Case Title: Lownsbury v. VanBuren

Citation: 2002-Ohio-646

Docket Number: 20001655

State: ohio

Court: Ohio Supreme Court

Date: 2002-02-20T00:00:00Z

Document:
[Cite as Lownsbury v. VanBuren, 94 Ohio St.3d 231, 2002-Ohio-646.] 
 
 
LOWNSBURY ET AL., APPELLANTS, v. VANBUREN ET AL.; STOVER, APPELLEE. 
[Cite as Lownsbury v. VanBuren (2002), 94 Ohio St.3d 231.] 
Physician and patient — Physician-patient relationship can be established 
between a physician who contracts to provide resident supervision at a 
teaching hospital and a hospital patient with whom the physician had no 
direct or indirect contact. 
(No. 00-1655 — Submitted October 2, 2001 — Decided February 20, 2002.) 
APPEAL from the Court of Appeals for Summit County, No. 19365. 
__________________ 
SYLLABUS OF THE COURT 
A physician-patient relationship can be established between a physician who 
contracts, agrees, undertakes, or otherwise assumes the obligation to 
provide resident supervision at a teaching hospital and a hospital patient 
with whom the physician had no direct or indirect contact. 
__________________ 
 
ALICE ROBIE RESNICK, J.  This is an appeal from a summary judgment in 
favor of defendant-appellee Thomas Stover, M.D., in a medical malpractice 
action.  The action was brought by plaintiffs-appellants Mary and Gerald Fabich, 
in their own right and as next friends of their adopted daughter, plaintiff-appellant 
Rebecca Fabich (formerly Rebecca Lownsbury), who was born severely brain 
damaged on January 10, 1995. 
 
In their initial complaint, filed January 19, 1996, appellants asserted 
various claims of medical negligence against numerous defendants, all of which 
arise out of the prenatal care and treatment provided to Rebecca’s biological 
mother, Cathy Lownsbury, at Akron City Hospital from January 6, 1995 through 
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January 10, 1995.  After extensive discovery, appellants settled with and/or 
dismissed all but two of the original defendants. 
 
On September 9, 1997, appellants filed an amended complaint in which 
they reasserted their original claims against these two defendants, added new 
claims, and named Dr. Stover as an additional defendant.  As pertinent here, 
appellants alleged that on January 6, 1995, Lownsbury was given a nonstress test 
and an amniotic fluid index test at Akron City Hospital’s perinatal testing center.  
Based on the results of these tests, George VanBuren, M.D., a defendant below, 
ordered that Lownsbury be taken to the hospital’s labor and delivery unit for an 
induction of labor.  However, rather than inducing labor as ordered, the obstetrics 
residents administered a contraction stress test, after which they discharged 
Lownsbury from the hospital the same day.  The contraction stress test allegedly 
ran for two hours and twenty minutes and revealed repetitive late decelerations, 
suggesting fetal distress, but only an eighteen-minute portion of the fetal monitor 
tracing was reviewed, which showed no decelerations. 
 
Appellants claimed, among other things, that Dr. Stover was negligent in 
failing to supervise the obstetrics residents who actually cared for Lownsbury on 
January 6, 1995, and that such failure was a proximate cause of Rebecca being 
born permanently brain damaged on January 10, 1995. 
 
Dr. Stover moved for summary judgment on the sole ground that he owed 
no legal duty of supervision to Lownsbury or Rebecca because he and Lownsbury 
never had a physician-patient relationship.  In his motion, Dr. Stover maintained 
that a physician-patient relationship cannot be found to exist between an on-call 
physician and a hospital patient unless it appears that the physician was either in 
direct contact with the patient or actively involved in the patient’s care. 
 
In response, appellants argued that regardless of whether Dr. Stover had 
any contact with Lownsbury or the residents who actually cared for her, he 
nevertheless assumed the duty to provide Lownsbury with supervisory care by 
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3 
contracting to serve as the on-premises attending and supervising obstetrician at 
Akron City Hospital on January 6, 1995. 
 
Appellants’ supporting evidence tended to show that Dr. Stover was 
employed by East Market Street Obstetrical-Gynecological Co., Inc. (“East 
Market”) “to provide obstetrical and gynecological services to patients at Akron 
City Hospital in accordance with the working schedule promulgated by the Board 
of Directors of East Market from time to time.”  East Market had entered into an 
agreement with Akron City Hospital (“EMS-ACH contract”) to “[s]chedule 
sufficient PHYSICIANS to provide SERVICES on HOSPITAL premises twenty-
four (24) hours per day, seven (7) days per week, consistent with accreditation 
requirements of the HOSPITAL Obstetrical and Gynecological Residency 
Program.” 
 
The EMS-ACH contract also required East Market to “[p]rovide sufficient 
PHYSICIANS in order to perform SERVICES required by this Agreement so as 
to insure high quality professional medical care will be provided to HOSPITAL’S 
obstetrical and gynecological patients,” to provide physicians “to serve on such 
committees and in such similar positions as are necessary * * * to collaborate with 
the Medical Staff,” and to “[c]omply with all rules, regulations and bylaws of 
HOSPITAL and HOSPITAL’S professional staff.” 
 
The contract provided further that East Market physicians “must maintain 
membership on HOSPITAL’S Medical Staff and clinical privileges within 
HOSPITAL” and “shall be subject to HOSPITAL’S Articles of Incorporation, 
Code of Regulations, Professional Medical Staff Bylaws and Professional Rules 
and Regulations.”  In addition, both East Market and its physicians were obligated 
to “perform SERVICES to patients of HOSPITAL in accordance with currently 
approved medical standards, methods and practices.” 
 
Sometime between January 6 and January 10, 1995, Lownsbury signed a 
consent form setting forth conditions of admission to Akron City Hospital.  This 
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document explains that “[t]he Hospital is a teaching institution * * * for 
undergraduate, graduate and post-graduate education,” and that “[s]tudents may 
participate in the care of the patient.”  It also confirms that these students are 
present for educational and instructional purposes “under appropriate 
supervision,” that “[t]he patient will be under the professional care of a Medical 
Doctor called the attending physician,” and that “[t]he patient * * * consents to 
hospital services as ordered by the attending physician * * * or * * * rendered 
under the general and specific instructions of the physician.” 
 
Appellants also presented affidavit and deposition testimony of two 
medical experts who stated that Dr. Stover had a responsibility as the supervising 
physician on January 6, 1995, to familiarize himself with Lownsbury’s clinical 
condition and particularly to review the contraction stress test by the end of his 
scheduled working day and formulate a plan of management.  They opined that 
Dr. Stover should have maintained an operational presence in the labor and 
delivery unit, rather than sitting in the hospital’s staff room “wasting time” until 
his help was requested (as Dr. Stover claimed he could do), and that had Rebecca 
been delivered even a day earlier, she probably would not have suffered 
permanent neurological injury. 
 
The trial court granted Dr. Stover’s motion for summary judgment without 
opinion on July 22, 1998.  In a subsequent order dated October 9, 1998, the trial 
court certified its judgment as final and appealable pursuant to Civ.R. 54(B) upon 
an express determination that there is no just reason for delay. 
 
The trial court’s judgment was affirmed by a majority of the court of 
appeals, which held, “In order to establish a physician-patient relationship there 
must be some contact between the doctor and the patient.”  The majority 
recognized that such contact may be “indirect where the doctor takes an active 
part in diagnosing or treating the patient even without the patient’s knowledge,” 
but was unwilling to dispense with the requirement of contact in situations where 
January Term, 2002 
5 
the physician expressly or impliedly contracts with the hospital to serve in an 
attending or supervisory capacity.  Thus, while acknowledging that certain factual 
disputes remain as to Dr. Stover’s contractual status and duties on January 6, 
1995, the majority found that “[t]hese issues are not material to this case * * * 
because what is not in dispute is that Dr. Stover never saw, evaluated, [or] treated, 
[or was] consulted [about Lownsbury], or knew that Lownsbury was in the 
hospital.” 
 
The dissenting judge stated that “once a physician-patient relationship has 
been established by contract, as in the present case, whether the physician actually 
knows that the patient is in the hospital is irrelevant.”  The dissenter further noted, 
“Dr. Stover consented to the relationship when he entered into the agreement 
[with Akron City Hospital] to be the supervisory physician.  In turn, Lownsbury 
consented to the relationship when she signed the consent form to be under the 
care of an attending physician.”  Moreover, the dissenter contended, “[t]hose 
doctors who are employed to teach, supervise, and guide residents are not only 
permitted but also implicitly encouraged by the rationale of the majority’s 
decision to shield themselves from liability with bureaucratic armor.” 
 
The cause is now before this court pursuant to the allowance of a 
discretionary appeal. 
 
The question for review is whether appellants presented sufficient 
evidence to raise a genuine issue of material fact as to the existence of a 
consensual relationship between Dr. Stover and Lownsbury on January 6, 1995.  
Concomitantly, we are asked to decide whether a physician-patient relationship 
can be established between a supervisory physician at a teaching hospital and a 
hospital patient without evidence that the physician was either in direct contact 
with the patient, consulted by the treating residents, or otherwise actively 
involved in the patient’s care. 
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The existence of a duty is an essential element of proof in a medical 
malpractice claim.  Littleton v. Good Samaritan Hosp. & Health Ctr. (1988), 39 
Ohio St.3d 86, 92, 529 N.E.2d 449, 454.  In turn, the duty of care owed by a 
physician is predicated on the existence of a physician-patient relationship.  See, 
generally, Annotation, What Constitutes Physician-Patient Relationship for 
Malpractice Purposes (1982), 17 A.L.R.4th 132, 136, Section 2; Kohlman, 
Existence of Physician and Patient Relationship, 46 American Jurisprudence 
Proof of Facts 2d (1986) 373, 378. 
 
In Tracy v. Merrell Dow Pharmaceuticals, Inc. (1991), 58 Ohio St.3d 147, 
150, 569 N.E.2d 875, 879, we explained: 
 
“The physician-patient relationship arises out of an express or implied 
contract which imposes on the physician an obligation to utilize the requisite 
degree of care and skill during the course of the relationship.  The relationship is a 
consensual one and is created when the physician performs professional services 
which another person accepts for the purpose of medical treatment. 
 
“The physician-patient relationship is a fiduciary one based on trust and 
confidence and obligating the physician to exercise good faith.  As a part of this 
relationship, both parties envision that the patient will rely on the judgment and 
expertise of the physician. The relationship is predicated on the proposition that 
the patient seeks out and obtains the physician’s services because the physician 
possesses special knowledge and skill in diagnosing and treating diseases and 
injuries which the patient lacks.”  (Citations omitted.) 
 
This court has not considered the application of these principles to the 
complicated institutional environment of a teaching hospital.  Indeed, our 
development of these concepts has thus far been confined to the context of direct 
one-on-one, face-to-face relationships between physicians and patients.  
Accordingly, we find it helpful to review those cases in which other courts have 
considered whether, and under what circumstances, to recognize a duty of care 
January Term, 2002 
7 
owed by a supervisory physician to a patient actually cared for by a hospital 
resident. 
 
In Mozingo v. Pitt Cty. Mem. Hosp., Inc. (1992), 331 N.C. 182, 415 S.E.2d 
341, the Supreme Court of North Carolina held that a physician who undertook to 
provide on-call supervision of obstetrics residents at a teaching hospital owed the 
infant plaintiff and his parents a duty of reasonable care in supervising the 
residents who delivered plaintiff at his birth. 
 
In that case, Sandra Dee Mozingo was admitted to Pitt County Memorial 
Hospital on the afternoon of December 5, 1984, for the delivery of her second 
child, plaintiff Alton Ray Mozingo, Jr.  At 5:00 p.m. that same day, defendant Dr. 
Richard John Kazior began his assignment to provide on-call coverage for the 
obstetrics residents at the hospital.  Dr. Kazior remained at his home available to 
take telephone calls from the residents until shortly before 9:45 p.m., when he 
received a call from one of the residents informing him of a problem with the 
delivery of Alton.  Dr. Kazior immediately left his home, but when he arrived at 
the hospital the delivery of Alton had already been completed. 
 
The plaintiffs in Mozingo (Alton and his father) claimed that Dr. Kazior 
had negligently supervised the residents who cared for Alton and his mother 
during his birth.  However, there was no claim that Dr. Kazior was negligent in 
responding to the telephone call from the hospital or in anything he did or failed 
to do after receiving the call.  Instead, the plaintiffs’ claim for negligent 
supervision was based on what Dr. Kazior failed to do prior to receiving the 
request for assistance.  Specifically, plaintiffs submitted the affidavit of a medical 
expert who stated that Dr. Kazior had a responsibility as the supervising physician 
to call the hospital at the beginning of his coverage shift to find out what 
obstetrical patients had been admitted, their condition, and to formulate a plan of 
management, and also to call periodically thereafter to check on their status.  
Since it was undisputed that prior to receiving the phone call, Dr. Kazior was 
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never in direct contact with the patient, consulted by the treating residents, or in 
any way involved in the patient’s care, the issue presented in Mozingo is precisely 
the question confronting us in this case. 
 
In resolving this issue, the court in Mozingo explained: 
 
“[W]e conclude that the defendant’s duty of reasonable care in supervising 
the residents was not diminished by the fact that his relationship with the 
plaintiffs did not fit traditional notions of the doctor-patient relationship. 
 
“The modern provision of medical care is a complex process becoming 
increasingly more complicated as medical technology advances.  Large teaching 
hospitals, such as the Hospital in the present case, care for patients with teams of 
professionals, some of whom never actually come in contact with the treated 
patient but whose expertise is nevertheless vital to the treatment and recovery of 
patients. 
 
“* * * 
 
“Medical professionals may be held accountable when they undertake to 
care for a patient and their actions do not meet the standard of care for such 
actions as established by expert testimony.  Thus, in the increasingly complex 
modern delivery of health care, a physician who undertakes to provide on-call 
supervision of residents actually treating a patient may be held accountable to that 
patient, if the physician negligently supervises those residents and such negligent 
supervision proximately causes the patient’s injuries.”  (Citations omitted.)  Id., 
331 N.C. at 188-189, 415 S.E.2d at 345. 
 
In Maxwell v. Cole (1984), 126 Misc.2d 597, 482 N.Y.S.2d 1000, the 
plaintiff, Diane Maxwell, entered New York Hospital in Manhattan for an elective 
tubal ligation.  It was alleged that Maxwell’s bladder was punctured during 
surgery and that the residents providing postoperative care failed to detect it.  One 
of the defendants in the case was Dr. William Ledger, Chairman of the 
Department of Obstetrics and Gynecology at New York Hospital.  Maxwell 
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claimed that Dr. Ledger failed to adequately supervise the resident staff and to 
provide them with standards as to the necessity in certain circumstances to seek 
prompt consultation with attending physicians. 
 
Dr. Ledger moved for summary judgment, arguing that since he did not 
render any medical care or treatment personally to Maxwell, there was no 
physician-patient relationship between them and he could not be held liable for 
her injuries.  The court rejected “Dr. Ledger’s narrow reading of a physician’s 
responsibility,” id., 126 Misc.2d at 598, 482 N.Y.S.2d at 1001, and explained: 
 
“In this case, it is claimed that the responsibility for supervision of the 
medical personnel lay in the hands of the chief of service, Dr. Ledger.  With a 
broadened view of a hospital’s role as a provider of health care services comes an 
expanded notion of its supervisory responsibilities over those who practice 
medical care on its premises.  That supervisory responsibility, it is claimed was 
delegated to Dr. Ledger.  If the chief of service fails to provide medically 
acceptable rules and regulations which would insure appropriate supervision of ill 
patients, then it is reasonable to find that a breach of the standards of medical care 
by that individual has occurred.”  (Citation omitted.)  Id., 126 Misc.2d at 599, 482 
N.Y.S.2d at 1002. 
 
In McCullough v. Hutzel Hosp. (1979), 88 Mich.App. 235, 276 N.W.2d 
569, the plaintiff, Ophelia McCullough, underwent a tubal ligation at Hutzel 
Hospital.  Since Hutzel was a teaching hospital, the actual surgery was performed 
by a resident.  The case proceeded to trial and the jury returned a verdict against 
certain defendant specialists in obstetrics and gynecology who undertook to 
supervise the resident. 
 
On appeal, the defendants challenged the admission of certain testimony 
given by plaintiffs’ expert witness concerning the applicable standard of care.  
Defendants argued that because they did not actually perform the surgery, but 
were responsible only for supervising the resident who did, they were not engaged 
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in the practice of their specialty and were not subject to a national standard of care 
for their specialty.  While this is a different aspect of the present issue, the 
following portion of the court’s analysis is instructive: 
 
“When plaintiff entered Hutzel Hospital for gynecological surgery, 
defendants assumed responsibility for her care.  Even though the surgical 
procedure was actually performed by a resident, defendants were under a duty to 
see that it was performed properly.  It is their skill and training as specialists 
which fits them for that task, and their advanced learning which enables them to 
judge the competency of the resident’s performance.  Their failure to take 
reasonable care in ascertaining that the surgery was competently performed 
renders them liable for the resulting damages.  We reject defendants’ argument 
that supervision of a patient’s care does not constitute practice of medicine.”  
(Footnote omitted.)  Id., 88 Mich.App. at 239, 276 N.W.2d at 571. 
 
In an amplifying footnote, the court pointed out that “defendants’ liability 
is not predicated on the negligence of the resident, but upon their own negligence 
in failing to provide adequate supervision.”  Id. at 238, 276 N.W.2d at 571, fn. 1. 
 
The basic underlying concept in these cases is that a physician-patient 
relationship, and thus a duty of care, may arise from whatever circumstances 
evince the physician’s consent to act for the patient’s medical benefit.  The 
physician-patient relationship being consensual in nature, these courts recognize 
that physicians who practice in the institutional environment may be found to 
have voluntarily assumed a duty of supervisory care pursuant to their contractual 
and employment arrangements with the hospital.  Unlike the traditional 
personalized delivery of health care, where the patient seeks out and obtains the 
services of a particular physician, the institutional environment of large teaching 
hospitals incorporates a myriad of complex and attenuated relationships.  Here the 
presenting patient enters a realm of full-service coordinated care in which 
technical agreements and affiliations proliferate the specialized functions and 
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11 
designated obligations of various allied health professionals.  In this reality, the 
responsibility for resident supervision that rests generally with the hospital is 
often delegated to or assumed by an individual physician or group of physicians.  
It is their level of skill and competence that ensures adequate patient care.  When 
a patient enters this setting, he or she has every right to expect that the hospital 
and adjunct physicians will exercise reasonable care in fulfilling their respective 
assignments.  So it is a logical and reasonable application of the principles set 
forth in Tracy, 58 Ohio St.3d 147, 569 N.E.2d 875, to find that a physician may 
agree in advance to the creation of a physician-patient relationship with the 
hospital’s patients. 
 
According to Dr. Stover, however, the argument that a contract between a 
physician and hospital can be sufficient to form the basis for a physician-patient 
relationship was rejected in Hill v. Kokosky (1990), 186 Mich.App. 300, 463 
N.W.2d 265, and St. John v. Pope (Tex.1995), 901 S.W.2d 420.  We disagree.  In 
neither case was any such argument raised, nor any evidence of a contract 
presented. 
 
In Hill, the issue was “[w]hether a physician-patient relationship arises 
from a treating physician’s solicitation of a colleague’s informal opinion on 
patient treatment.”  Id., 186 Mich.App. at 303, 463 N.W.2d at 266.  The court 
stated, “In the absence of a referral, a formal consultation, or some other 
contractual relationship, * * * no physician-patient relationship arises in this 
context.”  Id. 
 
In St. John, the issue was “whether an on-call physician, consulted by an 
emergency room physician over the telephone, formed a physician-patient 
relationship by expressing his opinion that the patient be transferred to another 
facility.”  Id., 901 S.W.2d at 421.  Answering this question in the negative, the 
court explained: 
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“We do not dispute that a physician may agree in advance to the creation 
of a physician-patient relationship.  For example, a physician’s agreement with a 
hospital may leave the physician no discretion to decline treatment of the 
hospital’s clients. * * * If any agreement existed which divested St. John of the 
discretion to choose whether to treat a patient, it was incumbent on Pope to 
present it in order to preclude summary judgment for the doctor.”  Id. at 424. 
 
While these cases can be interpreted to indicate that consultation without 
contract is insufficient to establish a physician-patient relationship, it does not 
follow that contract without consultation is also insufficient to form the 
relationship.  These are two distinct questions, and these cases simply have 
nothing to do with the latter issue. 
 
Dr. Stover also relies on McKinney v. Schlatter (1997), 118 Ohio App.3d 
328, 692 N.E.2d 1045, and states in his brief the proposition that “direct contact 
and/or participation, or at the very least, knowledge regarding a patient, is 
necessary to establish a physician-patient relationship under any circumstances.”  
On the other hand, appellants rely on McKinney for the proposition that “lack of 
contact between an on-call physician and an emergency room patient does not 
alone preclude the existence of a physician-patient relationship.” 
 
In McKinney, an on-call consulting physician allegedly misdiagnosed the 
condition of an emergency room patient during two telephone conversations with 
the emergency room physician.  It was undisputed that the on-call physician had 
no personal contact with the patient.  The court held that a physician-patient 
relationship can be found to exist under these circumstances, provided that the on-
call physician “(1) participates in the diagnosis of the patient’s condition, (2) 
participates in or prescribes a course of treatment for the patient, and (3) owes a 
duty to the hospital, staff or patient for whose benefit he is on call.”  Id., 118 Ohio 
App.3d at 336, 692 N.E.2d at 1050. 
January Term, 2002 
13 
 
We cannot agree with appellants’ interpretation of McKinney.  The court 
in McKinney did not hold that a physician-patient relationship can be created 
despite the lack of any contact between the physician and the patient.  Instead, the 
court found that “the lack of direct contact between the patient and the on-call 
physician does not, in itself, preclude a physician-patient relationship.”  
(Emphasis added.)  Id. at 336, 692 N.E.2d at 1050.  However, when such personal 
contact is lacking, the McKinney test requires the plaintiff to show that the 
physician actually participated in the patient’s care and was obligated to do so.  In 
other words, even where an on-call physician is contractually obligated to perform 
the services at issue, the physician-patient relationship cannot be established 
unless it appears that the physician was actively involved in caring for the patient.  
McKinney does not support appellants’ position. 
 
However, we now reject the McKinney test.  In addition to the reasons 
stated above, we find that the test itself is incongruous, for it actually subsumes 
the ultimate question of duty.  In order to satisfy what is merely the third of the 
three elements comprising the test, the plaintiff must prove the existence of the 
very duty that the test is ultimately designed to identify.  Thus, even if a physician 
is shown to owe a duty of care to the patient, or to act for the patient’s benefit, this 
duty is negated where the physician takes no affirmative action as provided in the 
other two elements of the test toward fulfilling his or her obligations.  Simply put, 
the test allows a voluntarily assumed duty of care to be nullified by virtue of its 
very breach. 
 
Of course, the physician-patient relationship cannot come into being 
without the physician’s consent.  Otherwise, the physician would be forced to 
provide care to anyone who desired medical attention.  But there are many forms 
of consent, and the three elements of the McKinney test are, in reality, a 
compilation of the various possible ways in which the physician’s consent can be 
manifested.  The physician may consent to the relationship by explicitly 
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contracting with the patient, treating hospital, or treating physician.  Or the 
physician may take certain actions that indicate knowing consent, such as 
examining, diagnosing, treating, or prescribing treatment for the patient.  The 
McKinney test essentially takes the sum total of these various possible forms of 
consent and converts them into a set of cumulative requirements.  Consequently, 
the test requires not only proof of consent, actual or implied, but proof of consent 
in every conceivable form. 
 
Under the McKinney test, as applied in the present context, a physician 
who explicitly accepts or voluntarily assumes the obligation to provide resident 
supervision, knowing full well that the fulfillment of these supervisory duties is 
vital to the interests of the hospital’s patients, could escape his or her obligation 
simply by failing to provide any supervision at all.  We find such a rigid, 
formalistic notion of consent to be both unrealistic and unjustified. 
 
Accordingly, we hold that a physician-patient relationship can be 
established between a physician who contracts, agrees, undertakes, or otherwise 
assumes the obligation to provide resident supervision at a teaching hospital and a 
hospital patient with whom the physician had no direct or indirect contact. 
 
This holding does not, however, end the inquiry in this case, but instead 
brings the pivotal issue into focus.  As explained by the dissenting justice in 
Mozingo, supra: 
 
“The mere existence of such an agreement [delegating the responsibility of 
supervision] does not, however, end the inquiry of determining who has 
responsibility for supervision.  As with the delegation of all duties, the terms of 
the agreement between the delegator and the delegatee control.  The delegatee 
will be charged only with the duties that he has voluntarily assumed.”  Id., 331 
N.C. at 194, 415 S.E.2d at 348 (Meyer, J., dissenting). 
January Term, 2002 
15 
 
While disagreeing with the dissent as to its application, the majority in 
Mozingo also recognized “the general principle that a physician may contractually 
limit the extent and scope of his employment.”  Id. at 191, 415 S.E.2d at 346. 
 
Similarly, although the court in Maxwell, 126 Misc.2d 597, 482 N.Y.S.2d 
1000, held that a hospital may delegate its supervisory responsibilities to a 
particular physician, it did not determine whether such a delegation had occurred.  
Instead, the court concluded: 
 
“Accordingly, summary judgment is at this time inappropriate.  There 
needs to be full discovery to ascertain whether, in fact, Dr. Ledger was designated 
to carry out the duties and responsibilities claimed for him * * *.  If those 
supervisory responsibilities are demonstrated to be beyond his actual grant of 
power, then it would be appropriate for Dr. Ledger to renew his motion.”  Id., 126 
Misc.2d at 599, 482 N.Y.S.2d at 1002. 
 
Thus, the determinative issue in this case is not whether Dr. Stover had 
any contact with Lownsbury or the residents treating her, but whether and to what 
extent Dr. Stover assumed the obligation to supervise the residents at Akron City 
Hospital.  Specifically, did Dr. Stover assume only a limited and passive duty to 
remain in his call room until consulted by a resident with a problem, or did he 
assume an active duty to gauge the performance of the residents or familiarize 
himself with the condition of the patients at Akron City Hospital? 
 
Having reviewed the entire record in this case, including the EMS-ACH 
contract, the consent form signed by Lownsbury, the agreement between Dr. 
Stover and EMS, and the various affidavits and depositions given by appellants’ 
experts, EMS physicians and hospital residents, we conclude that there is 
sufficient evidence upon which the jury could decide this question either way.  In 
so doing, we are aware that the EMS physicians and hospital residents testified 
that Dr. Stover had no responsibility to a hospital patient unless and until he was 
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contacted by a resident.  However, this testimony is disputed by the consent form 
and the testimony of appellants’ experts. 
 
Although it is not clear, as Dr. Stover points out, whether Lownsbury 
signed the consent form on January 6 or January 10, 1995, that form nevertheless 
establishes that Akron City Hospital considers the supervisory physician to be the 
patient’s “attending physician” and expects that patient services will be ordered 
by or rendered under the general and specific instructions of such physician.  
Therefore, the consent form constitutes substantial evidence that Dr. Stover was 
required to take an active role in supervising the hospital’s residents and caring 
for the hospital’s patients.  See Fenley [sic, Fence] v. Hospice in the Pines 
(Tex.App.1999), 4 S.W.3d 476, 480. 
 
Also, we disagree with the court of appeals that the testimony of 
appellants’ experts confined itself to whether Dr. Stover breached the standard of 
care.  Instead, as indicated above, these experts specifically testified as to the 
existence and nature of Dr. Stover’s duties on January 6, 1995. 
 
We are also aware that the “RECITALS” portion of the EMS-ACH 
contract indicates that one of its objectives is to provide “for the ready availability 
of PHYSICIANS for the purpose of resident supervision.”  However, we cannot 
agree with Dr. Stover that this statement necessarily allows him to avoid all 
contact and communication with the resident staff except when consulted, or that 
it places the decision as to when supervision is needed into the hands of those 
who need to be supervised. 
 
Despite Dr. Stover’s repeated reference to EMS physicians as “on-call 
obstetricians,” nowhere in any of the agreements in this case is such a designation 
to be found.  Indeed, the phrase “ready availability” is itself susceptible of 
differing interpretations.  “Available” can mean “accessible” or “obtainable,” but 
it is also defined as “qualified or willing * * * to assume a responsibility.”  
Merriam-Webster’s Collegiate Dictionary (10 Ed.2000) 79.  In turn, “supervision” 
January Term, 2002 
17 
means “esp.:  a critical watching and directing (as of activities or a course of 
action).”  Id. at 1180.  Considering that the phrase appears in the context of a 
clause that obligates EMS to provide continuous, around-the-clock on-premises 
resident supervision, it is reasonable to interpret “ready availability” to mean that 
EMS physicians must be willing to assume the responsibility to watch and direct 
the residents at Akron City Hospital.  Moreover, this phrase is conspicuously 
omitted from the actual “AGREEMENTS” portion of the EMS-ACH contract, 
which provides simply that EMS is to “provide SERVICES on HOSPITAL 
premises twenty-four (24) hours per day, seven (7) days per week” and “insure 
[that] high quality professional medical care will be provided to HOSPITAL’S 
obstetrical and gynecological patients.” 
 
In light of all the foregoing, we hold that appellants presented sufficient 
evidence to raise a genuine issue of material fact as to whether a physician-patient 
relationship existed between Dr. Stover and Lownsbury on January 6, 1995. 
 
Accordingly, we find that summary judgment was inappropriately granted 
in favor of Dr. Stover, and the judgment of the court of appeals is hereby 
reversed.  The cause, therefore, is remanded to the trial court for further 
proceedings. 
Judgment reversed 
and cause remanded. 
 
DOUGLAS, F.E. SWEENEY and PFEIFER, JJ., concur. 
 
MOYER, C.J., COOK and LUNDBERG STRATTON, JJ., concur separately in 
syllabus and judgment. 
__________________ 
 
MOYER, C.J., concurring in syllabus and judgment.  I concur only in 
the syllabus and judgment. 
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SUPREME COURT OF OHIO 
18 
 
COOK, J., concurring in syllabus and judgment only.  The existence of 
a legal duty in ordinary negligence cases is generally a question of law for the 
court.  Mussivand v. David (1989), 45 Ohio St.3d 314, 318, 544 N.E.2d 265, 270.  
Similarly, the question of whether there exists a physician-patient relationship—
upon which the legal duty in medical malpractice cases is predicated—is a legal 
issue that a court must decide before the factfinder decides what the appropriate 
standard of care was in a given case.  St. John v. Pope (Tex.1995), 901 S.W.2d 
420, 424.  It does not necessarily follow, however, that the court may always 
decide at the summary-judgment stage the existence or nonexistence of a 
physician-patient relationship as a matter of law.  There are some circumstances 
in which “the existence of a duty may depend on preliminary questions that must 
be determined by a fact finder.”  Diggs v. Arizona Cardiologists, Ltd. 
(Ariz.App.2000), 198 Ariz. 198, 200, 8 P.3d 386, 388.  Such is the case in the 
medical-malpractice context, where the existence of a physician-patient 
relationship may depend on the facts of the particular case and essentially become 
a question for the trier of fact.  See Irvin v. Smith (Kan.2001), 31 P.3d 934, 940-
941; Gallion v. Woytassek (1993), 244 Neb. 15, 20, 504 N.W.2d 76, 80; Eby v. 
Newcombe (1989), 116 Idaho 838, 840, 780 P.2d 589, 591; Lyons v. Grether 
(1977), 218 Va. 630, 633, 239 S.E.2d 103, 105. 
 
In this case, the consent form signed by Cathy Lownsbury, the contract 
between East Market and Akron City Hospital, and the contract between Dr. 
Stover and East Market raise a genuine issue of material fact concerning the 
existence of a physician-patient relationship.  Accordingly, I concur in the court’s 
syllabus and judgment. 
__________________ 
 
LUNDBERG STRATTON, J., concurring in syllabus and judgment only.  I 
join Justice Cook’s concurrence but also write to state that once we determined 
that issues of fact existed, our duty ended.  The majority, however, goes on to 
January Term, 2002 
19 
comment on and evaluate the disputed evidence.  That is not our role in this case 
and is unnecessary to the disposition of this case.  Having sent the matter back to 
the trier of fact, we should refrain from possible prejudicial comments regarding 
those facts.  Therefore, I respectfully concur in the syllabus and judgment only. 
__________________ 
 
Sandra J. Rosenthal; Muth & Shapiro, P.C., and Andrew S. Muth; Beam 
& Associates and Jack Beam; Alpert, D’Anniballe & Visnic and Robert 
D’Anniballe, Jr., for appellants. 
 
Reminger & Reminger Co., L.P.A., Thomas Mannion and James M. Kelley 
III, for appellee Thomas D. Stover, M.D. 
 
Zavarello & Davis Co., L.P.A., A. William Zavarello and Rhonda Gail 
Davis, urging reversal for amicus curiae, Ohio Academy of Trial Lawyers. 
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