Knowing When to Help -- And When Not

Probably the most disheartening of claims brought against physicians are those in which the doctor is just trying to help.

When the human desire to help others conflicts with better medical judgment, however, accusations can follow.

Dr. P is a pediatrician with a loyal patient base. One day, the mother of one of her patients asks Dr. P for treatment for her own recurring colds. The mother, 46 years old and obese, also tells Dr. P that she is seeing another physician who is treating her with herbs and prescription medication for another medical condition. Later, the mother asks Dr. P for a prescription for that medication because her prescription has run out and the mother’s other physician is out of the area.

Even though Dr. P had never before prescribed that particular medication, she writes a prescription for the mother and renews the prescription twice again over the next three months. Dr. P charts these prescriptions and when the mother fails to respond to the medication after the second refill, Dr. P declines to renew the prescription.

The mother then goes to a third physician, who prescribes the medication through the next year.

Two years later, the mother tells Dr. P, who continued as the child’s pediatrician, that she has been diagnosed with a heart disease related to her use of the prescription medication. The mother tells Dr. P that she has consulted with a medical malpractice attorney, but assures Dr. P that she will not sue her. Despite that assurance, Dr. P receives a “Notice of Intention to Sue” in the mail from the attorney representing the mother.

As it turns out, the mother never followed through on the lawsuit, which itself would have had to overcome significant statute-of-limitations obstacles.

Nevertheless, Dr. P would have to clear several hurdles of her own in defending her medical judgment:

• Was Dr. P qualified to treat adult patients with this medication?
• Did Dr. P obtain a history and otherwise consult with the mother’s previous physician? Was she sure that the mother’s previous physician had not intended to limit the patient’s use of the medication to the prescription given?
• Did she warn the patient of the dangers of switching doctors as a way of avoiding Dr. P’s decision that the patient should not continue to receive the medication?
• Was she familiar with the protocols for the medication, including appropriate patient selection?

The threat of litigation over Dr. P’s venture outside her specialty highlights some of the risks applicable to physicians in virtually all specialties—especially to those physicians who are simply trying to help.

Gordon Ownby is CAP-MPT’s General Counsel.