Boren Ex Rel. Boren v. Weeks
251 S.W.3d 426, 2008 Tenn. LEXIS 317, 2008 WL 1945985 (2008)
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Rule of Law:
A hospital may be held vicariously liable for the negligence of an independent contractor physician under a theory of apparent agency unless it provides meaningful notice to the patient that the physician is not a hospital agent or employee. A disclaimer buried in a multi-page consent form, without more, may not constitute meaningful notice as a matter of law.
Facts:
- On May 26, 2004, Dorothy Boren fell in her home.
- The next morning, Mrs. Boren went to the River Park Hospital emergency room. Her husband, Marvin Boren, was handed admission papers and told to sign. He initialed and signed a three-page 'Consent for Medical Procedures and Treatment' form, which contained a disclaimer in bold, normal-sized font stating that emergency department physicians were not agents or employees of the hospital.
- Mr. Boren testified he was in a hurry, was not told to read the forms, and was not verbally informed of the physicians' independent contractor status.
- Mrs. Boren returned to the same emergency room later that evening, where Mr. Boren again signed a consent form with the same disclaimer. She was treated by Dr. Mark Weeks and admitted to the hospital.
- On June 3, 2004, Mrs. Boren returned to the emergency room a third time, accompanied by her daughter, who signed similar admission forms. Dr. Weeks again treated and discharged Mrs. Boren.
- The Boren family did not choose the physician who provided treatment, instead relying on the hospital to provide care. Dr. Weeks' name tag did not identify his actual employer or his independent contractor status.
- On June 7, 2004, Mrs. Boren was admitted to the hospital a final time, where a CT scan revealed multiple pulmonary emboli.
- Mrs. Boren died later that evening as a result of the emboli.
Procedural Posture:
- Marvin Boren sued River Park Hospital and Dr. Mark Weeks in Warren County Circuit Court (trial court), alleging River Park was vicariously liable for Dr. Weeks's negligence.
- River Park Hospital filed a motion for summary judgment, arguing it could not be held liable because Dr. Weeks was an independent contractor.
- The trial court denied the motion for summary judgment as to the apparent agency claim, finding that a genuine issue of material fact existed.
- River Park Hospital (appellant) was granted an interlocutory appeal to the Tennessee Court of Appeals.
- The Court of Appeals reversed the trial court and granted summary judgment to River Park Hospital, finding the hospital's disclaimer was sufficient to defeat the apparent agency claim.
- Marvin Boren (appellant) was granted permission to appeal to the Supreme Court of Tennessee.
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Issue:
Is summary judgment for a hospital appropriate on a claim of apparent agency when the hospital provided a written disclaimer of an employment relationship with its emergency room physicians in a standard consent form, but did not otherwise call the patient's attention to this fact?
Opinions:
Majority - Chief Justice Barker
No. Summary judgment is inappropriate because genuine issues of material fact exist as to whether the hospital provided meaningful notice to the patient, which is necessary to defeat a claim of apparent agency. To hold a hospital vicariously liable for the acts of an independent contractor physician, a plaintiff must show that (1) the hospital held itself out as providing medical services, (2) the plaintiff looked to the hospital rather than a specific physician for care, and (3) the patient reasonably believed the services were provided by the hospital or its employee. While a hospital can avoid liability by providing meaningful notice, a disclaimer located in the middle of a paragraph within a multi-page consent form, which admissions staff do not point out and which is signed under the stressful circumstances of an emergency room visit, may not be sufficient. The reasonableness of the patient's belief and the adequacy of the hospital's notice are questions of fact for a jury to decide.
Analysis:
This case formally adopts the Restatement (Second) of Torts § 429 framework for apparent agency in the hospital context for Tennessee. The decision's significance lies in its definition of 'meaningful notice,' establishing that a boilerplate disclaimer in admission forms is not a guaranteed shield against vicarious liability. By focusing on the totality of the circumstances from the patient's perspective, the ruling makes it more difficult for hospitals to win on summary judgment, thereby encouraging them to implement more conspicuous and direct methods of informing patients about the employment status of their physicians.
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