Pennsylvania Supreme Court Ruling on Patient Awareness of Who is Rendering Care

The Pennsylvania Supreme Court has concluded that in the case of a hospital patient experiencing an acute medical emergency, it is more than reasonable for that patient to believe that the emergency care rendered to him is being rendered by the hospital or its agents.

In a September 2015 decision, the Pennsylvania Supreme Court ruled on the issue of the ostensible agency of a physician in the setting of an in-patient hospital emergency. In Green v. Pennsylvania Hospital, the Pennsylvania Supreme Court reversed the Superior Court's decision affirming the trial court's grant of a nonsuit in favor of the hospital, holding that when a hospital patient experiences an acute medical emergency, and an attending nurse or other medical staff issues an emergency request for additional help, it is more than reasonable for the patient who is in medical distress, to believe that such emergency care is being rendered by the hospital or its agents.

The plaintiff-patient presented to the emergency department of the hospital with shortness of breath and was admitted to the intensive care unit where it was determined that he needed to be intubated. He remained in the ICU for over a week on a ventilator. In an attempt to wean the patient from the ventilator, a tracheostomy was performed. Due to bleeding at the tracheostomy site, a team of emergency personnel were summoned which included an anesthesiologist and ENT physician. Despite the medical team's efforts, the patient died. The executor of the decedent's estate commenced a negligence suit against the hospital, the nurse, the anesthesiologist and the ENT physician. The allegations against the defendant hospital included vicarious liability for the negligence of the ENT physician.

At the trial court level, the hospital moved for a nonsuit at the close of the plaintiff's case contending that the plaintiff's evidence failed to establish that the ENT physician was an ostensible agent of the hospital as required under the MCARE Act. The trial judge granted the nonsuit on the grounds that the plaintiff failed to offer any evidence that "a reasonably prudent person in decedent's position would have been justified in the belief that the care in question was rendered by the hospital or its agents." Specifically, the court explained that the plaintiff did not present any witnesses to establish the agency structure of the hospital with regard to the ENT physician or as to how the ENT physician presented herself to the patient.

On appeal to the Superior Court, the trial court's order regarding ostensible agency was affirmed.

On further appeal to the Pennsylvania Supreme Court, the plaintiff asserted that he offered sufficient evidence at trial that (1) the doctor first became involved in treating the decedent as part of an emergency response team at the hospital; (2) the doctor had no prior doctor/patient relationship with the patient; and (3) the doctor rendered emergency treatment to the decedent at the request of the hospital, and not at the request of the decedent or his family. As such, the plaintiff argued that the jury should have been allowed to determine whether "a reasonably prudent person in decedent's position would have been justified in the belief that the care in question was rendered by the hospital or its agents."

Counsel for the hospital argued that the plaintiff's evidence of the doctor's ostensible agency offered at trial consisted only of the fact that (1) that the nurse paged anesthesia and the doctor when the emergency arose; and (2) that the doctor testified that he was not an agent of the hospital but an independent contractor. The hospital argued that evidence of the fact that emergency treatment by a doctor authorized to practice in the hospital was insufficient evidence to establish ostensible agency and would violate Section 1303.516(b) of the MCARE Act which provides that "evidence that a physician holds staff privileges at a hospital shall be insufficient to establish vicarious liability through principles of ostensible agency (absent other requirements)." The hospital further argued that the evidence was insufficient upon which a jury could conclude that a reasonably prudent person in the decedent's position would have been justified in believing that the doctor's car e was being rendered by the hospital or its agents.

The Pennsylvania Supreme Court specifically held that, "It is more than reasonable for a patient who is in the throes of medical distress to believe that the emergency care rendered to him is being rendered by the hospital or its agents." The Court held that, in this case, there was sufficient evidence to create a jury question concerning whether a reasonably prudent person in the decedent's position would be justified in the belief that the doctor was acting as the hospital's agent when she rendered care to the decedent.

Comment: Based upon this holding, hospitals in Pennsylvania must be aware that the Pennsylvania Supreme Court specifically provides for vicarious liability of hospitals for those medical personnel responding to a conscious patient's medical emergency. In order to defend against these claims, defense counsel must seek discovery on this issue, both through interrogatories and deposition testimony, as to the patient's actual conscious perception as to where the actual care being rendered was coming from during an emergency response. If the evidence permits, defense counsel must also seek to dismiss ostensible agency claims through pre-trial dispositive motions and or pre-trial motions in limine.

For more information, please contact Noah E. Katz at nkatz@wglaw.com or 570.961.2706.