COA: Doctor had duty to nurse practitioner’s patient who died

December 31, 2015

An Indiana doctor who entered into an agreement with a nurse practitioner to review her prescription practices had a duty to one of the nurse practitioner’s patients, who later died in part because of medicines prescribed to him.

Robert A.J. Ratts was treated by nurse practitioner Dena Barger, who owns her own medical practice. Pursuant to a collaborative practice agreement with Dr. John Collip, he was to oversee her prescriptive authority and review at least 5 percent of her charts on a weekly basis to evaluate her prescriptive practices. Indiana law requires a licensed physician to oversee an NP who prescribes legend drugs.

Ratts, a high-risk patient, was prescribed multiple medications by Barger, including Lortab, methadone, Wellbutrin, lithium and Xanax. He died in March 2009, and an autopsy revealed the cause of death was acute bronchopneumonia complicating mixed-drug interaction.

Collip never treated or saw Ratts in any capacity and never reviewed any of his medical records before his death or the lawsuit filed by Ratts’ mother, Vickie. In fact, he admitted that he never reviewed any of Barger’s charts on a weekly basis. Collip also has CPAs with 11 or 12 other NPs and also was working 90 hours per week as a family practice physician.

Vickie Ratts argued that Collip owed a duty to Ratts as a matter of law. The trial court granted summary judgment to her on that issue, which the Court of Appeals affirmed on interlocutory appeal in John Collip, M.D. v. Vickie Ratts on behalf of Robert A.J. Ratts, deceased, and Little Creek Family Health Center, LLP, 49A05-1501-CT-1.

The judges found all three of the Webb v. Jarvis factors weigh strongly in favor of the imposition of duty and held as a matter of law that a physician who enters into a CPA with a nurse practitioner has a duty of reasonable care to the NP’s patients in fulfilling his or her obligations under the CPA. The appellate court also found Collip had a duty under Section 324A of the Restatement (Second) of Torts.

“We again note that this holding does not render Dr. Collip the guarantor of Barger’s medical practices; instead, it merely requires him to fulfill his duty of reasonable care in complying with the CPA,” Judge John Baker wrote. “We express no opinion as to the remaining elements Mother must prove to prevail on her complaint, as those must be considered by a factfinder.”


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