Hospital Liability: Nondelegable Duty in Hospital Emergency Rooms-Simmons V. Tuomey Regional Medical Center

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Hospital Liability: Nondelegable Duty in Hospital Emergency RoomsSimmons v. Tuomey Regional Medical Center]-The Court of Appeals for South Carolina held for the first time that hospitals have a nondelegable duty to render competent services to patients in their emergency rooms, even it the hospital statts its emergency room with independently contracted physicians.2 Like many other jurisdictions, South Carolina had once applied the doctrine of charitable immunity to shield its hospitals from tort liabilities.3 However, this court indicated that changing public policy considerations in the health care arena compelled it to conclude that a hospital's duty to its emergency room patients has "evolved into an absolute duty that is incapable of being delegated."4 Thus, although a hospital may freely transfer its duties to an independently contracted medical staff, liabilities accompanying some of those duties cannot be delegated.5 Whether a hospital's responsibility is nondelegable depends on whether it is "so important to the community that the employer should not be permitted to transfer it to another."6

This case arose from a medical malpractice action filed by Alethia Simmons, as personal representative of her father, P.J. McBride, against Tuomey Regional Memorial Center (Tuomey) and the doctors who treated him there. McBride was brought to Tuomey on January 24, 1994, after sustaining head injuries from a moped accident.7 At the hospital, Simmons signed an admission form for her father.8 The form stated that "independent physicians" staffed Tuomey's emergency room and are "not employees of Tuomey Regional Medical Center."9 The emergency room doctors who examined McBride treated his contusions and released him from the hospital.lo McBride returned to Tuomey the following day, where his head injury was diagnosed as a subdural hematoma.ll He died six weeks later at another hospital of complications from the subdural hematoma.iz Simmons claimed that Tuomey's emergency room physicians failed to diagnosis and treat her father's head injuries properly when he was first brought to the hospital.l3 In its own defense, Tuomey alleged that it was not liable because its emergency room doctors were independent contractors.14 The trial court agreed and granted Tuomey's motion for summary judgment.15 The court relied heavily on a carefully worded 1987 contract between Tuomey and Coastal Physicians Services, which supplied the emergency room doctors to Tuomey.ib The contract referred numerous times to the Coastal physicians as "independent contractors" over whom Tuomey did not exercise "any control over the means, manner, or methods" by which the physicians carried out their duties.17

Simmons appealed, arguing that the trial court erred on the issues of actual agency, apparent agency and nondelegable duty.ls The court of appeals found the nondelegable duty issue to be dispositive of the appeal and did not discuss the plaintiff's two other arguments. After briefly reviewing how the doctrine of charitable immunity has evolved in South Carolina,l9 the court reversed the trial court's decision in favor of Tuomey, finding that the hospital must be accountable to its patients for actions of caregivers working in its emergency rooms.20

The court concluded that three factors support this absolute nondelegable duty. First, public reliance on hospital emergency rooms imposes a nondelegable duty on the part of hospitals to those who utilize its emergency services.21 As hospitals increasingly provide immediate, around-the-clock medical care, emergency rooms become of vital import to public safety.22 Furthermore, as the court observed, patients seeking emergency assistance generally cannot choose to pass by the nearest emergency room in hopes of finding a hospital whose emergency services are staffed by employees rather than independent contractors.23

The court also concluded that Tuomey owed a nondelegable duty to its emergency room patients because the public has come to consider a hospital as a single-entity providing multifaceted medical services. …