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Murray v. UNMC Physicians

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Brief Fact Summary.

Plaintiff brought suit against defendant for failing to administer an expensive but potentially life-saving drug to the decedent, who suffered from a medical condition and subsequently died of cardiac arrest, without insurance approval. Experts testified that the treatment, once administered, would be dangerous to interrupt, and experts were overall unsure whether the treatment would have prevented the death of the decedent anyway.

Synopsis of Rule of Law.

Medical standards of care are defined by how other medical providers in the same or similar community would act under similar circumstances and are not tied to wealth or ability to pay.

Points of Law - Legal Principles in this Case for Law Students.

While the existence of a duty and the identification of the applicable standard of care are questions of law, the ultimate determination of whether a party deviated from the standard of care and was therefore negligent is a question of fact.

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Facts.

The decedent, Mary Murray, suffered from pulmonary arterial hypertension, which can ultimately lead to heart failure. Flolan vasodilator can extend life if administered 24 hours a day and costs about $100,000 per year. Mary’s doctor wrote the order for Flolan, pending insurance approval, but Mary died of cardiac arrest before the approval came through. Mary had not started the treatment due to fears of the potentially deadly consequences of interrupting treatment at a later date. Medical experts could not agree on what caused the heart failure and thus if earlier use of Flolan would have prevented it.

Issue.

Should the doctors be found liable for medical malpractice?

Held.

No. The defendant made a judgement regarding the health of the patient, not one based on economics or cost of treatment. That judgement about health seems to be supported by the medical community. The court rules that the question of whether the standard of care required the treatment to be administered immediately was one for the jury, so a new trial should not have been ordered, and the verdict was reversed.

Discussion.

The court first noted that the customary standard of care is both unitary and wealth-blind, but also that this standard has become harder to reconcile with growths in technology. Even so, health care providers generally have the ability to refuse to treat an indigent patient. Attaching liability to providing some, but not all, possible care makes it more likely that providers will just altogether refuse to treat those who cannot pay. Physicians make value judgements all the time about risks and benefits, and cost often factors into these judgements, albeit with significant ethical (but not necessarily legal) restrictions. That being said, this case does not involve insurance declining to pay for treatment or a dispute over the cost-effectiveness of treatment—it involves a health concern about starting and potentially having to pause treatment, about which the defendant made a reasonable judgement call.


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