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Law and Biosciences Blog

Outbreaks and Duties

Last month, in Seebold v. Prison Health Services, Inc., the Supreme Court of Pennsylvania ruled that prison doctors were not negligent in failing to warn corrections officers about an outbreak of the “superbug“ methicillin-resistant staphylococcus aureus (MRSA) among twelve inmates. (One of the corrections officers apparently contracted MRSA.) On its face, the ruling seems absurd. Prison doctors are clearly those most knowledgeable about inmates’ medical conditions; shouldn’t they be required to warn prison officials about the dangers of coming into contact with infected inmates? But–and as Seebold makes clear–unpacking that question simply raises a host of numerous and particularly difficult problems. What is a physician’s duty during an outbreak? And to whom? And when? And does it matter if the outbreak occurred in a prison? Seebold provides at least some of the answers.

The facts in Seebold are amazingly simple. The Pennsylvania State Correctional Institution at Muncy hired Prison Health Services, Inc.. (PHS) as an independent contractor, to medically treat its inmates. At some point, twelve of Muncy’s prisoners contracted MRSA–an outbreak at least in my book. PHS thought they were spider bites. And one corrections officer–Michelle Seebold–allegedly contracted MRSA herself, relying on PHS’s description. Should Seebold recover against PHS?

The intuitive answer seems to be, Yes. But for PHS’s wildly incorrect assessment of an outbreak of “spider bites” among Muncy’s prisoners, Seebold would not have contracted the illness. And PHS should have been aware that corrections officers would have relied on its medical assessments. That’s textbook proximate cause. But I think this intuitive answer is at least partially wrong.

First, and as thoroughly dissected by the court opinion, PHS did not serve as Seebold’s physician; PHS was Muncy’s inmates’ physicians. It seems a little strange then–perhaps too strange–to give Seebold the right sue PHS for failing to diagnose its own patients. One can imagine the consequences of such a rule downstream. I walk into my doctor’s with a stuffy nose and a cough; she claims it’s a common cold when it’s really rotovirus; and I pass it on to someone else. But that someone else could be anybody. Indeed, it could be  dozens or hundreds of people. The punishment of allowing all of these third-parties to sue physician for simple, even actionable, misdiagnoses just simply doesn’t fit the crime.

The dissent suggests however that where the disease is communicable, and where the third-party is in the class of individuals likely to affected by the misdiagnosis, then that third-party should have a case against the physician. But again–where to draw the line?

Second, even assuming that PHS properly diagnosed the inmates infected with MRSA, what to make of their right to patient confidentiality? Could PHS simply inform corrections’ officers of their illnesses without those inmates’ consent? One may argue that medical confidentiality is a right inmates lose upon being incarcerated. But where to draw the line? All communicable diseases? What about noncommunicable ones? And all inmates, irrespective of crime? This too may be a bridge too far.

Outbreaks are, in many instances, exceptional medical and public health concerns. As Seebold suggests, though, physicians’ duties to their patients, and others, during times of outbreak seem to remain very much the same.

Jake Sherkow, CLB Fellow

One Response to “Outbreaks and Duties”

  1. hgreely says:

    Interesting case and you raise good solid issues about the result. I think I might come out the other way.

    Starting with your second point first, confidentiality in health care is much weaker than most people think and when public health is involved, it is (almost?) non-existent. Mandatory disclosure and contact tracing of sexual partners of people with STDs, for example, doesn’t care much about privacy.

    And health care professionals have been held to have duties to third parties in many contexts – spouses and families of patients with infectious diseases, the employees and insureds where the examination was not for the individual’s benefit but the employer’s or insurer’s, people for whom the doctor-patient relationship revealed a serious and imminent threat of violence from the patient. Not all of those cases come out the same way, but many of them find a duty to a third party. They’ve got all the line-drawing problems that you point out – but, hey, if law were easy, no one would need lawyers, judges, or (heaven forbid!) law professors!

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