Scott v. SSM Healthcare St. Louis
2002 WL 109595, 70 S.W.3d 560 (2002)
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Rule of Law:
A hospital may be held vicariously liable for the negligence of a non-employee physician if it retains the right to control the physician's work. Furthermore, under Missouri's medical malpractice statute, the cap on non-economic damages applies 'per occurrence' of a negligent act, allowing for multiple caps against a single defendant for distinct acts of negligence by its agents that contribute to a single injury.
Facts:
- Seventeen-year-old Matthew Scott was treated at SSM Healthcare St. Louis ('Hospital') for minor injuries after a car accident and released.
- Two days later, Scott returned to the Hospital's emergency room complaining of a severe headache.
- Dr. Doumit, a Hospital employee, examined Scott and ordered a CT scan of his head.
- Dr. Koch, a radiologist employed by Radiologic Imaging Consultants (RIC) but working at the Hospital, read the CT scan and concluded it was normal.
- Based on this, Scott was diagnosed with a mild concussion and sent home.
- The next day, Scott's parents called Dr. Doumit three times to report worsening symptoms, including lethargy and vomiting; Dr. Doumit advised them to continue observing Scott at home.
- Early the following morning, Scott collapsed and was rushed to a different hospital, where tests revealed a severe brain infection that had caused swelling inside his skull.
- As a result of the delayed diagnosis, Scott suffered permanent injuries, including partial paralysis and the need for a permanent ventricular drainage tube in his brain.
Procedural Posture:
- Matthew Scott and his mother, Josephine Scott, filed a medical malpractice action in a Missouri trial court against SSM Healthcare St. Louis ('Hospital'), Dr. Koch, and his employer, Radiologic Imaging Consultants ('RIC').
- Before trial, plaintiffs settled their claims against Dr. Koch and RIC for $624,800.
- The case proceeded to trial solely against Hospital on a theory of vicarious liability for the negligence of Dr. Doumit (its employee) and Dr. Koch (its alleged agent).
- The jury returned a verdict in favor of the plaintiffs, finding that Dr. Koch was an agent of the Hospital and apportioning 75% of fault to Dr. Koch and 25% to Dr. Doumit.
- After post-trial motions, the trial court entered an amended judgment that applied two statutory caps on non-economic damages and reduced the verdict by the dollar amount of the Koch settlement.
- Hospital appealed the trial court's final judgment to the Missouri Court of Appeals, Eastern District.
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Issue:
Does the statutory cap on non-economic damages in a medical malpractice action under § 538.210 apply per negligent act ('occurrence') rather than per resulting injury, thereby permitting multiple caps to be applied against a single defendant found vicariously liable for two separate acts of negligence by its agents?
Opinions:
Majority - Teitelman, J.
Yes, the statutory cap applies per negligent act ('occurrence'), not per injury, allowing for multiple caps. A hospital can be held vicariously liable for the acts of a physician, even one not directly employed by it, if the hospital exercises sufficient control over the physician's work. The evidence of Hospital's control—such as setting standards, providing all equipment and staff, setting prices, and retaining the right to terminate—was sufficient for a jury to find that Dr. Koch was an agent of the Hospital. Because the jury found both Dr. Doumit and Dr. Koch were agents, the Hospital is fully liable for their negligence and is only entitled to a dollar-for-dollar set-off for the settlement with Dr. Koch under § 537.060, not a percentage-of-fault reduction under § 538.230. The court further held that the term 'occurrence' in the non-economic damages cap statute, § 538.210, refers to each distinct act of negligence, not the ultimate injury. Therefore, because there were two separate acts of malpractice—Dr. Koch's misreading of the CT scan and Dr. Doumit's subsequent failure to advise Scott to return to the hospital—the trial court correctly applied two separate statutory caps for non-economic damages.
Analysis:
This decision significantly impacts hospital liability in Missouri by reinforcing a broad view of agency, making it difficult for hospitals to avoid vicarious liability for contracted physicians over whom they exert substantial control. It establishes a key precedent by defining 'occurrence' in the context of statutory damage caps as the negligent act itself, rather than the resulting injury. This interpretation can substantially increase a single defendant's potential liability in cases where multiple, distinct medical errors contribute to a plaintiff's harm, shifting the financial risk more toward healthcare providers in such scenarios.
