Court Opinion

ID: 9959443
Source: CourtListenerOpinion
Date Created: 2024-04-11 17:19:21.82214+00
Date Added: 2024-06-11T08:18:39.013393
License: Public Domain

FILE                                                        THIS OPINION WAS FILED
                                                                       FOR RECORD AT 8 A.M. ON
                                                                             APRIL 11, 2024
       IN CLERK’S OFFICE
SUPREME COURT, STATE OF WASHINGTON
         APRIL11, 2024
                                                                          ERIN L. LENNON
                                                                       SUPREME COURT CLERK

                 IN THE SUPREME COURT OF THE STATE OF WASHINGTON

        THE ESTATE OF CINDY ESSEX, by      )
        and through JUDY ESSEX, as Personal)
        Representative of the ESTATE OF    )
        CINDY ESSEX,                       )
                                           )   No. 101745-6
                           Petitioners,    )
                                           )
              v.                           )   En Banc
                                           )
        GRANT COUNTY PUBLIC                )
        HOSPITAL DISTRICT NO. 1, d/b/a     )
        SAMARITAN HEALTHCARE, a            )   Filed: April 11, 2024
        Public Hospital                    )
                                           )
                           Respondent,     )
                                           )
        DR. IRENE W. CRUITE, MD, and       )
        JOHN DOE CRUITE, husband and wife, )
        and the marital community composed )
        thereof; CONFLUENCE HEALTH, a      )
        Washington Corporation;            )
        WENATCHEE EMERGENCY                )
        PHYSICIANS, PC, a Washington       )
        Corporation; DR. CHRISTOPHER       )
        DAVIS, MD, and JANE DOE DAVIS, )
        husband and wife, and the marital  )
        community composed thereof; and    )
        JOHN and JANE DOES 1-10,           )
                                           )
                           Defendants.     )
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

         GONZÁLEZ, C.J. — A patient who goes to the emergency room, if conscious,

is mostly concerned with getting care, not with untangling the contractual

relationship between the hospital and the doctors who work there. And yet the

characterization of the hospital-doctor relationship has profound implications for a

patient’s ability to recover against the hospital for negligent treatment. This case

asks us to decide when a hospital may be liable for the negligence of a doctor

working in, but not as an employee of, a hospital in its emergency room.

         Cindy Essex 1 went to Samaritan Hospital’s emergency room because she

was experiencing unbearable pain in her left shoulder. Doctors working at, but not

as employees of, Samaritan failed to diagnose Cindy’s necrotizing fasciitis, an

aggressive soft-tissue infection. Cindy died less than 24 hours later. Her estate

seeks to hold Samaritan liable for the doctors’ alleged negligence under theories of

nondelegable duty, inherent function, and agency law principles of delegation.

         We conclude that our statutes and regulations impose nondelegable duties on

hospitals concerning the provision of emergency services. A hospital remains

responsible for those nondelegable duties regardless of whether it performs those

duties through its own staff or contracts with doctors who are independent

1
    We use Cindy Essex’s first name for clarity. We intend no disrespect.
                                                 2
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

contractors to do so. Accordingly, we reverse the Court of Appeals and remand for

further proceedings consistent with this opinion.

                                             FACTS

       Cindy Essex went to Samaritan Hospital’s emergency room complaining of

unbearable pain in her left shoulder and chest that radiated to her abdomen. When

Cindy arrived at the emergency room, she was incoherent and experiencing a pain

level of 10 out of 10. As a result, her mother, Judy Essex, checked Cindy in and

signed the treatment consent form. 2 Cindy continued to writhe and cry out in pain.

Nurses moved Cindy to a quiet room to wait for a doctor.

       Shortly after arriving, nurses triaged Cindy. About an hour later, Dr.

Christopher Davis, an independent contractor, evaluated Cindy. Cindy reported

increasing left shoulder pain, blood in her stool, vomiting, and a fever. Dr. Davis

ordered pain medication, and Cindy’s reported pain level subsequently decreased

to 7 out of 10.

       Dr. Davis ordered x-rays and a CT (computerized tomography) scan to keep

his “diagnostic net fairly wide.” Clerk’s Papers (CP) at 987. The x-rays showed

“a large gastric air bubble” in Cindy’s abdomen. CP at 519. A CT scan showed a

2
  The form said that patients “must look fully to the attending physician(s) for interpretation of
the results of any diagnostic procedure or test and medical and surgical treatment.” Clerk’s
Papers at 502. It also said that the doctors on staff “may be employees or agents of the hospital
or, are independent contractors who have been granted the privilege of using its facilities for the
care and treatment of their patients.” Id.
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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

“[m]arkedly distended stomach” with “fluid, suspicious for gastric outlet

obstruction although no cause for obstruction [was] identified.” Id. Relying on the

x-rays and CT scan, Dr. Davis diagnosed Cindy with gastric outlet obstruction and

ordered a nasogastric tube as recommended by Dr. Irene Cruite. Dr. Cruite was the

radiologist responsible for interpreting Cindy’s scans. Like Dr. Davis, Dr. Cruite

was an independent contractor, not a Samaritan employee.

       Cindy reported feeling better following the insertion of the nasogastric tube.

Dr. Davis consulted with a gastroenterologist about the cause of Cindy’s gastric

outlet obstruction. Dr. Davis transferred Cindy to Central Washington Hospital at

the recommendation of the gastroenterologist.

       While waiting to be transferred, Cindy’s pain returned to a level of 10 out of

10. Nurses administered pain medication, but it does not appear that they told Dr.

Davis about Cindy’s recurring pain. Almost five hours after she arrived at

Samaritan’s emergency room, a nurse reported bruising on Cindy’s upper arms for

the first time. It does not appear that this bruising was reported to Dr. Davis.

       Cindy arrived at Central Washington Hospital just after 10:00 p.m. Cindy

continued to suffer extreme lower back and abdomen pain. Nurses noted redness

on Cindy’s inner arm and chest. This redness darkened, and nurses noted new

raised areas on Cindy’s skin. Dr. Stephen Wiest took over Cindy’s care. Dr. Wiest

reviewed Cindy’s CT scans from Samaritan and identified “some soft-tissue skin

                                              4
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

changes” that Dr. Cruite previously failed to recognize and report. CP at 543. Dr.

Wiest ordered further laboratory testing that indicated elevated inflammation.

Concerned by “the possibility of necrotizing fasciitis,” Dr. Weist ordered an

additional CT scan that “showed worsening soft-tissue swelling.” Id. Dr. Weist

called for examination by a surgeon.

       A surgeon arrived and evaluated Cindy. Doctors discovered the extent of

Cindy’s necrotizing fasciitis while attempting debridement, the removal of dead,

infected, or damaged tissue. Doctors concluded that her condition was ultimately

“nonsurvivable.” CP at 243, 249. Dr. Weist moved Cindy to comfort care where

she later died.

       Cindy’s mother, serving as the personal representative of the estate of Cindy

Essex (Essex), brought a medical negligence and wrongful death claim against

Samaritan, Dr. Davis, and Dr. Cruite, among others. Essex asserted that the

defendants owed Cindy a duty of care, that they breached that duty, and that Cindy

died as a result of that breach. Essex also claimed that Samaritan was liable under

a theory of corporate negligence.

       After extensive discovery including expert declarations and depositions,

Essex moved for partial summary judgment concerning Samaritan’s potential

vicarious liability for Dr. Davis’s and Dr. Cruite’s alleged negligence. Essex

argued that Samaritan was liable under several legal theories including, in part, (1)

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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

nondelegable duty, (2) inherent function, and (3) delegation.3 The trial court

denied Essex’s motion.

       Samaritan successfully sought summary judgment concerning Essex’s (1)

corporate negligence claim and (2) vicarious liability claim concerning the acts of

Samaritan’s nurses. The trial court certified its orders to the Court of Appeals

under RAP 2.3(b)(4).

       The Court of Appeals concluded, in part, that “(1) ostensible agency is the

sole basis for holding a hospital vicariously liable for the negligence of

nonemployee physicians” and (2) summary judgment was appropriate concerning

Essex’s corporate negligence claim against Samaritan. Est. of Essex v. Grant

County Pub. Hosp. Dist. No. 1, 25 Wn. App. 2d 272, 274, 523 P.3d 242 (2023).

       We granted review.

                                          ANALYSIS

       The hospital-doctor-patient relationship is ever evolving. Before the 20th

century, doctors generally provided health care through house calls. Laura D.

Hermer, The Scapegoat: EMTALA and Emergency Department Overcrowding, 14

J.L. & POL’Y 695, 702 (2006) (citing PAUL STARR, THE SOCIAL TRANSFORMATION

OF AMERICAN MEDICINE 68-71 (1982)). As the quality of modern medicine

3
 Essex argued that Samaritan was also liable under theories of ostensible agency and acting in
concert; however, those arguments are not before this court.
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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

increased, the prevalence of house calls decreased. Id. Instead, patients traveled to

their doctors’ private offices. Id. Meanwhile, with advancements in surgical care,

the need for hospitals grew. Id. at 703. Hospitals extended admitting privileges to

doctors, which allowed them to use the hospital’s facilities. Patients needing more

complex care could meet their own doctor at the hospital for treatment.

       Modern hospitals “‘do far more than furnish facilities for treatment.’”

Adamski v. Tacoma Gen. Hosp., 20 Wn. App. 98, 106, 579 P.2d 970 (1978)

(quoting Bing v. Thunig, 2 N.Y.2d 656, 666, 143 N.E.2d 3, 163 N.Y.S.2d 3

(1957)). As in this case, a patient can go to a hospital emergency room without

contacting their personal doctor and be treated by a nonemployee physician. See

Adamski, 20 Wn. App. at 108. The relevant common law, of course, developed

before current conditions existed. As so often happens, we must decide how those

common law principles apply to these new conditions.

       The main question before us is whether ostensible agency is the only theory

under which a hospital can be vicariously liable for the negligence of nonemployee

doctors providing emergency services. See Essex, 25 Wn. App. 2d at 274. Essex

contends that in addition to ostensible agency, a hospital can be liable based on (1)

breach of a nondelegable duty, (2) negligent performance of an inherent function,

and (3) delegation under agency law.

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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

       This case is here on review of summary judgment. Our review is de novo.

Bass v. City of Edmonds, 199 Wn.2d 403, 408, 508 P.3d 172 (2022). Summary

judgment is appropriate where there is no genuine dispute as to any material

question of fact and where the moving party is entitled to judgment as a matter of

law. CR 56(c).

1.     Nondelegable Duty

       Essex argues that hospital licensing statutes and regulations create a

nondelegable duty to emergency room patients. We agree.

       Generally, an entity is not liable for the injuries caused by an independent

contractor whose services are engaged by the entity. Stout v. Warren, 176 Wn.2d

263, 269, 290 P.3d 972 (2012) (citing Hickle v. Whitney Farms, Inc., 107 Wn.

App. 934, 937, 29 P.3d 50 (2001)). However, where an entity has a nondelegable

duty, it cannot avoid liability simply by delegating its duty to an independent

contractor. Instead, an entity will be vicariously liable for the independent

contractor’s negligent performance of that duty absent special circumstances not

present here. Millican v. N.A. Degerstrom, Inc., 177 Wn. App. 881, 896, 313 P.3d

1215 (2013) (quoting RESTATEMENT (THIRD) OF TORTS: LIABILITY FOR PHYSICAL

AND EMOTIONAL HARM § 57 cmt. b (AM. L. INST. 2012)); Knutson v. Macy’s W.

Stores, Inc., 1 Wn. App. 2d 543, 547, 406 P.3d 683 (2017); see also Eylander v.

                                              8
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

Prologis Targeted U.S. Logistics Fund, LP, 2 Wn.3d 401, 539 P.3d 376 (2023)

(outlining one such circumstance).

       Statutes and regulations can establish nondelegable duties. See Tauscher v.

Puget Sound Power & Light Co., 96 Wn.2d 274, 283-85, 635 P.2d 426 (1981)

(explaining that a statute can “create the nondelegable duty of providing safeguards

or precautions for the safety of ‘others’”). In Adamski, the Court of Appeals

observed that then existing regulations might 4 impose a nondelegable duty on

hospitals concerning their provision of emergency care services to the public. 20

Wn. App. at 111 n.5 (citing former WAC 248-18-285 (1975)). Those regulations

required hospitals to provide emergency care in accordance with the community’s

needs and to adopt policies specific to the provision of that care. Former WAC

248-18-285. The regulations also required hospitals to retain a doctor who was

responsible for emergency services and subject to the hospital’s medical direction.

Id.

       Samaritan argues that Adamski is inapplicable because the regulations the

court relied on in that case have since been amended. But while the regulations

have been amended, the principles still apply. As in Adamski, our current statutory

4
  Although the Adamski court recognized the possible applicability of the nondelegable duty
theory, the issue was not before the court. 20 Wn. App. at 111 n.5.
                                               9
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

and regulatory scheme imposes a nondelegable duty concerning a hospital’s

provision of emergency services.

       Chapter 70.41 RCW governs hospital licensing and regulation. Its primary

purpose “is to promote safe and adequate care of individuals in hospitals through

the development, establishment and enforcement of minimum hospital standards

for maintenance and operation.” RCW 70.41.010. The Department of Health

(Department) is responsible, in part, for effectuating that purpose. Id.

Accordingly, the Department must establish minimum standards and rules

concerning the operation of hospitals. RCW 70.41.030. The Department must

amend or modify those rules as is necessary to maintain “standards of

hospitalization required for the safe and adequate care and treatment of patients.”

Id.

       In response to chapter 70.41 RCW, the Department adopted regulations to

“establish minimum health and safety requirements for the licensing, inspection,

operation, maintenance, and construction of hospitals.” WAC 246-320-001. As a

result, the Department regulates hospital leadership and its role in assuring that

care is provided “according to patient and community needs.” WAC 246-320-136.

Regulations require hospital leaders to (1) appoint an executive level nurse to

“[a]pprove patient care policies, nursing practices and procedures,” (2) establish

hospital-wide patient care services, including standardizing processes concerning

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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

the performance of patient care, (3) adopt policies and procedures that define

standards of care for specialty services, (4) provide practitioner oversight for

specialty services, including emergency services, (5) provide “all patients access to

safe and appropriate care,” (6) adopt policies addressing nursing practices and

patient care, and (7) “[r]equire that individuals conducting business in the hospital

comply with hospital policies and procedures.” WAC 246-320-136(1)(b), (2)(c),

(3)-(7).

       In addition to regulating hospital leadership broadly, the Department

specifically regulates “the management and care of patients receiving emergency

services.” WAC 246-320-281. A hospital does not need to provide emergency

services in order to be licensed. Id. However, once a hospital undertakes to

provide emergency services, it is subject to regulation and must

              (2) Maintain the capacity to perform emergency triage and
       medical screening exam twenty-four hours per day;
              (3) Define the qualifications and oversight of staff delivering
       emergency care services;
              (4) Use hospital policies and procedures which define standards
       of care;
              ....
              (8) Assure emergency equipment, supplies and services
       necessary to meet the needs of presenting patients are immediately
       available.

WAC 246-320-281.

       When read together, these regulations impose a nondelegable duty on

hospitals providing emergency services. Our current regulations provide for
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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

hospital oversight that is substantially similar to the hospital oversight required by

the regulations identified in Adamski. Compare WAC 246-320-281, with former

WAC 248-18-285; Adamski, 20 Wn. App. at 111 n.5.

       Hospitals must provide “all patients access to safe and appropriate care” and

are required to establish policies concerning standards of care, nursing practices,

and staff oversight. WAC 246-320-136(3)-(6), -281(3)-(4). We conclude that

WAC 246-320-136 and WAC 246-320-281 create a nondelegable duty for

hospitals providing emergency care services through nonemployee doctors.

Although hospitals may delegate the performance of this duty to nonemployee

doctors, the ultimate duty—and thus the potential vicarious liability for the failure

to meet that duty—remains with the hospital.

2.     Other Theories of Vicarious Liability

       Essex also argues that Samaritan is liable under agency law principles of

delegation. Samaritan responds, correctly, that Washington courts have not

applied that theory in these circumstances. On this record and briefing, we decline

to reach this question today and will await a case that more squarely addresses the

interplay between the nondelegation theory we embrace today, ostensible agency,

and this agency theory.

       Essex further argues that Adamski, 20 Wn. App. 98, establishes inherent

function as an independent basis for vicarious liability. We conclude that inherent

                                             12
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

function is not an independent basis of liability, but that it may be relevant to

determining what actions are nondelegable.

       Adamski turned on whether a jury should have decided whether an

independent contractor doctor was an agent of a hospital. The Adamski court did

not go so far as to establish inherent function as an independent basis of liability.

Instead, the court considered the performance of an inherent function as one factor

in analyzing the hospital-doctor relationship. Adamski, 20 Wn. App. at 112.

Similarly, we recognize that the performance of an inherent function may be a

relevant factor in determining whether a duty may be delegated, but given the

record and briefing before us, we will await a case that more directly addresses that

question.

3.     Corporate Negligence

       The trial court dismissed Essex’s corporate negligence claim finding that as

a matter of law, a trier of fact could not find that Samaritan’s corporate negligence

was the proximate cause of Cindy’s death. 5 Essex argues that it provided sufficient

evidence that, if believed by the trier of fact, would establish Samaritan’s

negligence in training and supervising its nurses was a proximate cause of Cindy’s

5
  In its complaint, Essex contends that Samaritan breached its corporate duties by failing to (1)
hire and retain competent staff, (2) ensure oversight of its staff, (3) accurately diagnose and care
for Essex, and (4) develop, adopt, and enforce necessary policies. CP at 24. Essex argues that
Samaritan is liable for breaching its duty to retain, train, and supervise its emergency department
staff. CP at 889.
                                                 13
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

death. Samaritan contends Essex cannot show that Dr. Davis’s treatment would

have been different had he received information concerning Cindy’s condition

from her nurses. We find sufficient evidence to survive summary judgment on this

theory.

       Corporate negligence is a sustainable legal theory in Washington. A

successful negligence claim requires (1) the existence of a duty owed to the

complaining party, (2) a breach of that duty, (3) a resulting injury, and (4)

proximate cause between the breach and the injury. Pedroza v. Bryant, 101 Wn.2d

226, 228, 677 P.2d 166 (1984) (citing Hansen v. Wash. Nat. Gas Co., 95 Wn.2d

773, 776, 632 P.2d 504 (1981)).

       RCW 7.70.040 sets out the elements of medical malpractice. In medical

negligence cases an injured individual must prove that

               (a) The health care provider failed to exercise that degree of care,
       skill, and learning expected of a reasonably prudent health care provider
       at that time in the profession or class to which [they] belong[] . . . acting
       in the same or similar circumstances;
               (b) Such failure was a proximate cause of the injury complained
       of.

RCW 7.70.040(1). The standard of care for a hospital “is that of an average,

competent health care facility acting in the same or similar circumstances.”

Ripley v. Lanzer, 152 Wn. App. 296, 324, 215 P.3d 1020 (2009) (citing

Pedroza, 101 Wn.2d at 233).

                                             14
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

       Proving “proximate cause” requires “‘first, a showing that the breach of duty

was a cause in fact of the injury, and, second, a showing that as a matter of law

liability should attach.’” Mohr v. Grantham, 172 Wn.2d 844, 850, 262 P.3d 490

(2011) (quoting Harbeson v. Parke-Davis, Inc., 98 Wn.2d 460, 475-76, 656 P.2d

483 (1983)). “Expert testimony usually is required to establish proximate cause in

medical malpractice cases.” Douglas v. Freeman, 117 Wn.2d 242, 252, 814 P.2d

1160 (1991) (citing McLaughlin v. Cooke, 112 Wn.2d 829, 837, 774 P.2d 1171

(1989)).

       The doctrine of corporate negligence “imposes on [a] hospital a

nondelegable duty owed directly to the patient, regardless of the details of the

doctor-hospital relationship.” Pedroza, 101 Wn.2d at 229. Accordingly, a

hospital’s liability under a theory of corporate negligence is separate from its

vicarious liability under the nondelegable duty doctrine.

       We first adopted the corporate negligence doctrine in Pedroza, 101 Wn.2d at

233. We “adopted the doctrine . . . to address negligence beyond that of the

physician, to recognize the onus on the hospital itself for the competency of the

hospital’s medical staff.” Taylor v. Intuitive Surgical, Inc., 187 Wn.2d 743, 756,

389 P.3d 517 (2017) (citing Pedroza, 101 Wn.2d at 231-33). We observed that the

role of hospitals in our communities is changing. Pedroza, 101 Wn.2d at 231.

Hospitals serve as “‘comprehensive health center[s] ultimately responsible for

                                             15
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

arranging and co-ordinating total health care.’” Id. (quoting Arthur F. Southwick,

The Hospital as an Institution—Expanding Responsibilities Change Its

Relationship with the Staff Physician, 9 CAL. W. L. REV. 429 (1973)). We adopted

the corporate negligence doctrine in response to the public’s increased reliance on

hospitals. Id.

       Samaritan argues that Washington law does not recognize Essex’s “mutated”

corporate negligence theory. Resp’t Grant County Pub. Hosp. Dist. No. 1 D/B/A

Samaritan Healthcare’s Resp. Br. at 58-59 (Wash. Ct. App. No. 37804-7-III

(2022)). Samaritan appears to argue that case law limits corporate negligence to

issues concerning (1) incompetent staff, (2) granting privileges to doctors, (3)

furnishing hospital supplies and equipment, and (4) hospital intervention in the

event of negligent doctor care. Id. at 60-62.

       Samaritan’s argument is inconsistent with our pattern jury instructions

concerning corporate negligence. 6 WASHINGTON PRACTICE: WASHINGTON

PATTERN JURY INSTRUCTIONS: CIVIL 105.02.02, at 606 (7th ed. 2019) (providing

four examples of duties that hospitals owe its patients but allowing counsel to

argue the existence of any duty “the court finds legally applies and is supported by

the evidence”). We recognize that our pattern jury instructions are not binding,

and we decline to cabin corporate negligence to the limited circumstances

                                             16
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

Samaritan identifies. See State v. Stein, 144 Wn.2d 236, 246-48, 27 P.3d 184

(2001) (rejecting pattern jury instructions as inaccurate).

       Next, we must determine whether Essex presented sufficient evidence to

survive summary judgment. Summary judgment is appropriate only if, in

considering all of the facts and reasonable inferences in the light most favorable to

the nonmoving party, there are no genuine issues of material fact. Schoening v.

Grays Harbor Cmty. Hosp., 40 Wn. App. 331, 335, 698 P.2d 593 (1985) (citing

Wendle v. Farrow, 102 Wn.2d 380, 686 P.2d 480 (1984)). As the nonmoving

party, Essex had to present some evidence that Samaritan’s negligence in retaining,

training, and overseeing its nurses proximately caused Cindy’s death. Essex

satisfied that burden.

       Essex provided several expert declarations and transcripts of depositions

concerning Samaritan’s training and oversight of its nurses and the causal

relationship between that oversight and Cindy’s death. An emergency nurse, Amy

Curley, provided expert analysis concerning the emergency room nurses’ standard

of care. Curley explained that “there was a delay in recognizing the severity of

illness in this” case. CP at 329. Curley emphasized the nurses’ failures to (1) take

Cindy’s complete vitals, (2) appropriately document Cindy’s symptoms, and (3)

recognize signs of sepsis. Curley concluded that the nurses’ treatment of Cindy

fell below the standard of care for registered nurses and that their failings

                                             17
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

“contributed to the delay in diagnosis and treatment.” CP at 334. Curley

concluded that the nurses lacked training and that Samaritan “was negligent in

respect to its core training policies and oversight function in respect to the

emergency department.” CP at 927. Curley opined that had the nurses received

appropriate training, Cindy “would have been afforded the opportunity to be alive

today.” CP at 932.

       Dr. Thomas Cumbo analyzed Samaritan’s standard of care and oversight of

its nursing staff. Dr. Cumbo took the position that “the hospital was negligent with

respect to the oversight, training and enforcement” of policies related to its nurses

and that “that was a cause of the delay which ultimately led to [Cindy’s] death.”

CP at 981. Dr. Cumbo expressed his concern that Samaritan did not have a way to

ensure its nurses were adequately trained to recognize and respond to Cindy’s

symptoms. Dr. Cumbo explained that nurses did not timely recognize and report

Cindy’s worsening condition “despite fairly obvious signs and symptoms.” CP at

907. The nurses failed to report Cindy’s symptoms “in the context of her

worsening pain,” preventing doctors from fully evaluating her symptoms. CP at

980. Dr. Cumbo concluded that had Cindy’s symptoms been “caught sooner

debridement probably would have saved [Cindy’s] life.” CP at 965. Ultimately,

Dr. Cumbo agreed that (1) the hospital was negligent in its oversight and training

                                             18
Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

of its nurses and (2) that that negligence “was a cause of the delay [that] ultimately

led to [Cindy’s] death.” CP at 981.

       In light of Essex’s expert testimony, we conclude that there is sufficient

evidence concerning Samaritan’s negligence in training and overseeing its nurses

to survive summary judgment. We reverse the trial court’s summary judgment

order on this issue.

                                       CONCLUSION

       Where a hospital elects to provide emergency services, our statutes and

regulations create a nondelegable duty concerning the provision of those services.

Doctors perform an inherent function of the hospital in carrying out that duty.

Thus, we conclude that a hospital cannot escape liability for the negligent

provision of emergency services by delegating that duty to its nonemployee

doctors. Furthermore, we conclude that Essex provided evidence sufficient to

survive summary judgment concerning its corporate negligence claim.

       Accordingly, we reverse the Court of Appeals and remand to the trial court

for further proceedings consistent with this opinion.

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Estate of Essex v. Grant County Pub. Hosp. Dist. No. 1, No. 101745-6

                                                  ____________________________

WE CONCUR:

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