Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration

Interview Liability for Referrals

by Attorney Frank E. Reardon

May 1999

        When caring for a patient, doctors must keep in mind that the standard of care may require more than just simply providing medical treatment.  The United States District Court for the Eastern District of Pennsylvania recently held that general practitioners can be held liable for referring a patient to an incompetent specialist or for failing to recognize deficiencies in the specialist’s care during follow-up treatment.  The Supreme Court of Arkansas has held that a physician who observed evidence of physical abuse while examining a child, but failed to report this abuse may be held viable for civil damages as a result of the child’s death.

In the Estate of Tranor vs. Bloomsburg Hospital, the District Court for the Eastern District of Pennsylvania was faced with the issue of how far a physician’s duty of care extends.  In that case, Jeanette Tranor went to see her general practitioner, Dr. Richard Hinkle, because she was experiencing vaginal bleeding.  After diagnosing Ms. Tranor with cancer, Dr. Hinkle referred her to Dr. Marion Brown for surgery.  In October of 1993, Dr. Brown performed a total hysterectomy upon Ms. Tranor with the assistance of Dr. Curtis Vickers. 


During the procedure, one of the doctors allegedly cut one of Ms. Tranor's ureters.  The other doctor inadvertently sewed the other ureter closed.  Neither physician sampled the surrounding lymph tissue.  As a result of this surgical procedure, Ms. Tranor claimed she was so injured she was unable to continue radiation treatment to cure her cancer.  Her cancer later metastasized and Ms. Tranor died in November of 1996. 


The representative of Ms. Tranor’s estate brought a claim of malpractice against both doctors Brown and Vickers and added a claim of negligent referring to an incompetent specialist against Dr. Hinkle.  The executor of the estate also claimed that Dr. Hinkle never discussed with Ms. Tranor what physician would be best suited to perform the necessary operation.  In particular, the executor claims that Dr. Hinkle never discussed the possibility of referring Ms. Tranor to a gynecologic oncologist.  As a result, the executor claimed Ms. Tranor was referred to a physician who was not capable of performing the proper surgical procedure. 


Dr. Hinkle claimed he could not be held liable for referring Ms. Tranor to see these physicians and filed a motion to dismiss.  The District Court of Pennsylvania found that a physician’s ability to delegate his duty of care to a patient is based upon the presumption that the specialist who he is relying on to provide care is competent.  The Court found that if the plaintiff could show that Dr. Hinkle had reason to believe that the specialist’s care was inadequate, then he may be held liable for failing to take appropriate steps to prevent or remedy the negligent treatment.


In the case of Steckler v. First Commercial Trust, the administrator of the estate of a child who died as a result of child abuse, filed a complaint against the child’s family practitioner for failing to report her suspicions that the child was being abused.  This child was brought to the family practitioner after her family observed her wobbling and running into things.  The physician diagnosed the problem as dizziness and concluded that the child had been drinking too much juice.  In addition, she also recognized that the child’s symptoms were consistent with the possibility of head trauma. 


The child presented again two weeks later with swollen eyelids.  This time, the mother reported that the child had fallen down several stairs.  When the physician discussed the possibility of abuse with the mother, the mother was adamant that abuse was highly unlikely.  She explained that her five-year-old son had been around the child and may have dropped her.  The doctor considered reporting her suspicions of child abuse to the authorities but in the end decided not to.  She made a conscious decision that there was not enough evidence to warrant an intrusive investigation by the authorities.


Weeks later, the mother returned home from work and found her child, whom she had left in the care of her boyfriend, unconscious.  The child was pronounced dead shortly after. 


At trial, the jury heard expert testimony that the child’s life could have been saved if the abuser was identified.  The jury concluded that the doctor should have reported the abuse, and that her failure to do so resulted in the death of the child.  On appeal, the Court found that there was sufficient evidence presented to support the jury’s verdict.


In light of the Tranor and the Steckler decisions, physicians must be aware of just how broad their duty of care is to their patients.  Physicians should make sure that they discuss the need for treatment by a specialist in detail with their patients.  They should look into the credentials of a specialist before transferring their patients’ care to them.  Physicians also must be aware of any statutes requiring them to report suspected child abuse to the authorities.  Physicians should be aware of the types of observations that may suggest that a child is being abused, and how to approach a parent with such suspicions.  In cases of doubt, it is better for the physician to err on the side of caution and file a report.  In fact, many statutes impose immunity for filing a report which is later unsubstantiated if the physician had reason to believe that a child was being abused.


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