Court Opinion

ID: 9959555
Source: CourtListenerOpinion
Date Created: 2024-04-12 05:05:46.296359+00
Date Added: 2024-06-11T08:18:08.194501
License: Public Domain

If this opinion indicates that it is “FOR PUBLICATION,” it is subject to
                 revision until final publication in the Michigan Appeals Reports.

                            STATE OF MICHIGAN

                            COURT OF APPEALS

RONALD J. KOWALSKI, as Personal                                     UNPUBLISHED
Representative of the ESTATE OF ANDREW                              April 11, 2024
KOWALSKI,

               Plaintiff-Appellee/Cross-Appellant,

v                                                                   No. 366373
                                                                    Wayne Circuit Court
PRIME HEALTHCARE SERVICES GARDEN                                    LC No. 21-011019-NH
CITY, LLC,

               Defendant-Appellant/Cross-Appellee,
and

DR. RONALD KATTOO,

               Defendant.

Before: CAVANAGH, P.J., and K. F. KELLY and RICK, JJ.

PER CURIAM.

        In this medical malpractice case, defendant Prime Healthcare Services Garden City, LLC,
(“PHS”) appeals by delayed leave granted1 the trial court’s order denying its motion for summary
disposition under MCR 2.116(C)(10) on the issue of whether PHS was vicariously liable for the
death of the decedent, Andrew Kowalski. Plaintiff has also cross-appealed the trial court’s order
granting PHS’s motion for summary disposition under MCR 2.116(C)(10) on the issue of whether
unnamed hospital staff were also liable for the decedent’s death. Finding no errors warranting
reversal, we affirm the trial court’s order and remand for further proceedings consistent with this
opinion.

1
 Kowalski Estate v Prime Healthcare Servs Garden City, LLC, unpublished order of the Court of
Appeals, entered July 31, 2023 (Docket No. 366373).

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                       I. BASIC FACTS AND PROCEDURAL HISTORY

       In 2018, the decedent began experiencing pain in his left knee. After consultation with his
orthopedic doctor, Dr. Paul Drouillard, the decedent was scheduled to have a left total knee
replacement surgery on February 11, 2019, at Garden City Hospital. Dr. Drouillard successfully
performed the surgery; however, the decedent experienced a decline in pulmonary status while in
recovery and was transferred to the intensive care unit (“ICU”) on February 12, 2019.

        In the ICU, the decedent was placed under the care of defendant Dr. Ronald Kattoo, the
director of “Unit 2” of the ICU. Dr. Kattoo was not an employee of PHS, but rather was engaged
by PHS through a contract with Pulmonary & Sleep Medicine, P.C. On March 3, 2019, Dr. Kattoo
approved the transfer of the decedent from the ICU to a general medical floor that was also
supervised by Dr. Kattoo. On March 5, 2019, the decedent was found in his hospital bed without
a heartbeat and expired.

        Plaintiff filed a complaint against defendants asserting that had the decedent “been in the
ICU[,] his respiratory and cardiac status could have been more closely monitored and timely
treatment instituted to either prevent the cardiac arrest or allow for there to have been successful
resuscitation.” As relevant here, the complaint sought to hold PHS vicariously liable for the
negligent acts of its agents, namely Dr. Kattoo and the other ICU staff, who plaintiff claimed did
not properly monitor and treat the decedent.

        In two separate motions, PHS sought summary disposition of plaintiff’s claims.
Concerning Dr. Kattoo, PHS argued that plaintiff failed to show that Dr. Kattoo was an agent of
PHS because he was not employed by the hospital and the decedent acknowledged some doctors
were not employees when he signed his consent for treatment form before his knee surgery.
Accordingly, PHS argued that it dispelled any belief the decedent may have had about Dr. Kattoo’s
employment by signing the form. With respect to the other ICU staff, who were not named in the
complaint, PHS argued that plaintiff’s standard-of-care expert, Dr. Ian Newmark, limited his
criticisms to Dr. Kattoo, and plaintiff, therefore, could not support a claim against the other staff.

        The trial court did not hold a hearing, and issued an order denying PHS’s motion
concerning Dr. Kattoo but granting it as to the other ICU staff. PHS filed a delayed application
for leave to appeal the trial court’s denial of its motion concerning Dr. Kattoo, which this Court
granted. Kowalski Estate v Prime Healthcare Servs Garden City, LLC, unpublished order of the
Court of Appeals, entered July 31, 2023 (Docket No. 366373). Plaintiff subsequently filed his
claim of appeal concerning the other ICU staff, and this appeal followed.

                                 II. STANDARDS OF REVIEW

        This Court reviews de novo a trial court’s decision on a motion for summary disposition.
Anderson v Transdev Servs, Inc, 341 Mich App 501, 506; 991 NW2d 230 (2022). Under MCR
2.116(C)(10), summary disposition is appropriate when, “[e]xcept as to the amount of damages,
there is no genuine issue as to any material fact, and the moving party is entitled to judgment or
partial judgment as a matter of law.” When deciding a motion for summary disposition under
MCR 2.116(C)(10), the trial court must consider the “affidavits, pleadings, depositions,
admissions, and other evidence submitted by the parties in the light most favorable to the party

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opposing the motion.” Williamson v AAA of Mich, 343 Mich App 496, 502-503; 997 NW2d 296
(2022) (quotation marks and citations omitted).

                 III. VICARIOUS LIABILITY AND OSTENSIBLE AGENCY

        On appeal, PHS argues that the trial court erred when it denied PHS’s motion for summary
disposition because the evidence demonstrated there was no genuine issue of fact that Dr. Kattoo
was not an agent of PHS. We disagree.

        Vicarious liability “is based on a relationship between the parties, irrespective of
participation, either by act or omission, of the one vicariously liable, under which it has been
determined as a matter of policy that one person should be liable for the act of the other.” Lee v
Detroit Med Ctr, 285 Mich App 51, 65; 775 NW2d 326 (2009). The principle is, in other words,
that “a master is responsible for the wrongful acts of his servant committed while performing some
duty within the scope of his employment.” Rogers v JB Hunt Transp, Inc, 466 Mich 645, 651;
649 NW2d 23 (2002) (quotation marks and citation omitted).

       Hospitals are generally not liable for the negligence of the acts of its independent
contractors. Grewe v Mt Clemens General Hosp, 404 Mich 240, 250; 273 NW2d 429 (1978). A
hospital may be liable, however, if the plaintiff can show the following elements:

       “[First] The person dealing with the agent must do so with belief in the agent’s
       authority and this belief must be a reasonable one; [second] such belief must be
       generated by some act or neglect of the principal sought to be charged; [third] and
       the third person relying on the agent’s apparent authority must not be guilty of
       negligence.” [Markel v William Beaumont Hosp, ___ Mich ___; 982 NW2d 151
       (2022), slip op at 1, quoting Grewe, 404 Mich at 253 (quotation marks and citations
       omitted; alterations in original).]

        In Markel, ___ Mich at ___; slip op at 1, the Michigan Supreme Court clarified Grewe,
stating that the central issue is whether the plaintiff “looked to” the hospital for care and treatment
and not merely the location where the plaintiff’s physician selected. “A relevant factor in this
determination involves resolution of the question of whether the hospital provided the plaintiff
with [the doctor] or whether the plaintiff and [the doctor] had a patient-physician relationship
independent of the hospital setting.” Grewe, 404 Mich at 251. The plaintiff bears the burden to
demonstrate the existence of the agency relationship. Cox v Flint Bd of Hosp Managers, 467 Mich
1, 12; 651 NW2d 356 (2002).

         There is no dispute in this case that Dr. Kattoo was not an employee of PHS, and plaintiff’s
ability to demonstrate an agency relationship between Dr. Kattoo and PHS thus depends upon the
establishment of an ostensible agency relationship. See Grewe, 404 Mich at 252 (“An agency is
ostensible when the principal intentionally or by want of ordinary care, causes a third person to
believe another to be his agent who is not really employed by him.”) (quotation marks and citation
omitted). Moreover, there is also no dispute that before the decedent was placed in the ICU, the
decedent had no preexisting relationship with Dr. Kattoo. PHS argues, however, that because the
decedent’s initial contact with Garden City Hospital was for an elective surgery with his own
orthopedic doctor, the decedent did not “look to” the hospital for treatment. This argument ignores,

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however, that while the decedent may not have initially looked to Garden City Hospital for
treatment, once his medical prognosis worsened, he was placed in the hospital’s ICU. The ICU
was not simply the location chosen by the decedent’s physician, but rather the most logical location
for care and treatment given the decedent’s critical status.

        PHS also relies on the fact that unlike in Grewe, the hospital did “something” to dispel a
belief by the decedent that Dr. Kattoo was its employee by having the decedent sign a consent
form. PHS argues that the form, which states, “[s]ome doctors and staff are not employees of
Garden City Hospital,” and that Garden City Hospital “is not responsible for their actions,” had
the legal effect of removing any liability for the acts of PHS’s independent contractors because it
put patients on notice that its doctors may not be its employees. We disagree.

        In Stempniak v Prime Health Servs Garden City, LLC, unpublished per curiam opinion of
the Court of Appeals, issued July 27, 2023 (Docket No. 361018),2 the Court addressed identical
language used by PHS and considered whether it was sufficient under Markel to dispel a patient’s
belief about agency. The Court stated:

       In this case, Garden City Hospital asserts that the record establishes that it
       affirmatively acted to inform Stempniak that some of the physicians were not its
       employees when it provided her with a consent form that she signed before the
       surgery. The two-page “consent for treatment” form, in a section titled, “I
       understand that,” provided:

                       Some doctors and staff are not employees of Garden City
               Hospital. I know that Garden City Hospital is not responsible for
               their actions. I also know I may receive separate bills from them
               even though they provide services to me at Garden City Hospital. I
               will work with their offices to answer questions about my insurance.

               While the above language arguably informed Stempniak that “some”
       doctors and staff were not employees of Garden City Hospital, it did not provide
       her with any information regarding Dr. Gross’s employment status. Further,
       Stempniak testified that she had no memory of signing the form, no memory of
       whether its contents were explained to her, and no understanding of what it meant
       because she was in significant pain at the time that she signed it. Stempniak
       explained, “I was in so much pain I would have signed anything that I thought was
       going to help me get rid of the pain.” Viewing the evidence in the light most
       favorable to Stempniak as the non-moving party, we find that there is a genuine
       issue of material fact whether Stempniak had a reasonable belief that Gross was an
       agent of the hospital and thus affirm the trial court’s denial of the hospital’s motion
       for summary disposition. [Stempniak, unpub op at 4-5.]

2
 Unpublished cases are not binding on this Court but may be considered for their persuasiveness.
Eddington v Torrez, 311 Mich App 19203; 874 NW2d 394 (2015).

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        Similarly here, the consent form the decedent signed put him on notice that some doctors
may not be employees of Garden City Hospital, but did not inform him of Dr. Kattoo’s status.
This is particularly relevant where here, Dr. Kattoo was not “just” a physician working in the
hospital, but the director of the ICU itself, which he described as his “team.” Dr. Kattoo’s conduct
while the decedent was in his care did nothing to dispel any belief about his agency and, quite the
opposite, bolstered it. Dr. Kattoo’s responsibilities included training the hospital’s residents,
whom he brought into the decedent’s hospital room to observe as part of their training. Dr. Kattoo
also explained to plaintiff that he was in charge of and supervising the decedent’s care, and had
the authority to transfer the decedent to a different unit within the hospital, which he also oversaw.
In sum, no reasonable patient would believe that the director of the ICU, with power to make
transfer decisions within other departments in the hospital, was not an employee of the hospital
simply because the patient was informed that “[s]ome doctors and staff are not employees . . . .”

         PHS urges the Court to follow Grzywacz v Hidalgo, MD, unpublished per curiam opinion
of the Court of Appeals, issued June 29, 2023 (Docket Nos. 360424 & 361005), which it contends
is dispositive of the issue because, as in this case, the hospital in Grzywacz successfully defended
itself against a claim of vicarious liability on the basis of a consent form. While it is true that the
Court in Grzywacz relied on the hospital’s consent form when affirming the trial court’s summary
disposition order, critical to the Court’s analysis was the fact that in that case, none of the doctors
were “offered” to the patient; one of the defendant-doctors was an on-call cardiologist from the
patient’s primary care physician’s practice, and the other doctor was the on-call neurologist at the
hospital who was brought in by the cardiologist. Grzywacz, unpub op at 6. With respect to the
neurologist, the most similarly situated doctor to Dr. Kattoo here, the Court noted that “nothing
implied” that the doctor was an agent of the hospital. Id. In contrast here, Dr. Kattoo held himself
out as the leader of a “team” in the ICU for which he had supervisory control over residents and
patients and their direction of care.

        In sum, the trial court did not err when it denied PHS’s motion for summary disposition on
the issue of ostensible agency. The patient consent form did not clearly inform the decedent that
Dr. Kattoo was not an employee of the hospital, which is especially true where Dr. Kattoo took
affirmative steps to imply that he was.

                                 III. OTHER HOSPITAL STAFF

        On cross-appeal, plaintiff argues the trial court erred when it granted PHS’s motion for
summary disposition concerning the other ICU staff because Dr. Newmark, his standard-of-care
expert, included those individuals in his criticisms of the breaches of the standard of care. We
disagree.

        A plaintiff in a medical malpractice case must show: “(1) the applicable standard of care,
(2) a breach of that standard by the defendant, (3) an injury, and (4) proximate causation between
the alleged breach of duty and the injury.” Rock v Crocker, 499 Mich 247, 255; 884 NW2d 227
(2016). “[T]he plaintiff has the burden of proving that he or she suffered an injury that more
probably than not was proximately caused by the negligence of the defendant or defendants.”
MCL 600.2912a(b)(2). Expert testimony is generally required in a medical malpractice case “in
order to establish the applicable standard of care and to demonstrate that the professional breached
that standard.” Elher v Misra, 499 Mich 11, 21; 878 NW2d 790 (2016). Such testimony is required

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because “the ordinary layperson is not equipped by common knowledge and experience to judge
the skill and competence of the service and determine whether it meets the standard of practice in
the community.” Wiley v Henry Ford Cottage Hosp, 257 Mich App 488, 492; 668 NW2d 402
(2003). The expert’s testimony cannot be made on the basis of speculation and there must be
“facts in evidence to support the opinion testimony of an expert.” Gonzalez v St John Hosp & Med
Ctr (On Reconsideration), 275 Mich App 290, 294-295; 739 NW2d 392 (2007).

       Dr. Newmark, plaintiff’s standard-of-care expert, testified in deposition regarding his
opinions regarding the circumstances that caused the decedent’s death. PHS contends that Dr.
Newmark limited his testimony to the actions of Dr. Kattoo, specifically pointing to the following
colloquy:

               Q. Do you have any other standard of care criticisms other than the elective
       intubation and he should not have been transferred on March 3?

               A. No, sir.

               Q. Is it correct that your standard of care criticisms are directed at the ICU
       attending Dr. Kattoo?

               A. That’s correct.

         Plaintiff insists, however, that Dr. Newmark’s criticisms were not so limited and that his
testimony, in conjunction with Dr. Kattoo’s testimony, demonstrates that the ICU staff was
responsible for intubation of the decedent, which did not occur. It is true that Dr. Newmark
testified that the failure to intubate the decedent breached the standard of care. For example, Dr.
Newmark testified that when the decedent “was showing signs of deterioration . . . he would have
benefitted from being selectively intubated at that time and put into the ICU.” Dr. Newmark also
stated that intubating the decedent “would have prevented him from having his arrest and dying.”
When coupled with Dr. Kattoo’s testimony that the responsibility for intubation was shared among
the ICU staff, plaintiff contends the testimony was sufficient to support his claim.

        Dr. Newmark’s testimony never specifically identified unnamed ICU staff as being
responsible for failing to intubate the decedent. Regardless of how plaintiff attempts to frame his
testimony, Dr. Newmark did not state that such individuals were responsible. Indeed, Dr.
Newmark was directly asked if his standard-of-care criticisms, including those concerning
intubation, were solely leveled at Dr. Kattoo, to which he responded, “That’s correct.”

        Plaintiff’s reliance on Bahr v Harper-Grace Hosps, 448 Mich 135; 528 NW2d 170 (1995),
is misplaced. In that case, the Michigan Supreme Court partially reversed this Court’s decision to
remand the plaintiff’s medical malpractice case for a new trial on the basis that the plaintiff did
not adequately support her expert testimony for her claims against the defendant-hospital’s
residents, interns, and nurses. Bahr, 448 Mich at 136-137. Unlike this case, however, the issue
before the Michigan Supreme Court was whether the plaintiff’s expert was qualified to testify
regarding the standard of care for residents, interns, and nurses. See id. at 141. There is no similar
challenge in this case to Dr. Newmark’s qualifications, and we do not interpret Bahr as standing
for the proposition that expert testimony regarding residents and interns is always relevant and
admissible.

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        Indeed, in Cox v Flint Bd of Hosp Managers, 467 Mich 1, 15; 651 NW2d 356 (2002), the
Michigan Supreme Court held that “in order to find a hospital liable on a vicarious liability theory,
the jury must be instructed regarding the specific agents against whom negligence is alleged and
the standard of care applicable to each agent.” Neither plaintiff nor Dr. Newmark identified any
“specific agent” apart from Dr. Kattoo. Accordingly, the trial court did not err when it granted
PHS’s motion for summary disposition on the issue of unnamed ICU staff.

        Affirmed and remanded for further proceedings consistent with this opinion. We do not
retain jurisdiction. Neither party having prevailed in full, no costs may be taxed. MCR 7.219(A).

                                                              /s/ Mark J. Cavanagh
                                                              /s/ Kirsten Frank Kelly
                                                              /s/ Michelle M. Rick

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