Inadequate treatment results in verdict of $1.6 million for widow and her children
News: The patient, a 48-year-old man, was admitted to a medical center seeking treatment in September 2009. The patient was diagnosed with autoimmune hemolytic anemia (AIHA), a condition in which the body begins to destroy its own red blood cells quickly. However, the physician treating the patient did not sufficiently stabilize the patient. The patient went into cardiac arrest two days after the initial presentation and died. The patient’s surviving widow and children brought suit against the physician and medical center. They alleged that the physician’s treatment was negligent and that the physician was acting as the agent of the medical center. The physician and medical center denied any wrongdoing. The jury found both liable and awarded the patient’s family $1.6 million in damages.
Background: In this matter, the patient was a 48-year-old man who was admitted to a medical center seeking treatment in September 2009. The patient complained of general weakness, headache, and shortness of breath. He was initially diagnosed with possible sinusitis. Testing revealed his hemoglobin level at 11.1 and microscopic red blood cells in his urine, but he was discharged and went home. The next morning, the patient returned to the emergency department in a worse condition and was admitted again. His hemoglobin level had dropped to 7.0, and at this time, a physician properly diagnosed the patient with AIHA, which is a condition in which the antibodies attack the person’s own red blood cells, which causes them to burst. AIHA severely limits oxygen distribution, and it has serious and potentially deadly effects on the body. Treatment for AIHA involves temporarily treating the shortness of red blood cells through blood transfusion and then suppressing the autoimmune activity through the use of steroids. Transfusions and steroids are required to fully treat the condition. Transfusions alone are insufficient, as the individual’s antibodies will continue to destroy the red blood cells without any suppression or treatment of the underlying cause.
After the diagnosis, the patient was admitted to the intensive care unit, and his hemoglobin level continued to drop. The physician ordered the patient to receive only two units of blood, which was an insufficient amount to stabilize the patient. During this second admission, the patient was in the hospital for almost 12 hours while receiving only this transfusion. The patient’s condition did not improve, and he remained in critical condition in the intensive care unit even after the blood transfusion. The patient suffered cardiac arrest in the early morning. At this time, the physician finally ordered a steroid injection and another supplemental blood transfusion, but it was too late. The patient died two days after the initial presentation.
The patient’s surviving widow and children brought suit. They claimed that the physician was negligent in his treatment of the patient and that the hospital was liable as the apparent principal of the physician. Experts for the plaintiffs stated that the proper course of treatment for AIHA is to give the patient a blood transfusion along with intravenous immunoglobulin (IVIG) to decrease the severity of the autoimmune activity, followed by steroids to suppress the autoimmune activity. At trial there was also an issue regarding whether the physician ever saw the patient. The medical record contained nothing revealing that the physician saw the patient, but the defense attested that the physician did, in fact, see the patient. After a three-week trial and 10 hours of deliberation, the jury found the physician and hospital liable: 70% was awarded from the physician and 30% was awarded from the hospital on the basis that the physician was the apparent agent of the hospital. The jury awarded $1.6 million to the widow and children.
What this means to you: The primary issue for the hospital in this case was whether the physician was the agent of the hospital. Liability can arise based on the relationship of the individual and the entity based on agency principles. In general, agents are individuals authorized to act on behalf of another individual, known as the principal. If an agent acts negligently, the principal can be held responsible for the agent’s improper actions. Employees act as agents of their employers, whereas independent contractors are typically not considered agents of those who hire them. Courts look to numerous factors to decide whether an individual is an employee of agent, but one of the most important factors is the level of control: Can the principal control the manner and means by which the end goal is accomplished? If the entity simply pays the individual to achieve a result, while not dictating how the result is achieved, this individual is likely an independent contractor.
In the hospital setting, there are numerous individuals who have relationships to the hospital entity: nurses, medical technicians, physicians, paramedics, etc. Many of these individuals are considered employees, and there can be little debate otherwise. Nurses and technicians easily fall under the "employee" category, as they are supervised, regulated, and have little discretion in performing their duties. The hospital directly controls their actions and dictates how they are to accomplish their tasks. In this case, if a nurse is negligent, the hospital will be held responsible for the improper actions.
Physicians present a much different and potentially more difficult agency analysis, for two reasons. First, some states prohibit hospitals from hiring physicians directly. This issue is a complicated and state-specific one tabled for the working purposes of this article. Second, due to the nature of their work, in which hospitals can hire physicians, the question of whether a physician is an employee/agent of the hospital or an independent contractor is likely to require a highly factual determination. Courts can come out either way by holding physicians to be employees or independent contractors, based on the particular circumstances of the relationship.
There are benefits and detriments to treating physicians as either one. A hospital has less control over an independent contractor physician, but it is less likely to be liable for the physician’s actions. A hospital has more control over an employee physician, but it is more likely to be liable for the physician’s actions. This decision is a difficult one to make. This treatment has many implications and should be discussed with a competent attorney, as the ramifications go beyond the medical practice realm and into tax considerations as well. Whichever route the hospital chooses to go, it is also important to work with competent counsel to craft appropriate documents to protect the hospital’s legal position on that question should litigation subsequently ensue.
Hospitals also can sometimes be liable for a physician’s actions, regardless of their status as independent contractor, under apparent agency principles, as found in this case. Apparent agency occurs when the third-party reasonably believes the individual to be an agent, based on the actions of the principal. If a patient receives no notice that physicians working at the hospital are not hospital employees, then the patient might reasonably believe that physicians are, in fact, employees. The hospital can be found liable for their actions. To prevent this, hospitals can include this specific information in admission forms which clearly state that physicians are not employees of the hospital, but rather are independent contractors. This disclaimer might help reduce a hospital’s liability based on apparent agency principles.
Finally, as in the previous case discussed above, this case raises issues of record-keeping. Trials often involve difficult determinations that must be made by the jury regarding issues of fact, as parties contradict each other about important events that might or might not have occurred. Having some types of physical record to support any factual argument is a much-needed edge. Keeping records of specific visits to patients and any orders given regarding treatment can help ensure that when a trial comes around, these facts are securely in place and there is less room for debate about whether they happened. Hospitals with robust records can better evaluate potential liabilities as well. This situation might lead to less speculation about how a jury’s findings will be at trial, thus facilitating settlement and preventing the chance that a jury decides that the plaintiffs set of facts are more believable. If the record is clear, but damaging to your case, then settlement might be a better option to reduce liability and prevent the record from being exposed. Being fully informed is inherently a better position to be in. Having employees who keep proper records is a strong way of ensuring that the hospital leaders can know what is going on.
- Circuit Court of Peoria County, IL. Case No. 10-L-00087.March 28, 2014.
