Giles v. Anonymous Physician I
2014 WL 3572831, 13 N.E.3d 504, 2014 Ind. App. LEXIS 333 (2014)
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Rule of Law:
A physician-patient relationship, which is a prerequisite for a medical malpractice claim, is not established unless the physician performs an affirmative act with regard to the patient, such as providing treatment, examination, or diagnosis. Merely being an on-call physician who responds to a consult but declines to treat the patient based on a pre-existing protocol does not create a duty of care.
Facts:
- On August 11, 2010, Ruth Giles underwent a ten-minute outpatient nasal reduction surgery performed by ENT Surgeon at Anonymous Hospital.
- In the post-anesthesia care unit (PACU), Ruth developed complications, including low oxygen saturation, low blood pressure, and chest pain.
- ENT Surgeon, the attending physician, requested a consultation from the on-call hospitalist, Hospitalist, to see Ruth in the PACU.
- Hospitalist went to Ruth's bedside but, after checking her chart, discovered her primary care physician, Family Doctor, had not contracted with the hospitalist group to treat his patients.
- Hospitalist informed Ruth and ENT Surgeon that he could not treat her because she was not a hospitalist patient under the established protocol.
- Hospitalist did not examine, treat, or bill Ruth, and his only actions were to check her chart and decline care based on the protocol.
- After a delay in contacting her Family Doctor, Ruth's condition deteriorated, and she was eventually admitted to the hospital.
- Ruth Giles died ten days later from cardiopulmonary arrest due to respiratory failure and pneumonia.
Procedural Posture:
- James Giles, on behalf of Ruth Giles's estate, filed a proposed complaint with the Indiana Department of Insurance and contemporaneously filed a medical malpractice complaint in the Bartholomew Superior Court (trial court).
- The complaint named Hospitalist and Medical Corporation as defendants, among others.
- Hospitalist and Medical Corporation filed a motion for summary judgment in the trial court, seeking a preliminary determination of law on the issue of duty.
- The trial court granted summary judgment in favor of Hospitalist and Medical Corporation, finding no physician-patient relationship existed.
- Giles, as the appellant, now appeals the trial court's grant of summary judgment to the Indiana Court of Appeals.
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Issue:
Does an on-call physician establish a physician-patient relationship, and thus a duty of care, when he responds to a request for a consult but then declines to treat the patient after determining that the patient's primary care physician has not authorized his group to provide care?
Opinions:
Majority - Pyle, Judge
No. A physician-patient relationship is a legal prerequisite for a medical malpractice cause of action, and it does not exist where a physician performs no affirmative act toward the patient. The court reasoned that Indiana law requires a consensual, contractual relationship between a doctor and patient. This relationship is formed only when a physician performs an affirmative act, such as treating, examining, or diagnosing the patient. Here, Hospitalist's actions were limited to checking Ruth's chart to determine eligibility for care and then expressly declining to enter into a physician-patient relationship based on a pre-existing protocol with Ruth's family doctor. Citing Miller v. Martig, the court held that where a doctor does not treat, see, or in any way participate in the care or diagnosis of a patient, a doctor-patient relationship is not formed. Because Hospitalist performed no affirmative act and did not treat Ruth, no relationship was established, and therefore he owed her no duty of care.
Analysis:
This case reinforces the strict requirement in Indiana law that a physician-patient relationship must be established through an affirmative act of care before a duty arises. The decision clarifies that an on-call physician's mere presence or response to a consultation request is insufficient to create such a relationship, especially when care is explicitly declined due to established hospital or group protocols. This provides a significant legal protection for hospitalists and other on-call physicians, defining a clear line where their legal duty begins and ends. It signals that courts will not impose a duty based on a patient's need or another doctor's request alone, absent the physician's knowing acceptance of the patient.
