This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Recognize some of the key factors that are required for some courts to require a physician to be responsible for nonpatient care
2. Discuss some of the potential negative outcomes that may result if courts rule in favor of expanding duty to care to nonpatients
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Sema4, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from August 14 2018 through August 14 2020, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
A general principle of medical bioethics is beneficence – a healthcare professional should be guided by providing benefit to the patient which also includes preventing and/or removing harm. As medicine has advanced, nonpatients such as family members and intimate partners sometimes become downstream or ancillary recipients of direct care to the primary patient. In what instance will a physician be liable to a nonpatient in regards to treatment of a patient? The Connecticut Supreme Court ruled on this thorny issue in Doe v. Cochran, 332 Conn. 325, 328 (2019).
Briefly, in Cochran, the male patient might have been told his test results for herpes was negative when it was positive. The male patient later infected his girlfriend with herpes. She sued the physician for professional negligence. The trial court dismissed the case after ruling that the physician didn’t have a duty to the girlfriend because she was not his patient.
Several medical societies had requested from the Connecticut Supreme Court to uphold a trial court ruling that dismissed the case. The trial court ruled that the physician didn’t have a duty to the girlfriend because she was not his patient. Expansion of duty of care to nonpatients could potentially have a negative impact on patient confidentiality, patient care, and medical malpractice insurance rates.
Generally, Connecticut case law is strongly in favor of not expanding duty of care to nonpatients except under limited circumstances. Those circumstances include that the third-party is readily identifiable, there is an emergency risk of serious physical bodily harm or death, and a special relationship exists.
In other cases, physicians have been found to be responsible to nonpatients. For example, in Safer v. Pack 677 A.2d 1188, the court ruled held that a physician had a duty to warn those known to be at risk of avoidable harm from a genetically transmissible condition even if those individuals were not patients of the defendant physician. The physician had to take reasonable steps to assure that the information reaches those likely to be affected or is made available for their benefit.
On appeal of the case, the Supreme Court determined that the plaintiff’s claim was for ordinary negligence, not medical malpractice, even though it occurred in a medical setting. The error occurred because of a clerical or ministerial act. The alleged error could have occurred either in the initial interpretation of the report or in the inaccurate communication of the results, via the staff member, to the patient. The test result was obviously positive for herpes and its interpretation did not require advanced medical training. Moreover, the fact that the physician delegated communication of the test results to a nonphysician shows that communication with the patient was a nontechnical matter.
The Court ruled that the defendant owed a duty of care to the plaintiff despite her status as a non-patient, third party. The specific harm in this particular case was foreseeable because an untreated sexually transmitted disease (STD) was direct implication for the infected person’s intimate partners. In addition, the third party or nonpatient was readily identifiable. The ruling is limited “only to identifiable third parties who are engaged in an exclusive romantic relationship with a patient at the time of testing, and, therefore, may foreseeably be exposed to any STD that a physician fails to diagnose or properly report.” Patient confidentiality is not violated because the physician is not obligated to communicate with nonparties but is obligated to communicate accurate results to patients.
The take home message is that the accurate communication of test results to patients during the course of medical treatment remains the responsibility of the physician even if downstream harm may impact someone other than her patient.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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