Public Health Law Map - Beta 5 - Medical and Public Health Law Site

to find a specialist willing to see the patient. In this situation, the obstetrician would
be obligated to treat the thyroid disease, despite its being outside his or her chosen
area of expertise.
The more difficult problem is the patient who develops a condition that the specialist
cannot treat alone, but the management of which is part of his or her specialty—for
example, a gastroenterologist who finds that the patient has acute appendicitis. The
physician cannot perform the surgery, but it would be unacceptable to try to treat the
patient without surgery. The gastroenterologist must be able to arrange proper
surgical referrals as part of his or her duty to the patient. The patient is entitled to
assume that the specialist is prepared to coordinate all of the personnel necessary to
treat the patient’s gastrointestinal problems.
3. Occupational Physician–Patient Relationship
Most of the law on occupational medical services involves full-time employee
physicians working for the employer, or contract physicians who only perform
screening examinations. In these cases, the courts have found that patients receiving
occupational medical services and examinations do not have the expectation of a full
physician–patient relationship in all situations. If the physician is performing a
screening examination for someone other than the patient, such as an employer or
insurer, there is no physician–patient relationship. The patient must be told of
abnormal results that the medical care practitioner knows of, but may not sue for
failure to detect problems. [Tumblin v. Ball-Incon Glass Packaging Corp., 478
S.E.2d 81 (S.C. App. 1996).] The physician can be liable if he or she injures the
patient during the examination. [Mero v. Sadoff, 31 Cal. App. 4th 1466, 37 Cal. Rptr.
2d 769 (Cal. App. 2 Dist. 1995).] If the occupational medicine physician treats the
patient, there is a physician–patient relationship for that treatment and the physician
will be liable for any medical malpractice. The physician’s duty will be limited to the
injury and conditions related to it. There is no broader duty to evaluate the patient’s
condition, even if such evaluation would be standard of care in a non–occupational
medicine setting.
E. Contractual and Statutory Duties to Treat
Under the traditional common law, physicians and patients entered into voluntary
contracts for services. Patients could choose their own physicians, and physicians were
free to refuse to treat patients for any reason they chose. This right to refuse to treat
was substantially limited by the Civil Rights laws in the 1960s. Medical care
practitioners and institutions could no longer refuse to treat based on race, religion, or
ethnicity. Subsequent to the Civil Rights Act, the government further limited
physicians’ right to refuse to treat in the Americans with Disabilities Act (ADA) and
the Emergency Medical Treatment and Active Labor Act (EMTALA). However, the
greatest change in the freedom of physicians and patients to contract for medical care
has been brought about by private health plans, not statutes. As private insurance plans
have moved to the MCO model, they have limited both the physician’s right to refuse
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