What't A Doctor To Do?

A recent case, decided by the Appellate Division, Third Department, has given many medical professionals pause Juric v. Bergstraesser, 2013NY Slip Op. 02808(3^rd Dept. April 25, 2013). There, the Appellate Court took the unusual action of not only reversing the jury's verdict in favor of the physician, but directed a verdict in favor of the plaintiff and sent the case back to the trial court for the single purpose of determining damages.

The case arose out of actions taken by a family practitioner who had cared for a husband and wife. The wife had reported to the physician an increasing pattern of verbal abuse by her husband. Indeed, the physician had personally observed the husband act in an overbearing and verbally aggressive manner toward his wife. The family practitioner concluded that the husband needed treatment for mental illness. However, her attempts to discuss this issue with the husband resulted in his becoming offended and storming out of the doctor's office, never to see her again.

Subsequently, the wife confided to the practitioner that her husband had threatened to physically assault her and to take their daughter out of the country. A few months later, the husband presented to the emergency room of a local hospital. The same family practitioner was on call. The patient husband specifically told the emergency room physician that he didn't want the family practitioner to treat him or admit him. Nevertheless, the ER doc phoned the family practitioner that evening and explained that the husband was exhibiting bizarre behavior, likely due to major psychiatric pathology. The ER physician asked the family practitioner whether she felt that anyone would be at risk from this patient, because he was carrying a large stack of gun magazines. The husband had refused recommendation of treatment and had left the hospital against medical advice. The family physician consented to his leaving the hospital, but then made repeated calls to his wife the next day and, when she finally reached her, reported the details of her husband's visit to the emergency room.

That information was subsequently used by the wife's attorney in their marital dispute, resulting in the husband's forced psychiatric exam and a temporary denial of visitation rights with his daughter for several months.

The husband sued the family practitioner for damages, claiming her unauthorized release of protected medical information had harmed him. Her defense was that she was justified in disclosing a medical confidence because the husband had posed a serious and imminent danger to himself or another person. This issue was submitted to a jury, who found in the physician's favor. However, the appellate court overturned the jury's verdict and directed a verdict against the family practitioner, based on its review of the trial transcript. How can this happen?

The Appellate Division Court noted that, even accepting all the testimony the family practitioner had offered as true, there was no justification for her violation of the trust and confidence she owed the husband with respect to his medical issues. The court noted that she never had any knowledge that the husband had physically harmed his wife or anyone else; had never herself witnesses physical threats by the husband against anyone; was never told by the ER physician that the husband was violent or made threats and, in fact, had consented to his leaving the hospital; the ER record did not mention anything about gun magazines, bizarre behavior nor psychological issues; and she admitted that she had agreed with the ER physician that there was insufficient evidence to admit him to the hospital on an involuntary basis or to compel psychiatric evaluation. In her own words at trial, she admitted that he hadn't been a danger at the time because, if he had been, she would have insisted on admission. She never notified law enforcement of her concerns and, before disclosing the details of that hospital visit, she hadn't even bothered to ask the wife if she was aware of the visit. It turns that she was, having been supplied the details by her sister.

The court, therefore, determined that there was no valid and permissible line of reasoning that could possibly lead a rational person to the conclusion that there was justification for the disclosure of the husband's medical information. To put it another way, good intentions on the part of the physician did not constitute an excuse for her blatant disregard of the obligation of confidentiality. Depending upon the facts, an unauthorized breach of a patient's medical information may subject a physician to disciplinary action, including suspension or revocation of license, as well as civil damages.

At the same time, the physician is subject to mandatory reporting to the appropriate authorities of evidence of child abuse or neglect, gunshot or knife wounds, and certain burn injuries. Additionally, physicians may be required to report communicable diseases and conditions hazardous to public health, but again, to the appropriate authorities, such as State or local health agencies or officials. Finally, the law does recognize that a physician can notify law enforcement if the physician determines that a patient constitutes a serious and imminent threat to himself or another person. Remember, that was never done here.

It is important to note that the physician here had not had any communication with either spouse for several months and, therefore, had no personal knowledge of the current status of their relationship. Often, it is the mechanism of reporting which may provide some protection to the physician. Additionally, those efforts the physician takes to explore the ramifications of action or inaction will clearly assist in the defense of any claim that there was an improper course of action embarked upon by the physician.

What if the physician had taken no action and the husband, that evening, inflicted severe physical harm on the wife? Would she have, then, also been subject to civil action?

The answers to these dilemmas in which physicians find themselves are often nuanced. Physicians should consider consulting experienced counsel for assistance.

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