Taylor v. Jewish Hospital & St. Mary's Healthcare, Inc.
Docket: Civil Action No. 3:13-CV-00361-CRS
Court: District Court, W.D. Kentucky; June 11, 2014; Federal District Court
The court addressed motions for summary judgment from Defendants Jewish Hospital and St. Mary’s Healthcare, Inc. and University Medical Center, resulting in partial denial and partial granting of Jewish's motions, while UMC's motion was fully granted. The case involves Plaintiff Renetta L. Taylor, administratrix of her late son Brandon Pillow's estate.
Pillow sought treatment at Jewish's emergency department on April 23, 2011, for severe abdominal and shoulder pain. Dr. Anne Lorraine Brady evaluated him, noting a slight fever and normal white blood count after a Complete Blood Count (CBC). A CT scan led to a diagnosis of bilateral lung base pneumonia. Pillow was discharged with a prescription for Bactrim.
He returned to Jewish on April 25, 2011, experiencing chest pain, where Dr. Terry McGann ordered a chest x-ray. Despite no fever and negative blood cultures, McGann noted worsening infiltrates and prescribed Ciprofloxacin. Pillow was advised to return if his condition worsened.
On April 28, 2011, Pillow was seen at UMC by Dr. Robert McKnight, who found no fever and a normal white blood count. An x-ray indicated atelectasis and pleural effusion, leading to a diagnosis of atypical pneumonia and a prescription for Amoxicillin.
Pillow collapsed on April 30, 2011, and was pronounced dead at Jewish. An autopsy conducted by Dr. Donna Stewart on May 1, 2011, revealed that the cause of death was pulmonary thromboembolism due to two pulmonary emboli in the right lung.
On May 17, 2011, the Plaintiff initiated a medical negligence lawsuit in Jefferson County Circuit Court against Defendants Jewish and UMC, claiming inadequate diagnosis of her condition. On March 22, 2013, the Defendants removed the case to federal court, asserting that the Plaintiff's reference to an Emergency Medical Treatment and Active Labor Act (EMTALA) claim created federal question jurisdiction under 28 U.S.C. § 1331. The Plaintiff sought to remand, clarifying that she intended to incorporate EMTALA standards into her state-law negligence claim rather than assert a separate EMTALA claim. On October 31, 2013, the court denied the remand, concluding that an independent EMTALA claim was indeed presented, thus establishing federal jurisdiction.
When considering motions for summary judgment, the Court assesses whether there are genuine issues of material fact. The burden initially lies with the moving party to demonstrate the absence of such issues, which can be met by citing specific record materials. If successful, the burden shifts to the non-moving party to provide evidence of genuine factual disputes. The Court evaluates evidence favorably for the non-moving party, but mere speculation or minimal evidence is insufficient to counteract the moving party's case. If the non-moving party fails to meet its burden of production, summary judgment is granted.
In the discussion of Jewish's motion for summary judgment, the court will examine whether there is a genuine dispute regarding the nature of the relationship between Jewish and Physicians in Emergency Medicine (PEM). Jewish contends that PEM and its physicians are independent contractors, not agents of Jewish, supporting this with undisputed facts including: the Plaintiff signed a consent form acknowledging the independent contractor status of the physicians, the Agreement between Jewish and PEM explicitly states PEM as an independent contractor, Jewish’s insurance responsibilities are separate from PEM's, PEM bills independently for its services, and PEM compensates its physicians without Jewish's involvement.
Jewish contends it lacks control over PEM and its physician-employees, suggesting they are not its actual agents. Conversely, Plaintiff argues that Jewish exerts significant control, citing its authority to hire and terminate PEM physicians as outlined in the Agreement. Plaintiff highlights Jewish's sole discretion in terminating physicians and the criteria for their hiring as evidence of control. Additionally, Jewish's bonus incentive program tied to physician performance metrics is presented as further indication of oversight. Plaintiff asserts that Jewish provides essential work tools and is responsible for securing patient consent forms, indicating a shared employer-employee relationship.
The legal framework for determining agency under Kentucky law requires an examination of various factors, including the degree of control the employer has over work details, the nature of the occupation, and the employer's provision of work tools. The primary criterion is the right to control work details, which is a critical factor in distinguishing between an agent and an independent contractor. The Court finds that while some factors suggest the physicians could be independent contractors, the control exercised by Jewish is significant enough to create a genuine issue of material fact regarding the agency relationship. Thus, it cannot be concluded as a matter of law that PEM physicians are solely independent contractors.
Factors indicating that PEM and its physician employees are independent contractors include their specialization in emergency medicine, the typical unsupervised practice by specialists in Louisville, the high skill level required, and the explicit acknowledgment of an independent-contractor relationship in their Agreement with Jewish. However, the right to control work details is the primary consideration. Evidence of Jewish's indirect control includes:
1. An incentive compensation structure designed by Jewish to guide physicians' job functions, which prioritized throughput, patient satisfaction, and core measures, indirectly influencing patient treatment practices.
2. Jewish's exclusive authority to set eligibility criteria for PEM physicians.
3. Jewish's sole discretion to terminate physicians for various reasons, including conduct deemed harmful to Jewish.
Jewish also provided the necessary tools and work environment for PEM employees. Given these control factors, a genuine issue of material fact exists regarding whether PEM physicians are Jewish’s actual agents, leading to the denial of Jewish’s Motion for Summary Judgment on the medical negligence claim.
Regarding EMTALA, it imposes two primary obligations on emergency room departments: first, to conduct an appropriate medical screening examination for all patients, which must not be deficient in relation to individual patient characteristics.
"Appropriate medical screening" requires that patients receive screening similar to that offered to others, as per legal precedent. Hospitals are obligated to stabilize any "emergency medical condition" before transferring or discharging a patient, defined by acute symptoms that could jeopardize health or bodily functions without immediate care. A hospital's duty to stabilize only arises if there is actual knowledge of the emergency condition. The Sixth Circuit clarified that if the emergency is not recognized, the hospital cannot be accountable for failing to stabilize.
The hospital, Jewish, seeks summary judgment on the Plaintiff's EMTALA claim, arguing that the Plaintiff has not shown that Jewish failed to provide appropriate screening related to Pillow’s financial status or necessary stabilizing treatment for his emergency condition. The Plaintiff contends that Jewish did not conduct adequate diagnostic testing before diagnosis and that Pillow’s severe pain constituted an emergency requiring stabilization. The Plaintiff cites the requirement for "appropriate medical screening" to determine if an emergency medical condition exists, asserting that expert testimony indicates Jewish's failure to screen appropriately.
However, without evidence that the screening Pillow received differed from standard practice, the Plaintiff's claim fails. Thus, summary judgment is granted for Jewish regarding the screening claim. Regarding the stabilizing treatment claim, the Plaintiff argues that Pillow's severe pain should have alerted Jewish to his emergency condition. Jewish counters that its staff was unaware of any life-threatening condition, which is undisputed. To succeed, the Plaintiff must prove that Jewish had actual knowledge of an acute condition severe enough to risk health or bodily functions.
Pillow's diagnosis of pneumonia during two visits to Jewish’s emergency department did not provide Jewish with actual knowledge of an emergency medical condition. The Court determined that the severity of Pillow's pneumonia did not meet the criteria for an emergency that could lead to serious health risks or bodily impairments without immediate medical attention. Consequently, Jewish was not found to have failed in providing necessary stabilizing treatment, justifying summary judgment on the Plaintiff's claim.
Regarding UMC's motion for summary judgment on the medical negligence claim, UMC contends that Dr. McKnight was an independent contractor rather than an agent, supported by the Emergency Professional Services Agreement (EPSA) which explicitly states that physicians operate as independent contractors. UMC also references the Consent and Acknowledgment Form signed by Pillow, which clarifies that hospital physicians are not employees of the hospital, further negating any agent relationship. In contrast, the Plaintiff cites the case City of Somerset v. Hart to argue that Dr. McKnight acted as a dual agent of UMC and UEMA, highlighting the hospital's responsibilities in staffing and supervising the operating room, suggesting a degree of control that could imply agency.
The Hospital's operating room staff is responsible for assembling surgical packs and performing post-operation counts of instruments, including scalpel blades. Although the Hospital does not mandate pre-operation or pre-closing counts, it requires a post-operation count and reporting any deficiencies, which did not occur in this case. The operating room staff must replace dull blades upon the surgeon's request, but it is unclear if this was done during the operation in question. The Hospital claimed that the operating room staff were "borrowed servants" of the surgeon, limiting its liability for their negligence. The plaintiff countered that the Hospital is liable for administrative failures, such as the lack of scalpel blade accountability, distinguishing between administrative and medical acts. The court rejected the notion that only one party could be held liable, affirming that hospital employees can serve dual roles for both the surgeon and the hospital. The court emphasized that the accurate accounting of surgical instruments is beneficial to both parties, thus applying the doctrine of respondeat superior to both the Hospital and the surgeon. Furthermore, the plaintiff argued that Dr. McKnight, as a resident, acted as a dual agent for both University Hospital and University Emergency Medicine Associates (UEMA), as both had control over his actions. However, the court ultimately concluded that summary judgment was appropriate because it could not establish that Dr. McKnight was an actual agent of UMC, despite the potential for dual agency as noted in City of Somerset.
In Nazar v. Branham, 291 S.W.3d 599 (Ky.2009), the Kentucky Supreme Court clarified the criteria for establishing an agency relationship, citing that such relationships arise when one party has the authority to control another's work. The court emphasized that while the case of City of Somerset recognized the possibility of dual agency involving surgical nursing staff, the determination of agency should primarily rest on traditional principles. Under Kentucky law, agency is defined as a fiduciary relationship where one party acts on behalf of another with consent and control.
The doctrine of respondeat superior holds a principal vicariously liable for an agent's torts unless the agent is an independent contractor. Factors to distinguish between an agent and an independent contractor include the extent of control over work details, the nature of the occupation, skill level required, provision of tools and workspace, employment duration, payment method, the relationship of the work to the employer's business, and the parties' intent to create a master-servant relationship. The right to control is the chief criterion.
In this case, the Agreement between UMC and Dr. McKnight indicated an independent-contractor relationship, limiting hospital control to regulatory compliance. The court concluded that Dr. McKnight could not be classified as UMC's agent due to the hospital's lack of control over his professional duties, reinforcing the significance of the right to control in determining agency and liability.
The high degree of skill required of licensed physicians, such as Dr. McKnight, is typically exercised in a locality with minimal hospital supervision. Dr. McKnight is identified as an independent contractor rather than an actual agent of UMC, despite Plaintiff's argument that UMC's financial support for the Department—including resident and student teaching programs—implies agency. UMC's indirect payment does not establish Dr. McKnight as its agent. The Court concludes that relevant factors strongly indicate his independent contractor status, leading to the granting of UMC's Motion for Summary Judgment on Plaintiff's medical negligence claim.
Regarding the EMTALA claim, UMC asserts it complied with statutory requirements, arguing that Plaintiff failed to show it did not provide standard medical screenings or necessary stabilizing treatment for an emergency medical condition. Plaintiff contends that UMC inadequately supervised Dr. McKnight and failed to recognize Pillow's severe pain and labored breathing as indicators of an emergency condition. However, the Court finds Plaintiff did not present evidence that UMC's screening differed from that of other patients, which is critical for her claim. Additionally, the Court determines that UMC lacked actual knowledge of an emergency medical condition based on Pillow's symptoms, which is essential for a failure-to-stabilize claim under EMTALA. Consequently, summary judgment is granted on both claims. A separate order will follow this opinion. The excerpt also mentions PEM, an independent group providing emergency services at Jewish’s emergency departments under a written agreement.
Plaintiff's failure to address Jewish's arguments on ostensible agency limits the Court's analysis to whether PEM and its physician-employees were actual agents of Jewish. Plaintiff's expert acknowledged that Jewish was not aware of Pillow's pulmonary embolism, as evidenced by their failure to diagnose the condition. Similarly, the Court will evaluate whether Dr. McKnight was an actual agent of UMC, given Plaintiff's neglect of UMC's ostensible agency arguments. University Emergency Medical Associates (UEMA) functions as an independent group of emergency room physicians at UMC's emergency department. The Court clarifies that Dr. McKnight, categorized by Plaintiff as an "intern," is a licensed medical resident and cannot be classified as such. While UMC has the authority to terminate physicians, the standards for termination are more objective compared to Jewish, which lacks the authority to dismiss physicians for conduct deemed materially harmful to UMC.
