Shared Liability? Consultants, Pharmacists, and the EP
Shared Liability? Consultants, Pharmacists, and the EP
In Walters v Rinker, the court ruled that the examination of a culture or tumor establishes a physician–patient relationship. In this case, the patient had a mass excised, and the specimen was sent to a pathologist for examination. In his report, the pathologist stated, "conclusive evidence of malignancy was not present, and changes in the lymph node from the thigh area were of an active rather than a neoplastic nature". Based on the pathologist's report, the mass was determined to be benign. The patient's health declined, and he was diagnosed with large cell lymphoma 2 years later.
The court ruled that the pathologist established a physician–patient relationship in this case. Although the pathologist never personally saw or treated the patient, he provided professional input for the patient's care. The court stated that the tissue examination and diagnosis were clearly performed for the purpose of evaluating for possible treatment. In such instances, a physician–patient relationship can be created without direct patient contact.
This legal analytical approach was again applied in Diggs v Arizona Cardiologists, Ltd. Here, the court decided that the interpretation of test results by a specialist establishes a duty to the patient. The plaintiff presented to the St. Luke's Medical Center ED with severe chest pain. The emergency physician ordered an electrocardiogram (ECG) and an echocardiogram. The computerized ECG interpretation indicated a myocardial infarction (MI), however, the emergency physician determined the clinical picture to be more consistent with pericarditis. The emergency physician asked Dr. Valdez (a cardiologist who was in the ED visiting a different patient and not on call) for an informal consultation aimed at better interpretation of the echocardiogram. Dr. Valdez reviewed the patient's clinical history, physical examination results, and ECG. He did not choose to physically see the patient. Dr. Valdez agreed with the diagnosis of pericarditis and advised discharge with a prescription for antiinflammatory medications. Three hours later, the patient suffered a cardiac arrest and died. A second cardiologist reviewed the ECG and echocardiogram from earlier in the day and concluded that the results were consistent with an MI.
Dr. Valdez argued that his consultation with the emergency physician was informal and that he owed no duty of care to the patient. Multiple prior courts had ruled that no duty could exist without a contractual relationship and that an informal consultation did not establish a physician–patient relationship. Yet, in this case, the court ruled that a doctor providing consulting services has an implied contract of employment, which therefore establishes a duty to the patient. The court opined that the duty of care goes to the doctor most capable of preventing possible harm due to others' negligence. Dr. Valdez was thus determined to be most qualified to make treatment decisions in this case, and his qualifications provided him with authority to do so. Therefore, he had a responsibility to recommend admission to the hospital so that the patient could receive proper care. This court ruled that the negligent care of Dr. Valdez resulted in the patient's death.
In this case, Dr. Valdez took specific information on a particular patient, reviewed results, and provided definite recommendations for care. In the court's view, this established a relationship with the patient and thus, liability for his actions. Again, a physician was held liable when they examined specific test information but did not see the patient.
Discussion
Can a Physician Establish a Patient Relationship and Resultant Liability Without Seeing a Patient?
In Walters v Rinker, the court ruled that the examination of a culture or tumor establishes a physician–patient relationship. In this case, the patient had a mass excised, and the specimen was sent to a pathologist for examination. In his report, the pathologist stated, "conclusive evidence of malignancy was not present, and changes in the lymph node from the thigh area were of an active rather than a neoplastic nature". Based on the pathologist's report, the mass was determined to be benign. The patient's health declined, and he was diagnosed with large cell lymphoma 2 years later.
The court ruled that the pathologist established a physician–patient relationship in this case. Although the pathologist never personally saw or treated the patient, he provided professional input for the patient's care. The court stated that the tissue examination and diagnosis were clearly performed for the purpose of evaluating for possible treatment. In such instances, a physician–patient relationship can be created without direct patient contact.
This legal analytical approach was again applied in Diggs v Arizona Cardiologists, Ltd. Here, the court decided that the interpretation of test results by a specialist establishes a duty to the patient. The plaintiff presented to the St. Luke's Medical Center ED with severe chest pain. The emergency physician ordered an electrocardiogram (ECG) and an echocardiogram. The computerized ECG interpretation indicated a myocardial infarction (MI), however, the emergency physician determined the clinical picture to be more consistent with pericarditis. The emergency physician asked Dr. Valdez (a cardiologist who was in the ED visiting a different patient and not on call) for an informal consultation aimed at better interpretation of the echocardiogram. Dr. Valdez reviewed the patient's clinical history, physical examination results, and ECG. He did not choose to physically see the patient. Dr. Valdez agreed with the diagnosis of pericarditis and advised discharge with a prescription for antiinflammatory medications. Three hours later, the patient suffered a cardiac arrest and died. A second cardiologist reviewed the ECG and echocardiogram from earlier in the day and concluded that the results were consistent with an MI.
Dr. Valdez argued that his consultation with the emergency physician was informal and that he owed no duty of care to the patient. Multiple prior courts had ruled that no duty could exist without a contractual relationship and that an informal consultation did not establish a physician–patient relationship. Yet, in this case, the court ruled that a doctor providing consulting services has an implied contract of employment, which therefore establishes a duty to the patient. The court opined that the duty of care goes to the doctor most capable of preventing possible harm due to others' negligence. Dr. Valdez was thus determined to be most qualified to make treatment decisions in this case, and his qualifications provided him with authority to do so. Therefore, he had a responsibility to recommend admission to the hospital so that the patient could receive proper care. This court ruled that the negligent care of Dr. Valdez resulted in the patient's death.
In this case, Dr. Valdez took specific information on a particular patient, reviewed results, and provided definite recommendations for care. In the court's view, this established a relationship with the patient and thus, liability for his actions. Again, a physician was held liable when they examined specific test information but did not see the patient.
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