In a case that could have wide-reaching implications for medical practice in Minnesota, the Minnesota Supreme Court issued a ruling on April 17 in the case of Warren v. Dinter holding that the existence of a physician-patient relationship is not a prerequisite for a medical malpractice action. Rather, a person may sue a physician for malpractice – even if that person was not a patient of the physician – if the harm suffered by the person was a “reasonably foreseeable consequence” of the physician’s actions.
The MMA partnered with the AMA and the Minnesota Hospital Association to participate in the case as amici curiae, forcefully arguing that expanding physician liability outside of the physician-patient relationship would damage physician collaboration and informal consultation and ultimately harm patients. Despite this counsel, the Court issued a ruling that may hinder a physicians’ ability to collaborate with care partners.
“The overall expansive language in the Court’s opinion does raise concerns,” said Mark Fogg, COPIC’s General Counsel. Colorado-based COPIC is the MMA’s endorsed medical professional liability insurance (MPLI) provider for its members. “We respectfully believe that it is important that a physician-patient relationship be established before any liability may occur for alleged medical malpractice.”
The Warren v. Dinter case arises out of the care provided to a woman (Susan Warren), who complained of abdominal pain, fever, chills, and other symptoms to a nurse practitioner at Essentia Health Clinic in Hibbing. After testing showed that Warren had an elevated white blood cell count, the nurse practitioner suspected infection and sought hospitalization for her at Fairview Range Medical Center. The nurse practitioner’s call was randomly assigned to a hospitalist at Fairview to discuss admission.
After a brief conversation, during which the physician was unable to view the patient’s medical record, the physician and the nurse practitioner discussed hospitalization and whether the elevated white-cell count and blood sugar could be the result of diabetes. The physician did not recommend hospitalization during the conversation and the nurse practitioner did not seek hospitalization for the patient following the conversation. The patient subsequently died from sepsis caused by an untreated staph infection. Warren’s family sued both the nurse practitioner and the physician for medical malpractice.
Before its ruling April 17, Minnesota law has generally required the existence of a physician-patient relationship to sustain a malpractice action against a physician. The Court’s decision to rely on a broader legal theory of “foreseeability” represents a troubling change that puts Minnesota in the minority of states that do not require the existence of a physician-patient relationship for a malpractice action. This change may expose physicians and other health professionals to malpractice risk in a variety of actions that were previously protected, including unbilled consultations. Although the ruling puts Minnesota physicians in uncertain legal territory, it does not change the underlying duty that physicians have to their patients and, more generally, to maintain a professional and ethical medical practice.
The MMA is developing resources for physicians to better understand their legal risks following the Warren v. Dinter decision and is exploring policy options to ensure that physicians can continue to collaborate with their peers and provide the best care possible to their patients.