Dingle v. Belin
749 A.2d 157, 2000 Md. LEXIS 174, 358 Md. 354 (2000)
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Rule of Law:
A physician's violation of a specific agreement with a patient to personally perform certain tasks during a medical procedure can give rise to a distinct cause of action for breach of contract, separate from tort-based claims of negligence or lack of informed consent.
Facts:
- Deborah Belin hired Dr. Lenox Dingle, a general surgeon, to perform a laparoscopic cholecystectomy (gall bladder removal).
- Belin, a surgical technician, was aware that Mercy Hospital was a teaching hospital and testified that she specifically requested, and Dr. Dingle agreed, that he would perform the actual cutting and removal of the gall bladder, with a resident only assisting as necessary.
- Dr. Dingle denied making any such specific agreement with Belin.
- During the surgery on July 2, 1993, Dr. Dingle performed the retractions while a resident, Dr. Magnuson, performed the dissection (cutting) and removal of the gall bladder.
- Dr. Magnuson mistakenly dissected and clipped Belin's common bile duct instead of the cystic duct.
- The surgical error caused bile to leak into Belin's abdomen, resulting in significant pain and requiring extensive corrective surgery.
- The written consent form Belin signed authorized Dr. Dingle "and/or such assistants as may be selected and supervised by him" to perform the procedure and contained no special remarks limiting the role of assistants.
Procedural Posture:
- Deborah Belin sued Dr. Lenox Dingle, Dr. Magnuson, and Mercy Hospital in the Circuit Court for Baltimore City (trial court).
- The complaint included counts for breach of contract, negligence in performance of surgery, and negligence based on lack of informed consent.
- At the conclusion of the evidence, the trial court granted judgment as a matter of law for Dr. Dingle on the breach of contract claim, ruling it was subsumed by the negligence claims.
- The negligence claims were submitted to a jury, which returned a verdict in favor of the defendants.
- Belin, as appellant, appealed the dismissal of her breach of contract claim to the Court of Special Appeals of Maryland (intermediate appellate court).
- The Court of Special Appeals reversed the trial court's judgment, holding that the breach of contract claim was a valid, separate cause of action that should have gone to the jury.
- Dr. Dingle, as petitioner, sought review from the Court of Appeals of Maryland (the state's highest court).
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Issue:
Does a surgeon's violation of a specific oral agreement with a patient, stipulating that the surgeon personally perform the cutting during a procedure, give rise to a distinct cause of action for breach of contract?
Opinions:
Majority - Wilner, J.
Yes, a claim for breach of contract is a valid and distinct cause of action when a physician allegedly violates a specific agreement with a patient regarding the allocation of surgical tasks. The doctor-patient relationship is fundamentally contractual, allowing parties to define the physician's role with precision. A breach of such a specific promise is separate from traditional malpractice, which focuses on the standard of care, and from lack of informed consent, which focuses on the adequacy of disclosure. Although the court recognizes the validity of this cause of action, it reverses the intermediate appellate court's decision in this specific case. The central factual question underlying both the breach of contract and lack of informed consent claims was whether Dr. Dingle had actually made the promise Belin alleged. This factual issue was presented to the jury under the informed consent claim, and the jury's verdict in favor of Dr. Dingle constituted a necessary finding that no such agreement existed. Therefore, the breach of contract claim, which depends on the existence of that same agreement, cannot succeed.
Analysis:
This decision solidifies that a physician's specific promises regarding the performance of a medical procedure can create a contractual duty distinct from the general duty of care owed in tort. It affirms the principle of patient autonomy by allowing patients to contract for the specific skills of a chosen surgeon and hold them liable for breach if a different or less experienced physician performs the key tasks. This creates a separate avenue for liability even if the substitute's performance does not fall below the standard of care. However, the case also underscores the practical challenge for plaintiffs in proving the existence of such specific oral agreements, especially when contradicted by general written consent forms, and highlights the procedural risk that a dispositive factual finding under one theory can preclude recovery under another.
