Dr. Wrong has recently been sued in a most disturbing case. Three years ago, an independent nurse practitioner (NP) he supervises by employment contract, saw a young woman with a pigmented lesion, took a photo of it, and showed it to Dr. Wrong. He saw nothing atypical and conveyed this to the nurse practitioner. Unfortunately, the patient died two years later from metastatic melanoma. The estate ultimately sued both the NP and the dermatologist. He does not understand. He tells his lawyer that since he never saw the patient, he never established a patient-physician relationship; therefore, should have no liability. Is he right?
A recently decided case in Minnesota, Warren v. Dinter took a good look at this situation. This case analyzed the essential law underpinning a medical negligence claim – that a doctor-patient relationship must exist for a plaintiff to prevail. Generally, a physician owes no duty to a patient without a physician-patient relationship. Without a physician-patient relationship, with no duty owed, there is no liability for “breach” of that nonexistent duty. In what seemed to be a similar case to that of Dr. Wrong, the physician was found to have liability. Should we now be concerned that a physician can be held liable for malpractice even if there is no physician-patient relationship at all?
Dinter is a case that shows just how important it is to know how that relationship can still form when you never see the patient.
In this case, a patient saw a nurse practitioner for abdominal pain, fever and chills. The NP found that the patient had a high white count and so suspected an infection. The patient also had an elevated blood glucose. The NP tried to get the patient admitted to the hospital, a process which required vetting the case with a hospitalist. The hospitalist attributed the patient’s symptoms to diabetes and refused hospitalization. The patient subsequently died from sepsis caused by an untreated staph infection. Her family sued both the nurse practitioner and the physician for medical malpractice.
The hospitalist sought to be released from the case and a lower court granted it. In this case, although the hospitalist blocked the admission, the lower court nevertheless considered that he was only giving his “thoughts,” treating his interaction with the NP as an a informal curbside consult provided as an act of professional courtesy.