Opinion ID: 1058706
Heading Depth: 1
Heading Rank: 6

Heading: determining existence of physician-patient relationship

Text: Under the few Tennessee cases discussing the subject, [t]he [physician-patient] relationship is generally characterized as a contractual one in which the patient knowingly and voluntarily seeks the professional assistance of the physician, and the physician knowingly agrees to treat the patient. Church, 39 S.W.3d at 164 (citing Jennings v. Case, 10 S.W.3d 625, 628 (Tenn.Ct.App.1999) and Osborne, 425 S.W.2d at 771). The relationship may either be express or implied. Jennings, 10 S.W.3d at 628. A face-to-face meeting between the physician and patient is not required, and a physician-patient relationship therefore may arise out of a consultation by the patient's primary physician with another physician when that consultation is for the treatment of the patient. Bass, 671 S.W.2d at 487. While the Tennessee cases cited above mention that the physician-patient relationship is a contractual one, it is clear that the question of whether a physician-patient relationship arises (for purposes of a medical malpractice action) is not governed solely by the law of contracts. [10] As Bass suggests, the physician-patient relationship can arise in situations in which a contract might not be found to exist under a strict application of contract principles. Our review of cases from other jurisdictions supports that conclusion. In most jurisdictions in which the issue has been addressed, courts continue to require the plaintiff in a medical malpractice case to prove the existence of a physician-patient relationship, but most courts also state that such a relationship is implied if the physician affirmatively undertakes to diagnose and/or to treat the plaintiff. See, e.g., Oliver v. Brock, 342 So.2d 1, 3-4 (Ala.1976) (quoting 61 Am.Jur.2d, Physicians, Surgeons, and Other Healers § 96 [11] and stating, `the voluntary acceptance of the physician-patient relationship by the affected parties creates a prima facie presumption of a contractual relationship between them. A physician may accept a patient and thereby incur the consequent duties although his services are performed gratuitously or at the solicitation and on the guaranty of a third person. . . .'); Bovara v. St. Francis Hosp., 298 Ill.App.3d 1025, 700 N.E.2d 143, 146, 233 Ill. Dec. 42 (1998) (stating, A consensual relationship can be found to exist where a physician contacts another physician on behalf of the patient or where a physician accepts a referral of a patient; the reasoning is that the consent of the patient to the service provided by the second physician is implied. (internal citations omitted)); Walters v. Rinker, 520 N.E.2d 468, 472 (Ind.Ct.App.1988) (stating, The important fact in determining whether the relationship is a consensual one, however, is not who contracted for the service but whether it was contracted for with the express or implied consent of the patient or for his benefit. . . . Where . . . healthcare services are rendered on behalf of the patient, and are done for the patient's benefit, a consensual physician-patient relationship exists for the purposes of medical malpractice.); Irvin v. Smith, 272 Kan. 112, 31 P.3d 934, 941 (2001) (A physician's indirect contact with a patient . . . does not preclude the finding of a physician-patient relationship. A physician-patient relationship may be found where a physician is contacted by someone on behalf of the patient. 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. (internal citations omitted)); Sterling v. Johns Hopkins Hosp., 145 Md.App. 161, 802 A.2d 440, 455 (2002), cert. denied, 371 Md. 264, 808 A.2d 808 (2002) (stating, In the final analysis, we take it as well-settled that a physician-patient relationship may arise by implication where the doctor takes affirmative action to participate in the care and treatment of a patient.); Oja v. Kin, 229 Mich.App. 184, 581 N.W.2d 739, 743 (1998) (stating that merely listening to another physician's description of a patient's problem and offering a professional opinion regarding the proper course of treatment is not enough to create a physician-patient relationship, but a doctor who receives a description of a patient's condition and then essentially directs the course of that patient's treatment, has consented to a physician-patient relationship.); Corbet v. McKinney, 980 S.W.2d 166, 169 (Mo.Ct.App.1998) (stating, The liability of a physician who is consulted on a case by a patient's treating or family physician generally depends on whether the physician undertakes to examine, diagnose, or treat the patient, or merely undertakes to advise the patient's treating physician as to general patient care. Thus, where the question is whether a physician-patient relationship has arisen between another doctor's patient and a physician consulted on the case, we look for these @indicia of consent as well as other evidence of a consensual relation. (internal citation omitted)); Flynn v. Bausch, 238 Neb. 61, 469 N.W.2d 125, 128 (1991) (stating, While the relationship is often described as contractual in nature, based upon the express or implied consent of both physician and patient, we have held that absent fraud or misrepresentation, consent to medical treatment is presumed. (internal citations omitted)); Cogswell by Cogswell v. Chapman, 249 A.D.2d 865, 672 N.Y.S.2d 460, 462 (N.Y.App.Div.1998) (stating, a doctor-patient relationship can be established by a telephone call when such a call `affirmatively advis[es] a prospective patient as to a course of treatment' and it is foreseeable that the patient would rely on the advice. (internal citation omitted)); Lownsbury v. VanBuren, 94 Ohio St.3d 231, 762 N.E.2d 354, 360 (2002) (stating, The basic underlying concept in these cases is that a physician-patient relationship, and thus a duty of care, may arise from whatever circumstances evince the physician's consent to act for the patient's medical benefit.); St. John v. Pope, 901 S.W.2d 420, 424 (Tex.1995) (Creation of the physician-patient relationship does not require the formalities of a contract. The fact that a physician does not deal directly with a patient does not necessarily preclude the existence of a physician-patient relationship.). Two cases are particularly instructive in our consideration of the case under submission. The first case, Campbell v. Haber, 274 A.D.2d 946, 710 N.Y.S.2d 495 (2000), is very similar to the pending case. In Campbell , the plaintiff presented at a hospital emergency room complaining of chest pains. After obtaining test results indicating that the patient might have sustained heart muscle damage, the emergency physician consulted the defendant-cardiologist by telephone. The emergency physician informed the cardiologist of the patient's symptoms and test results. The cardiologist opined that the test results were not consistent with a cardiac event. The emergency physician informed the patient and her husband that he had consulted with a cardiologist, who had opined that the symptoms were not caused by the plaintiff's heart. The emergency physician discharged the patient. [12] Under these facts, and because there was a triable issue of fact whether [the cardiologist] was `on call,' the appellate court affirmed the trial court's denial of the defendant-cardiologist's motion for summary judgment. Id. at 496. A second case, Blazo v. McLaren Reg'l Med. Ctr., 2002 WL 1065710 (Mich.Ct.App. May 28, 2002), appeal denied, 467 Mich. 950, 656 N.W.2d 526 (2003), also is similar to the pending case. [13] In Blazo, the plaintiff, who was pregnant at the time, went into contractions while she was at the hospital for carpal tunnel surgery. A hospital nurse called the office of the plaintiff's obstetrician, but the obstetrician was unavailable. The nurse spoke with another doctor in the office, who was covering for the plaintiff's obstetrician. After the nurse related the plaintiff's condition to the covering physician, the physician told the nurse that there were three options: to transfer the patient to another facility, or to admit her to the hospital overnight, or to discharge her until her pregnancy progressed further. The plaintiff alleged that the covering physician's advice violated the standard of care. [14] Relying on Oja, supra, and Hill v. Kokosky, 186 Mich.App. 300, 463 N.W.2d 265 (1990), the covering physician argued that a physician-patient relationship did not arise. The Michigan Court of Appeals distinguished Hill , stating: the instant case does not involve a treating physician's solicitation of an informal opinion from another physician. Rather, viewing the facts in a light most favorable to plaintiff, a nurse called the patient's treating physician seeking directions for care, and was directed to the doctor who had assumed the responsibility of covering for the treating physician. Blazo, 2002 WL 1065710, . The court also distinguished Oja on factual grounds. The court in Blazo went on to hold that there was evidence that the defendant physician did something, such as participate in the plaintiff's diagnosis and treatment . . . that supports the implication that he consented to the physician-patient relationship. . . . This, coupled with evidence that [the defendant physician] . . . had assumed the responsibility of covering for plaintiff's treating obstetrician, created a question of fact regarding the existence of the physician-patient relationship. Id. In light of the increasing complexity of the health care system, in which patients routinely are diagnosed by pathologists or radiologists or other consulting physicians who might not ever see the patient face-to-face, it is simply unrealistic to apply a narrow definition of the physician-patient relationship in determining whether such a relationship exists for purposes of a medical malpractice case. [15] Based upon the foregoing authorities, we hold that a physician-patient relationship may be implied when a physician affirmatively undertakes to diagnose and/or treat a person, or affirmatively participates in such diagnosis and/or treatment.