BY ANN W. LATNER, JD
If the driver's medications caused him to lose consciousness, is the prescribing physician to blame?
Dr. L, 63, was a general practitioner in the suburbs of a northeastern city. He had a reputation among colleagues and patients for being compassionate and caring, and his bustling practice was a result of the positive word-of-mouth spread by his patients.
But it wasn't a patient or a patient's relative who accused the physician of causing a wrongful death. It was the mother of a young boy killed by an elderly, drowsy driver who Dr. L happened to be treating.
Mr. C was 71 years old when he began seeing Dr. L as his primary-care physician. A former construction worker who had smoked for more than 40 years, Mr. C suffered from a variety
of conditions, including chronic bronchitis, hypertension, emphysema, asbestosis, and lung cancer. Mr. C saw Dr. L every two months and sometimes more frequently.
After two years under Dr. L's care, Mr. C began chemotherapy for the lung cancer. Dr. L advised him not to drive while he was undergoing chemotherapy, and Mr. C grudgingly stopped driving for a year. As soon as he finished his treatments, Mr. C asked Dr. L if he could get back behind the wheel, and Dr. L agreed that he could.
Another year passed and Mr. C was placed on numerous medications, including metolazone (Zaroxolyn), prednisone, potassium, furosemide (Lasix), paroxetine (Paxil), oxazepam, oxycodone, and tamsulosin (Flomax). At most appointments, Dr. L asked Mr. C about any side effects, but Mr. C reported no problems.
A lethal fainting spell
Then, one fateful morning Mr. C got into his car to pick up his morning coffee and run some errands. At some point during the drive, he passed out. The car jumped the curb and ran onto the sidewalk, striking and killing a nine-year-old boy walking to school with a friend.
Mr. C, who was uninjured in the accident, was rushed to the hospital, but he checked himself out before the cause of his fainting could be determined. Over the next few weeks he went into a swift decline, both emotionally and physically. Within two months, he was dead.
Dr. L was saddened by the passing of his patient and the terrible circumstances that led to it. But while he felt for everyone in the tragedy, it never occurred to Dr. L that he might become directly involved in any way. When he received the papers notifying him that the boy's mother was suing him, he was shocked.
The suit alleged that drowsiness was a potential side effect of several of Mr. C's medications
and that Dr. L should have foreseen that an innocent person could be harmed if Mr. C got behind the wheel. The doctor's failure to warn Mr. C not to drive resulted in the boy's death, the mother charged.
Dr. L immediately called his lawyer. “I don't really think you have to worry,” said the defense lawyer. “I've never seen a case like this before. There was no relationship between you, as a physician, and the plaintiff. We'll make a motion to dismiss, and this will all go away.”
It almost did. A judge granted the defense attorney's motion to dismiss, but the physician's relief was short-lived. A few weeks later, the plaintiffs appealed the case to the state's supreme court. This time, Dr. L wasn't so lucky.
The six judges conferred for hours before coming to a decision. A majority agreed that Dr. L did owe a duty to the accident victim. They held that Dr. L could be sued and returned the case to
the lower court, where it is awaiting trial.
Legal background
In his ruling for the majority, the chief judge of the court wrote, “A physician owes a duty of reasonable care to everyone foreseeably put at risk by his failure to warn of the side effects of his treatment of a patient.”
That meant Dr. L had a duty to warn Mr. C that his medications could make him drowsy or disoriented and could even make him faint. The warning would have alerted Mr. C to the risk of an accident if he drove, and, if heeded, would have protected innocent third parties, such as the nine-year-old boy.
But the ruling was not unanimous. The dissenting judges felt it imposed too much responsibility on physicians, that it would lead to more lawsuits, and that the fear of litigation might affect the medication or course of treatment a physician chooses.
It is important to note that Dr. L has not been found liable yet. A jury will have to decide what caused the accident. Many scenarios are possible. Mr. C could have had a stroke, or fallen asleep at the wheel, or passed out for reasons unrelated to his prescriptions.
But if the jury finds that the medications caused Mr. C to lose consciousness and that he was driving because he believed his physician said it was okay, then Dr. L may be held responsible for the young boy's death.
Protecting yourself
A label on a pill bottle does not negate your duty to talk to patients about medications. Always discuss side effects. Even in the case of ongoing renewals, periodically assess how medications are affecting the pa-tient and remind him or her about potential side effects. This is particularly important with elderly patients, who may be more affected by prescription medications or whose many medicines may result in cumulative side effects.
Then keep a record that the patient has been warned. Document all conversations in the patient's chart and note precise cautions regarding driving, operating machinery, etc.
Ms. Latner, a former criminal defense attorney, is currently a freelance medical writer in Port Washington, N.Y.