Court Opinion

ID: 9673468
Source: CourtListenerOpinion
Date Created: 2023-08-24 04:12:20.62388+00
Date Added: 2024-06-11T11:27:34.762099
License: Public Domain

GONZALEZ, Justice,
concurring.
The Court assumes without deciding that the plaintiffs have a negligent referral cause of action against the referring physician. I concur in the judgment, but write separately to point out that the bounds of this cause of action, under Texas law, have yet to be fully developed.
Generally, the mere referral of a patient to another physician does not impose liability on the referring physician for the negligence of the latter. In one oft-quoted case, the court, *795in denying liability on the part of the referring physician, stated:
In this age of specialization in the practice of medicine it is the duty and function of courts of law to apply rules of law with an intelligent understanding of developing civilization in the field of medicine and surgery. Certainly it would be unjust to hold a family physician responsible for negligent acts of [another physician] whom he might recommend.
Huber v. Protestant Deaconess Hosp. Ass’n, 127 Ind.App. 565, 133 N.E.2d 864, 869-70 (1956). Although the referring physician bears no responsibility for the tortious acts of a recommended physician, the referring physician can generally be held liable for his own negligence in failing to exercise reasonable care in making the recommendation.
Support for a negligent referral cause of action is found within the case law of many states. One of the seminal cases in this area is this Court’s decision in Moore v. Lee, 211 S.W. 214 (Tex.1919). In Moore, Dr. Moore agreed to attend and treat Mrs. Lee during and after childbirth. However, at the time of childbirth, Dr. Moore was unable to attend and referred the Lees to Dr. Hardin. Subsequently, Dr. Hardin allegedly committed malpractice, and the Lees sued Dr. Moore for negligence in referring them to Dr. Hardin. This Court articulated the duty owed a patient by a referring doctor:
If [a referring doctor] acts in good faith and with reasonable care in the selection of the physician or surgeon, and has no knowledge of the incompetency or lack of skill or want of ability on the part of the person employed, but selects one of good standing in his profession, one authorized under the laws of this state to practice medicine and surgery, he has filled the full measure of his contract, and cannot be held liable in damages for any want of skill or malpractice on the part of the physician or surgeon employed.
Id. at 216-17 (quoting Youngstown Park & Falls St. Ry. v. Kessler, 84 Ohio St. 74, 95 N.E. 509, 511 (1911)). In fact, courts in several states cited Moore v. Lee when they adopted the negligent referral cause of action. See, e.g., Donald v. Swann, 24 Ala.App. 463, 137 So. 178, 180 (1931) (“[A] physician who sends a substitute ... is not answerable for the negligence or malpractice of the sub-stitute_”); Graddy v. New York Medical College, 19 A.D.2d 426, 243 N.Y.S.2d 940, 944 (1963) (“[A] referral of a patient by one physician to another competent physician, absent partnership, employment, or agency, upon abundant authority, does not impose a liability on the referring physician.”); Nash v. Royster, 189 N.C. 408, 127 S.E. 356, 358 (1925) (“By the clear weight of authority, a physician or surgeon who sends a substitute practitioner to treat a case ... is not liable for the latter’s negligence or malpractice, unless the substitute acts as his agent in performing the service, or due care is not exercised in selecting the substitute practitioner.”); Sturm v. Green, 398 P.2d 799, 804 (Okla.1965) (“[S]uch duty is violated when a physician selects another doctor to handle a potentially dangerous case and knows, or should know, the selectee lacks familiarity with the problems involved.... The general rule is that a physician who is unable to care for a patient may send a substitute to care for the patient, and no liability attaches for negligence of the substitute absent agency or negligence in selection of the substitute.”).
Several Texas cases have subsequently relied on Moore for this standard of negligent referral. See, e.g., Johnson v. Whitehurst, 652 S.W.2d 441, 445 (Tex.App.—Houston [1st Dist.] 1983, writ ref'd n.r.e.) (“[T]he referring doctor cannot be liable for the negligence of the doctor to whom he referred the patient, unless the referring doctor was negligent in recommending the second physician.”); Ross v. Sher, 483 S.W.2d 297, 301 (Tex.Civ.App.—Houston [14th Dist.] 1972, writ ref'd n.r.e.) (“[T]he referring doctor ... cannot be liable for the negligence of that other doctor unless the evidence shows that he failed to exercise reasonable care in recommending the second physician.”); Floyd v. Michie, 11 S.W.2d 657, 658 (Tex.Civ.App.—Austin 1928, no writ) (“A physician is not liable for the negligence of another independent practitioner whom he (in the exercise of reasonable care) recommends because he is unwilling to assume the responsibility of diagnosing and treating the malady, and whose services are accepted and *796continued under an mdependent contract. ). The common element among the cases, both from Texas and out of state, that recognize negligent referral as a cause of action is that the referral itself is not enough; there must be knowledge of incompetency or some other triggering factor which causes the negligence to manifest itself.
Recent developments in the health care industry have diffused the medical chain of authority for the sake of containing costs and increasing profits. For example, there are reports that in managed care systems like health maintenance organizations (HMOs), physicians are subjected to gag orders and are given financial incentives not to perform certain procedures or make referrals to outside specialists. Some HMOs hire bargain-rate labs and allow nonphysicians to decide what is or is not appropriate treatment based solely on economic considerations, not on the best interests of the patient. See generally Jim M. Perdue & Stephen R. Baxley, Cutting Costs—Cutting Care: Can Texas Managed Health Care Systems and HMOs Be Liable for the Medical Malpractice of Physicians?, 27 St. Maby’s L.J. 23 (1995); Jonathan J. Frankel, Medical Malpractice Law and Health Care Cost Containment: Lessons for Reformers from the Clash of Cultures, 103 Yale L.J. 1297 (1994). Unless the Legislature acts in a comprehensive way to address this issue, courts will be forced to re-think traditional notions of duty and standards of care, leading to fundamental doctrinal shifts gauged both to protect victims of medical malpractice and to shield physicians from frivolous malpractice claims.