Simmons v. Tuomey Regional Medical Center

Citation533 S.E.2d 312,341 S.C. 32
Decision Date05 June 2000
Docket NumberNo. 25143.,25143.
PartiesAlethia SIMMONS, in her fiduciary capacity as personal representative of the estate of P.J. McBride, deceased, Respondent, v. TUOMEY REGIONAL MEDICAL CENTER, Einar Anderson, M.D., and Sandy T. Cooper, M.D. Defendants, of whom Tuomey Regional Medical Center is Petitioner. John H. Cooper, Respondent, v. Tuomey Regional Medical Center, Coastal Physician Services of the Southeast, Inc., formerly known as Coastal Emergency Services of the Carolinas, Inc., and Luis Muniz, M.D. Defendants, of whom Tuomey Regional Medical Center is Petitioner.
CourtUnited States State Supreme Court of South Carolina

Harold W. Jacobs of Nexsen Pruet Jacobs & Pollard, LLP, Columbia, for petitioner.

J. Edward Bell, III, and Eugene C. Fulton, Jr., of Bell & Moore, P.A., Sumter, for respondents.

William L. Pope of Pope & Rodgers, Columbia, for amicus curiae, the South Carolina Health Alliance.

WALLER, Justice:

This case presents the novel issue of whether a hospital owes a common law nondelegable duty to render competent service to its emergency room patients, such that it may not avoid liability for the negligent acts of emergency room physicians hired as independent contractors under a contract between the hospital and a separate corporation. Alethia Simmons, personal representative for the estate of her father, P.J. McBride, and John H. Cooper (respondents) brought unrelated medical negligence actions against Tuomey Regional Medical Center (Tuomey Regional) and others. The circuit judge granted Tuomey Regional's summary judgment motions on the issues of actual agency, apparent agency, and nondelegable duty in both cases. The Court of Appeals reversed, addressing only the issue of the nondelegable duty. Simmons v. Tuomey Regional Medical Ctr., 330 S.C. 115, 498 S.E.2d 408 (Ct.App.1998); Cooper v. Tuomey Regional Medical Ctr., Op. No. 98-UP-077 (S.C. Ct.App. filed Feb. 17, 1998) (unpublished opinion citing Simmons). We granted Tuomey Regional's petitions for a writ of certiorari to review the Court of Appeals' decisions. We consolidated the cases for consideration because they raise the same issue. We affirm as modified the Court of Appeals' decision to impose a nondelegable duty and reverse the grant of summary judgment to Tuomey Regional.


P.J. McBride received medical care at Tuomey Regional's emergency room for a head injury he suffered in a moped accident. His daughter, Simmons, signed a form consenting to treatment at the emergency room that contained a provision stating, "THE PHYSICIANS PRACTICING IN THIS EMERGENCY ROOM ARE NOT EMPLOYEES OF TUMEY REGIONAL MEDICAL CENTER. THEY ARE IDEPENDENT PHYSICIANS, AS ARE ALL PHYSICIANS PRACTICING IN THIS HOSPITAL." Simmons said she did not read the form because she was upset about her father's injuries. She believed the physicians were Tuomey Regional employees.

The emergency room physicians examined McBride, but released him without treating a serious head injury that was visible on the back of his head, Simmons alleged. The physicians apparently believed his confused state was a result of intoxication. McBride was returned to Tuomey Regional's emergency room the next day by ambulance after his condition worsened. This time, physicians diagnosed him as suffering from a subdural hematoma1 and transferred him to a Columbia hospital. McBride died about six weeks later of complications caused by the head injury, Simmons alleged.

Cooper, who had suffered a previous heart attack, experienced chest pains while driving. A friend drove him to Tuomey Regional's emergency room, where Cooper informed the receptionist he was having a heart attack and asked for immediate help. Cooper alleged he sat on a gurney for at least 1½ hours before seeing a doctor, causing him serious injury. Unlike Simmons, he did not sign any form containing the "independent physician" statement. He believed the physicians were Tuomey Regional employees. Both Simmons and Cooper stated in affidavits they saw no signs or other indications that the physicians, working in an area that was an integral part of the hospital campus, were not Tuomey Regional employees.

Tuomey Regional signed a contract with Coastal Physicians Services, Inc. (Coastal), in 1987.2 The contract describes Coastal as an "independent contractor" that provides "independent-contractor physicians" to work in Tuomey Regional's emergency room on an around-the-clock basis. The contract provides that, "[e]xcept as hereinafter provided and to the extent practice and professional conduct of all Hospital's medical staff members are regulated by the Hospital, the Physicians shall not be under the direction or supervision of the Hospital in performance of their Emergency Department duties."

The contract states the physicians are not Tuomey Regional's employees, and the hospital does not directly pay or provide any benefits to the physicians. Under a 1989 amendment to the original contract, Tuomey Regional bills patients and their insurers for emergency room services provided by both it and Coastal physicians. Tuomey Regional then pays Coastal under a formula based on the "direct cost" plus a specified amount for each hour Coastal physicians work in the emergency room. Coastal physicians must maintain their own liability insurance coverage in minimum amounts.

Coastal physicians must meet many of the same requirements as any physician who seeks staff privileges, i.e., the right to admit patients to Tuomey Regional. Coastal physicians must, for example, apply and qualify for medical staff privileges in accordance with the bylaws and regulations of the medical staff. Their professional conduct is governed by Tuomey Regional and medical staff bylaws and rules, as well as standards set by the Joint Commission on the Accreditation of Hospitals, applicable statutes, and regulations of governmental bodies.

Tuomey Regional, however, maintains much more extensive control over Coastal physicians than physicians who only have staff privileges. For example, Tuomey Regional selects the emergency room medical director from among the physicians, with the consent of Coastal. Coastal physicians must remain on Tuomey Regional's premises during their shift, and must provide services to anyone who desires treatment. Tuomey Regional has the authority to prevent any physician from working in the emergency room when it "deems the clinical performance of any Physician ... to be detrimental to the health or safety of Hospital's patients." Within five days written notice, Coastal "shall reassign that Physician from the Hospital and shall not permit him to provide further services at the Hospital without the Hospital's approval."

Tuomey Regional retains the last word in most disagreements. The contract provides that "[a]ll matters relating to the Hospital's policies, rules, regulations, services, and other items of conduct wherein the Physicians may be involved, shall be determined jointly by [Coastal] and the Hospital's Chief Executive Officer, and in the event of a disagreement ... the decision of the Hospital shall be final."

Did the Court of Appeals err in holding that hospitals have a nondelegable duty under the common law to render competent service to the patients of their emergency rooms?

A trial court may properly grant a motion for summary judgment when "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Rule 56(c), SCRCP. See also Tupper v. Dorchester County, 326 S.C. 318, 487 S.E.2d 187 (1997)

. In determining whether any triable issues of fact exist, the court must view the evidence and all reasonable inferences that may be drawn from the evidence in the light most favorable to the non-moving party. Manning v. Quinn, 294 S.C. 383, 365 S.E.2d 24 (1988). On appeal from an order granting summary judgment, the appellate court will review all ambiguities, conclusions, and inferences arising in and from the evidence in a light most favorable to the appellant, the non-moving party below. Williams v. Chesterfield Lumber Co., 267 S.C. 607, 230 S.E.2d 447 (1976).

The court must determine, as a matter of law, whether the law recognizes a particular duty. If there is no duty, then the defendant in a negligence action is entitled to a judgment as a matter of law. See Ellis v. Niles, 324 S.C. 223, 479 S.E.2d 47 (1996)

; Sharpe v. South Carolina Dep't of Mental Health, 292 S.C. 11, 16, 354 S.E.2d 778, 781 (Ct.App. 1987) (Bell, J., concurring).


It is uncontroverted that the role that hospitals play in the delivery of health care across America has changed dramatically since the days when the doctrine of charitable immunity shielded hospitals from malpractice liability.

The hospital of the early to mid-nineteenth century would not be recognizable as such to a modern observer. "Respectable" people who fell sick or who were injured were treated by their doctors at home; only the lowest classes of society sought help in the "hospital," which was most often a separate wing on the almshouse. As late as 1873, there were only 178 hospitals in the United States, with a total of 50,000 beds. These hospitals were private charities, and their trustees were usually unable to raise sufficient funding to provide a pleasant stay. The hospital of the time was dirty, crowded and full of contagious diseases. The "nurses" were usually former patients. Doctors, who were not paid, tended the ill for a few hours per week out of a sense of charity mixed with the knowledge that they could "practice" their cures on the poor and charge young medical students for instruction in the healing arts. These young "house doctors" also worked without pay, practicing cures on the ill.


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