Apparent Agency Orthopedic Surgeon: Williams v. Dimensions

Kopec Law Firm

The Baltimore Medical Malpractice Lawyer Blog generally provides a comprehensive analysis of Maryland appellate decisions in medical malpractice cases. You can explore the resulting database of legal opinions by category. This post offers a detailed examination of the issue of orthopedic surgeon apparent agency and the Court of Appeals case in Williams v. Dimensions Health Corp., 480 Md. 24 (2022).

Factual Background for Apparent Agency of Orthopedic Surgeon

A car accident seriously injured the plaintiff, and afterward, EMTs, who are often the first responders in such situations, transported him by ambulance to a hospital’s emergency room. (Op. at 1). The EMTs decided to take the plaintiff to the defendant hospital because it had a trauma center, rather than a hospital closer to the accident that did not. The plaintiff was conscious but in and out of it. He specifically relied on the hospital and its trauma center to treat him. (Id. at 18).

The hospital had a two-page, 25-paragraph form stating that emergency room physicians and surgeons are not hospital employees. However, there was an x where the plaintiff was supposed to initial. Moreover, the patient’s signature line was blank. There also was a notation that said patient intubated unable to sign. But there was no evidence about how the x or notation got there. The plaintiff subsequently testified that he never saw the form. (Id. at 19-20).

Three hours after the plaintiff’s arrival, an orthopedic surgeon performed an emergency fasciotomy. Afterward, doctors amputated both of the plaintiff’s legs above the knee. (Id. at 20-21).

The plaintiff then brought suit against the surgeon and the hospital in the Circuit Court for Prince George’s County. (Id. at 1). The jury returned a verdict for the plaintiff. The hospital moved for judgment notwithstanding the verdict on the ground that there was insufficient evidence to show that the plaintiff had believed the surgeon was an agent of the hospital. The circuit court granted the motion, and the Court of Special Appeals affirmed. (Id. at 1-2).

Court of Appeals Analysis of Apparent Agency of Orthopedic Surgeon

Representation

The hospital specifically held out that it had a trauma-level emergency room that would have an orthopedic surgeon available. Accordingly, the Court of Appeals stated that the hospital did not seriously dispute this element. (Id. at 26).

Apparent Agency Orthopedic Surgeon
Apparent Agency Orthopedic Surgeon

Reliance

When a patient is in acute distress, they look to the hospital rather than a specific surgeon. A patient in that state has no time or ability to choose among doctors or explore their contractual status. (Id. at 27). The plaintiff knew the hospital was a trauma center and relied on the hospital to treat him. The EMTs also relied on the representation that the hospital would provide the needed staff. (Id. at 28). 

Reasonableness

The Court of Appeals found that the hospital’s consent form was not a model of clarity. The paragraph about certain medical providers not being employees was about billing and was unlikely to be understood to mean that the hospital would not be responsible for care. (Id. at 30). In addition, there was no evidence that the plaintiff ever saw the form. (Id. at 31).

The Court of Appeals concluded that there was sufficient evidence for a jury to find that the surgeon was the hospital’s apparent agent (Id. at 32). 

The Dissent

The dissent’s view was that the evidence was insufficient to conclude that the plaintiff believed an agency relationship existed. (Dis. at 1). They disagreed that the EMTs could rely on the representation on behalf of the plaintiff. (Id. at 2-3). In addition, the plaintiff did not talk with the EMTs about what hospital they would take him to. (Id. at 4).

Commentary by the Baltimore Medical Malpractice Lawyer on Apparent Agency of an Orthopedic Surgeon

Williams is a crucial case that reaffirms the principle of apparent agency in emergency room admission and treatment. Patients often choose a hospital based on how it holds itself out to the public in providing medical services. Significantly, the way hospitals have done this has changed over time. Now, hospitals advertise extensively on the internet, TV, and billboards. They emphasize all the medical services they can provide and highlight their doctors, who they believe are exceptionally qualified. However, any mention of independent contractor relationships with the doctors is noticeably absent from all of this advertising.

Hospitals cannot have it both ways. They cannot constantly advertise what they offer and then try to evade responsibility by saying they didn’t offer it, relying on undisclosed contracts. The fine print in an admission form should not undo the representations to the contrary that the hospitals consistently make to the public.

The Williams case helps hold hospitals accountable for their representations.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

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