Title: Prosise v. Foster

State: virginia

Issuer: Virginia Supreme Court

Document:

Present:  Carrico, C.J., Lacy, Hassell, Keenan, Koontz, and 
Lemons, JJ., and Whiting, S.J. 
 
FLORENCE A. PROSISE, ADMINISTRATOR 
OF THE ESTATE OF CRYSTAL NICOLE PROSISE, 
DECEASED 
 
v.  Record No. 001074     OPINION BY JUSTICE ELIZABETH B. LACY 
 
 
 
April 20, 2001 
ROBIN FOSTER, M.D., ET AL. 
 
FROM THE CIRCUIT COURT OF HENRICO COUNTY 
George F. Tidey, Judge 
 
 
The issue in this case is whether an on-call attending 
physician for a teaching hospital owed a duty of care to a 
patient based upon a physician-patient relationship in the 
absence of direct contact with or consultation concerning the 
patient. 
 
Dr. Robin L. Foster was the attending physician for the 
Medical College of Virginia Hospitals Pediatric Emergency Room 
(MCVPER) from noon on March 27 through 8:00 a.m. on March 28, 
1994.  She was physically present at the MCVPER until 
5:00 p.m., March 27, and was "on call" from then until 
8:00 a.m. on March 28.  As an on-call attending physician, Dr. 
Foster was not physically present in the emergency room, but 
she was available to answer any questions from the treating 
residents and interns. 
 
Florence A. Prosise took her four-year-old daughter, 
Crystal, to the MCVPER in the early evening of March 27, 1994.  
Crystal had chicken pox lesions in her mouth, was lethargic, 
and was not eating or drinking.  The first physician to see 
Crystal in the emergency room was Dr. Omprakash V. Narang, a 
first-year resident.  Prosise told Dr. Narang that Crystal had 
been treated for asthma with intravenous corticosteroids as an 
inpatient at another hospital from March 16 to March 18, 1994.  
Dr. Narang consulted Dr. Valerie Curry, a third-year resident, 
regarding Crystal's condition and prior treatment.  Dr. Curry 
examined Crystal but did not read Crystal's chart or otherwise 
learn that Crystal had been treated with corticosteroids. 
Neither Dr. Curry nor Dr. Narang called Dr. Foster regarding 
Crystal's condition or treatment.  Crystal was treated for 
dehydration and released early the next morning, March 28, 
1994, with instructions to see her pediatrician the next day. 
 
When Prosise took Crystal to her pediatrician on March 
29, Crystal was immediately transported back to the MCVPER 
because of a grave respiratory condition.  At the MCVPER, 
Crystal was seen for the first time by Dr. Foster.  Dr. Foster 
concluded that Crystal was suffering from "Varicella Infection 
S/P immunosuppresion asthma R/O Pneumonitis," a condition in 
which the chicken pox virus affects the body's entire system 
rather than just the skin.  Dr. Foster placed Crystal on an 
anti-viral medication administered intravenously.  The 
treatment was unsuccessful, and Crystal died as a result of 
the infection on April 22, 1994. 
 
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Prosise, as administrator of the estate of Crystal Nicole 
Prosise, filed a medical malpractice and wrongful death action 
against Dr. Foster and MCV Associated Physicians.1  Prosise 
alleged that Dr. Foster, as the on-call attending physician 
for the MCVPER on March 27 and 28, 1994, had a duty to 
supervise and was responsible for the medical care rendered by 
the residents working at the MCVPER during that time.  The 
motion for judgment claimed that Dr. Foster and her alleged 
employer, MCV Associated Physicians, were "vicariously liable 
and legally responsible for the acts and omissions of, and 
negligence of" Dr. Narang and Dr. Curry, which resulted in the 
death of Crystal. 
 
Dr. Foster and MCV Associated Physicians filed a motion 
for summary judgment asserting that there was no physician-
patient relationship between Crystal and the defendants, and, 
"therefore, the defendants owed no duty of care to" Crystal.  
The parties agreed that the trial court could consider 
discovery depositions in addressing the summary judgment 
motion.2  See Code § 8.01-420; Rule 3:18.  Following oral 
                     
1 Prosise's original motion for judgment included claims 
against a number of other defendants.  Following resolution of  
her claims against those defendants, Prosise nonsuited her 
claims against Dr. Foster and MCV Associated Physicians.  
Prosise refiled the nonsuited claims November 10, 1997.     
2 The trial court granted the defendants' motion to 
include the discovery conducted in the prior nonsuited action 
in the instant action. 
 
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argument, the trial court entered judgment in favor of Dr. 
Foster and MCV Associated Physicians, finding that there was 
no "minimum contact" between Dr. Foster and Crystal and, 
therefore, no physician-patient relationship existed.  We 
awarded Prosise an appeal from this judgment. 
 
Prosise argues that Lyons v. Grether, 218 Va. 630, 239 
S.E.2d 103 (1977), Lee v. Bourgeois, 252 Va. 328, 477 S.E.2d 
495 (1996), and Code § 54.1-2961 require a finding that a 
physician-patient relationship existed between Dr. Foster and 
Crystal on March 27 and 28, 1994.  As defined in Lyons, the 
physician-patient relationship is a consensual relationship 
that exists if a patient entrusts his or her treatment to the 
physician and the physician accepts the case.  218 Va. at 633, 
239 S.E.2d at 105.  Citing Lee and Code § 54.1-2961, Prosise 
argues that a physician-patient relationship existed in the 
instant case because, when Dr. Foster agreed to be the 
MCVPER's attending physician from noon on March 27, 1994 until 
8:00 a.m. on March 28, 1994, she accepted Crystal as her 
patient.  We disagree with Prosise's interpretation of Lee and 
Code § 54.1-2961. 
 
In Lee, an attending physician in a state university 
hospital was sued for medical malpractice in the treatment 
rendered to a patient by residents in the hospital.  The issue 
in the case was whether the attending physician was entitled 
 
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to sovereign immunity.  We concluded that under the 
circumstances presented, teaching was not the primary function 
of the attending physician.  Rather, the attending physician's 
primary function was directly related to assuring the proper 
care of the patient, regardless of whether the care was 
delivered by the attending physician or through the residents.  
252 Va. at 334, 477 S.E.2d at 498-99.  This patient care 
function involved only a slight degree of state interest and 
involvement, and, therefore, under the standards of James v. 
Jane, 221 Va. 43, 282 S.E.2d 864 (1980), the attending 
physician was not entitled to sovereign immunity.  Lee, 252 
Va. at 335, 477 S.E.2d at 499. 
The liability of an attending physician at a teaching 
hospital was not at issue in Lee.  Thus, we did not consider 
in Lee whether a duty of care existed between the attending 
physician and the patient, and, therefore, that case is not 
applicable to the issue presented here.  See also Benjamin v. 
Univ. Internal Med. Found., 254 Va. 400, 404 n.3, 492 S.E.2d 
651, 653 n.3 (1997) (declining to address arguments concerning 
the existence of a physician-patient relationship). 
We also reject Prosise's suggestion that Code § 54.1-
2961(B) imposes a duty of care on an on-call attending 
physician in a teaching hospital because the statute requires 
that interns and residents "be responsible and accountable at 
 
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all times to a licensed member" of the hospital staff.  
Although we discussed that statutory provision in Lee with 
regard to the question of sovereign immunity, 252 Va. at 334, 
477 S.E.2d at 498-99, we did not consider whether its 
requirements imposed a duty of care.  We engage in that 
analysis now. 
Code § 54.1-2961 is found within a series of provisions 
defining conditions under which medical students, interns, and 
residents may work in or be employed by a hospital.  Medical 
students may work in hospitals only under the "direct tutorial 
supervision of a licensed physician who holds an appointment 
on the faculty" of a medical school.  Code § 54.1-2959.  Third 
and fourth year medical students may be employed by hospitals 
to perform certain examinations and to take medical histories, 
but the attending physician retains the responsibility to 
assure "that a licensed physician [completes] a history and 
physical examination on each hospitalized patient."  Code 
§ 54.1-2960.  Finally, interns and residents employed by 
hospitals while part of an approved internship or residency 
program are "responsible and accountable" to licensed staff 
members but are not subject to further restrictions under Code 
§ 54.1-2961(B). 
We cannot conclude that the General Assembly, in merely 
listing the conditions under which medical students, interns, 
 
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and residents may work in a hospital during the course of 
their educational programs, intended to create a statutory 
physician-patient relationship between an on-call attending 
physician in a teaching hospital and a patient that would give 
rise to a duty of care.  Thus, we reject Prosise's argument 
that, under Lee and Code § 54.1-2961, a physician-patient 
relationship existed between Dr. Foster and Crystal because 
Dr. Foster, as the on-call attending physician, "accepted" 
Crystal as a patient when she came to the MCVPER the evening 
of March 27, 1994. 
Finally, Prosise urges us to follow the North Carolina 
Supreme Court and impose a common law duty on Dr. Foster, 
arguing that such duty is necessary to ensure appropriate 
supervision of residents and interns by attending physicians.  
In Mozingo v. Pitt County Memorial Hospital, Inc., 415 S.E.2d 
341 (N.C. 1992), the North Carolina Supreme Court held that an 
on-call attending physician had a common law duty to supervise 
residents who provided medical care to patients, even though 
the relationship "did not fit traditional notions of the 
doctor-patient relationship," because of the "increasingly 
complex modern delivery of health care."  Id. at 344-45. 
Dr. Foster and MCV Associated Physicians ask us to reject 
the rationale of Mozingo, as they assert that the Maryland 
Court of Special Appeals did in Rivera v. Prince George's 
 
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County Health Dept., 649 A.2d 1212 (Md. Ct. Spec. App. 1994), 
cert. denied, 656 A.2d 772 (Md. 1995).  The Maryland court 
stated that it would impose no duty on an on-call attending 
physician in the absence of proof that the doctor had accepted 
the patient, had consulted with a physician about the patient, 
or had been summoned for consultation or treatment, "unless 
the 'on call' agreement between a hospital and a physician 
provides otherwise."  Id. at 1232.  Thus, although the court 
acknowledged that direct treatment of a patient was not 
necessary to give rise to a duty of care, the court required 
that the evidence show that an on-call attending physician in 
a teaching hospital accepted responsibility for the patient's 
treatment in some way.  We agree with the Maryland court's 
analysis in Rivera and note that it applied virtually the same 
standard we enunciated in Lyons as the basis for a physician-
patient relationship.  218 Va. at 633, 239 S.E.2d at 105. 
Accordingly, to resolve this case, we look to the record 
to determine whether it contains any facts which indicate that 
Dr. Foster, by virtue of her actions or her status as the on-
call attending physician for the MCVPER, agreed to accept 
responsibility for the care of Crystal.  Clearly, Dr. Foster's 
direct actions do not indicate that she accepted Crystal as a 
patient prior to March 29.  She did not treat Crystal, she did 
not participate in any treatment decisions regarding Crystal, 
 
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and she was not consulted by Dr. Curry, Dr. Narang, or any 
other hospital staff regarding Crystal's condition. 
Similarly, the record in this case does not support a 
finding that, by agreeing to act as an on-call attending 
physician in a teaching hospital, Dr. Foster accepted 
responsibility for Crystal's care.  The record contains no 
information about the duties of attending physicians, whether 
on-call or otherwise, and there is no evidence of the 
hospital's policy regarding attending physicians.3  Cf., e.g., 
Lee v. Bourgeois, 252 Va. at 333, 477 S.E.2d at 498 (hospital 
policy that all patients be assigned an attending physician).  
The only evidence the record contains in this regard are 
statements from Dr. Curry that she assumed attending 
physicians had to review all patient charts and from Dr. 
Narang that he understood attending physicians were 
"ultimately responsible."  Furthermore, Dr. Foster's 
employment contract, which is in the record, makes no 
reference to her duties as an attending physician.  Thus, on 
this record, there is no basis to support a finding that Dr. 
Foster, directly, by contract, or by hospital policy, assumed 
responsibility for the care of Crystal. 
                     
3 Although Prosise did file a motion to compel the answer 
to an interrogatory that inquired into the duties and 
responsibilities of attending physicians, her motion was 
overruled and she did not assign error to that ruling. 
 
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Accordingly, for the above reasons, we conclude that the 
trial court did not err in holding that there was no 
physician-patient relationship between Dr. Foster and Crystal 
because the evidence failed to show a consensual relationship 
in which the patient's care was entrusted to the physician and 
the physician accepted the case.  Lyons, 218 Va. at 633, 239 
S.E.2d at 105. 
The judgment of the trial court will be affirmed. 
Affirmed.
 
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