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Court's Ruling Could Expand Physician Liability |
ISMIE is closely monitoring the impact of a recent medical malpractice ruling that could hold Illinois physicians liable if they fail to tell their patients that their HMO contract provides them with financial incentives to provide less care.
In its decision, the 2nd District Appellate Court, which serves Lake, McHenry and DuPage counties, reversed a trial court ruling based on a complaint alleging that the physician, an ISMIE policyholder, was negligent in failing to properly diagnose and treat a coronary artery blockage. Moreover, the estate of the patient alleged that the defendant breached his fiduciary duty to disclose the existence of an HMO contract containing a medical incentive fund that could have been used to pay for tests for the patient.
The appellate court noted that there is no Illinois case law regarding a physician’s fiduciary duty to disclose the existence of HMO contracts that offer doctors inducements to reduce the level of care they provide. However, the court ruled that physicians have a duty to disclose the existence of financial incentives that might affect the care they provide.
The physician first saw the 37-year-old patient in 1990 when the patient complained of chest pain radiating into his arm and shortness of breath. This patient had a family history of heart disease, was overweight, suffered from hypertension, smoked and had a high cholesterol count. During a hospitalization in 1990, the patient took a thallium stress test, but the results were normal.
Later that year, the patient suffered from the same conditions and returned to the physician. Based on the results of the stress test, the physician believed the pain was not cardiac related. Although a part-time associate of the physician recommended
an angiogram, the physician refused the request as well as a subsequent recommendation by another part-time associate for an angiogram. Months later, the patient suffered a massive myocardial infarction caused by coronary artery blockage and died nine days after the attack.
This latest ruling is one example of the numerous significant court cases ISMIE monitors on behalf of its policyholders that threaten to expand physicians’ liability. ISMIE may take a more active role in this case if circumstances warrant a response.
For a summary of the Supreme Court's decision follow this link http://www.state.il.us/court/appellates/1999/2971099.htm