Court Opinion

ID: 9680837
Source: CourtListenerOpinion
Date Created: 2023-08-24 07:39:36.90591+00
Date Added: 2024-06-11T18:17:30.849132
License: Public Domain

Justice ENOCH
filed a dissenting opinion, in which Justice HANKINSON joined.
St. Joseph Hospital is not only in the business of providing medical services, but also surgical training of medical residents. Dr. Mario Villafani was St. Joseph’s surgical resident, stationed at Brackenridge Hospital, when Stacy Wolff was admitted to Brackenridge as a “teaching patient,” and at which time, according to the jury, Dr. Villafani negligently treated Ms. Wolff. The only real question in this case is whether Dr. Villafani, as a medical doctor, can be an employee of St. Joseph such that St. Joseph would be vicariously hable for Dr. Villafani’s negligence. Although my colleagues and I are unanimous that a doctor can be an employee of a hospital, and thus, the hospital can be vicariously liable for the doctor’s negligence, six justices conclude that at the precise time Dr. Villafani was treating Ms. Wolff, he was the borrowed servant of the Central Texas Medical Foundation, and thus, St. Joseph was not vicariously hable for Dr. Villafani’s neghgence.
My colleagues’ reasoning acknowledges that St. Joseph controlled what medical services its residents could perform. But they then conclude that St. Joseph didn’t control those very medical services its resident, Dr. Villafani, performed. That is quite literally nonsense. Because I cannot join my colleagues’ reasoning or the Court’s judgment, I respectfully dissent.
With respect to whatever facts are in dispute, the plurality notes that the jury found that Dr. Villafani was the employee of both St. Joseph and the Medical Foundation and that he, when treating Ms. Wolff, was acting within the scope of his employment with each. From the extensive record, it is clear how the jury could find that Dr. Villafani worked for both St. Joseph and the Medical Foundation. What is not clear is how a majority of this Court could reach its conclusion, based on this same extensive record, that not only was Dr. Villafani not in the course and scope of his employment with St. Joseph when he treated Ms. Wolff, but also that he was the borrowed servant of the Medical Foundation as a matter of law.
My colleagues agree with me that “borrowed servant” is a doctrine that will relieve an employer from respondeat superi- or liability if the facts show that another employer had “borrowed” the employee when the act subjecting the employer to liability occurred.1 This issue, then, turns on who had the right to control Dr. Villafa-ni in his employment when Ms. Wolff was injured:
Solution of the question rests in right of control of the manner in which the employees perform the services necessary to accomplishment of their ultimate obligation. If the general employees of one employer are placed under control of another employer in the manner of performing their services, they become his special or borrowed employees. If the employees remain under control of their general employer in the manner of performing their services, they remain employees of the general employer and he is liable for the consequences of their negligence.
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When a contract, written or oral, between two employers expressly provides *546that one or the other shall have right of control, solution of the question is relatively simple.2
Where my colleagues’ reasoning begins to get muddled is when it ignores that this doctrine, dependent on who exercises control, is governed by what the contract, if any, says about who has control over the employee.3 St. Joseph apparently recognizes that contractual right-of-control can decide the borrowed-servant issue. It cites Palmer v. Flaggman,4 a case from the United States Court of Appeals for the Fifth Circuit that applies Texas borrowed-servant law, and notes that the case held that “military residents were found to be borrowed servants of the hospital where they were working because the hospital had by contract the exclusive right to control the residents.”
I agree that contractual right-to-control is sufficient to dispose of the borrowed-servant issue in this case. And here, St. Joseph contractually retained control of its medical residents, including Dr. Villafani. Consequently, Dr. Villafani could not be the Medical Foundation’s “borrowed servant.” As a result, St. Joseph should be liable for Dr. Villafani’s negligence.
It is undisputed in this case that St. Joseph provides a surgical residency program for doctors. To be an accredited residency program, the Accreditation Council for Continuing Medical Education (“Council”) requires that St. Joseph, as the sponsoring institution, “assume[ ] final responsibility for a program of graduate medical education.”5 The Council regulations state that “[t]he training of residents relies primarily on learning acquired through the process of their providing patient care under supervision.”6 In particular, surgical skills are learned by treating patients: “[o]perative skill is essential for the surgeon and can be acquired only through personal experience and training. The program must provide for sufficient operative experience to train qualified surgeons, taking into account individual capability and rate of progress.”7 To supply this operative training, an accredited residency program “must provide experience in preoperative, operative, and postoperative care for patients in all areas that constitute the principal components of general surgery.”8
The Council requires that St. Joseph: “1) appoint[ ] the members’ of the teaching staff at the integrated institution; 2) appoint ] the chief or director of the teaching service in the integrated institution; 3) appoint[ ] all residents in the program; and 4) determinef ] all rotations and assignments of both residents and members of the teaching staff.”9 Furthermore, all residents, even the most senior residents, must be supervised.10 As well, the regulations require St. Joseph to provide an attending physician — someone to delegate all responsibility with regard to a patient — for each patient that a St. Joseph’s resident is treating.11
*547Furthermore, St. Joseph agreed in its Integrated Program contract 'with the Medical Foundation that the residency program would follow the Council’s regulations. The express agreement between the parties follows the Council’s regulations and, as required for St. Joseph’s accreditation as a surgical residency program provider, expressly states that St. Joseph retains actual control over Dr. Vil-lafani’s residency education. St. Joseph contractually retained the right to tell residents what patients to see, what procedures they could perform, what hours to work, in what city to work, and to whom to report while at work. St. Joseph retained the right to control almost every aspect of Dr. Villafani’s work while he was a medical resident. Dr. Villafani, as all St. Joseph’s residents, served at St. Joseph’s pleasure.
Specifically, in its contract with the Medical Foundation, St. Joseph retained control of its residents. The contract provides that St. Joseph “shall appoint an Academic Chief of General Surgery who shall direct the total General Surgery Residency Program.” It further provides that the Medical Foundation, a theoretically independent organization, can appoint its own Director of Surgical Education subject to St. Joseph’s approval. But that Director must consult with St. Joseph’s academic chief on all academic aspects of the integrated program. Further, St. Joseph appoints all residents that go to Bracken-ridge Hospital for medical training with the Medical Foundation, and “[s]pecific training assignments of residents and teaching staff of [the Medical Foundation] ... will be made by the [Medical Foundation’s] Director of Surgical Education ... subject to the approval of the Academic Chief of General Surgery at St. Joseph Hospital.”
Notably, although St. Joseph purported to contract away its control of details of residents’ medical tasks, St. Joseph actually specifically retained the right to control those tasks: “St. Joseph Hospital will not control the details of the medical tasks performed by the residents when they are assigned to [the Medical Foundation] save through ... the mutual consent of the Academic Chief of General Surgery at St. Joseph Hospital and [the Medical Foundation’s] Director of Surgical Education.” (Emphasis added). My colleagues complain that I overstate the significance of this contractual control.12 But I remind my colleagues that in reviewing the trial court’s judgment where the complaint is that the evidence is legally insufficient, this Court must look only at the evidence in a light that supports the trial court’s judgment and disregard all evidence and inferences to the contrary.13
The record is replete with St. Joseph’s efforts to fully comply with the Council’s accreditation standards. And the evidence is virtually undisputed that St. Joseph exerted actual control over Dr. Villafani’s work at Braekenridge Hospital. St. Joseph’s Director of Medical Education, Dr. Ethan Natelson, summed it up: “St. Joseph retains control of their residents .... ” It is not surprising, then, why the jury found as it did — that Dr. Villafani, when treating Ms. Wolff, was in the course and scope of his employment with St. Joseph.
As an example and in line with the Council’s accreditation requirements, Dr. Villafani was supervised by more senior residents in St. Joseph’s program. In fact, St. Joseph structured its residency pro*548gram to have several surgery residents, each with different levels of experience, on rotation at Brackenridge simultaneously. The more senior residents exerted direction and control over the less senior residents during the process of patient care. Foremost, the whole purpose of St. Joseph’s surgical residency program is to educate its residents through patient care. It is through patient care that St. Joseph gives its residents the hands-on experience necessary to prepare them for the practice of medicine. When Ms. Wolff entered the emergency room at Brackenridge, when she was designated a “teaching patient,” and when she was assigned to Dr. Villafa-ni, St. Joseph’s resident, she became a part of Dr. Villafani’s learning experience controlled by St. Joseph. St. Joseph’s own Director of Medical Education stated that “[y]ou cannot train a medical school graduate in his specialty without the patients.” The treatment of Ms. Wolff was essential to Dr. Villafani’s medical education — the medical education provided by St. Joseph.
Not surprisingly, St. Joseph admits that it had the right to control Dr. Villafani’s training — to assert otherwise would imperil its accreditation. In fact, St. Joseph’s Director of Medical Education acknowledged that he could not think of “any other situation that exercises more control over physicians than a Residency Program.”
In addition to the control St. Joseph retained and exercised to have an accredited residency program, St. Joseph received direct financial benefits from providing this residency program, including increased federal funding and reimbursements for its employees’ salaries and benefits from the Medical Foundation out of revenue earned from billing for each resident’s services. St. Joseph also received indirect benefits. Its residency program attracted more students and more surgeons to its facility, meaning it could provide services to the patients at a lower cost while recruiting qualified physicians to practice in its community. As well, the accredited residency program brought St. Joseph prestige in the health care community.
The relationship between Dr. Villafani and St. Joseph further demonstrates St. Joseph’s pervasive control of its resident. St. Joseph selected Dr. Villafani to participate in its surgical residency program. Once selected, Dr. Villafani signed St. Joseph’s employment agreement that dictated the terms of his employment with St. Joseph, and which set forth St. Joseph’s expectations for Dr. Villafani’s surgical rotation. St. Joseph determined the professional duties and standards of medical practice and controlled the amount and type of work Dr. Villafani was assigned. The employment agreement was clear that Dr. Villafani was to follow St. Joseph’s policies and procedures while on rotation at Brackenridge. Truthfully, Dr. Villafa-ni’s resumé indicates that he received his residency training from St. Joseph, not the Medical Foundation.
St. Joseph operated a residency program in accordance with its accrediting body’s regulations. It provided its residents with the resources necessary to achieve their goal of medical education and required the residents, in return, to devote themselves solely to St. Joseph’s ends. The undisputed evidence shows that Dr. Villafani’s patient care was part of his academic training, which St. Joseph retained the right to control. Thus, not only is there more than a scintilla of evidence to support the jury’s findings that Dr. Villafa-ni was acting in the course and scope of his employment with St. Joseph when he treated Ms. Wolff, but the evidence establishes that he was so acting as a matter of law.14
*549Employers are generally liable for their employees’ acts that fall
within the scope of the general authority of the employee. It is not essential that the negligent act or omission should have been expressly authorized by the employer so long as it is in furtherance of the employer’s business and for the accomplishment of the object for which the employee is employed.15
Dr. Villafani’s treatment of Ms. Wolff was: (1) within the scope of his general authority; (2) in furtherance of St. Joseph’s business of educating medical residents through patient care; and (3) for the accomplishment of the object for which Dr. Villafani was hired.16 Thus, because Ms. Wolffs treatment was within the scope of Dr. Villafani’s employment, St. Joseph Hospital is vicariously liable under respon-deat superior for Dr. Villafani’s negligence.
In holding otherwise, my colleagues simply ignore the reality of medical residency programs. They seem to be influenced by the arguments that if St. Joseph wasn’t standing over Dr. Villafani’s shoulder at the precise time he provided medical treatment to Ms. Wolff, then St. Joseph was not exercising control. This reasoning is apparent in the plurality’s opinion. Paraphrasing, it says that “St. Joseph set ... the kinds of procedures [Dr. Villafani] performed,” but with respect to patient care, it was a different situation.17 According to the plurality, then, St. Joseph controls what treatment Dr. Villafani can perform, but St. Joseph didn’t control Dr. Villafani’s performance of that treatment. What nonsense! Shamelessly, the plurality confesses, as it must, that Dr. Villafani is supervised by “more senior residents,” 18 but hopes the reader forgets that these “more senior residents” are St. Joseph’s own residents. The plurality, in essence, says that St. Joseph has no direct control over Dr. Villafani’s patient care, because, in fact, it is St. Joseph’s employees who exercise control and not St. Joseph. More nonsense.
At most, my colleagues can point only to evidence showing that St. Joseph shared control over Dr. Villafani with the Medical Foundation. But that isn’t enough to find as a matter of law that Dr. Villafani was the borrowed servant of the Medical Foundation. According to the Restatement,
In the absence of evidence to the contrary, there is an inference that the actor remains in his general employment so long as, by the service rendered another, he is performing the business entrusted to him by the general employer. There is no inference that because the general employer has permitted a division of control, he has surrendered it.19
In short, when the general employer only shares its right to control its employee, that employee cannot be the borrowed servant of the special employer.20 As long as St. Joseph retained control over Dr. Villafani’s residency, he could not be the borrowed servant of the Medical Foundation.
As my colleagues agree, by contract, St. Joseph had the “ultimate responsibility” over Dr. Villafani in the residency pro*550gram.21 And as they admit, St. Joseph exercised control over Dr. Villafani’s patient care. While my colleagues try to distinguish academics versus patient care, they admit, again, as they must, that the academic portion of the program necessarily includes patient care. Simply, there is no difference in the exercise of control over academics and the exercise of control over patient care in this or any other surgical residency program.
The contract between St. Joseph and its resident, Dr. Villafani, and the contract between St. Joseph and the Medical Foundation demonstrate that St. Joseph exercises control over Dr. Villafani’s patient care, and the undisputed evidence shows that St. Joseph exercised actual control over Dr. Villafani. Thus, Dr. Villafani cannot be the borrowed servant of the Medical Foundation as a matter of either fact or law. I would overrule St. Joseph’s complaint that either the trial court erred in not instructing the jury on borrowed servant or in failing to find as a matter of law that Dr. Villafani was the borrowed servant of the Medical Foundation.
A hospital may have employees who are doctors for whom it may be vicariously liable, and there was evidence in this case to support the jury’s finding that Dr. Villa-fani was St. Joseph’s employee, acting in the course and scope of his employment, when he negligently injured Ms. Wolff. Additionally, because St. Joseph contractually retained and actually exercised the right of control over Dr. Villafani’s work even when he was at Brackenridge, he could not have been the borrowed servant of the Medical Foundation. Further, because I conclude that there was legally sufficient evidence to support the jury’s finding that Dr. Villafani was in the course and scope of his employment with St. Joseph when he negligently injured Ms. Wolff, I do not reach the question of joint enterprise, joint venture, and other theories of vicarious liability presented by Ms. Wolff. Finally, I agree with the court of appeals’ reasoning that the trial court’s error, if any, in failing to submit the negligence of the two settling drivers was harmless. Consequently, I would affirm the court of appeals’ judgment.

. See Producers Chem. Co. v. McKay, 366 S.W.2d 220, 225 (Tex.1963).

. Id. at 225-26; see Carr v. Carroll Co., 646 S.W.2d 561, 565 (Tex.App.-Dallas 1982, writ ref’d n.r.e.).

. Producers Chem. Co., 366 S.W.2d at 226.

. 93 F.3d 196 (5th Cir.1996).

. American Medical Association, 1993-94 Graduate Medical Education Directory 11 (1993).

. Id. at 9.

. Id. at 138.

. Id. at 137.

. Id. at 140.

. Id.

. Id.

. 94 S.W.3d at 523.

. See Lee Lewis Constr., Inc. v. Harrison, 70 S.W.3d 778, 782 (Tex.2001); see also Bradford v. Vento, 48 S.W.3d 749, 754 (Tex.2001).

. See, e.g., Darensburg v. Tdbey, 887 S.W.2d 84, 88-90 (Tex.App.-Dallas 1994, writ denied).

. Leadon v. Kimbrough Bros. Lumber Co., 484 S.W.2d 567, 569 (Tex.1972).

. See, e.g., Darensburg, 887 S.W.2d at 89.

. 94 S.W.3d at 542.

. Id. at 543.

. Restatement (Second) of Agency § 227 cmt. b (1958).

. See Lara v. Lile, 828 S.W.2d 536, 538 & n. 2 (Tex.App.-Corpus Christi 1992, writ denied).

. 94 S.W.3d at 542.