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WSHB Case Update: California Court of Appeal Mandates that Issue of Ostensible Agency in Emergency Room Setting is for Trier of Fact

June 10, 2015

Witlaw v Rideout Memorial Hospital (June 9, 2015) 3rd App Dist. C074810 Cert. for Partial Publication.

Why This Case is Important

Hospitals may not escape liability for its emergency room physicians and other independent contractor practitioners, despite giving notice of independent contractor status through admission papers, signage in emergency room, and insignia on clothing.

Holding

Despite hospital’s attempt to ensure that the patient should have known that the treating physician was not the hospital’s agent, (pursuant to the standards of Mejia v. Community Hospital of San Bernardino (2002) 99 Cal. App. 4th 1448,) the Third Appellate District Court of Appeal found that, in an emergency room setting, admission papers, signage in the emergency room, and insignia on the physician’s clothing notifying the patient that the emergency room physician was an independent contractor and not an agent of the hospital, did not constitute sufficient notice and placed an unreasonable burden on the presenting patient, who presumably is impaired and in distress at the time of admission.

The Court of Appeal found it unreasonable for a hospital to expect that a patient in an emergency room situation will comprehend the meaning and extent of its representation as to agency. Such expectation imposes an unfair and improper burden on the patient. In an emergency room, the patient looks to the hospital for care, rather than to the individual physician. The patient presents to the emergency room for services and accepts those services that are to be provided by the assigned physician. The patient who is impaired and distressed cannot reasonably be expected to discern from boilerplate advisement that the physician is not a hospital agent.

Impact of Decision

This decision creates a more stringent hurdle to overcome on the issue of agency in the emergency room setting based upon the nature of the patient’s urgent care needs and medical status when presenting to the emergency department.

In this wrongful death action, the surviving heirs brought suit against the hospital as a result of the failure of its emergency room physician to diagnose a massive left temporal hemorrhage. The trial court granted defendant Rideout Memorial Hospital’s Motion for Summary Judgment, finding that the emergency room physician, who failed to diagnose and treat decedent’s brain hemorrhage, was not an ostensible agent of the hospital. The Court of Appeal reversed the trial court’s decision. On appeal, the surviving heirs argued that, despite the hospital’s boilerplate admission papers, the signage suggesting that the emergency room physicians were independent contractors, and the insignia on the physician’s clothing indicating membership in a medical group, a triable issue of fact existed as to the state of mind of the decedent.

In this regard, the Court of Appeal found that triable issues of fact existed as to whether the decedent entrusted herself to the hospital, whether the hospital selected the physician, whether the decedent reasonably believed that the physician was an agent of the hospital, and whether the admission forms and signage could provide adequate notice of the employment status of the emergency room physician to a patient who was suffering acute pain in an urgent setting.

The Court of Appeal concluded that the patient is in no position to “bargain” with the hospital when signing the admissions paperwork and cannot be expected to comprehend representation as to agency in the emergency setting. The jury will be assigned the task of weighing the adequacy of the notice versus the state of mind of the patient. In the case at hand, the condition of the decedent upon admission was pivotal, as she was extremely ill and in grave pain. Hospitals may fare better in arguing against agency of its independent contractors in routine emergency admissions of non-urgent matters.

Factual Background

According to the evidence submitted, the decedent had awakened in the middle of the night, screaming in pain and declaring that she had suffered the worst headache in her life. She begged her son to take her to the emergency room. She vomited en route to the hospital and multiple times while in the waiting area of the emergency department. Her pain was rated as a 10/10. She had elevated blood pressure and complained of nausea, vomiting, and dizziness. As she sat crying in pain, an admissions processor asked her to sign a Conditions of Admission form which contained an advisement that the physicians and certain other staff members providing services to the patient were “not employees or agents of the hospital”. The signs on the walls of the emergency department stated, “[E]mergency physician services will be billed to you separately from the hospital services.” Finally, the physician’s clothing contained an insignia as to the name of the emergency medicine group of which he was a member. The patient was diagnosed with a muscle tension headache and discharged. Approximately fourteen hours later, decedent fainted and was rushed to a hospital. The decedent expired two days later of a massive left temporal hemorrhage.

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