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Spring 2008

Health Law Bulletin

Massachusetts Supreme Judicial Court Extends Physicians’ Duty of Care To Third Parties – Will Lawsuits Against Physicians Increase In Massachusetts?
By Christopher J. Scott, Esq.

On December 10, 2007, in a sharply divided opinion, the Massachusetts Supreme Judicial Court ruled in Coombes v. Florio that physicians in Massachusetts owe a duty of care to all those foreseeably put at risk by their failure to warn about the effects of treatment provided to their patients. In so doing, the Court vastly expanded the potential liability of a physician practicing in Massachusetts to persons with whom the physician has had no contact or relationship.

Kevin Coombes died from injuries he sustained when he was struck by an automobile driven by David Sacca. The accident occurred when Mr. Sacca lost consciousness while driving and hit Mr. Coombes with his car. Mr. Sacca regained consciousness shortly after the accident and was transported to a nearby hospital. He left the hospital against medical advice, and the cause of the incident was never determined.

At the time of the accident, Mr. Sacca was seventy-five years old and had been diagnosed with a number of serious medical conditions, including asbestosis, chronic bronchitis, emphysema, high blood pressure, and metastatic lung cancer that had spread to his lymph nodes. Mr. Sacca’s primary care physician was Roland Florio, M.D. Under Dr. Florio’s care, Mr. Sacca was prescribed Oxycodone, Zaroxolyn, Prednisone, Flomax, Potassium, Paxil, Oxazepam, and Furosemide. The potential side effects of these drugs include drowsiness, dizziness, lightheadedness, fainting, altered consciousness, and sedation. Dr. Florio did not warn Mr. Sacca of any potential side effects of the drugs he had prescribed, and did not warn Mr. Sacca not to drive a motor vehicle while taking these medications. Before the accident that claimed Mr. Coombes’s life, Mr. Sacca did not report any side effects from these medications to Dr. Florio and did not have any trouble driving an automobile.

An expert retained by the plaintiff opined that the medications taken by Mr. Sacca, when used in combination, have the potential to cause “additive side effects” that could be more severe than side effects resulting from separate use alone. The plaintiff’s expert also opined that the sedating effects of these drugs can be more severe in older patients, and that the standard of care of a primary care physician includes warning elderly or chronically ill patients about the potential side effects of these drugs and their effect on a patient’s ability to drive. Accordingly, the plaintiff’s expert opined that the accident was probably caused by a combination of Mr. Sacca’s medical conditions and the medications he was taking.

The plaintiff brought a lawsuit alleging that Dr. Florio negligently failed to warn Mr. Sacca of the known potential side effects of the medications prescribed to him. The trial court granted summary judgment in favor of Dr. Florio on the ground that he owed no duty of care to anyone other than his own patient. The plaintiff appealed and the Supreme Judicial Court took the case on its own motion.

Upon review, the Supreme Judicial Court, in a concurring opinion authored by Justice Ireland (with whom Justices Spina and Cowin joined), concluded that Dr. Florio owed a duty to Mr. Coombes under ordinary negligence principles. The Court reversed the trial court’s grant of summary judgment in favor of Dr. Florio and remanded the case to the trial court for further proceedings. In reaching this conclusion, the Court stated that a doctor’s duty of reasonable care owed to a patient includes the duty to provide appropriate warnings about side effects when prescribing drugs. When the side effects in question include drowsiness, dizziness, fainting, or other effects that could diminish a patient’s mental capacity, the Court found that such a warning serves to protect the patient from the foreseeable risk of an automobile accident caused by driving while under the influence of the medication.

The Court further found that, in the case of automobile accidents, the foreseeable risk of injury is not limited to the patient and that the physician owes a duty of reasonable care to everyone foreseeably put at risk by the physician’s failure to warn of the side effects of his or her treatment of a patient. The Court rationalized that imposing such a duty did not create a heavy burden because it requires nothing from a physician that is not already required by his duty to his patient. Accordingly, under this analysis, any duty that Dr. Florio owed to warn of the side effects of medication he prescribed extended not only to Mr. Sacca, but also to those whose injuries were foreseeably caused by a resulting accident. Nevertheless, the Court cautioned that “this does not imply that Dr. Florio owed a duty to [Mr.] Coombes to warn of every side effect of every drug he prescribed.” Rather, the Court noted that, given the number and nature of the drugs prescribed and the age and health of the patient, it was foreseeable in this case that Mr. Sacca would suffer side effects that would impair his driving, and that an accident would result.

As previously indicated, the Court’s decision in Coombes was far from unanimous. Chief Justice Marshall and Justice Cordy wrote separate dissenting opinions. Justice Greaney concurred with the Court’s ultimate decision to reverse the trial court’s grant of summary judgment in favor of Dr. Florio, but for different reasons. In her dissenting opinion, Chief Justice Marshall warned that, under the Court’s decision, “[t]he physician’s concern for a patient’s ability to assess information about needed and appropriate treatment would be forced to compete with concern for an amorphous, but widespread, group of third parties whom a jury might one day determine to be ‘foreseeable’ plaintiffs.” Justice Cordy forecast that “it [would be] hard to imagine a plaintiff’s attorney failing in negligence cases to sue not just the negligent party who caused the injury but also his or her doctor” in the wake of the Court’s decision. Justice Cordy also opined that the Court’s decision will threaten the confidentiality inherent in the physician-patient relationship because it will open the door to inquiries from third parties about discussions physicians have had with their patients about their treatment and medical conditions.

Time will tell whether the Coombes decision will adversely impact the physician-patient relationship, the delivery of health care services, or lead to an increase in lawsuits filed against physicians in Massachusetts. In the meantime, physicians practicing in Massachusetts are well advised to:

  • Warn their patients of any risks of harm that they may cause to third parties as a result of their condition or course of treatment (e.g., warn their patients not to drive motor vehicles or operate heavy machinery if their patients’ condition or treatment warrants such a warning);
  • Ascertain that their patients have understood any such warnings;
  • Document, in their patients’ charts, any and all such warnings and the patients’ acknowledgement or understanding of such warnings; and
  • Review any such warnings with their patients as needed over the course of the patients’ treatment.

For questions regarding the Coombes case or any other health law issues, please contact Christopher J. Scott, Esq., a member of the Health Law Practice Group, or Kelly A. McCarthy, Esq., coordinator of the Health Law Practice Group at Bulkley, Richardson and Gelinas, LLP, at 413-781-2820.