Nancy J. Harris appeals the Circuit Court of Newport News' judgment granting Jeffrey S. Kreutzer, Ph.D.'s demurrer and dismissing her claims with prejudice. The court affirms the dismissal of Count III, claiming intentional infliction of emotional distress, but reverses the dismissal of Count I, alleging medical malpractice.
Harris claims to have sustained a traumatic brain injury from a 1991 automobile accident and initiated a personal injury lawsuit in 1992. As part of that case, the court ordered a medical examination under Rule 4:10, which was conducted by Dr. Kreutzer, a clinical psychologist specializing in neuropsychology, on January 19, 1996.
In her 2003 motion for judgment against Dr. Kreutzer, Harris alleges medical malpractice, defamation, and intentional infliction of emotional distress due to his conduct during the examination. She asserts that Dr. Kreutzer had a duty to exercise care and not harm her, especially given her pre-existing mental conditions, which made her vulnerable to emotional harm. Specifically, she alleges that he verbally abused her, caused her to break down in tears, accused her of faking, and exacerbated her mental health issues.
In Count I, Harris contends that Dr. Kreutzer breached his duty by failing to conduct a proper assessment and being deliberately abusive, leading to a significant deterioration in her mental and physical health. In Count III, she claims that Dr. Kreutzer intentionally inflicted emotional distress or acted with reckless disregard for the consequences of his actions.
Dr. Kreutzer's demurrer argues that a Rule 4:10 examination does not establish a physician-patient relationship, negating any duty to Harris. He further claims that even if such a duty existed, Harris failed to allege sufficient facts to demonstrate a breach of the standard of care expected of a psychologist.
Dr. Kreutzer argued that Harris did not provide sufficient allegations to support her claim for intentional infliction of emotional distress in Count III, asserting that the conduct in question was neither outrageous nor did it result in severe injuries. The trial court granted Dr. Kreutzer's demurrer for all counts, dismissing Harris' motion with prejudice on January 7, 2005. The court noted it did not find a valid medical malpractice claim arising from a Rule 4:10 examination, suggesting that while such claims could exist, this case did not exemplify that situation. The trial court concluded there were insufficient factual allegations to support either Count I or Count III.
Harris appealed, challenging the trial court's decision on Counts I and III. She claimed Dr. Kreutzer had a duty to conduct the examination without causing harm and asserted that her motion sufficiently alleged a breach of that duty, violation of the standard of care, and resulting damages. Regarding Count III, she contended that her allegations met the criteria for intentional infliction of emotional distress under Virginia law. The appeal involves a review of whether a medical malpractice cause of action can arise from a Rule 4:10 examination, with reference to existing malpractice law and statutes. Harris recognized that traditional medical malpractice cases involve a consensual physician-patient relationship, which does not apply in this context, yet she argued that a limited duty of care exists in the examiner-plaintiff dynamic.
Harris argues that physicians conducting court-ordered examinations (Rule 4:10) owe a duty of care to nonpatient examinees, asserting this as a reasonable standard in Virginia. She claims that a medical malpractice cause of action can be established if it is shown that the physician breached this duty, violating the standard of care, and that this breach caused injury. Harris maintains her motion for judgment is sufficient to withstand a demurrer.
Dr. Kreutzer counters that Harris’ claim fails legally because it lacks a consensual physician/patient relationship, asserting that such a relationship cannot exist in adversarial Rule 4:10 examinations. He argues that without this relationship, no duty is owed, negating the malpractice claim. Furthermore, even if a malpractice cause of action were possible, Dr. Kreutzer contends that the motion for judgment does not adequately demonstrate a deviation from the standard of care.
While courts in various jurisdictions recognize a malpractice cause of action for court-ordered examinations, their analyses differ. The trial court did not explicitly rule on the existence of a malpractice cause of action in this context but indicated that Harris’ motion failed due to insufficient facts. The analysis begins with whether such a cause of action can exist in Virginia. It is concluded that a malpractice claim can be valid under the right circumstances. Although traditionally a consensual physician-patient relationship is necessary for malpractice liability, this requirement may not be strictly applicable in Rule 4:10 examinations, which may involve an implied consent.
Harris provided implied consent for a Rule 4:10 examination by filing a motion for judgment in her automobile accident case, which placed her mental or physical condition in controversy. This implied consent establishes a limited physician/patient relationship with Dr. Kreutzer, who expressly consented to conduct the examination. Under the Rules of the Supreme Court of Virginia, a plaintiff must submit to such an examination, or risk dismissal of their case. The examination conducted by Dr. Kreutzer qualifies as "health care" under Code § 8.01-581.1, as it involves a health care provider performing an act for a patient's medical diagnosis. Both Harris, as the patient, and Dr. Kreutzer, as a licensed health care provider, fall within the definitions outlined in the malpractice statute, allowing for a potential malpractice claim based on the examination resulting in personal injury. However, the scope of any malpractice cause of action is limited due to the unique nature of the physician/patient relationship in court-ordered examinations, which does not encompass the full responsibilities typically expected in a traditional medical relationship. Consequently, the IME physician is not liable for damages arising from their conclusions or reports, as the patient does not have a conventional professional relationship with the physician during the Rule 4:10 examination.
An individual undergoing an Independent Medical Examination (IME) places their physical well-being in the care of a physician who is expected to exercise reasonable care based on their training and experience. The IME physician's responsibilities are limited to performing the examination without the duty to diagnose or treat the patient, thus limiting liability to instances where harm results from the examination itself. Case law supports that the only duty of an examining physician in this context is to avoid causing harm during the examination process.
For example, in Dyer v. Trachtman, the Michigan Supreme Court recognized malpractice when a physician did not adhere to the standard of care during the examination, resulting in injury. Conversely, in Henkemeyer v. Boxall, the Minnesota Court of Appeals ruled that a physician conducting a court-ordered examination had no obligation to diagnose or inform the patient of any medical condition discovered, as long as the examination did not result in harm.
This framework aims to prevent the misuse of malpractice claims to deter physicians from conducting court-ordered examinations, which could lead to a chilling effect on the willingness of physicians to serve as expert witnesses. The discussion emphasizes that liability for malpractice in the context of Rule 4:10 examinations is confined to negligent actions causing harm during the examination, thereby protecting the integrity of the examination process and ensuring that expert witnesses are not deterred from offering their evaluations.
Harris is permitted to pursue a malpractice claim due to alleged harm during the Rule 4:10 examination. The trial court's dismissal of her allegations as legally insufficient was erroneous. Harris contends that Dr. Kreutzer failed to adhere to the standard of care by inadequately assessing her mental status and providing inappropriate psychological care, including verbal abuse and accusations that exacerbated her fragile emotional state. She asserts that these actions directly caused her severe psychological trauma, resulting in nightmares, sleep difficulties, and depression, necessitating further psychological treatment. Consequently, her factual allegations are deemed sufficient to support a malpractice claim.
Regarding her claim for intentional infliction of emotional distress, Virginia law requires proof of four elements: intentional or reckless conduct, outrageousness, a causal link to emotional distress, and severe emotional distress. While Harris may have met the first and third elements, her allegations do not satisfy the requirements for outrageous conduct or the severity of emotional distress as defined by precedent. The standard seeks to prevent frivolous lawsuits and is not met by mere bad behavior or hurt feelings. Therefore, the court found her claim for intentional infliction of emotional distress insufficient.
Liability for intentional infliction of emotional distress requires conduct that is extreme and outrageous, exceeding the bounds of decency in a civilized community. The court must initially assess whether the defendant's actions meet this standard. Ms. Harris claims Dr. Kreutzer verbally abused her, causing her emotional distress, which she defines as severe psychological trauma, nightmares, depression, and injury to her reputation. However, the court found that even if Dr. Kreutzer's behavior was insensitive, it did not rise to the level of being "beyond all possible bounds of decency." Additionally, Harris's symptoms mirrored those previously deemed insufficient for establishing extreme emotional distress, as they did not demonstrate a level of suffering that no reasonable person could endure. Consequently, she failed to meet the Womack standard for outrageous and intolerable conduct, leading to the trial judge's appropriate granting of Dr. Kreutzer's demurrer regarding Count III. The court affirmed the dismissal of Count III but reversed the dismissal of Count I, remanding the case for further proceedings on that count.
