Curbside consults are one of medicine’s most useful unofficial tools. A clinician catches a specialist in the sends a secure message asking, “Would you worry about this?” Within minutes, the treating professional may have a better differential diagnosis, a smarter testing plan, or reassurance that an urgent referral is unnecessary.
Then came Warren v. Dinter, a 2019 Minnesota Supreme Court decision that complicated the traditional assumption that an informal consultant cannot be liable because no physician-patient relationship exists. The ruling did not outlaw curbside medicine, nor did it automatically convert every colleague-to-colleague conversation into a formal consultation. It did, however, make one message unmistakably clear: labels such as “informal,” “professional courtesy,” and “not my patient” do not necessarily eliminate a physician’s duty of care.
That distinction matters because modern health care runs on collaboration. Clinicians routinely exchange advice across clinics, hospitals, transfer centers, electronic systems, and specialty hotlines. The Minnesota decision asks physicians and health systems to examine when a casual exchange stops being general guidance and becomes a professional decision on which another clinicianand ultimately a patientis expected to rely.
What Is a Curbside Consult?
A curbside consultation is an informal discussion in which one health care professional asks another for clinical guidance without arranging a traditional consultation. The consultant may not examine the patient, review the complete chart, enter a note, bill for services, or communicate directly with the patient.
The name suggests two doctors chatting beside an actual curb, perhaps while balancing coffee and pretending their pagers are not vibrating. In reality, today’s curbside consult may happen by telephone, secure text, email, electronic consultation platform, videoconference, or hospital transfer line.
Why Clinicians Use Informal Consultations
Curbside advice can improve access to specialty knowledge, especially in rural communities or facilities without every specialty on site. It may help a primary care clinician decide which tests should be ordered before referral, whether a medication adjustment is reasonable, or whether a patient needs immediate emergency care.
Research has also found that these conversations support care coordination and professional education. They may prevent unnecessary referrals while helping the treating clinician recognize cases that should be escalated. In other words, a good curbside consultation can save time, money, and several hours in a waiting room decorated with magazines from the previous decade.
The Built-In Limitations
The consultant normally receives a compressed version of the case. Important symptoms may be omitted, test results may be summarized incorrectly, and the question itself may steer the consultant toward a particular conclusion. Studies of informal consultations have identified incomplete information and limited documentation as recurring safety concerns.
A specialist who hears, “This looks like uncomplicated reflux, right?” is processing a differently framed problem than one who hears, “This patient has chest pressure, sweating, diabetes, and new electrocardiogram changes.” The patient may be identical; the mental doorway is not.
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The Story Behind Warren v. Dinter
On August 8, 2014, 54-year-old Susan Warren visited an Essentia Health clinic in Hibbing, Minnesota. She reported abdominal pain, fever, chills, and other symptoms. Nurse practitioner Sherry Simon ordered testing, which revealed a substantially elevated white blood cell count and additional abnormalities. Simon suspected an infection and believed Warren needed hospitalization.
Because the clinic did not operate its own hospital in Hibbing, Simon called Fairview Range Medical Center. The call was assigned to Dr. Richard Dinter, a hospitalist responsible for evaluating admission requests. The two clinicians spoke for approximately ten minutes, although they later disagreed about exactly what information was communicated and whether Simon formally requested admission.
According to Simon’s account, Dinter concluded that hospitalization was unnecessary and suggested that the abnormal results were probably related to diabetes. Warren was informed that the hospitalist did not believe admission was needed. She received medication and a follow-up plan and was sent home.
Three days later, Warren was found dead. The reported cause was sepsis associated with an untreated infection. Her son filed a professional-negligence lawsuit against Dinter and Fairview, alleging that the hospitalist’s conduct contributed to the failure to admit, diagnose, and treat her.
Why the Lower Courts Dismissed the Claim
Dinter and Fairview argued that he had merely offered his thoughts as a professional courtesy. He had not examined Warren, spoken with her, opened a formal chart, or established a traditional physician-patient relationship.
The district court agreed that Dinter owed no legal duty to Warren, characterizing the exchange as an informal conversation between medical colleagues. The Minnesota Court of Appeals affirmed that decision. Without a physician-patient relationship, the lower courts reasoned, there could be no malpractice duty.
What the Minnesota Supreme Court Decided
On April 17, 2019, the Minnesota Supreme Court reversed the dismissal and returned the case for further proceedings. The court held that a physician-patient relationship is not always required for a professional-negligence claim under Minnesota law.
The majority explained that a physician may owe a duty when the physician acts in a professional capacity and it is reasonably foreseeable that another person will rely on those actions and could be harmed by negligent conduct. Because Dinter allegedly functioned as the hospital’s admission gatekeeper, the court concluded that a fact-finder could determine that reliance by Simon and Warren was reasonably foreseeable.
Importantly, the Supreme Court did not decide that Dinter committed malpractice. It did not determine whether he breached the standard of care or caused Warren’s death. It decided that the case should not be dismissed solely because Dinter had never formed a conventional physician-patient relationship with her.
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Why This Was More Than an Ordinary Hallway Conversation
The broad language about foreseeability attracted attention, but the majority also included an important limitation. It said the decision should not be misunderstood as a ruling about ordinary informal advice between medical professionals.
In the court’s view, Dinter was not simply brainstorming possibilities. He was a hospital employee participating in a process established for admission decisions. Simon allegedly could not independently admit Warren. Dinter therefore occupied a position of authority that could determine whether Warren gained access to hospital care.
This means the most legally significant issue was not whether the conversation happened over a telephone or whether it lasted only ten minutes. The important question was what function the physician performed. A brief conversation can still carry enormous weight when the consultant controls admission, transfer, treatment authorization, or access to a specialized service.
The Dissent’s Warning
The dissenting justices argued that foreseeability had been stretched too far. They emphasized that Simon remained Warren’s treating professional and could have pursued alternative options, including emergency-department evaluation. From that perspective, Dinter could not reasonably have predicted that one limited conversation would end further investigation or attempts to obtain hospital care.
The dissent also worried that expanding duty beyond formal relationships could discourage clinicians from helping colleagues. A specialist who fears that every quick question creates liability might respond, “Schedule a formal consult,” even when a two-minute discussion could safely guide care.
That concern is not imaginary. Informal consultation works partly because it is fast and accessible. If every exchange requires complete chart review, documentation, patient consent, credentialing checks, and seventeen clicks in an electronic record, the curbside consult may become a formal consult wearing casual shoes.
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How the Decision Could Affect Curbside Consult Liability
1. The Name of the Conversation Is Not Decisive
Calling an exchange “informal” does not guarantee that a court will treat it that way. A court may examine the substance of the interaction, including the consultant’s role, the specificity of the advice, the authority attached to it, and whether reliance was predictable.
A general discussion about how a specialist commonly manages a condition is less likely to resemble direct patient care. A recommendation that an identifiable patient should not be admitted, transferred, tested, or treated may sit much closer to the liability line.
2. Foreseeable Reliance May Matter More Than Direct Contact
The Minnesota Supreme Court rejected the idea that personal contact is always necessary. A consultant may never see or speak with the patient and still make a decision that predictably shapes the patient’s care.
For example, suppose an on-call neurologist tells an emergency physician that a particular patient does not require transfer to a stroke center. If the neurologist is the designated transfer decision-maker, it may be foreseeable that the emergency team will rely on that conclusion. The absence of a handshake does not erase the practical effect of the decision.
3. Gatekeeping Roles Carry Greater Risk
Physicians who approve or deny admissions, transfers, procedures, specialty evaluations, or access to treatment may face different exposure than colleagues offering broad educational advice. Their decisions can directly open or close a path to care.
Hospitals should therefore distinguish informal teaching conversations from operational decisions made under institutional protocols. A transfer-center call may sound conversational, but it can function as a formal clinical process with serious consequences.
4. Specific Recommendations Increase the Stakes
There is a meaningful difference between saying, “In general, patients with that laboratory pattern sometimes need additional testing,” and saying, “This patient does not need admission; send her home.” The second statement is patient-specific, directive, and easier to rely upon as a definitive recommendation.
Consultants who lack sufficient information should state their limitations clearly. “I cannot determine disposition without reviewing the chart and examining the patient” is less likely to be mistaken for a fully informed clinical decision than an unqualified yes-or-no answer.
5. State Law Still Matters
Warren v. Dinter interprets Minnesota law. Other states may use different tests for determining whether a duty exists, and many have historically placed greater emphasis on establishing a physician-patient relationship.
Nevertheless, the ruling may be persuasive when courts elsewhere consider similar disputes involving telemedicine, electronic consultations, transfer centers, remote specialists, and collaborative care. Clinicians should not assume that the old rule“no formal relationship, no duty”will be applied uniformly across the country.
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How Clinicians Can Make Informal Consultations Safer
Clarify the Question and the Consultant’s Role
At the beginning of the conversation, identify whether the treating clinician wants general education, advice about testing, assistance with triage, or a formal decision. Consultants should be especially cautious when they are being asked to approve or deny access to care.
A useful opening might be: “Are you asking for general guidance, or do you need me to make an admission or transfer decision?” That sentence is not glamorous, but neither is a deposition.
Provide a Structured Clinical Summary
The requesting clinician should communicate the patient’s age, relevant history, symptoms, vital signs, examination findings, laboratory results, imaging, treatment already provided, and reason for concern. Critical negatives and uncertainty should be included rather than quietly left in the waiting room.
Closed-loop communication can reduce misunderstanding. After receiving advice, the requesting clinician should summarize the plan: “To confirm, you recommend emergency evaluation now rather than outpatient follow-up tomorrow.” The consultant can then correct any inaccurate interpretation.
Know When to Convert the Curbside Into a Formal Consult
An informal exchange should become a formal consultation when the patient is unstable, the diagnosis is uncertain, the decision carries substantial risk, essential records must be reviewed, or the consultant’s recommendation will determine admission, transfer, discharge, or treatment.
The same is true when the discussion becomes lengthy or repeatedly returns to the same patient. When the consultant is effectively directing management, maintaining the fiction that the conversation is merely educational benefits no one.
Document High-Impact Decisions
Documentation expectations vary by institution and situation, but important clinical decisions should not disappear into the mist. The treating clinician should accurately record whom they contacted, the information provided, the advice received, and the resulting plan.
When a consultant participates in a formal operational decision, the health system should provide a reliable method for documenting that involvement. A short, accurate note is generally more useful than reconstructing a ten-minute conversation several years later from memory and call logs.
Avoid False Reassurance
Consultants should avoid definitive recommendations when the available information is incomplete. They can explain which findings would change the recommendation and identify warning signs that require escalation.
For example: “Based only on what you have described, outpatient care may be reasonable, but I have not examined the patient. New hypotension, confusion, worsening pain, respiratory distress, or concern for sepsis should trigger immediate emergency evaluation.”
Build Better Institutional Policies
Health systems should create clear rules for transfer calls, admission requests, e-consults, and specialty hotlines. Policies should identify who has decision-making authority, what information must be exchanged, when documentation is required, and how disagreements are escalated.
The goal should not be to eliminate curbside consults. The goal should be to preserve their speed and educational value while recognizing when a conversation has become a consequential clinical decision.
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Practical Experiences: Life After the Curbside Consult Warning
The following composite scenarios reflect common clinical situations and illustrate how the lessons of Warren v. Dinter can be applied. They are educational examples rather than accounts of specific patients.
Experience One: The “Quick” Cardiology Question
A primary care physician calls a cardiologist about a patient with intermittent chest discomfort. The initial question sounds simple: “Can this wait for an office appointment?” Before answering, the cardiologist asks for the patient’s age, risk factors, current symptoms, vital signs, electrocardiogram findings, and whether troponin testing is available.
The additional details reveal that the patient has diabetes, active pressure-like discomfort, and new electrocardiogram changes. What began as a curbside request becomes an emergency referral. The cardiologist does not need to write a novel, but the physician records the conversation and confirms that the patient is being transported.
The lesson is that a consultant should resist answering a disposition question from a headline. The words “chest discomfort” can describe heartburn, unstable angina, or the consequences of eating gas-station sushi. Context is not decorative.
Experience Two: The Rural Transfer Call
A clinician at a small hospital calls a regional intensive care unit about a patient whose blood pressure is falling. The intensivist initially offers treatment suggestions while waiting for updated laboratory results. As the discussion progresses, it becomes clear that the rural team is asking whether the regional center will accept the patient.
At that moment, the nature of the interaction changes. The intensivist is no longer merely sharing general knowledge; the physician is participating in a transfer decision that may determine access to higher-level care. The parties use the transfer-center protocol, document the relevant findings, identify the accepting service, and agree on what should happen if the patient deteriorates before transportation arrives.
The practical lesson is simple: recognize the transition from advice to authority. The same telephone call may contain both, and liability does not politely ring a bell when the border has been crossed.
Experience Three: The Secure-Message Trap
A clinician sends a specialist a photograph and a short message about a patient’s skin lesion. The specialist replies, “Probably benign.” The treating clinician interprets this as a definitive diagnosis and tells the patient no follow-up is needed.
Months later, the lesion has changed. On formal evaluation, the specialist learns that the original message omitted rapid growth, bleeding, and a history of melanoma. The consultant’s two-word reassurance now looks much more confident than the information justified.
A safer response would have explained the limits of image-only review: “The photograph is somewhat reassuring, but I cannot exclude malignancy without history and examination. Given the reported change, arrange an in-person dermatology assessment.” The extra sentence takes seconds and may prevent the recipient from treating a tentative impression as a final answer.
Experience Four: When the Consultant Says No
Admission and transfer disagreements require an escalation pathway. If a hospitalist declines admission but the treating clinician remains concerned, the conversation should not end with a shrug and an entry in the unofficial competition for shortest phone call.
The treating professional can request clarification, involve the emergency department, contact another appropriate service, seek a second opinion, or escalate the disagreement through established leadership channels. Meanwhile, the patient should receive a safe interim plan, explicit return precautions, and timely reassessment.
Warren v. Dinter does not remove the treating clinician’s responsibilities. Instead, it highlights that responsibility may be shared when another professional makes a foreseeable, high-impact decision. Good teamwork requires each participant to understand what decision was made, who made it, what information supported it, and what happens next.
Conclusion
The Minnesota Supreme Court’s decision did not announce the death of curbside medicine. It rejected a rigid shield that would have made the absence of a formal physician-patient relationship automatically decisive, regardless of the consultant’s actual role.
The ruling is most significant when a physician acts professionally, makes a patient-specific decision, controls access to care, and can reasonably expect others to rely on that decision. Ordinary educational conversations remain distinguishable, but merely calling a decision “informal” will not change what it accomplishes in practice.
For clinicians, the safest response is not silence. It is better communication: clarify the question, identify limitations, avoid unjustified certainty, document consequential decisions, and convert informal advice into a formal consultation when the stakes demand it. Curbside consults can remain valuable, but they should be treated like clinical tools rather than magical conversations that leave no fingerprints.
