Legislating for a New Age in Medicine: Defining the Telemedicine Standard of Care to Improve Healthcare in IowaNew Article

• Author: Bradley J. Kaspar
• Pages: 839-866

839

Legislating for a New Age in Medicine:

Defining the Telemedicine Standard of

Care to Improve Healthcare in Iowa

Bradley J. Kaspar

ABSTRACT: Telemedicine (also referred to as telehealth or e-health) is the

use of technology to connect patients and healthcare providers from a

distance, and it allows for accessible, efficient, cost-effective, and convenient

healthcare. Most states, including Iowa, have not updated their laws to

account for the rapid emergence of telemedicine. This leaves healthcare

providers uncertain of the legal implications of using telemedicine and thus

discourages its use for fear of malpractice liability. Iowa should define the

standard of care for telemedicine while balancing two public policy concerns.

First, it should seek to maximize the potential benefits of telemedicine,

including its accessibility, efficiency, cost-effectiveness, and convenience.

Second, it should seek to minimize the risks associated with telemedicine,

most notably the risk of misdiagnosis when a patient forgoes an in-person

examination by a physician. In legislating for this new age in medicine,

Iowa should follow the approach of Hawaii and adopt a standard of care

that recognizes the diagnostic disadvantage associated with telemedicine but

affirms liability for physicians that fail to comply with regulatory guidelines.

I. INTRODUCTION ...................................................................................... 841

II. BACKGROUND ........................................................................................ 843

A. TELEMEDICINE DEFINED ................................................................... 844

B. TRADITIONAL MALPRACTICE LAW .................................................... 845

C. APPLICATION OF TRADITIONAL MALPRACTICE LAW TO

TELEMEDICINE AND THE LEGAL UNCERTAINTIES THAT RESULT ......... 848

III. TELEMEDICINE STANDARD OF CARE: THEORIES AND IMPLICATIONS ..... 850

 J.D. Candidate, The University of Iowa College of Law, 2014; B.B.A. & B.S., University

of Wisconsin-Whitewater, 2011. I thank the members of Volumes 98 and 99 of the Iowa Law

Review for their diligent and skillful work on this Note. Most of all, I thank my mother and

father for their undying love, continued support, and endless inspiration.

840 IOWA LAW REVIEW [Vol. 99:839

A. DEFINITIONAL BOUNDS AND REGULATIONS OF TELEMEDICINE ............ 851

B. THE CUSTOM-BASED STANDARD VERSUS THE REASONABLE-

PHYSICIAN STANDARD ...................................................................... 853

C. THE LOCALITY RULE ........................................................................ 854

D. THE “COMPARATIVE VARIABLE” ....................................................... 854

1. Approaches to the “Comparative Variable” ......................... 855

2. Public Policy Concerns .......................................................... 857

a. Benefits of Telemedicine ...................................................... 857

b. Risks of Telemedicine .......................................................... 859

1. Mitigating the Risks of Telemedicine ..................... 860

2. Accepting Risk and Limiting the Liability of

Physicians to Achieve Public Policy Goals .............. 860

IV. DEFINING THE APPROPRIATE STANDARD OF CARE FOR

TELEMEDICINE IN IOWA ......................................................................... 861

V. CONCLUSION ......................................................................................... 864