Court: Patient or not, doctor liable for care

The state Court of Appeals sent a message to doctors who do reviews for insurance companies: Just because the person you're checking isn't technically your patient, that doesn't immunize you from malpractice suits.

In a unanimous decision, the judges rejected the contention of Dr. Scott Krasner that he owed no duty of care to Jeremy Ritchie, whose injuries he was reviewing at the request of an insurer. Without a legal duty of care, Krasner argued, any mistake or omission he might have made is legally irrelevant.

But Judge Patrick Irvine said Krasner, and other doctors in his position, do have a duty to provide patients the information they need, information they will rely on in deciding whether to seek further treatment.

The case stems from a 2000 incident in which Ritchie injured his back while at work. Chiropractors he consulted recommended to the workers' compensation carrier that he visit a specialist to evaluate the symptoms.

The insurer then contracted with Krasner to perform an independent medical evaluation. Krasner reported back that there was no indication of a need for supportive care and that he could go back to work without any restrictions.

Ritchie eventually became eligible for the Arizona Health Care Cost Containment System, the state's Medicaid program, and a doctor who examined him ordered immediate surgery to prevent further deterioration of his spinal cord. That doctor said the delay in getting the surgery contributed to the injury, causing part of the spinal cord to die.

At a malpractice trial, which was conducted after Ritchie died of an accidental overdose of painkillers, a jury found Krasner 28.5 percent at fault for his injuries.

Irvine said that to maintain a malpractice action, a plaintiff must first prove there was a duty requiring the defendant to conform to a certain standard of care.

Krasner argued that there is no duty when there is not a doctor-patient relationship.

Irvine said that is generally true, but he said other factors can determine when there is a duty.

For example, the judge said, a duty to exercise care exists when a doctor is in "a unique position to prevent harm.'' Irvine said factors to be considered include whether the patient relied on the doctor's diagnosis, the closeness of the connection between the doctor's conduct and the injury suffered, and the skill or special reputation of the people involved.

Irvine said someone who puts himself or herself in the hands of a medical professional, even at the request of an insurer, is entitled to assume that the doctor will warn of any dangers within that professional's area of expertise.

In this case, Krasner, at the request of the insurer, reviewed Ritchie's records, conducted an examination and reviewed an MRI of his lumbar spine.

The judge also noted that Ritchie, in a deposition, said he delayed seeking further medical care based on Krasner's assessment that there was no problem.

Irvine said the appellate court "cannot envision a public benefit in encouraging a doctor with specialized individual knowledge not to investigate the symptoms of a cervical spine injury.''

The appellate court acknowledged that Ritchie, prior to being seen by Krasner, signed an agreement saying that there was no doctor-patient relationship and that the results of the exam ordered by the insurer would not be provided to Ritchie. But Irvine said that did not eliminate Krasner's duty to do his job in a reasonable manner.