What is the nature of the contractual/fiduciary relationship with the patient?
This may be compared to the hospital – doctor – patient situation. (See below) (a) Fiduciary The doctor – patient relationship is a recognised category of fiduciary relationship. Where a fiduciary relationship exists, the fiduciary, in this case the doctor, is bound to act for the benefit of the principal, in this instance the patient such that the fiduciary cannot allow any personal interest to conflict with his or her duty to the principal. Thus, it is a relationship of the utmost good faith, where the rights of the patient are recognised as paramount, and protected accordingly. A health care institution such as a hospital owes independent, non-delegable duties of care to the patient. By analogy, a managed care organisation would arguably owe such duties and thus owe independent fiduciary duties to the patient. Therefore, a managed care organisation would owe a duty not only to take reasonable care but to ensure that reasonable care was taken by the doctor. (b) Contractual The doctor
