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Health care providers have a duty to consider how treatment of a patient may affect that patient's family, the Utah Supreme Court ruled Tuesday in a decision that opens the door for family members to sue doctors if they are impacted when things go wrong with a loved one's care.
The high court's decision could have a widespread effect on the number of malpractice lawsuits filed against health care providers a concern foreshadowed by attorneys in the medical community who argued before the high court in November that doctors should be immune from litigation from third-parties.
Tuesday's ruling is a response to a lawsuit filed by the children of Kristy Ragsdale, who was shot to death by her heavily medicated husband in a Lehi church parking lot three years ago.
The two Ragsdale children were 4 and 19 months old when David Ragsdale approached his wife, Kristy, outside the LDS Church during Sunday meeting on Jan. 6, 2008. He gunned down Kristy, 30, who had requested a restraining order against him.
Following the woman's death and David Ragsdale's subsequent murder conviction, a conservator filed a lawsuit on behalf of the Ragsdale children. The suit, filed against several health care providers, claims that prescription medications given to David Ragsdale contributed to his actions the day he shot his wife.
The children, identified in court documents as B.R. and C.R., sued doctor Hugo Rodier and nurse practitioner Trina West for prescribing antidepressants and other medications that allegedly carried risks of psychiatric complications. West was Ragsdale's primary care provider and Rodier was a consulting physician on the case.
Third District Judge Denise Lindberg dismissed the case in February 2011, writing that the children could not pursue a medical malpractice lawsuit because they were not the patients.
But attorneys for the Ragsdale children and their conservator, William Jeffs, appealed that decision and on Tuesday, the high court reversed Lindberg's decision.
"Healthcare providers perform a societal function of undoubted social utility. But they are not entitled to an elevated status in tort law that would categorically immunize them from liability when their negligent prescriptions cause physical injury to nonpatients," Justice Thomas Lee wrote in the high court's unanimous opinion. "We uphold a duty of healthcare providers to nonpatients in the affirmative act of prescribing medication."
In the months before Kristy Ragsdale's murder, West prescribed David Ragsdale a cocktail of steroids, antidepressants and other medications, according to the lawsuit filed by the Ragsdale children. Other drugs were added to the combination one month before the shooting at an appointment where David Ragsdale discussed his marital problems and the restraining order, the suit alleged.
Ragsdale, who pleaded guilty to first-degree felony aggravated murder and is serving a 20 years to life prison term, said he took full responsibility for his wife's death. But he also claimed he would not have murdered her had he not been on medications.
The children's lawsuit seeks damages from West, Rodier and Pioneer Comprehensive Medical Clinic.
The clinic's attorney had argued that Ragsdale's care was "exceptional and appropriate," and other qualified health care providers would have made similar decisions.
In a brief filed prior to November arguments, attorney Tawni J. Anderson, who represents the Utah Medical Association and several other health care providers, said that if the Utah Supreme Court reversed Lindberg's ruling it would have "far-reaching and gravely deleterious consequences for the provision and quality of health care" in Utah.
Anderson wrote that doctors only have a duty to their patients. She claimed that reversing Lindberg's ruling would increase medical costs by causing physicians to practice "defensive medicine," ordering tests or treatments that they otherwise might forego, but instead deem necessary because of concern over liability to third parties. Reversing the ruling would also dissuade health care providers from treating patients in the first place because of an uncertainty over how third parties connected to the patient could claim they are affected by a diagnosis, she claimed.
Lee's opinion, however, disputed that theory in the high court's opinion.
"Defendants' concerns about the impacts of a duty on malpractice insurance and health care costs falter… the supposed effects on insurance premiums and patient costs are speculative…" Lee wrote in a 19-page opinion, in which justices Christine Durham, Matthew Durrant, Jill Parrish and Ronald Nehring joined. The opinion states that the defendants had presented no evidence showing that insurance costs are lower in states that do not impose third-party liability on health care providers.
"And in any event, the alternative suggested by defendants is to impose these costs on injured parties and permit negligent physicians to remain unaccountable," the opinion states. "It seems more reasonable to require physicians and their insurers to account for the consequences of physicians' careless acts than to foist that cost solely on the injured."
Attorneys for the Ragsdale children Allen Young and Tyler Young of Provo, and Jonah Orlofsky of Illinois argued in November that the Ragsdale children have a right to damages from the medical team that treated their father. Orlofsky said health care providers must think about how their actions affect those who interact with a patient regularly.
Ragsdale's case, Orlofsky said, is a prime example of doctors overlooking how a disturbed patient could have reacted to family members around him while on prescription medication.
"We have too much violence in society to say, 'This is something you don't need to consider,'" Orlofsky said.
Following the high court's decision on Tuesday, Allen Young said he is pleased for his clients.
"We are elated and we think that the Supreme Court got it absolutely right," Young said.
Mark Fotheringham, a spokesman for the Utah Medical Association, said Tuesday the organization finds the ruling troubling.
"Prescribing medication is not an exact science, especially when it comes to mental health. And patients are not manufactured on an assembly line. One big problem with today's ruling by the Utah Supreme Court is that it fails to recognize no human brain is identical to another. What might be helpful and curative in 1,000 patients, could, in the case of one patient, be harmful," Fotheringham said in a statement on behalf of the UMA's leadership.
"If we establish a duty of care for anyone who might possibly be harmed by the one patient who reacts badly to a regimen that has worked well for others, we will likely lose that regimen for everyone," he said.
"Until such time as science can assure us of how any one person will react differently from another, physicians have to play the odds. But this ruling just changed the odds. And the losers will be the patients who would likely be helped by the antidepressants or other mental health medications, which their physicians or other providers will now think twice about prescribing."