Williams v. Dimensions Health Corp.

1

Terence Williams v. Dimensions Health Corporation

No. 42-21

Court of Appeals of Maryland

July 28, 2022

Argued: March 8, 2022

Circuit Court for Prince George's County Case No. CAL17-35481

Getty, C.J., ^[*] Watts Hotten Biran Gould Raker, Irma S. (Senior Judge, Specially Assigned), McDonald, Robert N. (Senior Judge, Specially Assigned) JJ.

OPINION

McDonald, J.

This case concerns whether a hospital is vicariously liable for a surgeon's negligence in treating a patient in the hospital's emergency facility, which had been specifically designated for treating patients with serious and life-threatening injuries on an emergency basis. The patient, Petitioner Terence Williams, had suffered serious injuries as a result of a late night motor vehicle crash and had been transported by ambulance to the trauma center at the Prince George's Hospital Center of Respondent Dimensions Health Corporation ("the Hospital"). He suffered further injuries when the surgeon who treated him there failed to exercise the standard of care expected of trauma surgeons.

Mr. Williams sued both the surgeon and the Hospital in the Circuit Court for Prince George's County. The Hospital contended that the surgeon, like other staff at its trauma center, was an independent contractor rather than an employee of the Hospital and that the Hospital therefore was not responsible for his conduct in treating Mr. Williams. However, under prior decisions of this Court, as well as decisions by other courts around the country, a hospital may be vicariously liable for the negligence of a health care provider who staffs the hospital's emergency room, regardless of the formal relationship between the provider and the hospital, under the doctrine of apparent agency.

At the trial of this case, the jury returned a verdict finding that the surgeon was negligent and directly liable, that the surgeon was an agent of the Hospital, and that the Hospital was vicariously liable for that negligence. The Hospital moved for judgment notwithstanding the verdict on the ground that there was insufficient evidence to show that Mr. Williams had believed that the surgeon was an agent of the Hospital when he was brought there by the ambulance. The Circuit Court granted that motion and the Court of Special Appeals affirmed that ruling. For the reasons set forth in this opinion, we disagree and reverse the judgment of the intermediate appellate court. A court may not overturn a jury verdict if there is sufficient evidence, however slight and viewed in the light most favorable to the prevailing party, to support the verdict. In this case, there was ample evidence introduced at trial that, if credited by the jury, supported the jury's finding that the surgeon was the apparent agent of the Hospital.

I

Background

A. Hospital Emergency Rooms

1. Generally

An emergency room, or emergency department, as the name implies, is the part of a hospital that specializes in emergency medicine - the acute care of patients who appear at the facility without prior appointment, sometimes by ambulance. As a result of the nature of the care it provides, an emergency room will often operate around the clock. An emergency room must be prepared to provide treatment for a broad spectrum of unforeseen illnesses and injuries, many of which are serious and life-threatening.^[1] Closely related to emergency rooms are trauma centers where surgeons who specialize in trauma care treat patients with injuries from incidents such as serious motor vehicle crashes. Emergency rooms in hospitals that receive payments from Medicare must provide appropriate emergency treatment to all individuals who seek it, regardless of ability to pay, among other things.^[2]

2. Designations of Emergency Facilities in Maryland

To coordinate the delivery of emergency and trauma care to patients in distress in Maryland, the General Assembly has created the Maryland Institute for Emergency Medical Services Systems ("MIEMSS"). Maryland Code, Education Article ("ED"), §13501 et seq.; see also COMAR, Title 30. MIEMSS is charged with "coordination of all emergency medical services" in the State. ED §13-504(a).

According to MIEMSS, there are 48 hospital emergency departments in the State. See MIEMSS, Hospitals - Introduction.^[3] "It is imperative that all seriously ill and injured patients be delivered in a timely manner to the closest appropriate facility." Id. MIEMSS has developed a trauma and emergency medical system ("EMS") to ensure "that the patient get[s] to the right facility to receive the right care through the use of statewide medical protocols for EMS clinicians." Id. For that purpose and pursuant to its statutory authority, MIEMSS has designated nine trauma centers and specialty referral centers. Id.; see also ED §13-509; COMAR 30.08.02. MIEMSS classifies trauma centers into four categories, according to the availability of physicians and resources at the particular location. See ---------

COMAR 30.08.02.01; see also https://www.miemss.org/home/hospitals/trauma-centers.^[4]Pertinent to this case, a Level II trauma center must satisfy various criteria including having a trauma surgeon available in the hospital and an orthopedic surgeon on-call at all times. COMAR 30.08.05.09 Under the MIEMSS regulations, a hospital applies for an appropriate designation for its emergency facility. COMAR 30.08.02.03.

B. Agents - Actual and Apparent

The common law concept of agency applies in various contexts in Maryland law. This Court has defined the concept as "the fiduciary relation which results from the manifestation of consent by one person to another that the other shall act on his behalf and subject to his control, and consent by the other so to act." Green v. H &R Block Inc., 355 Md. 488, 503 (1999) (quoting Restatement (Second) of Agency, §1); see also Restatement (Third) of Agency, §1.01 ("Agency is the fiduciary relationship that arises when one person (a 'principal') manifests assent to another person (an 'agent') that the agent shall act on the principal's behalf and subject to the principal's control, and the agent manifests assent or otherwise consents so to act."). The existence of an agency relationship depends on the facts of the particular relationship; labels are not dispositive. See Restatement (Third) of Agency, §1.02 ("Parties' Labeling and Popular Usage Not Controlling"). For example, an actual agency relationship may exist even as to one labeled an "independent contractor." Restatement (Second) of Agency §14N &comment a ("'[I]ndependent contractor' is a term which is antithetical to the word 'servant', although not to the word 'agent'".).

Even when the legal definition of actual agency is not satisfied, the parties may still have an "apparent agency" relationship - sometimes referred to as "ostensible agency" or "agency by estoppel." While the existence of an actual agency relationship depends in part on the perspective of a reasonable agent, the existence of an apparent agency relationship depends in part on the perspective of a reasonable third party. See Bradford v. Jai Med. Sys. Managed Care Organizations, Inc., 439 Md. 2, 18 (2014); Restatement (Third) of Agency §2.03 (defining "apparent authority" as "the power held by an agent or other actor to affect a principal's legal relations with third parties when a third party reasonably believes the actor has authority to act on behalf of the principal and that belief is traceable to the principal's manifestations"). This doctrine prevents a principal from "choos[ing] to act through agents whom it has clothed with the trappings of authority and then determin[ing] at a later time whether the consequences of their acts offer an advantage." Restatement (Third) of Agency §2.03, comment c.

C. Liability of Hospital for Actions of Emergency Room Staff as Apparent Agents

A hospital can have a variety of formal employment or contractual relationships with the health care professionals who staff the hospital. See Marah Short et al., Baker Institute for Public Policy of Rice University, The Integration and De-Integration of Physicians and Hospitals over Time at 3 (Jan. 2017) (describing four models of employment or contractual relationships of hospitals with physicians).^[5] The use of independent contractors is more prevalent in emergency medicine than in any other medical specialty. See Carol K. Kane, Updated Data on Physician Practice Arrangements, Am. Med. Ass'n Policy Research Perspectives at 8 (2019)^[6] (noting that, in emergency medicine, "more than one-quarter of physicians were independent contractors, a share that was more than 10 percentage points higher than that of any other specialty"). A recent trend has been for hospitals to "outsource" the operation of the emergency room to an independent entity entirely.^[7]

One issue raised by a hospital's use of independent contractors rather than employees to staff its emergency room is whether the use of independent contractors changes the hospital's vicarious liability for any negligence by its emergency room staff in the treatment of patients. Substantial case law around the country, as well as two decisions of this Court, have assessed such liability under the common law doctrine of apparent agency.

1. Maryland Case Law

This Court has previously had two occasions to address a hospital's vicarious liability based on apparent agency for the negligence of physicians staffing its emergency room. In both cases, the hospital contended that it was not vicariously liable because the physicians staffing its emergency room were independent contractors. In both cases the Court concluded that there was sufficient evidence to establish that those physicians were apparent agents of the hospital, even if they...