Dr.'s immunity as state employee not lost by 'billing patient'.CASE ON POINT: Theobald v. University of Cincinnati The University of Cincinnati is a coeducational public research university in Cincinnati, Ohio. Ranked as one of America’s top 25 public research universities and in the top 50 of all American research universities, , 857 N.E.2d 573 -OH (2006)
CASE FACTS: Keith Theobald was seriously injured in·jure
tr.v. in·jured, in·jur·ing, in·jures
1. To cause physical harm to; hurt.
2. To cause damage to; impair.
3. in a motor vehicle accident motor vehicle accident Public health A morbid condition that kills 45,000/yr–US; 60% are < age 35; MVAs account for 500,000 hospitalizations and most 20,000 spinal cord injuries, at a cost of $75 billion/yr . He was taken to University Hospital (University). Dr. Frederick Luchette, the attending trauma surgeon on duty, began treating the patient. He contacted the hospital's neurotrauma department. The patient's care was assigned to Dr. Jamal Taha, the Interim Director of University's Neurotrauma Team. Because of the extent of the patient's injuries, Dr. Taha called Dr. Andrew Ringer, University's Chief Neurotrauma Resident. They determined that surgery was necessary. Drs. Taha and Ringer met with the patient's family and obtained consent for the surgery. Prior to surgery, a student nurse anesthetist nurse anesthetist
A person who, after completing the basic education of a nurse, is further trained in the supervised administration of anesthetics. , Amy Wehrman, prepared a preanesthesia note setting forth the patient's history and physical condition. Maureen Parrott, a Certified Registered Nurse Anesthetist (CRNA CRNA Certified Registered Nurse Anesthetist.
cRNA complementary RNA.
abbr. ), reviewed Wherman's note and discussed the plan for administering anesthesia with Wehrman and Dr. Harsha Sharma, the anesthesiologist Anesthesiologist
A medical specialist who administers an anesthetic to a patient before he is treated.
Mentioned in: Anesthesia, General, Appendectomy, Parathyroidectomy
anesthesiologist assigned to the case. The patient underwent ten hours of surgery in which Dr. Luchette, assisted by Dr. Steven Giss, a trauma resident, opened and closed the incision incision /in·ci·sion/ (in-sizh´un)
1. a cut or a wound made by cutting with a sharp instrument.incis´ional
2. the act of cutting.
1. , and Dr. Taha, assisted by Wehrman, administered anesthesia and monitored the patient's condition. When the patient awoke after surgery, he could not see, had lost the use of his right arm, and had little mobility in his left arm. In October 1999, the patient and his wife filed a suit for medical malpractice Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. against Drs. Luchette, Taha, Sharma, and Parrott, among others. They alleged that the defendants were negligent in providing medical care to the patient during and after his surgery. The defendants claimed that as state employees, they had personal immunity The term Personal immunity may refer to the following concepts.
COURT'S OPINION: The Supreme Court of the State of Ohio affirmed the judgment of the Court of Appeals and remanded the case for trial. The court limited the determination of whether the defendants were acting within the scope of their state employment when the patient was allegedly injured. The court observed that the plaintiffs acknowledged that the University had immunity from liability, regardless of the issue as to the physician-defendants. The court held, inter alia [Latin, Among other things.] A phrase used in Pleading to designate that a particular statute set out therein is only a part of the statute that is relevant to the facts of the lawsuit and not the entire statute. , that in a suit to determine whether a physician or other health-care practitioner is entitled to personal immunity from liability under Ohio law, the court must initially determine whether the particular practitioner is a state employee. If there is no express contract of employment, the court may require other evidence to substantiate an employment relationship with the state, such as financial and corporate documents, W-2 forms W-2 Form
The form that an employer must send to an employee and the IRS at the end of the year. The W-2 form reports an employee's annual wages and the amount of taxes withheld from his or her paycheck. , invoices, and other billing practices. If the court determines that the particular practitioner is not a state employee, the analysis is completed and personal immunity does not apply. If the court determines that the practitioner is a state employee, the court must next determine whether the practitioner was acting on behalf of the state when the patient was alleged to have been injured. If not, then the practitioner was acting "manifestly outside the scope of employment" for purposes of personal immunity.
LEGAL COMMENTARY: If there is evidence that a practitioner's duties include the education of students and residents, the court must then determine whether the practitioner was, in fact, educating a student or resident when the alleged negligence occurred. A practitioner who has dual status as a private practitioner and as an employee of a state medical institution is potentially immune from liability for medical malpractice only when he or she is performing duties for the state. Unless the employee of a state medical institution has acted "with malicious purpose, in bad faith or in a wanton Grossly careless or negligent; reckless; malicious.
The term wanton implies a reckless disregard for the consequences of one's behavior. A wanton act is one done in heedless disregard for the life, limbs, health, safety, reputation, or property rights of or reckless manner," or manifestly outside the scope of employment, personal immunity is applicable. Years ago, courts analyzed billing procedures as well as other financial factors, including the comparison of a practitioner's financial gain, with the state institutions financial gain from medical treatment. However, that is no longer the case. Courts now focus on the physician's role at the time of the treatment in question ando place less emphasis on financial factors. The court rejected the plaintiffs' request to adopt a bright-line test based on a health-care practitioner's billing practices to determine whether the practitioner's actions were manifestly outside the scope of employment. A dissenting opinion dissenting opinion n. (See: dissent) was filed.
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