Warren v. Dinter

Decision Date17 April 2019
Docket NumberA17-0555
Citation926 N.W.2d 370
Parties Justin WARREN, Appellant, v. Richard DINTER, et al., Respondents.
CourtMinnesota Supreme Court


In this case of first impression, we must decide whether a hospitalist’s alleged decision to deny a patient admission to a hospital may constitute professional negligence. We conclude that it may.

This case arises out of an interaction between employees of two Minnesota health systems. A nurse practitioner in one system sought to have a patient admitted to the hospital of the other system. Admission was allegedly denied by a hospitalist. Three days later, the patient died.

The patient’s son sued for malpractice. The district court and a divided panel of the court of appeals concluded that, as a matter of law, the hospitalist owed no duty of care to the patient because no physician-patient relationship had been established. We reverse and remand.


On August 8, 2014, Susan Warren, age 54, arrived at the Essentia Health clinic in Hibbing. She complained of abdominal pain, fever, chills, and other symptoms. Nurse practitioner1 Sherry Simon ordered a series of tests to determine the nature of Warren’s illness.

The test results showed that Warren had unusually high levels of white blood cells, as well as other abnormalities. These results led Simon to believe that Warren had an infection and needed to be hospitalized. Simon prepared a letter advising Warren’s employer that Warren "was unable to attend work ... due to illness and hospitalization." Simon then called Fairview Range Medical Center to seek Warren’s admission to the local hospital. Simon’s call was randomly assigned to Dr. Richard Dinter, who was one of three Fairview hospitalists2 on call that day.

Simon and Dinter were employed by different health systems. Because Essentia did not have a hospital in Hibbing, it was standard practice for Simon and other Essentia healthcare professionals to seek hospitalization of their patients at the Fairview hospital. As Simon explained, she would call the hospital, be assigned to one of the on-call hospitalists, "present the case, and [the hospitalist] would either admit or tell [Essentia staff] a different type of plan."

Simon’s call to Dinter lasted approximately ten minutes. They disagree about which diagnostic information Simon shared with Dinter. Simon says that she shared both the abnormal test results and Warren’s symptoms; Dinter says that Simon shared only some of the test results. Simon says that the conversation with Dinter took place after urinalysis results became available in the early afternoon; Dinter says that the conversation took place "in the late morning or noon," and that Simon did not share any urinalysis results. Simon says that she specifically requested that Warren be hospitalized; Dinter says that Simon only asked him whether Warren should be hospitalized.

Simon and Dinter disagree not only about what information Simon conveyed, but also about how Dinter responded. They agree that Dinter told Simon that the cause of Warren’s abnormal test results was likely diabetes, and that Simon should get that issue under control and see Warren the following Monday. Simon says that Dinter told her that Warren did not need to be admitted to the hospital. Dinter disagrees, saying that he responded "to what end[?]" to a question as to whether Warren should be admitted. Simon says she asked whether diabetes could actually be the source of the elevated white blood-cell count, and that Dinter responded that it could. Simon says she asked this question because it was the first time someone had told her that out-of-control diabetes could cause a high white-cell count. Dinter says Simon asked only "what about the blood sugar" and that he replied "it’s probably a Type 2 diabetes."

After speaking with Dinter, Simon met with Dr. Jan Baldwin, who served as Simon’s collaborating physician at Essentia.3 Simon met with Baldwin because she still felt Warren should be hospitalized and wondered whether Baldwin might be able to help make that happen. Baldwin concurred that diabetes could be responsible for Warren’s elevated white blood-cell count.

After speaking with Dinter and meeting with Baldwin, Simon met with Warren, who was still at the clinic. According to Simon, she told Warren that Simon had spoken with a hospitalist, who felt that hospital admission was not needed. Simon then discussed the diabetes diagnosis with Warren, prescribed diabetes and pain medication, scheduled a follow-up appointment, and sent her patient home. Three days later, Warren’s son found her dead in her home. An autopsy concluded that the cause of death was sepsis caused by an untreated staph infection.

On March 7, 2016, Warren’s son sued Dinter and Fairview,4 alleging that Dinter had been professionally negligent in the care and treatment of Warren, including advising Simon that Warren did not require hospitalization. The complaint further alleged that the negligence directly caused Warren’s death, and that Fairview was liable under a theory of respondeat superior.

Dinter and Fairview moved for summary judgment, arguing that Dinter owed no duty of care to Warren because Simon had called Dinter only "for his thoughts as a hospitalist" and, therefore, he had "provided his reactions ... as a professional courtesy" to Simon. They also argued that Dinter’s acts or omissions were not the proximate cause of Warren’s death.

Along with their motion for summary judgment, Dinter and Fairview filed affidavits which contained the opinions of each side’s medical expert. The plaintiff’s expert was Dr. Benjamin Whitten, a board-certified physician in internal medicine practicing with Abbott Northwestern General Medicine Associates with expertise as a hospitalist. Whitten opined that Dinter’s actions breached the standard of care for a hospitalist. He also opined that, had Warren been hospitalized for evaluation and treatment, it was highly likely that her infection would have been diagnosed and treated, and that she would have survived with no significant disability.

The defendants’ expert was Dr. Meghan Walsh, a board-certified physician in internal medicine, a practicing hospitalist at Hennepin County Medical Center, and an associate professor at the University of Minnesota Medical School. Walsh opined that Dinter’s actions were consistent with the standard of care for a hospitalist and that Warren’s death was not caused by any negligence on his part. She also opined that, even if Warren had been admitted to the hospital on the day Simon called Dinter, it is unlikely and doubtful that Warren would have survived her infection.

The district court granted Dinter’s and Fairview’s summary-judgment motion on the issue of duty, concluding that the relationship between Simon and Dinter was "in the nature of an informal conversation between medical colleagues and did not create a doctor patient relationship" between Dinter and Warren. The district court concluded that "there [was] a fact question regarding causation," and denied summary judgment on proximate cause.

Warren’s son appealed, arguing that, as a matter of law, a physician-patient relationship is not necessary for Dinter to have a duty to Warren. The court of appeals, in a divided, unpublished decision, affirmed the district court, holding that there was no duty because there was no physician-patient relationship. Warren v. Dinter , No. A17-0555, 2018 WL 414333, at *3, 5 (Minn. App. Jan. 16, 2018). The court of appeals did not reach the issue of proximate cause. Id. at *5. Judge Hooten dissented, reasoning that the district court should have denied summary judgment because, viewing the evidence in the light most favorable to the non-moving party, there was a duty because the harm was foreseeable. Id. at *6. We granted review.


This is an appeal from an order granting summary judgment. Such an order "is appropriate when there is no genuine issue of material fact and a party is entitled to judgment as a matter of law." Senogles v. Carlson , 902 N.W.2d 38, 42 (Minn. 2017). We review a grant of summary judgment de novo. Commerce Bank v. W. Bend Mut. Ins. Co. , 870 N.W.2d 770, 773 (Minn. 2015). "In conducting this review, we view the evidence in the light most favorable to the nonmoving party ... and resolve all doubts and factual inferences against the moving parties.’ " Fenrich v. Blake School , 920 N.W.2d 195, 201 (Minn. 2018) (quoting Rochester City Lines Co. v. City of Rochester , 868 N.W.2d 655, 661 (Minn. 2015) ). As we have emphasized repeatedly, summary judgment is " ‘inappropriate when reasonable persons might draw different conclusions from the evidence presented.’ " Montemayor v. Sebright Prods., Inc. , 898 N.W.2d 623, 628 (Minn. 2017) (quoting Osborne v. Twin Town Bowl, Inc. , 749 N.W.2d 367, 371 (Minn. 2008) ).

This case involves a claim of professional negligence, specifically medical malpractice. See Kohoutek v. Hafner , 383 N.W.2d 295, 303 (Minn. 1986) ; see also Molloy v. Meier (Molloy II ), 679 N.W.2d 711, 717 (Minn. 2004) ("A medical malpractice action is based on principles of tort liability for negligence...."). Physicians are "required to possess only the skill and learning possessed by the members of [their] profession in good standing in [their] locality and to exercise that skill and learning with due care." Manion v. Tweedy , 257 Minn. 59, 100 N.W.2d 124, 129 (1959). As in all negligence actions, "the existence of a duty running [from the defendant] to the plaintiff is a prerequisite" to a finding of malpractice liability. Molloy II , 679 N.W.2d at 717. This case turns on whether Dinter owed Warren a duty of care.

Both the district court and the court of appeals held that there was no duty based on the idea that, as a matter of law, a physician-patient relationship is a necessary predicate for a doctor to owe a duty of care. The court of appeals relied on its own precedent in Molloy v. Meier (Molloy I ), 660 N.W.2d 444,...

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