## Facts

- Susan Warren went to an Essentia Health clinic with abdominal pain, fever, chills, and abnormal laboratory results suggesting infection.
- Essentia nurse practitioner Sherry Simon concluded Warren needed hospitalization; because Essentia had no local hospital, Simon called Fairview Range Medical Center to arrange admission.
- Simon was connected to Dr. Richard Dinter, an on-call Fairview hospitalist; Fairview hospitalists commonly decided whether patients presented by outside clinicians would be admitted or given an alternative plan.
- Simon and Dinter spoke by phone for about ten minutes and disputed what information was provided and whether Simon requested admission.
- Viewing the record in the light most favorable to the plaintiff, Dinter denied admission and advised that uncontrolled diabetes, not infection, was the likely cause.
- Simon and her collaborating physician treated Warren as an outpatient for diabetes and sent her home.
- Warren died three days later from sepsis caused by an untreated staphylococcal infection.
- Warren’s trustee sued Dinter and his employer for professional negligence, alleging the admission denial breached the standard of care and caused Warren’s death.

## Issues

1. Whether a physician–patient relationship is a required element of a professional-negligence claim under Minnesota law.
2. Whether an on-call hospitalist who denies admission can owe a duty of care to a nonpatient when it is reasonably foreseeable the patient will rely on the hospitalist’s professional decision and be harmed by negligence.

## Decision

- The Minnesota Supreme Court reversed summary judgment for Dinter and Fairview and remanded.
- The court held a physician–patient relationship is not categorically required to establish duty in a professional-negligence claim.
- The court held a physician owes a duty to a third party when acting 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.
- Applying that standard, the court concluded it was reasonably foreseeable that a patient seeking hospital admission would rely on the hospitalist’s gatekeeping decision; therefore, summary judgment on duty was improper.

## Legal Principles

- Duty in professional negligence may arise without a formal physician–patient relationship.
- A physician owes a duty of care to a nonpatient when:
  - the physician acts in a professional capacity; and
  - it is reasonably foreseeable the nonpatient will rely on the physician’s act or advice and suffer harm if the standard of care is breached.
- In the hospital admission context, an on-call hospitalist’s admission decision can be a professional act supporting duty where reliance and risk of harm are foreseeable.
- Recognizing duty does not establish breach or causation; those elements remain for proof (typically through expert testimony) on remand.

## Conclusion

The court allowed the malpractice claim to proceed by recognizing that an on-call hospitalist’s admission decision can create a duty to a patient despite the absence of a formal physician–patient relationship when foreseeable reliance and risk of harm are shown.


Warren v. Dinter, 926 N.W.2d 370 (Minn. 2019)