Court Opinion

ID: 9854600
Source: CourtListenerOpinion
Date Created: 2023-09-24 06:09:45.180514+00
Date Added: 2024-06-11T09:23:10.247838
License: Public Domain

Benham, Judge,
dissenting.
While I readily agree that the majority opinion correctly states the rule of law applicable in this state as to medical malpractice claims, I see a clear and unmistakable need, based on case law interpretations and public policy consideration, for a change in the direction of the development of the law in this area; therefore, I am compelled by overriding considerations of fairness, as explained herein, to dissent.
Although the main opinion contains four divisions, appellant has only one enumeration of error, divided into four subparts. Since these subparts are inextricably intertwined with the main enumeration, this dissent will not address them separately. The question posed by this case is whether a physician who merely performs a consultative examination is answerable in damages to the examinee in a medical malpractice claim.
Appellant argues that OCGA § 51-1-27 and the Social Security Administration’s Disability Insurance State Manual (DISM) 00601.215 provide an independent basis for liability by the physician. I agree with the majority opinion insofar as it says that there is no independent basis for liability under the facts of this case using the “classic medical malpractice” approach. However, we must look to statutory provisions, case law, and governmental regulations in an attempt to identify public policy considerations. In doing so, I find that while OCGA § 51-1-27 does not clearly cover the case sub judice, it *703does evidence a public policy favoring recovery for “[a]ny injury resulting from want of . . . care and skill.” Likewise, while DISM 00601.215 does not clearly require the consulting physician to report the results of his test to the patient, it does evidence a public policy favoring the reporting of such information.
The general rule regarding classic medical malpractice actions is outlined on page 698 of the majority opinion: “It is a well-settled principle of Georgia law that there can be no liability for malpractice in the absence of physician-patient relationship. ‘There are three essential elements imposing liability upon which recovery is bottomed: (1) the duty inherent in the doctor-patient relationship; (2) the breach of that duty by failing to exercise the requisite degree of skill and care; and (3) that this failure be the proximate cause of the injury sustained. [Cits.]” This state has traditionally required that physician-patient privity must exist in order to maintain a classic malpractice action (Buttersworth v. Swint, 53 Ga. App. 602 (186 SE 770) (1936)), and the rule is generally followed by most other states, e.g., psychiatrist not liable for providing student placement report (Davis v. Tirrell, 110 Misc.2d 889 (443 NYS2d 136) (1981)); pediatrician not liable where he declined treatment but offered case management (Sullenger v. Setco Northwest, 74 Or. App. 345 (702 P2d 1139) (1985); consultative examiner not liable (Rogers v. Horvath, 65 Mich. App. 644 (237 NW2d 595) (1975); examiner of employee or job applicant not liable (Lotspeich v. Chance Vought Aircraft, Tex. Civ. App. 5th Dist. (369 SW2d 705) (1963); Riste v. Gen. Elec. Co., 47 Wash.2d 680 (289 P2d 338) (1955).
As the above-cited cases show, “[o]rdinarily recovery for malpractice or negligence against a doctor is allowed only where there is a relationship of doctor and patient as a result of a contract, express or implied, that the doctor will treat the patient with proper professional skill and the patient will pay for such treatment, and there has been a breach of professional duty to the patient. Thus, it has been held that there is not a doctor-patient relationship between: (a) a prospective or actual insured and the physician who examines him for the insurance company; or (b) a prospective or actual employee and the doctor who examines him for the employer. There is, however, a broader, a more fundamental rule of long standing under which a physician may incur a tort obligation which is nonconsensual and independent of contract. This is the general rule that one who assumes to act even though gratuitously, may thereby become subject to the duty of acting carefully, if he acts at all. Restatement, Torts, Sec. 325, says the law is that one who gratuitously undertakes to render services which he should recognize as necessary to another’s bodily safety, and leads the other in reasonable reliance on the services to refrain from taking other protective steps, or to enter on a dangerous course of conduct... is sub*704ject to liability to the other for bodily harm resulting from the actor’s failure to exercise reasonable care to carry out his undertaking. [Cit.]” Hoover v. Williamson, 236 Md. 250 (203 A2d 861, 863) (1964).
In certain instances where the physician-patient relationship has been called into question in other states, doctors have been subject to liability, e.g., injuries to patient during examination (Jones v. Tri-State Tel. & Tel. Co., 118 Minn. 217 (136 NW 741)); furnishing inaccurate report that injures examinee’s employment chances (Armstrong v. Morgan, Tex. Civ. App. 6th Dist. (545 SW2d 45) (1976)); furnishing inaccurate report to insurance company (Brousseau v. Jarrett, 73 Cal. App. 3d 864 (141 Cal. Rptr. 200) (1977)); and misrepresentation of examinee’s true condition or concealment of evidence (Hoover v. Williamson, supra). In a federal case, Betesh v. United States, 400 FSupp. 238 (D.C. 1974), government physicians who examined decedent Betesh for an Army pre-induction physical were held liable for failing to disclose information to him about his abnormal X-ray until six months after the physicians became aware of it. During those six months, the tumor progressed from a highly curable state to a terminal one. In allowing the decedent’s widow and parents to recover on their medical malpractice claim, the court held that a physician who undertakes a physical examination has a duty to disclose what he has found and to warn the examinee of any finding that would indicate that the patient is in danger and should seek further medical evaluation and treatment, and that that duty is stronger when the physician has no reason to believe that the examinee is aware of the condition and the danger. Applying an analysis that apparently parallels the one used in Hoover v. Williamson, supra, the court based its conclusion on the premise that “[h]aving assumed to act, the Government physicians were under a duty to act carefully, not merely in the conduct of the examination but also in subsequent communications to the examinee . . . [since the examinee] relies on the assumption that any serious condition will be revealed. [Cits.]” Id. at 246.
As early as 1955, in Norton v. Hamilton, 92 Ga. App. 727, 731 (89 SE2d 809) (1955), this court recognized certain public policy considerations and held: “The duty of a physician or surgeon to bring skill and care to the amelioration of the condition of his patient arises not only from the implied contract between the physician and his patient [cit.], but such duty also has its foundation in public considerations which are inseparable from the nature and exercise of his calling and it is predicated by the law on the relation which exists between physician and patient which is a result of a consensual transaction, and not necessarily one of contract. [Cit.] . . . ‘Negligent failure to attend and treat a patient at a time when the need of treatment is known to the physician and there is opportunity to apply proper *705treatment amounts to the same as negligent treatment and the physician is answerable for such failure.’ [Cit.]” Id. at 731. (Emphasis supplied.)
In reviewing the case law of this state as it relates to public policy and medicine, I find the decision in Emory Univ. v. Porubiansky, 248 Ga. 391, 393-394 (282 SE2d 903) (1981), very illuminating and instructive. In declaring invalid a waiver of liability between a hospital and patient, our Supreme Court stated: “It is this strong interest of the state in the health and health care of its citizens which gives the state the right to regulate the health professional. [Cit.] ‘The right to practice medicine is a conditional right which is subordinate to the state’s power and duty to safeguard the public health, and it is the universal rule that in the performance of such duty and in the exercise of such power, the state may regulate and control the practice of medicine and those who engage therein, subject only to the limitation that the measures adopted must be reasonable, necessary, and appropriate to accomplish the legislature’s valid objective of protecting the health and welfare of its inhabitants.’ [Cit.]” The next year, in Bradley Center v. Wessner, 161 Ga. App. 576 (287 SE2d 716) (1982), aff'd, 250 Ga. 199 (296 SE2d 693) (1982), this court recognized that physicians are under an independent duty to control mental patients so as not to allow them to cause injury to others; and, in doing so, the court concluded that the imposition of the duty to control would not do violence to the public policy favoring readily accessible treatment for mental patients. Bradley Center is important because it allows recovery by a third party in the absence of privity between the injured party and the physician. “The legal duty in this case arises out of the general duty one owes to all the world not to subject them to an unreasonable risk of harm.” Id. at 250 Ga. 201.
It is my view that the statutes, regulations, and case law reflect a clear and unmistakable public policy favoring the preservation of life by those who are engaged in the medical profession. It is my further understanding that while most claims of medical malpractice can be handled within the confines of the law developed under the “classic malpractice” approach, there should be an exception for cases, such as the case sub judice, in which some special relationship might have been established. If such a relationship is established, I believe that a “preservation of life exception” should be applied.
Under the persuasive authority of Bradley Center, supra, the following rule of law should be applied in the case before us: (1) Where a consultative examination gives rise to a special relationship involving the administration of medical tests and procedures, an independent duty arises from that relationship requiring the examiner to take reasonable steps to inform the examinee of any findings that pose a serious and imminent threat to the preservation of life; (2) this duty *706must be breached by the examining physician for a cause of action to arise; (3) there must be legally sufficient evidence showing that the breach of this duty was the proximate cause of the injury; and (4) the examinee must suffer damages.
Decided March 2, 1988
Rehearing denied April 1, 1988
Albert E. Jones, for appellant.
Paul J. Quiner, James M. Head, Jr., Judson Graves, for appellee.
Gene Mac Winburn, Gregory C. Sowell, Thomas W. Bennett, amici curiae.
Since the rule announced here should only be applied in exceptional cases, I would reverse the grant of summary judgment and remand the case to the trial court for a determination not inconsistent with the rule announced herein.
I am authorized to state that Presiding Judge Deen and Judge Pope join in this dissent.