Can a Medical Professional be Liable to a Patient’s Caregiver?

From the Desk of Melanie Gillette:

A medical professional owes a duty of care to their patients, but can a medical professional be liable for physical injuries to a third party who is not their patient? Read on for more…

Claims Pointer:

In this case, the Oregon Court of Appeals determined that a third party may be able to bring a cognizable claim against medical service providers for personal injuries sustained by the third party.

Maltais v. PeaceHealth, 326 Or App 318 (2023)

Facts:

In this case, Plaintiff Mathais was the biological mother of N.H., an adult with paranoid schizophrenia and severe intellectual disabilities who lived with Plaintiff and her husband. N.H.’s condition profoundly disabled him and Plaintiff was N.H.’s primary caregiver. Plaintiff managed N.H.’s medical care, accompanied N.H. to his medical visits, and communicated necessary medical information to his providers. Plaintiff was also authorized to receive medical information concerning N.H., including information related to visits to his psychiatrist and other medical providers at Defendant PeaceHealth for many years.

Notwithstanding, N.H.’s condition deteriorated, and he began to exhibit severe and uncharacteristic symptoms, including hearing voices. N.H. feared losing control and felt driven to stab his family members. Concerned that N.H. had become dangerous, Plaintiff took N.H. to Defendants’ emergency department on January 28, 2018. The hospital staff interviewed N.H. and released him. The next day, N.H. was seen by his regular psychiatrist, who evaluated N.H.’s condition and noted in his chart, “[d]ue to active psychosis and recent threats, dangerousness is clear.” On January 30, 2018, N.H.’s psychiatrist told Plaintiff that she would inform Defendants’ emergency department that N.H. needed to be admitted. The psychiatrist spoke to an intake worker and a crisis worker and explained that N.H. was coming to the emergency department and should be admitted, as well spoke to an emergency department doctor and advised that admission was appropriate because N.H. was dangerous to himself and others. The emergency department staff member agreed that they would admit N.H. Plaintiff took N.H. to the emergency department later that day, but there had been a shift change and the emergency department staff did not admit N.H. After returning home, N.H. stabbed Plaintiff with a knife, puncturing her lung in the presence of her husband.

Plaintiff then brought an action against the hospital and emergency room doctor who refused to admit N.H., alleging that Defendants were negligent in, among other things, failing to properly restrain, admit, or secure N.H. despite knowing or having reason to know that he was a danger to himself or others, failing to convey the decision to admit N.H. at the change of shift, and failing to adequately document the decision to admit N.H.

Defendants moved to dismiss the complaint. The trial court granted Defendants’ motion to dismiss, but allowed Plaintiff to replead with the assertion that Defendants owed Plaintiff a duty. Plaintiff amended her complaint, adding additional detail regarding the relationship between Plaintiff, N.H., and his medical providers, but Defendants renewed their arguments that the complaint was legally insufficient because it failed to allege facts showing Defendants had a duty that ran to Plaintiff, and thus Plaintiff could not state a third-party medical negligence claim. The trial court agreed and dismissed the complaint with prejudice, and Plaintiff appealed.

Law:

Under Oregon law, a person whose conduct unreasonably creates a foreseeable risk of harm to others and causes an injury is generally liable for that injury, “unless the parties invoke a status relationship, or a particular standard of conduct that creates, defines, or limits the defendant’s duty.” Fazzolari v. Portland School Dist. No. 1J, 303 Or 1, 17, 734 P2d 1326 (1987). The Oregon Supreme Court articulated the professional standard of care for physicians in Tomlinson v. Metropolitan Pediatrics, LLC, 362 Or 431, 434, 412 P3d 133 (2018), and further explained that this standard of care does not limit a physician’s professional duty to just their patients. Rather, whether a physician has a duty that runs to a non-patient third party depends on “the existence of an undertaking, express or implied, between the [professional] and the third party.” Id. at 445. 

In the present case, the Oregon Court of Appeals examined the three considerations identified in Tomlinson to determine whether Defendants may be required to protect the interests of Plaintiff, a non-patient third party: “whether the relationship between the parties is a type of relationship that generally entails a mutual expectation of service and reliance,” “whether the potential plaintiffs were identifiable to the defendant or otherwise could be defined as a class that avoids indeterminate liability,” and “whether recognizing such a claim would interfere with or impair the loyalties that the professional owes to the client.” Tomlinson, 362 Or at 446.

Analysis:

When analyzing the first consideration from Tomlinson, “whether the relationship between the parties is a type of relationship that generally entails a mutual expectation of service and reliance,” the Court of Appeals found that Defendants’ professional undertaking could reasonably include Plaintiff in her role as N.H.’s primary caregiver and as someone endangered by his condition. In particular, the appellate court noted that a factfinder could reasonably infer from the complaint allegations that Defendants and N.H. relied on Plaintiff to ensure N.H. received appropriate care, and that Plaintiff, in turn, relied on Defendants to come to a correct diagnosis of N.H.’s condition and provide him with appropriate treatment. Thus, Plaintiff’s complaint allegations were sufficient, if proven, to show that the relationship between Plaintiff and Defendants fell within the scope of a professional undertaking giving rise to legal protection.

Regarding the second consideration, whether “the potential plaintiffs were identifiable to the defendant or otherwise could be defined as a class that avoids indeterminate liability,” the Court of Appeals found that Plaintiff’s allegations that she was present during the three encounters that formed the basis of the litigation, that N.H. expressed specific concern that he was being driven to physically harm his family members, and that Plaintiff was N.H.’s mother and current caregiver, supported an inference that Defendants should have been aware of Plaintiff’s relationship to N.H. and the danger he posed to her safety. As such, Defendants could readily identify Plaintiff as a person who was at risk of physical harm at the hands of their patient.

Finally, the Court of Appeals considered whether recognizing Plaintiff’s claim “would interfere with or impair the loyalties that the professional owes to the client.” In particular, the court examined whether the Defendants’ professional standard of care included a duty to guard against the harm from N.H.’s psychiatric condition allegedly suffered by Plaintiff, and what steps Defendants were obligated to take to fulfill that duty. The appellate court found that Plaintiff had sufficiently pled her theory that Defendants’ professional duty of care under these circumstances would include a duty to restrain or admit patients to mitigate the risks of physical harm posed to others. Further, a reasonable factfinder could conclude based on Plaintiff’s allegations that Defendants did not mitigate this risk of harm by restraining or admitting N.H., and that the harm suffered by Plaintiff resulted from Defendants’ failure to do so.

Ultimately, the Court of Appeals reversed and remanded the case to the trial court, finding that Plaintiff had alleged sufficient facts in her complaint that, if proven, supported a reasonable inference that Defendants owed a duty of care that extended to Plaintiff.  

Big Picture:

The professional standard of care for medical providers does not necessarily limit the provider’s professional duty to just their patients—the duty may run to non-patient third parties as well. When considering whether a medical professional may be required to protect the interests of a non-patient third-party, the three considerations in Tomlinson should be utilized to assess the potential viability of the third party’s claim.