Opinion ID: 1852398
Heading Depth: 1
Heading Rank: 2

Heading: Deference to Policy-makers

Text: The second premise underlying the separation-of-powers rationale is that it requires deference to the policy-makers of the coordinate branches of government in matters involving the issues of basic policy. Ransom, 113 Idaho at 205, 743 P.2d at 73. Here again, the legislative and executive branches are uninvolved. This is so, because there is nothing inherently governmental about decisions regarding individual medical treatment. They do not involve the formulation of public policy in any respect. Therefore, the notion of promoting governmental decisions that are in the public good is completely inapplicable. Womble, 618 So.2d at 1263. Hence, the distinction between governmental [discretion] and medical discretion. Kassen v. Hatley, 887 S.W.2d at 11 (emphasis added). [T]he exercise of medical discretion does not require the same protection as the exercise of governmental discretion. Without immunity, some government officials might hesitate to take actions for the public's protection that could subject them to individual liability. Id. For example, a police officer might decide not to pursue a suspect. However, a doctor cannot avoid personal liability through inaction because physicians are under a duty to exercise ordinary care to treat patients. Id. (Citation omitted.) Thus, the threat of suit will not discourage physicians from seeking and accepting government employment, because they will face the exact same potential exposure to liability that they would as private physicians. Womble, 618 So.2d at 1264 (emphasis added). `The common law of malpractice, as normally applied to private doctors ..., already grants the leeway properly left for expert judgment in the relatively stringent requirements it imposes upon plaintiffs in medical negligence suits. No further leeway is required for the publicly employed doctor ... than for [that doctor's] private counterparts.' Henderson v. Bluemink, 511 F.2d 399, 402 n. 19 (D.C.Cir.1974) (quoting Spencer v. General Hosp. of District of Columbia, 425 F.2d 479, 489 (D.C.Cir.1969)). Under this distinction, physicians still enjoy immunity for the exercise of governmental discretion, that is, decisions establishing governmental policy. Otherwise stated, immunity would attach to such decisions as require governmental judgment. Gleason v. Beesinger, 708 F.Supp. 157, 159 (S.D.Tex.1989). Examples of such decisions would be those related to the questions whether a patient is eligible for treatment and whether facilities are available to treat a patient, id. at 162 (citing Costley v. United States, 181 F.2d 723, 724-26 (5th Cir.1950)); and whether to provide health service, which and how many services to provide, and where and how to provide them. Comley v. Emanuel Lutheran Charity Bd., 35 Or.App. 465, 478, 582 P.2d 443, 450 (1978). In short, acts involving only medical discretion do not implicate the premises underlying the separation-of-powers rationale. I say once again, the only branch of government with a legitimate role in issues involving a breach of the standard of care owed by a physician to a patient is the judicial branch, acting in its constitutional, fact-finding, remedial role. The rule proposed by the plaintiff in this case and the patients in the cases orally argued with this one does not offend that principle; the rule proposed by the defendant physicians does. This is so, because the separation-ofpowers principle would be offended by a rule that established absolute immunity for State-paid physicians operating within the physician/patient relationship. Such a rule would oust the judiciary of jurisdiction in matters precisely within the sphere of its constitutional prerogative. See Alabama Power Co. v. Citizens of Alabama, supra, 740 So.2d at 381 (judiciary has special competence to decide discrete cases and controversies involving particular parties and specific facts). Ifas the defendant physicians urge us to hold physician immunity includes acts of medical-treatment discretion, then, in every conceivable medical-malpractice action against a State-paid physician, once the physician invoked the defense of discretionary-function immunity, the court would have nothing to do but summarily dismiss the physician from the action. Indeed, during oral argument, counsel were unable to hypothesize any credibly foreseeable scenario under which a State-paid physician would not be immune under the immunity rule urged by the physicians in this case. Simply stated, the rule would leave the judiciary nothing to do in a class of cases committed to it by the constitution. See Ex parte Jenkins, 723 So.2d 649 (Ala. 1998); Broadway v. State, 257 Ala. 414, 60 So.2d 701 (1952) (separation-of-powers principle was violated by a statute that deprived the court of the right to act judicially in a certain class of cases); Sanders v. Cabaniss, 43 Ala. 173 (1869). This Court may not, under the guise of a separation-of-powers argument, abdicate its constitutional duty to adjudicate disputes between physicians and their patients alleging medical malpractice. It goes without saying that neither the judicial branch nor either of the other two branches of government may voluntarily abdicate its respective constitutional role. Millcreek Township School Dist. v. County of Erie, 714 A.2d 1095, 1103-04 (Pa. Commw.Ct.1998); Texas Boll Weevil Eradication Foundation, Inc. v. Lewellen, 952 S.W.2d 454, 465 (Tex.1997); Turpen v. Oklahoma Corp. Comm'n, 769 P.2d 1309, 1368 (Okla.1988) (Wilson, J., dissenting). Therefore, this Court cannot, consistent with the separation-of-powers doctrine, declare that it will no longer hear a certain class of cases. Today, the Court quite properly declines the physicians' invitation to do that. Thus, I concur in the judgment and, except as to the two matters discussed above, I agree with the main opinion.