MN: State Supreme Court offers decision with stark medicolegal implications

Imagine that you’re an on-call hospitalist at a larger institution 30 miles from a small rural hospital who is phone consulted by the latter institution’s advanced practice nurse (NP) on whether a patient with vague abdominal pain symptoms should be transferred to the larger hospital for more definitive care.

As the on-call doc at the larger hospital, you have never previously collaborated with the aforementioned NP, and of course, the patient. After a lengthy, reasoned discussion with the NP, you determine that the patient does not need urgent transfer, as you recommend ongoing primary care follow up at the patient’s native clinic.

Now, imagine being sued by the patient’s family months later, as you struggle to recall the incident consultation, because the patient died a few days later, based upon your “negligence”. Sound far fetched, even in this era of accountability and the pervasiveness of the electronic medical record? Think again:

In a ruling that is causing a stir in Minnesota’s medical and legal communities, the state Supreme Court has said that a doctor can be sued for malpractice even in the absence of a traditional physician-patient relationship. [T]he MMA and the Minnesota Hospital Association both raised concerns that the opinion will have a chilling effect on medical decisionmaking.

“Thousands of times every day, physicians and clinicians call on others to give their informal opinions,” said Dr. Rahul Koranne, chief medical officer of the hospital group. “This decision will not serve Minnesotans and has the potential to increase health care costs.”

But while the court was clear that the physician-patient relationship was not a malpractice requirement, it also sought to set some boundaries.

“Our decision today should not be misinterpreted as being about informal advice from one medical professional to another,” the opinion said. “This case is about a formal medical decision.”

Therein lies the gray area. In this era of technology disruptions within healthcare administration, care provision, and documentation within which anything recorded is “fair game”, no matter how innocuous, what constitutes “formal”? 😤

Michael L. Douglas @doctorpundit

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