Minnesota Supreme Court Expands Medical Malpractice Liability Outside of Physician-Patient Relationship

The Minnesota Supreme Court issued an opinion in Warren v. Dinter. At issue was whether a physician-patient relationship is a necessary element to sustain a medical malpractice claim. The Court held a physician could be held liable for malpractice, even in the absence of a physician-patient relationship, if it was “reasonably foreseeable that the third party will rely on the physician’s acts and be harmed by a breach of the standard of care.”

The case centers around the care of a patient, Susan Warren, who sought treatment for symptoms of abdominal pain, fever and chills at a local health clinic. Warren was treated by a nurse practitioner at the clinic. The nurse practitioner suspected that Warren was suffering from an infection and contacted the Fairview Range Medical Center (“Fairview”) to arrange for hospitalization. Fairview randomly assigned the call to Dr. Dinter, a hospitalist. After a brief telephone conversation, Dinter allegedly denied the request for hospitalization, and thereafter, the nurse practitioner discontinued efforts to seek hospitalization. Warren subsequently died from an untreated Staphylococcus (“staph”) infection. Warren’s son sued Dinter and Fairview. Dinter and Fairview argued that Dinter owed no duty of care to Warren because there was no physician-patient relationship. The trial court and court of appeals agreed with Dinter.

The Minnesota Supreme Court, however, reversed and remanded the case, holding that a medical malpractice case can be sustained even in the absence of an express physician-patient relationship, if a tort duty has been created by the foreseeability of harm. Specifically, the court noted that the nurse practitioner was unable to admit Warren to the hospital on her own, that Dinter decided that Warren would not be admitted, that Dinter knew, or should have known, that his decision not to admit would be relied on by the nurse practitioner and her patient, and that Dinter knew, or should have known, that breach of the standard of care could result in serious harm.

This decision significantly expands medical malpractice liability in Minnesota. While the right to redress medical malpractices is critical and should be supported, this ruling may have significant unintended consequences. The Minnesota Medical Association notes that this expansion of liability has the potential to curtail physician collaboration and informal consultation, and will ultimately result in harming patients. There could also be more remote consequences of the ruling. For instance, since Minnesota is in the minority of states with this expanded view of liability, healthcare providers could move to another state, resulting in provider shortages in Minnesota. In addition, the ruling could drive up the cost of medical malpractice insurance which would ultimately be passed on to patients in Minnesota. According to the Wall Street Journal, Minneapolis is the most expensive city in the country for a primary care visit. It is clear that this decision could have a ripple effect on an already segmented healthcare marketplace.  This decision could have a ripple effect, a hospitalist may be less inclined to step in if there is a medical emergency in the hospital for patients that are not theirs.