Referrals are a standard part of medical care. Whether it’s sending a patient to a specialist, an imaging center, or a surgical facility, referrals happen thousands of times a day. But what happens when a patient is unhappy with the person or place you referred them to? Can that dissatisfaction morph into a lawsuit… against you?
The short answer: yes, a patient can sue. This is America. There’s nothing more American than apple pie and lawsuits. But the better question is whether such a lawsuit would hold water.
Let’s break it down.
Legal Theories Patients Might Try
If a patient believes they were harmed by someone you referred them to, they might look for a way to hold you responsible. The most common legal theories are:
- Negligent referral: This argues that the referring doctor should have known the person or facility they recommended was incompetent, unsafe, or otherwise unfit.
- Failure to warn: If you knew (or should have known) that a provider had red flags—such as revoked privileges, malpractice claims, or dangerous outcomes—you could be blamed for not disclosing that.
- Agency theory: If the referral was “in-house” or appeared to be part of your practice (even if legally separate), a patient might assume there’s shared responsibility.
While these claims are rare, they’re not imaginary. There have been lawsuits over referrals, especially when the second provider’s mistake led to a severe outcome and the referring doctor had reason to know the risk.
What Courts Often Consider
When courts examine these cases, they ask questions like:
- Was the referral part of the standard of care?
- Did the referring doctor have any reason to doubt the competence or safety of the provider?
- Did the doctor disclose any relevant conflicts of interest?
- Did the patient have freedom of choice?
Generally, as long as the referral is made in good faith, based on clinical judgment, and not in violation of anti-kickback or self-referral laws, the referring doctor is shielded from (practical) liability. But if you referred to someone with a known history of harm—or had a financial stake you failed to disclose—you’ve opened the door. Even with the door open, you are still likely to prevail.
Ways to Protect Yourself
- Document the referral rationale. Chart why you’re referring the patient—diagnostic need, specialist expertise, etc.
- Avoid referring to problematic providers. If a colleague has a known history of harming patients, think twice. This goes without saying. Why would you refer a patient to someone with a consistent bad track record? Still, anyone can make a mistake, so an occasional error should not be a reason to forever shun that doctor as a professional pariah
- Disclose relationships. If you have ownership in a facility or receive any benefit, let the patient know. In some states, you are mandated by law to do so.
- Offer options. Whenever possible, give the patient a choice of providers. That autonomy protects both of you.
- Check referral agreements. Be especially careful if you refer “in-house.” Make sure patients understand where your role ends and the next provider’s begins.
The Bottom Line
A patient’s dissatisfaction with a referral doesn’t automatically translate into liability. Dissatisfaction alone is not enough to trigger a successful lawsuit. The patient would have had to been harmed. And you would have had to breached assorted legal expectations to have caused that harm, even if chain of causality was long and tortuous. But if harm results—and if it turns out you referred someone with a checkered past or a conflict of interest—it could land in your lap.
Practicing good medicine includes making thoughtful referrals. The more transparent, documented, and patient-centered your approach, the safer you’ll be.
What do you think?
