Jaramillo v. Morris

Citations: 750 P.2d 1301; 50 Wash. App. 822Docket: 8206-7-III

Court: Court of Appeals of Washington; March 22, 1988; Washington; State Appellate Court

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Sunnyside General Hospital appeals a medical malpractice judgment in favor of Diana Jaramillo, who suffered complications following ankle surgery performed by Dr. Jack Morris, a podiatrist. The court found that Dr. Morris' actions fell below acceptable medical standards, leading to undisputed damages due to his negligence. The hospital was implicated for allegedly failing to supervise Dr. Morris and allowing him to perform surgery outside the scope of his podiatry license, as the Jaramillos argued that relevant licensing statutes did not permit podiatrists to operate on the ends of the tibia and fibula.

Dr. Morris settled with the Jaramillos for $95,000 prior to trial. The hospital sought to have the Washington State Podiatry Board (WSPB) determine if Dr. Morris exceeded his licensing authority, but the trial court denied this request. Despite this, the hospital petitioned the WSPB, which led to the Jaramillos filing a summary judgment motion in Yakima County Superior Court regarding the same issue. The court ruled that Dr. Morris' surgery was outside the scope of his license and granted partial summary judgment to the Jaramillos, stating that Dr. Morris' actions constituted negligence per se, implicating the hospital as well.

Subsequently, the WSPB held its own hearings and concluded that the surgery was indeed within Dr. Morris' licensing scope, which contradicted the trial court's findings.

Dr. Morris performed a type of surgery that is common within podiatry practices, both in Washington and nationally. The trial court, aware of the Washington State Podiatry Board (WSPB) ruling, declined to reconsider its summary judgment order. The hospital's attempt to seek discretionary review of this decision was unsuccessful. Before the case was presented to the jury, the trial court indicated its inclination to apply the Consumer Protection Act (CPA) to the hospital if it found liability for Mrs. Jaramillo's economic loss, but ultimately did not submit the CPA claim to the jury. The jury was instructed that the hospital was negligent as a matter of law for allowing Dr. Morris to perform unlicensed surgery and could also find negligence based on his improper training, lack of supervision, and violation of regulations.

The jury ruled in favor of the Jaramillos, awarding them $53,500, which included $18,500 for economic loss. The court subsequently granted their request for $55,467.46 in attorney fees and costs under the CPA. After offsetting this award with a $95,000 settlement from Dr. Morris, the Jaramillos received no recovery from the hospital. The court upheld the attorney fees and costs award despite the hospital's appeal. The primary legal issue on appeal is whether the trial court erred by ruling that the hospital violated the CPA by allowing Dr. Morris to perform surgery outside the scope of his license. 

The hospital argued that the CPA does not apply in this context, as it is intended to protect trade or commerce rather than compensate for negligence. A successful CPA claim requires that the conduct be unfair or deceptive, impact public interest, and cause injury to the plaintiff's business or property. Established case law indicates that claims related to professional negligence, such as those against medical practitioners, do not fall under the CPA's jurisdiction unless they involve entrepreneurial aspects. The Jaramillos’ claims pertain to the hospital's alleged negligence in assessing Dr. Morris’ qualifications and supervision during surgery, not the hospital's business practices. Consequently, the court concluded that the Jaramillos’ negligence claims were not cognizable under the CPA, reversing the trial court's ruling and the award of attorney fees and costs.

The trial court's decision not to refer the scope of Dr. Morris' podiatry license to the Washington State Podiatry Board (WSPB) under the doctrine of primary jurisdiction is examined. Primary jurisdiction allows courts to defer to administrative agencies with specialized expertise when resolving particular issues. For such deference, three requirements must be satisfied: (1) the agency must have the authority to address the issues, (2) the agency must possess special competence that makes it better suited than the court to resolve the issues, and (3) the court's claim must intersect with a comprehensive regulatory scheme to avoid conflicting judicial action.

The trial court concluded that the legislative statute, RCW 18.22.010, clearly defines the scope of podiatry practice as limited to the human foot, and therefore, no interpretation was necessary. The surgery in question involved the leg bones, not the foot, indicating that it fell outside the defined scope of podiatry. The court asserted that any expansion of the podiatrist's licensing authority is a legislative matter, not a judicial one. Furthermore, the court emphasized that its decision to exercise or defer jurisdiction is discretionary.

In evaluating whether the trial court abused its discretion, it referenced the three requirements of primary jurisdiction and noted that the WSPB, as an agency created by the Legislature, does not have inherent powers and can only act within the scope defined by the Legislature. Mrs. Jaramillo contends that the WSPB lacks the authority to redefine 'podiatry' beyond the legislative definition, thereby supporting the trial court's refusal to defer the matter to the WSPB. The legislative intent for the WSPB's establishment is to regulate podiatry practices to safeguard public health and safety.

The WSPB (Washington State Podiatry Board) has several responsibilities, including administering laws related to podiatry, overseeing licensure examinations for podiatrists, certifying qualified applicants, and establishing necessary rules for these processes. One key statute under its jurisdiction is RCW 18.22.010(1), which defines podiatry practice as involving the diagnosis and treatment of ailments of the human foot, with specific exclusions for certain procedures such as amputations and administering general anesthesia. The WSPB also has the authority to conduct hearings regarding license actions and investigate malpractice complaints.

In a recent case, the WSPB resolved a dispute regarding the scope of practice for podiatrists, emphasizing that the term "foot" encompasses not just the anatomical foot but also associated structures, including muscles and ligaments, extending to the ankle joint. This interpretation aligns with WAC 308-31-025, which defines "ailment of the human foot" to include conditions affecting the functional foot and permits podiatrists to use various treatment methods for diagnostic and treatment purposes beyond the anatomical foot.

The evidence presented indicated that the term "foot," while not broadly defined, is complex and includes the ankle as a functional component necessary for certain treatments. Unlike previous cases where practitioners sought to exceed their statutory authority, the WSPB's interpretation reflects its expertise in this specialized field, warranting judicial deference to its construction of the ambiguous statute.

The doctrine of primary jurisdiction is invoked in legal matters requiring specialized expertise, as illustrated in *In re Stockwell*, where the court deferred to the Washington State Chiropractic Disciplinary Board's interpretation of licensing statutes due to its quasi-judicial authority. This principle applies similarly in the current case involving the Washington State Podiatry Board (WSPB) regarding the scope of Dr. Morris’ podiatry license related to a surgical procedure. The court failed to refer critical issues to the WSPB, risking a conflict with the established regulatory framework that governs podiatry practice, as emphasized in RCW 18.22.005. This oversight led to an erroneous conclusion of negligence per se against the hospital, as it was based on an unlicensed finding which was not properly evaluated by the WSPB.

Additionally, the court's determination that the Consumer Protection Act (CPA) applied was flawed, necessitating the reversal of the CPA judgment, including the award of attorney fees and costs. Although a new trial would typically be warranted due to these errors, it is deemed unnecessary given the jury's damage award of $53,500, which was already offset by a prior settlement with Dr. Morris. The appellate court has the authority to reverse or modify the trial court's decision in the interest of justice. The trial court's failure to defer to the WSPB is acknowledged as an error, but it is considered harmless, and no retrial is required. The court also rejected the Jaramillos' analogy to *Bowers v. Transamerica Title Ins. Co.*, noting that Dr. Morris was not acting as the hospital’s agent. Lastly, legislative changes effective June 11, 1986, amended the regulatory framework governing podiatry licenses and practices.