of Appeals Office of Appellate Courts
Hanson, Robert J. King, Benjamin E. Gurstelle, Amarachi
Iherjirika, Briggs and Morgan, P.A., Minneapolis, Minnesota,
William L. Davidson, Paul C. Peterson, Eric J. Steinhoff,
João C. Medeiros, Lind, Jensen, Sullivan &
Peterson, P.A., Minneapolis, Minnesota, for respondents.
Patrick Stoneking, J. Qortney McLeod, Jason L. DePauw, Robins
Kaplan LLP, Minneapolis, Minnesota; and Paul D. Peterson,
Harper & Peterson, PLLC, Woodbury, Minnesota, for amicus
curiae Minnesota Association for Justice.
R. Whitmore, Christine E. Hinrichs, Bassford Remele, P.A.,
Minneapolis, Minnesota, for amici curiae Minnesota Hospital
Association, Minnesota Medical Association, and American
Lillehaug, J. Dissenting, Anderson, J., Gildea, C.J.
physician-patient relationship is not a necessary element of
a claim for professional negligence. A physician owes a duty
of care to a third party when the physician acts in a
professional capacity and it is reasonably foreseeable that
the third party will rely on the physician's acts and be
harmed by a breach of the standard of care.
Viewed in the light most favorable to the non-moving party,
it was reasonably foreseeable that a patient seeking
admission to a hospital would rely on a hospitalist's
acts and be harmed by a breach of the standard of care, thus
making summary judgment for the hospitalist and his employer
on the element of duty of care improper.
case of first impression, we must decide whether a
hospitalist's alleged decision to deny a patient
admission to a hospital may constitute professional
negligence. We conclude that it may.
case arises out of an interaction between employees of two
Minnesota health systems. A nurse practitioner in one system
sought to have a patient admitted to the hospital of the
other system. Admission was allegedly denied by a
hospitalist. Three days later, the patient died.
patient's son sued for malpractice. The district court
and a divided panel of the court of appeals concluded that,
as a matter of law, the hospitalist owed no duty of care to
the patient because no physician-patient relationship had
been established. We reverse and remand.
August 8, 2014, Susan Warren, age 54, arrived at the Essentia
Health clinic in Hibbing. She complained of abdominal pain,
fever, chills, and other symptoms. Nurse
practitioner Sherry Simon ordered a series of tests to
determine the nature of Warren's illness.
test results showed that Warren had unusually high levels of
white blood cells, as well as other abnormalities. These
results led Simon to believe that Warren had an infection and
needed to be hospitalized. Simon prepared a letter advising
Warren's employer that Warren "was unable to attend
work . . . due to illness and hospitalization." Simon
then called Fairview Range Medical Center to seek
Warren's admission to the local hospital. Simon's
call was randomly assigned to Dr. Richard Dinter, who was one
of three Fairview hospitalists on call that day.
and Dinter were employed by different health systems. Because
Essentia did not have a hospital in Hibbing, it was standard
practice for Simon and other Essentia healthcare
professionals to seek hospitalization of their patients at
the Fairview hospital. As Simon explained, she would call the
hospital, be assigned to one of the on-call hospitalists,
"present the case, and [the hospitalist] would either
admit or tell [Essentia staff] a different type of
call to Dinter lasted approximately ten minutes. They
disagree about which diagnostic information Simon shared with
Dinter. Simon says that she shared both the abnormal test
results and Warren's symptoms; Dinter says that Simon
shared only some of the test results. Simon says that the
conversation with Dinter took place after urinalysis results
became available in the early afternoon; Dinter says that the
conversation took place "in the late morning or
noon," and that Simon did not share any urinalysis
results. Simon says that she specifically requested that
Warren be hospitalized; Dinter says that Simon only asked him
whether Warren should be hospitalized.
and Dinter disagree not only about what information Simon
conveyed, but also about how Dinter responded. They agree
that Dinter told Simon that the cause of Warren's
abnormal test results was likely diabetes, and that Simon
should get that issue under control and see Warren the
following Monday. Simon says that Dinter told her that Warren
did not need to be admitted to the hospital. Dinter
disagrees, saying that he responded "to what
end[?]" to a question as to whether Warren should be
admitted. Simon says she asked whether diabetes could
actually be the source of the elevated white blood-cell
count, and that Dinter responded that it could. Simon says
she asked this question because it was the first time someone
had told her that out-of-control diabetes could cause a high
white-cell count. Dinter says Simon asked only "what
about the blood sugar" and that he replied
"it's probably a Type 2 diabetes."
speaking with Dinter, Simon met with Dr. Jan Baldwin, who
served as Simon's collaborating physician at
Essentia. Simon met with Baldwin because she still
felt Warren should be hospitalized and wondered whether
Baldwin might be able to help make that happen. Baldwin
concurred that diabetes could be responsible for Warren's
elevated white blood-cell count.
speaking with Dinter and meeting with Baldwin, Simon met with
Warren, who was still at the clinic. According to Simon, she
told Warren that Simon had spoken with a hospitalist, who
felt that hospital admission was not needed. Simon then
discussed the diabetes diagnosis with Warren, prescribed
diabetes and pain medication, scheduled a follow-up
appointment, and sent her patient home. Three days later,
Warren's son found her dead in her home. An autopsy
concluded that the cause of death was sepsis caused by an
untreated staph infection.
March 7, 2016, Warren's son sued Dinter and Fairview,
alleging that Dinter had been professionally negligent in the
care and treatment of Warren, including advising Simon that
Warren did not require hospitalization. The complaint further
alleged that the negligence directly caused Warren's
death, and that Fairview was liable under a theory of
and Fairview moved for summary judgment, arguing that Dinter
owed no duty of care to Warren because Simon had called
Dinter only "for his thoughts as a hospitalist"
and, therefore, he had "provided his reactions . . . as
a professional courtesy" to Simon. They also argued that
Dinter's acts or omissions were not the proximate cause
of Warren's death.
with their motion for summary judgment, Dinter and Fairview
filed affidavits which contained the opinions of each
side's medical expert. The plaintiff's expert was Dr.
Benjamin Whitten, a board-certified physician in internal
medicine practicing with Abbott Northwestern General Medicine
Associates with expertise as a hospitalist. Whitten opined
that Dinter's actions breached the standard of care for a
hospitalist. He also opined that, had Warren been
hospitalized for evaluation and treatment, it was highly
likely that her infection would have been diagnosed and
treated, and that she would have survived with no significant
defendants' expert was Dr. Meghan Walsh, a
board-certified physician in internal medicine, a practicing
hospitalist at Hennepin County Medical Center, and an
associate professor at the University of Minnesota Medical
School. Walsh opined that Dinter's actions were
consistent with the standard of care for a hospitalist and
that Warren's death was not caused by any negligence on
his part. She also opined that, even if Warren had been
admitted to the hospital on the day Simon called Dinter, it
is unlikely and doubtful that Warren would have survived her
district court granted Dinter's and Fairview's
summary-judgment motion on the issue of duty, concluding that
the relationship between Simon and Dinter was "in the
nature of an informal conversation between medical colleagues
and did not create a doctor patient relationship"
between Dinter and Warren. The district court concluded that
"there [was] a fact question regarding causation,"
and denied summary judgment on proximate cause.
son appealed, arguing that, as a matter of law, a
physician-patient relationship is not necessary for Dinter to
have a duty to Warren. The court of appeals, in a divided,
unpublished decision, affirmed the district court, holding
that there was no duty because there was no physician-patient
relationship. Warren v. Dinter, No. A17-0555, 2018
WL 414333, at *3, 5 (Minn.App. Jan. 16, 2018). The court of
appeals did not reach the issue of proximate cause.
Id. at *5. Judge Hooten dissented, reasoning that
the district court should have denied summary judgment
because, viewing the evidence in the light most favorable to
the non-moving party, there was a duty because the harm was
foreseeable. Id. at *6. We granted review.
an appeal from an order granting summary judgment. Such an
order "is appropriate when there is no genuine issue of
material fact and a party is entitled to judgment as a matter
of law." Senogles v. Carlson, 902 N.W.2d 38, 42
(Minn. 2017). We review a grant of summary judgment de novo.
Commerce Bank v. W. Bend Mut. Ins. Co., 870 N.W.2d
770, 773 (Minn. 2015). "In conducting this review,
'we view the evidence in the light most favorable to the
nonmoving party . . . and resolve all doubts and factual
inferences against the moving parties.'" Fenrich
v. Blake School, 920 N.W.2d 195, 201 (Minn. 2018)
(quoting Rochester City Lines Co. v. City of
Rochester, 868 N.W.2d 655, 661 (Minn. 2015)). As we have
emphasized repeatedly, summary judgment is"
'inappropriate when reasonable persons might draw
different conclusions from the evidence presented.'"
Montemayor v. Sebright Prods., Inc., 898 N.W.2d 623,
628 (Minn. 2017) (quoting Osborne v. Twin Town Bowl,
Inc., 749 N.W.2d 367, 371 (Minn. 2008)).
case involves a claim of professional negligence,
specifically medical malpractice. See Kohoutek v.
Hafner, 383 N.W.2d 295, 303 (Minn. 1986); see also
Molloy v. Meier (Molloy II), 679 N.W.2d 711,
717 (Minn. 2004) ("A medical malpractice action is based
on principles of tort liability for negligence . . .
."). Physicians are "required to possess only the
skill and learning possessed by the members of [their]
profession in good standing in [their] locality and to
exercise that skill and learning with due care."
Manion v. Tweedy, 100 N.W.2d 124, 129 (Minn. 1959).
As in all negligence actions, "the existence of a duty
running [from the defendant] to the plaintiff is a
prerequisite" to a finding of malpractice liability.
Molloy II, 679 N.W.2d at 717. This case turns on
whether Dinter owed Warren a duty of care.
the district court and the court of appeals held that there
was no duty based on the idea that, as a matter of law, a
physician-patient relationship is a necessary predicate for a
doctor to owe a duty of care. The court of appeals relied on
its own precedent in Molloy v. Meier (Molloy
I), 660 N.W.2d 444, 450 (Minn.App. 2003),
aff'd, 679 N.W.2d 711 (Minn. 2004), and
Peterson v. Saint Cloud Hosp., 460 N.W.2d 635, 638
(Minn.App. 1990). Warren, 2018 WL 414333, at *2.
These decisions require that we examine whether such a
relationship is a necessary element of a malpractice claim.
sure, most medical malpractice cases involve an express
physician-patient relationship. And a physician-patient
relationship is a necessary element of malpractice claims in
many states. But we have never held that such a
relationship is necessary to maintain a malpractice action
under Minnesota law. To the contrary: when there is no
express physician-patient relationship, we have turned to the
traditional inquiry of whether a tort duty has been created
by foreseeability of harm. Two cases-one a ...