Content area
Full Text
Intradepartmental consultations are part of most pathologists' daily professional practice. They are encouraged, and in some situations are required by laboratory policy; and they serve as an excellent tool for both increasing diagnostic quality and reducing medical malpractice liability.1,2 Perhaps surprisingly, given their frequency, pathologists remain uncertain as to their medical malpractice liability for performing intradepartmental consultations.
The medical literature is silent on the issue; the legal literature addresses it, but only in the overall context of physician consultations. Nonetheless, a reasonable understanding of medical malpractice liability for pathology intradepartmental consultations can be developed. Traditionally, much of the legal literature regarding the application of liability to physicians performing consultations has involved whether or not a physician-patient relationship had been formed by the consultation. "In the traditional medical negligence case, the plaintiff must establish the existence of a physician-patient relationship." 3 Rather than from direct, face-to-face patient contact, which has traditionally been the method for establishing the relationship for treating physicians, pathologists' physician-patient relationships develop predominantly from their contractual or quasi-contractual obligations to take care of their patients. The contractual basis of finding a physician-patient relationship exists is elemental in pathology, and is based on the contractual acceptance of the pathology work, the conduction of tests, the preparation of a report, and the acceptance of a fee for services rendered. With those features, courts have determined that "there could be no doubt that the diagnostic services were furnished on behalf of the patient." 4 As such, a pathologist-patient relationship arises, for example, through performance of an anatomic pathology diagnosis or provision of clinical laboratory value accuracy. Direct, face-to-face contact, for example with transfusion medicine procedures, is currently a less-common method of establishing a pathologist-patient relationship; however, as pathologists transform themselves and begin having more direct patient interactions, it is reasonable to expect those interactions will be sufficient to establish pathologist-patient relationships as well.
Although the issue of whether a specific consultation gives rise to a physician-patient relationship occasionally arises in medical malpractice litigation involving treating physicians, the issue is typically not one that arises in medical malpractice litigation involving pathologists' direct diagnoses, because the physician-patient relationship between the patient and the pathologist is almost always assumed to be contractually or quasi-contractually present, and therefore is not...