Liability of Health Care Professionals

Question 1

Elements of Negligence Case

Answer 1

– Duty

– Breach

– Harm

– Causation (was injury caused by medical management
rather than underlying condition?)

Question 2

Standard of Care

Answer 2

Did D exercise “that reasonable degree of:

(1) Skill

(2) Knowledge; &

(3) Care

(4) Ordinarily possessed & exercised by members of
profession under similar circumstances”?

-Relevant to a duty & breach analysis

-Requires expert testimony (e.g. by dr in same specialty as D)

-Available resources are relevant (e.g. rural
hospital vs. big city hospital)

Question 3

Is the standard of care, national, regional, or local?

Answer 3

National

Question 4

Can proof that doctor followed practice of a respectable minority constitute a defense?

Answer 4

Yes, at least according to most courts.

Question 5

Hall v. Hilbun

Answer 5

Cleveland vs Mississippi hospital standard of care case

Facts:

-Doctor stupidly left a sponge in a patient’s abdomen

-Patient died, but sponge didn’t contribute to death

Issue:

Does a physician have a nondelegable duty to treat each patient with skill and competence comparable to physicians in the same field throughout the nation?

Holding:

Yes. A physician has a nondelegable duty to treat each patient with skill and competence comparable to other physicians in the same field throughout the nation, not simply within the locality.

However, the duty of care must also be objectively determined by examining the availability and quality of facilities, equipment, and other resources

Dr. Hilbun was held liable.

Question 6

Preauthorization/prior authorization

Answer 6

Health insurer determines treatment is
medically necessary and that it is willing to
pay for it.

-Does not apply to emergency services

-Needed for certain services e.g. non-
emergency surgery or hospitalization.

Question 7

Wickline v. State

Answer 7

Facts:

-Medi-Cal denies Dr’s request for additional hospital days

-Dr. Polonsky doesn’t appeal

-Wickline goes home & leg ultimately amputated

-Wickline sues Medi-Cal & Dr. Polonsky for not fighting w/ insurer and insisting on 8 day extension

Issue:
May third-party payors of health care services be held liable when a patient’s treating physician makes a medical determination to discharge a patient from a hospital?

Holding:
Ct. states in dicta that dr may not be able to use insurance decisions as liability shield (e.g. when discharging unstable
patient)

-Medi-Cal not liable b/c didn’t discharge P
-Dr. Polonsky not liable b/c P was stable at time of discharge