The Indiana Court of Appeals recently held that a physician, who entered into a collaborating practice agreement (CPA) with a nurse practitioner, had a duty of care to the nurse practitioner’s patient even though the physician never treated or saw the patient.

In John Collip, M.D. v. Vickie Ratts on behalf of Robert A.J. Ratts, deceased, and Little Creek Family Health Center, LLP, Dena Barger, a nurse practitioner who owns her own practice, saw her patients under a CPA with Dr. John Collip. In accordance with Indiana law, Dr. Collip was required to review at least five percent of Barger’s charts every week to evaluate her prescriptive practices under the CPA.

Barger prescribed her patient, Robert Ratts, multiple medications, including Lortab, methadone, Wellbutrin, lithium and Xanax. Ratts passed away in March 2009, and an autopsy revealed the cause of his death as acute bronchopneumonia complicated by a mixed-drug interaction. Dr. Collip never examined or treated the patient, and he never reviewed any of Ratts’ medical records prior to his death. In fact, Dr. Collip admitted that he never reviewed Berger’s charts on a weekly basis.

Ratts’ mother, Vickie Ratts, filed a lawsuit against Dr. Collip, claiming he owed a duty to Ratts as a matter of law. In an attempt to defend himself, Dr. Collip contended that because he never saw Ratts or reviewed his medical records, he owed no duty of care. Agreeing with Vickie Ratts, the trial court found that Dr. Collip did owe a duty of care to the patient, which the Court of Appeals affirmed. The judges found that all three of the Webb v. Jarvis factors weighed heavily in favor of the obligation of duty and that as a matter of law collaborating physicians owe a duty of reasonable care to the nurse practitioners’ patients in fulfilling their duties under the CPA.

The lawsuit is not over as there remains the issue of whether Dr. Collip breached this duty and whether the breach was the cause of the patient’s death. However, this case provides warning to physicians of the need to thoroughly review any CPA they are entering into and ensure they are always adhering to the directives of state law when collaborating with nurse practitioners.

The full opinion in John Collip, M.D. v. Vickie Ratts on behalf of Robert A.J. Ratts, deceased, and Little Creek Family Health Center, LLP can be read here.