1. Analysis/Application
1.1. Impact
1.1.1. Statue of Limitations - standard 2 year limitations
1.1.2. Duty refers to the legal obligation to "care" The standard of care is the level in which a physician is expected to provide care.
1.1.2.1. The reasonable physician
1.1.2.2. School Rule
1.1.2.3. The neighborhood
1.1.2.4. Duty of care is necessary to hold physicians responsible for their service to the patient
1.1.3. Breach of Duty - once the standard of care is not met then a plaintiff has grounds to show negligence by a physician.
1.1.4. Adverse Outcomes - when the outcome is egregious than there is additional grounds for negligence.
1.1.5. Health Systems
1.1.5.1. The concept of duty of care is a critical for the longevity of the business and for its reputation
1.1.5.2. Physicians are required to complete continuing education to ensure physicians are kept abreast of new practices, while testing physicians' knowledge and to maintain compliance
1.2. Influence
1.2.1. Assumption of Risk
1.2.2. Dr, Gillespie had a Duty to Care and misdiagnosed Jane with a birthmark. This was negligence because if he had properly diagnosed her at this time the outcome would have been much different.
1.2.3. Medical Resident was not negligent because they never establish a patient relationship.
1.2.3.1. The dermatologist at University Hospital also never established a patient / physician relationship because Jane missed her appointment.
1.3. Importance
1.3.1. Contributory and Comparative Negligence - contributory negligence from patient
1.3.2. Causation - what is the proximate cause, would the outcome been the same or did the Physician cause the outcome?
1.3.3. "The Reasonable Physician - every physician is required to perform "reasonable and ordinary" treatment.
1.3.4. Patient-physician relationship
1.3.4.1. Jane requested and received a physical examination at the university’s student clinic
1.3.4.1.1. . Jane implicitly expressed her reason for the visit and for her worry to check for skin tumors that may be precancerous.
1.3.4.2. Dr. Gillespie, a part-time physician at the University’s clinic
1.3.4.2.1. Dr. Gillespie owed a duty of care to Jane
2. Conclusion
2.1. Outcomes largely depend on specific case-by-case details. Scenario lacking certain details (such as exact timeline, state, and survival rate based on different discovery dates) so poetic license necessary for conclusion.
2.1.1. If Medical Student has high suspicion for skin cancer, certainly a doctor should have equal suspicion and pursue further investigation. This strongly suggests a breach of duty.
2.1.1.1. Misdiagnosis by Dr. Gillepsie is proximate cause
2.1.1.1.1. Based on progression of disease, 1 year diagnosis difference significantly diminished prognosis
3. Potential Defendants
3.1. Dr. Gillepsie (University Student Clinic)
3.1.1. Potential mis-diagnosis. Stated that the nodule/mole was a birthmark and non-cancerous.
3.1.1.1. Difficult to sue -- (1) would need to prove that Dr. Gillepsie practiced below reasonable standard and breached duty. Could another reasonably prudent physician have known the nodule was in the early stages of cancer and/or concerning at the time of examination? (2) Did the misdiagnosis cause harm? Jane continued to engage in high risk activities by staying in the sun for prolonged hours. She would need to prove that she would have changed her job had she known the nodule was melanoma.
3.2. Medical Resident
3.2.1. Recommended Jane see a dermatologist and provided a referral. Did not conduct a physical exam.
3.3. Dermatologist (University hospital)
3.3.1. Never saw Jane. Physician-patient relationship was never established.
3.3.1.1. Difficult to sue -- (1) Jane failed to uphold her end of the relationship by showing up for the appointment (2) the physician had made any actions for Jane (e.g., diagnosis, offer medical advice, treatment plans)
3.4. Dr. James (Family doctor)
3.4.1. No obligation. Offered advice to seek expert evaluation. His relationship with Jane Rogers ended there.
3.5. Employer Physician
3.5.1. although he had no obligation to Jane, he followed-up on abnormal findings, made the formal diagnosis, and referred her for treatment from an oncologist.
4. A benchmark of standard of care is required to determine if duty of care responsibility was violated
5. What problems do you see with the suit by Jane Rogers’ estate against the available defendants (list all potential defendants)?
6. Facts
6.1. Jane Roger's sister died for melanoma
6.1.1. Dr. James, the family physician, recommends the Roger's family get a thorough physical to evaluate for skin abnormalities
6.1.1.1. Dr. Gillepsie, a student clinic doctor, identifies a mole on Jane but states that it is not cancerous
6.1.1.2. Medical resident at a party believes the mole looks like melanoma. Refers Jane to a dermatologist
6.1.1.2.1. Jane misses appointment with dermatologist; did not rescheduled
7. Issue Before the Court
7.1. Whether Dr. Gillespie, and/or his respective medical facility are liable for negligence and/or medical malpractice on the basis of misdiagnosis of melanoma
7.2. Whether Dr. Gillespie caused or directly contributed to Jane Rodgers' injury and death
7.3. Whether Dr. Gillespie provided the medical standard of care in his examination of Jane Rodgers
7.4. Whether Dr. James, in his capacity as family physician, provided informed consent in layperson terms to the exact risk and the necessity of follow-up
7.5. Whether Dr. James acted with the standard of care to provide a qualified referral to a dermatologist for evaluation and treatment
8. Rule of Law
8.1. Medical negligence (malpractice); Medical Standard of Care
9. Application
9.1. Negligence/Malpractice
9.1.1. Duty
9.1.1.1. What is the medical standard of care? Would most general practitioners refer a patient to a dermatologist for biopsy in suspected melanoma cases with significant family history? If yes, then Dr. Gillespie/Dr. James may be found to not uphold the standard of care for his specialty and this aspect of malpractice is fulfilled
9.1.2. Dereliction
9.1.2.1. This is satisfied via the misdiagnosis; also may be satisfied by breaching standard of care
9.1.3. Direct Causation
9.1.3.1. But for Dr. Gillespie/Dr. James misdiagnosing Ms. Rodgers, would she have had melanoma anyway?
9.1.3.1.1. Dr. Gillespie/Dr. James, et al. should not be held liable for Ms. Rodgers' melanoma as they did not directly cause her cancer
9.1.3.1.2. But for Dr. Gillespie misdiagnosing Ms. Rodgers, would she have had the same health outcome?
9.1.4. Damages
9.1.4.1. This is satisfied through the death of Ms. Rodgers and any distress caused (physically, emotionally, monetarily)