Case Title: McCloskey v. Kane

Citation: 

Docket Number: 040264

State: virginia

Court: Virginia Supreme Court

Date: 2004-11-05T00:00:00Z

Document:
PRESENT: Hassell, C.J., Lacy, Keenan, Koontz, Lemons, and Agee, 
JJ., and Stephenson, S.J. 
 
CARL F. McCLOSKEY, ADMINISTRATOR OF 
 THE ESTATE OF JOHN W. McCLOSKEY 
 
 
 
OPINION BY 
v.  Record No. 040264   SENIOR JUSTICE ROSCOE B. STEPHENSON, JR. 
 
 
 
November 5, 2004 
TIMOTHY KANE, M.D. 
 
FROM THE CIRCUIT COURT OF AUGUSTA COUNTY 
Thomas H. Wood, Judge 
 
 
In this appeal, we decide whether the trial court erred in 
dismissing the plaintiff's negligence action based upon the 
doctrine of sovereign immunity. 
I 
 
Carl F. McCloskey, Administrator of the Estate of John W. 
McCloskey (the Plaintiff), filed a wrongful death action against 
Timothy Kane, M.D. (the Defendant), alleging that John W. 
McCloskey (the Decedent) died "as a result of the negligence 
. . . of [the Defendant], who committed malpractice while 
treating [the Decedent]."  The Defendant filed a plea of 
sovereign immunity.  By order entered November 7, 2003, the 
trial court granted the Defendant's plea and dismissed the 
matter with prejudice.  We awarded the Plaintiff this appeal. 
II 
A 
 
We will summarize the Plaintiff's negligence claim 
primarily from a reading of his motion for judgment.  On 
 
2
December 15, 1994, the Decedent, aged eighteen years, was 
involuntarily committed to Western State Hospital (Western 
State).  He was suffering from clinically diagnosed bipolar 
disorder.  At some time during his three days as a patient at 
Western State, the Decedent experienced a violent assault, 
likely through his rectum.  On the morning of December 18, the 
Decedent was found lying on the floor, vomiting and complaining 
of severe abdominal pain and of constipation.  The nurse on duty 
notified the Defendant, who was the physician on duty at the 
time of the Decedent's complaints. 
 
The Defendant did not examine the Decedent at that time, 
but ordered a suppository.  At noon that day, the Defendant was 
informed that the Decedent's complaints persisted and that he 
had vomited his own feces.  The Defendant examined the Decedent 
and ordered an x-ray. 
 
The Defendant did not have a radiologist read the x-ray.  
Instead, the Defendant read the x-ray and failed to note the 
presence of free air in the Decedent's abdominal cavity.  The 
Defendant ordered a soapsuds enema, which worsened the 
Decedent's condition. 
 
Later that day, the Defendant was informed that the 
Decedent's condition had not improved.  Thereupon, the Defendant 
decided to transfer the Decedent to the University of Virginia 
Medical Center at Charlottesville (UVA Medical Center).  The 
 
3
Decedent was transported, contrary to Western State's policy, in 
a security van rather than an ambulance.  
 
The doctors at the UVA Medical Center promptly diagnosed 
the Decedent's condition, but, by that time, the Decedent's body 
was so infected and weak that he could not recover.  The 
Decedent lapsed into a coma, struggled for 14 months, and 
finally died on February 24, 1996. 
B 
 
Western State is a state mental hospital, operated under 
the authority of the Department of Mental Health, Mental 
Retardation and Substance Abuse Services (the Department) 
pursuant to Title 37.1 of the Code of Virginia.  Western State 
is "operated by the Department . . . to provide mental health 
care to all eligible patients regardless of [their] ability to 
pay for such care." 
 
The Defendant was a "physician extender," classified as a 
"P-14" doctor, meaning he worked part-time, was paid hourly, and 
received no state benefits.  His job was "to help the 
psychiatrists with the medical problems."  He was not a 
psychiatrist; rather, he was a resident in psychiatry at the 
University of Virginia. 
 
The Defendant was on duty for weekend shifts to respond to 
emergent non-psychiatric medical situations.  He requested the 
on-call weekend shifts that suited his schedule, and he could 
 
4
choose to work between one and four 12- or 24-hour shifts a 
month. 
 
While on duty during weekend shifts, the Defendant was not 
consistently engaged in treating patients, and he was permitted 
to sleep when not seeing patients.  Conversely, full-time, "P-3" 
doctors at Western State worked a 40-hour week and were not 
allowed to sleep at work. 
 
The Defendant was not authorized to hire or fire any of 
Western State's employees.  He did not have access to the state 
employee grievance procedure, as did the full-time, "P-3" 
doctors.  The details of his schedule were not dictated or 
controlled by Western State, and he was not directly supervised 
or controlled by anyone at Western State.  Western State policy 
required the Defendant to see a patient when requested to do so 
by a nurse.   
 
At the time the Defendant was treating the Decedent, 
Western State "had 15 or 16 psychiatrists who would have been 
responsible for overall [psychiatric] care."  Western State also 
"had two internists assisted by four or five physician extenders 
to help the psychiatrists with the medical problems." 
III 
 
In determining whether a state-employed physician is 
entitled to the protection of sovereign immunity, a court must 
apply the four-factor test first set forth in James v. Jane, 221 
 
5
Va. 43, 282 S.E.2d 864 (1980).  Those four factors are: (1) the 
nature of the function performed by the employee, (2) the extent 
of the state's interest and involvement in that function, (3) 
the degree of control exercised by the state over the employee, 
and (4) whether the alleged negligent act involved the use of 
judgment and discretion.  Id. at 53, 282 S.E.2d at 869.  Accord 
Lee v. Bourgeois, 252 Va. 328, 331, 477 S.E.2d 495, 497 (1996). 
 
Both parties in the present case agree that James is 
controlling.  They disagree, however, with respect to its 
application to the facts presented. 
 
The Plaintiff contends that Western State's primary 
function is to provide psychiatric care to its patients and that 
the Commonwealth's interest therein is great.  The Plaintiff 
further contends that the Defendant's primary function was to 
provide limited medical care, as opposed to psychiatric care, to 
Western State's patients.  This function, the Plaintiff asserts, 
is only incidental to Western State's primary function, and, 
therefore, the Commonwealth's interest and involvement therein 
is slight.  Additionally, according to the Plaintiff, the 
Commonwealth exerted little control over the Defendant. 
 
On the other hand, the Defendant contends that Western 
State's psychiatric and medical functions are inextricably 
linked, and, therefore, the Commonwealth had a substantial 
interest in the Defendant's actions.  Further, the Defendant 
 
6
asserts that Western State had substantial control over the 
Defendant. 
IV 
 
We limit our discussion of James to the factor involving 
the degree of control because we find it dispositive in the 
present case.  In James, the defendant-physicians were employed 
by the University of Virginia to teach in the Medical School and 
to practice their specialties as attending physicians at the 
University Hospital.  Their duties were two-fold:  to teach and 
to attend patients.  221 Va. at 50, 282 S.E.2d at 867.  With 
regard to the physician-patient relationship, we said that, 
when the physician agrees to treat or operate on a 
certain patient, although his employment by the 
University makes possible the arrangement, the 
relationship becomes the personal and confidential one 
of doctor and patient, not the Commonwealth of 
Virginia and patient.  The physician owes his best 
professional efforts on behalf of the patient, and the 
patient expects, and has a right to expect, the same 
care and attention from the physician that he would 
receive if he were in a private hospital and the 
physician in private practice.  The exercise by the 
attending physician of his professional skill and 
judgment in treating his patient, and the means and 
methods used, from the very nature of things, are not 
subject to the control and direction of others. 
Id. at 50-51, 282 S.E.2d at 867-68.  We have also said that the 
greater the control of an employee's actions by the 
Commonwealth, the greater the likelihood of immunity.  Lohr v. 
Larsen, 246 Va. 81, 88, 431 S.E.2d 642, 646 (1993). 
V 
 
7
 
In the present case, the record does reveal that Western 
State exercised some control over which patients the Defendant 
would see because the Defendant was expected to see patients 
that the nurses requested him to see.  Otherwise, however, the 
Defendant was free to exercise his judgment and discretion about 
seeing patients, and he was not under anyone's supervision.  
Indeed, as we said in James, "[t]he exercise by the attending 
physician of his professional skill and judgment in treating his 
patient, and the means and methods used, from the very nature of 
things, are not subject to the control and direction of others."  
221 Va. at 50-51, 282 S.E.2d at 867-68.  We conclude, therefore, 
that the Commonwealth's control over the Defendant was, at best,  
slight.1 
VI 
 
We hold, therefore, that the Defendant is not entitled to 
the protection of the doctrine of sovereign immunity from 
liability for his alleged negligent acts in treating the 
                     
 
1 In Lohr v. Larsen, we found a state-employed public-health 
physician entitled to the protection of the doctrine of 
sovereign immunity.  246 Va. at 88, 431 S.E.2d at 646.  In doing 
so, however, we said that the Commonwealth's paramount interest 
was the provision of quality medical care to economically 
disadvantaged citizens, and we held that the physician's 
function as a public-health physician and his exercise of 
discretion were essential to the Commonwealth's objective of 
preserving the public health.  Id. at 86, 431 S.E.2d at 645.  We 
further held that the Commonwealth's control and direction of 
the physician was great.  Id. at 88, 431 S.E.2d at 646.  Lohr, 
therefore, is distinguishable from the present case. 
 
8
Decedent, and the trial court erred in sustaining the 
Defendant's plea of sovereign immunity.2  Accordingly, we will 
reverse the trial court's judgment and remand the case for 
further proceedings. 
Reversed and remanded. 
                     
 
2 The Plaintiff also claims that the trial court "erred in 
determining that [the Defendant] was a state employee as a 
matter of law rather than sending the issue to a jury."  If the 
Defendant were an independent contractor, he would not be 
entitled to sovereign immunity.  See Atkinson v. Sachno, 261 Va. 
278, 283-84, 541 S.E.2d 902, 905 (2001).  For the purpose of 
this opinion, however, we have accepted the Defendant's 
contention that he was an employee of the Commonwealth and 
assumed, without deciding, that he was not an independent 
contractor.