICS AS PRACTICE STANDARDS THE LEGAL CONTEXT OF THE SOCIAL WORK PROFESSION

LEGAL CONCERNS WILL I BE SUED? A GROWING NUMBER OF SOCIAL WORKERS ARE BEING SUED FORMALPRACTICE MALPRACTICE & PROFESSIONAL NEGLIGENCE FALL UNDER A CATEGORYOF LAW KNOWN AS TORT LAW TORT LAW A TORT IS A PRIVATE OR CIVIL WRONG OR INJURY THAT RESULTS FROMACTIONS OTHER THAN BREACH OF A FORMAL LEGAL CONTRACT & THECOMMISSION OF A CRIME (GARTHWAIT, 2012, P. 157)

MALPRACTICE IS A FORM OF NEGLIGENCE THAT OCCURS WHEN ASOCIAL WORKER, OR ANY OTHER PROFESSIONAL, ACTSIN A MANNER INCONSISTENT WITH THATPROFESSION’S STANDARD OF CARE AND CAUSES HARMTO A CLIENT THROUGH A LACK OF CARE OR SKILL. ACTS OF COMMISSION OR OMISSION23

LEGAL CONCERNS WHETHER A BREACH OF DUTY HAS OCCURRED IS DETERMINED BYMEASURING THE ALLEGEDLY HARMFUL ACT OR OMISSION AGAINSTPUBLISHED STANDARDS OF PRACTICE, AGENCY POLICY, & THEPERFORMANCE OF SOCIAL WORKERS IN SIMILAR SETTINGS. THE CLIENT’S INJURY MUST BE ONE THAT WOULD NOT HAVEOCCURRED HAD IT NOT BEEN FOR THE SOCIAL WORKER’SNEGLIGENCE.(SHEAFOR & HOREJSI (2008) IN GARTHWAIT, 2012, P.157)

TO BE SUCCESSFUL IN A LAWSUIT: THE PLAINTIFF’S (CLIENT) ATTORNEY MUST PROVE FOUR POINTS: THE SOCIAL WORKER HAD A PROFESSIONAL OBLIGATION OR DUTY TOPROVIDE THE PLAINTIFF WITH A CERTAIN LEVEL OF SERVICE, A CERTAINSTANDARD OF CARE, OR A CERTAIN MANNER OF PROFESSIONALCONDUCT. THE SOCIAL WORKER WAS NEGLIGENT OR DERELICT IN HIS OR HERPROFESSIONAL ROLE BECAUSE HE OR SHE DID NOT LIVE UP TO THISRECOGNIZED OBLIGATION OR DUTY, STANDARD OF CARE, OR EXPECTEDPROFESSIONAL CONDUCT.

TO BE SUCCESSFUL IN ALAWSUIT: THE PLAINTIFF SUFFERED INJURY OR HARM (E.G., PHYSICAL, MENTAL,EMOTIONAL, OR FINANCIAL) AS A RESULT OF WHAT THE SOCIALWORKER DID (ACT) OR DID NOT DO (OMISSION) AND THIS ACT OROMISSION HAD A FORESEEABLE HARMFUL CONSEQUENCE FOR THEPLAINTIFF THE SOCIAL WORKER’S ACT OR OMISSION WAS A DIRECT ORPROXIMATE CAUSE OF THE HARM EXPERIENCED BY THE PLAINTIFF.(GARTHWAIT, 2012, P. 157)

EVERY TIME THERE IS ALAWSUIT, IT NOT ONLYDAMAGES THE INDIVIDUAL, ITALSO DAMAGES THEPROFESSION.

VICARIOUS OR INDIRECT LIABILITYANYONE CAN BE HELD PARTIALLYACCOUNTABLE FOR MALPRACTICE ACTIONS(ACTS OF OMISSION OR COMMISSION) OFSUBORDINATES, ASSISTANTS, STUDENTS,SUPERVISEES, OR EVEN COLLEAGUES.

DIRECT LIABILITYSUPERVISORS MAY BE HELD LIABLE FOR NEGLIGENT SUPERVISORYPRACTICES SUCH AS: ALLOWING A SUPERVISEE TO PRACTICE OUTSIDE YOUR AND/ORHIS/HER SCOPE OF PRACTICE NOT PROVIDING CONSISTENT TIME FOR SUPERVISION SESSIONS LACK OF EMERGENCY COVERAGE AND PROCEDURES LACK OF SUFFICIENT MONITORING OF SUPERVISEE’S PRACTICEAND/OR DOCUMENTATION LACK OF CONSISTENT FEEDBACK PRIOR TO EVALUATION VIOLATION OF PROFESSIONAL BOUNDARIES IN THE SUPERVISORYRELATIONSHIP

STUDENT-FIELD INSTRUCTOR/TASKSUPERVISOR RELATIONSHIP STUDENTS AND FIELD INSTRUCTORS/TASK SUPERVISORS ARE RESPONSIBLE FORPROTECTING CLIENTS BY ENSURING STUDENTS RECEIVE ADEQUATE SUPERVISION. SUPERVISORS ARE EXPECTED TO KNOW WHAT THEIR STUDENTS ARE DOING AND TOSTOP INAPPROPRIATE BEHAVIOR. THE SUPERVISOR IS ULTIMATELY RESPONSIBLE FOR THE WORK ASSIGNED. TO PREVENT MISTAKES – FIELD INSTRUCTORS MUST ENSURE THAT SUPERVISIONOCCURS AND THAT THERE IS ADEQUATE TIME TO BECOME FAMILIAR WITH ALL OF THESTUDENTS CASES. MAINTAINING A LOG DESCRIBING THE MEETINGS AND THE CASES DISCUSSED.SPECIFIC ADVICE REGARDING A CASE OR A SITUATION SHOULD BE DOCUMENTED. SEE MORE AT: /SUPERVISION/#STHASH.FAN7SMSO.DPUF

STUDENT-FIELD INSTRUCTOR/TASKSUPERVISOR RELATIONSHIPDO NOT ASSUME THERESPONSIBILITY FOR A STUDENT IFYOU DO NOT HAVE THE TIME ORRESOURCES TO PERFORM THE TASKWELL.

4 ARENAS THAT CAN SANCTION STATE LICENSING BOARD NASW ETHICS COMMITTEE CRIMINAL COURT CIVIL COURT – (MALPRACTICE SUITS)ONE ACTION CAN BE SANCTIONED BY MORE THAN ONE ARENA

WHEN CLIENTS TEND TO SUE(NASW) DISAPPOINTMENT WITH OUTCOME OF TREATMENT. FAILURE TO MAINTAIN & PROTECT CONFIDENTIALITY MISREPRESENTATION OF PROFESSIONAL TRAINING, EXPERIENCE, &CREDENTIALS BELIEVE THEY HAVE BEEN EXPLOITED OR USED FINANCIALLY,EMOTIONALLY, OR SEXUALLY. FAILURE TO REPORT SUSPECTED CHILD OR ELDER ABUSE, NEGLECTOR EXPLOITATION HAD A NEGATIVE OUTCOME AND ATTRIBUTE IT TO THE SOCIALWORKER’S INCOMPETENCE OR NEGLIGENCE. TERMINATION OF TREATMENT; ABANDONMENT.

SOME COMMON CAUSES OFMALPRACTICE ACTION INCORRECT TREATMENT; INACCURATE DIAGNOSIS ORASSESSMENT (#1) SEXUAL MISCONDUCT (#2) FAILURE TO ALERT OTHERS WHEN A CLIENT DISCLOSES INTENT TOHARM SELF OR CAUSING OR FAILING TO PREVENT A SUICIDE (#3) FAILURE TO WARN OTHERS WHEN A CLIENT DISCLOSES CLEARINTENT TO INFLICT SERIOUS PHYSICAL HARM ON SOMEONE (#4) BREACH OF CLIENT CONFIDENTIALITY (#5) FAILURE TO PROVIDE ADEQUATE CARE FOR CLIENTS INRESIDENTIAL SETTINGS. DEFAMATION

RISK MANAGEMENT TIPS(NASW INSURANCE TRUST) LEARN THE STANDARDS OF ACCEPTED PRACTICE. KNOW YOUR LIMITATIONS. HAVE AN ATTORNEY YOU CAN TALK TO REGULARLY. DEVELOP CLEAR TREATMENT PLANS WITH CLIENTS. HAVE A ROUTINE AND CONSISTENT CONSULTATION AND REFERRAL PROCEDURE. CONDUCT AN INTERNAL AUDIT OF AGENCY/PRACTICE. ATTEND IN-SERVICE STAFF TRAINING. AVOID ANY TYPE OF DUAL RELATIONSHIP WITH CLIENTS & SUPERVISEE’S. HAVE ADEQUATE COVERAGE, BACK-UP AND EMERGENCY NUMBERS AVAILABLE.

RISK MANAGEMENT TIPS BE CAUTIOUS IN USING NONTRADITIONAL THERAPIES AND MODALITIES. DO NOT PROMISE CURES. RECOGNIZE HIGH-RISK CLIENTS FROM A LIABILITY STANDPOINT. KEEP THE WELL-BEING AND WELFARE OF THE CLIENT AT THE FOREFRONT OFDECISION-MAKING. TREAT THE CLIENT WITH RESPECT AND KINDNESS TO AVOID A PERSONALITYCONFLICT AND/OR LAWSUIT. EXPLAIN AND OBTAIN NECESSARY RELEASE FORMS. ADVOCATE FOR CLIENTS WITH MANAGED CARE COMPANIES. TERMINATE RESPONSIBLY WITH CLIENTS. MAINTAIN ACCURATE CLIENT RECORDS. OFTEN THE SINGLE BEST TOOL FOR A SOCIAL WORKER’S DEFENSE IS IF IT IS WELL-WRITTENAND ACCURATE.

UCF & FIELD INSTRUCTOR’S STEPSTO REDUCE RISKUCF UCF FIELD ORIENTATION PRE-PLACEMENT INTERVIEW WITH FIELDFACULTY UCF FIELD MANUAL NEW BSW & MSW STUDENT ORIENTATION EXPECTATION OF PROFESSIONAL BEHAVIOR(BSW & MSW STUDENTS SIGN) EDUCATIONAL LEARNING CONTRACT MID-TERM EVALUATION SITE VISIT INTEGRATIVE FIELD SEMINARS FIELD REPORTSAGENCY PRE-PLACEMENT INTERVIEW WITHPROPOSED FIELD INSTRUCTOR AGENCY ORIENTATION WEEKLY SUPERVISION(INCLUDING LEARNING STYLESAND TEACHING STRATEGIES DOCUMENTATION (CASE,SUPERVISION, CORRECTIVEACTION PLAN) EDUCATIONAL LEARNINGCONTRACT MID-TERM EVALUATION SITE VISIT FIELD INSTRUCTOR ONGOINGEDUCATION AND SUPERVISION

ADDITIONAL RESOURCES NASW ASSURANCE SERVICES HTTP:/WWW.NASWASSURANCE.ORG/ WEBPAGE ON “UNDERSTANDING RISK MANAGEMENT” – PRACTICE POINTERS& ADDITIONAL RESOURCES LIABILITY INSURANCE INFORMATION FLORIDA LAWS & RULES UPDATE THROUGH NASWFL.ORG FLORIDA STATUTES 456 (REGULATION OF PROFESSIONS & OCCUPATIONS) &491(CLINICAL, COUNSELING, & PSYCHOTHERAPY SERVICES) FLORIDA ADMINISTRATIVE CODE RULE CHAPTER 64B4

REFERENCES Barker, R., (2003). The social work dictionary. (5th ed.). Silver Spring, Md. Dolgoff, R., Loewenberg, F., Harrington, D. (2009). Ethical decisions for socialwork practice. (8th ed.). Belmont, Ca., Brooks/Cole – Thomson Learning. Garthwaith, C. (2011). The social work practicum: A guide & workbook forstudents. (5th ed). Boston: Allyn & Bacon, Pearson Education, Inc. Miley, K., O’Melia, M., Dubois, B. (2013). Generalist social work practice: Anempowering approach. (7th ed). Boston: Allyn & Bacon, Pearson Education, Inc. NASW Code of Ethics (1996 & 2008) Approved by the Delegate Assembly NASW Insurance Trust Best Practice Standards for Supervision Reamer, Frederic G. (2005). Social work values and ethics. (3rd ed.) New York:Columbia University Press. Ward, K., Sakina Mama, R, (2010). Breaking out of the box: Adventure-basedfield instruction. (2nd ed.). Chicago, Il. Lyceum Books, Inc.

THANK YOU FOR TAKING ONTHIS IMPORTANT ROLE!QUESTIONS?

vicarious liability supervisors can manage vicarious liability —while increasing the likelihood of a favorable ruling in the. event of a malpractice action —in several ways: clearly defined policies and expectations; awareness of high-risk areas; provision of appropriate trainin