Baptist Memorial Hospital System v. Sampson
969 S.W.2d 945, 1998 WL 253914 (1998)
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Rule of Law:
A hospital is not vicariously liable for the negligence of an independent contractor physician under the theory of ostensible agency unless the plaintiff can show that 1) they had a reasonable belief the physician was a hospital agent, 2) the belief was generated by the hospital's affirmative conduct, and 3) they justifiably relied on that representation.
Facts:
- On March 23, 1990, Rhea Sampson was bitten on the arm by what was later determined to be a brown recluse spider.
- That evening, with her arm swollen and painful, Sampson went to the Southeast Baptist Hospital emergency room.
- Dr. Susan Howie, an emergency room physician, diagnosed an allergic reaction, provided treatment, and discharged Sampson.
- Over a day later, Sampson's condition worsened, and she returned to the same emergency room by ambulance.
- On her second visit, Dr. Mark Zakula, another emergency room physician, administered pain medication and released her.
- During both visits, before receiving treatment, Sampson signed consent forms which explicitly stated that all physicians were independent contractors and not agents or employees of the hospital.
- The hospital also had signs posted in the emergency room notifying patients that the physicians were independent contractors.
- About fourteen hours after her second visit, Sampson went to a different hospital where she was diagnosed with a brown recluse spider bite and admitted to intensive care in septic shock.
Procedural Posture:
- Rhea Sampson sued Dr. Zakula for medical malpractice and Baptist Memorial Hospital System (BMHS) for direct negligence and vicarious liability in state trial court.
- The trial court granted summary judgment in favor of BMHS on Sampson's claims of vicarious liability and negligent treatment.
- The trial court severed these claims to make the judgment final for appeal.
- Sampson, as appellant, appealed the summary judgment on the vicarious liability theory to the court of appeals.
- The court of appeals, finding a genuine issue of material fact, reversed the trial court's summary judgment.
- BMHS, as petitioner, then sought review from the Supreme Court of Texas, the state's highest court.
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Issue:
Is a hospital vicariously liable under the theory of ostensible agency for the negligence of an independent contractor emergency room physician when the hospital provides express written notice to the patient that its physicians are independent contractors?
Opinions:
Majority - Phillips, Chief Justice
No. A hospital is not vicariously liable for the negligence of an independent contractor physician when it takes affirmative steps to inform patients of the physician's independent status. To establish a hospital's liability under ostensible agency, a plaintiff must prove three elements: 1) a reasonable belief that the physician was the hospital's agent or employee; 2) that this belief was generated by the hospital's conduct (either affirmatively holding the physician out as its agent or knowingly permitting the physician to do so); and 3) justifiable reliance on that representation. The court explicitly rejected the more lenient standard from the Restatement (Second) of Torts § 429 and declined to impose a nondelegable duty on hospitals for emergency room physician negligence. In this case, the hospital's conduct—providing signed consent forms and posting signs that disclaimed an agency relationship—prevented Sampson from establishing that her belief was generated by the hospital. Even if Sampson did not read the forms, the hospital took overt measures to dispel any notion of agency, and therefore, as a matter of law, no conduct by the hospital could have led a reasonable patient to believe the physicians were its employees.
Analysis:
This case solidifies the traditional, estoppel-based test for ostensible agency in the hospital liability context in Texas, rejecting a modern trend towards imposing stricter, nondelegable duties for emergency room care. The court's decision provides hospitals with a clear safe harbor from vicarious liability: by using explicit consent forms and posted notices to inform patients that physicians are independent contractors, they can effectively defeat ostensible agency claims. This ruling places a significant burden on patients, holding them accountable for the content of forms they sign, even in the distracting and stressful environment of an emergency room. It clarifies that the focus of the inquiry is on the hospital's objective representations, not the patient's subjective belief.
