June 9, 2019

The State of Minnesota Supreme Court (“Minnesota Supreme Court”) held in its opinion filed on April 17, 2019 that a physician-patient relationship is not a necessary element of a claim for professional negligence (medical malpractice). A physician owes a duty of care to a third party when the physician acts in a professional capacity and it is reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care.

In the Minnesota medical malpractice case it was deciding, the Minnesota Supreme Court held that it was reasonably foreseeable that a patient seeking admission to a hospital would rely on a hospitalist’s acts and be harmed by a breach of the standard of care, thus making summary judgment for the hospitalist and his employer on the element of duty of care improper. That is, “a hospitalist’s alleged decision to deny a patient admission to a hospital may constitute professional negligence.”

The Underlying Facts

A nurse practitioner in one of the defendant health care systems sought to have a patient admitted to the hospital of the other system. Admission was allegedly denied by a hospitalist. Three days later, the patient died.

The telephone call between the nurse practitioner who wanted to admit the patient into the hospital and the defendant on-call hospitalist who practiced in the other health care system lasted approximately ten minutes. The nurse practitioner alleged that she shared both the patient’s abnormal test results and the patient’s symptoms with the hospitalist whereas the hospitalist alleged that the nurse practitioner shared only some of the test results. The nurse practitioner further alleged that she specifically requested that the patient be hospitalized whereas the hospitalist alleged that the nurse practitioner only asked him whether the patient should be hospitalized.

The nurse practitioner alleged that she told the patient that she had spoken with a hospitalist, who felt that hospital admission was not needed, and that she then discussed with the patient the diabetes diagnosis, prescribed diabetes and pain medication, scheduled a follow-up appointment, and sent her home. Three days later, the patient’s son found her dead in her home. An autopsy concluded that the cause of death was sepsis caused by an untreated staph infection.

The son filed a Minnesota medical malpractice wrongful death lawsuit against the hospitalist and others, alleging that the defendant hospitalist had been professionally negligent in the care and treatment of his mother, including advising the nurse practitioner that the decedent did not require hospitalization. The complaint further alleged that the negligence directly caused the mother’s death.

The district court granted the defendants’ motion for summary judgment on the issue of duty, concluding that the relationship between the nurse practitioner and the defendant hospitalist was in the nature of an informal conversation between medical colleagues and did not create a doctor patient relationship between the hospitalist and the decedent. The district court concluded that there was a fact question regarding causation, and denied summary judgment on proximate cause.

Minnesota Supreme Court Opinion

The Minnesota Supreme Court stated that both the district court and the court of appeals held that there was no duty based on the idea that, as a matter of law, a physician-patient relationship is a necessary predicate for a doctor to owe a duty of care. The Minnesota Supreme Court stated that when there is no express physician-patient relationship, it has turned to the traditional inquiry of whether a tort duty has been created by foreseeability of harm: a duty arises between a physician and an identified third party when the physician provides medical advice and it is foreseeable that the third party will rely on that advice.

The Minnesota Supreme Court held: “for 100 years in Minnesota, a physician has had a legal duty of care based on the foreseeability of harm. Although ours is the minority rule, it is by no means unique. This rule has served Minnesota sufficiently well, and we have no compelling reason to overrule our precedent.”

The Minnesota Supreme Court stated with regard to the facts of the present case: “Viewing the record in a light favorable to [the decedent], it is reasonable to conclude that [the defendant hospitalist] knew, or should have known, that his decision whether or not to admit a prospective patient, based on his own medical judgment, would be relied on by [the nurse practitioner] and her patient. He also knew, or should have known, that a breach of the applicable standard of care could result in serious harm … Viewed in the light most favorable to [the decedent], this interaction was neither a curbside consultation nor what [the defendant hospitalist] … characterized as a “professional courtesy” … Viewing the evidence in the light most favorable to [the decedent], [the defendant hospitalist], as the gatekeeper, made the medical decision not to open the gate for [the decedent] … Summary judgment, therefore, should not have been granted.”

The Minnesota Supreme Court cautioned: “Our decision today should not be misinterpreted as being about informal advice from one medical professional to another. This case is about a formal medical decision—whether a patient would have access to hospital care—made by a hospital employee pursuant to hospital protocol. We decide only that hospitalists, when they make such hospital admission decisions, have a duty to abide by the applicable standard of care.”

Two justices dissented from the majority’s opinion.

Source Warren v. Dinter, A17-0555.

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