Opinion ID: 1132559
Heading Depth: 2
Heading Rank: 1

Heading: The Miller Test.

Text: ¶ 38. In Miller v. Meeks, 762 So.2d 302 (Miss.2000), this Court attempted to resolve a dilemma that has plagued the courts, namely, whether faculty-physicians at UMMC were employees or independent contractors when treating patients at the UMMC. This Court concluded that the previous test this Court employed, from Richardson v. APAC-Miss. Inc., 631 So.2d 143, 150 (Miss.1994), proved to be quite troublesome in evaluating the relationship between the University and its faculty-physicians. In Miller we adopted the following five-part test to be applied in making that determination:
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; 4. Whether the act complained of involved the use of judgment and discretion; 5. Whether the physician receives compensation either directly or indirectly, from the patient for professional services rendered. Miller, 762 So.2d at 310. In Miller, we reversed the grant of summary judgment in favor of the faculty-physician and remanded because there were triable issues of fact. Id. at 311. We did not decide whether the faculty-physician was a state employee at the time of the injury, but instead, left that determination for the trial court on remand, applying the newly adopted test. Id. In that case, the faculty-physician was not involved in any instruction while treating the patient, and there was no discussion whether or not the patient was covered by Medicaid, or directly or indirectly paid the doctor. Subsequent cases applying the Miller test have failed to resolve the faculty-physician issue and have left this Court deeply divided. ¶ 39. The first case applying the Miller test was Sullivan v. Washington, 768 So.2d 881 (Miss.2000), decided only two months later. In Sullivan, the plaintiffs were able to survive summary judgment and won a jury verdict award against the physicians. Id. at 882. On appeal, we reversed and rendered, holding that the physicians were employees of UMMC, and thus were personally immune from liability pursuant to the MTCA. Id. at 886. In Sullivan, we noted that the patient was covered under Medicaid and did not choose any particular doctor. Id. at 884. This fact was important in all but the fourth prong of the Miller test. Id. at 884-86. Another important factor was that the faculty-physician had merely supervised the resident-physician who actually assisted in the operation. Id. This fact was similarly important in all but the fourth prong of the Miller test. Id. Other important factors were that UMMC exercised a certain degree of control over the two physicians, there was no private-patient relationship established, and neither physician received payment from the patient. Id. ¶ 40. The next case was Smith v. Braden, 765 So.2d 546 (Miss.2000), decided on August 24, 2000, one week after Sullivan. Just as this Court had done in Miller, we reversed a grant of summary judgment in favor of the physician because there might remain a triable issue of material fact. Id. at 556-57. We concluded that the record before us made it impossible to fully and meaningfully apply the Miller test, and we remanded with instructions that the trial court do so. Id. ¶ 41. Four months after Braden, this Court decided Carter v. Harkey, 774 So.2d 392 (Miss.2000). As this Court had done in Miller and Braden, we reversed a grant of summary judgment in favor of the physician because there might remain triable issues of material fact. Id, at 396. We further noted that the trial court did not have the benefit of Miller when trying to determine whether the physician was an employee, protected under the MTCA, so on remand we instructed the trial court to reconsider its findings, based on the Miller factors. Id. We further noted that Miller and Braden were factually distinguishable from Sullivan in two ways. Id. First, in Miller and Braden the faculty-physicians actually performed the surgery themselves, while in Sullivan the faculty-physician only supervised. Id. Second, in Miller and Braden the faculty-physicians were in some way compensated for the surgery, while in Sullivan the faculty physician received no payment from the Medicaid patient. Id. Carter further presented a slightly different wrinkle in that the faculty-physician actually performed the surgery at Mississippi Methodist Rehabilitation Center, which had an affiliation agreement with UMMC whereby UMC faculty-physicians may be called upon to consult and operate upon patients admitted to MMRC for the purposes of providing medical care, teaching, and service. Id. at 394. We did not say whether this fact was important. ¶ 42. Next this Court decided Knight v. McKee, 781 So.2d 121 (Miss.2001). In Knight, we affirmed the circuit court's granting of summary judgment in favor of the faculty-physician and the resident-physician. Id. at 122. We held that resident physicians at UMMC are, as a matter of law, state employees for purposes of the MTCA. Id. (citing Owens v. Thomae, 759 So.2d 1117, 1122 (Miss.1999); Pickens v. Donaldson, 748 So.2d 684, 689 (Miss. 1999). The faculty-physician was deemed to be an employee as well because at all pertinent times he was employed by UMMC and was acting according to the terms and conditions of his contract. Id. Further, as a full-time employee of UMMC, he had never engaged in the practice of medicine outside the course and scope of his employment. Id. He was a supervising teacher and trainer of residents and did not receive any compensation from any person or entity other than UMMC. Id. Because both physicians were indisputably employees and not independent contractors, we found it unnecessary to apply the Miller test. Id. The real issue on appeal was whether the purchase of professional liability insurance by the physicians in excess of the limits imposed by the MTCA, waived their immunity protection. Id. As was discussed supra in Issue II, we said it did not. Id. ¶ 43. Finally, Conley v. Warren, 797 So.2d 881 (Miss.2001), was handed down last year. [1] In Conley, this Court reversed the circuit court's granting of summary judgment in favor of the UMMC faculty physician, as we had done in Miller, Braden, and Carter, because there were genuine fact issues as to whether the physician was acting as a State employee or private physician at the time of the surgery. Id. at 884. We noted that summary judgment was granted in that case prior to this Court's decision in Miller. Id. at 882. We further noted that Miller and Braden presented the same issue, namely, whether faculty physicians of UMMC who engage in clinical outpatient practice under the general auspices of the University, for which they are compensated, are State employees acting within the course and scope of their employment for purpose of the MTCA. Id. at 883. In Conley, just as in the case sub judice, the faculty-physician was the chief surgeon attending the operation, but was simultaneously teaching the resident-physician who was present. Id. at 882. We once again determined that the record was not sufficiently developed for a full and meaningful application of the Miller factors. Id. at 883. We held that: The trial court is in a better position to adequately examine the facts and issues of this case since it is not limited by the underdeveloped record which is before this Court. Id. ¶ 44. Analyzing the short history of Miller and its progeny, this is where we are. First, in all of these cases, the judgment of the court was entered prior to our decision in Miller. Second, the only time this Court has actually applied the Miller test, factor by factor, is in Sullivan. In Knight, we did not apply the Miller test because it was inapplicable, since the faculty-physician was paid solely by the State. In Miller, Braden, Carter, and Conley, we reversed summary judgment in favor of the faculty-physicians, finding it premature because there might remain triable issues of material fact. Third, in Sullivan, we applied the Miller test and concluded that the faculty-physician was a State employee. Fourth, the last time we addressed this issue, we stated that the faculty-physician is not protected by the MTCA if he acted as an independent contractor in the treatment of his patient. Conley, 797 So.2d at 883. Fifth and finally, while we have only applied the Miller factors once in a case before us, we have yet to review a circuit court's application of the factors. ¶ 45. In sum, this is the current state of the law. If the record is not sufficiently developed to determine the employment status of the faculty-physician, this Court will reverse and remand so the trial court can apply the Miller test, unrestricted by the limited record before us on appeal. However, as in Knight, if the faculty-physician is paid solely by the State, is at all times acting in accordance with his contract, and never acted outside the course and scope of his employment, the faculty-physician is an employee. Or if the same facts exist, as existed in Sullivan, the faculty-physician is an employee. In the case sub judice, we can affirmatively hold that Dr. Tsang was at all times an employee of the State, relying either on our decision in Sullivan or in Knight. ¶ 46. In Sullivan, we applied the Miller test and determined the faculty-physician was a state employee because of the following facts: (1) the faculty-physician was only supervising, not actually performing the operation; (2) the patient was covered by Medicaid; (3) the patient did not choose any particular doctor; (4) there was no private-patient relationship established; (5) UMMC exercised a certain degree of control over the faculty-physician; and (6) the faculty-physician did not receive payment from the patient. ¶ 47. In the case before us, Dr. Tsang was teaching and supervising Dr. Long, a fellow in training, and not actually performing the operation. Watts was covered by Medicaid. Watts did not choose Dr. Tsang to be his physician. There was no private-patient relationship established between Watts and Dr. Tsang. At all time Dr. Tsang was under the control of UMMC by contract and could work only at UMMC or affiliated sites. Dr. Tsang did not receive payment from Watts. In fact, pursuant to the point system for compensation used for distributing patient revenues from UMMC, Dr. Tsang received a certain amount of points for supervising the procedure. He received those points regardless of whether Watts paid in full, Medicaid paid, or no one paid. Thus, under Sullivan, Dr. Tsang is a state employee. ¶ 48. In Knight, the faculty-physician was deemed to be an employee as well because at all pertinent times he was employed by UMMC and was acting according to the terms and conditions of his contract. Further, as a full-time employee of UMMC, he had never engaged in the practice of medicine outside the course and scope of his employment. He was a supervising teacher and trainer of residents and did not receive any compensation from any person or entity other than UMMC. ¶ 49. In the case before us, Dr. Tsang was at all pertinent times employed by UMMC and acting according to the terms and conditions of his contract. Dr. Tsang was a full-time faculty member at UMMC and had never engaged in the practice of medicine outside the course and scope of his employment. Dr. Tsang was a supervising teacher and trainer of residents (interns and fellows as well) and did not receive compensation from any person or entity other than a State entity. In Knight, we determined that the faculty physician was indisputably an employee; thus, the application of the Miller test was unnecessary. We here likewise determine that Dr. Tsang was a state employee.