Mehlman v. Powell
281 Md. 269, 1977 Md. LEXIS 593, 378 A.2d 1121 (1977)
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Rule of Law:
A hospital is vicariously liable for the negligence of an independent contractor physician under the doctrine of apparent agency if the hospital represents to the patient that the physician is its employee and the patient justifiably relies on that representation. A patient's reliance is justified when the hospital does nothing to put the patient on notice that the physician is not a hospital employee.
Facts:
- Beginning in December 1973, William Powell experienced shortness of breath and other discomforts.
- In March and April 1974, Powell was seen by a specialist, Dr. Edward Mehlman, who performed tests but failed to administer a perfusion lung scan, which allegedly would have diagnosed a treatable pulmonary embolic disease.
- On May 28, 1974, Powell's condition worsened, and his wife took him to the Holy Cross Hospital emergency room.
- At the hospital, Dr. Ruben Cosca, an emergency room physician, misread Powell's electrocardiogram, misdiagnosed him with pneumonitis, and released him from the hospital.
- On the morning of May 30, 1974, William Powell died at home.
- An autopsy revealed that the cause of death was a pulmonary embolism.
Procedural Posture:
- The widow and children of William Powell filed a medical malpractice action in the Circuit Court for Montgomery County against Dr. Mehlman, Dr. Cosca, and Holy Cross Hospital.
- Holy Cross Hospital filed a cross-claim against Dr. Cosca for indemnity.
- A jury in the trial court found for the plaintiffs against all three defendants, awarding $221,000 in damages.
- The trial court also entered a judgment in favor of the Hospital on its cross-claim against Dr. Cosca.
- The defendants (appellants) appealed the judgments to the Court of Special Appeals, the state's intermediate appellate court.
- Prior to a decision by the intermediate appellate court, the Court of Appeals of Maryland, the state's highest court, issued a writ of certiorari to hear the case.
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Issue:
Does a hospital represent an emergency room physician as its agent, making it vicariously liable for the physician's negligence under the doctrine of apparent agency, when the hospital does not inform patients that the physician is an independent contractor and all appearances suggest the physician is part of the hospital staff?
Opinions:
Majority - Eldridge, J.
Yes, a hospital is liable for the negligence of an emergency room physician under the doctrine of apparent agency when it holds the physician out as its employee. The court adopted the principle from the Restatement (Second) of Agency § 267, which imposes liability on one who represents another as their agent, thereby causing a third person to justifiably rely on the skill of that apparent agent. Unlike a gas station, where independent ownership is common knowledge, a patient enters a hospital seeking medical services from the institution itself. Holy Cross Hospital did nothing to put Mr. Powell on notice that the emergency room physicians were independent contractors; all appearances suggested the ER was an integral part of the hospital. Therefore, the hospital represented the ER staff as its employees, Mr. Powell justifiably relied on that representation, and the hospital is liable for Dr. Cosca's negligence as if he were an employee.
Analysis:
This decision establishes that the doctrine of apparent agency is applicable to the hospital-physician relationship, particularly in the emergency room context where patients do not choose their physician. It prevents hospitals from insulating themselves from liability by classifying ER doctors as independent contractors, effectively creating a non-delegable duty to patients. The ruling creates a strong presumption that patients rely on the hospital's reputation for care, not that of an unknown individual physician. Consequently, hospitals must take affirmative steps, such as providing clear and conspicuous notice, if they wish to avoid vicarious liability for the negligence of independent contractors working on their premises.
