Comment by jawns | Hacker News Reader

Comment by jawns | Hacker News Reader

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Let's agree that a reasonable person would see that as a refusal.

In fact, let's make the refusal even more explicit.

Let's suppose that he flat-out said, "I don't think she needs emergency care, and if you send this patient to the ER, I will refuse to treat her."

Even so ... isn't it ultimately on the NP -- who seemed to grasp that he was blowing her off -- to either get a second opinion or (ideally) use her own medical training to determine that the patient really should go to the ER, no matter what he says, knowing that he can't actually refuse to treat her?

Stating that you intend not to do something, after all, is not always the same as actually refusing to do it.

That's not the most compelling argument, I know.

But I do worry about the broader implications of this ruling. Should physicians fear malpractice claims arising out of consultations with colleagues? In what cases can you feel free to give your opinion "off the record," with the understanding that the person who has consulted you will bear ultimate responsibility for the treatment they are providing?

> Still concerned about Ms. Warren’s condition, Simon then spoke to Dr. Jan Baldwin, her “collaborating physician” at the Essentia clinic. Amazingly, Baldwin, who also did not examine Warren, agreed with Dinter – Warren was suffering from out-of-control diabetes. (Neither court opinion indicates whether Warren had been previously diagnosed with diabetes.) At that point, Simon relented.

Based on my reading of that block from the article, she did get a second opinion. Once you've got two more credentialed professionals agreeing on something, it's a lot harder to justify going against their opinion.

> isn't it ultimately on the NP

No, because we don’t live in a world where only one person has to be responsible for every outcome.

Multiple people can share responsibility (and legal liability) for an outcome. In this case, the NP may bear some responsibility for the reasons you outlined. In fact the NP and her organization were sued and settled out of court already:

> At some point prior to that date, Justin Warren “sued Essentia Health for the alleged malpractice of its employees, Simon and Baldwin.” (p. 6) That case was settled out of court.

So, the NP may bear some responsibility, but there’s no reason why that should be the end of the investigation as to who else may bear some responsibility.

I think you're setting this up as a "just following orders" argument on the part of the NP, which justifiably should be shot down. But this isn't just her following orders, it's her asking for an opinion on something outside of her knowledge. Just because she had a gut feeling that he was wrong doesn't make her culpable. _Nurses should accept the opinions of doctors in regard to diagnoses because the doctors have specifically trained for this to a much greater extent than nurse practitioners._

It seems to me that if NPs are incapable of making (at least some) correct diagnoses and must defer to the expertise of a supervising doctor, then they cannot also be responsible for the doctor being incorrect.

Either they are trained well enough to make the decision on their own (which would mean the NP shouldn't need permission for this patient to be admitted) or the doctor is actually the person who is responsible for the patient's well-being.

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