The relationship between a patient and a physician is based on mutual trust; the patient trusts that the physician is there to help them, and the physician trusts that the patient is giving accurate information. But what if that isn’t always the case? While patients may sometimes forget things, or omit things they feel are embarrassing, physicians must assume that patients are being truthful about their medical history. But what if a patient isn’t truthful, the physician prescribes based on the wrong information, and something happens to the patient, who is responsible for the poor outcome?
Just the Facts
Dr D was an OB/GYN working in a small practice. In the summer of 2012, his practice was in the process of converting its paper patient files into electronic versions, and so, when Ms M, the patient, 34, came in asking for a refill of birth control pills, her record was not available for the physician to view.
To be safe, Dr D decided to take a new medical history since the patient’s chart was unavailable. The history was unremarkable, and the physician wrote a prescription for a combined oral contraceptive pill. Because it was a refill, he didn’t offer the patient any counseling or warnings since he normally did that when first prescribing the medication. The patient thanked him and left, and Dr D thought nothing of the interaction until he received notice, months later, that the patient had suffered a stroke and was suing him for medical malpractice and lack of informed consent.
Dr D was surprised and disturbed when he learned about the lawsuit. He pulled up the patient’s medical record, which was now computerized, to try to understand what had happened. He was shocked to discover that Ms M’s original medical record, the one that had not been available when she came into the office, indicated that she had a history of stroke and a diagnosis of thrombophilia. But in the history he took on the day she actually came in there was no note of stroke or thrombophilia. Moreover, it was clear from Ms M’s records that the physician had not originally prescribed birth control pills for the patient at all. Dr D was aware that this form of birth control would be inappropriate for someone who had a history of stroke. He never would have prescribed hormonal birth control for this patient had he known this information.
He met with the defense counsel provided by his malpractice insurance and explained what had happened. The attorney agreed that this was a case worth fighting.
It took 5 years for the case to go to trial in front of a jury. Dr D testified on his own behalf, explaining how the patient’s medical chart, which showed a history of stroke and thrombophilia, was missing from the office on the date he saw the patient. He testified that because the chart was unavailable, he obtained a new medical history, but the patient did not disclose the information about stroke and thrombophilia. In response to the plaintiff’s informed consent complaint, charging that the physician had prescribed birth control pills without warning the patient of the risks, Dr D testified that he had been misled into believing he was refilling a prescription that he had already written. “I discuss the risks of medication with my patients when I originally order the medication,” he testified. “I would not normally discuss risks for a refill.” He also testified that he would never have prescribed the plaintiff birth control pills had he known her history.
At the end of the trial, the jury returned a verdict finding that Dr D had not departed from the standard of care and was not liable. The plaintiff immediately moved to have the jury verdict set aside and to have the judge rule in her favor, or give her a new trial. The court denied her motion and entered judgment in favor of the physician. The plaintiff appealed to the appeals court.
The four-judge appeals court affirmed the lower court’s decision. First, the appeals court noted that a motion to set aside a jury verdict and for judgment as a matter of law will only be granted if there is “no valid line of reasoning and permissible inference which could possibly lead a rational jury to the conclusion reached on the basis of the evidence presented at trial.” The court pointed out that there was indeed a valid line of reasoning in this case which could lead the jury to conclude that Dr D did not violate the standard of care. The court noted that Dr D had never prescribed the medication to the patient, and was misled by her into believing that he had. Furthermore, when specifically asked about her medical history, the patient did not disclose essential information.
The court also explained that the bar is very high for setting aside a jury’s verdict. “It is for the jury to make determinations as to the credibility of the witnesses, and great deference in this regard is accorded to the jury, which had the opportunity to see and hear the witnesses.” Courts do not like to set aside a jury verdict unless the evidence weighs “so heavily in the plaintiff’s favor that the verdict could not have been reached on any fair interpretation of the evidence.” Where both parties have presented expert testimony to support their positions, it’s up to the jury to determine the experts’ credibility. “Based on the evidence introduced at trial, the verdict in favor of the defendant should not be disturbed,” the court concluded.
It’s a terrible thing for a physician to be sued by a patient whose lies or omissions are what caused her own bad outcome. Even more so when the trial and appeal takes a full decade to be resolved. And yet, the physician-patient relationship must be based on trust, and physicians must rely on the information that patients provide in order to properly treat them. Most patients understand that giving a clinician accurate information improves the likelihood of successful and appropriate treatment. Ms M learned the hard way that sometimes the one who suffers the most from lying to a physician is the patient.