Supreme Court Rules Physician-Patient Relationship is Not Necessary to Sue Docs

[bronx43]

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I’m done. I think the NP and hospitalist both deserved to be sued. There was a preventable death that exposed a system problem. I think the judgment here was the right one. I think the fear that this is going to result in massive lawsuits for all curbsides or hospitals full beyond capacity is not correct. I am confident that the hospitalist’s biggest misstep (in terms of protecting against liability) was one of documentation. The system of an NP calling a randomly assigned hospitalist when seeking hospital admission should have never existed in the first place. That was the system problem and someone had to take the fall.

Actually, there is a big discussion on doximity talking about the implication of curbside consults. Everyone is uneasy about this ruling. Whether or not there will be massive lawsuits for curbsides is not the point. It's the perception of the physicians and the resultant change of behavior that it leads to.

Yes, it's a system problem. The system at fault here is called reality and humanity.
Funny, because I suspect you would be the same one to complain if every hospital was overcapacity daily, and this patient wasn't able to be seen and died waiting in the ED or driving to the closest open hospital. Who are they going to sue then? Who is going to "take the fall?" Because SOMEONE has to, right?

 

[GravelRider]

Just abdominal pain, white count, and elevated glucose by report from an outside provider doesn’t necessarily warrant admission to a hospital. I wouldn’t have recommended a direct admit either. That problem is the primary providers problem and the only way to make the case it should be someone else’s problem is a visit to an ED. I fail to see where the hospitalist has any legal liability for a bad outcome here.

Wait. So now you are giving recommendations without seeing a patient? You wouldn’t admit a patient with white count, abdominal pain, and hyperglycemia? Ok, fine, but what if the patient is septic? You don’t know what information is missing or who is providing the information, but you would still give a recommendation?

Maybe you should just withhold any recommendation to admit or not admit without seeing the patient? Maybe it’s not good practice for physicians to be giving important treatment recommendations without the full picture?

 

[GravelRider]

Actually, there is a big discussion on doximity talking about the implication of curbside consults. Everyone is uneasy about this ruling. Whether or not there will be massive lawsuits for curbsides is not the point. It's the perception of the physicians and the resultant change of behavior that it leads to.

Yes, it's a system problem. The system at fault here is called reality and humanity.
Funny, because I suspect you would be the same one to complain if every hospital was overcapacity daily, and this patient wasn't able to be seen and died waiting in the ED or driving to the closest open hospital. Who are they going to sue then? Who is going to "take the fall?" Because SOMEONE has to, right?

I think we both agree this case was not a curbside consult, so I think extrapolating this ruling to curbsides is a bit of a stretch. The curbside provides a well known practice where a physician-patient relationship is not established. I don’t see that practice being put in danger at all. I’m probably more conservative than most in terms of documentation. My expertise is valuable and documentation is a way to show that.

I don’t know what you call this phone conversation from the NP to the hospitalist. Is it a consult? What is it? When there is a preventable death, should we ignore that this call took place? According to some documentation there was a recommendation to not admit this patient by the hospitalist. In giving that recommendation, he intervened on this patient’s care. He affected the patient’s care that then resulted in her death. If he said “I don’t know” then he would be fine. He probably should have never been put in the position to give that recommendation (system error) and should have never given that recommendation in the first place (his error).

 

[jdh71]

Wait. So now you are giving recommendations without seeing a patient? You wouldn’t admit a patient with white count, abdominal pain, and hyperglycemia? Ok, fine, but what if the patient is septic? You don’t know what information is missing or who is providing the information, but you would still give a recommendation?

Maybe you should just withhold any recommendation to admit or not admit without seeing the patient? Maybe it’s not good practice for physicians to be giving important treatment recommendations without the full picture?

I think I said that a patient with an elevated white count, abdominal pain, and hyperglycemia does not necessarily need an admission to a hospital let alone a DIRECT admit. Yes. I would recommend not directly admitting. If the NP thought the patient needed a closer look then they needed to send them to an ED. I can have opinions based on info given and give them, especially as it is NOT a consult.

 

[chessknt]

I think we both agree this case was not a curbside consult, so I think extrapolating this ruling to curbsides is a bit of a stretch. The curbside provides a well known practice where a physician-patient relationship is not established. I don’t see that practice being put in danger at all. I’m probably more conservative than most in terms of documentation. My expertise is valuable and documentation is a way to show that.

I don’t know what you call this phone conversation from the NP to the hospitalist. Is it a consult? What is it? When there is a preventable death, should we ignore that this call took place? According to some documentation there was a recommendation to not admit this patient by the hospitalist. In giving that recommendation, he intervened on this patient’s care. He affected the patient’s care that then resulted in her death. If he said “I don’t know” then he would be fine. He probably should have never been put in the position to give that recommendation (system error) and should have never given that recommendation in the first place (his error).

It is less than a curbside consult. It was a request for direct admission which was denied. It does not imply the patient no longer needs medical care, it just means that they don't need to be admitted without er eval.

What is the problem with a system having a hospitalist eval for direct admits? Sometimes clinic patie ts with known chf or copd come in with sx obvious for exacerbation but not unstable and can bypass the overloaded er. Sometimes someone needs a procedure tomorrow and lives far away. What system should there be instead?

 

[Robotic Wis-Hipple]

I think I said that a patient with an elevated white count, abdominal pain, and hyperglycemia does not necessarily need an admission to a hospital let alone a DIRECT admit. Yes. I would recommend not directly admitting. If the NP thought the patient needed a closer look then they needed to send them to an ED. I can have opinions based on info given and give them, especially as it is NOT a consult.

I think this is a lot of semantics. I think if you give that opinion to another doc, or in the hallway about a general scenario I agree with your position. But I think once an NP is calling a hospitalist asking for advice, and you give that answer the NP is going to roll on you everytime.

There’s an inherent position/power difference in play here and as this scenario played out I think it’s implies that a midlevel provider asked a doctor to admit or simply for advice about whether or not to admit and whether it’s an official consult or not, I think the doc’s answer played a role in the care. And as this was a specific patient it’s going to be treated as a consult. I guarantee that the NP considered this as such, and therein lies the problem.

It’s sad, but I think the hospitalist just has to say send the Pt to an ED in this type of scenario.

 

[jdh71]

I think this is a lot of semantics. I think if you give that opinion to another doc, or in the hallway about a general scenario I agree with your position. But I think once an NP is calling a hospitalist asking for advice, and you give that answer the NP is going to roll on you everytime.

There’s an inherent position/power difference in play here and as this scenario played out I think it’s implies that a midlevel provider asked a doctor to admit or simply for advice about whether or not to admit and whether it’s an official consult or not, I think the doc’s answer played a role in the care. And as this was a specific patient it’s going to be treated as a consult. I guarantee that the NP considered this as such, and therein lies the problem.

It’s sad, but I think the hospitalist just has to say send the Pt to an ED in this type of scenario.

Agree. Patient should be seen by an ED doc. The decision not to do a direct admit isn’t the same as saying everything is fine. I think the primary provider being an NP is irrelevant. If they can practice on their own as per the state they practice in, then that decision is on them.

 

[Robotic Wis-Hipple]

Agree. Patient should be seen by an ED doc. The decision not to do a direct admit isn’t the same as saying everything is fine. I think the primary provider being an NP is irrelevant. If they can practice on their own as per the state they practice in, then that decision is on them.

I mostly agree. If the doc said “I don’t believe this patient requires a direct admission” and that’s it, or they said, “direct admit is not necessary but the patient should be evaluated in the ED” I don’t think the doc would be at risk. Probably.

But I do think the fact this was an NP factored in. They didn’t call another NP that works in the inpatient world, they called a physician hospitalist. Why? Either it was the built in system for admissions this area/hospital had (which I think then legally implies the doc on the receiving end of that accept/triage call assumes some professional responsibility/liability/relationship) or the NP felt they wanted an elevated level of experience to weigh in. Either way, I think it’s realistic to assume all legal or layman individuals who do not work as physicians to think of that as a consult.

And regardless of whether an NP can work alone in whatever jurisdiction they are in, they, or their lawyers, will latch onto any physician tangentially attached to the case to attempt to dilute their blame/risk. Theirs is the “independent practice” of having cake and eating it.

 

[IMGASMD]

having cake and eating it.

F that!