Am I Liable for the Actions of an Impaired Patient?

Carolyn Buppert, MSN, JD

Disclosures

October 16, 2013

In This Article

The Importance of Having a Policy

This case is not the first of its kind. The justices cited cases from Hawaii and Maine, where courts have held that doctors owed a duty to a person killed by the doctor's patient who was driving after taking medication prescribed by the doctor (the Hawaii case) or who was wearing an eye patch given to him by his doctor (the Maine case). In other states, courts have held doctors liable when they failed to warn of the effects of drugs or treatments that they administered, but declined to extend liability where the drugs were prescribed by the doctor but used outside of his presence.

In the second case, a police officer for the town of Whitman, Massachusetts, responded to an emergency report of an accident between a pedestrian and automobile.[2]

On his way to the scene, the officer's cruiser was hit by another vehicle, and the officer was seriously injured. He later learned that the pedestrian involved in the accident to which he was responding had earlier that day undergone a colonoscopy at a local hospital. Before the procedure, the patient had received meperidine, 50 mg, and midazolam, 2 mg. Hospital policy required that patients under the influence of narcotics be escorted when leaving the hospital. The patient was discharged from the hospital without an escort, and shortly thereafter, as he was walking home, he was struck and killed by a car.

The injured police officer alleged that the hospital and two of its registered nurses owed him a duty of care that was breached when they released the patient without an escort. The hospital argued that it owed no duty to the policeman. The trial judge agreed and the policeman appealed. The Massachusetts appeals court agreed with the trial judge and the hospital -- that the hospital was not liable for the police officer's injuries.

The judges held that the hospital had no duty to the police officer, had no duty to control the patient's conduct, and that the hospital's policy of requiring staff to ensure that a medicated patient had an escort to drive him home covered the hospital; that is, the hospital didn't have a duty to control the patient or detain the patient if the patient didn't have a driver. The court added that one need not conclude that medicated patients are inherently dangerous.

On the other hand, the court held that it may be a foreseeable risk that a third party non-patient could be injured by a medicated patient who drives home from the hospital.

The important difference between these cases is that in the second case, the hospital had attended to the issue of driving impairment. The hospital had a policy that patients needed to be escorted home (although they didn't enforce it). In the first case, the physician hadn't documented any discussion with the patient in which the physician advised the patient not to drive.

The bottom line for clinicians is that courts differ over whether a clinician is liable to an injured third party if an impaired patient has an accident. But everyone agrees that advice should be given about the risks associated with driving. Advise your patients of the side effects of the medications you prescribe or administer. Advise them to have someone else drive if you believe that they are impaired. If you or they question whether they are impaired, consider referring them for a test of reaction time, or help them take an online test. Document the advice that you give.

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