Why Did Susan Warren Die?


On April 17, the Minnesota Supreme Court published an opinion holding that doctors who deny services to patients may be sued even if they did not have a doctor-patient relationship with the patient. The decision drew expressions of surprise and consternation from observers inside Minnesota. Many malpractice experts had expected the court to conclude that patients cannot sue doctors unless the doctor had actually treated the patient. But in this case, Warren v. Dinter , the court held that a hospitalist [1] who refuses to admit a patient to the hospital may be sued for causing the death of the patient even though the hospitalist never laid eyes on the patient. 

The court sent the case back to the district court for trial. 

The defendants listed in this case are both the hospitalist, Dr. Richard Dinter, and the Fairview Range Medical Center in Hibbing, a small town on Minnesota’s Iron Range. The plaintiff is Justin Warren, the son of Susan Warren, a woman who died at the age of 54 one day after being denied admission to the Fairview hospital.

This is an odd case, and a complex case. It raises at least three questions worthy of extensive public debate. In the next section I will recite the basic facts of this story as they were reported by the opinions of the Minnesota Supreme Court and the Court of Appeals. In the section after that, I will discuss the three issues.

What we know about the death of the plaintiff’s mother

On the morning of Friday, August 8, 2014, Susan Warren visited Essentia Health Clinic in Hibbing. The clinic is part of the 15-hospital-75-clinic chain called Essentia Health that extends over much of northern Minnesota and Wisconsin. The clinic is about a block away from the Fairview Range Medical Center, the only hospital in Hibbing, one of 12 owned by Fairview Health Services a hospital-clinic chain that sprawls over the eastern half of Minnesota. 

Warren was suffering from fever, chills and stomach pain. A nurse practitioner at the Essentia clinic, Sherry Simon, drew some blood from Warren and sent it to a lab. That afternoon the lab reported that “Warren had unusually high levels of white blood cells, as well as other abnormalities,” as the court put it (p. 3). (Unless I note otherwise, “the court” refers to the Supreme Court, not the Court of Appeals.) Simon concluded, naturally enough, that Warren had an infection and needed to be hospitalized immediately. However, rather than send Warren straight to the ER of the Fairview Range Medical Center, Simon called the hospital “to seek Warren’s admission.” (p. 3) Simon’s call was routed to Dr. Richard Dinter, one of three hospitalists on call that day. 

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Why Mentors Matter: Navigating When There Are Many Alternatives


For people starting out in their careers or contemplating a mid-career change, an honest conversation with a mentor can make a big difference. Mentoring seems to have gone out of fashion in a tech-driven world where nearly instantaneous feedback from wide networks of “friends’ seems to have taken the place of confidential conversation with older people. But reflecting on my own career, I can say with certainty that mentors made a huge difference. And I was lucky enough to have three of them, at different stages of my career. I am grateful to them for helping me navigate in a changing world.

Graduate School

As an undergraduate at Reed College in the late 1960’s, I became interested in social science research, specifically how institutions selected out types of people by their personalities and interests. While my academic work focused on classics and psychology, a research project on Reed’s brutal attrition rate (only a little more than a third of people who entered Reed as freshmen graduated in four years) that sought out the selection factors that predicted “success”, at least surviving the four years of a very intense undergraduate experience.

This work brought me in contact with Professor David Riesman at Harvard, whose 1954 book “The Lonely Crowd” made him a leading public intellectual and social critic (and landed him on the cover of Time). “Lonely Crowd” decried the erosion of individualism and the rise of the “other directed” personality in America. This work eerily presaged (by a mere fifty years) today’s obsessive internet-driven hunger for the approval of strangers. Reisman, who was then in his early 60’s, had come to Harvard, and had become a leading sociologist of higher education. I sent him my Reed research to see what he thought, and the correspondence led to a friendship that stretched over the next thirty years.

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Congress Needs to Support a Competitive Healthcare Market


With the 116th Congress actively discussing several healthcare topics, now is an opportune time to discuss how we can move our country to a truly value-based healthcare system that better serves patients’ needs. One of the most pressing issues affecting where and how patients access care remains the unchecked pace of hospital mergers and acquisitions. Not only are physicians like me concerned with this trend, most Americans are worried about the rate at which hospitals are purchasing independent physician practices, which they see as a threat to affordable care.

As a urologist who has fought for the rights of independent physicians for years, it is clear we can no longer allow hospitals to monopolize the conversation about care delivery, the organization of resources and the best reimbursement strategies. For too long, Americans have considered hospitals to be benevolent organizations more concerned with patient health and community service. The truth, as any informed observer of healthcare knows, is quite the contrary: hospitals are no different than any other business seeking to monopolize its service area and increase revenues. Multiple studies show that hospital consolidation in a market increases prices and reduces options for purchasers of health services, which includes self-insured businesses, insurers, government programs and individual patients.

For our patients, the increasingly rapid rate of hospital consolidation is leading to fewer and fewer options for care. Across the country, patients are less satisfied, less trusting and more concerned about the future of their healthcare than ever. In fact, a recent poll found that the majority of patients (65 percent) trust an independent physician to give them the best recommendation over those employed by hospital systems. Even worse, lesscompetition due to mergers has been shown to affect care quality. For example, Medicare beneficiaries who experienced a heart attack were more likely to die within one year of treatment if they were treated by a hospital that faced few potential competitors, compared to patients in the most competitive areas.

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