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Duty to Refer
Most states likewise require a physician to refer
a patient to a specialist, if under the circumstances the standard of
care would require the general practitioner to do so.
In California, for example, the following jury
instruction may be given in certain instances:
"It is the duty of a physician who is a
general practitioner to refer a patient to a specialist if under the
circumstances of reasonably careful and skillful general practitioner
would do so. If the physician fails to fulfill that duty and undertakes
or continues to perform professional services without the aid of a specialist,
it is the further duty of the physician to have the knowledge and skill
ordinarily possessed and exercise the care and skill ordinarily used
by reputable specialists in the same field and in the same or similar
locality and under similar circumstances. A failure to fulfill any such
duty is negligence. [BAJI 6.04]
 An Alaska case is illustrative of this point. In
Steele v. United States, (D.C. Alaska 1978) 463 F.Supp. 321, the defendant,
an optometrist, examined his patient and found evidence of possible disease
of the eye. He decided that no serious disease was present and therefore
did not refer the patient to an ophthalmologist for further examination.
The disease of the eye worsened over time and eventually resulted in its
removal.
The court found the optometrist breached his duty
to the patient by failing to refer him to an ophthalmologist. Optometrists
are trained to recognize symptoms of many diseases which may be discovered
by eye examinations, but were not then permitted to undertake a definite
diagnosis. This is the responsibility of a qualified medical doctor. Thus,
the court found that an optometrist who failed to refer his patient to
an ophthalmologist could be held liable for the injuries resulting from
the delay of the diagnosis and institution of treatment.
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