Opinion ID: 2514019
Heading Depth: 1
Heading Rank: 1

Heading: summary judgment in favor of gilmartin

Text: Irvin argues that the district court erred in granting summary judgment in favor of Gilmartin by holding that no physician-patient relationship existed between Gilmartin and Irvin. Summary judgment is appropriate when the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law. The trial court is required to resolve all facts and inferences which may reasonably be drawn from the evidence in favor of the party against whom the ruling is sought. When opposing a motion for summary judgment, an adverse party must come forward with evidence to establish a dispute as to a material fact. In order to preclude summary judgment, the facts subject to the dispute must be material to the conclusive issues in the case. On appeal, we apply the same rules, and where we find reasonable minds could differ as to the conclusions drawn from the evidence, summary judgment must be denied. Bergstrom v. Noah, 266 Kan. 847, 871-72, 974 P.2d 531 (1999). Prior to trial, Gilmartin moved for summary judgment, arguing that he owed no duty to Irvin because he had no physician-patient relationship with her. The district court agreed and granted the motion, stating: As to Mr. Day's Motion for Summary Judgment, my first reaction in this case is to offer the question as to whether or not a physician/patient relationship existed to the jury as a fact question; certainly [that] is the easiest thing to do. However, it is clear that the courts may and should decide under a number of different fact scenarios on a motion for summary judgment whether or not a physician/patient relationship exists, specifically whether or not such a relationship exists for a consulted physician. Now, I'm most concerned with the fact there is an obvious lack of Kansas law on this particular issue. I am willing to look to other jurisdictions for guidance, and I have done as much of my own research as I can also on the matter. It seems to me that while the scenarios can vary as to the facts involved and the facts looked at by appellate courts, those cases concerning the existence of a physician/patient relationship look to some facts other than the phone conversation itself, in that there is a contract, the doctor was on call, the doctor offered or gave direction for immediate medical care and treatment that he anticipated would be accepted and was accepted. Did offering to provideor, I guess, agreeing to provide a further physical exam in the morning and conducting a shuntogram create that further fact that would give rise to a physician/patient relationship on the evening of November 14th? My interpretation of all the prior case law that has been presented in this case directs me in this case that the relationship did not exist until the 15th. The Motion for Summary Judgment is granted. The plaintiff in a medical malpractice case bears the burden of proof in establishing the elements of the negligence claim. The existence of the duty of care is dependent on the existence of a physician-patient relationship. See Reynolds v. Decatur Memorial Hosp., 277 Ill. App.3d 80, 85, 660 N.E.2d 235 (1996) (duty of physician is limited to situations where there is a physician-patient relationship); Doherty v. Hellman, 406 Mass. 330, 333, 547 N.E.2d 931 (1989) (plaintiff has the burden to demonstrate existence of physician-patient relationship in order to prove medical malpractice claim); Millard v. Corrado, 14 S.W.3d 42, 49 (Mo. App. 1999) (physician-patient relationship is essential to medical malpractice claim); McKinney v. Schlatter, 118 Ohio App.3d 328, 332-37, 692 N.E.2d 1045 (1997) (cannot find that physician breached duty where no physician-patient relationship exists); St. John v. Pope, 901 S.W.2d 420, 423 (Tex. 1995) (physician cannot be liable for malpractice where there is no physician-patient relationship). Courts have concluded, as has this court, that whether a physician-patient relationship exists is generally a question of fact for the jury. See Rule v. Cheesman, Executrix, 181 Kan. 957, 964-65, 317 P.2d 472 (1957). See also Dodd-Anderson v. Stevens, 905 F. Supp. 937, 944 (D. Kan. 1995), affd 107 F.3d 20 (10th Cir. 1997) (in Kansas, following the Rule case, the existence of a physician-patient relationship is a question of fact); Walker v. Jack Eckerd Corp., 209 Ga. App. 517, 524, 434 S.E.2d 63 (1993) (existence of physician-patient relationship is question of fact for jury); Gallion v. Woytassek, 244 Neb. 15, 20, 504 N.W.2d 76 (1993) (purview of jury to determine whether physician-patient relationship exists); Cogswell v. Chapman, 249 App. Div.2d 865, 866, 672 N.Y.S.2d 460 (1998) (it is generally a question of fact for the jury whether an implied physician-patient relationship exists); Tumblin v. Ball-Incon Glass Packaging, 324 S.C. 359, 365, 478 S.E.2d 81 (Ct. App. 1996) (existence of physician-patient relationship is question of fact for the jury); Lyons v. Grether, 218 Va. 630, 633, 239 S.E.2d 103 (1977) (physician-patient relationship is a question of fact). A physician-patient relationship may be found and summary judgment may be considered, however, where the facts are shown by such clear, palpable, and undisputed evidence that the jury could reasonably draw but one conclusion. Walker, 209 Ga. App. at 524. Generally, a physician-patient relationship is created only where the physician personally examines the patient. Millard, 14 S.W.3d at 49. A physician's indirect contact with a patient, however, does not preclude the finding of a physician-patient relationship. Adams v. Via Christi Regional Med. Center, 270 Kan. 824, 835, 19 P.3d 132 (2001). See also McKinney, 118 Ohio App.3d at 336 (lack of direct contact between physician and patient does not preclude the finding of a physician-patient relationship); Cogswell, 249 App. Div.2d at 866 (physician-patient relationship can be established by a telephone call to physician); Millard, 14 S.W.3d at 49 (physician-patient relationship may be found even in the absence of contact between the physician and patient); St. John, 901 S.W.2d at 424 (physician-patient relationship does not require a formal contract and may be implied by the circumstances). A physician-patient relationship may be found where a physician is contacted by someone on behalf of the patient. Reynolds, 277 Ill. App.3d at 85. Indeed, an implied physician-patient relationship may be found where the physician gives advice to a patient by communicating the advice through another health care professional. Campbell v. Haber, 274 App. Div.2d 946, 946-47, 710 N.Y.S.2d 495 (2000). A physician who gives an informal opinion, however, at the request of a treating physician, does not owe a duty to the patient because no physician-patient relationship is created. See Oliver v. Brock, 342 So.2d 1, 4 (Ala. 1976) (no physician-patient relationship found where physician never met with patient, did not even know the patient's name, and merely conversed with treating physician on gratuitous basis); Hill v. Kokosky, 186 Mich. App. 300, 304, 463 N.W.2d 265 (1990) (opinion directed at treating physician to do with as he saw fit does not create physician-patient relationship); Reynolds, 277 Ill. App.3d at 85 (informal opinion from consulting physician at request of treating physician does not create physician-patient relationship); Lopez v. Aziz, 852 S.W.2d 303, 306 (Tex. Civ. App. 1993) (physician cannot be liable where he or she merely consulted with treating physician and nothing more). A physician who assumes the role of treating the patient, however, can be liable for medical malpractice. Tumblin, 324 S.C. at 365; Wheeler v. Yettie Kersting Memorial Hosp., 866 S.W.2d 32, 39-40 (Tex. Civ. App. 1993). In Adams, we recently discussed the foundational requirements for the existence of a physician-patient relationship, stating: A physician-patient relationship is consensual. Thus, where there is no ongoing physician-patient relationship, the physician's express or implied consent to advise or treat the patient is required for the relationship to come into being. Stated otherwise, the doctor must take some affirmative action with regard to treatment of a patient in order for the relationship to be established. 270 Kan. at 835. See also Reynolds, 277 Ill. App.3d at 85 (relationship between physician and patient is consensual and is founded in trust and confidence); Millard, 14 S.W.3d at 49 (relationship is consensual and exists where the patient or someone acting on his or her behalf employs a physician who consents to treat the patient); Tracy v. Merrell Dow Pharmaceuticals, 58 Ohio St.3d 147, 150, 569 N.E.2d 875 (1991) (physician-patient relationship is consensual and may be either implied or an express relationship); Tumblin, 324 S.C. at 365 (physician-patient relationship may be established when patient seeks assistance of physician and physician accepts patient). In the present case, Irvin argues that the undisputed facts show that there was a physician-patient relationship between Gilmartin and Irvin and that the district court erred in granting summary judgment in favor of Gilmartin. The facts, Irvin argues, show that Gilmartin received a lengthy telephone call from Smith during which they engaged in a detailed conversation about the condition, care, and treatment of Irvin. Gilmartin was called because of his experience and expertise as a pediatric neurologist. Gilmartin was not an employee of the hospital and was not on call the night he received the phone call from Smith. As a result of the conversation, Gilmartin testified he had a complete picture of Ashley Irvin's presentation and that he had surmised that Irvin's condition was stable. Gilmartin further testified that he and Smith jointly developed a plan for the evaluation of Ashley Irvin and that he assumed primary responsibility for performing the shuntogram tests the next day. Before receiving a call from Smith on November 14, 1995, Gilmartin had never had contact with Irvin or her family and had no involvement of any kind in her medical care. Clearly up to that point, there was no physician-patient relationship. Gilmartin was not on call on November 14, 1995, and was subject to no contractual obligation which would require him to attend any patients at Wesley. During the evening of November 14, 1995, Smith called Gilmartin and asked him to perform a consultation on Irvin. The working diagnosis at the time was new onset seizure disorder, with concern over possible shunt malfunction. The two doctors discussed the case and it was agreed that Gilmartin would see the patient the next morning, carry out a formal consultation, and assist in conducting the diagnostic test known as a shuntogram. Gilmartin's position is that he had no duty as a physician until he assumed a physician-patient relationship with Irvin on the morning of November 15, 1995. Without a legal duty, there can be no compensable negligence. Whether a physician owes a legal duty to a patient under a particular circumstance is a question of law. It is not a question of fact or of negligence. Absent the existence of a physician-patient relationship, there can be no liability for medical malpractice. The mere act of a physician agreeing to see a patient at a later time does not begin the relationship. Nor does the fact that a plaintiff produces an expert witness who will testify that a particular act or omission constitutes a departure from the standard of care establish that a duty exists as a matter of law. See, e.g., Calwell v. Hassan, 260 Kan. 769, 925 P.2d 422 (1996). Actionable negligence must be based upon breach of duty. Honey cutt v. City of Wichita, 251 Kan. 451, 463, 836 P.2d 1128 (1992); Hackler v. U.S.D. No. 500, 245 Kan. 295, 297, 777 P.2d 839 (1989). Whether a legal duty exists is a question of law. Calwell, 260 Kan. at 777; Boulanger v. Pol, 258 Kan. 289, 298, 900 P.2d 823 (1995). See Dodd-Anderson, 905 F. Supp. at 945-46. Whether the duty has been breached becomes a question of fact for the jury. However, when the controlling facts are not at issue, the question becomes one for the court. Without a duty, there can be no breach. See Calwell, 260 Kan. at 777-78, 789. Here, the sole involvement of Gilmartin was as a private practitioner who had been asked to carry out a consultation the following day. The formal consultation refers to a full bedside review of the case which includes a physical examination of the patient. At the time Gilmartin spoke with Smith, Gilmartin had not examined Irvin, had not reviewed her hospital chart, and had never spoken with either her or her parents. The only information he had was what he had been told by Smith. There is no claim that Gilmartin entered any orders in the case or took any other action other than discussing the case in general terms with Smith and agreeing to consult the next day. This, by itself, does not create a physician-patient relationship. This case, to a large extent, boils down to public policy concerns. The type of telephone conversation that took place here takes place on a frequent basis in the medical profession and is vital to the treatment of patients. For the courts to discourage such conversations is not to the patients' or the public's best interests.