Case Title: Delk v. Columbia/HCA HealthCare Corp.

Citation: 

Docket Number: 990175

State: virginia

Court: Virginia Supreme Court

Date: 2000-01-14T00:00:00Z

Document:
Present: All the Justices 
 
LILLIAN PARKER DELK 
OPINION BY JUSTICE LEROY R. HASSELL, SR. 
v.  Record No. 990175 
January 14, 2000 
 
COLUMBIA/HCA HEALTHCARE CORP., ET AL. 
 
FROM THE CIRCUIT COURT OF THE CITY OF HAMPTON 
William C. Andrews, III, Judge 
 
 
In this appeal of a judgment sustaining a demurrer in a 
medical negligence action, we consider, among other things, 
whether the plaintiff pled causes of action in her third 
amended motion for judgment for the defendants' negligent 
failure to protect her from the intentional acts of a third 
person, the defendants' negligent failure to control the acts 
of a third person, negligent infliction of emotional distress, 
and intentional infliction of emotional distress. 
I. 
 
The plaintiff, Lillian P. Delk, filed her third amended 
motion for judgment against Columbia/HCA Healthcare 
Corporation and Virginia Psychiatric Company, Inc., d/b/a 
Columbia Peninsula Center for Behavioral Health.  She alleged 
that the defendants breached certain duties owed to her when 
she was a patient at Columbia Peninsula Center for Behavioral 
Health, a psychiatric hospital.  The defendants filed 
demurrers to the amended motion and asserted that the 
plaintiff failed to allege viable causes of action against 
them.  The circuit court sustained the demurrers and entered a 
judgment in favor of the defendants.  Delk appeals. 
II. 
A. 
 
Our inquiry is governed by settled principles that 
control a circuit court's consideration of a demurrer.  A 
demurrer "admits the truth of all material facts that are 
properly pleaded, facts which are impliedly alleged, and facts 
which may be fairly and justly inferred from alleged facts."  
Cox Cable Hampton Roads, Inc. v. City of Norfolk, 242 Va. 394, 
397, 410 S.E.2d 652, 653 (1991); accord Plummer v. Center 
Psychiatrists, Ltd., 252 Va. 233, 234, 476 S.E.2d 172, 173 
(1996).  A demurrer, however, does not admit the correctness 
of the pleader's conclusions of law.  Ward's Equip., Inc. v. 
New Holland North America, Inc., 254 Va. 379, 382, 493 S.E.2d 
516, 518 (1997). 
 
When a circuit court sustains a demurrer to an amended 
pleading which is complete in itself and fails to incorporate 
by reference allegations in earlier pleadings, we will 
consider only the allegations contained in the amended 
pleading that was the subject of the demurrer sustained by the 
judgment appealed from.  Bell Atlantic-Virginia, Inc. v. 
Arlington County, 254 Va. 60, 63 n.2, 486 S.E.2d 297, 299 n.2 
(1997); Norfolk & W.Ry. Co. v. Sutherland, 105 Va. 545, 549-
 
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50, 54 S.E. 465, 466 (1906); see also Breeding v. Hensley, 258 
Va. 207, 212, 519  S.E.2d 369, 371 (1999); Trotter v. E.I. 
Dupont de Nemours & Co., 124 Va. 680, 682-83, 98 S.E. 621, 622 
(1919).  Thus, we will recite only those facts contained in 
Delk's third amended motion for judgment, and we will consider 
only her assignments of error that relate to that pleading. 
 
Delk assigned error to several rulings by the circuit 
court that are contained in orders sustaining the defendants' 
demurrers to her earlier motions for judgment:  "the [t]rial 
[c]ourt erred in ruling that all of the plaintiff's claims 
were medical malpractice"; "the [t]rial [c]ourt erred in 
holding that plaintiff had not sufficiently alleged actual 
fraud"; and "the [t]rial [c]ourt erred in holding that 
plaintiff had not sufficiently alleged punitive damages."  
Delk failed to incorporate by reference in her third amended 
motion for judgment allegations in her prior motions for 
judgment and, therefore, we cannot consider these assignments 
of error because they were not the subject of the circuit 
court's judgment sustaining the demurrers to her third amended 
motion for judgment. 
B. 
 
Delk, a married woman, was admitted as a patient to 
Columbia Peninsula Center for Behavioral Health.  The Virginia 
Psychiatric Company, Inc., which operated the hospital under 
 
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the assumed name of Columbia Peninsula Center for Behavioral 
Health, was "an affiliated partnership or wholly-owned 
subsidiary of Columbia/HCA Healthcare Corporation." 
 
Delk was admitted to the hospital because of exacerbation 
of her bipolar condition.*  "[A]t the time of her 
hospitalization, [Delk] was identified as being a potential 
danger to herself, others, and property.  [She] was further 
deemed unable to meet the capacity of the ordinary demands of 
her familial, occupational, and social environment.  
Hospitalization was necessary for continued skill observation, 
structured intervention, as well as medical and psychological 
support." 
 
Delk had a "history of mood disorders and 
hospitalizations."  She also had "a long-standing history of 
psychiatric problems since the age of seventeen (17), 
associated with sexual molestation as a young child and a gang 
rape while a teenager."  This information was "disclosed to 
relevant staff."  During "her hospitalization . . . [Delk] was 
deemed by Columbia Peninsula Center for Behavioral Health to 
be a high risk to herself and others and in need of constant 
24-hour supervision and surveillance." 
                     
* Bipolar disorder is a chronic disease which causes 
patients to experience recurrent episodes of elation and 
depression.  Robert Jean Campbell, M.D., Psychiatric 
Dictionary 97 (7th ed. 1996). 
 
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According to Delk's allegations, "[o]n or about February 
26 or February 27, 1997, [a] male who is believed to have been 
a patient at the Defendants' psychiatric facility at the time 
of the sexual assault, and who was also believed to be HIV 
positive, entered [Delk's] room on the acute care unit of 
Columbia Peninsula Center for Behavioral Health and sexually 
assaulted her.  Although members of the nursing staff . . . 
observed and documented the presence of this unauthorized 
adult male in [Delk's] room, no further actions occurred from 
the staff or management of Columbia Peninsula Center for 
Behavioral Health . . . .  No notation was made in [Delk's] 
medical records regarding the sexual assault." 
 
The hospital's "staff and administrators were under a 
duty of care to supervise and control the assailant, who was 
believed to be a patient in the acute care wing of the 
Defendants' psychiatric facility at the time of the sexual 
assault."  Delk pled that the defendants "were well aware of 
the assailant's troubled history, predisposition, disturbing 
interaction with other patients and medical condition, yet 
took no steps to protect [her] or the other potential victims.  
Defendants breached this duty of care by allowing the 
assailant to enter [Delk's] room on the acute care unit and 
thus, allowing sexual misconduct to take place."   
 
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Delk alleged that the sexual assault upon her was 
foreseeable and avoidable.  She pled that the defendants 
committed acts of ordinary negligence by failing to adequately 
protect her.  She also alleged that the defendants committed 
acts of ordinary negligence because they failed to control her 
assailant. 
 
Delk pled that "[d]efendant, Columbia Peninsula Center 
for Behavioral Health, by and through its agents, employees, 
and assigns, failed to undertake any actions although the 
Defendant had knowledge that the alleged assailant adult male 
patient was HIV positive.  Further, Defendant, Columbia 
Peninsula Center for Behavioral Health, did not relate 
information to [Delk] . . . or any criminal authorities 
concerning the sexual assault or her exposure to the HIV 
virus.  Defendant's conduct showed an utter disregard of 
prudence and such conduct amounted to the complete neglect for 
the safety of [Delk].  As a direct and proximate result of 
Defendant's gross negligence . . . [Delk], and possibly other 
members of her immediate family, have been exposed to the HIV 
virus." 
 
The plaintiff further alleged that as "a direct and 
proximate result of Columbia Peninsula Center for Behavioral 
Health's outrageous conduct, negligence and attempt to cover 
up its negligence (through misleading and faulty notations in 
 
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the medical records) in failing to adequately supervise the 
Plaintiff, [Delk] suffered physical and bodily harm."  She 
claimed that as a result of defendant's "reckless, outrageous 
and negligent infliction of emotional distress," she "suffered 
severe mental, emotional and physical trauma."  She alleged 
that, as a result of "[d]efendant's extreme, reckless, 
outrageous and intentional infliction of emotional distress," 
she "has suffered severe mental, emotional and physical 
trauma."  
III. 
A. 
 
Delk contends that she pled a cause of action for 
negligence against the defendants arising out of their failure 
to protect her and, therefore, the circuit court erred in 
sustaining the defendants' demurrer to this claim.  
Continuing, she asserts that the defendants had a duty of care 
to supervise her on a 24-hour basis to insure her safety and 
that a special relationship existed between her and the 
defendants which created this duty of protection.  Responding, 
defendants assert that they had no duty to prevent any 
criminal attack upon Delk because they claim that they did not 
have a special relationship with her.  Additionally, the 
defendants contend that the criminal attack upon Delk was not 
reasonably foreseeable.  
 
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A plaintiff who seeks to establish actionable negligence 
must plead the existence of a legal duty, violation of that 
duty, and proximate causation which results in injury.  
Marshall v. Winston, 239 Va. 315, 318, 389 S.E.2d 902, 904 
(1990); Fox v. Custis, 236 Va. 69, 73-74, 372 S.E.2d 373, 375 
(1988).  Generally, a person does not have a duty to protect 
another from the conduct of third persons.  Burdette v. Marks, 
244 Va. 309, 311, 421 S.E.2d 419, 420 (1992); Marshall, 239 
Va. at 318, 389 S.E.2d at 904.  This general rule, however, 
does not apply when a special relationship exists (1) between 
the defendant and the plaintiff which gives rise to a right to 
protection to the plaintiff, or (2) between the defendant and 
the third person which imposes a duty upon the defendant to 
control the third person's conduct.  A.H. v. Rockingham 
Publishing Co., 255 Va. 216, 220, 495 S.E.2d 482, 485 (1998); 
Burdette, 244 Va. at 312, 421 S.E.2d at 420; Dudley v. 
Offender Aid & Restoration, 241 Va. 270, 276, 401 S.E.2d 878, 
881 (1991); Fox, 236 Va. at 74, 372 S.E.2d at 375; Klingbeil 
Management Group Co. v. Vito, 233 Va. 445, 447-48, 357 S.E.2d 
200, 201 (1987). 
 
We hold that the allegations contained in Delk's third 
amended motion for judgment are sufficient to permit her to 
fall within the limited exception to the general rule and, 
thus, she pled a cause of action for negligence against the 
 
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defendants.  Delk's amended motion contains sufficient 
allegations which, if proven, would establish the existence of 
a special relationship between her and Columbia Peninsula 
Center for Behavioral Health and, thus, would give rise to a 
duty on the part of the defendants to protect her from third 
persons.  For example, Delk alleged that the defendants knew 
that:  she was a danger to herself and others; she had a long 
history of psychiatric problems associated with sexual 
assaults upon her; Columbia Peninsula Center for Behavioral 
Health deemed Delk to be a high risk to herself and others; 
and she was in need of constant 24-hour supervision and 
surveillance. 
 
The defendants, relying principally upon A.H. v. 
Rockingham Publishing Co., supra, assert that the sexual 
assault upon Delk was legally unforeseeable.  We disagree. 
 
In Rockingham Publishing, we considered whether a 
newspaper publishing company had a duty to warn a 13 or 14-
year old newspaper carrier of the danger of a criminal assault 
by a third person while the carrier was delivering newspapers 
in the early morning hours.  The carrier, identified as A.H., 
delivered newspapers in the City of Harrisonburg on an 
assigned route.  A.H. was sexually assaulted by a man while 
A.H. was delivering newspapers between 6:00 and 6:30 a.m. on 
November 7, 1989.  There had been three prior pre-dawn 
 
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assaults of a sexual nature upon other Rockingham Publishing 
carriers while they were delivering their newspapers, but none 
of the prior assaults had occurred on or near A.H.'s route.  
Rockingham Publishing knew about the prior assaults before the 
assault on A.H.  The first assault occurred about five years 
before the assault on A.H., the second about four and a half 
years before, and the third about four months earlier.  
Rockingham Publishing, 255 Va. at 219, 495 S.E.2d at 484. 
 
Even though we held that a special relationship existed 
between A.H. and Rockingham Publishing, we stated:  
"A court must still determine whether the danger of 
a plaintiff's injury from such conduct was known to 
the defendant or was reasonably foreseeable.  
'[W]here the duty does exist [arising from a 
requisite relationship], the obligation is not an 
absolute one to insure the plaintiff's safety[;] 
. . . . [t]here is . . . no liability . . . where 
the defendant neither knows nor has reason to 
foresee the danger or otherwise to know that 
precautions are called for.'  W. Page Keeton, et 
al., Prosser & Keeton on the Law of Torts § 56, at 
385 (5th ed. 1984)." 
 
Id. at 220-21, 495 S.E.2d at 485.  We concluded that the 
assault upon A.H. was not foreseeable.  We observed that  
"the three prior sexual assaults on Rockingham 
carriers in various locations in the City of 
Harrisonburg in the five years preceding the assault 
on the plaintiff were insufficient to raise a jury 
issue of whether a sexual attack on the plaintiff 
was reasonably foreseeable.  This is not a case in 
which it was shown that the prior assaults were at 
or near the location of the plaintiff's assault, or 
that they occurred frequently or sufficiently close 
 
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in time to make it reasonably foreseeable that the 
plaintiff would be similarly assaulted." 
 
Id.. at 222, 495 S.E.2d at 486. 
 
Here, unlike the plaintiff in A.H. v. Rockingham 
Publishing, Delk pled sufficient facts which, if established 
at trial, would create a jury issue on the question whether 
the assault upon her was reasonably foreseeable.  Delk 
essentially alleged that she was especially vulnerable to a 
sexual assault because of her psychiatric problems and her 
need for "constant 24-hour supervision and surveillance."  The 
defendants were aware of her particular vulnerabilities and 
her psychiatric history.  She also alleged that the defendants 
were well aware of the assailant's troubled history, 
predisposition, disturbing interaction with other patients, 
and medical condition, and that "members of the nursing staff 
of Columbia Peninsula Center for Behavioral Health observed 
and documented the presence of this unauthorized adult male in 
[Delk's] room," but took no action.  She further alleged that 
because of her "sexual abuse history and bipolar condition, 
[she was placed] at an additional high risk to such 
incidents."  
B. 
 
Delk contends that she pled a separate cause of action 
against the defendants for their "negligent failure to control 
 
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the assailant."  Continuing, she asserts that the defendants 
had a duty to control the assailant and, as a result of their 
breach of this duty, she was assaulted by him.  Responding, 
the defendants assert that the circuit court properly 
sustained their demurrers to Delk's claim that they failed to 
control the assailant because Delk failed to plead in her 
amended motion that the defendants had "taken charge" of the 
assailant.  We disagree with the defendants. 
 
Section 315(a) of the Restatement (Second) of Torts 
(1965), states in part:   
"There is no duty so to control the conduct of a 
third person as to prevent him from causing physical 
harm to another unless  
 
(a) a special relation exists between the actor 
and the third person which imposes a duty upon the 
actor to control the third person's conduct . . . ."   
 
Section 319 of the Restatement (Second) of Torts provides as 
follows: 
"One who takes charge of a third person whom he 
knows or should know to be likely to cause bodily 
harm to others if not controlled is under a duty to 
exercise reasonable care to control the third person 
to prevent him from doing such harm." 
 
 
We have held that the aforementioned provisions of the 
Restatement give rise to a duty in tort only if a special 
relationship exists between a defendant who is charged with 
negligence and the actor, and that this special relationship 
is established when the defendant has taken charge or 
 
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exercised control over the actor.  Fox, 236 Va. at 75, 372 
S.E.2d at 376.  We recently stated that "[i]t is a settled 
rule of decision in this Court . . . that, in order to 
establish a 'special relation' under Restatement § 315(a) 
. . . a plaintiff must allege facts which, if proven, would 
show that the defendant had 'take[n] charge' of a third person 
within the meaning of § 319."  Nasser v. Parker, 249 Va. 172, 
179-180, 455 S.E.2d 502, 505 (1995).  In Nasser, a plaintiff 
filed an amended motion for judgment against a psychiatrist 
and a psychiatric hospital and sought to recover damages for 
intentional torts committed by a patient against a third 
party.  We held that the circuit court properly sustained the 
defendants' demurrers to the plaintiff's amended motion 
because the plaintiff failed to allege facts, which if proven, 
would have shown that the defendants had taken charge of the 
patient.  Id. at 181, 455 S.E.2d at 506. 
 
Here, we hold that the circuit court erred in sustaining 
the demurrers to Delk's claim that the defendants were 
negligent because they failed to control her assailant.  As we 
have already stated, Delk alleged that her assailant was 
"believed to be a patient in the acute care wing of the . . . 
psychiatric facility" and that the hospital staff was aware of 
"assailant's troubled history, predisposition, disturbing 
interaction with other patients and medical condition."  There 
 
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is no allegation here, as there was in Nasser, that the 
assailant was in the hospital on a voluntary basis. 
 
Because we are required at the demurrer stage of the 
proceedings to view the allegations and the inferences 
therefrom in the light most favorable to Delk, we must infer 
from her allegations that the defendants exercised control 
over her assailant and, thus, had taken charge of him because 
he was a resident in the acute care wing of a psychiatric 
hospital.  Of course, at a subsequent trial, Delk will be 
required to prove, with evidence, that the defendants had 
taken charge of her assailant and that he was not in the 
hospital on a voluntary basis. 
IV. 
 
Defendant Columbia/HCA Healthcare argues that it has no 
legal duty to Delk because "Columbia/HCA is only alleged to be 
a corporate affiliate of [Columbia Peninsula Center for 
Behavioral Health] with no direct dealings with" Delk.  We 
will not consider this contention.   
 
Code § 8.01-273(A) states in part that "[i]n any . . . 
action at law, the contention that a pleading does not state a 
cause of action or that such pleading fails to state facts 
upon which the relief demanded can be granted may be made by 
demurrer. . . .  No grounds other than those stated 
specifically in the demurrer shall be considered by the 
 
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court."  Defendant Columbia/HCA Healthcare failed to assert 
this contention in its demurrer and, thus, may not make this 
assertion on appeal. 
V. 
A. 
 
Delk argues that she pled a cause of action for 
intentional infliction of emotional distress and, therefore, 
the circuit court erred by sustaining the demurrer to that 
claim.  Responding, the defendants argue that Delk failed to 
plead facts which would permit a jury to infer that they acted 
with an intent to cause her emotional distress.  We disagree 
with the defendants.   
 
In Russo v. White, 241 Va. 23, 26, 400 S.E.2d 160, 162 
(1991), we stated that a plaintiff who seeks to recover 
damages for intentional infliction of emotional distress must 
plead, and subsequently prove by clear and convincing 
evidence, that:  the wrongdoer's conduct is intentional or 
reckless; the conduct is outrageous and intolerable; the 
alleged conduct and emotional distress are causally connected; 
and the distress is severe.  A plaintiff must allege each of 
these elements with the requisite degree of specificity.  
Jordan v. Shands, 255 Va. 492, 499, 500 S.E.2d 215, 219 
(1998); Ely v. Whitlock, 238 Va. 670, 677, 385 S.E.2d 893, 897 
(1989). 
 
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We hold that Delk pled sufficient facts which if proven 
at trial, would permit a finder of fact to find that the 
defendants acted recklessly.  It is common knowledge that HIV, 
which can be transmitted sexually or through an exchange of 
bodily fluids, can develop into AIDS, a fatal disease.  
Certainly, a finder of fact could conclude that the defendants 
acted recklessly if Delk presents evidence at a trial that the 
defendants knew she may have been exposed to HIV, but failed 
to inform her so that she could have taken preventive measures 
to avoid transmission of the potentially fatal disease to her 
husband. 
 
We reject the defendants' contention that Delk failed to 
assert a legally sufficient claim for damages.  Delk 
specifically alleged that "she has incurred and will incur in 
the future hospital, doctors' and related bills in an effort 
to be cured of [her] injuries."  We must infer from this 
allegation that Delk incurred medical treatment in the past 
and will incur medical treatment in the future as a result of 
her exposure to HIV.  See Russo, 241 Va. at 28, 400 S.E.2d at 
163. 
B. 
 
Delk argues that the circuit court erred in sustaining 
the defendants' demurrer to her claim for negligent infliction 
of emotional distress.  She contends that she pled facts 
 
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which, if proven, would be sufficient to establish the 
elements of this cause of action.  Responding, the defendants 
contend that Delk failed to state a claim of negligent 
infliction of emotional distress because she failed to allege 
a physical injury in her amended motion.  We agree with the 
defendants. 
 
In Hughes v. Moore, 214 Va. 27, 197 S.E.2d 214 (1973), we 
discussed the elements of a cause of action for negligent 
infliction of emotional distress.  We stated: 
"We adhere to the view that where conduct is merely 
negligent, not willful, wanton, or vindictive, and 
physical impact is lacking, there can be no recovery 
for emotional disturbance alone.  We hold, however, 
that where the claim is for emotional disturbance 
and physical injury resulting therefrom, there may 
be recovery for negligent conduct, notwithstanding 
the lack of physical impact, provided the injured 
party properly pleads and proves by clear and 
convincing evidence that his physical injury was the 
natural result of fright or shock proximately caused 
by the defendant's negligence.  In other words, 
there may be recovery in such a case if, but only 
if, there is shown a clear and unbroken chain of 
causal connection between the negligent act, the 
emotional disturbance, and the physical injury." 
 
Id. at 34, 197 S.E.2d at 219; accord Myseros v. Sissler, 239 
Va. 8, 9, 387 S.E.2d 463, 464 (1990).   
 
Delk's conclusional allegation that she incurred "severe 
mental, emotional and physical trauma" is not sufficient to 
support a cause of action for negligent infliction of 
emotional distress.  Delk failed to plead with specificity 
 
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that she incurred a physical injury which was the natural 
result of fright or shock proximately caused by the 
defendants' alleged negligence.  Delk fails to provide any 
description of her physical injury in her amended motion.   
Therefore, we hold that the circuit court did not err in 
dismissing this claim. 
VI. 
 
We will affirm that portion of the circuit court's 
judgment which sustained the defendants' demurrers to Delk's 
cause of action for negligent infliction of emotional 
distress.  We will reverse the remaining portions of the 
judgment, and we will remand this case to the circuit court so 
that Delk may proceed on her claims for the following causes 
of action:  the defendants breached a duty of care owed to her 
in that they failed to protect her from the assailant; the 
defendants breached a duty of care owed to her because they 
failed to control the assailant; and the defendants committed 
acts which constituted intentional infliction of emotional 
distress.  We express no opinion on Delk's assignments of 
errors which were not the subject of the demurrers to her 
third amended motion for judgment. 
Affirmed in part, 
reversed in part, 
and remanded. 
 
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