White v. Harris
190 Vt. 647, 2011 VT 115, 36 A.3d 203 (2011)
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Rule of Law:
A limited, one-time psychiatric consultation, even conducted as part of a research study and without direct follow-up or prescription services, can establish a doctor-patient relationship and a corresponding duty of due care. This duty, regarding the services rendered, is not extinguished by the mere termination of direct professional contact.
Facts:
- Decedent, a fourteen-year-old girl, suffered from ongoing mental health problems, including depressive behavior, increased angry and aggressive behavior, and self-mutilation.
- On the recommendation of her case manager, decedent consulted with defendant Fletcher Allen Health Care, Inc.'s psychiatrist through a telepsychiatry research study he was conducting.
- In August 2006, plaintiffs and decedent participated in a one-time, ninety-minute video-conference session with the psychiatrist.
- Following the session, the psychiatrist completed a consultation evaluation, describing decedent's history, diagnostic impression, and setting forth recommendations for an initial treatment plan.
- The evaluation explicitly stated that, consistent with the telepsychiatry research protocol, no follow-up services would be provided, and no medication prescriptions would be directly provided by the psychiatrist.
- The psychiatrist's recommended treatment plan was to be weighed by decedent’s treatment team, including her primary care physician, for possible implementation.
- After sending his evaluation, the psychiatrist had no further interaction with plaintiffs, decedent, or any member of her treatment team.
- On June 10, 2007, decedent committed suicide by ingesting Propoxyphene, opiates, and Citalopram, none of which had been prescribed or recommended by defendant's psychiatrist.
Procedural Posture:
- Plaintiffs filed an amended complaint in June 2009, alleging that defendant and other medical care providers treated decedent below the standard of care, proximately causing her death.
- Defendant moved for summary judgment in December 2009, arguing that its doctor had no duty to decedent due to the absence of a doctor-patient relationship, or that any such relationship had been formally terminated.
- The superior court (trial court) granted defendant's summary judgment motion, finding that the psychiatrist's contact was too minimal to establish a physician-patient relationship, and even if one existed, it was terminated before decedent's death, thus extinguishing any duty.
- Plaintiffs appealed the superior court's summary judgment order.
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Issue:
Does a limited, one-time telepsychiatry consultation, provided as part of a research study, create a doctor-patient relationship and a corresponding duty of care, such that a doctor can be held liable for alleged malpractice during that consultation despite the formal termination of further services?
Opinions:
Majority - Vermont Supreme Court
Yes, a limited, one-time telepsychiatry consultation, even within a research study and without direct follow-up or prescription, can establish a limited doctor-patient relationship and a corresponding duty of due care. The Court affirmed that the existence of a legal duty is a question of law, guided by policy considerations, and focused on whether the relationship required the defendant to exercise some care to prevent injury. The factors considered include the doctor's unique position to prevent harm, the burden of preventing harm, the plaintiff's reliance on the diagnosis, the closeness of the connection between conduct and injury, certainty of harm, and public policy. Here, the psychiatrist performed a psychiatric evaluation and offered recommendations, and the parties expected aid in treatment through his expertise, as the treatment team specifically sought recommendations for decedent's medication and behavior. The Court analogized the situation to independent medical examinations (IMEs), where a limited doctor-patient relationship imposes fewer duties but still requires due care during the examination. It found this case even more direct than an IME, as the doctor was referred by decedent's treatment team and reported findings to them. Therefore, the ninety-minute consultation established a limited doctor-patient relationship and a duty of due care regarding the services provided. Furthermore, the Court held that even if doctor-patient contact had ended, this does not terminate the doctor's responsibility for consequences of any lapses in duty to provide services consistent with the applicable standard of care while treating the patient, pursuant to 12 V.S.A. § 1908(1). The duration of the relationship itself is less significant than the doctor's responsibility for the services actually provided. The Court clarified the distinction between the existence of a duty and the standard of care, noting that the latter requires expert testimony and was not at issue in the summary judgment motion.
Analysis:
This case is significant for clarifying the scope of a physician's duty in evolving healthcare contexts, particularly telepsychiatry and other limited, consultative interactions. It establishes that a formal, ongoing treatment relationship is not a prerequisite for a duty of care to arise; even brief professional engagements can create such a duty. The decision reinforces that a professional is responsible for the quality of services rendered during their involvement, regardless of the subsequent termination of the relationship. This impacts future cases involving novel forms of medical consultation, emphasizing that the focus should be on the nature of the professional services provided and the potential for harm, rather than the traditional model of care.
