The Supreme Court of California recently considered a case that could reduce important medical liability protections for physicians under the seminal Medical Injury Compensation Reform Act (MICRA).

Under deliberation in Winn v. Pioneer Medical Group was whether a claim based on medical negligence committed against an elderly patient could give rise to action under the California Elder Abuse Act.  Such an approach would avoid protections allowed in medical negligence cases under MICRA, California’s historic tort reform law, which keeps liability insurance premiums low and places a $250,000 cap on noneconomic damages in medical liability lawsuits to ensure patients in the state have access to affordable health care.

An elderly patient with peripheral vascular disease was treated over a period of time by Pioneer Medical Group, and the condition steadily worsened until she died in 2010. The plaintiffs alleged that Pioneer Medical Group violated the Elder Abuse Act by failing to provide the patient with proper care by not referring her to a specialist.

Following lower court decisions that called into question whether the case was of professional negligence or reckless neglect, the case moved to the state supreme court. Professional negligence does not fall under the Elder Abuse Act, which specifically states that professional negligence should be governed by laws that apply to professional negligence—in this case, MICRA. A lower court held that if the conduct of a physician amounted to reckless neglect, then the Elder Abuse Act would apply.

As defined by MICRA, professional negligence includes any negligent act, or failure to act, by a physician in the rendering of professional services. The Elder Abuse Act’s definition of reckless neglect focuses on the failure to provide medical care at all and specifically excludes professional negligence.

The Litigation Center of the AMA and State Medical Societies joined the California Medical Association and several others in an amicus brief (PDF - log in) supporting Pioneer Medical Group in 2013. “The [lower court] decision fails to recognize the critical and necessary difference between reckless neglect and professional negligence,” the brief said. “As a result, it interprets the Elder Abuse Act in a way that fundamentally conflicts with MICRA.”

“Clarification by this court is needed to make clear that reckless neglect elder abuse and professional negligence are indeed mutually exclusive,” the brief said, calling for appeal.

In order for the Elder Abuse Act to apply, the physician must to have had a relationship with the patient that involved specific caretaking responsibilities. The act defines “caretaker” as a “person who has the care, custody or control of … an elder or dependent adult.” Because the patient was treated in an outpatient facility and not in a nursing home or resident health care facility, the act does not apply.

The state supreme court decision stated that the Elder Abuse Act “does not apply unless the defendant health care provider had a substantial caretaking or custodial relationship, involving ongoing responsibility for one or more basic needs, with the elder patient.”

Rather, the decision said, it is the nature of the relationship between physician and patient—not the physician’s professional standing—that makes the physician potentially liable for neglect.

“Plaintiffs cannot bring a claim of neglect under the Elder Abuse Act unless the defendant health care provider has a caretaking or custodial relationship with the elder,” the court said.

This decision reverses the Court of Appeal decision and upholds the critical protections offered physicians within MICRA.

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