Opinion ID: 1613536
Heading Depth: 2
Heading Rank: 2

Heading: whether the grant of summary judgment to dr. madakasira was appropriate.

Text: ¶ 12. As stated previously, Dr. Ali consulted with Dr. Madakasira on his treatment for Jake, and, because Dr. Ali had not yet obtained a DEA number, Dr. Madakasira wrote certain prescriptions for Jake. There is no indication in the record whether Dr. Madakasira was a member of a private medical group within UMMC, as was Dr. Ali. ¶ 13. We have set out a five-part test to follow in determining whether a physician who practices at a public hospital is subject to the MTCA and thereby granted immunity. Miller v. Meeks, 762 So.2d 302 (Miss.2000). A court is to consider: 1. the nature of the function performed by the employee; 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. Id. at 310. ¶ 14. Shortly after adopting the test in Miller, we again addressed the issue in Sullivan v. Washington, 768 So.2d 881, 883-86 (Miss.2000). There, the plaintiff/patient elected to have a tubal ligation. Dr. Sullivan, a resident, was the physician initially scheduled to perform the tubal ligation, and Dr. Meeks was the admitting and attending physician for the surgery. A third physician, however, actually performed the tubal ligation because Dr. Sullivan had been assigned to another part of the hospital at the time of the surgery. At one point in the surgery, Dr. Sullivan came to the surgical suite and assisted for the remainder of the procedure. Over the next few days, the patient developed complications from the surgery, and her conditioned worsened. Dr. Sullivan continued to follow the patient's progress but her condition worsened. Thereafter, the patient brought a medical malpractice action against Dr. Meeks and Dr. Sullivan. Applying the Miller five-part test, we held that the physicians were employees of UMMC and were therefore immune from liability pursuant to MTCA. ¶ 15. The test focuses on the physician-patient relationship, Miller, 762 So.2d at 310, and though the determination of whether MTCA applies is fact sensitive, the question of the applicability of the MTCA is as much a question of law as of fact. Pickens v. Donaldson, 748 So.2d 684, 688-89 (Miss.1999).
¶ 16. In Sullivan, the Court found Dr. Meeks's supervisory role in the surgery to be significant because he did not have a private-patient relationship with the patient, but rather, served a public function by providing care for a Medicaid patient. 768 So.2d at 884. Likewise, Dr. Madakasira argues he held a supervisory role in the psychiatry department at UMMC. When presented with the facts of Bennett's condition, he merely signed off on the prescription because Dr. Ali did not have a DEA number. The only reason that he was involved at all, he argues, was because University procedure required a DEA number. Dr. Madakasira avers: [W]ithout the opportunity to avail himself of the University procedure of presenting the case to him, as his supervisor, Dr. Ali would not have been able to prescribe medication that required a DEA number, and therefore would not have been able to carry out his clinical responsibilities as a member of the psychiatric department and UMMC faculty member. ¶ 17. We find that Dr. Madakasira did not exercise a supervisory role over Dr. Ali, who, unlike Dr. Sullivan, had been practicing medicine for years. Although Dr. Madakasira did not render any direct treatment to Jake, his supervision occurred as a part of patient care, not as part of insuring a reputable medical school. As such, his function was more than simply being available to consult with residents; his primary function was related to the treatment of patients. See Lee v. Bourgeois, 252 Va. 328, 477 S.E.2d 495, 498 (1996).
¶ 18. We observed in Sullivan that the State has a strong interest in maintaining a working hospital along with an educational environment by meeting the needs of both the physicians and the patients. 768 So.2d at 885. As to the patients, UMMC fulfilled its operational purpose under Miss.Code Ann. § 37-115-31 (1996) by providing care to the patient. [3] The State also has an interest in ensuring that physicians have necessary training so that the State has a ready pool of competent physicians. As a resident, Dr. Sullivan had to practice medicine under the guidance of a learned physician such as Dr. Meeks in order to master his profession. ¶ 19. Neither Dr. Madakasira nor Dr. Ali was a resident during the relevant time period. Dr. Ali has been licensed in Mississippi since 1994 and in Louisiana since 1989. The State does not have the any interest in one of its faculty members treating a private patient. As stated previously, there is no mention in the record about whether Dr. Madakasira was associated with a private medical clinic serving patients of UMMC during the relevant period of time. If he is a member of such a group, the private patient clinic is an enterprise designed to allow faculty members to earn additional income and is beyond the scope of duties as a faculty member.
¶ 20. In Sullivan, we found that the direction and control of UMMC over Dr. Meeks was significant. He was the staff physician assigned to the operating room to supervise the physicians performing the surgery, and, other than admitting the patient to the hospital and transferring her care according to regulations, Dr. Meeks took no further interest in the patient and was under no duty to do so. Id. The fact that Dr. Sullivan was obligated to fulfill his residency requirements showed a certain amount of control exercised by UMMC. Dr. Sullivan, as a resident, had little decision-making power over the course of Washington's treatment. Id. Also, importantly, Dr. Meeks and Dr. Sullivan did not choose their patient, and the patient did not choose them. ¶ 21. Likewise, Dr. Madakasira argues that UMMC had significant control and direction over him. Under the dictates of the university's procedure requiring a DEA number, he was required to sign off on the prescription for Jake's treatment but took no further interest in Jake. He did not have a private patient relationship with him. He did not choose Jake as a patient, but was only presented with the case with regard to the prescription. ¶ 22. We take judicial notice of the fact that, as a matter of federal regulation, no physician may prescribe controlled substances without an DEA number, see 21 C.F.R. § 1306.03, so any policy promulgated by UMMC regarding signing off on a prescription would not be dispositive of the issue of whether Dr. Madakasira was supervising Dr. Ali pursuant to UMMC procedures.
¶ 23. This factor is counter-intuitive with regard to any medical treatment in general, and psychiatry particularly. A physician must examine and evaluate a patient. Based on the evaluation, the physician will use his judgment and discretion based on his specialized training in deciding what form of treatment is needed and how the treatment is provided. We observed in Sullivan that virtually every act performed by a person involves the exercise of some discretion. Id. at 884. ¶ 24. Dr. Madakasira contends, however, that, just as Dr. Meeks's supervisory acts involved little judgment and discretion, his involvement with Jake and Dr. Ali was limited exclusively to signing off on the prescription. He contends, Just as Dr. Meeks in the Sullivan case was in the operating room to correct the resident if he saw something he was doing incorrectly, Dr. Madakasira reviewed the prescription written by Dr. Ali to make sure Dr. Ali was doing nothing incorrectly. This assertion may be true, but Dr. Madakasira's supervision did not involve merely rubber stamping a DEA number on Jake's prescription. Following a consultation, the two doctors, in their judgment and discretion, agreed on Jake's medication. It should be noted, however, that the record does not reflect that Dr. Madakasira had any supervisory capacity with respect to Dr. Ali's treatment of private patients.
¶ 25. There is no evidence in the record that Dr. Madakasira was ever compensated for his consultation with Dr. Ali. Dr. Madakasira argues his only compensation for fulfilling his role as a supervisor in the psychiatry department was the salary that he was paid pursuant to his contract with UMMC. Since even Bennett admits that he was not Jake's physician, Dr. Madakasira argues there is no issue as to whether he received compensation from Jake. ¶ 26. With no single factor being dispositive, we find that, based on the record before the court and the forgoing analysis, the majority of the factors do not weigh in favor of finding that Dr. Madakasira was acting as an employee of UMMC during the relevant time period. Sullivan, 768 So.2d at 886 n. 3. Contested status issues invariably require discovery.... While summary judgment may be appropriate where the status issue has been fully fleshed out and there are no material issues of fact, it cannot be said that the status issue in this case has been fully fleshed out. Owens v. Thomae, 759 So.2d 1117, 1122 (Miss.1999). Summary judgment was inappropriate.