St. Joseph Hosp. v. Wolff

• Decision Date: 05 November 2002
• Docket Number: No. 99-1192.,99-1192.
• Citation: 94 S.W.3d 513
• Parties: ST. JOSEPH HOSPITAL, Petitioner, v. Stacy Lynn WOLFF, and Ray Wolff and Sandra Wolff, individually, and as next friends of Stacy Lynn Wolff, Respondents.
• Court: Texas Supreme Court

Page 513

94 S.W.3d 513

ST. JOSEPH HOSPITAL, Petitioner, v. Stacy Lynn WOLFF, and Ray Wolff and Sandra Wolff, individually, and as next friends of Stacy Lynn Wolff, Respondents.

No. 99-1192.

Supreme Court of Texas.

Argued September 20, 2000.

Delivered November 5, 2002.

Rehearing Denied February 13, 2003.

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Reagan Wm. Simpson, Fulbright & Jaworski, Houston, Stephanie A. Smith, Fulbright & Jaworski, Austin, for Petitioner.

Michael Ernest Archuleta, Michelle Mei-Hsue Cheng, Bill Whitehurst, Whitehurst Harkness Ozmun & Archuleta, Pamela Stanton Baron, Austin, for Respondents.

Justice MOSELEY¹ delivered the judgment of the Court in which Chief Justice PHILLIPS, Justice HECHT, Justice OWEN, Justice O'NEILL, and Justice JEFFERSON joined, and an opinion in which Justice HECHT, Justice OWEN, and Justice JEFFERSON joined.

This case involves whether a teaching hospital that sponsors a medical residency program is vicariously liable for a resident's negligent treatment of a patient, occurring while the resident, as part of the residency training program, was receiving training at another hospital under the immediate supervision of another medical institution's agent. To answer this question we must reexamine, among other theories of vicarious liability, the particular theory often referred to as "joint enterprise" liability.

We conclude there is no evidence to support the jury's findings of joint enterprise, joint venture, "mission" or non-employee respondeat superior, or ratification. We also conclude the undisputed evidence proved conclusively, or as a matter of law, that when the resident treated the patient he was acting as the borrowed employee of the medical institution supervising him. Therefore, we reverse the judgment of the court of appeals² and render judgment that the plaintiffs take nothing by way of their claims against the teaching hospital.

I. BACKGROUND

A. Introduction

In May 1994, Stacy Wolff was severely injured when an automobile in which she was a passenger collided with a truck. She was flown by medical helicopter to Austin's Brackenridge Hospital, where she was admitted to intensive care and placed on a ventilator. Her attending physician, Dr. David Harshaw, and a third-year resident, Dr. Mario Villafani, performed a tracheostomy on Wolff and inserted a breathing tube in her throat.

Several days after the tracheostomy, Wolff began to bleed from the surgical wound. Villafani examined Wolff but decided not to alert Harshaw, Harshaw's substitute, or the chief resident, none of whom were at the hospital at the time. Shortly after one particularly severe bleeding episode, Wolff went into cardiac and respiratory arrest. She survived but suffered permanent, severe brain damage.³

At all times during his treatment of Wolff, Villafani was enrolled in an integrated general surgery residency program. The program was operated by St. Joseph Hospital ("St. Joseph") in Houston, the sponsoring institution, and the Central Texas Medical Foundation ("Foundation"), a participating institution. The Foundation is a certified health organization operated by physicians under Texas law⁴ that was formed for the purpose of operating a residency program. The Foundation is based in Austin. Harshaw, Wolff's attending physician, was also the Foundation's Director of Surgical Education.

B. Lawsuit

Wolff and her parents sued a number of defendants, some for having caused the vehicle accident and others for medical malpractice. Before trial, the Wolffs either settled with or dismissed all defendants except St. Joseph. At the close of evidence, the trial court submitted questions to the jury based on five vicarious liability theories asserted by the Wolffs: employment, joint enterprise, joint venture, "mission," and ratification. The trial court refused St. Joseph's request to instruct the jury as to the law regarding a "borrowed employee."

The jury found that:

• 85% of the negligence that proximately caused Wolffs cardiac respiratory arrest resulting from her tracheoinnominate fistula — a serious, permanent, and disabling injury — was attributable to Villafani;

• on the occasion in question, St. Joseph and the Foundation were engaged in a joint enterprise;

• on the occasion in question, St. Joseph and the Foundation were engaged in a joint venture;

• on the occasion in question, Villafani was employed by each of St. Joseph, the Foundation, and the joint venture, and was acting within the scope of his employment with each;

• Villafani treated Wolff in furtherance of a mission for the benefit of St. Joseph, the Foundation, and their joint venture and was subject to their control as to the details of the mission;

• St. Joseph, the Foundation, and their joint venture ratified Villafani's conduct; and

• Wolffs and her parents' damages totaled $9.5 million.⁵

The trial court rendered judgment against St. Joseph on the verdict, but credited St. Joseph with $2.75 million the Wolffs received from the settling defendants.

C. Appeal

The court of appeals affirmed, holding that: (1) the trial court did not abuse its discretion in the manner in which it defined "joint enterprise" in the jury charge; and (2) there was sufficient evidence to support the jury's finding that St. Joseph and the Foundation were engaged in a joint enterprise.⁶ Because those findings alone supported the trial court's judgment, the court of appeals did not address whether the evidence supported any other liability theory.⁷

The court of appeals also concluded that the joint enterprise finding rendered harmless any error in the trial court's refusal to instruct the jury regarding the law on "borrowed employees" because both participants in the enterprise, St. Joseph and the Foundation, were jointly liable for all of the enterprise's actions.⁸ Finally, the court of appeals determined that the trial court's error in refusing to ask the jury to determine the extent of the drivers' responsibility for Wolff's injury was harmless because the trial court instructed the jury not to award damages for injuries caused by the automobile accident.⁹ This Court granted St. Joseph's petition for review.¹⁰

D. Issues

St. Joseph contends the court of appeals erred in affirming the trial court's judgment, attacking each of the vicarious liability theories asserted by the Wolffs. Generally, St. Joseph disputes the legal sufficiency of the evidence as to at least one element of the jury's findings relevant to each of the Wolffs' theories of recovery; St. Joseph also complains of charge error. Conversely, the Wolffs argue: (1) the trial court properly rendered judgment against St. Joseph based on its vicarious liability for Villafani's negligence under each theory; (2) the court of appeals properly affirmed the judgment based on the joint enterprise theory; and (3) the trial court's judgment can be upheld on any of their other theories of recovery.

II. EVIDENCE

Critical to our discussion of these issues is an understanding of the evidence concerning the relationships among St. Joseph, the Foundation, and Villafani. To evaluate the legal sufficiency of the evidence to support a finding, we must "determine whether the proffered evidence as a whole rises to a level that would enable reasonable and fair-minded people to differ in their conclusions."¹¹ Thus, we "consider all the evidence in the light most favorable to the prevailing party, indulging every reasonable inference in that party's favor."¹² Although it is often stated that a reviewing court performing a no-evidence review must disregard all evidence contrary to the finding in question, we need not "disregard undisputed evidence that allows of only one logical inference."¹³ Nevertheless, we sustain a no-evidence point only if there is no more than a scintilla of evidence proving each element of joint enterprise.¹⁴ It is from this perspective that we review the record.

A. Accredited Residency Programs

After completing medical school, medical students receive an M.D. degree and are eligible to continue their training in a graduate medical education program, commonly referred to as a residency program.¹⁵ Residency programs focus on developing clinical skills and professional competencies and preparing the physicians in the programs ("residents") to practice in a medical specialty. Residency training takes place primarily through the residents' provision of patient care while under the supervision of more experienced physicians. During the course of a residency, the resident takes on progressively greater responsibility for patient care.¹⁶

Medical residency programs are accredited under the general authority of the Accreditation Council for Graduate Medical Education ("ACGME").¹⁷ St. Joseph's general surgery residency program was accredited by ACGME, which has rigorous, detailed requirements for residency programs. Among other things, ACGME requires that "[a] residency program must [operate under the authority and control of] a sponsoring institution."¹⁸ However, general surgery residency programs are sometimes multi-institutional. Sponsoring institutions that cannot provide sufficient resources and clinical experience within their own facilities may make arrangements with other entities, called "participating institutions,"¹⁹ to provide additional resources and experience.²⁰ A participating institution may be "integrated" with the parent or sponsoring institution through an agreement that must specify, among other things:

[T]hat the program director of the parent institution: 1) appoints the members of the teaching staff at the integrated institution; 2) appoints the chief or director of the teaching service in the integrated institution; 3) appoints all residents in the program; and, [sic] 4) determines all rotations and assignments of both residents and members of the teaching staff.²¹

Although the "general rule" is that the...