Lead Opinion
delivered the opinion of the Court,
, We must decide in this case whether a physician owes a duty to third parties to warn an epileptic patient not to drive or to report the patient’s condition to state authorities that govern the issuance of drivers’ licenses. We conclude that we should not impose a duty that is owed to third parties and accordingly reverse the judgment of the court of appeals in part and render judgment that the plaintiffs take nothing.
I
Ronald Peterson, an epileptic, suffered a grand mal seizure while driving and broadsided a vehicle driven by Terri Lynn Praesel, who died from the injuries she sustained. Her husband andmother, Stan Praesel and Louise Herbert, brought this suit against three physicians who had treated Peterson, Drs. Raymond Johnson, Jr., Stephen Waller, and Hans Wendenburg, and against the Sad-ler Clinic and Doctor’s Hospital where Peterson had been treated prior to the collision.
Dr. Johnson is board-certified in Family Practice and first saw Peterson approximately seven years before the accident that resulted in Terri Lynn Praesel’s death. Peterson’s medical history indicated that he had suffered from epileptic seizures since the age' of nine but that for an extended length of time before his first consultation with Dr. Johnson, his seizures had been controlled with Dilantin and Phenobarbital. Johnson periodically checked the levels of medication in Peterson’s bloodstream, which were within therapeutic ranges on each occasion, and Peterson experienced no seizure activity until May and June of 1986, approximately four and one-half years before the accident. Dr. Johnson admitted Peterson to a hospital at that time because of seizures and referred him to a neurologist, Dr. Stephen Waller. Dr. Johnson thereafter treated Peterson for a number of ailments and complaints, most of which were unrelated to epilepsy, and did not prescribe anticonvulsant medication for him. That was done by the two other physicians who are defendants in this case. However, Johnson did continue to monitor the Dilantin levels in Peterson’s bloodstream.
Seven days before the collision with Prae-sel, Peterson saw Dr. Johnson and complained of flu-like symptoms. Johnson prescribed medication for that condition and again checked the serum level of Dilantin to ensure that it was within the therapeutic range. Dr. Johnson’s records contain no indication that Peterson had experienced any seizures from June 1986 until the collision with Terri Lynn Praesel in 1991, and it is conceded that Dr. Johnson was not advised of any seizures after June 1986. However, Peterson had reported to another physician, Dr. Wendenburg, that he had a seizure in April 1990, ten months before the accident. Peterson did not volunteer that information to Dr. Johnson. One of the allegations of negligence in this case is that during the
Dr. Waller, the neurologist who was called in by Dr. Johnson when Peterson was hospitalized in 1986, treated Peterson’s epilepsy until approximately one year before the collision. The hospital records indicate that in 1986, Dr. Waller instructed Peterson not to drive, although Peterson disputes that he was ever warned not to drive by any of the defendants in this case. By October 1989, Peterson had been seizure-free for over three years, and Dr. Waller asserts that he told Peterson there was “no reason either medically or legally why he [Peterson] should not be driving.”
Dr. Waller prescribed Dilantin and Phenobarbital during the three years that he treated Peterson and was satisfied that the medication was taken as directed. Waller last saw Peterson in 1989, and last rendered medical services to Peterson in March 1990 when he authorized a refill of a prescription for Phenobarbital. Waller did not learn about the following month’s seizure until after Terri Lynn Praesel’s death.
Peterson began seeing a third physician, Dr. Wendenburg, approximately one year before the collision. Wendenburg, a neurosurgeon, treated Peterson for pain in his neck, shoulders and arm, and performed surgery to repair a ruptured disc. During the course of this treatment, Wendenburg ordered a myelogram, and Peterson suffered a seizure several days after the procedure. This was the April 1990 seizure that occurred ten months before the collision. Wendenburg contends that upon learning of the episode, he warned Peterson not to drive and advised him to confer with the physicians treating him for epilepsy. Peterson denies that any warning was given. Although Wendenburg primarily treated Peterson for problems unrelated to epilepsy, Wendenburg prescribed Phenobarbital and Dilantin for Peterson seven months before the collision.
Stan Praesel and Louise Herbert allege that each of the physicians was negligent in failing to warn Peterson that he should not drive, in failing to inquire of Peterson whether he had experienced seizures, and in failing to contact the state Medical Advisory Board regarding Peterson’s condition pursuant to former Texas Revised Civil Statute article 6687b.
The court of appeals affirmed the summary judgments with respect to Johnson, Waller, and the Sadler Clinic, but reversed the summary judgment in favor of Wenden-burg, with one justice dissenting.
For the reasons we consider below, we agree with the court of appeals that Johnson, Waller and the Sadler Clinic owed no duty to third parties. However, the court of appeals erred in concluding that Wendenburg owed a duty to third parties to warn Peterson not to drive. We further hold that physicians do not owe a duty to third parties to report an epileptic’s condition to state authorities that issue drivers’ licenses.
Under the common law, a cause of action for negligence has three elements: 1) a legal duty; 2) a breach of that duty; and 3) damages proximately resulting from the breach. See Greater Houston Transp. Co. v. Phillips,
We have on at least one occasion looked to enactments by the Legislature to determine if a civil tort duty should be imposed. Nixon v. Mr. Property Management Co.,
The Legislature has established a Medical Advisory Board to “assist the Department of Public Safety of the State of Texas in determining whether ... an applicant for a driver’s license or a license holder is capable of safely operating a motor vehicle.” Tex. Health & Safety Code § 12.092(b). The rules of the Department of Public Safety provide that persons “holding a Texas drivers license and having a physical or mental condition, the extent of which cannot be determined by the department,” are referred by the Department to the Medical Advisory Board for further evaluation. 37 Tex. Admin. Code § 15.58. The Department’s rules contain guidelines for referral that include epileptic seizures:
(F) Neurological disorders. All applicants who have had an epileptic seizure within the past three years or are under the care of a physician for any other seizure, dizzy spell, or similar disorder.
Id. § 15.58(1)(F). The term “under the care of a physician” is defined as
having been referred to for treatment or having received treatment from a physician for the medical condition or conditions indicated in the past 12 months without a release from further treatment. This does not apply to a condition(s) diagnosed over 12 months ago and treatment consisting of only periodic visits for check up and maintenance.
Id. § 15.58(4)(A). These same regulations were in effect at the time Peterson’s car collided with Praesel’s.
Treating physicians are permitted by statute, but are not-required, to inform the Department of Public Safety or the Medical Advisory Board of the name, date of birth, and address of a patient “whom the physician has diagnosed as having a disorder specified in a rule of the Department,” which would include patients with epilepsy. Tex. Health & Safety Code § 12.096(a)
A patient’s license is not automatically revoked when a physician does report information. If the Department requests an opinion from the Medical Advisory Committee, a three-person panel is convened, and each panel member is required to prepare “an individual independent written report” stating the member’s “opinion as to ability of the ... license holder to operate a motor vehicle safely.” Tex. Health & Safety Code § 12.095. The panel may require the license holder to undergo a medical examination. Id.
In those instances in which we have determined that it would be appropriate to base civil liability on a statute, the standard of conduct has been clearly defined, and the injury at issue grew directly out of a breach of that standard. See Carter v. William Sommerville and Son, Inc.,
Many of the statutes that this Court has utilized to establish a standard of conduct for civil tort liability have been criminal laws. See generally Parrott,
We have looked at the purpose of the statute and at whether it was enacted to protect the class of persons to which the injured party belongs “‘against the hazard involved in the particular case.’” Parrott,
Another element this Court has generally required before imposing civil liability for breach of a statutory standard of conduct is that the “ ‘alleged conduct ... would be considered substandard even in the absence of statute.’ ” Parrott,
An additional consideration in determining whether a duty should be recognized based on a statute is whether compliance with the statute would directly protect the class of persons to which the injured party belongs. A report to the Medical Advisory Board by a treating physician does not translate into automatic revocation of the patient’s license. The Board can recommend that a driver be permitted to retain a license even if there has been a seizure within three years. See 37 Tex. Admin. Code § 15.58(F) (setting out guidelines for referral to the Board); Tex. Health & Safety Code § 12.095 (providing that each member of a three-person panel must give their independent opinion of whether a license holder is able to operate a vehicle safely).
“adopt[ed] the statutory test rather than that of the ordinarily prudent man as the more accurate one to determine negligence because the Legislature, by reason of its organization and investigating processes, is generally in a better position to establish such tests than are the judicial tribunals.”
Parrott,
We conclude that section 12.096 of the Texas Health and Safety Code provides no sound basis for imposing negligence per se for failing to report an epileptic seizure to state licensing authorities. We next consider whether, separate and apart from the statute, we should create a common-law duty to third parties to warn a patient not to drive.
Ill
This Court has generally limited the scope of the duty owed by physicians in providing medical care to their patients. Recently, we held in Edinburg Hospital Authority v. Trevino,
Similarly, in Bird v. W.C.W.,
In Bird, we cited two decisions of the courts of appeals that had concluded mental health professionals who misdiagnosed sexual abuse did not owe any duty to third parties. See
This Court has not yet determined whether mental health practitioners have a duty to an identifiable victim of a patient. We did not reach that issue in Kerrville State Hospital, although four dissenting Justices would have imposed a duty. See Kerrville State Hosp. v. Clark,
The two Texas cases that have considered a physician’s duty in the context of facts closer to this case are Flynn v. Houston Emergicare, Inc.,
The court in Gooden v. Tips reached a different conclusion, A physician had prescribed Quaalude to a patient with a history of drug abuse but had faded to warn her not to drive. Relying on decisions from other jurisdictions, the court of appeals held that there was a duty owed to third parties. Gooden,
The court of appeals in this case relied on Gooden and on Freese v. Lemmon,
In deciding whether to impose a common-law duty, this Court has applied the familiar factors identified in Graff v. Beard,
All parties and the court of appeals have recognized that none of the physicians had the right or the ability to control the conduct of Peterson. We have observed in other contexts that as a practical matter, it would be very difficult for someone to prevent another from driving in an impaired condition. See Graff,
We do not presume, as the concurrence suggests, that those who suffer from epilepsy would be negligent per se if they have a seizure while driving and injure third parties. It is, however, relevant to our inquiry that those suffering from epilepsy have some responsibility under the law to determine whether it is lawful to drive. As just noted, a treating physician does not make that determination. It is made by the Department of Public Safety.
Praesel and Herbert argue that Peterson’s responsibility for his own actions should be left to comparative negligence. We do not hold that epileptics’ knowledge of their condition, in and of itself, is a bar to the liability of physicians. Rather, the relative knowledge of the risk as between a patient and a physician is another factor to consider in deciding the threshold question of whether a physician owes a duty to third parties to warn a patient.
In determining whether to erect a legal duty to warn, we must also consider the efficacy of that warning in preventing injury to third parties. We cannot simply assume that a person who is advised not to drive will actually respond and refrain from driving. See Graff,
Balancing both the need for and the effectiveness of a warning to a patient who already knows that he or she suffers from seizures against the burden of liability to third parties, we conclude that the benefit of warning an epileptic not to drive is incremental but that the consequences of imposing a duty are great. The responsibility for safe operation of a vehicle should remain primarily with the driver who is capable of ascertaining whether it is lawful to continue to drive once a disorder such as epilepsy has been diagnosed and seizures have occurred. Accordingly, we decline to impose on physicians a duty to third parties to warn an epileptic patient not to drive.
⅜ ⅜: # ⅜ ⅜
For the foregoing reasons, we reverse the judgment of the court of appeals in part and render judgment that the plaintiffs take nothing.
Notes
. See Act of April 14, 1941, 47th Leg., R.S., Ch. 173, 1941 Tex. Gen. Laws. 245, amended by Act of May 23, 1985, 69th Leg., R.S., Ch. 819, § 1, 1985 Tex. Gen. Laws 2875, 2876, amended by Act of May 1, 1989, 71st Leg., R.S., Ch. 95, § 1, 1989 Tex. Gen. Laws 422, recodified by Act of May 1, 1995, 74th Leg., R.S., Ch. 165, §§ 9, 24(a), 1995 Tex. Gen. Laws 1834, 1870, 1871.
. At the time of the collision, former Texas Revised Civil Statute article 6687b(21A)(d)(3) was in effect, which provided:
A physician who is licensed to practice medicine in Texas may voluntarily inform the department [of Public Safety] or the board, orally or in writing, of the full name, date of birth, and address of a patient over the age of 15 years whom he or she has diagnosed as having a disorder or disability specified in the rules of the department. The release of such information by the physician to the board is an exception to the patient-physician privilege requirements of Section 5.08 of the Medical Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
Act of April 14, 1941, 47th Leg., R.S., Ch. 173, 1941 Tex. Gen. Laws. 245, amended by Act of May 23, 1985, 69th Leg., R.S., Ch. 819, § 1, 1985 Tex. Gen. Laws 2875, 2876, amended by Act of May 1, 1989, 71st Leg., R.S., Ch. 95, § 1, 1989 Tex. Gen. Laws 422, recodified by Act of May 1, 1995, 74th Leg., R.S., Ch. 165, §§ 9, 24(a), 1995 Tex. Gen. Laws 1834, 1870, 1871.
It has since been codified in § 12.096 of the Health and Safety Code without any substantive change pertinent to our consideration here. For ease of reference, we refer to the current statutes.
Concurrence Opinion
concurring.
I join parts I and II of the Court’s opinion and the Court’s judgment in this case. I write separately because I disagree with the
At the outset, I am troubled by the Court’s conclusion that the doctors owed no duty because “the risk that a seizure may occur while driving and the potential consequences should be obvious to those who suffer from epilepsy.”
This case should not be decided on the basis that epileptics should know not to drive without being told by a doctor. Even if the Court is correct in making this assumption, it is unwarranted on this record and will have unforeseen effects in cases involving other medical conditions.
My greater concern, though, is how the Court' anguishes over whether the doctors had a duty to warn. The Court makes it clear that the Praesels do not claim that the doctors should have warned them; rather, they claim the doctors should have warned the patient. In short, the Praesels are bringing a third-party claim for breach of the doctors’ duty to the patient. We have rejected these types of claims time and time again. In fact, the Court today cites the seminal cases that hold that a health care professional’s duty is to the patient, not to a third party.
Edinburg and Bird should dispose of the issue. But the Court engages in an extended discussion about whether these doctors have a duty to warn. So I must point out that the duty to warn, if there is one, is to warn the third party directly, not the patient. Small wonder then that courts wrestle over whether such a duty exists when the third parties are not known. See Limon v. Gonzaba,
Also, the Court cites Gooden v. Tips,
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As we have held more than once, a doctor’s duty is to the patient, not a third party. I join parts I and II of the Court’s opinion and the Court’s judgment. Because I cannot join part III of the Court’s opinion, I respectfully concur.
. I concede we noted Gooden in Bird, but we neither applied its reasoning nor considered whether it was a correct statement of the law. Bird,
