My guess is that this line gets shot down because the lawyers for Warren are going to ask Dinter to explain about how this mechanism where the NP admits patients over his objection works, maybe giving examples, and the hospital knows there aren't any examples because in fact policy is to never allow this to happen. It's going to cause the court to dwell on what you did wrong (not admitting the patient), which isn't what you want to happen if you're worried the court may rule against you.
It's pretty obvious that they're hiding behind the idea it's a kerbside consult when really it's a gatekeeper role, and courts are ideally placed in law to judge that sort of thing because they're obliged to work with events that really happened whereas lawmakers can live in a hypothetical universe. Maybe hypothetically there is no "gatekeeper" role, but if the fact is that every admission goes through one of these hospitalists, then de facto that's a gatekeeper.
So at least she has a 100% success rate in bypassing the gatekeeper.
He said it in the context of someone explicitly asking him to admit a patient, of course it's a refusal! The most commons way to refuse to answer questions likewise doesn't explicitly involve shouting "I refuse" loudly.
In fact, let's make the refusal even more explicit.
Let's suppose that he flat-out said, "I don't think she needs emergency care, and if you send this patient to the ER, I will refuse to treat her."
Even so ... isn't it ultimately on the NP -- who seemed to grasp that he was blowing her off -- to either get a second opinion or (ideally) use her own medical training to determine that the patient really should go to the ER, no matter what he says, knowing that he can't actually refuse to treat her?
Stating that you intend not to do something, after all, is not always the same as actually refusing to do it.
That's not the most compelling argument, I know.
But I do worry about the broader implications of this ruling. Should physicians fear malpractice claims arising out of consultations with colleagues? In what cases can you feel free to give your opinion "off the record," with the understanding that the person who has consulted you will bear ultimate responsibility for the treatment they are providing?
Based on my reading of that block from the article, she did get a second opinion. Once you've got two more credentialed professionals agreeing on something, it's a lot harder to justify going against their opinion.
No, because we don’t live in a world where only one person has to be responsible for every outcome.
Multiple people can share responsibility (and legal liability) for an outcome. In this case, the NP may bear some responsibility for the reasons you outlined. In fact the NP and her organization were sued and settled out of court already:
> At some point prior to that date, Justin Warren “sued Essentia Health for the alleged malpractice of its employees, Simon and Baldwin.” (p. 6) That case was settled out of court.
So, the NP may bear some responsibility, but there’s no reason why that should be the end of the investigation as to who else may bear some responsibility.
Either they are trained well enough to make the decision on their own (which would mean the NP shouldn't need permission for this patient to be admitted) or the doctor is actually the person who is responsible for the patient's well-being.
I agree with you on the second part. I wonder if there is actually a clear chain of responsibility in patient->clinic->hospital relationship.
Based on the facts details in the post, it is at least arguable that the conversation between the NP and the doctor was merely a consultation on a diagnosis, which medical professionals do among themselves all the time, and not an actual denial of service.
Simon, the NP, described the symptoms to Dinter, the MD, and he gave his opinion -- which turned out to be a really bad opinion with deadly consequences.
But I think it could be argued that it is ultimately the responsibility of the NP or doc who is actually treating the patient, not any physician she might have consulted (and especially not one who has not actually seen the patient), to recognize when she's being given horrible advice. And it seems as if she did recognize that it was horrible advice, but wasn't willing to overrule it and send the patient to the ER against Dinter's advice.
The post says that Dinter implied, during his conversation with Simon, that it would be pointless to admit the patient. But does that mean he _refused_ to admit her? It seems to me that there's at least arguably a difference between the two, and that his conduct did not actually constitute a refusal of service.