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Dr.-pt. relationship is sine qua non for hospital liability. (Hospital Law Case of the Month).

CASE ON POINT: Sterling v. Johns Hopkins Hospital, 2002 WL1401872 A.2d -MD

ISSUE: Ordinarily, a hospital is liable for the negligence of its employees and others working at the hospital. The liability is predicated upon the legal doctrine of Respondeat Superior pursuant to which all employers are liable for the negligence of their employees. In this extraordinary Maryland case, an obstetrical patient who was in severe distress presented herself to a hospital which did not have adequate facilities to care for her or her newborn. It was expected that the baby would have serious complications. As a result, the patient was transferred to a second hospital. After the patient lost her child, she brought suit against her obstetrician as well as the first and second hospital that treated her. The case against the patient's obstetrician and the hospital, which initially treated her, was settled. The case against the transferee hospital proceeded to trial. The threshold issue in the case was whether or not the receiving hospital could be liable absent a physician-patient relationship with one of its physicians.

CASE FACTS: On August 2, 1993, Laverne Sterling, who was pregnant was admitted to Peninsula Regional Medical Center (PRMC). As a result of complications surrounding the patient's pregnancy, the patient was transferred to Johns Hopkins Medical Center. After the patient's death, the personal representative of the patient's estate brought suit against PRMC, Dr. Gray, and Johns Hopkins. After motions for summary judgment by PRMC and Dr. Gray were denied, the suit against them was settled leaving Johns Hopkins as the sole defendant. The hospital filed a Motion for Summary Judgment on the grounds that there was no physician-patient relationship between any of its physicians and the patient. After a hearing, the Circuit Court entered judgment in favor of the hospital. The patient's representative appealed.

COURT'S OPINION: The Court of Special Appeals of Maryland affirmed the judgment of the lower court. The court held, inter alia, that the duty of care owed to an individual is based primarily on the existence of a physician-patient relationship. Inherent in the concept of a duty is the concept of the relationship between the parties out of which the duty arises. The court noted that before a physician may be found liable for an act of medical malpractice, it is essential that a physician-patient relationship be in existence at the time the alleged act of medical malpractice occurred. With the exception of circumstances in which a physician acts gratuitously or in an emergency situation, recovery for medical malpractice is permitted only when a physician-patient relationship has been established, and there has been a breach of professional duty to a patient.

LEGAL COMMENTARY: It is beyond cavil that a physician-patient relationship may be created through an implied contract. The relationship between a physician and patient may result from an express or implied contract, either general or special, and the rights and liabilities of the parties thereto governed by general contract law. However, the existence of the relationship does not have to rest on any express contract between the physician and patient. The voluntary acceptance of the physician-patient relationship by the affected parties creates a prima facie presumption of a contractual relationship between them. The court found that it was axiomatic that a physician-patient relationship may arise from, briefly exist, and be limited by the unique circumstances presented in a transfer situation. Otherwise, a hospital's requirement for physician approval of patient transfers would require a patient to subject herself to the physician's medical decision whether to transfer her without imposing any obligation on the physician to make that decision in a responsible manner. The court held, and in doing so was mindful that it was elaborating in the field of medical malpractice, that a physician-patient relationship can exist by implication between an emergency room patient and an on-call physician who is consulted by the patient's physician, but who has never met, spoken with, or consulted with the patient when the on-call physician (1) participates in the diagnosis of the patient's condition, (2) participates in or prescribes a course of treatment for the patient, and (3) owes a duty to the hospital, staff, or patient, for whose benefit he is on call. The court concluded that in the absence of an express agreement "on-call" means nothing more than that. The physician acting on behalf of Johns Hopkins hospital did not exercises control over the hospital resident's actions on a regular basis. In the final analysis, however, a physician-patient relationship may arise by implication.

A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the Rhode Island law firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in the American Law.
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Article Details
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Author:Tammelleo, A. David
Publication:Hospital Law's Regan Report
Article Type:Brief Article
Geographic Code:1U5MD
Date:Jul 1, 2002
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