Collip v. Ratts — Dec. 2015 (Summary)

AHP/DUTY OF COLLABORATING PHYSICIAN

Collip v. Ratts
No. 49A05–1501–CT–1 (Ind. Ct. App. Dec. 31, 2015)

The Indiana Court of Appeals held that a physician who entered into a collaborative practice agreement (“CPA”) with a nurse practitioner to oversee her prescriptive authority owes a duty of care to the nurse practitioner’s patients even if the physician never treated any of those patients.   The mother of a patient brought a malpractice action after her daughter died from bronchopneumonia complicated by mixed drug interaction. The mother sued not only the nurse practitioner (“NP”) who treated her daughter but also the physician with whom the NP had entered into a collaborative agreement.

Pursuant to the CPA, and as required by state law, the physician was required to review at least 5% of the NP’s charts on a weekly basis for the purpose of evaluating her prescriptive practices. The physician admitted that he never complied with this requirement. The physician had, however, performed a limited review of the NP’s notes. Following this review, the physician was concerned enough about the amount of narcotics that the NP was prescribing that he suggested that she attend a narcotic-prescribing seminar. The physician failed to follow up regarding the seminar even though he knew he held the “keys to the drugstore” for the NP.

In arguing that the malpractice claim against him should be dismissed, the physician pointed out that there was no physician-patient relationship between him and the patient who had died and therefore he did not owe a duty to the patient. The court disagreed.

The court found that the physician voluntarily undertook to supervise the NP’s practice, including her prescribing practices, and he was compensated for his services. (The court pointed out that the physician had a CPA with 11 or 12 other NPs and worked 90 hours per week in his own medical practice.) The services required by the CPA were necessary for the protection of the NP’s patients. The court concluded that it was “eminently foreseeable that the nurse practitioner’s patients could suffer harm” if the physician failed to perform his oversight duties.   Therefore, the physician owed a duty, as a matter of law, to the NP’s patients to fulfill the undertakings outlined in the CPA. The court pointed out that the CPA does not make the physician a guarantor of the NP’s medical practice; instead, it merely requires the physician to fulfill his duty of reasonable care in complying with the CPA.