The physician as a public health officier

International Academy of Cosmetic Dermatology

THE PHYSICIAN AS A PUBLIC HEALTH OFFICIER

Brown vs. Purdy, 54, New York, Superior Court Reports for 1885, page 109

It was an action for damages for the removal of the plaintiff by the public authorities to the small-pox hospital and the facts of the cases were as follows:  – Dr. A. E. M. Purdy, a physician of high standing and ex president of the County Medical Society, was called to see Miss Brown, a florist on 6th Ave., in Nov, 1879.  The patient had a slight eruption on the face and elsewhere which both Dr. Purdy and his father, Dr. A. S. Purdy, suspected to be small-pox.

In accordance with the law which made I the duty of every practicing physician to report in writing to the Board of Health within twenty four hours every patient ascertained or unsuspected to have any “pestilential, contagious or infectious disease,” a report was made and Dr. Lockwood, an inspector for the Health Department, saw the patient, made a diagnosis of small-pox and ordered her removal to the hospital.  Some time after this suit was brought, the plaintiff claiming that proper care and skill had not been used, that she had been forcibly removed from her residence during severe and inclement weather and that she was not suffering from small-pox but from an eczema of the face resulting from the application of a lotion containing hop and dilute glacial acetic acid.

Since Dr. Purdy did not treat the patient and simply obeyed the law in reporting the case to the Health department and since it was the Health inspector who ordered her sent to the cover in what respect Dr. Purdy could be held in the slightest degree culpable.  But the judge submitted the case to a jury who, listening with sympathetic ears to the story of the rain and wet clothing on the trip to the hospital and doubt on the part of the attending physician as to whether the case was one of varioloid or eczema decides that as it seemed to be difference between a possibly rich doctor and a woman in moderate circumstances the proper thing would be to award her, not the ten thousand dollar which she claimed as damages, but a trifling sum as a slight recompense for her misfortune.

The physicians of New York on learning of this verdict were all greatly interested and for the most part indignant.  They felt that if they were required to report every case of undoubted or even suspected small-pox, they should not be thereby rendered liable to ay suit for damages and loud protests against such an injustice were freely expressed.

In the trial of the case in 1885 Prof. Austin Flint (senior), Prof. Edward L. Keyes and I were called as expert witnesses.  Of course we had not seen the patient and were simply asked to testify to a hypothetical case in which a chill, fever subsiding with the outbreak of the eruption, one or two umbilicated vesicles and lesions upon the hard palate and pharynx would point to a mild attack of varioloid and not to an artificial eczema produced by irritation.

The plaintiff’s counsel was a gentleman with stentorian voice and well known as a very shrewd and extremely fierce cross-examiner.  On the witness stand the venerable Dr. Flint, on account of his age and great reputation, was treated a show of suavity while Dr. Keyes was subjected to a grueling catechism.  Having been recently made a Professor of Skin Diseases and being the youngest of the experts I well knew what was in store for me and no reason to feel disappointed when my cross examination was concluded.  But I had resolved to keep my cool under all circumstances, to answer questions deliberately and in as few words a possible and survived the ordeal.  But I well remember how annoying it was to have my answers repeated with a verbal twist which made them sound like the very opposite of what I had said.   And when I testified that something was so I recall the thunderous tone with which the question was hurled at me “Didn’t you hear Professor Flint testify that it was not so?” evidently with the intention of disconcerting me and thereby weakening my testimony.”

This case of Brown vs. Purdy was appealed and the judgment was reversed by the General Term, Dec. 1886.(1)

Comment
This case brings to the fore the role  of a physician as a public health officer.  In New York State  during the 21st century, the role of the physician as a public health official surfaces in cases where syphilis is diagnosed.  Because syphilis is a “reportable” disease, a reactive RPR or positive ANA test result will be sent by the test laboratory to the New York City Health Department.  A health department officer will then contact the physician who ordered the test to ascertain if the patient has follow-up and if penicillin has been administered to the patient.  This health officer will contact the patient and ascertain the identity of the patient’s intimate contacts and follow-up to insure they are tested.

No cause of action lies against a doctor whose patient’s spouse is informed that the patient has syphilis by a public health officer.  The public interest trumps privacy.  This is not the cause with HIV infection.

Other instances in which the physicians play the role of public health official and even public health police, is in the case of tuberculosis.  The 2007 case of the lawyer with multidrug-resistant TB who eventually had to be hospitalized for a time under lock-and-key shows how seriously the state can take the interests of public health.  Dr Fox’s actions are consonant with the idea that patient care and public safety must be accounted for even if the mix is sometimes a bit uneven.

The fact that the case was decided one way and reversed on appeal shows the complex feelings that society has when asked to decide between personal health and liberty and society’s public health needs.

Reference:
1.  Fox, GH:  Reminiscences.   New York, Medical Life Press, 1926:204-7.

Noah Scheinfeld, MD, JD
New York, NY