Question: A 52-year-old male with back pain and hypertension came in for a follow-up appointment after diet, exercise and chiropractic care all failed to improve his hypertension. His blood pressure was at critical level, 195/106. The patient's internist wanted to see the patient right away, and after leaving my practice, the patient fainted while driving and nearly struck a young girl. Would I be liable if she was injured?
by Keith Henaman in Malpractice Defense on Monday, January 04, 2016
Answer: In general, healthcare malpractice suits are based on negligence, and the plaintiff has the burden of proving the doctor was negligent. The four elements required to show negligence are:
- Duty or standard of care owed to the patient by the doctor
- Breach of that duty or standard of care
- Causal connection between the breach and the injury
- Damages sustained by the patient
In the situation you described, the issue is that the injured party is not the patient. However, if the patient would have hit the girl, you could still be found negligent since you allowed the patient to drive in an impaired condition, which in turn led to the patient’s fainting, an accident, and the girl’s resultant injuries. You might have limited your potential liability in this situation if you would have:
- Educated the patient early on that he shouldn’t operate a vehicle or equipment if his blood pressure reaches a critical level. With the patient’s permission, you could have brought family members into this discussion.
- Documented your discussion and instructions carefully, especially any short- or long-term driving restrictions once you deemed the patient unsafe to drive.
- Complied with your state laws and regulations about mandatory reporting. Contact your state’s department of transportation as required by law anytime a patient’s ability to safely operate a motor vehicle is jeopardized.
- Taken the conservative approach—erring on the side of caution rarely gets a doctor in trouble. Ideally, a family member of the patient would have driven him to the internist’s office.
Cases of third-party liability—allegations of healthcare negligence that result when a patient causes injury—are becoming more frequent across various healthcare settings. Even conscious sedation from a colonoscopy requires someone to drive a patient home. An eye examination requiring dilation of the pupils requires a patient either to have a driver or to wait until they are re-examined and cleared for driving.
A Doctor of Chiropractic must exercise sound clinical judgment, especially when there is a serious health situation. In this case, perhaps you should have restricted the patient’s driving when his blood pressure reached the level that could lead to a loss of consciousness.