Kelley v. Middle Tennessee Emergency Physicians, P.C.

Citations: 133 S.W.3d 587; 2004 Tenn. LEXIS 333; 2004 WL 868500Docket: M2001-00702-SC-R11-CV

Court: Tennessee Supreme Court; April 23, 2004; Tennessee; State Supreme Court

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The Supreme Court of Tennessee reviewed a medical malpractice case involving James H. Kelley and others against Mid-State Cardiology Associates and associated defendants. The appeal arose from the Circuit Court's summary judgment, which found no physician-patient relationship existed between Mrs. Lillie Kelley and the physicians involved. The Court of Appeals reversed this decision, prompting the Supreme Court's review. Upon examining the records, the Supreme Court identified disputed factual issues regarding the existence of a physician-patient relationship and upheld the Court of Appeals' ruling. Consequently, the case was remanded for further proceedings. 

The factual background revealed that Mrs. Kelley was diagnosed with a heart attack on April 18, 1999, and treated by Dr. William Fleet. Following her hospital stay, she returned to the emergency room on June 10, 1999, with similar symptoms. Dr. John Anderson, the emergency physician, attempted to contact Dr. Fleet but was unable to reach him, so he spoke with Dr. John Cage instead, who was on call. Dr. Anderson conveyed Mrs. Kelley's medical history and current condition to Dr. Cage, noting her atypical chest pain and lack of significant changes in diagnostic tests.

Dr. Cage inquired about a cardiac catheterization performed on Mrs. Kelley in April 1999, which revealed an occluded left anterior descending artery without other disease. Dr. Anderson confirmed that no intervention was executed at that time, as the treating physician, Dr. Fleet, recommended medical therapy. Following discussions on managing Mrs. Kelley's chest pain, they agreed on symptomatic treatment and scheduled follow-up care. After being discharged with medication instructions, Mrs. Kelley contacted Dr. Patten on June 11, 1999, with new leg pain and received pain medication. On June 14, she reported heart racing and chest discomfort; Dr. Patten attributed this to her anemia and performed a normal EKG, advising an increase in anticoagulants and a follow-up with Dr. Fleet. Mrs. Kelley later contacted Dr. Berkebile at Heritage Medical Associates for chest discomfort and was prescribed a 'GI cocktail.' On June 17, after going to the emergency room, she experienced acute cardiopulmonary arrest and was pronounced dead shortly after. Her family filed a lawsuit against several defendants, including Dr. Cage and Mid-State, who sought summary judgment, claiming no physician-patient relationship existed. Dr. Cage provided an affidavit stating he was unaware of Mrs. Kelley and had not accepted her as a patient. The trial court granted summary judgment based on the absence of a physician-patient relationship, not addressing the standard of care. However, the Court of Appeals reversed this decision, citing genuine issues of material fact regarding the relationship and standard of care, leading to the defendants' application for permission to appeal, which was granted.

The Court affirms the Court of Appeals' reversal of summary judgment and remands for further proceedings. Summary judgment requires the moving party to demonstrate no genuine issue of material fact exists, allowing judgment as a matter of law. In reviewing summary judgment motions, the Court evaluates evidence favorably for the non-moving party while disregarding conflicting evidence. The review is de novo, without presumption of correctness.

Dr. Cage and Mid-State argue that proof of a physician-patient relationship is essential for a medical malpractice claim, asserting that Dr. Cage’s involvement constituted merely a "curbside consultation," thus negating the existence of such a relationship. Conversely, the plaintiffs contend that a physician-patient relationship is not a necessary element for a malpractice claim and argue that Dr. Cage had a duty of care regardless of this relationship. They also claim there are disputed facts regarding the existence of a physician-patient relationship.

In medical malpractice cases, Tennessee Code Annotated § 29-26-115(a) outlines that plaintiffs must prove: (1) the standard of acceptable professional practice in the relevant community, (2) that the defendant failed to act in accordance with that standard, and (3) that the plaintiff suffered injuries as a proximate result of the defendant's negligence. While the Medical Malpractice Act does not explicitly require proof of a duty of care, it codifies the common law elements of negligence, which include duty, breach of duty, causation, proximate cause, and damages, indicating that all these elements are essential for a negligence claim to succeed.

In medical malpractice actions, the plaintiff must establish the existence of a physician-patient relationship, which is critical to proving that the defendant-physician owed a duty of care. Numerous Tennessee cases affirm that this relationship is an essential element of such actions, as it creates the physician's duty to exercise proper care. The relationship is characterized as contractual, where the patient voluntarily seeks assistance, and the physician agrees to provide treatment. It can be express or implied; a direct meeting is not necessary for its formation, as a consultation for treatment between physicians can suffice. The determination of this relationship is not solely governed by contract law, as it may arise in contexts where a formal contract isn't evident. Most jurisdictions also require proof of this relationship, typically implying its existence if the physician actively undertakes diagnosis or treatment. Additionally, a physician may accept a patient and assume the associated duties, even if the services are provided without charge or guaranteed by a third party.

A consensual physician-patient relationship can be established through various forms of communication and actions that imply patient consent. Key points include:

- A physician can form this relationship by contacting another physician on behalf of a patient or accepting a patient referral, with the patient’s consent being implied (Bovara v. St. Francis Hosp.).
- The determination of a consensual relationship hinges on whether the patient's express or implied consent exists, rather than who initiated the service (Walters v. Rinker).
- Healthcare services provided for the patient's benefit indicate a consensual relationship for medical malpractice claims.
- Indirect contact with a patient does not negate the existence of a physician-patient relationship (Irvin v. Smith), and advice given through another healthcare professional can establish an implied relationship.
- Affirmative participation in a patient's care, rather than merely listening to another physician, is essential for creating a relationship (Oja v. Kin).
- A physician's liability depends on whether they examine, diagnose, or treat the patient directly, or merely advise another physician (Corbet v. McKinney).
- Consent to medical treatment is generally presumed unless there is fraud or misrepresentation (Flynn v. Bausch).
- A phone call that advises a patient on treatment can establish a doctor-patient relationship if reliance on that advice is foreseeable (Cogswell by Cogswell v. Chapman).
- The essence of these cases is that a physician-patient relationship and duty of care can arise from any situation indicating the physician's consent to act in the patient's medical interest (Lownsbury v. VanBuren).
- Formal contractual agreements are not necessary for the establishment of this relationship, and lack of direct interaction with a patient does not preclude its existence.

The case of Campbell v. Haber serves as a relevant example in evaluating the current matter.

In Campbell, a plaintiff presented to an emergency room with chest pains, and after tests suggested potential heart muscle damage, the emergency physician consulted a cardiologist. The cardiologist concluded that the test results did not indicate a cardiac event, leading the emergency physician to discharge the patient after conveying this information. The appellate court affirmed the trial court's denial of the cardiologist’s motion for summary judgment, noting a triable issue regarding whether the cardiologist was "on call." 

In a similar case, Blazo v. McLaren Reg’l Med. Ctr., a pregnant plaintiff experienced contractions during a hospital visit. A nurse consulted a covering physician for the obstetrician, who provided three options for the patient's care. The plaintiff claimed the covering physician's advice fell below the standard of care. The Michigan Court of Appeals found that a physician-patient relationship could be implied due to the covering physician's involvement in the patient’s diagnosis and treatment, distinguishing this case from prior rulings. The court emphasized that the complexity of modern healthcare systems necessitates a broader interpretation of physician-patient relationships in malpractice cases. 

In the current matter, defendants Dr. Cage and Mid-State sought summary judgment, claiming no genuine issue existed regarding the physician-patient relationship. However, the record did not support their assertion, and the court would evaluate the evidence favorably toward the plaintiffs, without presuming correctness in the defendants' claims.

Mrs. Kelley experienced a heart attack on April 18, 1999, and was treated by Dr. William Fleet at Mid-State. On June 10, 1999, Dr. Anderson, the emergency room physician, sought advice from Dr. Fleet regarding Mrs. Kelley’s treatment but instead spoke with Dr. Cage, who was covering for Dr. Fleet. Dr. Anderson reported that Mrs. Kelley presented with chest pain similar to her previous heart attack, and he provided Dr. Cage with detailed medical history and current status, including records of her partially occluded artery. Dr. Cage recommended medication and outpatient follow-up, which Dr. Anderson implemented. Mrs. Kelley died from heart failure seven days later. 

The evidence raises disputed issues regarding the existence of a physician-patient relationship between Dr. Cage and Mrs. Kelley, contradicting the defendants’ claim that the interaction constituted merely a "curbside consultation." The court did not address whether Dr. Cage owed a duty of care regardless of a formal relationship, as this argument was not presented in the lower courts. The plaintiffs cited the Medical Malpractice Act, arguing it does not require proof of a physician-patient relationship, referencing the case of Diggs v. Arizona Cardiologists, Ltd. However, the court emphasized that issues not raised in the trial court cannot be considered on appeal, leaving the matter for future cases. The court refrained from commenting on other elements of the plaintiffs’ medical malpractice claim against Dr. Cage and Mid-State.

The holding addresses whether there are disputed factual issues regarding the existence of a physician-patient relationship between Dr. Cage and Mrs. Kelley. The determination of such a relationship is a question for the jury, as it relies on factual evidence. The court clarifies that while the existence of a duty of care is a legal question for the court, it can depend on factual findings established by the jury. The Michigan Supreme Court's view reinforces that the jury must ascertain whether the requisite elements for a physician-patient relationship exist based on the facts presented. The trial court is instructed to guide the jury accordingly, emphasizing that if a relationship is established, Dr. Cage owes a duty of care to Mrs. Kelley as a matter of law. The Court of Appeals correctly identified disputed factual issues, leading to the reversal of the trial court’s summary judgment in favor of Dr. Cage and Mid-State. The case is remanded for further proceedings, with costs assigned to the defendants.