Hand v. Tavera
864 S.W.2d 678, 1993 WL 366864, 1993 Tex. App. LEXIS 3201 (1993)
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Rule of Law:
A physician-patient relationship is established when an insured member of a health plan seeks care at a participating hospital, and the plan's designated on-call physician is consulted by an emergency room doctor regarding the patient's treatment and admission, even if the on-call physician never physically examines the patient.
Facts:
- Lewis Hand went to the Humana Hospital emergency room complaining of a three-day headache.
- Hand informed the emergency room physician, Dr. Boyle, that he had a history of high blood pressure and that his father had died of an aneurysm.
- Hand was an enrollee in the Humana Health Care Plan.
- After observing Hand for several hours, Dr. Boyle decided that Hand should be admitted to the hospital.
- Hospital staff identified Dr. Robert Tavera as the on-call physician for the Humana plan responsible for authorizing admissions.
- Dr. Boyle consulted with Dr. Tavera by telephone, briefing him on Hand's condition and recommending hospitalization.
- Dr. Tavera disagreed with the recommendation, concluding that Hand could be treated as an outpatient with medication.
- A few hours after being sent home, Hand suffered a stroke.
Procedural Posture:
- Lewis Hand and his wife sued Dr. Robert Tavera, Dr. Boyle, and Humana Hospital in a Texas trial court for medical malpractice.
- The Hands settled their claim against Humana Hospital.
- The Hands non-suited (voluntarily dismissed) their claim against Dr. Boyle.
- Dr. Tavera filed a motion for summary judgment, arguing he owed no duty to Hand because no physician-patient relationship ever existed.
- The trial court granted summary judgment for Dr. Tavera, resulting in a take-nothing judgment against Hand.
- Lewis Hand, as appellant, appealed the trial court's judgment to the Court of Appeals of Texas, San Antonio, an intermediate appellate court.
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Issue:
Does a physician-patient relationship, and its corresponding duty of care, exist between a health plan's on-call physician and a plan member when the physician is consulted by telephone by an emergency room doctor regarding the member's admission but never meets or examines the member in person?
Opinions:
Majority - Peeples, Justice
Yes. A physician-patient relationship exists between a health plan's on-call physician and a plan member under these circumstances. The court reasoned that the contractual arrangement between the patient, the health plan, and the physician's medical group brings the parties together just as if they had met directly. Hand paid premiums to Humana for medical care, and Humana contracted with Tavera's group to provide that care to enrollees. By being the designated on-call physician and being consulted about Hand's treatment, Tavera entered into a physician-patient relationship and assumed a duty of care. The court rejected Tavera's argument that Hand was merely a third party to the contract, holding that the entire health-care plan arrangement established the relationship.
Analysis:
This decision adapts the traditional requirements for forming a physician-patient relationship to the realities of modern managed care systems like HMOs. It clarifies that a duty of care can arise without a direct, physical encounter between a doctor and patient. The ruling expands potential liability for physicians who act as gatekeepers or consultants within health plans, holding them accountable for treatment decisions made remotely. This precedent is significant for medical malpractice litigation involving managed care organizations, as it prevents on-call physicians from disclaiming a duty of care simply because they did not physically examine the patient.
