48 of 279 DOCUMENTS

Copyright (c) 1998 Boston University School of Law.

American Journal of Law & Medicine

1998

24 Am. J. L. and Med. 135

LENGTH: 2641 words

MEDICAL LEGAL REFERENCE: Hospital Liability: Nondelegable Duty in Hospital Emergency Rooms - Simmons v.
Tuomey Regional Medical Center n1 -

NAME: Alison Chen

LEXISNEXIS SUMMARY:
... The Court of Appeals for South Carolina held for the first time that hospitals have a nondelegable duty to render
competent services to patients in their emergency rooms, even if the hospital staffs its emergency room with
independently contracted physicians. ... The form stated that "independent physicians" staffed Tuomey's emergency
room and are "not employees of Tuomey Regional Medical Center." ... Simmons claimed that Tuomey's emergency
room physicians failed to diagnosis and treat her father's head injuries properly when he was first brought to the
hospital. In its own defense, Tuomey alleged that it was not liable because its emergency room doctors were
independent contractors. ... The court relied heavily on a carefully worded 1987 contract between Tuomey and Coastal
Physicians Services, which supplied the emergency room doctors to Tuomey. ... The court also concluded that Tuomey
owed a nondelegable duty to its emergency room patients because the public has come to consider a hospital as a single-
entity providing multifaceted medical services. ... The specific duties prescribed by state regulation, thus, support
imposing a nondelegable duty on Tuomey. ... In finding that a nondelegable duty exists, the court rejected Tuomey's
defense that South Carolina does not impose corporate negligence on its hospitals. ... As such, Tuomey's defense does
not defeat Simmons's vicarious liability cause of action. ...

TEXT:
[*135]
The Court of Appeals for South Carolina held for the first time that hospitals have a nondelegable duty to render
competent services to patients in their emergency rooms, even if the hospital staffs its emergency room with
independently contracted physicians. n2 Like many other jurisdictions, South Carolina had once applied the doctrine of
charitable immunity to shield its hospitals from tort liabilities. n3 However, this court indicated that changing public
policy considerations in the health care arena compelled it to conclude that a hospital's duty to its emergency room
patients has "evolved into an absolute duty that is incapable of being delegated." n4 Thus, although a hospital may freely
transfer its duties to an independently contracted medical staff, liabilities accompanying some of those duties cannot be
delegated. n5 Whether a hospital's responsibility is nondelegable depends on whether it is "so important to the
community that the employer should not be permitted to transfer it to another." n6
This case arose from a medical malpractice action filed by Alethia Simmons, as personal representative of her
father, P.J. McBride, against Tuomey Regional Memorial Center (Tuomey) and the doctors who treated him there.
McBride was brought to Tuomey on January 24, 1994, after sustaining head injuries from a moped accident. n7 At the
hospital, Simmons signed an admission form for her father. n8 The form stated that "independent physicians" staffed
Tuomey's emergency room and are "not employees of Tuomey Regional Medical Center." n9 The emergency room
doctors who examined McBride treated his contusions and released him from the hospital. n10 McBride returned to
Tuomey the following day, where his head injury [*136] was diagnosed as a subdural hematoma. n11 He died six weeks
later at another hospital of complications from the subdural hematoma. n12 Simmons claimed that Tuomey's emergency
room physicians failed to diagnosis and treat her father's head injuries properly when he was first brought to the
hospital. n13 In its own defense, Tuomey alleged that it was not liable because its emergency room doctors were
independent contractors. n14 The trial court agreed and granted Tuomey's motion for summary judgment. n15 The court
relied heavily on a carefully worded 1987 contract between Tuomey and Coastal Physicians Services, which supplied
the emergency room doctors to Tuomey. n16 The contract referred numerous times to the Coastal physicians as
"independent contractors" over whom Tuomey did not exercise "any control over the means, manner, or methods" by
which the physicians carried out their duties. n17
Simmons appealed, arguing that the trial court erred on the issues of actual agency, apparent agency and
nondelegable duty. n18 The court of appeals found the nondelegable duty issue to be dispositive of the appeal and did not
discuss the plaintiff's two other arguments. After briefly reviewing how the doctrine of charitable immunity has evolved
in South Carolina, n19 the court reversed the trial court's decision in favor of Tuomey, finding that the hospital must be
accountable to its patients for actions of caregivers working in its emergency rooms. n20
The court concluded that three factors support this absolute nondelegable duty. First, public reliance on hospital
emergency rooms imposes a nondelegable duty on the part of hospitals to those who utilize its emergency services. n21
As hospitals increasingly provide immediate, around-the-clock medical care, emergency rooms become of vital import
to public safety. n22 Furthermore, as the court observed, patients seeking emergency assistance generally cannot choose
to pass by the nearest emergency room in hopes of finding a hospital whose emergency services are staffed by
employees rather than independent contractors. n23
The court also concluded that Tuomey owed a nondelegable duty to its emergency room patients because the
public has come to consider a hospital as a single-entity providing multifaceted medical services. n24 Patients typically
view physicians who practice in the hospital as the hospital's instrumentalities, regardless of the nature of the
contractual relationship that may exist between them. n25 Hospitals actively solicit business through commercial
advertising fueling this [*137] perception. n26 Imposing a nondelegable duty on hospitals therefore is consonant with
the public's perception of the unity of hospitals' services. n27
Finally, the court found that South Carolina's Minimum Standards for Licensing Hospitals and Institutional
General Infirmaries regulation created a nondelegable duty for hospitals in this case. n28 This hospital accreditation
regulation requires all hospitals, unless exempted, to maintain an open emergency room as a condition for hospital
accreditation. n29 It also requires a licensed physician to be available and on call at all times. n30 The specific duties
prescribed by state regulation, thus, support imposing a nondelegable duty on Tuomey. n31
In finding that a nondelegable duty exists, the court rejected Tuomey's defense that South Carolina does not
impose corporate negligence on its hospitals. n32 Instead, the court distinguished a tort claim against a hospital based on
vicarious liability from one premised on direct liability. n33 According to the court, Simmons's nondelegable duty
argument is based on a form of vicarious liability, which imposes liability on the hospital as the delegating party
regardless of any fault on its part. n34 Tuomey's corporate negligence defense, however, is grounded on the theory of
direct liability and imposed liability on the hospital if it was negligent. n35 As such, Tuomey's defense does not defeat
Simmons's vicarious liability cause of action. n36 More important, the court rejected Tuomey's interpretation of its
corporate negligence rule, discussed in Strickland v. Madden, n37 as not supported by the language of that case.
According to the court, the plaintiff in Strickland lost not because South Carolina does not recognize the doctrine of
corporate liability, n38 but because the plaintiff failed to establish the requisite standard of care that the defendant
hospital allegedly violated. n39
This decision has a two fold significance. First, to the extent that the court imposed a nondelegable duty on
hospitals to their emergency room patients, South Carolina hospitals remain liable to third parties for the negligence of
those to whom the hospitals have delegated medical care responsibilities, whether or not the hospitals were reasonable
in their delegation. n40 Second, and more importantly, the court indicated that its decision to impose a nondelegable duty
on hospitals for malpractice that occurs in their emergency rooms ultimately rests not on traditional [*138] agency
rules or tort laws, but on public policy. n41 The court's extensive reference to public policy considerations, albeit dicta,
signals that the scope of tort liability for South Carolina hospitals may continue to expand in the future. Even though
this court did not clarify its position on the applicability of the doctrine of corporate negligence in light of Strickland,
lessons from other jurisdictions suggest that efforts to stretch the vicarious liability doctrine to reach hospital liability
would inevitably lead to the direct imposition of corporate negligence liability on the hospitals. n42

Legal Topics:
For related research and practice materials, see the following legal topics:
Healthcare LawActions Against FacilitiesFacility LiabilityHospitalsTortsMalpractice & Professional
LiabilityHealthcare ProvidersTortsVicarious LiabilityGeneral Overview

FOOTNOTES:

n1. No. 2788, 1998 WL 57450 (S.C. Ct. App. Feb. 2, 1998).

n2. See id. at *6.

n3. Because most hospitals were originally charitable organizations that served a public service, South Carolina courts had held as early as
1914 that "it would be against public policy to hold a charitable institution [in this case a hospital] responsible for the negligence of servants"
who were selected with due care. Id. at *2 (quoting Lindler v. Columbia Hospital, 81 S.E. 512 (S.C. Ct. App. 1914)). As the function of
hospitals changed over time, the doctrine of charitable immunity began losing its appeal with South Carolina courts. The South Carolina
Supreme Court first scaled back the doctrine's scope in the seminal case of Brown v. Anderson County Hospital Ass'n, holding that hospitals
may be held liable if the plaintiff could prove that "the injuries occurred because of the hospital's heedless and reckless disregard" of the
plaintiff's rights. Id. (quoting Brown v. Anderson County Hosp. Ass'n, 234 S.E.2d 873 (S.C. Ct. App. 1977)). Four years later, South
Carolina formally abandoned the doctrine of charitable immunity in Fitzer v. YMCA, where the court's majority concluded that the doctrine
has "no place in today's society" because "the public policies that once supported the doctrine of charitable immunity has changed over the
course of time." Id. (quoting Fitzer v. YMCA, 282 S.E.2d 230 (S.C. Ct. App. 1981)).

n4. Id. at *1.

n5. See id. at *5.

n6. Id. at *3.

n7. See id. at *1.

n8. See id.

n9. See id.

n10. See id.

n11. See id.

n12. See id.

n13. See id.

n14. See id.

n15. See id.

n16. See id.

n17. Id.

n18. See id.

n19. See id. at *2.

n20. See id. at *6.

n21. See id. at *3.

n22. See id.

n23. See id.

n24. See id.

n25. See id.

n26. See id. at *4. The court also noted the commercialization of American medical care as an additional reason for scaling back limitations
on hospital liability. See id.

n27. See id.

n28. See id.

n29. See id.

n30. See id.

n31. See id.

n32. See id. at *5.

n33. See id.

n34. See id.

n35. See id.

n36. See id.

n37. 488 S.E.2d 581 (S.C. Ct. App. 1994). In Strickland v. Madden, the plaintiff attempted to prove that the defendant hospital was
negligent by inadequately monitoring its medical staff's privileges. See Simmons, 1998 WL 57450, at *5.

n38. The Strickland court assumed, without deciding, that corporate negligence was recognized in South Carolina as a cause of action. See
id.

n39. See id.

n40. See id.

n41. See id. at *6.

n42. See Barry R. Furrow et al., Health Law Cases, Materials and Problems 270 (3d ed. 1997).