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The Arizona Supreme Court recently upheld a ruling broadening a doctor’s obligation to inform a patient about his or her medical tests�even if the two never actually met. With the finding, Arizona now finds itself in a small group of states that holds doctors potentially liable despite the absence of a traditional doctor-patient relationship. The court cited similar rulings in Washington, Mississippi, Maryland and Ohio. Stanley v. McCarver, No. CV-03-0099-PR. The decision�which sends the case back to a trial court�stems from a case involving Tempe, Ariz., radiologist Robert McCarver, who was contracted in 1998 by Nelson & Carr X-Ray Service to examine a chest X-ray of a nurse, Christine Stanley, for signs of tuberculosis. The test was standard procedure for nurses hired at a nursing home. McCarver, who never met Stanley, noted spots on Stanley’s chest X-ray in his report to the plaintiff’s employer, and recommended further evaluation. The company had a policy of relaying the information within 72 hours, but for reasons that were never divulged, Stanley never saw McCarver’s report. Ten months later, she was diagnosed with lung cancer. Stanley died in April of this year. Duty of care In 1999, Stanley sued the nursing home, the X-ray service and McCarver for improper medical care. The Maricopa County Superior Court granted summary judgment in McCarver’s favor. But the Court of Appeals of Arizona (Division One) ruled that although there was no traditional doctor- patient relationship, by examining the X-rays, the doctor undertook a professional obligation with respect to Stanley’s well-being and owed a duty of care to the nurse. Stanley v. McCarver. The Arizona Supreme Court upheld the decision that a doctor in a nontraditional doctor-patient relationship could have a duty to communicate directly with the patient based on a set of factors, including whether another treating physician is involved in the transaction or if the physician had the means to contact the patient. But the high court vacated the rest of the court of appeal’s decision, leaving the decision of McCarver’s liability to a jury. “The absence of a formal doctor-patient relationship does not necessarily preclude the imposition of a duty of care,” the court ruled. In this and similar instances an examinee “reasonably expects the physician to sound the alarm if any serious abnormality is discovered. “The trend now favors imposing a duty, and we can envision no public benefit in encouraging a doctor who has specific individualized knowledge of an examinee’s serious abnormalities to not disclose such information,” the court wrote. Stanley’s attorney, Karen Lugosi of the Karen Lugosi firm in Phoenix, said the family is currently deciding whether they now want to proceed and file a wrongful death suit. Fear among doctors McCarver’s lawyer, Richard Kent of Phoenix’s Kent & Wittekind, said there is fear among the state’s radiologists of becoming liable if the doctor doesn’t properly relay the information to the patient. Kent said he was surprised by the court’s ruling since it “found a duty where no duty had been found before.” He said the doctor thought the employer would relay his diagnosis, and was provided with no contact information for Stanley. Lugosi said her client was never informed of McCarver’s report, but responsibility still lies with the physician. “It didn’t make sense to me that a physician could know of a potentially life-threatening [illness] and not advise the person of that problem in some way,” she said. Lugosi said she did not think the court’s ruling changes the current standard and responsibility established for physicians. “A good doctor . . . that recognizes abnormalities on an X-ray will take the steps to see that person is notified,” she said. Andrea Smiley, spokeswoman for the Arizona Medical Association, said the association’s legal counsel is reviewing the implications of the ruling for doctors who perform independent medical examinations, but deal with the employer and not the individual patients. Landau’s e-mail address is [email protected].

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