Sometimes it takes a harsh jury verdict to show physicians the risks they take when trying to do too much for their patients.
A middle-aged gentleman treated with Dr. P, a psychiatrist, for several years for depression and anxiety. Dr. P treated the patient with a range of medications, certified him for medical leave four times over three years, and changed her diagnosis to bipolar disorder and depression with psychotic features.
After a two-year hiatus, the patient returned to Dr. P and told her that he had not been taking his medications and that he was feeling depressed. Dr. P prescribed medications again and certified the man for medical leave twice again during the ensuing year. During his visits, the patient reported that he felt that his co-workers had turned on him and that he was talking to a lawyer about his work situation.
In a series of visits early the next year, the patient told Dr. P that he had been jailed following a domestic argument, had been hospitalized for a minor heart attack, and had been living out of his car. Dr. P adjusted the patient’s medications again, certified another medical leave, and suggested therapy.
In a visit that spring, the patient told Dr. P that he was being made fun of at work and could not deal with it. Dr. P certified a five-week medical leave and wrote two telephone numbers on a prescription pad, one for the insurance carrier and one for the employer, for the office staff to fax. Three weeks later, however, the patient called to report that his employer had not received the certified leave. Dr. P then wrote a note on the top of that phone message slip “please fax” and wrote another medical leave certification specifying the leave.
Less than two weeks later, the patient telephoned again to say that he had been terminated from his job. When Dr. P got the message, she made a series of calls to the carrier and employer and faxed a handwritten letter to the employer’s nurse noting the patient’s bipolar disorder and explaining that she had faxed a disability note more than a month earlier. Three weeks later, the patient nevertheless reported to Dr. P that he had been terminated and denied benefits.
Following the conclusion of an employment action brought by the worker — at which the employer denied receiving Dr. P’s faxed messages — the patient sued Dr. P alleging that she failed to fax the medical leave message to his employer and failed to maintain confirmation of the fax.
At trial, Dr. P’s lawyer contended that she owed no professional obligation to the patient to send the fax reports to the work location. The plaintiff’s attorney, however, produced testimony from a retired psychiatrist who said Dr. P established such an expectation by faxing her disability certifications to the carrier and employer over the course of several years. According to that witness, the staff at the medical group was negligent in failing to fax the disputed documents initially and again when the patient reported that his employer had not received the original fax. The witness faulted Dr. P for not ensuring that the employer received the second fax.
In the end, the jury found against Dr. P and awarded the patient a substantial amount, which was later reduced through a settlement.
Physicians who learned from their schooling the dangers of going down the “primrose path” would probably never consider extending such caution to the courtesy of sending fax documents to a patient’s job site. But this jury’s verdict shows the danger of doing something that by all accounts was not a professional expectation initially, but ended up as one when things went wrong.
Author Gordon Ownby is General Counsel for the Cooperative of American Physicians, Inc.(CAP).
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