In this case, the Court addressed three emerging and common issues.  These included Plaintiff’s claims that the hospital should have been held vicariously liable for the alleged acts and omissions of an emergency room physician, that the hospital had a non-delegable duty to provide emergency services, and that the alleged failure of nursing staff to obtain a complete medical history related to the outcome.

In Bain, the Plaintiff alleged that the emergency room physician and hospital failed to diagnose and treat a dissecting aortic aneurysm.  On appeal, Plaintiff argued that summary judgment was inappropriate claiming that the hospital should be liable for the acts of the emergency room physician who was allegedly the apparent or ostensible agent of the hospital.  In doing so, Plaintiff pointed to various elements frequently considered in these cases such as the physician’s Helen Keller Hospital name tag, the use of Helen Keller Hospital’s medical records and forms, the lack of signage indicating that emergency room physicians were independent contractors, and the like.  Of course, under Alabama law apparent agency is dependent upon the hospital allegedly holding the physician out as its employee or having authority to act on its behalf.  Here, Plaintiff argued that the act of operating a full-service hospital with an emergency room was tantamount to such a holding out.  The Court disagreed, stating “[c]ertainly, the mere existence of an emergency department in a hospital cannot be evidence of an affirmative act by HKH from which we could conclude that HKH held itself out as employing the physicians who worked in the emergency department”.

Regarding the alleged failure on the part of the hospital to disclose the physician’s status as an independent contractor, the Court noted that Plaintiff’s argument was an attempt to reverse the burden of proof in an agency-by-estoppel claim.  Again, the test is whether the purported principal held the alleged agent out as having authority to act on the principal’s behalf.   Significantly, the Court also focused on an often-overlooked element of such claims, the requirement that the Plaintiff prove that he or she relied upon the supposed holding out.  The Court found that there was no proof that the injured party was misled into believing that the physician was a hospital employee.  

In addition, Plaintiff alleged that Helen Keller Hospital owed a non-delegable duty to provide the decedent with emergency medical physician services within the standard of care.  In doing so, Plaintiff relied upon Alabama State Board of Health Regulations generally providing that the hospital shall have an effective governing authority responsible for the care provided, and that the governing authority has an obligation to ensure that services performed under a contract are provided in a “safe and effective manner”.  Noting that the Board of Health Regulations also provided that “a doctor of medicine or osteopathy is responsible for the care of each patient” the Court found, when reviewing these regulations in context, that they do not impose a specific duty on a hospital to provide emergency medical physician services falling within the standard of care.  

In reaching this conclusion, the Court noted that, per the Alabama Medical Liability Act, the duty of care owed to a patient by a physician is distinct from that owed by a hospital. Recognizing these differing roles, the Court noted that had the Plaintiff truly felt that HKH breached its duty in allowing the physician to work in the hospital, she could have brought a “corporate liability” claim alleging, for example, negligent credentialing.

Finally, the Court rejected Plaintiff’s direct claim against the hospital in which she alleged that the emergency room nurses failed to obtain the patient’s family history of hypertension and aneurysm which would have, likewise, made the emergency room physician aware of this history.  Noting that the widow acknowledged that the patient’s family history was discussed with the emergency room physician, the Court affirmed summary judgment finding no causal link between the alleged omissions by the nursing staff and the outcome.  In doing so, the Court explained that causation would only be supported if the emergency room physician had otherwise failed to receive the patient’s family history.