Title: Lee v. Bourgeois
Citation: N/A
Docket Number: 952317
State: Virginia
Issuer: Virginia Supreme Court
Date: November 1, 1996

Present:  All the Justices 
 
TRINICA ANN LEE, AN INFANT, WHO 
SUES BY EARTHA K. LEE, HER MOTHER 
AND NEXT FRIEND 
 
v.  Record No. 952317 
OPINION BY JUSTICE ELIZABETH B. LACY 
                                      November 1, 1996 
F. JOHN BOURGEOIS, M.D. 
 
 
FROM THE CIRCUIT COURT OF THE CITY OF CHARLOTTESVILLE 
 
Jay T. Swett, Judge 
 
 
In this case we consider whether an attending physician 
employed by the state is entitled to sovereign immunity for 
alleged acts of simple negligence. 
 
Eartha K. Lee was admitted to the high risk pregnancy 
service at the University of Virginia Hospital (University 
Hospital) on September 23, 1985, when she was approximately 28 
weeks pregnant.  Dr. Siva Thiagarajah, Lee's attending physician, 
prescribed a management plan for her medical treatment.  Dr. 
Thiagarajah's plan was to stop preterm labor with drugs and to 
monitor Lee for infection.  When Dr. Thiagarajah went off duty on 
the afternoon of September 27, 1985, Dr. Francis John Bourgeois 
took over as Lee's attending physician.   
 
Around five o'clock on the evening of September 27, 1985, 
Dr. Julie L. Blommel, a first year resident, was notified by 
nurses that Lee was having contractions.  Dr. Blommel visited Lee 
45 minutes later and determined that she needed to be moved 
across the hall to the labor and delivery room for assessment of 
whether she was in labor.  Around 6:45 p.m., Dr. John Donnelly, 
the chief resident of the high risk pregnancy service, performed 
a pelvic examination on Lee.  Although delivery by cesarean 
section was the preferred form of delivery for Lee's condition, 
Lee's labor had progressed too far and a cesarean section was no 
longer a viable option.  Therefore, Dr. Donnelly performed an 
emergency vaginal delivery.  The baby was in a breech position 
and during delivery its head was entrapped when the cervix 
constricted upon the baby's neck and head after the delivery of 
the legs.  In the course of the delivery, Dr. Donnelly applied 
traction.  The baby's spinal cord was traumatically injured and 
she is permanently paralyzed.   
 
The infant, Trinica Ann Lee, filed a motion for judgment by 
her mother and next friend, Lee, naming the Commonwealth and 
seven doctors, including Drs. Thiagarajah and Bourgeois as 
defendants, alleging that they negligently provided medical 
treatment to her.  The plaintiff nonsuited five of the doctors 
and the Commonwealth.  One of the remaining doctors, Dr. 
Bourgeois, filed a plea of sovereign immunity and a motion for 
summary judgment based on that plea.  The trial court held that 
Dr. Bourgeois was entitled to sovereign immunity and dismissed 
Dr. Bourgeois from the case with prejudice.  Dr. Thiagarajah was 
subsequently nonsuited.  We awarded the plaintiff an appeal to 
review the trial court's determination that Dr. Bourgeois was 
entitled to sovereign immunity. 
 
In determining whether a state employee is entitled to 
sovereign immunity in an action alleging acts of simple 
negligence, we apply the four-part test set out in James v. Jane, 
221 Va. 43, 267 S.E.2d 108 (1980), and Messina v. Burden, 228 Va. 
301, 321 S.E.2d 657 (1984).  The four factors are:  the nature of 
the function performed by the employee, the extent of the state's 
interest and involvement in that function, the degree of control 
exercised by the state over the employee, and whether the alleged 
negligent act involved the use of judgment and discretion.  Id. 
at 313, 321 S.E.2d at 663. 
 
In this case, the trial court focused its analysis on the 
first two factors, the function of the employee and the state's 
interest in that function.  These two factors have previously 
been addressed in the context of state-employed physicians.  In 
James v. Jane, we determined that three physicians employed by 
the Commonwealth as faculty members at the Medical School of the 
University of Virginia were not entitled to sovereign immunity in 
actions for negligence based on allegations that they failed to 
exercise reasonable care in attending a patient.  221 Va. at 55, 
267 S.E.2d at 114.  The rationale of the decision was two-fold.  
First, the Commonwealth's paramount interest was that the 
University of Virginia operate a good medical school staffed with 
competent professors.  The Commonwealth's interest in quality 
patient care was the same whether that patient was being treated 
in a public teaching hospital or in a private medical 
institution.  Since the actions complained of related to the 
provision of patient care, not the educational function of the 
faculty members, the state's interest was slight.  Second, a 
physician's exercise of professional skill and judgment in 
treating a patient is not subject to the control of the 
Commonwealth.  221 Va. at 54-55, 267 S.E.2d at 114; Lohr v. 
Larsen, 246 Va. 81, 85-86, 431 S.E.2d 642, 644-45 (1993).    
 
Since James v. Jane, we have considered other cases 
involving allegations of negligence against physicians who were 
employed by the Commonwealth.  In Gargiulo v. Ohar, 239 Va. 209, 
387 S.E.2d 787 (1990), a board-certified physician was employed 
by a state hospital as a fellow in a medical research and 
training program run by the hospital.  We held the employee was 
entitled to immunity in an action alleging that she negligently 
treated a patient participating in the research program.  In 
discussing the nature of the employee's function, we concluded 
that the alleged negligent acts were performed by the employee in 
her capacity as a student which was a function "essential to 
achievement of the Commonwealth's goal . . . of training and 
maintaining a pool of specialists skilled in a particular 
discipline."  Id. at 213, 387 S.E.2d at 790.  
 
Subsequently in Lohr, we concluded that a physician treating 
a patient for breast cancer in a public health clinic was 
entitled to sovereign immunity for alleged acts of simple 
negligence.  Analyzing the function of the physician employee and 
the state's interest, we concluded that treating the patient was 
"an essential part of the clinic's delivery of its health care 
services" and that the state had a substantial interest in 
providing quality medical care for citizens in certain areas of 
the state who are economically unable to secure such services 
from the private sector.  246 Va. at 86, 431 S.E.2d at 644-45. 
 
In analyzing the employee's function and the Commonwealth's 
interest and involvement in that function in this case, the trial 
court found that Dr. Bourgeois' function at the time of the 
alleged negligent acts was to be "available for consultation by 
any member of the obstetrical house staff." Because no member of 
the house staff consulted Dr. Bourgeois concerning Lee's 
pregnancy and delivery and he had no other personal contact with 
her, the trial court concluded that Dr. Bourgeois' function was 
that of "a teacher and consultant to residents, as opposed to a 
treating physician administering medical care to patients."  The 
trial court held that in this role Dr. Bourgeois was furthering 
the paramount interest of the University Hospital as set out in 
James v. Jane, that is, operating a good medical school staffed 
with competent professors. 
 
Our review of the record, however, indicates that Dr. 
Bourgeois' function at the time of the alleged negligent acts was 
more than simply being available to consult with residents or 
other members of the obstetrical staff.  In his role as attending 
physician, his primary function related to the treatment of 
patients and is analogous to that of Dr. Hakala, the attending 
physician in James v. Jane.  We conclude that Dr. Bourgeois, like 
Dr. Hakala, is not entitled to sovereign immunity under the 
circumstances of this case.  
 
The physicians at the University Hospital are divided into 
two categories.  The "house staff" category includes interns, 
residents, and fellows.  The house staff does not have hospital 
admitting privileges.  The "medical staff" category is comprised 
of fully-licensed physicians who have completed their training 
and are full-time faculty members in the Department of the School 
of Medicine.  The medical staff supervises the house staff.   
 
The University Hospital requires that all patients in the 
hospital be assigned an attending physician who is a member of 
the medical staff.  The attending physician is responsible for 
determining a treatment plan for the patient and for making 
decisions regarding the medical care of the patient.  The 
attending physician is also responsible for supervising the 
patient care administered by the house staff.  The house staff 
may not undertake certain procedures, such as performing a 
delivery by cesarean section, without consulting the attending 
physician. 
 
If the attending physician for a patient goes off duty, 
another member of the medical staff of the hospital must be 
designated as the attending physician for that patient.  The 
subsequent attending physician has the same responsibilities 
regarding the medical care of the patient as the previous 
attending physician.
*
 
In this case, Lee arrived at the emergency room with 
pregnancy complications.  Dr. Allen Hogge admitted her to the 
high risk pregnancy service and later Dr. Thiagarajah became her 
attending physician.  Both Dr. Hogge and Dr. Thiagarajah were 
members of the medical staff and the Maternal Fetal Medicine 
division of the Department of Obstetrics and Gynecology at the 
University Medical School.  Dr. Thiagarajah devised a treatment 
                     
 
*The trial court and Dr. Bourgeois refer to the doctor's 
role as an "on call attending" or an "on call faculty member." 
 These terms are not defined in the record and the record 
speaks only of an "attending physician" in terms of the 
requirements for patient care. 
management plan for Lee.  Dr. Thiagarajah and various interns and 
residents, under Dr. Thiagarajah's supervision and direction, 
attended to the care of Lee. 
 
On September 27th, Dr. Bourgeois became the attending 
physician for Dr. Thiagarajah's patients.  As part of the 
transfer of patients from one attending physician to another, Dr. 
Thiagarajah reviewed the condition and status of his patients 
with Dr. Bourgeois.  According to Dr. Bourgeois, the patients 
were not identified by name, but their conditions were summarized 
in general categories.  In accepting this assignment as attending 
physician, Dr. Bourgeois testified that he assumed the same 
responsibilities for Lee's care as those borne by Dr. 
Thiagarajah.  He acknowledged that, as attending physician, he 
became responsible for making the final decisions on Lee's care. 
 He could examine Lee, review her chart, change Dr. Thiagarajah's 
treatment plan, and alter instructions to the residents regarding 
notification of labor or the method of delivery.  As attending 
physician, Dr. Bourgeois was also obligated to respond to 
inquires from the residents regarding the care of the patients. 
 
As the trial court noted, the role of the attending 
physician includes teaching responsibilities, particularly when 
responding to questions raised by residents or other members of 
the house staff.  However, the hospital policy requiring an 
attending physician for each patient at all times is not 
primarily directed to the goal of good teaching practices, but to 
insuring that patients receive competent care.  Furthermore, the 
General Assembly has required that all persons in the category of 
house staff be responsible and accountable to a licensed member 
of the hospital staff.  Code §§ 54.1-2960, -2961.  The care of 
the patient could not be, and was not, left solely to the house 
staff.  Thus, the function of Dr. Bourgeois as attending 
physician was directly related to assuring that the patient, in 
this case Lee, received the proper care, whether delivered 
directly by him or indirectly through a member of the house 
staff.  
 
 The trial court and Dr. Bourgeois put significant emphasis 
on the fact that Dr. Bourgeois did not engage in any direct 
treatment of Lee and was not consulted by a member of the house 
staff regarding her treatment.  The argument that the absence of 
action by the attending physician or the failure of a resident to 
call on the attending physician makes the attending physician's 
function solely a teaching function is not persuasive.  Dr. 
Bourgeois accepted Lee as a patient for whose care he was 
responsible when he agreed to replace Dr. Thiagarajah as Lee's 
attending physician.  Dr. Bourgeois used his professional medical 
judgment when he determined that the medical treatment plan 
devised for Lee by Dr. Thiagarajah was proper and would remain in 
place during Dr. Bourgeois' time as attending physician.  As 
noted above, Dr. Bourgeois also used his professional judgment 
regarding Lee's treatment when he decided that he did not need to 
examine her or her charts or engage in any other clinical 
evaluation of her at the time he became her attending physician. 
 The responsibility of an attending physician and the decisions 
incumbent upon one in that position are directly aimed at 
insuring quality care for the patient.  While the acts which Dr. 
Bourgeois did, or did not do, may be relevant to issues of 
liability, his acts or omissions are not dispositive on the issue 
of sovereign immunity in this case. 
 
The only difference between Dr. Bourgeois and Dr. Hakala, an 
attending physician in James v. Jane, is that Dr. Hakala was 
consulted as to the need for surgery and was present in the room 
while the surgery was performed by another.  221 Va. at 49, 267 
S.E.2d at 111.  Dr. Hakala did not render any direct treatment to 
the patient.  Nevertheless, we held he was not entitled to 
sovereign immunity because the alleged acts of negligence 
occurred as part of patient care, not as part of maintaining a 
good medical school, and the acts involved the exercise of 
professional medical judgment, a function beyond the control of 
the Commonwealth.  Id. at 54-55, 267 S.E.2d at 114. 
 
Because we find that Dr. Bourgeois' function as an attending 
physician in this case was related to patient care and that acts 
taken regarding patient care are within the professional medical 
judgment of the physician, we conclude that the state's interest 
and degree of involvement are slight.  Id.  Therefore, Dr. 
Bourgeois is not entitled to sovereign immunity for the alleged 
negligent acts raised in this action.   
 
Accordingly, the judgment of the trial court will be 
reversed and the case remanded for further proceedings. 
 
Reversed and remanded.