When hiring staff and distributing staff assignments, it's important to avoid potential legal problems by planning ahead. You, your administrators and your staff must be aware of federal and state law as well as regulatory guidelines (such as those of Medicare and OSHA). Here, we'll discuss the most reliable ways to ensure that staff are apprised of guidelines, and we'll tell you what broad guidelines to follow in various aspects of your practice.

Every practice needs an employee handbook or policy manual, which must be distributed to everyone in the practice. The manual should be drafted by an attorney and should include policies for vacation and leave (including disability and maternity) and for all forms of harassment, according to OSHA and state regulations. The manual could also include regulations for telephone usage and hours. It's extremely important to have a set leave policy and to apply that policy consistently to all employees.

Each office should also supply employees with a written guide covering job descriptions, training procedures and explanations of all office activities, with clear specifications about staff responsibilities.

Remember that procedures included in policy manuals must be followed by the physicians, administrative staff and other staff. If, for example, an employee brings a harassment claim and the physician office produces a policy manual with a strict harassment policy as its defense, that defense probably won't be successful if the office didn't follow the policy.

Consider our advice regarding the following issues between you and your staff:

• Interview.
When interviewing staff candidates, you may not ask questions aimed at finding out whether the person is disabled. You may only ask whether the applicant is able to perform the duties required for the job for which he or she is interviewing. Even if the applicant volunteers information about a disability in response to a question, you must be careful not to ask a follow-up question to elicit more information. It's imperative that you -- or whoever else conducts the interview -- be aware of which questions can and can't be asked.
• Staff training.
Staff must be adequately trained to carry out their duties in accordance with state medical practice laws. Employees, in turn, must recognize and adhere to their duties and limitations. Cross-training can create a problem if an employee is working in another area and is called upon to do something beyond his or her expertise.
Training and cross-training start with clear job descriptions. Each office position must be defined as to required skills, training procedures and the requirements for those who are cross-trained.
Training protocol should be spelled out. It should include resource material and explain who is available for backup, questions and advice. Specify required continuing education, and evaluations or tests that will assure the employee is carrying out her duties. Document the achievement of levels of expertise, attendance at courses and procedure for evaluations.
• Staff supervision.
Give special consideration to the specific duties that staff may carry out when you're not in the office. Because of decreasing fees, practices sometimes attempt to save time by asking staff to carry out some of the physician's duties. Staff members also recognize the limitations on your time and may try to handle situations without "bothering" you. This practice can result in staff making medical decisions that are beyond their expertise.
These methods of increasing efficiency may be dangerous (for you and the patient) as well as counterproductive. You must always keep in mind that you are ultimately responsible for the conduct of your staff. If a problem occurs, it's insufficient for you to claim that you didn't know what the staff member was doing.
Non-physician staff should never carry out those duties that are restricted to physicians. For example: Only you, the physician, may diagnose problems and provide treatments such as surgery and medication prescriptions. Staff are also prohibited from initiating treatments. Phone calls for prescription information and refills, from pharmacies and other eyecare providers (including opticians), must be handled by trained staff, which should provid documentation in the chart which you countersign.
When patients call for medical advice, you must be the one to give it. Staffers who over-extend themselves in an effort to "protect" you create a potential legal problem.
One important consideration for any medical office that employs professionals licensed by the state is to remember that if a non-licensed individual provides medical treatment, that individual may be liable for practicing without a license. In addition, certain state licensing and Medicare reimbursement regulations require that a physician be present in the office or in the room when certain types of procedures, such as visual fields, are conducted.
• Harassment.
At all costs, avoid any action or words that might be construed as or mistaken for sexual harassment or discrimination. Treat employees fairly and equally within staff categories. This advice applies to relations with staff, other physicians in the practice and patients. An emerging trend in certain states has employees initiating harassment actions for claims other than sexual harassment. The employees claim that some of their characteristics -- such as a disability, race or ethnicity -- subject them to harassment in the form of a hostile work environment.
• Special situations.
When someone joins or leaves your staff, goes on vacation or is otherwise unavailable, it's essential that the person filling in knows his or her duties and limitations. The office must have a standard protocol for handling any unusual situation that arises. When a question about the propriety of staff performing certain duties comes up, discuss the concern with your attorney or with the legal staff of your state medical society.

There are also legal issues to consider regarding your role in overseeing interactions between your staff and your patients.

• Contact lens fitting.
This is an area of particular concern. Prescribing and fitting contact lenses requires special attention. Doctors often delegate much of this responsibility to staff members who have varying degrees of training and ability. But contact lens patients sometimes develop irritation or non-specific complaints, which may indicate potential serious problems, such as sight-threatening infection, corneal distortion and other medical conditions.
You must have a clear protocol for your contact lens staff to follow, and be available and willing to see any patient who is causing your technician concern.
Train your staff to assure that you see the patient on a regular basis. You should see a patient for follow-up exams and also perform a complete exam as indicated by the patient's age and medical condition. Remove contact lenses at the exam, dilate the patient's eyes and check his intraocular pressure.
• Glasses.
Because patients commonly return to the dispensary with complaints about their glasses, you need to have a protocol and an education program in place to help the optician handle potential problems.
Patients often assume that any change in their vision after receiving glasses is due to the glasses not having been made correctly. The standard advice is often "try wearing the glasses for a while." However, patients have returned to the optician with double vision, diabetic changes, strokes and other symptoms.
You must be available any time an optician encounters an unusual situation that doesn't appear to be related to the glasses. In turn, the optician must provide the patient with advice about the proper type of lenses, such as polycarbonate lenses and safety frames for industrial use, children's athletics or patients with only one eye.
Even if the practice doesn't own the optical, it's still responsible for it. You must meet with the optician and be aware of what's happening. This may require special arrangements and meetings with the owner of the optical or whoever is running the dispensary.

Remember, the best way to avoid potential claims and lawsuits about employment and staffing issues is to have specific policies in place. A properly drafted policy manual that's regularly consulted, updated and followed is an excellent way to avoid legal claims.

Because staff members come and go, it's also important to conduct regular meetings to reiterate provisions of the manual. This could avoid potential legal problems by allowing staffers to discuss problems before they escalate.

Focus meetings on practical, constructive issues the staff face every day. Allow for their input. Ultimately, you, as the doctor, must provide adequate training for all staff so that they understand and can carry out their duties.