Case Title: White v. Harris

Citation: 

Docket Number: 2010-246

State: vermont

Court: Vermont Supreme Court

Date: 2011-09-29T00:00:00Z

Document:
White and Searles v. Harris,
Foote, Farrell, et al. (2010-246)
 
2011 VT 115
 
[Filed 29-Sep-2011]
 
 
ENTRY ORDER
 
2011 VT 115
 
SUPREME COURT
  DOCKET NO. 2010-246
 
FEBRUARY TERM, 2011
 
Terrence White, Individually, and
  as Administrator of Estate of Krystine White, and
  Pauline Searles
}
}
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APPEALED FROM:
 
}
 
     v.
}
Caledonia Superior Court
 
}
 
Mark S. Harris, M.D., Nancy Foote,
  Susan Farrell, Upper Valley Pediatrics, Northeast Kingdom Human Services,
  Inc., Rita M. Gelsomini Gruber, M.D., Fletcher
  Allen Health Care, Inc., and Gain Paolo Bentivoglio,
  M.D.
}
}
}
}
}
}
 
 
 
 
DOCKET NO. 155-6-09 Cacv
 
 
 
 
 
 
Trial Judge:  Harold E. Eaton, Jr. 
 
In the above-entitled
cause, the Clerk will enter:
 
¶ 1.            
Plaintiffs appeal from a superior court order granting summary judgment
to defendant Fletcher Allen Health Care, Inc. in this wrongful death action
alleging medical malpractice.  This case arises from the suicide of
plaintiffs' fourteen-year-old daughter.  Plaintiffs sued defendant, which
employed a psychiatrist who was briefly involved with decedent's case through a
telepsychiatry research study.  Plaintiffs argue that summary judgment was
improperly granted on the issue of the duty owed to decedent by the
psychiatrist.  We agree, and thus reverse and remand for additional
proceedings.  
¶ 2.            
The record indicates the following.  Decedent suffered from ongoing
mental health problems.  On the recommendation of her case manager, she
consulted with defendant's psychiatrist through a telepsychiatry research study
he was conducting.  As part of the study, plaintiffs and decedent
completed pre-assessment documentation, and they participated in a one-time,
ninety-minute video-conference session with the psychiatrist in August
2006.  Following the session, the participants completed a questionnaire
about their reaction to using telemedicine.  The psychiatrist later
completed a consultation evaluation that described decedent and the history of
her present illness; it also provided the doctor's diagnostic impression of
decedent and set forth recommendations for an initial treatment plan.  The
evaluation specifically stated that, consistent with the telepsychiatry
research protocol, no follow-up services would be provided, and no medication
prescriptions would be directly provided by the doctor.  The report further
explained that the recommended treatment plan was to be weighed by decedent's
treatment team, including her primary care physician, for possible
implementation.  After sending his evaluation, the psychiatrist had no
further interaction with plaintiffs, decedent, or any member of her treatment
team.  
¶ 3.            
On June 10, 2007, decedent committed suicide.  An autopsy report
indicated that she died from the combined effects of ingesting Propoxyphene, opiates, and Citalopram. 
The psychiatrist had not prescribed or recommended any of these
medications.  
¶ 4.            
In June 2009, plaintiffs filed an amended complaint, alleging that
defendant, among eight doctors and medical care providers, treated decedent in
a manner that "fell below the standard of care required of reasonably skillful,
careful, and prudent professionals," and that decedent died as a proximate
result.  Defendant moved for summary judgment in December 2009, asserting
that its doctor had no duty to decedent when she committed suicide because
there was no doctor-patient relationship.  Alternatively, defendant argued
that any such relationship was formally terminated in writing following their
one-time interaction.  Defendant acknowledged that if the trial court
found that a duty existed, its motion would be premature.  The trial court
also recognized that the motion came at an early stage in the proceedings, but
reasoned that if no duty existed, then no additional discovery to show a breach
of that duty would be necessary.  Ultimately, the trial court agreed that
the psychiatrist's contact with decedent was "so minimal as to not establish a
physician-patient relationship," and consequently found that no duty existed at
the time of decedent's death.  Even assuming that a doctor-patient relationship
was established, the court concluded that it was terminated following the
video-conference and, thus, any duty was extinguished by termination of the
relationship and no duty existed at the time of decedent's death.  The
court thus granted defendant's summary judgment motion.  This appeal
followed.
¶ 5.            
Plaintiffs argue that the court erred in finding that the doctor owed no
duty to decedent.  They maintain that the doctor had a duty to exercise
reasonable care to protect decedent from the danger she posed to herself, and
that the doctor did not effectively terminate the doctor-patient relationship
prior to decedent's death.  
¶ 6.            
We review motions for summary judgment de novo, using the same standard
of review as the trial court.  Campbell v. Stafford, 2011 VT 11, ¶
10, ___ Vt. ___, 15 A.3d 126.  We afford the
non-moving party "the benefit of all reasonable doubts and inferences," Doe
v. Forrest, 2004 VT 37, ¶ 9, 176 Vt. 476, 853 A.2d 48, and we will affirm
summary judgment orders when there is no genuine issue as to any material fact
and a party is entitled to judgment as a matter of law.  V.R.C.P. 56(c)(3).  
¶ 7.            
We agree that a duty applies to the service provided.  The doctor
had a duty of due care in his professional contact with decedent, which was not
extinguished by the ministerial act of termination of their professional
relationship.  See Endres v. Endres, 2008 VT 124, ¶ 11, 185 Vt. 63, 968 A.2d 336 (noting that the existence of a legal duty is "central to a negligence
claim" and is "primarily a question of law"); see also Markowitz v. Arizona
Parks Bd., 706 P.2d 364, 366 (Ariz. 1985) (en banc) ("[A] negligence action
may be maintained only if there is a duty or obligation, recognized by law,
which requires the defendant to conform to a particular standard of conduct in
order to protect others against unreasonable risks of harm.").  We have
defined duty as "an expression of the sum total of those considerations of
policy which lead the law to say that the plaintiff is entitled to
protection."  Endres, 2008 VT 124, ¶ 11 (quotation omitted).  In
assessing whether a duty exists, "[t]he question is whether the relationship of
the parties was such that the defendant was under an obligation to use some
care to avoid or prevent injury to the plaintiff."  Markowitz, 706 P.2d  at 368; see also Langle v. Kurkul, 146 Vt. 513, 520, 510 A.2d 1301, 1305 (1986)
(in determining whether duty of care exists, courts consider relationship
between parties, nature of the risk (including its foreseeability),
and public policy implications of imposing a duty on defendant to protect
against the risk).  In their analysis of circumstances similar to those
here, other courts have considered these factors:
whether
the doctor was in a unique position to prevent harm, the burden of preventing
harm, whether the plaintiff relied upon the doctor's diagnosis or
interpretation, the closeness of the connection between the defendant's conduct
and the injury suffered, the degree of certainty that the plaintiff has or will
suffer harm, the skill or special reputation of the actors, and public
policy.  
Stanley v. McCarver, 92 P.3d 849, 853 (Ariz. 2004). 
  
¶ 8.            
The facts here disclose a consultation of limited duration. 
Decedent and her mother signed an informed consent form, and the doctor stated
in writing that the scope of his services was limited.  At the same time,
however, there is no dispute that the doctor performed a psychiatric evaluation
of decedent, following which the doctor offered recommendations for decedent's
treatment.  And the record reveals the parties' expectation that the
doctor would aid in decedent's treatment through his expertise, regardless of
the mechanism of doctor-patient contact. In requesting a consultation with the
doctor, decedent's treatment team specifically sought recommendations about
decedent's medication, particularly given the increase in decedent's angry and
aggressive behavior and self-mutilation.  They also sought the doctor's
diagnostic impression and recommendations about the role that Attention-Deficit
Hyperactivity Disorder might play in decedent's behavior.  While
decedent's medical records may not have been provided to the doctor, the doctor
was provided with a very recent medical evaluation of decedent performed by
another doctor, which was supplemented by additional information about decedent
from decedent's treatment team.  This included information that decedent
had a history of depressive behavior and had recently exhibited an increase in
angry, aggressive behavior, along with more frequent cutting behavior. 
All of this information bears on the scope of the professional relationship
from which defendant's duty arose and it helps to frame the applicable standard
of care.  We find it sufficient to support the existence of a duty
here.  
¶ 9.            
A professional consultation may arise in many different
circumstances.  Defendant's involvement here was limited, but that does
not mean it was nonexistent.  It may be analogized to cases in which a
doctor is asked to perform an independent medical examination (IME) of a
patient as part of a legal investigation or an insurance claim.  As in the
current case, an IME doctor usually does not see a patient again or maintain an
ongoing relationship with the patient, rather he or she performs a limited
analysis of the patient's condition that is provided to a third party. 
See Ritchie v. Krasner, 211 P.3d 1272, 1279-81 (Ariz. Ct. App. 2009)
(considering existence of duty where insurance carrier asked defendant doctor
to conduct IME); Harris v. Kreutzer, 624 S.E.2d 24, 29-32 (Va. 2006)
(considering medical malpractice claim against doctor retained to conduct a
court-ordered IME).  Many courts addressing IME cases have concluded that
an IME creates a doctor-patient relationship that "imposes fewer duties on the
examining physician than does a traditional physician-patient relationship,"
but "still requires that the examiner conduct the examination in such a way as
not to cause harm."  Dyer v. Trachtman,
679 N.W.2d 311, 316 (Mich. 2004); see also Ritchie, 211 P.3d  at 1280
("[A]n IME doctor has a duty to conform to the legal standard of reasonable
conduct in the light of the apparent risk." (quotation omitted)); Harris,
624 S.E.2d  at 32 (holding that "a cause of action for malpractice may lie for
the negligent performance of a [court-ordered medical examination]," but that
the examining physician's "duty is limited solely to the exercise of due care
consistent with the applicable standard of care so as not to cause harm to the
patient in actual conduct of the examination").  
¶ 10.         Here,
the relationship between doctor and patient was even more direct than a
third-party-retained IME doctor. The defendant became involved on referral from
decedent's treatment team and reported to them his findings and recommendations
after evaluation.  We hold that the ninety-minute consultation performed
in this case created a doctor-patient relationship.  We acknowledge that
the telepsychiatry research study conducted by the doctor provided no treatment
component directly to decedent, other than recommendations to her treatment
team.  However, through this consultation, a limited doctor-patient
relationship was established and we conclude that a duty of due care applies.
 Through this consultation, defendant's doctor assumed a duty to act in a
manner consistent with the applicable standard of care so as not to harm
decedent through the consultation services provided.     
¶ 11.         Defendant
argues that submission of the psychiatrist's consultation evaluation to
decedent's treatment team terminated any doctor-patient relationship that ever
existed, and defendant equates the ending of this relationship with the
termination of any "further duty to the patient."[1]  We hold, however, that even if
doctor-patient contact had ended, this does not terminate the doctor's
responsibility for the consequences of any lapses in his duty to provide
services consistent with the applicable standard of care for the
consultation.  Under 12 V.S.A. § 1908(1), a doctor must exercise "the
degree of care ordinarily exercised by a reasonably skillful, careful, and
prudent health care professional engaged in a similar practice under the same
or similar circumstances."  A doctor may be liable for malpractice if "as
a proximate result of . . . the failure to exercise this degree of care the
plaintiff suffered injuries that would not otherwise have been incurred." 
Id. § 1908(3).  Under this statute,
whether or not a doctor has ceased treating a patient is irrelevant to whether
he or she may be held liable for injuries resulting from his or her failure to
exercise the proper degree of care while treating the patient.  It
is the doctor's responsibility for the services provided that is significant
here, and not simply the duration of the doctor-patient relationship
itself.  
¶ 12.         On
these facts, however, the scope of defendant's duty and the standard of care
cannot yet be determined.  In evaluating the standard of care, we must not
conflate the existence of a duty with the appropriate standard of care, an
issue that takes us beyond the limited facts in the record before us and was
not properly raised below.  See W. Keeton, et al., Prosser and Keeton on
the Law of Torts § 53, at 356 (5th ed. 1984) ("It is better to reserve
duty' for the problem of the relation between individuals which imposes upon
one a legal obligation for the benefit of the other . . . .").  Prosser
explains that "in negligence cases, the duty is always the same'to
conform to the legal standard of reasonable conduct in light of the apparent
risk.  What the defendant must do, or must not do, is a question of the
standard of conduct required to satisfy the duty."  Id.; see also Markowitz,
706 P.2d  at 367 (emphasizing that conflating these issues "incorrectly leads to
attempts to decide on a general basis whether a defendant has a duty' " to
take certain actions, such as posting warning signs, or providing additional
traffic signs, and recognizing that "[t]hese details
of conduct bear upon the issue of whether the defendant who does have a duty
has breached the applicable standard of care and not whether such a standard of
care exists in the first instance" (citations omitted)). 
¶ 13.         As
the McCarver court observed, "[t]he standard
of care imposes on those with special skills or training . . . the higher
obligation to act in light of that skill, training, or knowledge."  92 P.3d  at 854.  Thus, in McCarver,
the court found that the doctor in question had "assumed a duty to conform to
the legal standard of care for one with his skill, training, and knowledge,"
but concluded that the question of "what is necessary to satisfy the standard
will depend upon the facts of each case."  Id.  We do not yet
know plaintiffs' position on the standard of care in this case, i.e., what a
"reasonably skillful, careful, and prudent health care professional" would have
done under similar circumstances, or how any alleged breach of this standard
was the proximate cause of harm to decedent.  12 V.S.A.
§ 1908(1).  
¶ 14.         The
issue of standard of care was not raised by defendant in its motion for summary
judgment, nor decided by the trial court.[2] 
It is not the role of this Court to set that standard or to evaluate whether it
was breached at this stage of the proceedings.  Expert testimony is
required.  See Senesac v. Assocs. in
Obstetrics & Gynecology, 141 Vt. 310, 313, 449 A.2d 900, 902 (1982) (in
medical malpractice action, plaintiff must ordinarily produce "expert medical
testimony setting forth: (1) the proper standard of medical skill and care; (2)
that the defendant's conduct departed from that standard; and (3) that this
conduct was the proximate cause of the harm complained of"); see also Ritchie,
211 P.3d  at 1279 (noting that, aside from duty, the remaining "elements of
negligence are factual issues, and are generally within the province of the
jury").  
¶ 15.         This
is a lawsuit in its formative stages.  The motion for summary judgment was
filed six months after the complaint was filed and raised the sole question of
the duty of care of this consulting doctor.  The remaining elements of
plaintiffs' claim have not yet been fully developed, and defendant did not move
for summary judgment on these elements.  See State v. Therrien, 2003 VT 44, ¶ 23 n.3, 175 Vt. 342, 830 A.2d 28 (recognizing "general rule that summary judgment should not be granted on an
issue not raised in the summary judgment motion unless the party against whom
summary judgment is granted is given full and fair notice and opportunity to
respond to the issue prior to the entry of summary judgment").  Given our
conclusion that a duty exists, we reverse and remand for additional
proceedings.
Reversed
and remanded.
 
 
BY THE COURT:
 
 
 
 
 
 
 
Paul L. Reiber,
  Chief Justice
 
 
 
 
 
John A. Dooley, Associate
  Justice
 
 
 
 
 
Denise R. Johnson,
  Associate Justice
 
 
 
 
 
Marilyn S. Skoglund, Associate Justice
 
 
 
 
Note:  Justice Burgess was present at oral argument,
but did not participate in this decision.
 

[1] 
Defendant contends that plaintiffs failed to properly preserve their arguments
pertaining to termination of the doctor-patient relationship, claiming that
"[p]laintiffs here did not . . . argue that the
doctor-patient relationshipif any ever existedbetween [defendant] and
[decedent] was not terminated in exactly the manner [defendant] contended it
was."  To some extent, defendant appears to conflate the issue of whether
a doctor-patient relationship existed with whether defendant had a continuing
responsibility for the quality of care provided to decedent.  We agree
that defendant had no ongoing duty to provide care for decedent after the
psychiatrist's consultation ended.  This does not affect, however, whether
defendant can be held liable for any alleged breach of the psychiatrist's duty
to meet the required standard of care during the course of the telepsychiatry
research study.  While plaintiffs may not have specifically addressed
defendant's argument about the termination clause in the psychiatrist's
consultation evaluation, whether or not the doctor-patient relationship was
terminated is not dispositive.
[2]  It is unclear why plaintiffs advanced
any argument regarding the standard of care and the alleged breach of such
standard in their response to defendant's motion for summary judgment.  As
defendant asserted below, plaintiffs appeared to have confused the issue of
duty with the remaining elements of their medical malpractice claim. 
Defendant expressly noted below that its motion "turn[ed]
solely on the threshold question of whether [the doctor] even had a duty to [decedent],
not whether a breach of that duty occurred."  It also agreed that "if the
basis of [its] Motion turned on an alleged breach of the standard of care, then
its Motion for Summary Judgment would be premature."  As previously noted,
the trial court did not address any issue other than duty in its
decision.