Pedroza v. Bryant

• Decision Date: 16 February 1984
• Docket Number: No. 49751-6,49751-6
• Citation: 677 P.2d 166,101 Wn.2d 226
• Parties: Rudolfo PEDROZA, individually, and as Administrator of the Estate of Maria Guadalupe Viscalia Pedroza, Appellant, v. Ben BRYANT, M.D., Defendant, Skagit Valley Hospital, Respondent.
• Court: Washington Supreme Court

Page 226

101 Wn.2d 226

677 P.2d 166

Rudolfo PEDROZA, individually, and as Administrator of the Estate of Maria Guadalupe Viscalia Pedroza, Appellant, v. Ben BRYANT, M.D., Defendant, Skagit Valley Hospital, Respondent.

No. 49751-6.

Supreme Court of Washington,

En Banc.

Feb. 16, 1984.

Sullivan & Associates, Daniel F. Sullivan, Thomas Golden, Seattle, for appellant.

Williams, Lanza, Kastner & Gibbs, Daniel E. Tolfree, William H. Robertson, Seattle, for respondent.

Paul N. Luvera, Jr., Mount Vernon, Riddell, Williams, Bullitt & Walkinshaw, Walter Walkinshaw, Washington Hospital Ass'n, Seattle, for amicus curiae.

PEARSON, Justice.

The issue before us is whether a hospital may be held liable under a theory of corporate negligence for its action in granting privileges to a nonemployee doctor who allegedly commits malpractice while in private practice off the hospital premises.

In December of 1978, Maria Pedroza was in her 35th week of pregnancy and under the care of Dr. Ben Bryant. During the week of December 3 through 9, Maria became ill and exhibited the classical symptoms of preeclampsia (a toxemia of pregnancy), namely, hypertension, headaches, and edema of the lower extremities. Mrs. Pedroza visited Dr. Bryant's office on December 6 and 7, and telephoned him on December 8. Dr. Bryant prescribed no medicine other than bed rest and aspirin. He did not refer Mrs. Pedroza to another health care provider.

On December 9, 1978, Maria Pedroza was admitted, comatose, to defendant Skagit Valley Hospital. She was admitted to surgery, with a diagnosis of irreversible cerebral death due to intracerebral hemorrhage resulting from eclampsia. Dr. Bryant was neither the admitting nor the treating physician for this hospitalization. Indeed, the hospital had, on April 13, 1977, limited Dr. Bryant's obstetrical and newborn privileges to Class II for the years 1977 and 1978. Dr. Bryant was thus required to consult with a Class I physician on all "seriously ill patients," including pregnancies with "major medical complications" and "[l]ate or severe toxemia of pregnancy." Thus, Dr. Bryant would not have been allowed to treat Maria Pedroza for eclampsia in the hospital.

In surgery, Mrs. Pedroza's child was successfully delivered by emergency cesarean section. After family consent was obtained, respiratory support for Mrs. Pedroza was discontinued on December 15, 1978, whereupon she died.

Plaintiff Rudolfo Pedroza was Maria's husband, and is administrator of her estate. He brought a malpractice action against Dr. Bryant, and further alleged that defendant Skagit Valley Hospital was negligent in that it violated a duty of care owed Maria Pedroza to grant hospital admitting and treating privileges only to those physicians who are competent. Defendant hospital moved for summary judgment dismissing plaintiff's claims against it. The motion was granted on July 15, 1981. The basis for the trial judge's ruling, as set forth in his oral decision, was that: (1) the theory of hospital corporate negligence relied on by plaintiff is not recognized in Washington, and (2) even if it were, the theory does not extend to acts done outside the hospital.

I.

The essential elements of actionable negligence are: (1) the existence of a duty owed to the complaining party; (2) a breach thereof; (3) a resulting injury; and (4) a proximate cause between the claimed breach and resulting injury. Hansen v. Washington Natural Gas Co., 95 Wash.2d 773, 776, 632 P.2d 504 (1981). The threshold determination of whether defendant owed Mrs. Pedroza a duty with respect to the competency of its staff physicians is a question of law. Peterson v. Pacific First Fed. Sav. & Loan Ass'n, 23 Wash.App. 688, 692, 598 P.2d 407 (1979). In arguing that such a duty exists in Washington, plaintiff urges the court to apply a theory of corporate negligence.

It should be noted at the outset that plaintiff is not claiming that defendant hospital is vicariously liable for the negligence of Dr. Bryant under the theory of respondeat superior. Dr. Bryant is an independent contractor, not an employee of defendant hospital. Plaintiff is instead relying solely on the doctrine of corporate negligence, which differs from respondeat superior in that it imposes on the hospital a nondelegable duty owed directly to the patient, regardless of the details of the doctor-hospital relationship. Plaintiff contends that defendant hospital owed a duty to Maria Pedroza of carefully selecting and reviewing the competency of its staff physicians. ("Staff physicians" are those doctors who have been given "staff privileges" at the hospital. A physician must be a member of the hospital's medical staff in order to regularly admit patients to the hospital.) Plaintiff alleges that defendant hospital breached this duty by allowing Dr. Bryant to possess staff privileges at the hospital, and that this breach was the proximate cause of Mrs. Pedroza's death.

II.

The first question we must address, then, is whether the doctrine of corporate negligence applies to hospitals in Washington. The doctrine of corporate negligence appears to have been introduced in Darling v. Charleston Community Mem. Hosp., 33 Ill.2d 326, 211 N.E.2d 253 (1965), where the Illinois Supreme Court found defendant hospital liable for its failure to review the plaintiff-patient's treatment and require consultation with appropriate medical staff members as needed. This established the concept that a hospital had an independent responsibility to patients to supervise the medical treatment provided by members of its medical staff. Liability for failure to do so was not founded on respondeat superior, which had been the traditional mode of recovery; rather, the court found the hospital liable for its own negligence and not that of the physician.

The doctrine of corporate negligence has since been utilized by courts to require hospitals to exercise reasonable care to insure that the physicians selected as members of hospital medical staffs are competent. See Johnson v. Misericordia Community Hosp., 99 Wis.2d 708, 301 N.W.2d 156 (1981); Ferguson v. Gonyaw, 64 Mich.App. 685, 236 N.W.2d 543 (1975); Corleto v. Shore Mem. Hosp., 138 N.J.Super. 302, 350 A.2d 534 (1975); Mitchell Cy. Hosp. Auth. v. Joiner, 229 Ga. 140, 189 S.E.2d 412 (1972). Jurisdictions adopting corporate negligence have also held that hospitals have a continuing duty to review and delineate staff privileges so that incompetent staff physicians are not retained. See Purcell v. Zimbelman, 18 Ariz.App. 75, 500 P.2d 335 (1972); Moore v. Board of Trustees, 88 Nev. 207, 495 P.2d 605 (1972). (For other jurisdictions adopting corporate negligence, see Elam v. College Park Hosp., 132 Cal.App.3d 332, 183 Cal.Rptr. 156 (1982); Bost v. Riley, 44 N.C.App. 638, 262 S.E.2d 391 (1980); Kitto v. Gilbert, 39 Colo.App. 374, 570 P.2d 544 (1977); Utter v. United Hosp. Ctr., Inc., 236 S.E.2d 213 (W.Va.1977); Gridley v. Johnson, 476 S.W.2d 475 (Mo.1972); Foley v. Bishop Clarkson Mem. Hosp., 185 Neb. 89, 173 N.W.2d 881 (1970)).

Before the emergence of corporate negligence, hospital liability for the negligence of a staff physician was based on the theory of respondeat superior. Plaintiffs found it difficult to recover, however, as courts tended to classify physicians as independent contractors for whose acts the hospital was not liable. Some states, Washington among them, have attempted to avoid the somewhat artificial distinctions associated with the independent contractor defense (e.g., classifying an independent private physician with staff privileges who is retained by the patient as an "independent contractor" while a physician whose salary is paid by the hospital is a "servant," even though both are on the same medical staff, performing the same tasks.) They have tried to avoid these distinctions by affixing vicarious liability upon the hospital when the individual is performing an "inherent function" of the hospital, or acting as an "ostensible agent." See Adamski v. Tacoma Gen. Hosp., 20 Wash.App. 98, 579 P.2d 970 (1978). Such an analysis does not, however, address the question of the hospital's direct negligence in its selection or retention of an incompetent doctor on the hospital's medical staff.

The doctrine of corporate negligence reflects the public's perception of the modern hospital as a multifaceted health care facility responsible for the quality of medical care and treatment rendered. The community hospital has evolved into a corporate institution, assuming "the role of a comprehensive health center ultimately responsible for arranging and co-ordinating total health care." Southwick, The Hospital as an Institution--Expanding Responsibilities Change Its Relationship with the Staff Physician, 9 Cal.W.L.Rev. 429 (1973). The patient treated in such a facility receives care from a number of individuals of varying capacities and is not merely treated by a physician acting in isolation. In Moore v. Board of Trustees, 88 Nev. at 211, 495 P.2d 605, the Nevada Supreme Court recognized the expanding role of the hospital:

Today, in response to demands of the public, the hospital is becoming a community health center. The purpose of the community hospital is to provide patient care of the highest possible quality. To implement this duty of providing competent medical care to the patients, it is the responsibility of the institution to create a workable system whereby the medical staff of the hospital continually reviews and evaluates the quality of care being rendered within the institution ... The role of the hospital vis-a-vis the community is changing rapidly. The hospital's role is no longer limited to the furnishing of physical facilities and equipment where a physician treats his private patients and practices his profession in his own individualized manner.

This increased public reliance upon hospitals favors adoption of corporate negligence.

Hospitals are also in a superior...