Ellis by Ellis v. Niles
| Decision Date | 09 September 1994 |
| Docket Number | No. 2248,2248 |
| Citation | 450 S.E.2d 631,316 S.C. 516 |
| Parties | Michael Anthony ELLIS, Deceased, by Deborah Scott ELLIS, Personal Representative of the Estate of Michael Anthony Ellis, Appellant, v. Judith Ann NILES, as Personal Representative of the Estate of Jack Niles, Jr., M.D., Respondent. Michael Anthony ELLIS, Deceased, by Deborah Scott ELLIS, Personal Representative of the Estate of Michael Anthony Ellis, Appellant, v. Raymond P. BYNOE, M.D., Respondent. . Heard |
| Court | South Carolina Court of Appeals |
Kimberly A. Raber, Columbia, Michael J. Miller and Deborah A. Vitale, Alexandria, VA, for appellant.
Ernest J. Nauful, Jr., and Andrew F. Lindemann, Columbia, for respondent Raymond P. Bynoe, M.D.
William L. Pope and Roy F. Laney, Columbia, for respondent Judith Ann Niles, as Personal Representative of the Estate of Jack Niles, Jr., M.D.
Michael Anthony Ellis 1 filed medical malpractice actions against Dr. Jack Niles, Jr. 2 and Dr. Raymond Bynoe alleging he received negligent treatment while under the care of the Richland Memorial Trauma Team for a serious neck injury suffered in a traffic accident. Before the close of the plaintiff's case the court directed a verdict in favor of Drs. Niles and Bynoe. Ellis appeals. We reverse and remand.
Ellis was injured in a single car accident the morning of October 3, 1988. The paramedics who arrived at the scene found Ellis's car upside down, with Ellis outside the car. The paramedics, assuming Ellis had suffered a spinal injury, placed a collar on him to secure his neck, and rolled him onto a spine board to maintain spinal alignment. Fully immobilized, Ellis was transported from the accident scene to Richland Memorial Hospital, a designated Level I Trauma Center. The paramedics radioed ahead to notify the trauma team of their arrival. According to Ellis, Richland Memorial thereby held itself out as providing personnel uniquely qualified in A.T.L.S., or Advanced Trauma Life Support.
There was evidence Ellis was not paralyzed at the time he arrived at the hospital. One of the paramedics noted Ellis had some movement in all four extremities. A nurse recalled Ellis was fighting and moving about on the stretcher when he first arrived, and Ellis ultimately had to be placed in arm and leg restraints. Furthermore, Dr. Weidner, a member of the trauma team, conducted a rectal examination on Ellis when he first arrived, and noted he had rectal tone, an indication of neurological response. As of October 4, 1988, however, Ellis was paralyzed, save for the ability to move his left arm slightly.
The trauma team treating Ellis consisted of Dr. Moore, a sixth year resident in trauma surgery, who headed the team, Dr. Pettigrew, a junior resident, Dr. Weidner, a junior resident and several nurses. Dr. Moore also called in Dr. Oliver, an anesthesiologist who was not a member of the trauma team. Dr. Oliver unsuccessfully attempted to nasotracheally intubate Ellis. Dr. Moore and Dr. Oliver then made a number of attempts to orotracheally intubate Ellis before they finally performed a cricothyroidotomy. 3 At the time they were attempting to intubate Ellis, the physicians had the cervical x-rays that revealed Ellis had sustained a spinal injury.
Dr. Bynoe was at the hospital October 3, 1988, and his name appears on an x-ray request. Dr. Bynoe did not examine or treat Ellis. However, he knew that Ellis had a cervical spine injury, and was informed by Dr. Moore by telephone that the team was about to attempt to establish an airway. Bynoe told Moore to proceed with the management of Ellis. In addition, Bynoe looked in on the team after the cricothyroidotomy had been performed. Dr. Niles was working in the emergency room on the day in question and recalled looking in on the team at various intervals. His name is reflected on the medical records, but he did not participate in the treatment of Ellis. However, Dr. Niles did see the attending physicians attempting to orotracheally intubate Ellis.
The hospital prepared a document entitled "The Trauma Team" which provides for a chain of command within the team, starting with the general surgeon/traumatologist as team leader, followed by the senior emergency department physician, the chief surgical resident, the senior surgical resident, other residents, the trauma nurses, and finally the scribe. (The most senior physician on the team treating Ellis was Dr. Moore, as chief surgical resident.) This document was apparently prepared in connection with the hospital's efforts to become certified as a Level I Trauma Center.
Ellis offered A.T.L.S. course materials indicating attempts at orotracheal intubation is contra-indicated for a patient suspected of having a cervical spine injury. Ellis maintains his paralysis is the result of the attempts at orotracheal intubation. Although Drs. Bynoe and Niles were not directly involved in the alleged negligent treatment, Ellis maintains they are nonetheless liable. Ellis contends that the doctors' status as A.T.L.S. specialists on the trauma team coupled with their participation (albeit limited) in Ellis's treatment is sufficient to establish a physician-patient relationship with Ellis.
In granting a directed verdict, the trial court determined there was no physician-patient relationship between Ellis and Dr. Bynoe or Dr. Niles, and therefore no duty to Ellis. On appeal, Ellis argues that the directed verdict was improper because genuine questions of fact existed. 4 Ellis also challenges the exclusion of the trauma team protocol prepared by the hospital.
There are two issues of novel impression in this state that could arise from the circumstances of this case. Both of them depend for their validity on the unique situation presented by the specialized services sought to be provided by the Richland Memorial Hospital as a Level 1 Trauma Center.
The first issue is whether the relationship of physician and patient existed between Niles and Bynoe and the patient Ellis, thereby imposing a duty on them to act with reasonable care in his treatment. The trial judge correctly concluded that a duty imposed by law is a question solely for the court. See, e.g., Rogers v. South Carolina Dept. of Mental Health, 297 S.C. 363, 377 S.E.2d 125 (Ct.App.1989). It is well-settled law that when a physician-patient relationship exists, the physician owes the patient a duty to exercise reasonable care. Roberts v. Hunter, --- S.C. ----, 426 S.E.2d 797 (1993). A physician-patient relationship is generally described as "a consensual one wherein the patient knowingly seeks the assistance of a physician and the physician knowingly accepts him as a patient." Id. at ----, 426 S.E.2d at 799. The question here, however, is whether a physician-patient relationship can exist in the context of the unusual facts presented by this case. While no South Carolina case has specifically addressed the issue, a review of case law from other jurisdictions makes clear that the existence of a physician-patient relationship is a question of fact for the jury. See, e.g., Walker v. Jack Eckerd Corp., 209 Ga.App. 517, 434 S.E.2d 63 (Ct.App.1993), cert. denied (1993); Mozingo v. Pitt County Mem. Hosp., Inc., 101 N.C.App. 578, 400 S.E.2d 747 (Ct.App.1991), aff'd, 331 N.C. 182, 415 S.E.2d 341 (1992); Gallion v. Woytassek, 244 Neb. 15, 504 N.W.2d 76 (1993); Bienz v. Central Suffolk Hosp., 163 A.D.2d 269, 557 N.Y.S.2d 139 (1990); Elliott v. State, 630 N.E.2d 202 (Ind.1994); see also Am.Jur.2d Physicians, Surgeons, and Other Healers § 159 (1981) ().
The second issue, which arises whether or not a physician-patient relationship is found to exist, requires a determination of the duty of care owed by a supervising physician. Other jurisdictions have held supervising physicians liable for negligent supervision, even if the physician did not actually treat the patient. See, e.g., Mozingo v. Pitt County Mem. Hosp., Inc., 331 N.C. 182, 415 S.E.2d 341 (1992). In Mozingo, the North Carolina Supreme Court affirmed the Court of Appeals' reversal of the trial court's order of summary judgment in favor of a supervising...
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