(142) Curbside Consults: Practice Considerations in an Evolving Legal Landscape

Background:
“Curbside” consults are an age old part of medicine, valuable for fostering collaboration and brainstorming, with evidence that they increase patient care. However, the informal nature of these consults naturally leads to a lack of details that are found in formal consults. In fact, affected patient's receive different management recs after a formal consult. This raises the question of liability when information may lead to patient harm. This question is especially relevant in consult-liaison psychiatry, where lack of a clear consult question from the primary team may lead to shunting what may be an appropriate consult towards a curbside.

Methods:
We will present clinical case examples of curbside consultation that lead to not fully considered advise due to incomplete information and potential for adverse outcomes. We will also highlight relevant court cases like Warren v. Dinter, where Minnesota Supreme Court in 2019 ruled that a clinician can be liable for medical malpractice, even when there is no treatment relationship with the patient if it is "reasonably foreseeable" that the patient could be injured by that advice.

Discussion:
To be sued to for malpractice four things must be proved, duty to the patient, breach of that duty, proximate cause, and damages. Typically, it was felt that there must be a “treatment relationship” with the patient for a malpractice suite to take place, however the decision in Warren v Dinter states that this is not always true. Thus, it becomes important to delineate what actions by a physician would or could create a “treatment relationship”. Therefore, a formal consult with thorough chart review, detailed patient interview, collateral information, and suicide and violence risk assessment may mote clinically and legally appropriate.

Conclusion:
Informal consults, while an important part of medical culture, may place physicians at risk of lawsuits whether a treatment relationship is created. It is important to have standardized guidelines to help determine which consults should be treated as formal or informal to minimize legal repercussions and inadvertent harm to patients.

References:
1. Garrick, T. (1994). Psychosomatics, 35(4), 474–484. https://doi.org/10.1016/s0033-3182(63)73187-2
2. Minnesota Medical Association, COPIC: Medical malpractice alert. May 2019. Available at www.mnmed.org/MMA/media/Hidden-Documents/MedicalMalpracticeAlert.pdf. Accessed May 22, 2019
3. Pope, T. M. (n.d.). Curbside consults: New liability risks to avoid when you are not a patient's physician. The ASCO Post. Retrieved April 3, 2023, from https://ascopost.com/issues/june-25-2019/new-liability-risks-to-avoid-when-you-are-not-a-patient-s-physician/
4. Baker K: United States: A doctor’s legal duty—Erosion of the curbside consultant. Mondaq, November 2003. Available at www.mondaq.com/unitedstates/x/23193/Professional+Negligence/A+Doctors+Legal+DutyErosion+of+the+Curbside+Consultant. Accessed May 30, 2019.