Duty to Third Parties

Question: Dr. E, an endocrinologist, diagnosed a patient with multiple endocrine neoplasia type I, a rare disorder that is inherited in an autosomal dominant fashion. Dr. E did not inform or counsel the patient's three siblings and two children. Which of the following best describes this situation?

A. Confidentiality prevents Dr. E from discussing the diagnosis with others.

B. Without an established doctor-patient relationship between Dr. E and family members, no legal duty of care exists.

C. Were Dr. E a general practitioner, his conduct would have met the standard ordinarily expected of a doctor.

D. Dr. E should have provided family counseling after securing his patient's permission.

E. Unless physical injury results, there can be no malpractice action.

Answer: D. In this case, an endocrinologist would be expected to offer counseling to family members after securing patient consent. This is an example of a physician's duty to “third parties.” No doctor-patient relationship is required. Ideally, after obtaining the patient's permission, the doctor should contact family members and advise them to seek clinical and genetic screening.

The law requires that one act reasonably, and for a doctor this means adhering to the standards expected of fellow members of the profession. The requisite standard of care is different for the specialist than for the generalist, and it can be argued that a generalist may not be sufficiently familiar with this rare disorder to offer family counseling. However, the doctor still owes a duty to make a referral to a specialist.

For a malpractice suit to succeed, the plaintiff must prove, in addition to substandard conduct by the defendant, the elements of causation and damages. If no harm can be traced to the negligent act, no cause of action will ensue. However, for the purposes of tort damages, nonphysical injuries such as loss of consortium or emotional distress are every bit as relevant.

In a case such as the one involving Dr. E, a doctor can be found liable to someone other than his or her patient. Sometimes another person, referred to as a “third party,” may sue the doctor despite the absence of a doctor-patient relationship. For example, an obstetrician may fail to treat a pregnant woman known to have been exposed to German measles, who then delivers a child with birth defects. A Rhode Island court has ruled that a cause of action could be instituted by the child (Sylvia v. Gobeille, 220 A.2d 222 [R.I. 1966]).

In another example, a missed diagnosis of meningitis in a mother led to her son contracting and dying from the disease. The son's estate sued. The appellate court found liability and held that the physician-mother relationship resulted in a special situation for imposing a duty of care for her son (Shepard v. Redford Community Hospital, 390 N.W.2d 239 [Mich. App. 1986]).

Similarly, the Supreme Court of Tennessee held that a physician has a duty to warn members of the patient's immediate family of the risk of a disease such as Rocky Mountain spotted fever, even though it is not contagious (Bradshaw v. Daniel, 854 S.W.2d 865 [Tenn. 1993]).

A doctor may even have a duty to a total stranger. The best-known case occurred in California, where a court imposed a duty on a college psychologist to warn an intended victim of harm, even though that meant breaching patient-doctor confidentiality (Tarasoff v. Regents of University of California, 551 P.2d 334 [Cal. 1976]).

An emerging area of malpractice litigation affects patients who drive. If a patient injures another driver or a pedestrian while taking a prescribed medication, the doctor could be faced with potential liability to the injured party, a total stranger.

The Hawaii Supreme Court recently held that: “A physician owes a duty to nonpatient third parties injured in an automobile accident caused by an adverse reaction to the medication … where the physician has negligently failed to warn the patient that the medication may impair driving ability” (McKenzie v. Hawaii Permanente Medical Group, 47 P.3d 1209 [Haw. 2002]). The medication in this case was an antihypertensive drug that caused syncope and loss of vehicular control.

Contact the author at [email protected].

Question: Dr. E, an endocrinologist, diagnosed a patient with multiple endocrine neoplasia type I, a rare disorder that is inherited in an autosomal dominant fashion. Dr. E did not inform or counsel the patient's three siblings and two children. Which of the following best describes this situation?

A. Confidentiality prevents Dr. E from discussing the diagnosis with others.

B. Without an established doctor-patient relationship between Dr. E and family members, no legal duty of care exists.

C. Were Dr. E a general practitioner, his conduct would have met the standard ordinarily expected of a doctor.

D. Dr. E should have provided family counseling after securing his patient's permission.

E. Unless physical injury results, there can be no malpractice action.

Answer: D. In this case, an endocrinologist would be expected to offer counseling to family members after securing patient consent. This is an example of a physician's duty to “third parties.” No doctor-patient relationship is required. Ideally, after obtaining the patient's permission, the doctor should contact family members and advise them to seek clinical and genetic screening.

The law requires that one act reasonably, and for a doctor this means adhering to the standards expected of fellow members of the profession. The requisite standard of care is different for the specialist than for the generalist, and it can be argued that a generalist may not be sufficiently familiar with this rare disorder to offer family counseling. However, the doctor still owes a duty to make a referral to a specialist.

For a malpractice suit to succeed, the plaintiff must prove, in addition to substandard conduct by the defendant, the elements of causation and damages. If no harm can be traced to the negligent act, no cause of action will ensue. However, for the purposes of tort damages, nonphysical injuries such as loss of consortium or emotional distress are every bit as relevant.

In a case such as the one involving Dr. E, a doctor can be found liable to someone other than his or her patient. Sometimes another person, referred to as a “third party,” may sue the doctor despite the absence of a doctor-patient relationship. For example, an obstetrician may fail to treat a pregnant woman known to have been exposed to German measles, who then delivers a child with birth defects. A Rhode Island court has ruled that a cause of action could be instituted by the child (Sylvia v. Gobeille, 220 A.2d 222 [R.I. 1966]).

In another example, a missed diagnosis of meningitis in a mother led to her son contracting and dying from the disease. The son's estate sued. The appellate court found liability and held that the physician-mother relationship resulted in a special situation for imposing a duty of care for her son (Shepard v. Redford Community Hospital, 390 N.W.2d 239 [Mich. App. 1986]).

Similarly, the Supreme Court of Tennessee held that a physician has a duty to warn members of the patient's immediate family of the risk of a disease such as Rocky Mountain spotted fever, even though it is not contagious (Bradshaw v. Daniel, 854 S.W.2d 865 [Tenn. 1993]).

A doctor may even have a duty to a total stranger. The best-known case occurred in California, where a court imposed a duty on a college psychologist to warn an intended victim of harm, even though that meant breaching patient-doctor confidentiality (Tarasoff v. Regents of University of California, 551 P.2d 334 [Cal. 1976]).

An emerging area of malpractice litigation affects patients who drive. If a patient injures another driver or a pedestrian while taking a prescribed medication, the doctor could be faced with potential liability to the injured party, a total stranger.

The Hawaii Supreme Court recently held that: “A physician owes a duty to nonpatient third parties injured in an automobile accident caused by an adverse reaction to the medication … where the physician has negligently failed to warn the patient that the medication may impair driving ability” (McKenzie v. Hawaii Permanente Medical Group, 47 P.3d 1209 [Haw. 2002]). The medication in this case was an antihypertensive drug that caused syncope and loss of vehicular control.

Contact the author at [email protected].

Question: Dr. E, an endocrinologist, diagnosed a patient with multiple endocrine neoplasia type I, a rare disorder that is inherited in an autosomal dominant fashion. Dr. E did not inform or counsel the patient's three siblings and two children. Which of the following best describes this situation?

A. Confidentiality prevents Dr. E from discussing the diagnosis with others.

B. Without an established doctor-patient relationship between Dr. E and family members, no legal duty of care exists.

C. Were Dr. E a general practitioner, his conduct would have met the standard ordinarily expected of a doctor.

D. Dr. E should have provided family counseling after securing his patient's permission.

E. Unless physical injury results, there can be no malpractice action.

Answer: D. In this case, an endocrinologist would be expected to offer counseling to family members after securing patient consent. This is an example of a physician's duty to “third parties.” No doctor-patient relationship is required. Ideally, after obtaining the patient's permission, the doctor should contact family members and advise them to seek clinical and genetic screening.

The law requires that one act reasonably, and for a doctor this means adhering to the standards expected of fellow members of the profession. The requisite standard of care is different for the specialist than for the generalist, and it can be argued that a generalist may not be sufficiently familiar with this rare disorder to offer family counseling. However, the doctor still owes a duty to make a referral to a specialist.

For a malpractice suit to succeed, the plaintiff must prove, in addition to substandard conduct by the defendant, the elements of causation and damages. If no harm can be traced to the negligent act, no cause of action will ensue. However, for the purposes of tort damages, nonphysical injuries such as loss of consortium or emotional distress are every bit as relevant.

In a case such as the one involving Dr. E, a doctor can be found liable to someone other than his or her patient. Sometimes another person, referred to as a “third party,” may sue the doctor despite the absence of a doctor-patient relationship. For example, an obstetrician may fail to treat a pregnant woman known to have been exposed to German measles, who then delivers a child with birth defects. A Rhode Island court has ruled that a cause of action could be instituted by the child (Sylvia v. Gobeille, 220 A.2d 222 [R.I. 1966]).

In another example, a missed diagnosis of meningitis in a mother led to her son contracting and dying from the disease. The son's estate sued. The appellate court found liability and held that the physician-mother relationship resulted in a special situation for imposing a duty of care for her son (Shepard v. Redford Community Hospital, 390 N.W.2d 239 [Mich. App. 1986]).

Similarly, the Supreme Court of Tennessee held that a physician has a duty to warn members of the patient's immediate family of the risk of a disease such as Rocky Mountain spotted fever, even though it is not contagious (Bradshaw v. Daniel, 854 S.W.2d 865 [Tenn. 1993]).

A doctor may even have a duty to a total stranger. The best-known case occurred in California, where a court imposed a duty on a college psychologist to warn an intended victim of harm, even though that meant breaching patient-doctor confidentiality (Tarasoff v. Regents of University of California, 551 P.2d 334 [Cal. 1976]).

An emerging area of malpractice litigation affects patients who drive. If a patient injures another driver or a pedestrian while taking a prescribed medication, the doctor could be faced with potential liability to the injured party, a total stranger.

The Hawaii Supreme Court recently held that: “A physician owes a duty to nonpatient third parties injured in an automobile accident caused by an adverse reaction to the medication … where the physician has negligently failed to warn the patient that the medication may impair driving ability” (McKenzie v. Hawaii Permanente Medical Group, 47 P.3d 1209 [Haw. 2002]). The medication in this case was an antihypertensive drug that caused syncope and loss of vehicular control.

Contact the author at [email protected].