Case Title: Lewis J. Bazakos v. Philip Lewis

Citation: 

Docket Number: 

State: new-york

Court: New York Appellate Court

Date: 2009-06-24T00:00:00Z

Document:
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This opinion is uncorrected and subject to revision before
publication in the New York Reports.
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No. 112  
Lewis J. Bazakos, 
            Respondent,
        v. 
Philip Lewis, 
            Appellant, 
et al.,
            Defendants.
Peter C. Kopff, for appellant.
Submitted by Ralph A. Hummel, for respondent.
SMITH, J.:
We hold that a claim against a doctor for his alleged
negligence in performing an independent medical examination (IME)
is a claim for malpractice, governed by CPLR 214-a's 2 year, 6
month statute of limitations.
I
Lewis Bazakos, plaintiff in this case, was also the
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plaintiff in a previously-brought action arising out of an
automobile accident.  In that action, Bazakos was required,
pursuant to CPLR 3121, to undergo an examination, commonly called
an IME, by a doctor designated by the adverse party. The person
Bazakos sued designated Dr. Philip Lewis, and Lewis examined
Bazakos on November 27, 2001.  
On October 15, 2004, approximately 2 years 11 months
later, Bazakos commenced this action against Lewis.  The
complaint alleges that Lewis injured Bazakos during the IME when
he "took plaintiff's head in his hands and forcefully rotated it
while simultaneously pulling." 
Lewis moved to dismiss the case as barred by the
statute of limitations.  Supreme Court granted the motion,
relying on the Appellate Division, Second Department's decision
in Evangelista v Zolan (247 AD2d 508 [2d Dept 1998]).  On
Bazakos's appeal, the Appellate Division, with two Justices
dissenting, overruled Evangelista and reversed Supreme Court,
holding the action to be timely (Bazakos v Lewis, 56 AD3d 15 [2d
Dept 2008]).  The Appellate Division majority concluded that,
because the doctor performing an IME and the person undergoing it
do not have a physician-patient relationship, the action was not
"for medical ... malpractice" (CPLR 214-a) and was therefore
governed by the three year statute applicable to personal injury
actions generally (CPLR 214 [5]).  The dissenting Justices,
relying on Evangelista and Twitchell v MacKay (78 AD2d 125 [4th
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Dept 1980]), argued that a "limited" physician-patient
relationship exists between the examining doctor at an IME and
the person examined, and that the action should therefore be
considered one for malpractice (56 AD3d at 24).
The Appellate Division granted Lewis leave to appeal,
certifying the question of whether its order was properly made. 
We answer the question in the negative and reverse.
II
Bazakos's argument, which the Appellate Division
accepted, is a simple one:  He says that medical malpractice is a
breach of a doctor's duty to provide his or her patient with
medical care meeting a certain standard; that Lewis was not
Bazakos's doctor, and Bazakos was not Lewis's patient; and that
therefore the negligence of which Lewis is accused cannot be
medical malpractice.  He points out that the relationship between
the doctor and the person the doctor examines at an IME is
essentially adversarial; the person examined is required by law
to submit to a procedure performed for the benefit of a party
seeking to defeat that person's legal claim.  The Appellate
Division majority quoted the observation in Payette v Rockefeller
Univ. (220 AD2d 69, 72 [1st Dept 1996]) that "the existence of a
physician-patient relationship" is "essential to a cause of
action in malpractice."  
There is some logic to Bazakos's position, but the
result he seeks would be an arbitrary one.  Bazakos, like any
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medical malpractice plaintiff, claims he was injured because a
doctor failed to perform competently a procedure requiring the
doctor's specialized skill; Lewis, like any medical malpractice
defendant, is called upon to defend his performance of
professional duties.  This case is not like Payette, in which a
volunteer participant in a diet study at Rockefeller University
complained of the University's "alleged negligent creation and
implementation of its diet research program" (220 AD2d at 72). 
The act on which Bazakos's lawsuit is based --Lewis's
manipulation of a body part of a person who came to his office
for a physical examination -- constitutes "medical treatment by a
licensed physician," and the negligent performance of that act is
not ordinary negligence, but a prototypical act of medical
malpractice (Weiner v Lenox Hill Hosp., 88 NY2d 784, 788 [1996],
quoting Bleiler v Bodnar, 65 NY2d 65, 72 [1985]).  We see no good
reason why the statute of limitations should be longer than it
would be if Lewis were accused of making exactly the same error
on a patient who came to him for consultation or care.  
CPLR 214-a, creating a statute of limitations for
certain forms of professional malpractice that is six months
shorter than the ordinary personal injury statute, was part of a
package of legislation passed in 1975 in response "to a crisis in
the medical profession posed by the withdrawal and threatened
withdrawal of insurance companies from the malpractice insurance
market" (Bleiler, 65 NY2d at 68).  The purpose of the legislative
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package was to enable "health care providers to get malpractice
insurance at reasonable rates" (id., quoting Mem of State
Executive Department, 1975 McKinney's Session Laws of NY at 1601-
1602).  It is unlikely, in our judgment, that the Legislature
would have found less reason to make insurance available to
doctors performing IMEs than to those practicing medicine in more
traditional contexts, or that it intended any distinction between
the two.
We agree with the dissenting Justices at the Appellate
Division that the relationship between a doctor performing an IME
and the person he is examining may fairly be called a "limited
physician-patient relationship" -- indeed, this language is used
in an American Medical Association opinion describing the ethical
responsibilities of a doctor performing an IME (Council on
Ethical and Judicial Affairs, American Medical Association, Code
of Medical Ethics: Current Opinions, Opinion 10.03).  As the
Michigan Supreme Court has explained, this relationship:
"is not the traditional one.  It is a limited
relationship.  It does not involve the full
panoply of the physician's typical
responsibilities to diagnose and treat the
examinee for medical conditions.  The IME
physician, acting at the behest of a third
party, is not liable to the examinee for
damages resulting from the conclusions the
physician reaches or reports.  The limited
relationship that we recognize imposes a duty
on the IME physician to perform the
examination in a manner not to cause physical
harm to the examinee."
(Dyer v Trachtman, 470 Mich 45, 49-50, 679 NW2d 311, 314-315,
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[2004].)
Bazakos's claim here is that Lewis breached his duty
"to perform the examination in a manner not to cause physical
harm to the examinee."  That is a claim for medical malpractice,
and it is governed by the 2 year, 6 month statute of limitations. 
Therefore, Bazakos's lawsuit was not timely.
Accordingly, the order of the Appellate Division should
be reversed, with costs, the order of Supreme Court reinstated
and the certified question answered in the negative.
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Lewis J. Bazakos v Philip Lewis, M.D. and 684 Associates, Inc.,
d/b/a D & D Associates
No. 112
LIPPMAN, Chief Judge(dissenting) :
 During a physical exam compelled by the court upon the
application of plaintiff's adversary in separate personal injury
litigation (see CPLR 3102 [a]; 22 NYCRR 202.17), defendant Dr.
Lewis, the examiner designated by plaintiff's adversary to
perform the exam, is alleged to have "[taken plaintiff's] head in
his hands and forcefully rotated it while simultaneously
pulling."  Some 2 years and 11 months later, plaintiff commenced
this action alleging that Lewis's manipulation of his head caused
him injury.  The complaint purports to sound in ordinary
negligence.  Defendant, however, contends that what is alleged is
not simple negligence but medical malpractice.  The distinction
relied on by defendant, although not marked by a "rigid
analytical line" -- medical malpractice being but a form of
negligence (Scott v Uljanov, 74 NY2d 673, 674 [1989]; see Weiner
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v Lenox Hill Hosp., 88 NY2d 784, 787-788 [1996]) -- is here of
pivotal import since plaintiff's claim would be timely as one for
simple negligence (see CPLR 214), but would be barred under the
shorter limitations period applicable to claims for medical
malpractice (see CPLR 214-a).
 Contrary to the impression that might be produced by
the majority writing, the issue of whether allegedly tortious
conduct is for statute of limitations purposes to be deemed
medical malpractice or ordinary negligence, is not new to this
Court.  Nor is it one whose disposition is ungoverned by settled
principles.  We have held clearly and repeatedly that "[c]onduct
may be deemed malpractice, rather than negligence, when it
'constitutes medical treatment or bears a substantial
relationship to the rendition of medical treatment by a licensed
physician'" (Scott, 74 NY2d at 674-675, quoting Bleiler v Bodnar,
65 NY2d 65, 72 [1985] [emphasis added]; accord Weiner, 88 NY2d at
787-788).  Here, although Lewis may have employed medical
techniques in examining plaintiff, it is plain that no medical
treatment was intended or in fact provided.  The exam was
conducted simply as a disclosure device in litigation and,
indeed, one whose benefit inured not to the examinee but to the
examinee's adversary.  Bereft of any medical treatment rationale
or application, Lewis's conduct during his examination of
plaintiff is not amenable to description as medical malpractice
within the meaning of CPLR 214-a.  
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This conclusion, of course, is entirely consistent with
the purpose of CPLR 214-a's abbreviated limitations period, which
was not to afford those providing litigation support services a
measure of protection against liability, but to address the
threat to the health and welfare of New Yorkers posed by the
"inability of health care providers to get malpractice insurance
at reasonable rates" and to help assure that "the adequate
delivery of health care services" would not be impaired
(Memorandum of State Executive Dept. [L 1975, ch 109] 1975
McKinney's Session Laws of NY at 1601-1602 [emphasis added]).  
While the majority supposes it unlikely that the
Legislature "would have found less reason" (majority op at 5) to
extend similar protection to doctors not engaged in the provision
of medical treatment, the basis for the supposition is far from
evident.  Indeed, there would appear to be ample reason to treat
the two groups of practitioners quite differently.  The risks
facing a medical clinician diagnosing and treating a patient are
of an entirely different order of magnitude than those ordinarily
encountered by a medical examiner in a non-treatment context. 
The situation at bar is illustrative of this disparity.  It is
conceded that Dr. Lewis's duty towards his examinee was no more
extensive than that of refraining from harming him during the
exam; he had no medical duty competently to diagnose, inform or,
indeed, to treat the subject of his exam.  Such an
extraordinarily limited scope of professional responsibility
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stands in sharp contrast to the enormous risks and obligations
routinely encountered by physicians providing actual patient care
and treatment.  While a shortened limitations period may, at the
time of CPLR 214-a's enactment, reasonably have been thought
necessary to the continued insurability of the latter group of
medical practitioners on economically feasible terms, there
exists no plausible argument that parity of protection was ever
thought necessary to the insurability of practitioners not
engaged in the provision of medical treatment.
The majority's embrace of the novel and highly
problematic notion that there may be medical malpractice in the
absence of medical treatment, evidently proceeds from the
conviction that the same conduct by a doctor should not be deemed
malpractice in one context and negligence in another.  Yet, in
postulating that a medical examiner, such as defendant,
undertakes a limited duty to the examinee not involving "'the
full panoply of the physician's typical responsibilities to
diagnose and treat'" (majority op at 5, quoting Dyer v Trachtman,
470 Mich 45, 49-50, 679 NW2d 311, 314-315 [2004]), the majority
must accept what it purports to reject, namely, that what will be
malpractice in the context of ongoing medical treatment may not,
no matter how glaring the breach, be malpractice in the context
of an exam understood by the parties thereto to have no medical
treatment objective.  Indeed, most of what would be malpractice
in the former context is not even actionable in the latter.
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Context cannot be consigned to irrelevance, even in the
case of what would be "prototypical malpractice."  We have held
as much.  In Weiner (supra), where the defendant hospital intent
on having its negligence deemed malpractice so as to avail itself
of the medical malpractice limitations period urged that the
failure of its physician properly to supervise blood collection
could not be viewed except as a breach of his obligations as a
physician, we replied, "although the Hospital correctly points
out that a physician must supervise the process of blood
collection (see, e.g., 10 NYCRR 58-2.1 [s]; 58-2.2 [a]), this
requirement does not resolve the question of whether the
challenged conduct 'bears a substantial relationship to the
rendition of medical treatment' to a particular patient, which
remains the determinative question on appeal" (Weiner, 88 NY2d at
788, quoting Bleiler v Bodnar, 65 NY2d, at 72).  Here, of course,
there was actual contact between plaintiff and physician, but
that factual distinction between this case and Weiner is one that
should possess no dispositive significance.  Propinquity,
particularly in what is essentially an adversarial situation
between an examiner and his or her subject, is not to be
confounded with medical treatment.  Here, as in Weiner, there was
no treatment, and that should be "determinative."
While I agree that Lewis in undertaking to examine
plaintiff assumed a duty not to harm him in the process, the
breach of such a duty would not sound in medical malpractice. 
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The very limited duty arising in this situation bears not the
slightest resemblance to the very much more comprehensive set of
responsibilities devolving upon a practitioner engaged in
treatment -- the defining set of responsibilities contemplated by
the Hippocratic injunction to do no harm.  The duty here
implicated does not arise from what is reasonably susceptible of
characterization as a doctor-patient relationship, i.e. a
treatment relationship; it is simply an instance of the general
obligation, frequently enforceable in tort, to refrain from
causing foreseeable harm.  That is ordinary negligence.  It is
today denominated "medical malpractice" only by dint of an
exercise in judicial artifice untethered to any law or to the
actual nature of the transaction known euphemistically as an
"independent" medical examination.  These exams, far from being
independent in any ordinary sense of the word, are paid for and
frequently controlled in their scope and conduct by legal
adversaries of the examinee.  They are emphatically not occasions
for treatment, but are most often utilized to contest the
examinee's claimed injury and to dispute the need for any
treatment at all.  Indeed, according to the guidelines of the
American Board of Independent Medical Examiners, the examiner at
the exam should "advise the examinee that no treating physician-
patient relationship will be established"
(http://abime.org/node/21, accessed June 19, 2009).  The
majority's bare assertion that medical treatment is compatible
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with this context is merely a form of words.  Describing the
sliver of a duty that an examiner has during an exam not to harm
the examinee as arising from a "limited physician-patient
relationship" will be recognized, given the reality it purports
to describe, as no more than a device to avail a litigant of a
statutory bar. 
The cause of action the majority now recognizes for
medical malpractice is not only still-born in this action, but, I
will venture, will never possess viability as an actual claim for
relief. I am confident that the majority has not the slightest
intention to open the vistas of malpractice so wide as to
actually permit such claims in the absence of anything cognizable
as treatment.  What is involved then is simply the arbitrary
creation of an exception for a group of practitioners who, as a
group, neither seek nor are entitled to the protection properly
afforded and reserved to those engaged in the delivery of medical
care and treatment.   
The well considered decision of the Appellate Division
should be affirmed.
*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *
Order reversed, with costs, order of Supreme Court, Nassau
County, reinstated and certified question answered in the negative.
Opinion by Judge Smith.  Judges Ciparick, Graffeo and Read concur.
Chief Judge Lippman dissents and votes to affirm in an opinion in
which Judges Pigott and Jones concur.
Decided June 24, 2009