Title: Benjamin v. University Internal Med. Found.
Citation: N/A
Docket Number: 962261
State: Virginia
Issuer: Virginia Supreme Court
Date: October 31, 1997

Present:  Carrico, C.J., Compton, Lacy, Hassell, Keenan, and 
Kinser, JJ., and Poff, Senior Justice 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 
32 
33 
34 
 
JANIE MAE BENJAMIN, ADMINISTRATOR 
OF THE ESTATE OF YUKEMA DENISE 
BENJAMIN, DECEASED 
 
v.    Record No. 962261 
OPINION BY JUSTICE ELIZABETH B. LACY 
                                      October 31, 1997 
UNIVERSITY INTERNAL MEDICINE  
FOUNDATION, ET AL. 
 
 
FROM THE CIRCUIT COURT OF THE CITY OF RICHMOND 
 
Melvin R. Hughes, Jr., Judge 
 
 
Eighteen-year-old Yukema Denise Benjamin went to the 
Emergency Room at the Medical College of Virginia (MCV) 
Hospital on October 25 and 28, 1994, complaining of headaches 
and neck pain.  On both occasions, Yukema was directed to the 
Hospital's Episodic Care Clinic (ECC) and, after examination, 
was discharged with prescriptions for medication to treat her 
headaches.  On October 31, 1994, Yukema died from the effects 
of intracranial pressure due to failure of a fluid shunt which 
had been placed in her head as an infant. 
 
Janie Mae Benjamin, administrator of Yukema's estate, 
filed a motion for judgment against Julie Ann Samuels, M.D., 
the medical director of the ECC, and University Internal 
Medicine Foundation (UIMF).  The motion for judgment alleged 
that when Yukema was treated, Dr. Samuels, as the medical 
director of the ECC, was in charge of, and responsible for, the 
physicians in the unit and was acting as the agent, servant, 
and employee of UIMF.   
 
Dr. Samuels filed a plea of sovereign immunity.  Following 
an evidentiary hearing on the plea, the trial court issued an 
 
 
 
 
2 
1 
2 
opinion letter deciding that Dr. Samuels was acting as an 
administrator of a state-run public health facility and, 
applying the four-prong test enunciated in Messina v. Burden, 
228 Va. 301, 313, 321 S.E.2d 657, 663 (1984), was entitled to 
sovereign immunity.  
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
 
UIMF then filed a motion for summary judgment based on the 
trial court's determination in its opinion letter that Dr. 
Samuels was acting "for the state as an administrator" of the 
ECC.  This determination, UIMF asserted, eliminated any basis 
upon which UIMF could be vicariously liable because Dr. Samuels 
was not acting as an agent, servant, or employee of UIMF at the 
time of Yukema's treatment in the ECC.  After hearing argument 
of counsel on the summary judgment motion, the trial court 
entered a final order sustaining Dr. Samuels' plea of sovereign 
immunity and UIMF's motion for summary judgment.  Benjamin 
filed an appeal challenging both the grant of sovereign 
immunity with respect to Dr. Samuels and the entry of summary 
judgment in favor of UIMF. 
 
I.  
 
SOVEREIGN IMMUNITY 
 
Sovereign immunity determinations must be made on a case 
by case basis, balancing factors identified in a test 
established in James v. Jane, 221 Va. 43, 53, 282 S.E.2d 864, 
869 (1980), and further enunciated in 
23 
Messina, 228 Va. at 313, 
24 
 
 
 
 
3 
1 
2 
3 
4 
5 
6 
321 S.E.2d at 663.
1  We have previously held that 
administrators of state-run institutions are entitled to 
sovereign immunity for actions taken in their administrative 
capacities because the state has a substantial interest in the 
efficient management of its entities and facilities, and 
administrators must exercise discretion in the performance of 
those duties.  Id. at 310-11, 321 S.E.2d at 662; Banks v. 
7 
Sellers, 224 Va. 168, 173, 294 S.E.2d 862, 865 (1982); Lawhorne 
8 
v. Harlan, 214 Va. 405, 407, 200 S.E.2d 569, 571-72 (1973).  
The trial court reached the same conclusion in this case.  
Applying the 
9 
10 
Messina test, the trial court determined that the 
ECC is a state-run facility, that there is "a heavy state 
interest and involvement" in its administration, and that the 
administrator of the ECC is required to exercise "a 
considerable amount of judgment and discretion."  The trial 
court sustained Dr. Samuels' sovereign immunity plea because, 
during the events in question, she was acting as the 
administrative director for the ECC rather than as an attending 
medical staff member of MCV Hospital to whom the physicians in 
the ECC were responsible and accountable. 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
                    
 
Benjamin assigns error to the trial court's factual 
 
     
1 The four factors of the test are:  (1) the nature of the 
function performed by the employee; (2) the extent of the 
state's interest and involvement in the function; (3) the 
degree of control and direction exercised by the state over the 
employee; and (4) whether the act complained of involved the 
use of judgment and discretion.  Messina, 228 Va. at 313, 321 
S.E.2d at 663. 
 
 
 
 
4 
1 
2 
3 
4 
determination that Dr. Samuels was acting as an administrative 
director of the ECC.  In reviewing this determination, we will 
not disturb the trial court's findings unless they are plainly 
wrong or without evidence to support them.  Code § 8.01-680; 
Norfolk Airport Authority v. Nordwall, 246 Va. 391, 393, 436 
S.E.2d 436, 437 (1993). 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
                    
 
The testimony established that Dr. Samuels was a 
physician, board-certified in internal medicine, and a full-
time faculty member with an appointment as an Assistant 
Professor at MCV.  In 1991, she was asked to assume the 
position of medical director of the ECC in addition to her 
teaching responsibilities.  She received $35,000 annually for 
her work as medical director.  These funds came from the 
state.
2    
 
Dr. Samuels' duties as medical director included arranging 
for physician coverage of the ECC, responding to complaints 
with respect to the operation of the ECC, and reviewing patient 
charts in connection with the administrative management of the 
ECC.  She did not hire or fire the physicians or any other 
personnel in the ECC and was not designated as an attending or 
admitting physician for ECC patients.  There was no requirement 
that Dr. Samuels approve or be consulted about treatment 
decisions for the patients in the ECC.  The ECC was not part of 
 
     
2 This amount was included in MCV Hospital's budget, but 
it was delivered to Dr. Samuels as part of the compensation she 
received from the Department of Internal Medicine. 
 
 
 
 
5 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
                    
any training program or residency rotation for medical students 
at MCV.  Thus, even though the title "medical director" implies 
responsibility for the medical care of patients, the record 
supports the trial court's determination that Dr. Samuels, as 
medical director of the ECC, performed administrative functions 
for the state in the operation of the ECC and was not 
performing the duties of an attending physician in that 
capacity. 
 
Accordingly, we will affirm the trial court's 
determination that Dr. Samuels was an administrative agent for 
a state institution, exercising substantial discretion in 
carrying out her administrative duties, and was, therefore, 
entitled to sovereign immunity.
3
 
II. 
 
SUMMARY JUDGMENT 
 
Benjamin also assigns error to the entry of summary 
judgment in favor of UIMF, arguing that whether Dr. Samuels was 
UIMF's agent in the operation of the ECC was a material fact in 
issue and, therefore, summary judgment was inappropriate.  We 
disagree.  
 
Resolution of Benjamin's challenge to the summary judgment 
 
     
3 We do not address Benjamin's argument that the trial 
court erred in finding that no doctor-patient relationship 
existed between Dr. Samuels and Yukema because that argument is 
also based on Benjamin's theory that Dr. Samuels was acting in 
the capacity of an attending physician, like Dr. Hakala in 
James and Dr. Bourgeois in Lee v. Bourgeois, 252 Va. 328, 477 
S.E.2d 495 (1996). 
 
 
 
 
6 
1 
2 
order requires a review of the procedural development of the 
case.  An evidentiary hearing was held on the sovereign 
immunity plea.  At that hearing, ore tenus testimony was 
presented by both Dr. Samuels and Benjamin.  Benjamin also 
introduced deposition testimony.  Dr. Samuels produced evidence 
showing that UIMF is a private, non-profit corporation, tax 
exempt under § 501(c)(3) of the Internal Revenue Code and 
organized for the private practice of medicine by faculty in 
the Internal Medicine Department of the Medical College of 
Virginia.  The members of the corporation are those physicians 
on the faculty of the Department who also engage in private 
practice.  UIMF bills the private patients of members for 
services received and pays the members for services they render 
to the private patients.  Dr. Samuels was a member of UIMF and 
was paid for her services to private patients by UIMF.  This 
payment was separate from the compensation she received from 
the Department.  
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
 
The evidence also established that the ECC is a non-acute 
care facility maintained by MCV Hospital for the treatment of 
non-emergency, walk-in patients, many of whom are indigent.  In 
1994, the ECC was staffed by two full-time physicians and by 
physicians who worked in the ECC at night or on weekends, 
generally referred to as "moonlighting" physicians.  
Moonlighting physicians were paid directly by the Hospital. 
 
John C. Girtman, III, Executive Director of UIMF, 
 
 
 
 
7 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
testified that UIMF receives no benefit from Dr. Samuels' 
service as medical director of the ECC, does not bill for 
patients seen in the ECC, receives no financial benefit from 
the ECC, and is not involved in any way in the daily operation 
of the ECC.  
 
Benjamin introduced two letters which she argued 
contradicted this evidence and supported the conclusion that 
Dr. Samuels was acting as an agent for UIMF, not for the state, 
in her capacity as medical director of the ECC.  Both letters 
were written by a Hospital administrator to Girtman.  The first 
letter, dated April 8, 1992, stated that two full-time 
physician positions in the ECC "will be set up and recruited 
for by U.I.M.F." and stated that the positions were being 
"created through UIMF."  The second, dated January 29, 1993, 
recited "commitments" of the Hospital for staffing and 
direction of the ECC:  $35,000 annual salary support for the 
medical director of the ECC, a sum of $125,000 annually for 
salaries for two full-time physicians in the ECC, and the 
continuation of hourly pay for the moonlighting "senior 
residents, fellows and attendings" who worked in the ECC at 
nights and on weekends.  The letter went on to state that 
billing for the medical director position and full-time 
positions would be "through memo to me," but the moonlighting 
physicians would be paid directly at the hourly rate.  
 
Girtman testified that, although these letters were 
 
 
 
 
8 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
written to him in his capacity as the executive director of 
UIMF, he was negotiating on behalf of the Internal Medicine 
Department to insure that sufficient funds were budgeted for 
the positions.  
 
After considering this evidence and argument of counsel, 
the trial court resolved any conflicts in the evidence in favor 
of Dr. Samuels and found that Dr. Samuels was acting in an 
administrative capacity as the medical director of a state-run 
medical facility, the ECC.  This determination was made in a 
June 4, 1996 opinion letter.  Six days later, UIMF filed its 
motion for summary judgment, asserting that this determination 
eliminated any factual dispute regarding whether Dr. Samuels 
was the agent, servant, or employee of UIMF while acting as the 
medical director of the ECC.  Thus, UIMF concluded, there was 
no basis for imposing vicarious liability on UIMF for Dr. 
Samuels' actions. 
 
At the hearing on the motion for summary judgment, the 
trial court read portions of Girtman's ore tenus testimony from 
the evidentiary hearing on the sovereign immunity plea 
concerning the lack of UIMF's involvement, financially or 
otherwise, in the "operations, upkeep or fundings of the ECC." 
The trial court specifically asked Benjamin's counsel if he had 
any evidence to "counter" Girtman's testimony.  Benjamin's 
counsel did not identify any such evidence, but argued only 
that he was not prepared to put on evidence that day.  The 
18 
19 
20 
21 
22 
23 
24 
25 
 
 
 
 
9 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
trial court subsequently entered the order sustaining UIMF's 
motion for summary judgment. 
 
Under these circumstances, we conclude that the trial 
court did not err in entering summary judgment in favor of 
UIMF.  It is true that, during the consideration of the 
sovereign immunity plea, no issue or finding specifically 
addressed whether an agency relationship existed between Dr. 
Samuels acting as medical director of the ECC and UIMF.  
Nevertheless, one of the theories offered by Benjamin to defeat 
the sovereign immunity plea was that UIMF was directly involved 
in the ECC by setting up the ECC, recruiting physicians for the 
ECC, and billing MCV Hospital for the physician and medical 
director positions in the ECC.  The letters written by the 
Hospital administrator to Girtman were introduced to support 
this theory.  Benjamin's counsel also argued that a contract 
existed between the Hospital and UIMF relating to the payment 
of Dr. Samuels' salary as medical director.  The trial court's 
determination that Dr. Samuels was acting for the state in 
administering the ECC and that the ECC was a state-run health 
facility necessarily rejected Benjamin's theory, evidence, and 
argument that UIMF had a connection or contract with the ECC or 
with Dr. Samuels, as medical director of the ECC.  While 
Benjamin may not have agreed, she was not entitled to a 
relitigation of that determination, especially given her 
inability to suggest additional evidence that could place a 
 
 
 
 
10 
1 
2 
3 
material fact in dispute.
4
 
Accordingly, for the reasons cited above, we will affirm 
the judgment of the trial court. 
 
Affirmed.
4 
                     
     
4 Benjamin also assigned as error the use of the 
depositions she introduced in the sovereign immunity hearing to 
decide the motion for summary judgment, absent her agreement.  
Rule 3:18.  The ore tenus evidence cited above, however, 
supports the trial court's conclusions and there is nothing in 
the record to indicate the trial court used the depositions in 
deciding the summary judgment motion.  Therefore, this 
assignment of error is without merit.