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Back To the Future?


A recent Superior Court decision holding a methadone clinic potentially liable for harm done by a patient who should not have been driving highlights an important distinction in this evolving area of the law.  Denying a motion for summary judgment by the clinic, Superior Court Judge James Lang focused on the clinic’s alleged affirmative acts of negligence, holding that the facts were more closely analogous to the Supreme Judicial Court’s decision in Coombes v. Florio, 450 Mass. 182 (2007) than the subsequent case of Medina v. Hochberg, 465 Mass. 102 (2013).

In Vasquez v. Community Health Care, Inc., several people were injured when their SUV was struck during a multi-car crash initiated by “John Doe,” a patient at a Peabody methadone clinic owned by the defendant.  The plaintiffs brought suit against the clinic, alleging that the health care providers had failed to warn Doe of the side effects of the prescribed medication it administered to him.  The clinic moved for summary judgment, claiming that it owed no duty to non-patient third parties to warn Doe, and that in any event, adequate warnings had been given.

Judge Lang carefully reviewed the emerging law in this area, and denied the defendant’s motion, finding that the clinic’s affirmative act of prescribing and administering medication to Doe created a duty to others who might foreseeably be endangered by Doe’s driving.  The court further found that, due to issues with Doe’s noncompliance during the treatment program–including numerous missed appointments and positive drug tests–there was a question about whether the clinic’s initial warnings about driving should have been repeated and/or strengthened.

In reaching his decision, Judge Lang relied on the apparent distinction created by the SJC in Coombes and Medina between a health care provider’s failure to warn the patient about dangerous side effects of a drug prescribed by the provider and the failure to warn about potentially harmful side effects of the patient’s underlying medical condition.  In essence, the SJC seems to be approaching a return to a long-discarded distinction between malfeasance, or affirmative acts of negligence, and non-feasance consisting of a failure to act.  The need to provide proper instructions and warnings to the patient when prescribing medication is seen as an essential part of the prescribing process.

Judge Lang certainly seems to have identified correctly the line drawn by the SJC in cases involving liability of medical providers to third parties.  Yet the rationale for the distinction is difficult to justify either as a matter of legal doctrine or public policy.  Long a stable of governmental immunity law, the misfeasance/nonfeasance distinction was abandoned 40 years ago as bad law and bad policy.  Yet it seems to be making a comeback.

The SJC’s opinion in Coombes rejected the defendant’s argument that imposing liability to injured third parties would greatly extend the provider’s duty and would interfere with the physician-patient relationship.  Indeed, the Court noted, that the physician would in any event need to warn the patient of medication side effects, so no further action would be required of the physician than under existing law.

Although there is no Massachusetts case directly on point, it would seem logical that a medical provider would be required to warn a patient of the potentially dangerous complications or limitations of an underlying medical condition–such as seizures from a brain tumor.  Given that existing duty, the logic of Coombes would dictate that the liability should extend to third parties.  Yet Medina held otherwise.

I think Judge Lang got it right in Vasquez.  I’m not so sure about the SJC.

Read the Vasquez opinion here.

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