Court Opinion

ID: 9604912
Source: CourtListenerOpinion
Date Created: 2023-08-22 02:28:13.611291+00
Date Added: 2024-06-11T18:02:25.277262
License: Public Domain

Justice MEYER
dissenting.
It should be remembered that the plaintiffs’ action against the resident physician who attended the birth of Alton Ray Mozingo, Jr., and the hospital is alive and well and will proceed to trial. The only question before this Court is the liability of Dr. Kazior. Dr. Kazior did not at any time examine, treat, care for, or in any other manner act as physician for Sandra Dee Mozingo or Alton Ray Mozingo, Jr., prior to or during the birth of Alton Ray Mozingo, Jr. Prior to the telephone call from the hospital, Dr. Kazior received no request for assistance of any kind from any person with respect to Sandra Dee Mozingo. Upon being notified by telephone that residents attending Mrs. Mozingo had encountered shoulder dystocia, Dr. Kazior immediately went to the hospital, arriving approximately three minutes after he was called, only *193to find that the delivery was completed before his arrival. Dr. Kazior’s only contact with Mrs. Mozingo and her infant son came after the event of the birth, and there is no claim that anything he did after the event of birth has caused any injury or damage to any plaintiff.
The agreement between East Carolina University Medical School and Eastern OB/GYN Associates, which was entered into prior to Dr. Kazior’s employment, provided that the physician employees of Eastern’s practice group could fulfill the on-call agreement by remaining at their homes and being immediately available to a telephone to respond to any call from the chief resident in obstetrics and gynecology for advice or assistance with respect to obstetric or gynecologic patients admitted to the hospital but not under the care of a private practitioner. This system of providing orircall supervision for resident physicians specializing in obstetrics at Pitt County Memorial Hospital was the same system that was used in the local teaching hospital facilities of Duke University Medical School, the University of North Carolina School of Medicine, and Wake Forest University’s Bowman Gray School of Medicine, as testified to by expert physicians from those institutions.
Until today, it has been fairly well settled that absent a physician-patient relationship or vicarious liability based on the negligence of a servant, a physician is liable for his negligence to the same extent as any other individual — a physician is liable in tort when he undertakes responsibility to do some act and negligently performs the act thereby causing injury to a person whom it was reasonably foreseeable might be injured as a consequence of the physician’s negligence. See W. Page Keeton et al., Prosser and Keeton on The Law of Torts § 56 (5th ed. 1984) (physician has no duty to render professional services but having volunteered or agreed to render such services must use due care); 9 Strong’s North Carolina Index 3d Negligence § 1.1, at 344 (1977) (same). To my knowledge, no court in the country has heretofore held a private physician liable for injuries suffered by an individual whom he has never treated, never met, and never agreed to treat based on that physician’s compliance with a contract to provide consultation to and limited on-call supervision of a hospital’s resident physician. This is not to say that a physician may never be held accountable for injuries caused by the acts of another physician not in his employ. To find such liability, however, there *194must be some evidence that the physician has negligently performed some responsibility voluntarily assumed by him.
In this case, the majority errs in concluding that there exists a genuine issue of material fact concerning Dr. Kazior’s liability for the alleged negligent delivery performed by resident physicians. The evidence of record in this case establishes that the residents who performed the delivery were “agent[s], servants] or employee[s] of . . . Pitt County Memorial Hospital, Inc.” Nothing in the record suggests that the residents were employed by or were servants of Dr. Kazior, and thus no liability may be vicariously imputed to Dr. Kazior for the resident’s alleged negligence. Smith v. Duke University, 219 N.C. 628, 633, 14 S.E.2d 643, 646 (1941), overruled on other grounds by Rabon v. Hospital, 269 N.C. 1, 152 S.E.2d 485 (1967); cf. Moeller v. Hauser, 237 Minn. 368, 54 N.W.2d 639 (1952) (hospital vicariously liable for negligence of resident physicians in its employ); Stuart Circle Hosp. Corp. v. Curry, 173 Va. 136, 3 S.E.2d 153 (1939) (liability imposed on hospital for negligent acts of interns and nurses).
Moreover, the record does not, as the majority apparently concludes, establish that Dr. Kazior had responsibility for the general supervision of the residents. As the employer of the resident physicians, such responsibility lay with Pitt County Memorial Hospital, Inc. Riverside v. Loma Linda Univ., 118 Cal. App. 3d 300, 173 Cal. Rptr. 371 (1981); Maxwell v. Cole, 126 Misc. 2d 597, 599, 482 N.Y.S.2d 1000, 1002 (Sup. Ct. 1984). As with most other duties, a hospital may, in appropriate circumstances, delegate its duty of supervision to others by, for example, entering into an affiliation agreement with a medical school. Id.
The mere existence of such an agreement does not, however, end the inquiry of determining who has responsibility for supervision. As with the delegation of all duties, the terms of the agreement between the delegator and the delegatee control. The delegatee will be charged only with the duties that he has voluntarily assumed. Stewart R. Reuter, Some Legal Aspects of Angiography and Interventative Radiology, 33 Med. Trial Tech. Q. 59, 67 (1987); see also Maxwell v. Cole, 126 Misc. 2d 597, 482 N.Y.S.2d 1000 (Sup. Ct.).
The evidence in this case establishes a number of agreements concerning the supervision of the resident physicians practicing at Pitt County Memorial Hospital. First, the record shows that *195Pitt County Memorial Hospital, like most other teaching hospitals, entered into an agreement whereby it delegated some or all of its responsibility to supervise the resident physicians of East Carolina University Medical School. Subsequent to this delegation of supervision, the medical school and Eastern OB/GYN Associates entered into an agreement whereby Eastern agreed to provide consultation services to and limited supervision of the residents of the obstetrics and gynecology service of Pitt County Memorial Hospital. The parties have not included the agreement in the record on appeal, and thus the Court is not aware of the specific details of the agreement. However, the uncontradicted evidence of record establishes that this agreement provided that Eastern would make its physician employees available at certain times
to the end that if the chief resident of the obstetrics and gynecology service of Pitt County Memorial Hospital identified a problem or if there was a difficult case, that chief resident would call a designated physician employee of Eastern OB/GYN Associates, and upon call the responding physician would assist the chief resident in whatever manner appeared to the responding physician to be appropriate.
(Emphasis added.) Specifically, the record establishes that “[i]t was understood by the parties to the agreement [Eastern and the medical school] that the physician could made [sic] himself available to the chief resident by being available to be reached by telephone.” (Emphasis added.)
Subsequent to the entry of this agreement, Dr. Kazior came into the employ of Eastern as a physician practicing in obstetrics and gynecology. The record is unclear whether Dr. Kazior contracted expressly with Eastern to assume Eastern’s responsibility under its agreement with the medical school; however, the record does establish that Dr. Kazior voluntarily assumed responsibility to fulfill Eastern’s contractual obligations. Having done so, Dr. Kazior thereby became obligated to perform the consultation and limited supervisory duties in a non-negligent manner so as to avoid injuring any persons whom it was reasonably foreseeable might be injured as a result of his actions.
Contrary to the majority’s conclusion, Dr. Kazior did not have a duty of general supervision of the residents. Pursuant to his employment with Eastern, Dr. Kazior merely assumed responsibility to provide limited supervision of the residents — to remain at *196home when he was assigned on-call supervision and to make himself available by telephone for advice and assistance to the chief resident. The majority places great importance on a stipulation made by Dr. Kazior but fails to interpret it in connection with and in light of the limited nature of Dr. Kazior’s duties under his employer’s contract. The stipulation made by Dr. Kazior merely states that he “was the Attending Physician on Call for the OB/GYN Service of Pitt County Memorial Hospital with the responsibility for supervision of the OB/GYN residents and interns at the time of the birth of [infant plaintiff].” This stipulation does not contradict the undisputed evidence of Dr. Kazior’s limited supervisory duties but, in fact, supports the evidence demonstrating that Dr. Kazior had assumed no more responsibility than to make himself available by telephone for advice and assistance when called by the chief resident.
Moreover, the cases relied upon by the majority do not support the conclusion that Dr. Kazior owed any duty beyond that which he voluntarily assumed pursuant to his employment agreement with Eastern. In Maxwell v. Cole, 126 Misc. 2d 597, 482 N.Y.S.2d 1000 (Sup. Ct.), the court considered the liability of a hospital’s chief of service for negligent supervision of residents providing post-operative care. The Maxwell court denied the physician’s motion for summary judgment, concluding that the physician had presented no evidence to rebut the plaintiff’s allegations that he had negligently performed his responsibilities “to supervise residents and interns and to develop and implement rules, regulations and guidelines for treatment and supervision.” Id. at 598, 482 N.Y.S.2d at 1002. The court did not, however, express any opinion as to whether such a duty had in fact arisen. Rather, the court determined that summary judgment was inappropriate as the scope of the physician’s duty had not been established. Recognizing that the physician could only be charged with those duties voluntarily assumed by him, the court stated, “If those supervisory responsibilities are demonstrated to be beyond his actual grant of power, then it would be appropriate for Dr. Ledger [the defendant physician] to renew this motion [for summary judgment].” Id. at 599, 482 N.Y.S.2d at 1002.
Moeller v. Hauser, 237 Minn. 368, 54 N.W.2d 639 (1952), and McCullough v. Hutzel Hosp., 88 Mich. App. 235, 276 N.W.2d 569 (1979), two other cases relied upon by the majority, are inapposite to this case. In those cases, the physicians sought to be held liable *197were the attending physicians to whom the injured patients were assigned for treatment. As the attending physicians, they had a duty to exercise due care to see that the patients received adequate medical care. The majority correctly notes that the plaintiff in Moeller was a patient injured “by the negligent post-operative care rendered by resident physicians.” While the physician in that case had assumed some responsibility to supervise the residents who injured the plaintiff, the case against the physician was not predicated on the theory of negligent supervision but upon the theory that the physician had failed to care adequately for a patient for whom he had assumed responsibility to provide medical services. In fact, after examining the hospital’s rules and regulations, which vested the staff physicians with responsibility for “the training of internes [sic] and residents,” the Moeller court concluded that “there is nothing to indicate that [the staff physicians’ responsibility to supervise residents] extends to the duties which the residents perform as a part of the general hospital routine.” Moeller, 237 Minn. at 372, 377, 54 N.W.2d at 642, 645.
Even assuming that the duty undertaken by Dr. Kazior was of such a nature as to permit plaintiff to recover for a breach thereof, the uncontradicted evidence of record shows that Dr. Kazior did not breach his duty. Pursuant to the terms of the contract between Eastern and the medical school, Dr. Kazior was at his home, approximately two miles from the hospital, when he came on call at 5:00 p.m., 5 December 1984.. Plaintiff concedes that Dr. Kazior remained there, with an open telephone line, available to respond to any request for assistance from the chief resident of the obstetrics and gynecology service of the hospital. Plaintiff has not shown that Dr. Kazior was negligent in failing to take any telephone calls or in giving any advice or assistance. When Dr. Kazior received a telephone call informing him that the residents had encountered a birthing problem with one of the hospital’s obstetrics patients, Dr. Kazior immediately went to the hospital, arriving approximately three minutes after he was called, to find that delivery was complete.
Plaintiff does not dispute the evidence that Dr. Kazior fully performed the terms of his contract, but instead proffers as evidence of negligence on Dr. Kazior’s part an affidavit alleging that “[acceptable standards of care require[ ] that [an on-call] attending [physician] . . . communicate[ ] with the hospital when he [comes] ‘on call.’ ” Whatever weight is given the allegations of this affidavit, *198they do not constitute evidence that Dr. Kazior breached any duty voluntarily assumed by him. If the contract between the medical school and Eastern falls short of the acceptable standards of care required for supervising resident physicians practicing obstetrics and gynecology, then liability would rest with the hospital (or the medical school if it had assumed responsibility for general supervision of the residents).
To permit liability for negligent supervision to be imposed against Dr. Kazior, however, flies in the face of the cardinal principles of contract and tort law. We have long recognized that a physician may contractually limit the extent or scope of professional services to be rendered. See Childers v. Frye, 201 N.C. 42, 45, 158 S.E. 744, 746 (1931). In Nash v. Royster, 189 N.C. 408, 127 S.E. 356 (1925), we stated:
A physician or surgeon may agree to perform an operation without undertaking or rendering himself responsible for the subsequent treatment of the- case. He thus contracts against liability beyond the exercise of reasonable care, diligence and skill in the performance of the operation and for such services as are contemplated by both parties to the special or limited contract.
Id. at 413, 127 S.E. at 359. The Nash reasoning applies equally well where, as here, a private physician enters a contract to provide limited supervision of residents employed by a teaching hospital.
The majority’s bold extension of tort liability to on-call physicians who have no physician-patient relationship with persons seeking medical care from a hospital because they have no personal physician will, in my opinion, chill the willingness of experienced medical practitioners to serve in that capacity. If that proves to be the case, the impact of the majority opinion will fall not upon those who have personal attending physicians, but upon those who cannot afford them. The impediment to the delivery of obstetric and gynecologic services to which I alluded in my dissent in Johnson v. Ruark Obstetrics, 327 N.C. 283, 311-12, 395 S.E.2d 85, 101-02 (1990) (Meyer, J., dissenting), will be exacerbated by today’s decision.
The uncontradicted evidence presented in this case shows that Dr. Kazior performed his legal duty to provide advice and assistance when telephoned by the chief resident of the obstetrics and gynecology service of the hospital. Because plaintiff failed to pro*199duce a forecast of evidence showing that Dr. Kazior breached a legal duty owed to plaintiff, the trial court properly entered summary judgment for Dr. Kazior. For these reasons, I dissent from the majority opinion and vote to reverse the decision of the Court of Appeals and remand for reinstatement of the judgment entered by the trial court.