Ms. B, a 36-year-old nurse practitioner (NP), had known Dr. C, a 45-year-old family practice physician, for several years before she asked him to enter into a collaborative practice agreement with her. The two clinicians had once worked together and were friends. 


Ms. B knew that the physician, in addition to having his own busy practice, had collaborative practice agreements with several other NPs. Ms. B wanted to start her own practice but needed a physician to sign a collaborative practice agreement to do so. Dr. C quickly agreed to Ms. B’s request, telling her that he was already in collaborative practice agreements with 8 other NPs. The clinicians signed the agreement, and Ms. B opened her practice and began treating and writing prescriptions for her patients. 


According to the law of the state in which they practiced, as part of the collaborative practice agreement, Dr. C was required to review at least 5% of Ms. B’s charts each week to evaluate her prescriptive practices. Although both clinicians were aware of this, neither was particularly concerned about the requirement, and Dr. C did not review any of the charts of Ms. B’s patients, although he did occasionally review her notes. At one point after reviewing Ms. B’s notes, the physician expressed some concern about Ms. B’s prescribing practices and suggested that she attend a narcotic-prescribing seminar. However, he never followed up, and Ms. B never took the suggestion. 



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One of Ms. B’s patients was high-risk, with a history of pain, depression, suicide attempts, and polysubstance abuse. During the 3-month period, from January to March, in which Ms. B was treating the patient, she prescribed multiple medications, including hydrocodone/acetaminophen, methadone, bupropion, lithium, and alprazolam. In late March, the patient died, and an autopsy revealed the cause of death to be acute bronchopneumonia complicated by a mixed-drug interaction. 


The patient’s widow consulted with a plaintiff’s attorney. After a discussion with the attorney and examination of the patient’s records by an expert, the widow decided to sue. Although Dr. C never examined the patient or looked at his file, both he and Ms. B were named in the lawsuit. 


The lawsuit caused terrible tension between the two clinicians. Their working relationship swiftly turned hostile and fell apart. Dr. C was angry and resentful at being drawn into a lawsuit that he felt was none of his business. He hired a defense attorney and filed a motion to dismiss the case, based on his assertion that he owed no duty of care, which is a required element for a medical malpractice case, because he never saw or treated the patient. 


The trial court ruled that Dr. C did indeed owe a duty of care to the patient. Dr. C appealed to the state’s Court of Appeals. During the appeal, Dr. C argued that he had never even seen the patient’s file, that the patient was not his patient, and that the only one who owed a duty of care to the patient was Ms. B. The Court of Appeals disagreed and held that Dr. C did have a duty to the patient. 


Legal background


Dr. C’s main argument was that since he had no doctor-patient relationship with the patient, then he owed no duty to the patient. However, healthcare practitioners can still sometimes owe a duty to a third party to whom they have not provided care. In analyzing whether a duty existed, the Court of Appeals looked at 3 factors: 1) the relationship of the parties; 2) the reasonable foreseeability of harm to the person who was injured; and 3) public policy concerns. 


While there was no direct relationship between Dr. C and the patient, the court held that when a physician voluntarily enters into a contract with a nurse practitioner pursuant to which he agrees to provide oversight of her prescriptive practices, the purpose is for the protection of the NP’s patients. The court found this to weigh in favor of a duty.