Opinion ID: 1608738
Heading Depth: 1
Heading Rank: 8

Heading: Correct Statement of Law and Warranted by the Evidence

Text: Whether a legal duty exists for actionable negligence is a question of law dependent on the facts in a particular case. Fu, supra ; Sharkey, supra . This court has previously held that in certain circumstances, the ultimate responsibility for the performance of duties owed by a physician to his or her patient is nondelegable. Hawkes v. Lewis, 252 Neb. 178, 560 N.W.2d 844 (1997); Long v. Hacker, 246 Neb. 547, 520 N.W.2d 195 (1994); Swierczek v. Lynch, 237 Neb. 469, 466 N.W.2d 512 (1991). In Hawkes, supra, this court held that the surgeon in charge of performing an abdominal hysterectomy owed a nondelegable duty to his patient to properly `pack away' the patient's small intestine during the surgery so as to avoid damage to surrounding organs. 252 Neb. at 179, 181, 560 N.W.2d at 846-47. In Swierczek, supra, this court held that the `surgeon in charge' while an operation was in progress had a nondelegable duty to ensure the safety of his patient while she was in the operating room having her teeth removed. 237 Neb. at 479, 466 N.W.2d at 518. See, also, Burns v. Metz, 245 Neb. 428, 513 N.W.2d 505 (1994) (noting that principal surgeon performing breast reduction surgery had nondelegable duty to properly close surgical incisions). Long, supra, involved a surgeon who, in reliance on a radiologist's misinterpretation of a spinal X ray, operated on the wrong vertebrae of his patient's spine. In the ensuing medical malpractice action brought by the patient against the surgeon, the surgeon contended that he acted within the prevailing standard of care by relying on the radiologist's x-ray interpretation to localize the operative site of his patient. This court found no merit in the surgeon's contention. We relied on our prior decisions in medical malpractice cases as authority for the rule that a head surgeon is ultimately liable for the negligent acts or omissions of others who are assisting in the surgery. Id. at 555, 520 N.W.2d at 201. Accordingly, we held that the ultimate responsibility for identifying the operative site of his patient could not be delegated by the surgeon to the radiologist. The nondelegable duty rule evolved as an exception to the general rule that an employer of an independent contractor is not liable for physical harm caused to another by an act or omission of the contractor or his servants. Erickson v. Monarch Indus., 216 Neb. 875, 347 N.W.2d 99 (1984); Sullivan v. Geo. A. Hormel and Co., 208 Neb. 262, 303 N.W.2d 476 (1981); Restatement (Second) of Torts § 409 (1965). See, also, Kleeman v. Rheingold, 81 N.Y.2d 270, 614 N.E.2d 712, 598 N.Y.S.2d 149 (1993); Saiz v. Belen School Dist., 113 N.M. 387, 393, 827 P.2d 102, 108 (1992) (noting that [t]he absence of a right of control over the manner in which the work is to be done is the most commonly accepted criterion for distinguishing independent contractors from employees whose negligence the employer is vicariously liable). Whether a duty is nondelegable is a question of law. Saiz, supra; Summers v. A.L. Gilbert Co., 69 Cal.App.4th 1155, 82 Cal.Rptr.2d 162 (1999). There is no set formula for determining when a duty is nondelegable. Indeed, whether a particular duty is properly categorized as `nondelegable' necessarily entails a sui generis inquiry, since the conclusion ultimately rests on policy considerations. Kleeman, 81 N.Y.2d at 275, 614 N.E.2d at 715, 598 N.Y.S.2d at 152. See, also, Restatement, supra, Introductory Note for §§ 416 to 429. As stated by the Michigan Supreme Court in Funk v. General Motors Corp., 392 Mich. 91, 101-02, 220 N.W.2d 641, 645 (1974), reversed on other grounds, Hardy v. Monsanto Enviro-Chem, 414 Mich. 29, 323 N.W.2d 270 (1982), which was cited with approval in Erickson, supra : Inevitably it becomes a matter of judgment, case by case, where to draw the line between so-called delegable and nondelegable tasks and duties. In a given case, the policy question facing a court (the law of torts is largely judge-made) is whether on the facts presented the public interest warrants imposition upon a person who has delegated a task the duty to guard against risks implicit in the performance of the task. Courts have often deemed a duty to be nondelegable when `the responsibility is so important to the community that the employer should not be permitted to transfer it to another.' Feliberty v. Damon, 72 N.Y.2d 112, 119, 527 N.E.2d 261, 264, 531 N.Y.S.2d 778, 781 (1988) (quoting W. Page Keeton et al., Prosser and Keeton on the Law of Torts § 71 (5th ed.1984)). See, also, Restatement, supra, §§ 417 and 418; Hammond v. The Nebraska Nat. Gas Co., 204 Neb. 80, 281 N.W.2d 520 (1979) (holding that duty natural gas utility owed to public to install safe natural gas pipelines was nondelegable). The exception for nondelegable duties requires the person upon whom it is imposed to answer for it that care is exercised by anyone, even though he be an independent contractor, to whom the performance of the duty is entrusted. Restatement, supra, Introductory Note for §§ 416 to 429 at 394. This court has explained that a nondelegable duty `means that an employer of an independent contractor ... by assigning work consequent to a duty, is not relieved from liability arising from the delegated duties negligently performed. [Citation omitted.] As a result of a nondelegable duty, the responsibility or ultimate liability for proper performance of a duty cannot be delegated, although actual performance of the task required by a nondelegable duty may be done by another.' Long v. Hacker, 246 Neb. 547, 555, 520 N.W.2d 195, 201 (1994) (quoting Swierczek v. Lynch, 237 Neb. 469, 466 N.W.2d 512 (1991), and Foltz v. Northwestern Bell Tel. Co., 221 Neb. 201, 376 N.W.2d 301 (1985)). Thus, the person owing a nondelegable duty is not excused from taking the necessary precautions by contracting with or relying on others to take necessary precautionary measures. Hickman v. Parks Construction Co., 162 Neb. 461, 470, 76 N.W.2d 403, 410 (1956). While this court has previously determined that duties owed by the principal surgeon are nondelegable, it has not had occasion to determine whether duties owed by an anesthesiologist are nondelegable. However, the rationale behind nondelegable duties does not limit their application to principal surgeons, since the determination of whether a particular duty is nondelegable is a question of law which ultimately rests on policy considerations. Kleeman v. Rheingold, 81 N.Y.2d 270, 614 N.E.2d 712, 598 N.Y.S.2d 149 (1993); Saiz v. Belen School Dist., 113 N.M. 387, 827 P.2d 102 (1992); Summers v. A.L. Gilbert Co., 69 Cal.App.4th 1155, 82 Cal.Rptr.2d 162 (1999). This court has stated that the risk reasonably to be perceived defines the duty to be obeyed. Knoll v. Board of Regents, 258 Neb. 1, 601 N.W.2d 757 (1999). The experts in this case would appear to agree that significant symptoms which put one's patient at risk should be known by the anesthesiologist prior to commencing anesthesia. The disagreement lies in the acceptable manner in which such information is made known to the anesthesiologist. Given the inherent risks of anesthesia, it is reasonable for a patient to assume that medical information significant to a determination of whether the patient can be safely anesthetized will be known by the anesthesiologist before the patient receives anesthesia. Under established principles, the client's reasonable expectations and beliefs about who will render a particular service are a significant factor in identifying duties that should be deemed to be `nondelegable.' Kleeman, 81 N.Y.2d at 276, 614 N.E.2d at 716, 598 N.Y.S.2d at 153. Accord Restatement (Second) of Torts § 429 (1965). We therefore determine that because a patient can sustain severe injuries and even death if anesthesia is not administered properly, public interest warrants the imposition of a nondelegable duty upon an anesthesiologist to be aware of reasonably available medical information significant to the health of his or her patient prior to administering anesthesia. Kleeman, supra; Feliberty v. Damon, 72 N.Y.2d 112, 527 N.E.2d 261, 531 N.Y.S.2d 778 (1988); Funk v. General Motors Corp., 392 Mich. 91, 220 N.W.2d 641 (1974). Such duty is an integral part of the care the anesthesiologist delivers, and he or she should not be able to avoid the responsibility for the proper performance of such duty by delegating it to others. The appropriate standard of care in a medical malpractice action is a question of fact. See Burns v. Metz, 245 Neb. 428, 513 N.W.2d 505 (1994). If, on retrial, the standard of care is ultimately found to be one which delegates to others the responsibility for reporting to the anesthesiologist reasonably available medical information significant to the health of the patient, the anesthesiologist is not relieved from liability if the finder of fact determines the delegated duties were performed negligently. Long v. Hacker, 246 Neb. 547, 520 N.W.2d 195 (1994). Tendered jury instruction No. 12A is both a correct statement of the law and warranted by the evidence. In essence, the tendered instruction informed the jury that an anesthesiologist who delegates to others the responsibility for reporting to him or her reasonably available medical information significant to the health of the patient prior to the patient's undergoing anesthesia is not relieved from liability if the delegated responsibility is done negligently.