1 476 July-August 2003 Family Medicine Special Article Malpractice Liability for Informal Consultations Robert S. Olick, JD, PhD; George R. Bergus, MD, MAEd Background: Informal ( curbside ) consults are widely used by primary care physicians. These interactions occur in person, by telephone, or even by . Exposure to malpractice liability is a frequent concern of subspecialty physicians and influences their willingness to engage in this activity. To assess this risk, we reviewed reported judicial opinions involving informal consultation by physicians. Methods: A search of the existing medical literature, and of the Westlaw national database was undertaken to identify reported judicial opinions involving informal physician consults that address whether informal consultations create a legal relationship between consulting specialist physicians and patients that gives rise to a legal duty of care owed by the consulting specialist to the patient. Conclusions: Courts have consistently ruled that no physician-patient relationship exists between a consultant and the patient who is the focus of the informal consultation. In the absence of such a relationship, the courts have found no grounds for a claim of malpractice. Malpractice risks associated with informal consultation appear to be minimal, regardless of the method of communication. While informal consultation is not a term used by the courts, the courts have applied a consistent set of criteria that help define the legal parameters of this activity. (Fam Med 2003;35(7): ) Malpractice Liability for Informal Consultations I have a 24-year-old healthy patient who, over the last 8 years, develops diarrhea when she gets very nervous. At her best friend s wedding, in which she was maid of honor, she had to leave the picture-taking session because of stool urgency and diarrhea. Her own wedding is coming up in 6 weeks, and she wants to know what she can do to prevent getting diarrhea. Do you think a prophylactic dose of Immodium would work? A fairly healthy, well-functioning, 75-year-old lady recently asked me for a tetanus shot because she has never had one before. She does not know if she had immunizations as a child but knows she has not had any vaccinations or boosters as an adult. If this is primary immunization, she needs three doses, but I don t know if it is primary. Would you give three doses or check tetanus antibody levels after one dose? From the Center for Bioethics and Humanities, SUNY Upstate Medical University (Dr Olick); and the Department of Family Medicine and the Department of Psychiatry, University of Iowa (Dr Bergus). I have a 64 year old whose prostate-specific antigen (PSA) was 2.28 last year and 12 months later it is 3.60 (same lab). His prostate was moderately enlarged without nodularity. My concern is the velocity of his PSA increase. Is it time for him to see the urologist, or should I just follow it up in 6 months with another PSA? Family physicians and residents asked subspecialty physicians the above questions after encountering clinical situations they were not sure how to handle. 1 Clinical questions such as these regularly arise during patient care, and physicians frequently seek answers to these questions by querying a colleague. 2,3 Indeed, about one third of the information needs of family physicians are fulfilled by these informal ( curbside ) consultations, 4-7 sometimes undertaken to satisfy intellectual curiosity but more often used to support the medical care of patients. For this reason, the informal, or curbside, consultation is widely viewed as central to good clinical medicine 8 and has been characterized as among the survival skills of the busy clinician. 9 These informal consultations occur in hospital hallways, doctors lounges, and by telephone. 10,11 Today, e- mail offers another medium for these consultations. 12 One such system was the source of the clinical
2 Special Article Vol. 35, No questions at the start of this paper. This system, at the University of Iowa, has handled more than 2,000 consultations between primary and specialty care physicians. The vast majority of these curbside consultations have been about specific patients. 13 Physicians who provide informal consults frequently worry about the quality of the information supplied by the asking physician and whether the asking physician accurately and appropriately documents, recalls, interprets, and uses the specialist s advice. 12 The most common concern with this activity, however, is increased exposure to malpractice liability, 11,14 a concern expressed in our recruitment of more than 40 consultants for the University of Iowa -based curbside consultation system. A survey of these consultants during the third year of their involvement found that while most enjoyed answering questions from primary care physicians and residents, nearly half (44%) were uncertain whether their involvement with the service increased their exposure to malpractice claims. Another persistent, and related, concern has been the creation of a retrievable record that could give third parties access to these exchanges. No consultants have terminated their involvement due to these concerns, but several routinely place legal disclaimers at the end of each consultation. To answer the liability concerns of subspecialty physicians, we undertook an in-depth analysis of whether informal consultation occurring by personal encounter, telephone, or exposes the informal consultant to a risk of malpractice liability. Our findings also inform primary care physicians and residents about their legal risk associated with use of informal consultations in patient care. Methods Search of the Legal Literature The analysis presented here rests largely on a national review of reported judicial opinions involving informal telephone or in-person consultations. Computerized searches of the Westlaw database for all 50 states and the District of Columbia (West Group, Eagan, Minn) were conducted using literal keyword searches for combinations of the terms liability, doctor or physician, patient, relationship, and variations on the term consultant. Similar searches were conducted under the topical heading health and medicine, also in the multistate database. Using the term formal or informal was not helpful because courts rarely characterize consultations expressly in these terms. All cases were key cited ( shepherdized ) to determine their current status as law of the state. We also reviewed precedents cited on relevant points of law in key cases. Our research discovered no reported cases specifically addressing liability for consultations using , although communications have on occasion been involved in other medical cases when they have been introduced as evidence. 15,16 Legal Assumption It is well established that the existence of a physician-patient relationship is a prerequisite to any malpractice claim. Existence of such a relationship creates legal (not just ethical) responsibilities to exercise sound professional skill and judgment on the patient s behalf and to act with due care as a reasonable physician with like expertise would under the circumstances. Failure to do so would constitute negligence. But, if there is no physician-patient relationship, no duty is owed to the patient, and hence no legal duty can be breached. Absent a legal duty, physicians cannot be said to have caused the alleged injury, nor can they be found liable for damages. 17 In sum, if there is no legal relationship with the patient, there is no basis for an informal consultant s liability. The further implication is that primary care physicians and residents remain legally responsible for the advice and care they provide to patients, even when they seek out and rely on recommendations from specialists. Results Does Informal Consultation Create a Consulting Physician-Patient Relationship? The physician-patient relationship is consensual in nature and is based on the idea of contract, whether express or implied. Typically, the scope and nature of the relationship are not explicitly agreed on at the outset. Rather, the relationship evolves and is inferred from the communications and conduct of physician and patient. Most often, the essential issue for informal consultations is whether a physician-patient relationship has been implicitly created, based on assessment of the facts and circumstances of the consultant s role. To make this assessment, courts have consistently inquired whether the physician exercised independent medical judgment on the patient s behalf A small number of courts have framed the inquiry in slightly different terms, asking whether it was reasonable and foreseeable that the patient would rely on the physician s advice or whether the physician s actions created a reasonable expectation of care. 21,22 Application of these general principles requires a factual inquiry into the nature and content of physician-patient communications and interactions. Review of pertinent court cases involving alleged malpractice by a specialist consulted by a treating physician, either by telephone or in person, suggests a number of indicators of a physician-patient relationship or, conversely, its absence. The Michigan case of Hill versus Kokosky 23 illustrates how judges typically frame the issues. An obstetric patient, at 23 weeks gestation, was hospitalized
3 478 July-August 2003 Family Medicine with an incompetent cervix. During the hospitalization, her obstetrician sought the advice of two physicians at a nearby hospital. The child was born with severe disabilities, and the parents subsequently sued two physicians for rendering substandard advice during telephone conversations with the treating obstetrician. Rejecting the parents claims, the court ruled that no physician-patient relationship existed between the mother and the physicians consulted by telephone because it found several factors persuasive: (1) The telephone consultants never contacted the patient, examined her, or spoke with her, (2) They never reviewed her chart, (3) There was no referral for treatment or in-person consultation, (4) The patient never sought advice or treatment directly from the consulting physicians nor otherwise tried to hire them, (5) The telephone consultants opinions were directed solely to the treating physician, and (6) The treating physician retained authority to accept or reject the recommendations. In summary, the telephone conversations between the treating and consulting physicians did not, by themselves, create an agreement between the consultants and the patient. Using similar reasoning, numerous state courts have held that informal consultations between physicians do not create a legal relationship between the consultant and the patient In several of these cases, treating physicians used the telephone to obtain a consultant s opinion about whether a diagnosis or treatment was correct and received an answer based solely on the content of the conversation(s). 18,26,27 Other instances in which malpractice liability has been rejected include a conversation in the newborn nursery while the informally consulted physician attended his own newborn patient, 28 a mere request for in-person consultation, 29 discussing patients at weekly staff meetings in a private practice, 30 and a professor s response to a case presentation during a medical education meeting. 31 Collectively, these legal decisions support a general rule: a physician contacted by a treating physician to discuss medical concerns or options related to a patient does not form a legal relationship with the patient whose care is being discussed. The general understanding is that informal consultations are services to medical colleagues, not to patients. 22 Moreover, courts have specifically affirmed the importance of informal consultation. One case notes that holding informal consultants directly accountable to patients would be detrimental in the long run to those seeking competent medical attention and would be contrary to public policy. 26 Other decisions assert that exposure to legal liability would unacceptably inhibit the exchange of information and expertise among physicians 24 and would have a chilling effect on the practice of medicine. 32 Still, it is not always easy to mark off the line between formal and informal consultation. Several factors have been repeatedly identified as important features of informal consultation, but the law does not provide one simple checklist of necessary or sufficient conditions for a physician-patient relationship. Few factors taken alone clearly differentiate formal from informal consultation. Personally examining the patient or expecting payment for services features typical of formal consults would almost certainly establish a legal relationship with the patient. This is the case even if diagnostic information and recommendations for care are communicated to the treating physician rather than the patient, and the treating physician retains control of the patient s care and treatment. 16 On the other hand, the absence of these two features does not necessarily make the consult informal. Providing care without compensation does not negate a legal relationship; charity care does not give license to be negligent. Nor is the absence of direct contact with the patient necessarily conclusive, as shown by the cases discussed later involving pathologists and radiologists (see Invisible Specialists ). Other Consultative Relationships and the Duty of Care Physicians regularly encounter various consultative relationships that share some features of informal consultation but are distinguishable in important ways. Our research came across a number of cases involving teaching physicians and residents, pathologists, radiologists, and on-call contracts with hospitals or health plans in which the existence of a physician-patient relationship was a central issue. These cases illustrate important points that can help physicians understand when they might be transitioning from an informal to a formal consultative role and a relationship with the patient that has legal importance. Supervisory Relationships Several cases suggest that a supervisory (ie, teaching attending) role that may feel consultative actually creates a physician-patient relationship, at least where the supervising physician s authority extends to directing patient care. Courts have consistently ruled that a staff teaching physician has a legal duty to the patient managed by a resident when the staff physician renders medical advice to a resident under the staff physician s supervision. 33,34 This duty may arise even if the staff physician does not actively participate in the patient s care. In one such case, a court found that a doctor-patient relationship existed between a patient and a group of staff neurosurgeons, despite the staff physicians claim that they did not interact with the residents managing the patient during a 3-week hospital stay and did not recommend the care that was delivered to the patient. Central to this ruling was the physicians contractual obligation to provide guidance and direction
4 Special Article Vol. 35, No to a group of residents on the neurosurgical service at the medical center. Because of the contract, the court held that even if the staff physicians did not have ongoing interaction with the patient, they were nonetheless obligated to do so under the terms of their contract... and accepted medical practice. 35 Absent this defined contractual supervisory responsibility, we found no cases suggesting that other exchanges of information between residents and staff physicians established formal responsibility for patient outcomes. Indeed, if the mere existence of a mentorstudent relationship established a physician-mentor s duty to all patients under the care of a resident, this would be detrimental to both patient care (the courts concern) and medical education. A cardiologist would be reluctant to respond to a resident s hallway inquiry about patient management, concerned that if his/her response were used in the care of the patient, he/she could be involved in a lawsuit, despite having had no direct supervision of the involved resident. Invisible Specialists Another group of cases suggests that invisible specialists who routinely provide patient care services but (almost) never see or speak with patients may be liable for the services they render. The leading examples are pathologists and radiologists. Notwithstanding their distance from the bedside, these specialists are expected to act consonant with the standard of care in their area of expertise and typically can be held liable for negligence if they fail to do so What distinguishes these situations from informal consultations involving these same specialists is the shared understanding among patient, treating physician, and specialist that professional services are knowingly rendered for a specific patient s benefit (not as an educational service for a colleague) and will be directly relevant to the patient s care. Most often, the patient consents to delivery of a tissue sample or the taking of an X ray and to the sharing of pertinent medical information with the specialist. In turn, the specialist s assessment generates a fee for these services. On-call Physicians Another set of cases involves on-call arrangements, typically involving emergency room care. The key factors here are control over patient care and the nature of the on-call agreement. On-call physicians expressly responsible for admission and patient care decisions under a contract with a hospital or health plan have been held responsible for refusing to accept a patient s care 39 and for denying inpatient care in favor of outpatient treatment. 40 An on-call specialist had a duty to the patient when he authorized discharge and transfer of a woman in labor 41 and when the specialist, on call for his group, actively participated in the diagnosis and treatment of a patient s cardiac condition. 42 In each of these cases, decisions were made by telephone, without the physician having ever seen or spoken with the patient. By contrast, merely being on call does not create a legal duty to all patients admitted to the emergency room during the call period On-call physicians may, in appropriate circumstances, decline to accept the care of a patient, notwithsta nding the emergency room physician s request for their expertise. 43,46 In sum, the nature of the on-call physician s role and responsibilities, as shaped by both the on-call agreement and the way in which the consultation is handled, are essential determinants of a legal duty to the patient. Discussion Courts generally view informal consultation as a service to a colleague, not as providing care to a patient. The typical informal consultation creates no legal relationship between consultant and patient. Consequently, this frequent and important practice appears to involve minimal risk of malpractice liability for consultants, while providing opportunity to help a colleague deliver good medical care. Other commentators have reached similar conclusions. 15,16,47-49 Our analysis is based on case law in nearly 20 states and allows us to articulate guidelines for how to categorize the legal implications of physician-to-physician consultations (Table 1). It is important to note that relevant cases were not found in every state, but, equally important, we did not find any cases contrary to our conclusions. This uniform body of law should be highly persuasive in states where courts are yet to address the question. Curbside consults betwee n medic al colleagues should be understood as legally distinct from formal consultations, from advice given by staff physicians to residents they supervise, and from consults undertaken because of on-call obligations, though these latter distinctions are less developed in extant law. Physicians should be attentive to the nature of the services they provide and the point at which informal consultation becomes formal. Contractual agreement to provide emergency on-call services is a condition of staff privileges at many hospitals. Attorney review of proposed contracts to clarify on-call obligations may be advisable. Fox and colleagues have previously studied the malpractice risk for informal consults rendered by infectious disease specialists. 49 Our analysis, based on a much larger body of case law, reaches similar conclusions to their 1996 paper. Expansion of the case law over the past 7 years allows for more strongly grounded conclusions about the state of the law. The more extensive, contemporary body of cases also affords greater insight into the legal rules applicable to some of the various
5 480 July-August 2003 Family Medicine Table 1 Indicators of Informal Consultation Each of the following features suggests that a consult may be informal. The typical informal consult shares a number of these characteristics. No single feature establishes that the consult is informal or that there is no legal relationship between consultant and patient. 1. The consulting physician has not examined the patient. 2. The consulting physician has no direct communication with the patient. 3. The consulting physician does not review the patient s records. 4. The consulting physician has no obligation for formal consultation. 5. The consulting physician receives no payment for services. 6. The consulting physician gives opinion and advice solely to the treating physician. 7. The treating physician remains in control of the patient s care and treatment. relationships between physicians that sometimes seem merely informally consultative in everyday practice but may be viewed differently by the law. The increasingly busy nature of medical practice, together with constantly evolving specialization in medicine, make the informal consultation as much an essential resource of primary care practice as it has ever been. is a valuable tool for the busy clinician. Among its advantages are that it allows asynchronous communication, alleviates the need to be in the same place (or on the telephone) at the same time, avoids the frustration of telephone tag, facilitates opportunities to reflect on and clarify questions and replies, enables preservation and later retrieval of information provided by a colleague, and reduces on-the-spot time pressure, which has been identified as a source of incomplete or erroneous advice with curbside consults. 14 Although our analysis discovered no cases involving the use of for physician-to-physician communication, the same rules governing informal consultation by traditional means should be equally applicable to informal consultations using . It is the nature of the communication, not the method used, that truly matters. Our conclusions are not intended to suggest that e- mail consultations raise no new issues when compared to traditional in-person or telephone consults. New rules implementing the Health Insurance Portability and Accountability Act (HIPAA) strengthen protections for the privacy and security of personal health information, in particular information that is electronically transmitted or maintained. Compliance with HIPAA may foster greater vigilance in deleting or masking identifying information, a hallmark of informal consultations for example, the common use of hypothetical cases. As noted earlier, a distinguishing feature of is ready creation of a permanent electronic (and perhaps paper) record of communications that ordinarily should be considered part of the medical record and, thus, potential evidence in a malpractice suit. 15,16,50 Responding to concerns about accuracy and liability, a group of neurosurgeons recently decided to fax their recommendations to physicians at other hospitals following informal telephone consults after discovering that their recommendations were often inaccurately recorded in patients charts. 51 offers a convenient alternative approach to this problem. In addition to confidentiality concerns, , like telemedicine more generally, also presents some new challenges for interpreting rules against practicing medicine across state lines without a license These are important questions but lie beyond our more narrow inquiry about the malpractice risks associated with informal consultations. Finally, that the typical curbside consult does not increase the malpractice exposure of subspecialists does not mean that consulting physicians have no obligations of professionalism and due care in the conduct of informal consults. To the contrary, consultants have professional and ethical obligations to act with the skill, knowledge, and diligence commonly expected in their field of specialty. In addition, both parties need to be in agreement about when these educational exchanges should be used in lieu of formal involvement of the subspecialist in the patient s care. Acknowledgments: This paper was supported in part by the US Public Health Service, Health Resources and Services Administration, grant #5 D15 PE We thank Dana N. Turkel for her invaluable research assistance. Correspondence: Address correspondence to Dr Olick, SUNY Upstate Medical University, Center for Bioethics and Humanities, 725 Irving Avenue, Suite 406, Syracuse, NY Fax: REFERENCES 1. Consultation Service. Iowa City, Iowa: University of Iowa. 2. Smith R. What clinical information do doctors need? BMJ 1996;313: Hang JD. Physicians preferences for information sources: a metaanalytic study. Bull Med Libr Assoc 1997;85: Gruppen LD, Wolf FM, Van Voorhees CV, Stross JK. Informationseeking strategies and differences among primary care physicians. Mobious 1987;XX: Ely JW, Burch RJ, Vinson DC. The information needs of family physicians: case-specific clinical questions. J Fam Pract 1992;25: Gorman PN, Ash J, Wykoff L. Can primary care physicians questions be answered using the medical journal literature? Bull Med Libr Assoc 1994;82: Dee C, Blazek R. Information needs of the rural physician: a descriptive study. Bull Med Libr Assoc 1993;81: Manian FA, Janssen DA. Curbside consultations. A closer look at a common practice. JAMA 1996;275: Golub RM. Curbside consultations and the viaduct effect. JAMA 1998; 280: Manian FA, McKinsey DS. A prospective study of 2,092 curbside questions asked of two infectious disease consultants in private practice in the Midwest. Clin Infect Dis 1996;22: Magnussen CR. Infectious disease curbside consultations at a community hospital. Infectious Diseases in Clinical Practice 1992;6:391-4.
6 Special Article Vol. 35, No Kuo D, Gifford DR, Stein MD. Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA 1998;280: Bergus GR, Sinift SD, Randall CS, Rosenthal DM. Use of an curbside consultation service by family physicians. J Fam Pract 1998; 47: Keating NL, Zaslavsky AM, Ayanian JZ. Physicians experiences and beliefs regarding informal consultation. JAMA 1998;280: Spielberg AR. On-line without a net: physician-patient communication by electronic mail. Am J Law Med 1999;25: Granade PF. Medical malpractice issues related to the use of telemedicine: an analysis of the ways in which telecommunications affects the principles of medical malpractice. North Dakota Law Review 1997;73: Furrow BR, Greaney TL, Johnson SH, Jost TS, Schwartz RL. Health law. Minneapolis: West Publishing Company, 1995: Corbet v McKinney, 980 SW2d 166 (Mo Ct App, 1998). 19. Prooth v Walsh, 432 NYS 2d NBD v Barry, 223 Mich App 370, 566 NW2d Cogswell v Chapman, 249 AD2d 865, 672 NYS2d 460 (1998). 22. Bovara v St Francis Hosp, 298 Ill App 3d 1025, 700 NE2d 143 (1998) Mich App 300, 463 NW2d 265 (Ct App, 1990). 24. Oliver v Brock, 342 So2d 1 (S Ct Ala, 1976). 25. Roberts v Hunter, 310 SC 364, 426 SE2d 797 (1992). 26. Lopez v Aziz, 8852 SW 2d 303 (Ct App Tex, 1993). 27. Ingber v Kandler, 128 AD2d 591, 513 NYS2d 11 (App Div, 1987). 28. Flynn v Bausch, 238 Neb 61, 469 NW2d 125 (1991). 29. Sullenger v Setco Northwest, 74 Or App 345, 702 P2d 1139 (Or Ct App, 1985). 30. Sawh v Schoen, 215 AD2d 291, 627 NYS2d 7 (App Div 1st Dept, 1995). 31. Rainer v Grossman, 31 CalApp3d 539, 107 Cal Rptr 469 (Ct App 1973). 32. Reynolds v Decatur Memorial Hosp, 277 Ill App 3d 80, 660 NE2d 235 (1996). 33. Gilinsky v Indelicato, 894 F Supp 86 (EDNY 1995). 34. Sibley v Board of Supervisors of Louisiana State Univ, 490 So2d 307 (CtAppLa 1986). 35. Schendel v Hennepin Cty Med Ctr, 484 NW2d 803 (CtAppMinn 1992). 36. Walters v Rinker, 520 NE2d 468 (CtAppInd, 1988). 37. Peterson v St Cloud Hosp, 460 NW2d 635 (MinnApp, 1990). 38. Dougherty v Gifford, 826 SW2d 668 (CtAppTex, 1992). 39. Hiser v Randolph, 126 Ariz 608, 617 P2d 774 (ArizApp, 1980). 40. Hand v Tavera, 864 SW2d 678 (CtAppTex, 1993). 41. Wheeler v Yettie Kersting Mem Hosp, 866 SW2d 32 (CtAppTex, 1993). 42. McKinney v Schlatter, 118 Ohio App3d 328, 692 NE2d 1045 (1997), aff d, 1999 WL St John v Pope, 38 TexSupJ 723, 901 SW2d 420 (SCtTex, 1994). 44. Fought v Solce, 821 SW2d 218 (TexApp, 1991). 45. Rivera v Prince George s County Health Dept, 102 MdApp 456, 649 A2d 1212 (CtSpApp, 1994). 46. Miller v Martig, 754 NE2d 41 (CtAppInd, 2001). 47. Granade PF, Sander JH. Implementing telemedicine nationwide: analyzing the legal issues. Defense Counsel Journal 1996;63: Rigelhaupt JL. What constitutes physician-patient relationship for malpractice purposes. American Law Reports 1998;7(4): Fox BC, Siegel ML, Weinstein RA. Curbside consultation and informal communication in medical practice: a medicolegal perspective. Clin Infect Dis 1996;23: Jurevic AM. When technology and health care collide: issues with electronic records and electronic mail. UMKC Law Review 1998;66: Cartmill M, White BD. Telephone advice for neurosurgical referrals. Who assumes duty of care? Br J Neurosurg 2001;15(6): Spielberg AR. On call and on-line: sociohistorical, legal, and ethical implications of for the patient-physician relationship. JAMA 1998;280: Tyler BJ. Cyberdoctors: the virtual housecall the actual practice of medicine on the Internet is here: is it a telemedical accident waiting to happen? Indiana Law Review 1998;31: Berger SB, Cepelewicz BB. Medical-legal issues in teleradiology. Am J Roentgenol 1996;166:
RECENT MEDICAL MALPRACTICE CASES By Judge Bryan C. Dixon 1. MERE TELEPHONE CONVERSATION WITH TREATING DOCTOR DOES NOT ESTABLISH DUTY TO PATIENT Jennings v. Badgett, 2010 OK 7 Facts: Plaintiffs are parents
IN THE SUPREME COURT OF MISSISSIPPI NO. 2000-CA-00099-SCT KIMBERLY KNIGHT, INDIVIDUALLY AND ON BEHALF OF HER MINOR DAUGHTER, BRANDE SKINNER v. LISA GIBSON McKEE, M.D. AND RICK MARTIN, M.D. DATE OF JUDGMENT:
The Changing Landscape and J a r r o d M a l o n e, J D email@example.com WHAT WE WILL TALK ABOUT TODAY Medical and legal issues for physicians best practices Reducing liability Medical Malpractice
LIABILITY EXPOSURE AND CHILD CARE HEALTH CONSULTATION Prepared by Abby J. Cohen, JD, under contract with the Child Care Law Center, for the California Child Care Health Program, Child Care Health Linkages
Selling/Closing a Medical Practice This publication is a snapshot of South Carolina laws, regulations and best practices as of July 2009. The material presented is likely to evolve and change from year
WHEN A CHILD MAY HAVE A TORT CLAIM: WHAT S THE CHILD S COURT- APPOINTED ATTORNEY TO DO? The Oregon Child Advocacy Project Professor Leslie J. Harris and Child Advocacy Fellows Colin Love-Geiger and Alyssa
Page 1 of 7 809.66 MEDICAL NEGLIGENCE - HEALTH CARE PROVIDER'S LIABILITY FOR ACTS OF NON-EMPLOYEE AGENTS - RESPONDEAT SUPERIOR - APPARENT AGENCY. 1 NOTE WELL: This instruction previously was labeled N.C.P.I.
Portfolio Media. Inc. 860 Broadway, 6th Floor New York, NY 10003 www.law360.com Phone: +1 646 783 7100 Fax: +1 646 783 7161 firstname.lastname@example.org Alternative Burdens May Come With Alternative Causes
MISSOURI COURT OF APPEALS WESTERN DISTRICT DOROTHEA LEBLANC, Appellant, v. RESEARCH BELTON HOSPITAL, Respondent. WD69248 OPINION FILED: December 9, 2008 Appeal from the Circuit Court of Jackson County,
Virtual Mentor American Medical Association Journal of Ethics March 2009, Volume 11, Number 3: 242-246. HEALTH LAW Difficult Patient-Physician Relationships and the Risk of Medical Malpractice Litigation
Statute of Limitations for Suits Against Attorneys: Contract or Tort? When a former client brings a malpractice suit against an attorney, is the suit normally a tort action or a contract action? Does it
IN THE SUPERIOR COURT OF THE STATE OF DELAWARE IN AND FOR KENT COUNTY ANASTACIO ORTIZ and SARA MARIA ORTIZ, his wife, - JTV Plaintiffs, 5. SATOSHI IKEDA, M.D., SATOSHI IKEDA, M.D., P.A., ANDREA K. LANGE,
August 26, 2005 FLSA2005-25 Dear Name*, This is in response to your request for an opinion concerning whether insurance claims adjusters employed by your client qualify for the administrative exemption
IN THE MISSOURI COURT OF APPEALS WESTERN DISTRICT IRETTA MORGAN, ) ) Appellant, ) WD75098 ) vs. ) Opinion filed: June 28, 2013 ) SAINT LUKE'S HOSPITAL OF ) KANSAS CITY, ) ) Respondent. ) APPEAL FROM THE
Implementation of the t Protection of Life During Pregnancy Act 2013 Guidance Document for Health Professionals 2014 Table of Contents 1. Introduction... 4 1.1 Background to the Act... 4 1.2 The Protection
Do good, but do it right: Wyoming s Medical Volunteer Immunity Law Law s specific exceptions require Doctors to jump through some hoops By Nick Healey Dray, Dyekman, Reed & Healey, P.C. Wyoming physicians
MUSINGS ON PROFESSIONAL LIABILITY IMPLICATIONS OF ACOS While we are still currently in the early stages of implementing Obamacare, we do know that the future of medicine will involve integrated healthcare
NOTICE Decision filed 10/15/15. The text of this decision may be changed or corrected prior to the filing of a Petition for Rehearing or the disposition of the same. 2015 IL App (5th 140227-U NO. 5-14-0227
STANLEY V. MCCARVER: FORMAL DOCTOR- PATIENT RELATIONSHIP NOT REQUIRED FOR NEGLIGENCE LIABILITY Patrick I. Biggerstaff I. FACTS AND PROCEDURAL HISTORY Nurse Christine Stanley submitted to a tuberculosis
ATTORNEYS FOR APPELLANTS ATTORNEY FOR APPELLANTS ATTORNEYS FOR APPELLEE QUERREY & HARROW, LTD., SANDERS PIANOWSKI, LLP AND TRANSCONTINENTAL INS. CO. JAMES N. KOSMOND, AND ROBERT A. SANDERS GRETCHEN CEPEK
APP MALPRATICE ISSUES Christopher G. Henderson, J.D Melanie Morano, J.D., R.N. Simmons Law Group, P.A. March 4, 2013 LEGAL AND REGULATORY ENVIRONMENT As APPs have become more prominent in the medical community
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. 480A.08, subd. 3 (2010). STATE OF MINNESOTA IN COURT OF APPEALS A10-1489 Barry H. Nash, Appellant, vs. James D. Gurovitsch,
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. 480A.08, subd. 3 (2006). STATE OF MINNESOTA IN COURT OF APPEALS A08-0222 Karyn Larson Smith, Appellant, vs. Argosy
2015 IL App (1st) 141985-U No. 1-14-1985 NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as precedent by any party except in the limited circumstances allowed under Rule 23(e)(1).
Psychology CLINICAL PRIVILEGE WHITE PAPER Psychology Background Psychology is a broad field that includes the scientific study of mental processes and behavior. It is similar to the medical field of psychiatry.
AFFIRMED; Opinion Filed June 16, 2014. S In The Court of Appeals Fifth District of Texas at Dallas No. 05-13-00632-CV OFFICE OF THE ATTORNEY GENERAL, Appellant V. GINGER WEATHERSPOON, Appellee On Appeal
STATE OF MICHIGAN COURT OF APPEALS BUDDY JOHNSON, Plaintiff-Appellant, UNPUBLISHED August 20, 1999 and NANCY JOHNSON, Plaintiff, v JAMES K. FETT and MUTH & FETT, P.C., No. 207351 Washtenaw Circuit Court
Case 2:08-cv-04597-LDD Document 17 Filed 02/05/09 Page 1 of 7 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA SUZANNE BUTLER, Individually and as : Administratrix of the Estate
Reflections on Ethical Issues In the Tripartite Relationship [click] By Bruce A. Campbell 1 Introduction In most areas of the practice of law, there are a number of ethical issues that arise on a frequent
Updated as of 05/15/13-1 - GENERAL OFFICE POLICIES Thank you for choosing the Quiroz Adult Medicine Clinic, PA (QAMC) as your health care provider. The following general office policies are provided to
By Darryl S. Weiman, M.D., J.D. Federal Tort Claims Act Passed by Congress in 1946 to reduce the negative impacts of the doctrine of sovereign immunity Designed to eliminate the practice of congressman
5.51 LEGAL MALPRACTICE (Approved 6/79) CHARGE 5.51A Page 1 of 9 A. General Duty Owing An action brought against an attorney alleging negligence in the practice of law is referred to as a malpractice action.
FOR PUBLICATION ATTORNEYS FOR APPELLANT: PATRICK J. DIETRICK THOMAS D. COLLIGNON MICHAEL B. KNIGHT Collignon & Dietrick, P.C. Indianapolis, Indiana ATTORNEY FOR APPELLEE: JOHN E. PIERCE Plainfield, Indiana
Report of the Ad Hoc Committee on Telemedicine Federation of State Medical Boards of the United States The Federation's governing body accepted the following Report of the Ad Hoc Committee on Telemedicine
SAFETY REVIEW NOT SPECIFIED IN CONTRACT James C. Kozlowski, J.D., Ph.D. 2008 James C. Kozlowski In contracting for personal services, an architect's duty depends on the particular agreement entered into
Birth Trauma: Litigating Medical Malpractice Cases in Numerous States is currently litigating birth trauma cases throughout the country. The firm s attorneys are licensed to practice law in Texas, Louisiana
IN THE COMMON PLEAS COURT OF FAIRFIELD COUNTY, OHIO MARY LEMASTER, : Plaintiff, : Case No. 12 CV 422 v. : Judge Berens BERGER HEALTH SYSTEM ET AL., : ENTRY Granting Defendant s Motion to Dismiss Defendants.
APPENDIX 1: Frequently Asked Questions Practice Name Q: What is the HIPAA Privacy Rule? A: The HIPAA Privacy Rule controls the use and disclosure of what is known as Protected Health Information (PHI).
Ontario Hospital Association/Ontario Medical Association Hospital Prototype Board-Appointed Professional Staff By-law 2011 ONTARIO HOSPITAL ASSOCIATION/ ONTARIO MEDICAL ASSOCIATION HOSPITAL PROTOTYPE BOARD-APPOINTED
Notice: This opinion is subject to formal revision before publication in the Atlantic and Maryland Reporters. Users are requested to notify the Clerk of the Court of any formal errors so that corrections
H O S P I C E A N D P A L L I A T I V E C A R E P R A C T I C E G R O U P HOSPICE AND PALLIATIVE CARE PRACTICE GROUP: Mary H. Michal, Chair Linda Dawson. Meg S. L. Pekarske Matthew K. McManus 22 East Mifflin
A&E Briefings Structuring risk management solutions Spring 2012 Indemnification Clauses: Uninsurable Contractual Liability J. Kent Holland, J.D. ConstructionRisk, LLC Professional consultants are judged
THIS OPINION IS MERELY ADVISORY AND IS NOT BINDING ON THE INQUIRING ATTORNEY, OR THE COURTS OR ANY OTHER TRIBUNAL. DELAWARE STATE BAR ASSOCIATION COMMITTEE ON PROFESSIONAL ETHICS Opinion-1991-3 June 18,
Legal Compensation & Ethical Duties of a Health Care Professional " Alexander M. Voudouris Pace Law Firm Overview" Learning objectives Legal Compensation Compensation for Personal Injury Potential Ethical
LIABILITY OF AN ATTORNEY FOR NEGLIGENCE IN TITLE EXAMINATION - FAILURE TO DISCLOSE INFORMATION TO THE CLIENT Generally it is well understood that an attorney is not liable for every mistake or error of
This article originally appeared in The Colorado Lawyer, Vol. 25, No. 26, June 1996. by Jeffrey R. Pilkington TORT AND INSURANCE LAW REPORTER Informal Discovery Interviews Between Defense Attorneys and
NONPRECEDENTIAL DISPOSITION To be cited only in accordance with Fed. R. App. P. 32.1 United States Court of Appeals For the Seventh Circuit Chicago, Illinois 60604 Argued January 8, 2008 Decided July 23,
Case: 14-11987 Date Filed: 10/21/2014 Page: 1 of 11 [PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT No. 14-11987 Non-Argument Calendar Docket No. 1:13-cv-02128-WSD PIEDMONT OFFICE
2016 IL App (1st) 133918-U No. 1-13-3918 SIXTH DIVISION May 6, 2016 NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as precedent by any party except in the limited circumstances
Background and Introduction The Vermont Board of Medical Practice (the Board) is committed to protecting the public and to assisting its licensees to meet their professional obligations by providing quality
2:12-cv-11685-BAF-RSW Doc # 35 Filed 08/02/13 Pg 1 of 7 Pg ID 216 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION ANGELA CADE, vs. Plaintiff, Civil Action No. 12-cv-11685 HON.
June 1, 2011 I. EMPLOYMENT LAW Employer Must Show Economic Injury to Successfully Invoke Key Employee Exception Under the Family and Medical Leave Act In Johnson v. Resources for Human Development, Inc.,
The Hospital, the Board, and the Medical Staff: Who is the Client when Advising on Medical Staff Issues? March 2, 2011 1:00 2:00 pm EST Presenters: Jeffrey D. Moseley, W. Kyle Simonton, and Travis G. Lloyd
IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO BROOKE B. DEMAREE, Plaintiff-Appellant, vs. UNIVERSITY HOSPITAL, Defendant-Appellee, APPEAL NO. C-090892 TRIAL NO. A-0906987
IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO BROOKS J. SPRADLIN-CHEEKS, Plaintiff-Appellant, vs. DAVID B. SCHWARTZ, M.D., and DAVID B. SCHWARTZ, M.D., LLC, Defendants-Appellees.
ATTORNEY FOR APPELLANT Paul T. Fulkerson Skiles Detrude Indianapolis, Indiana ATTORNEY FOR AMICUS CURIAE, DEFENSE TRIAL COUNSEL OF INDIANA Donald B. Kite, Sr. Wuertz Law Office, LLC Indianapolis, Indiana
STATE OF WISCONSIN MEDICAL EXAMINING BOARD IN THE MATTER OF RULEMAKING : PROPOSED ORDER OF THE PROCEEDINGS BEFORE THE : MEDICAL EXAMINING BOARD MEDICAL EXAMINING : ADOPTING RULES BOARD : (CLEARINGHOUSE
Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Appellate Division In the Case of: The Physicians Hospital in Anadarko, Petitioner, - v. - Centers for Medicare & Medicaid Services. DATE:
THE PHILADELPHIA BAR ASSOCIATION PROFESSIONAL GUIDANCE COMMITTEE Opinion 2009-11 (December 2009) The inquirer represented the Decedent in 1999 when he prepared her will. At the time, the Decedent was elderly
STATE OF MICHIGAN IN THE 17th CIRCUIT COURT FOR KENT COUNTY THE HANOVER INSURANCE COMPANY, on its own behalf and as subrogee of Grand Rapids Women's Health, P.C., and Kaaren Dewitt, vs. Plaintiffs, Case
In the United States Court of Appeals No. 12-3901 For the Seventh Circuit CINDY GOLDEN, Plaintiff-Appellant, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant-Appellee. Appeal from the United
Pursuant to Ind.Appellate Rule 65(D, this Memorandum Decision shall not be regarded as precedent or cited before any court except for the purpose of establishing the defense of res judicata, collateral
Patient Access of Laboratory Test Results Effective date: 12/23/15 Pursuant to the authority vested in the Public Health and Health Planning Council and the Commissioner of Health by Sections 576 and 587
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MISSOURI EASTERN DIVISION CINCINNATI INSURANCE COMPANY, Plaintiff, v. No. 4:01 CV 726 DDN VENETIAN TERRAZZO, INC., Defendant. DECLARATORY JUDGMENT Pursuant
================================================================= This opinion is uncorrected and subject to revision before publication in the New York Reports. -----------------------------------------------------------------
The plaintiff in Schmidt filed suit against her employer, Personalized Audio Visual, Inc. ("PAV") and PAV s president, Dennis Smith ("Smith"). 684 A.2d at 68. Her Complaint alleged several causes of action
STATE OF MICHIGAN COURT OF APPEALS HOLLY DEREMO, DIANE DEREMO, and MARK DEREMO, UNPUBLISHED August 30, 2012 Plaintiff-Appellant/Cross- Appellees, v No. 305810 Montcalm Circuit Court TWC & ASSOCIATES, INC.,
[Cite as Stanley v. Community Hosp., 2011-Ohio-1290.] IN THE COURT OF APPEALS FOR CLARK COUNTY, OHIO GEORGE STANLEY, et al. : Plaintiff-Appellant : C.A. CASE NO. 2010 CA 53 v. : T.C. NO. 07CV213 COMMUNITY
Agents E&O Standard of Care Project Survey Maryland To gain a deeper understanding of the differing agent duties and standard of care by state, the Big I Professional Liability Program and Swiss Re Corporate
Guide to Reference Checking Resource Information for Classified Supervisors and Managers Published by The Personnel Commission Table of Contents Page Introduction............................................................
NOTICE Decision filed 02/09/11. The text of this decision may be changed or corrected prior to the filing of a Petition for Rehearing or the disposition of the same. NO. 5-09-0460 IN THE APPELLATE COURT
NO. 12-12-00183-CV IN THE COURT OF APPEALS TWELFTH COURT OF APPEALS DISTRICT TYLER, TEXAS IN RE: TRUCK INSURANCE EXCHANGE, ORIGINAL PROCEEDING RELATOR MEMORANDUM OPINION Relator Truck Insurance Exchange
: A guide to making a claim 2 Our guide to making a clinical negligence claim At Kingsley Napley, our guiding principle is to provide you with a dedicated client service and we aim to make the claims process
CAROL PRICE IN THE Plaintiff CIRCUIT COURT vs. FOR SINAI HOSPITAL OF BALTIMORE, INC. BALTIMORE CITY CASE NO.: 24-C-04-007323 Defendant MEMORANDUM This case comes before this Court on a Petition for Court
[Cite as Boggia v. Wood Cty. Hosp., 2010-Ohio-4932.] IN THE COURT OF APPEALS OF OHIO SIXTH APPELLATE DISTRICT WOOD COUNTY Mary Boggia, et al. Appellants Court of Appeals No. WD-09-091 Trial Court No. 2007-CV-0422
AAFP Reprint No. 281 Recommended Curriculum Guidelines for Family Medicine Residents Risk Management and Medical Liability This document was endorsed by the American Academy of Family Physicians (AAFP).
IN THE NEBRASKA COURT OF APPEALS MEMORANDUM OPINION AND JUDGMENT ON APPEAL (Memorandum Web Opinion) CITY OF LINCOLN V. DIAL REALTY DEVELOPMENT NOTICE: THIS OPINION IS NOT DESIGNATED FOR PERMANENT PUBLICATION
Management Consulting Client and Engagement Intake: Practical Considerations and Tools A CNA RISK CONTROL GUIDE FOR MANAGEMENT CONSULTANTS Table of Contents Executive Summary... 3 Client and Engagement
2008 Decisions Opinions of the United States Court of Appeals for the Third Circuit 3-27-2008 Henkel Corp v. Hartford Accident Precedential or Non-Precedential: Non-Precedential Docket No. 06-4856 Follow
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCL OSE D AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. B ACK GR OUND
GEORGIA MEDICAID TELEMEDICINE HANDBOOK CONNECTING GEORGIA OVERVIEW The Department of Community Health s (DCH) Telemedicine and Telehealth policies are slated to improve and increase access and efficiency