Opinion ID: 1058434
Heading Depth: 1
Heading Rank: 3

Heading: joseph's appeal

Text: With regard to the questions whether Joseph proved a physician-patient relationship with Dr. Solos-Kountouris and if not, whether Dr. Solos-Kountouris nevertheless undertook to provide Joseph with health care, Joseph acknowledges that he must rely on the events that transpired during Julie's April 19, 2002 appointment to establish that Dr. Solos-Kountouris owed him a duty of care. Joseph testified that he first accompanied Julie to the Doctors' office on that date and conceded at trial and before this Court that all the alleged negligence occurred on or before April 19, 2002. Therefore, we focus on the facts surrounding Julie's April 19, 2002 appointment. In that regard, Joseph provided the only relevant testimony. [6] During his direct examination, the following exchange occurred: Q. [Counsel for the Granatas] I direct your attention then, Mr. Granata, specifically to the date of April 19th. Do you recall anything at all that was significant? A. [Joseph] I do. April 19th was the first time I went to the doctor with Julie. It was at the Burke office. I remember going in the office and waiting in a chair next to Julie. We filled out some paperwork. We also filled out a genetic screening questionnaire, and then they came to get Julie and I started to walk back to be with her for the exam, and they asked me to wait outside until they would call me at a later time. Q. What happened then when they brought you back? A. I went back. Dr. Sol[o]s, myself and Julie were discussing her pregnancy. I remember discussing the genetic questionnaire. I remember when Julie was filling out the questionnaire my nephew had something called Prader-Willi, and Julie was writing down that it was a form of Down syndrome, and I remember telling her I don't think it's a form of Down syndrome. I wouldn't put it there in a spot where it had, I guess, any genetic Down syndrome-related children or relatives. We spoke about that genetic screening sheet for a while. I remember the doctor mentioning amniocentesis. I remember that we talked about if the twins were in one egg or in two sacs.... Q. Can you tell us what Dr. Sol[o]s told the two of you when she was discussing the genetic screening form[?] A. When we were discussing the genetic screening form, I remember her asking some questions about my nephew, about my ethnicity. If there was any other history in my family background that had any kind of genetic disorder. Q. Why were you there at the appointment with Julie? A. Well, because I wasyou know, we were a family. That was part of what we were going through together. This was my children as well. Q. What recommendations, if any, did Dr. Sol[o]s make to the two of you? A. Again, I believe she recommended amniocentesis, and I believe she recommended a geneticist. Q. Let me ask you specifically if you can tell us whether or not the word CVS was mentioned by her. A. I never heard that word ever until after the twins were born. .... Q. Let me ask [w]hat was your reason for being there to discuss these issues? A. Because I was an active participant in the pregnancy. I wanted to support Julie, and I was seeking guidance from her doctors. Joseph gave the following relevant testimony during cross-examination: Q. [Counsel for the Doctors] When you attended the visit on April 19th, 2002, that was conducted by Dr. Sol[o]s-Kountouris, was advanced maternal age discussed? A. [Joseph] Yes. When I was in the room there was a portion of the time when I was outside. When I was invited into the room to discuss the questionnaire, that was certainly a topic that was discussed as well as the twins being a potentially high-risk pregnancy because of those things. Q. So the risks were discussed of this pregnancy? A. That's correct. Q. You also, I think, indicated to us Dr. Sol[o]s-Kountouris discussed the possibility or recommended amniocentesis at that time; is that correct? A. That's correct ... she also said there was plenty of time, but she wanted to put it out there so we had an opportunity to consider it. .... Q. Did Dr. Sol[o]s-Kountouris also talk to you about genetic counseling at that time? A. I remember the conversation about genetic counseling. I don't remember specifically back and forthit was during the time we were actually discussing the genetic questionnaire, and I remember questions about my nephew. I remember questions about my ethnicity. .... Q. And you participated in the completion of the genetic screening sheet on the April 19th visit? A. Could you define what you mean by completion. Did I help fill it out? Yes. Q. You provided input to that form? A. Yes. In addition to Joseph, two of the Granatas' expert witnesses, Dr. Williams and Dr. Wapner, provided testimony relevant to the issues in Joseph's appeal. They opined about the relationship between an obstetrician and a father. Dr. Williams did not consider a husband to be an obstetric patient because there is no treatment or service of an obstetrical or gynecological nature that can be provided to a male individual. Dr. Williams, however, did state that when a physician takes care of a pregnant woman, the physician is taking care of a couple [,s]o in that case the husband is not specifically an OB patient, but we're taking care of the family. According to Dr. Williams, when a husband accompanies his wife as the husband, they are entitled to receive information regarding care of the pregnancy as well. Dr. Wapner stated, [W]hen you're counseling about genetic risks to a fetus you are counseling the couple which includesthe woman andand the man. Finally, Dr. Williams acknowledged that, if the term medical care is defined as the giving of advice, then a husband should receive medical care.
Although the circuit court granted the Doctors' motion to strike the evidence in Joseph's case, it did so after the jury had returned a verdict in his favor. Regardless, the standard of appellate review is the same: whether the evidence viewed in the light most favorable to the plaintiff is sufficient to sustain a jury verdict in favor of the plaintiff. Bitar, 272 Va. at 141, 630 S.E.2d at 325-26. The decision as to whether a physician-patient relationship exists is a question of fact, turning upon a determination whether the patient entrusted his treatment to the physician and the physician accepted the case. Lyons v. Grether, 218 Va. 630, 633, 239 S.E.2d 103, 105 (1977). A physician's duty arises only upon the creation of a physician-patient relationship; that relationship springs from a consensual transaction, a contract, express or implied, general or special. Id. ; accord Washburn v. Klara, 263 Va. 586, 590, 561 S.E.2d 682, 685 (2002) ([T]he physician-patient relationship is a consensual one.) (citing Pugsley v. Privette, 220 Va. 892, 899, 263 S.E.2d 69, 74 (1980)); see also Harris v. Kreutzer, 271 Va. 188, 198, 624 S.E.2d 24, 30 (2006); Didato v. Strehler, 262 Va. 617, 626, 554 S.E.2d 42, 47 (2001). Joseph first argues he meets the definition of the term patient as defined in Virginia's Medical Malpractice Act, (the Act), Code §§ 8.01-581.1 through-581.20:1, and therefore, Dr. Solos-Kountouris owed him a duty of care as a patient. In relevant part, the term ` [p]atient ' means any natural person who receives or should have received health care from a licensed health care provider. Code § 8.01-581.1. Under the Act, the term  `[h]ealth care' means any act, professional services in nursing homes, or treatment performed or furnished, or which should have been performed or furnished, by any health care provider for, to, or on behalf of a patient during the patient's medical diagnosis, care, treatment or confinement. Code § 8.01-581.1. Relying on these definitions and the testimony of Dr. Williams and Dr. Wapner, Joseph contends that a physician's advice about genetic testing constitutes health care under the Act and that Dr. Solos-Kountouris' failure to advise about the availability of CVS was an act ... which should have been ... furnished. Code § 8.01-581.1. Continuing, Joseph asserts he was a person who should have received information from Dr. Solos-Kountouris about CVS and was, therefore, a patient. Joseph's argument, however, ignores the language included at the end of the definition of health care, referring to any act or treatment which should have been furnished  during the patient's medical diagnosis, care, treatment or confinement. Code § 8.01-581.1 (emphasis added). As already noted, only the events that occurred during Julie's April 19, 2002 appointment are relevant to the question whether Dr. Solos-Kountouris diagnosed, cared for, or treated Joseph, in addition to Julie, on that date. The facts surrounding the appointment, viewed in the light most favorable to Joseph, show that Joseph accompanied Julie to the Doctors' office, assisted Julie in filling out the genetic screening questionnaire, and responded to questions from Dr. Solos-Kountouris about his family background as to genetic disorders. Joseph was excluded from the initial portion of Julie's appointment with Dr. Solos-Kountouris and was, in Joseph's words, invited into the room to discuss the questionnaire. Although Dr. Solos-Kountouris discussed and/or recommended amniocentesis and genetic counseling, the evidence demonstrates her diagnosis, care, [or] treatment on that day was directed to Julie, not to Joseph. Code § 8.01-581.1. In other words, there is no evidence that Joseph entrusted his treatment to [Dr. Solos-Kountouris] and the physician accepted the case. Lyons, 218 Va. at 633, 239 S.E.2d at 105; cf. Gray v. INOVA Health Care Servs., 257 Va. 597, 599-600, 514 S.E.2d 355, 356 (1999) (physician had no duty of care to the mother of a patient because the mother was not the physician's patient upon whom the procedure was being performed and any negligence was a breach of duty to the patient, not the mother); Bulala v. Boyd, 239 Va. 218, 230, 389 S.E.2d 670, 676 (1990) (stating that the father, of course, was not the [obstetrician's] `patient,' within the meaning of the Act); Dehn v. Edgecombe, 384 Md. 606, 865 A.2d 603, 615 (2005) (A duty of care does not accrue purely by virtue of the marital status of the patient alone; some greater relational nexus between doctor and patient's spouse must be established.). Furthermore, Joseph and Julie did not allege that the Doctors breached the standard of care by failing to advise them as a couple about genetic counseling or to recommend genetic screening tests that either Joseph alone or both of them would need to undergo. Instead, they asserted that the Doctors breached the standard of care by failing to inform Julie about the availability of CVS during the first trimester of her pregnancy. Obviously, Julie is the only person who could consent to and undergo that procedure. Information about CVS was not an act ... which should have been ... furnished to Joseph. Code § 8.01-581.1. The medical expert witnesses' testimony about what constitutes health care does not alter our conclusion. In the context of a pregnancy, a husband may be entitled to receive such information about a fetus' risk of having genetic abnormalities. The question whether Joseph had a physician-patient relationship with Dr. Solos-Kountouris, however, turns solely on the facts surrounding the April 19, 2002 appointment. See Lyons, 218 Va. at 633, 239 S.E.2d at 105. Thus, we conclude the evidence, as a matter of law, was insufficient to show a consensual transaction giving rise to a physician-patient relationship and a duty to perform the service contemplated. Id.; see also Harris, 271 Va. at 199-200, 624 S.E.2d at 30-31 (finding a limited physician-patient relationship exists in the context of a Rule 4:10 examination because the physician expressly consents to the relationship when he agrees to conduct the examination and the patient's consent is implied); Prosise v. Foster, 261 Va. 417, 423, 544 S.E.2d 331, 334 (2001) (refusing to impose a duty of care on an on-call physician in a teaching hospital in the absence of proof that the doctor agreed to accept responsibility for the care of the patient). Relying on this Court's decision in Didato, Joseph next argues that even in the absence of a physician-patient relationship, Dr. Solos-Kountouris undertook to provide health care to him and was thus required to act in accordance with the standard of care. See Code § 8.01-581.20. In Didato, we noted the legal principle that one who assumes to act, even though gratuitously, may thereby become subject to the duty of acting carefully, if he acts at all. 262 Va. at 628, 554 S.E.2d at 48 (quoting Nolde Bros. v. Wray, 221 Va. 25, 28, 266 S.E.2d 882, 884 (1980)). The Court concluded the plaintiffs had pled sufficient facts which, if proven at trial, would permit the finder of fact to conclude that the defendants assumed the duty to provide health care. Didato, 262 Va. at 629, 554 S.E.2d at 48. Additionally, we rejected [t]he defendants' contention that they could not assume a duty to a non-patient to comply with the standard of care in Code § 8.01-581.20. Id. As we recognized in Didato, a physician can, in certain circumstances, affirmatively undertake to provide health care to an individual, who prior to that moment was not the physician's patient, and thereby assume the duty to comply with the applicable standard of care. But see Code § 8.01-225. Such a scenario is in contrast to the more traditional situation where the patient knowingly and voluntarily seeks the professional assistance of the physician, and the physician knowingly agrees to treat the patient. Kelley v. Middle Tenn. Emergency Physicians, P.C., 133 S.W.3d 587, 593 (Tenn.2004). Nevertheless, in the former circumstance, the physician-patient relationship arises by implication because the doctor takes affirmative action to participate in the care and treatment of a patient. Sterling v. Johns Hopkins Hosp., 145 Md.App. 161, 802 A.2d 440, 455 (2002); see also Lownsbury v. VanBuren, 94 Ohio St.3d 231, 762 N.E.2d 354, 360 (2002) ([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.). In Didato, the trial court sustained the defendants' demurrers, so we based our decision solely on the plaintiffs' pleadings. 262 Va. at 630, 554 S.E.2d at 49. We have not had the occasion before today to decide whether particular evidence adduced at trial was sufficient to prove a physician undertook to provide health care to a non-patient, thereby assuming the duty to comply with the standard of care. We agree with the holding in Jenkins v. Best, 250 S.W.3d 680, 693 (Ky. Ct.App.2007), requiring a physician to personally engage[] in some affirmative act amounting to a render[ing of] services to another. Id. at 693 (second alteration in original; internal quotation marks omitted); see also Stanley v. McCarver, 208 Ariz. 219, 92 P.3d 849, 853 (2004) (in the absence of the traditional physician-patient relationship, the court nevertheless imposed a duty of care because the physician undertook, for consideration, to interpret the patient's x-rays); Dekens v. Underwriters Laboratories Inc., 107 Cal.App.4th 1177, 132 Cal.Rptr.2d 699, 702 (2003) (in applying the negligent undertaking doctrine, the actor must specifically have undertaken to perform the task that he is charged with having performed negligently, for without the actual assumption of the undertaking there can be no correlative duty to perform that undertaking carefully). Applying these principles to Joseph's claim that Dr. Solos-Kountouris affirmatively undertook to provide him with health care, we again conclude the evidence was insufficient as a matter of law. As demonstrated by our prior discussion, Joseph did not establish an affirmative act by Dr. Solos-Kountouris during the April 19, 2002 appointment that would amount to the rendering of health care to Joseph. See Jenkins, 250 S.W.3d at 693. Thus, Dr. Solos-Kountouris assumed no duty to comply with the applicable standard of care with regard to Joseph. We therefore hold that the circuit court did not err in granting the Doctors' motion to strike the evidence in Joseph's case.