Ms T was a family nurse practitioner (NP) working in a primary care practice. She saw her own patients and did her own prescribing. To be able to prescribe controlled substances, Ms T needed to have a consultation and referral plan with a consulting physician. Dr H, another physician in the practice, agreed to be Ms T’s consulting physician. The two clinicians worked well together, but as time went on Ms T consulted with the physician less often, and ultimately rarely, if ever.
One of Ms T’s patients was Mr D, 32. The young man was married and had a new baby and a toddler, but he was stressed and exhausted. His marriage was struggling and he felt overwhelmed. He sought care from Ms T beginning in April for a variety of issues, including depression, anxiety, and other complaints. Ms T prescribed testosterone and pregnenolone for Mr D. The following month, she increased the dosage of both drugs. In July, Ms T diagnosed Mr D with attention-deficit/hyperactivity disorder and prescribed methylphenidate. In September, Ms T doubled the patient’s dosage. The patient was also taking diazepam, doxepin, and paroxetine, as well as the hair loss medication, finasteride.
Ms T relied on her own judgment in prescribing and did not consult with Dr H when changing the dosage or ordering new medications for her patient. The clinician last saw Mr D in late December. He did not look well and confided in the clinician that his marriage was on the rocks and his wife had filed for separation. Ms T was sympathetic, but after the patient left her office she did not think about him until a few weeks later when she saw his picture on the news.
Mr D had shot and killed his wife in the parking lot of a church as she was on her way into services with the children. He was arrested and eventually pled guilty to aggravated murder and was sentenced to 20 years to life in prison. During Mr D’s sentencing, he told the judge that he took full responsibility for his wife’s death. But he also claimed that he would not have murdered her had he not been on medications. Mr D’s two young children were taken in by their maternal grandmother, and a conservator was appointed to look after their legal and financial interests.
Ms T, like everyone else in the community, was horrified by what had happened. But she did not understand that there could be a connection to her, until she was served with papers notifying her that she, and Dr H, were being sued by the minor children via the conservator. The lawsuit alleged that the clinicians were negligent in prescribing the medications to Mr D, and that this resulted in Mr D killing his wife and going to jail, leaving the children without a parent.
The NP immediately sought counsel from a defense attorney, who reassured her, “We should be able to get this dismissed. You only owe a duty to your patient, not to a third-party.”
Sure enough, the attorney made a motion to dismiss the case against Ms T based on the fact that “no patient–health care provider relationship existed” between the plaintiffs (the children) and the defendants (Ms T and Dr H). The lower court agreed, and the case was dismissed.
Ms T’s relief was short-lived. The plaintiffs filed an appeal, claiming that the lower court had incorrectly concluded that defendants did not owe a duty of care to nonpatient plaintiffs. On appeal, the state’s supreme court agreed with the plaintiffs.