Hospital Liability for Not Warning Patient of Driving Impairment

ISSUE OF THE CASE

Is a legal duty of due care owed to a nonpatient who is injured by a patient who received medications that arguably impaired her ability to operate an automobile safely or is liability limited to the patient with whom a relationship existed with the health professional?

FACTS OF THE CASE

A woman was treated as an outpatient at the emergency department of a hospital in a Mid-Atlantic state. Her treatment included intravenous administration of hydromorphone, an opioid, and lorazepam, a benzodiazepine, at 11 am. Neither of the treating practitioners, a physician and a physician assistant, warned her that these medications could impair her ability to safely operate an automobile. She left the hospital at 12:30 pm, and 19 minutes later while driving, her car crossed a double yellow line and struck a vehicle being driven by the plaintiff.

The patient/driver was not named as a defendant in this lawsuit. Rather, the defendants being sued were (1) the hospital where the woman had received treatment and (2) the professional medical services company that employed the 2 practitioners and assigned them to the hospital under a contractual relationship. The allegations in the suit centered around the failure to inform the patient that her ability to drive safely could be compromised by the medications. Hence, the central arguments focused on the health professionals and their actions, or failure to act, and the hospital, not the errant driver.

Attorneys for the medical services company made a motion at the trial court level to have the case dismissed. Their argument was that their clients did not owe the plaintiff a legal duty of due care because the plaintiff was a third party to the treatment administered to the driver. The representatives of the hospital joined in that motion, which was granted by the trial court judge. The plaintiff appealed to the intermediate level state court of appeals, which affirmed the trial court’s decision. The appellate court stated that “only the patient/driver had a physician—patient relationship with the defendants” and “the allegations do not support a duty of care owed by the defendants to the injured plaintiff.” The plaintiff then pursued the matter with an appeal to the state supreme court.

THE RULING

The state supreme court overturned the lower courts’ the rulings, concluding that the defendants had a legal duty extending to the injured driver. The ability of the plaintiff to pursue the matter through the state court system was reinstated.

THE COURT’S REASONING

The court’s starting point was whether a recognized legal duty of due care was owed to the plaintiff. It concluded that the assignment of the “responsibility of care was to that person or entity that can most effectively fulfill that obligation…” In addition, the court stated that “to take the affirmative step of administering the medication at issue without warning the patient about the disorienting effect of those drugs was to create a peril affecting every motorist in her vicinity. The defendants were the only ones who could have provided a proper warning of the effects of that medication.”

The court noted that it was within its authority to clarify how that legal duty may be discharged and the obligation met. The expectation would have been fulfilled “merely by advising one to whom such medication is administered of the dangers of that medication. Indeed, this case is not about preventing the patient from leaving the hospital, but ensuring that when she left the hospital that she was properly warned about the effects of the medication administered to her.”

The decision of the state supreme court was not unanimous; the vote was 4-2, with one of the judges preparing a rather lengthy dissenting opinion. The focus of the dissent was on limiting the legal duty to warn the patient receiving the medication rather than extending it to include nonpatients. Another argument was that extension of the legal duty to include those other than the actual patient “will have little or no deterrent effect on the conduct that actually results in the harm (ie, the operation of a motor vehicle by a person under the influence of medication).”

The overarching conclusion by the state supreme court was that “where a medical provider has administered to a patient medication that impairs or could impair the patient’s ability to safely operate an automobile, the medical provider has a duty to third parties to warn the patient of that danger.”

Joseph L. Fink III, BSPharm, JD, DSc (Hon), FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy, Lexington.