# Situation: A nurse works in the delivery room of a provincial hospital that is a comprehensive emergency obstetric and newborn care (CEmONC) referral facility. During a cesarean birth, the scrub nurse, a hospital employee, follows the obstetrician's direct instructions throughout the operation. A sponge is later found retained. The mother's lawyer argues that the obstetrician shares liability for the nurse's act because the nurse was under the obstetrician's direct control in the operating room. Which doctrine is the lawyer relying on?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629612  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the delivery room of a provincial hospital that is a comprehensive emergency obstetric and newborn care (CEmONC) referral facility.

During a cesarean birth, the scrub nurse, a hospital employee, follows the obstetrician's direct instructions throughout the operation. A sponge is later found retained. The mother's lawyer argues that the obstetrician shares liability for the nurse's act because the nurse was under the obstetrician's direct control in the operating room. Which doctrine is the lawyer relying on?

## 보기

1. Res ipsa loquitur
2. Captain of the ship **✔ 정답**
3. Respondeat superior
4. Personal liability rule

**정답: 2**

## 해설

The captain of the ship doctrine holds that when a nurse works under a surgeon's direct control in the operating room, the surgeon may share liability for the nurse's acts. Res ipsa loquitur would let negligence be inferred from the retained sponge itself, and respondeat superior would make the hospital, as employer, liable. The lawyer's argument rests on the obstetrician's control, not on the event or on employment.

## 심화 해설

Legal Doctrine in the Operating Room

The lawyer is invoking the captain of the ship doctrine. This doctrine emerged in 1949 and gained traction through the 1950s, largely because injured patients at that time were often barred from suing hospitals under charitable immunity rules [1]. Under the doctrine, the surgeon’s presence and authority in the operating room could make the surgeon legally responsible for the negligence of others on the team, much like a ship captain is accountable for what occurs on board [1].

The key element in this scenario is the surgeon’s direct control over the scrub nurse during the operation. The lawyer is not arguing that the retained sponge itself proves negligence, nor that the hospital is liable as the nurse’s employer. Instead, the argument focuses on the obstetrician’s supervisory role in the operating room, which is precisely the basis of the captain of the ship concept.

| Doctrine | Core Basis | Who Is Held Liable |
| --- | --- | --- |
| Captain of the ship | Surgeon’s direct control in the OR | Surgeon may share liability for team members’ acts |
| Res ipsa loquitur | The event itself implies negligence | Inference of negligence without direct proof |
| Respondeat superior | Employment relationship | Employer is liable for employee’s acts |

Key point! The choice hinges on the lawyer’s stated reasoning. Because the argument rests on the obstetrician’s control over the nurse, not on the sponge itself or on employment, the captain of the ship doctrine is the correct match.

The doctrine has weakened over time as charitable immunity declined in the 1960s and into the 1970s, shifting more liability toward hospitals and facilities [1]. However, it still appears in legal discussions of operating room responsibility, particularly when the surgeon’s authority over personnel is a central issue [1].References (research sources)

- [1]"Captain of the ship" doctrine continues to take on water.Research articleMurphy EK. (2001) · DOI: 10.1016/s0001-2092(06)61686-4

## 임상 시나리오

Captain of the Ship in the ORSurgeon liability for team negligence under direct control
The captain of the ship doctrine may make a surgeon share liability for a scrub nurse's error when the surgeon has direct control in the operating room. The lawyer's argument rests on the obstetrician's supervisory role, not on the retained sponge itself or on employment.

Compare doctrines: res ipsa loquitur infers negligence from the event, such as a retained sponge, without direct proof. respondeat superior makes the hospital, as employer, liable for the nurse's act.

CautionThe captain of the ship doctrine has weakened over time, but it remains relevant when the surgeon's direct control is the stated basis for shared liability.

## 핵심 개념

- **Captain of the ship** — Doctrine holding a surgeon may share liability for team members' negligence when the surgeon has direct control in the operating room.
- **Res ipsa loquitur** — A doctrine allowing negligence to be inferred from the very nature of an event, such as a retained sponge, without direct proof.
- **Respondeat superior** — A doctrine making an employer liable for the negligent acts of an employee performed within the scope of employment.
- **Retained sponge** — A surgical item left inside a patient after an operation, often used as evidence of negligence.
- **Charitable immunity** — A historical legal protection that barred patients from suing hospitals, contributing to the rise of captain of the ship liability.

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