## Facts

- Fourteen-year-old Krystine White had significant mental health issues and later died by suicide in 2005.
- Krystine and her parents enrolled in a telepsychiatry research study affiliated with Fletcher Allen Health Care, Inc. (FAHC).
- As part of the study, Dr. Mark S. Harris conducted a single, approximately ninety-minute videoconference psychiatric consultation with Krystine and her parents.
- Dr. Harris prepared a written consultation evaluation describing Krystine’s condition, providing a diagnostic impression, and recommending an initial treatment plan for consideration and implementation by her existing local treatment team and primary care physician.
- Study-related documentation and the evaluation stated that no follow-up services would be provided and that no medication prescriptions would be directly provided by Dr. Harris.
- After sending his evaluation to the local providers, Dr. Harris had no further contact with Krystine, her family, or her treatment team.
- Krystine’s parents, including her father as administrator of her estate, sued multiple providers for wrongful death/medical malpractice, alleging care fell below the applicable standard and contributed to her death.
- The trial court granted summary judgment to FAHC, concluding Dr. Harris owed no duty at the time of Krystine’s death because no physician–patient relationship existed, or any relationship ended after the one-time consult based on the written limitations.

## Issues

1. Whether a one-time telepsychiatry consultation conducted within a research study can create a physician–patient relationship and a corresponding duty of care.
2. Whether a physician may limit or eliminate the duty of reasonable care through research/consent documents stating there will be no follow-up care or prescriptions.

## Decision

- The Vermont Supreme Court reversed the grant of summary judgment for FAHC and remanded.
- The court held the record, viewed favorably to plaintiffs, could support a finding that Dr. Harris formed at least a limited physician–patient relationship with Krystine during the telepsychiatry consultation.
- The court held a physician cannot avoid the duty of reasonable care for professional services rendered by contractual disclaimer or limiting language in research/consent materials.
- The court concluded that questions about the existence and scope of any relationship and duty, including any effective termination, were not resolved as a matter of law on summary judgment.

## Legal Principles

- Duty in negligence is evaluated by considering the parties’ relationship, the nature and foreseeability of the risk, and public policy.
- A physician–patient relationship may arise from a single consultative encounter when the physician provides clinical evaluation, diagnostic impressions, and treatment recommendations directed to an individual patient.
- The relationship may be limited in scope to the services undertaken, but scope limits do not negate the baseline duty to act with reasonable professional care in providing those services.
- A physician may not contract out of liability for negligent performance of professional medical services; disclaimers in research or consent documents cannot eliminate the duty of reasonable care.
- Whether a physician effectively terminated any therapeutic relationship and any continuing obligations may present factual questions not suitable for summary judgment.

## Conclusion

The Vermont Supreme Court held that a one-time telepsychiatry consultation can create a limited physician–patient relationship imposing a duty of reasonable care, and that such duty cannot be negated by research or consent-language disclaimers; summary judgment was reversed and the case remanded for further proceedings.


White v. Harris, 190 Vt. 647, 36 A.3d 203 (Vt. 2011)